In the first 10 months of this financial year 2024, over 22,797 trained health professionals, including 4,699 overseas doctors, have relocated to Australia, significantly strengthening the country’s healthcare system.
New figures released on Sunday indicate that the number of healthcare workers, such as nurses and midwives, who have registered to practice in Australia for the 2023-24 financial year is more than double the pre-Covid figures from 2018-19.
59-year-old gentleman with T2DM, on insulin glargine, presents with lethargy & diarrhea. Recent bloods: HbA1c 10.1%, eGFR 40, creatinine 235. Previous creatinine 105, eGFR 80. Next step?
a. Urgently repeat blood tests, refer to ED if creatinine >235 μmol/l.
b. Withhold insulin, recheck eGFR today.
45-year-old man with sudden severe pain and popping sensation of right upper arm after lifting a heavy object. Image given (swelling, with visible bulge at lower part of upper arm). Diagnosis?
a. Rotator cuff tear
b. Biceps tendon rupture
32-year-old presented with conjunctival injection, corneal dendritic ulcers, and reduced visual acuity in the affected eye (herpes eye). Treatment?
a. Oral acyclovir
b. Topical antiviral
65-year-old lady with underlying T2DM, lost 10% weight, walks daily. On perindopril for HTN, BP still 170/90. Non-smoker, non-drinker, healthy diet. Manage BP now?
a. Add amlodipine 5mg daily.
b. Add Irbesartan 150mg daily.
28-year-old female, 37 weeks pregnant, rash on abdomen spreading to thighs. 2-year-old daughter at childcare, recent chickenpox case. Feels well, no fever/urine/bowel changes. Rash management?
a. Reassure, no adverse pregnancy outcomes.
b. Refer to dermatologist.
65-year-old lady with enlarging papule on right neck, non-pigmented, raised with central keratotic horn, 8mm diameter. Suspected keratinocytic tumor. Max dose of lignocaine 1% with adrenaline for biopsy?
a. 490 mg
b. 140 mg
c. 210 mg
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GERD given PPI and patient improved, asked about further management?
a. Increase dose
b. Arrange for OGDS
28-year-old with easy bruising, petechiae, and prolonged bleeding (ITP). Treatment?
a. IVIG
b. Splenectomy
c. Oral corticosteroid
d. Platelet infusion
Patient on warfarin has a dental check-up in one week. Asked about further management?
a. Check INR levels before the procedure.
b. Hold warfarin for 5 days prior to dental check-up.
c. Refer to dentist for advice on bleeding risk.
79-year-old lady overweight with worsening left knee pain, x-ray shows OA. Awaiting ortho opinion, paracetamol helps. Asks about glucosamine, advised low evidence. Recommend non-pharmacological management?
a. Referral for CBT for pain management.
b. Knee brace in valgus position.
4-month-old boy with asymmetric red reflex in eyes during well-child check. Statements about this condition?
a. Retinoblastoma, cataracts, and refractive errors can cause abnormal red reflex.
b. Retinoblastoma is never fatal.
36-year-old lady with left breast lump, tender, diagnosed as benign cyst 2 months ago. Lump feels bigger, ongoing pain. No significant family history. Next step?
a. Referral for ultrasound-guided FNA of the cyst.
b. Referral to breast surgeon for review.
24-year-old male swimmer presents to the emergency department with intense pain, redness, and welts on his left arm after being stung by a bluebottle while swimming in the ocean. He reports severe burning pain and local swelling. Management?
a. Apply vinegar
b. Apply ice
c. Rinse with seawater and remove tentacles
d. Rub with sand
e. Oral antibiotics
28-year-old in the first trimester presents with nausea and vomiting (hyperemesis gravidarum). Investigations?
a. CBC
b. Urinalysis
c. Abdominal ultrasound
d. Serum electrolytes
e. OGDS
50-year-old male, never smoked, asks about coronary calcium scoring. Brings article, regular patient. Scenarios for ordering Coronary Calcium Score?
a. If his father died of cardiovascular disease at age 40
b. If he had Familial Hypercholesterolaemia
48-year-old gentleman with fatigue, consults naturopath, brings pathology order form with various tests. Thinks fatigue is due to lack of sleep. Naturopath wants test results. Next step?
a. Take thorough history, physical exam for fatigue, then investigate if needed.
b. Explain inappropriate ordering, can’t sign form.
Motor vehicle accident for a pregnant woman at 30 weeks gestation, no leakage of water, but symphysio-fundal height shows 34 weeks. Diagnosis?
a. Preterm labor
b. Uterine rupture
c. Fetal growth restriction
d. Placental abruption
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Travelling to Thailand, returned to Australia 10 days ago. M-P rash & bilateral conjunctivitis, fever, and cough. Diagnosis?
a. Measles
b. Dengue fever
c. Zika virus
d. Malaria
35-year-old with high-risk behavior and multiple sexual partners requests initial HIV testing.
a. CD4 count
b. HIV RNA PCR
c. HIV-1/HIV-2 antibody
d. Western blot
PTSD / Panic Disorder and Adjustment Disorder related question.
JMO has needle stick injury from a patient who is in a comatose state, and the HIV status is unknown. What to do next?
a. Start PEEP
b. Screen patient’s HIV status and decide
3-week-old baby born to a Hepatitis C positive mother is now jaundiced. What is the diagnosis?
a. Neonatal hepatitis
b. Jaundice due to hepatitis C infection
c. Biliary atresia
d. Physiologic jaundice
51-year-old male ex-smoker with COPD, diagnosed via spirometry, FEV1 70%. On ipratropium, but symptoms of cough/breathlessness are not controlled. Next medication?
a. Add formoterol 12mcg, 1 inhalation twice daily
b. Add tiotropium 18mcg, 1 inhalation once daily
82-year-old lady with severe Alzheimer’s, disruptive behavior, and assaulting staff/residents. Non-pharmacological strategies tried. Nurse asks for medication order. Most appropriate management?
a. Obtain consent from medical POA, order low dose antipsychotic, review tomorrow.
b. Order temazepam 20mg nocte, review next week.
27-year-old lady with a rash on legs for a week, initially thought from netball, now painful lumps. Feels tired and achy. Meds that could cause this?
a. Trimethoprim
b. Cephalexin
c. Furosemide
18-month-old baby has jaundice. What is the investigation to find the diagnosis?
a. Bilirubin level and liver function tests
b. Ultrasound of the liver and biliary tract
c. Hemoglobin electrophoresis
d. Serum creatinine and electrolytes
12-month-old baby with symptoms of cough, fever, and an X-ray showing right upper lobe opacities. Treatment?
a. Oral antibiotics for pneumonia
b. Inhaled steroids for asthma
c. Admission for IV antibiotics and monitoring
d. Chest physiotherapy and observation
Elderly patient on multiple medications is feeling light-headed. What is the next step?
a. Review medications for potential interactions or side effects
b. Perform a full neurological examination
c. Order a full blood count and electrolytes
d. Increase fluid intake
Patient has started using skin products and has developed scaly, erythematous papules. What to do next?
a. Discontinue the skin products and advise follow-up
b. Prescribe topical steroids
c. Refer for dermatology consultation
d. Start systemic antibiotics
Atopic eczema vs. Guttate psoriasis?
a. Atopic eczema presents with intense pruritus and flexural areas involvement.
b. Guttate psoriasis is characterized by small, drop-shaped lesions on the trunk and limbs.
A woman comes for psychiatric check-up and reports having had melanoma excised but refuses further treatment. What should you do?
a. Discuss her reasons for refusing treatment and ensure informed consent
b. Refer to a specialist for further evaluation and treatment options
c. Document her refusal and monitor for signs of recurrence
d. Counsel regarding the importance of follow-up and provide educational materials
School-aged girl on risperidone for 12 months develops breast discharge. She is embarrassed and wants to withdraw the medication. What should be done?
a. Cease risperidone
b. Add bromocriptine
c. Change to quetiapine
10 cm anal verge tumor. Treatment options?
a. Radiotherapy
b. Chemotherapy
c. Radiotherapy & Chemotherapy combined
21-year-old male with teeth discoloration, recently tired, diarrhea at times. Dentist suggests a GP check-up. Test for diagnosis?
a. Serum transglutaminase-IgA (tTG-IgA) and deamidated gliadin peptide-IgG (DGP-IgG)
b. Serum ferritin
c. Hydrogen breath test
6-week-old baby girl, family going to Uganda, concerned about malaria. Only child, breastfed, in good health, no travel history. Advice on preventing mosquito bites?
a. No insect repellent for the baby; use pram netting, light-colored long-sleeved clothes.
b. Use roll-on mosquito repellent with 10% DEET for the baby.
53-year-old female with hot flushes, periods ceased at 51, interested in Menopausal Hormone Therapy (MHT). Discussed benefits/risks, screened for contraindications. Possible contraindication to MHT?
a. Established cardiovascular disease
b. Treated hypertension
92-year-old lady, frail, bed-bound, no appetite, difficulty swallowing meds. End-of-life care planned, comfort-focused. Nurse reports distress, SOB, no pain. Midazolam given, cooling room. Advise staff?
a. Give morphine for dyspnoea, 1-2.5mg subcut every hour as needed.
b. Apply 2L oxygen via nasal specs to reduce dyspnoea sensation.
58-year-old lady with palpitations, tremor, heat intolerance, tachycardia, irregular HR. Right-sided thyroid nodule, brisk reflexes, AF on ECG. TSH <0.05, free T4 48. Next step for thyroid nodule?
a. Perform radionuclide imaging, refer to endocrinologist.
b. Order CT scan of neck.
Patient with a family history of father having melanoma, now presenting with a small intra-dermal nevus. What is the risk factor?
a. Sun exposure
b. Genetic predisposition
c. Fair skin
d. Age
Patient has HIV. As GP, what will you advise the patient to prevent transmission to their partner?
a. Use condoms during all sexual activity
b. Encourage vaccination for Hepatitis B
c. Start antiretroviral therapy (ART) for both partners
d. Advise partner testing for HIV
35-year-old man with right heel pain post-half marathon, diagnosed with Achilles tendinopathy via ultrasound. Advised rest, returns with ongoing pain. Further management today?
a. Refer to physiotherapist for further management.
b. Advise strict bed rest until pain resolves.
66-year-old male with left eye pain, intermittent double vision, dull frontal headache. Poorly controlled type 2 diabetes and hypertension. Left ptosis, normal pupil, eye movement paralysis. Most likely cause?
a. Microvascular ischaemia
b. Microvascular embolus
c. Infection
64-year-old male with left lower quadrant pain, diarrhea for 3 days, increasing pain, feels unwell. Tender LLQ, fever 38.4°C, heart rate 112, blood pressure 100/64. Appropriate management?
a. Admit to hospital for IV antibiotics, rehydration.
b. Urgent outpatient CT abdomen.
c. Prescribe oral antibiotics and discharge.
d. Start NSAIDs for pain management.
84-year-old lady with diarrhea, now confused, on valsartan, ibuprofen, alendronate. Admitted for viral gastroenteritis, 4 loose stools in the last 24 hours, diffuse tenderness. Investigation for next step?
a. Renal function test
b. Abdominal X-ray (erect and supine)
c. Pulse oximetry
58-year-old male with severe chest pain at rest, 2 weeks of exertional chest pain, type 2 diabetes, hypertension, ex-smoker. ST elevation in leads II, III, aVF. Coronary artery likely occluded?
a. Right coronary artery
b. Left anterior descending
c. Left circumflex artery
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50-year-old male with erectile dysfunction, otherwise well, normal exam. Common condition to exclude?
a. Diabetes Mellitus
b. Peyronie’s disease
c. Hypothyroidism
30-year-old couple planning pregnancy, concerned about cystic fibrosis due to wife’s brother’s diagnosis. Advice to couple?
a. Organize blood test for cystic fibrosis carrier status.
b. Chances of having a baby with cystic fibrosis is 25%.
5-year-old with knock knees, mother concerned due to family history. Intermalleolar distance 9 cm, no limp, 75th percentile for weight/height. Next step?
a. Refer for a paediatric orthopaedic opinion.
b. Refer to a paediatric physiotherapist for exercises.
35-year-old female returns from Thailand with persistent diarrhea, started on day 4 of holiday, 2 weeks duration. Azithromycin ineffective, uses rehydration solution. No night sweats, fever, or blood. Correct statement?
a. Protozoan infections most common cause of prolonged diarrhea (>14 days) in returned traveler.
b. Viral infections most common cause of prolonged diarrhea (>14 days) in returned traveler.
55-year-old male with new gynaecomastia, past BPH, CHF, AF. Not seen for 12 months, brings meds. Medication causing gynaecomastia?
a. Amiodarone
b. Prazosin
c. Apixaban
58-year-old male with erectile dysfunction, past hypertension, type 2 diabetes. Review medications. Med likely contributing to problem?
a. Indapamide
b. Gliclazide
4-year-old with left arm pain after being spun by arms, refuses to use arm. Correct statement about diagnosis?
a. Apply pressure over radial head, fully pronate forearm while elbow is flexed.
b. X-ray needed to diagnose pulled elbow.
34-year-old male, new patient with right ankle issues, antalgic gait, recent ORIF, uses oxycodone. Correct statement?
a. Drugs of dependence most likely prescription drugs to be abused.
b. Oxycodone least common opioid prescribed based on PBS data.
42-year-old female with 1-day severe epigastric pain, vomiting, fever. RUQ tenderness, positive Murphy’s sign. Likely diagnosis?
a. Acute cholecystitis
b. Gallbladder polyps
22-year-old male at rural ER, took unknown drug at party, agitated, tremor, diaphoretic, flushed. High HR, RR, uncooperative. Next step?
a. Sedate, then check electrolytes, glucose, ECG, creatine kinase, blood lactate.
b. Sedate, then start IV hypertonic saline infusion.
6-month-old girl, elective C-section, 4.1kg, gestational diabetes. Babbling, transfers objects, sits unsupported. Even leg lengths, deep uneven buttock creases. Next step?
a. Arrange a plain X-ray of the hips.
b. Arrange an ultrasound of the hips.
35-year-old lady with fever, runny nose, sore throat, cough, joint pain, non-itchy rash. On carbamazepine for trigeminal neuralgia. Rash on face, forearms, trunk, painful mouth ulcers. Important diagnosis?
a. Stevens-Johnson syndrome
b. Erythema multiforme
24-year-old lady pregnant, worried about cystic fibrosis due to family history. Brother’s newborn diagnosed. True statement about CF testing?
a. Positive newborn CF screen, do sweat test at 6 weeks.
b. No carrier screening, already pregnant.
58-year-old lady with Hodgkin’s lymphoma, back home after chemo, short of breath, headache, dizziness, facial swelling, hoarse voice, cyanosed. Immediate management?
a. Emergency air retrieval, 2L O2 via nasal cannula, IV line, stat morphine and dexamethasone.
b. Call 000 for emergency road transfer, urgent chest/neck/head X-rays, 2L O2, oral paracetamol, oral prednisolone.
28-year-old male with 3-month irritating cough, worse at night, slightly productive, no shortness of breath or wheeze. Non-smoker, recent hayfever, clear chest exam. Likely cause?
a. Allergic rhinosinusitis
b. Bronchitis
c. Malignancy
45-year-old male indigenous, poorly controlled diabetes, ischemic heart disease, fevers, productive cough, night sweats, hemoptysis. Suspect TB. First-line investigation?
a. Chest X-ray, sputum microscopy, culture, sensitivity for acid-fast bacilli.
b. Chest X-ray, tuberculin skin prick test.
44-year-old male discussing smoking cessation, thinks he can quit anytime. Reliable indicator of nicotine dependence?
a. Time to first cigarette after waking (<30 minutes).
b. Number of cigarettes smoked per day.
68-year-old female with mild-moderate Alzheimer’s, on Donepezil, aspirin, perindopril. Daughter asks about ginkgo biloba. Correct statement?
a. Ginkgo biloba linked to anti-platelet effects, bleeding risk with other drugs.
b. Ginkgo biloba increases MI risk with aspirin.
