Australian Medical Council (AMC) MCQ Recalls SEPTEMBER 2024 compilation
35y/o PCOS (diagnosis not given but with hirsutism, irregular periods, weight gain, and metabolic features). What is the most appropriate screening with regards to her management?
a. testosterone
b. LH/FSH
c. DHEA
d. FBS
e. lipid profile
4-year-old boy bitten on hand by a family dog. 4 contaminated puncture wounds on the palm, no active bleeding, minor abrasions on the dorsum. Flexor tendons intact. Management of wound?
a. irrigate with sterile saline, apply antiseptic, bandage, leave open. Start oral amoxicillin/clavulanic acid, review in 2-3 days.
b. irrigate with povidone-iodine, suture, start oral flucloxacillin, review in 1 week.
59-year-old male with first seizure, no focal neurological findings, CT brain normal. History of COPD, ex-smoker, worsening cough. CXR: large central mass. Likely lab finding?
a. sodium 115 mmol/L
b. albumin 32g/L
8-year-old female treated for E. coli UTI (confirmed), presenting after 1 week with fever, dysuria, frequency, and loin pain. What will be useful to determine the cause?
a. VCUG
b. Cystoscopy
c. CT Urography
d. USS
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78-year-old lady with Type 2 DM, on max dose metformin & gliclazide, moderate cognitive impairment, latest HbA1c 6 months ago was 8.2%. Next HbA1c target?
a. Less than 8.0%
b. Less than 7.0%
c. Less than 7.5%
12-year-old girl bitten by redback spider on R hand, pain persists at 5/10 despite paracetamol/ibuprofen. Next step?
a. Apply ice pack to bite site.
b. Apply pressure immobilization to R arm.
19-year-old lady with swollen, red R hand after punching someone. Tender over 5th metacarpal, difficulty making fist, 2 small abrasions on knuckles. Main concern?
a. Abrasions on 4th MCP could indicate human bite, risk of serious infection/systemic illness.
b. Likely flexor tendon damage requiring surgical repair.
79-year-old male diagnosed with moderate Alzheimer’s. Geriatrician recommended donepezil 5mg, daughter concerned about side effects, hasn’t started. Common side effects?
a. Urinary incontinence, vivid dreams, dyspepsia
b. Hypotension, tachycardia, weight gain
47-year-old lady with heavy periods (soaked through pads every 1-2 hrs), dizzy, BP low, pale. Hb 88, β-hCG negative, IV fluids given, bleeding slowed. Next treatment?
a. Administer IV/oral tranexamic acid.
b. Administer IM medroxyprogesterone.
15-year-old boy with worsening asthma, waking at night, using salbutamol 4x/week. Mum wants to discuss complementary therapies. Best complementary option?
a. Physical activity
b. Selenium
c. Sodium restriction diet
Menopausal lady with itching and redness of vulva for 3 months, no other symptoms. Next step?
a. Punch biopsy
b. Skin scraping
c. Estrogen levels
56-year-old male missed 3 dialysis sessions, SOB, ECG faxed, waiting for electrolytes. Most concerning electrolyte?
a. Potassium
b. Sodium
c. Chloride
68-year-old male with acute agitation, confusion, BP 180/100, HR 115, temp 39.3°C. Recently started citalopram, takes meds for OA. Pain med likely cause?
a. Tramadol
b. Aspirin
c. Diclofenac
12-year-old boy diagnosed with OSD 6 weeks ago, parents worried about no improvement. Advice on management and prognosis?
a. Avoid painful activities for at least 2 weeks.
b. Corticosteroid injections for improvement.
66-year-old man with slow movement, R hand tremor. History of L4/5 laminectomy, R shoulder arthroplasty, OA knees. Resting tremor in R hand. Feature most consistent with Parkinson’s?
a. Takes multiple small steps when turning.
b. Wide-based gait observed.
28-year-old male grinding teeth for weeks, worried about teeth damage. History of anxiety on escitalopram 20mg, smokes, binge drinks, uses ecstasy on weekends. Advice on teeth grinding?
a. Encourage reduced smoking, alcohol, ecstasy; refer to psychologist for stress management and habit reversal.
b. Recommend dental splint, refer to psychologist for CBT.
42-year-old male melanoma patient on immunomodulatory Rx now presents with watery diarrhea and fatigue. What to do?
a. Gancyclovir
b. Hydrocortisone
c. Azithromycin
d. Infliximab
35-year-old female with severe nausea, abdominal pain, and vomiting. Recently returned from Thailand. Husband and son ate same food but no symptoms. Physical exam: generalized tenderness. Most accurate test to make the diagnosis?
a. HCG
b. Lipase
c. Upper USG
d. STI screening
You run a GP clinic focusing on skin lesions/cosmetic procedures. Most appropriate advertising allowed by Medical Board?
a. Create practice social media with general info on procedures, sun safety tips.
b. Display de-identified “before”/“after” photos of cosmetic procedures on website.
43-year-old lady with increasing pain after tooth extraction, afebrile, no swelling, pus at site. History of asthma, allergic to penicillin. Likely organism?
a. Streptococcus viridans
b. Enterococcus faecalis
c. Candida species
Patient on isotretinoin and Implanon. Now Implanon is out of stock but wants to renew contraception. GP away for 3 months. Best management?
a. Condoms
b. Mirena
c. IUD
d. COCP
e. Depo
74-year-old lady unconscious in waiting room, abnormal breathing. ALS started, ambulance called. Reversible causes to consider during ALS?
a. Pulmonary embolism, hypovolaemia, tamponade
b. Pulmonary hypertension, toxins, hyperthermia
28-year-old male with schizophrenia on zuclopenthixol depot, arrested for stabbing employer. You receive subpoena for his medical records. Next step?
a. Send complete medical records to Court.
b. Provide written statement on mental health, not full records.
62-year-old male with HTN, hypercholesterolaemia, prostate cancer, wants to try Sativex for pain from bony mets. Asks about side effects of THC. Possible side effects?
a. Tachycardia, dizziness, dependence, psychosis, cognitive impairment
b. Cognitive impairment, peripheral neuropathy, abdominal pain, vomiting
3-year-old boy with 3-week itchy rash on trunk, hands, scalp, crusted lesions, other kids with similar rash. History of recurrent otitis media. First-line treatment combo?
a. Topical permethrin 5%, leave on for 8 hrs + oral trimethoprim/sulfamethoxazole 60/300mg 12hrly for 3 days.
b. Topical diluted benzyl benzoate 25% for 24hrs + dicloxacillin 200mg 6hrly for 7 days.
4-year-old boy with 1 BM past week, hard, painful stool, started preschool. Abdomen soft, faeces in LLQ. Management of constipation in kids?
a. Encourage good toileting behavior, aim for sitting on the toilet 2-3x/day after meals.
b. Treat constipation with oral docusate sodium/Senna 50/8mg daily.
67M, Hx of pneumothorax treated with pleurodesis, planning flight to NZ. CXR shows resolved pneumothorax. True statement about air travel and pneumothorax?
a. Delay air travel for 6 weeks after pneumothorax treated with pleurodesis.
b. Delay air travel until pleurodesis is performed.
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47M, generalized itch for weeks, no rash. Most likely cause of itch?
a. Iron deficiency anemia.
b. Folate deficiency anemia.
c. Vitamin B12 deficiency.
33F, irregular spotting since IUD insertion 3 months ago. No pelvic pain/discharge, normal cervix, IUD strings visible. Next step for bleeding?
a. Request urine beta-hCG and STI swabs before recommending further management.
b. Urgent gynae referral for further investigation of bleeding.
23F, L ear pain and fullness for 2 weeks, trouble opening mouth. No fever, normal ear exam, tender anterior to tragus. Advice for management?
a. Soft diet, warm compresses, passive stretching exercises.
b. Start 5mg diazepam orally daily for 1 week.
72M, fatigue, SOB on stairs, 3kg weight gain, socks leave marks on ankles. Echo shows impaired LVEF <40%. Correct statement?
a. Beta blockers may initially worsen symptoms in heart failure with reduced EF.
b. Loop diuretics improve survival in heart failure with reduced EF.
7yo girl still bedwetting at night, dry in daytime. Mom concerned about school camp soon. No underlying issues found. Management strategy for enuresis with best long-term efficacy?
a. Enuresis alarm.
b. Desmopressin.
c. Child education about enuresis.
35yo lady with epilepsy on phenytoin, seeking contraception. Tried combined OCP but forgetful, interested in implant. True statement about etonogestrel implant?
a. Implant is immediately effective if inserted during the first 5 days of the cycle.
b. Implant has no effect on ovulation.
27yo male with R big toe pain spreading up leg, headache, nausea. Had been cleaning shed, suspects bite. Local sweating on toe. Likely cause?
a. Redback spider.
b. Brown snake.
c. Copperhead snake.
36yo female with recurrent headaches interfering with work/life. Further history taken. Red flag for headache?
a. Headache made worse by coughing.
b. Headache severity maximal in the evenings.
28yo lady, 6 weeks pregnant, hx of hypothyroidism on 125mcg levothyroxine. Taking iodine and folic acid. Advice on thyroid management in pregnancy?
a. Increase levothyroxine to 150mcg daily, recheck TFT in 4 weeks.
b. Increase levothyroxine to 200mcg daily, recheck TFT in 4 weeks.
58yo female with palpitations, tremor, hot/sweaty for 2 weeks, eyelid retraction, proptosis, periorbital oedema. Reflexes brisk. Likely cause of symptoms?
a. Graves Disease
b. Toxic multinodular goitre
c. Toxic adenoma
42yo man with R eye lump, red with irritation in dry air, no vision issues. Exam: 4mm yellow fleshy lesion on sclera, normal vision. Management?
a. Advise sunglasses, hat, and lubricant eyedrops.
b. Urgent referral for conjunctival surgery.
25yo man with 3-month history of blood-stained rhinorrhoea, itchy eyes, partial relief with antihistamines, diagnosed with chronic rhinosinusitis & polyps. Completed antibiotics. Next management step?
a. Check for sensitivity to aspirin/NSAIDs.
b. Cease oral antihistamines.
60yo lady with 24hr R facial droop, otalgia, blisters in R ear canal, paralysis on R face incl. forehead. Neuro and ENT exam otherwise normal. Management?
a. Prescribe famciclovir 500mg orally 3x/day for 7 days.
b. Prescribe cephalexin 500mg 4x/day for 5 days.
17yo lady reports non-consensual sex after party, offender known, denies drug use, embarrassed, no police involvement. STI screen 6mo ago negative. Next step?
a. Give Ulipristal acetate 30mg orally stat.
b. Give Hepatitis B immunoglobulin.
62yo male with bright red rectal bleeding on TP for 2 months, no pain, no blood in stool, no weight loss. Exam: external haemorrhoid, no mass. Next step?
a. Refer for colonoscopy to rule out anorectal cancer.
b. Arrange CT colonography.
61yo female with AF review, no palpitations, BP 125/80, hx of OSA, obesity, hypothyroidism on thyroxine. No hx of stroke, HF, vascular disease. Management of AF?
a. Focus on risk factor control (e.g. OSA, euthyroid, weight loss).
b. Start oral amiodarone 200mg daily.
49yo man with post-bronchodilator FEV1/FVC ratio of 0.64, quit smoking 3 months ago, 20 pack-year hx, physically active, no SOB. Spirometry report follow-up?
a. Encourage lifestyle measures like smoking cessation.
b. Start long-acting beta2-agonist inhaler.
25yo lady with halos around lights at night post-LASIK 3 weeks ago, family hx of macular degeneration, mild dry eye using lubricants. Cause of symptoms?
a. Side effect of LASIK surgery.
b. Cataract.
c. Glaucoma.
