AMC Collection

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AMC Collection




SOME MCQ’S FROM AMC EXAM IN WORD FILE
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The Australian Medical Council (AMC) has prepared this book to assist overseas-trained doctors who are preparing for the AMC AMCQ examination. This book will be a valuable guide and self-assessment tool to assist in sitting for this exam. It also illustrates the best-practice principles for a wide range of medical conditions found in the Australian community. All medical students will find this book an invaluable aid as an educational resource in preparation for their clinical assessments, as should postgraduate trainnes preparing for higher degrees across the spectrum of general and specialist practice. The questions are representative of curricula of medical schools at universities across Australia.
GET IT HERE (IT’S ONLY THE PRE-VIEW BUT CONTAINS MANY PAGE


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PSYCHIATRY


1.A lady with a previous divorce now comes to you with a seductive behaviour

a. Narcistic
b. Histrionic
c. Borderline

2.In Australia bush fire are common either accidentally or some people lighting fire deliberately. Which is true regarding pyromaniacs?

a. Done for notoriety or publicity
b. To hide their acts
c. As they like to play with fire
d. Set fire and get panic attacks
e. For satisfaction

3.Depersonalization may occur in

a. Schizophrenia
b. Ecstatic religious experience
c. Depression
d. Post traumatic disorder
e. All of the above

4.A middle aged lady present to you with nausea dyspepsia abdominal distention. She had a past history of going to many doctors and being treated for many disorders. she has been treated by a rheumatologist for aches and pains, cardiologist for her palpitations and gave her propanolol without improvement , a neurologist for her epilepsy. On examination you find a tense anxious woman in spite of her daily dose of benzodiazepine. There are scar from appendectomy and hysterectomy operations. What is the most appropriate diagnosis?

a. Munchausen syndrome
b. Conversion disorder
c. Hypochondriasis
d. factitious disorder,
e. Neurotic anxiety

5.Many psychopharmacologic substance are lipophilic the advantage is

a. better absorbed with meals
b. promptly binds with free fatty acids
c. more resistant to be metabolized by thae liver
d. the pass rapidly to the brain and to the blood
e. a drug which has a long life and needs to be given once a day daily

6. Lithium:

a. loses it effectiveness over the time
b. is non addictive
c. works better in women than men
d. interaction with NSAIDS

7. morbid jealousy

a. alcoholism
b. schizophrenia
c. depression
d. obsessive compulsive
e. mania

8. A 40 yr old male school teacher who has recently separated from his wife was; prescribed imipramine 25 mg for his depression. He had a road accident in which he hurt his child. He was admitted to hospital for taking an overdose of imipramine with alcohol. He does not give consent to go for psychiatric counselling or to be admitted hospital for further treatment. Your next step in the management of this patient is:

a. Ask him to go to alcoholics anonymous
b. Increase the dose of Amitriptyline to 125 mg and send him home
c. Change to another drug
d. Retain him in the hospital against his using he Mental health act
e. Contact his wife and try to persuade her to return to him
f. Alcohol counselling

9.A 46 year old widow consults you for advice on management of insomnia, indifferent appetite; recent weight loss of 5 kg., headaches and tearfulness. 4 weeks ago her only son died after subarachnoid haemorrhage. Since then she had experienced auditory hallucination, of her son's voice calling out her name and had felt his presence in their living room. Your initial management of this woman would involve:

a. Grief counselling and a brief course of benzodiazepine
b. Grief counselling and a brief course of TCA
c. Grief counselling and a brief course of phenothiazine’s
d. Referral to psychiatrist
e. Referral for hospitalisation and treatment

10.Depersonalization may occur in:

a. schizophrenia
b. ecstatic religious experience
c. depression
d post traumatic disorder
e.A11 of the above

11. A 36 yr old engineer is due to give an speech soon and is reluctant to be exposed to people. At the same time, he does not want to sign cheques or write anything in public. He also thinks his, boas is controlling what he is doing although he knows that there is no motive for that because he is a very good worker. He realizes there is no reason to act this way, Lately he has been avoiding to go to the canteen with his mates and takes alcohol to cope with the situation. What he is suffering from?

a. Social phobia
b. agoraphobia
d. antisocial personality disorder
e. panic disorder
f. paranoid disorder

12. Deinstitutionalisation means:

a. Transferring a patient from a psychiatric hospital to a community based facility.-
b . Put him in prison hospital
c. discharge the patient to a nursing home
d. Put patient in a psychiatric hospital
e. psychiatric patients are not permitted to vote


13.Lithium:

a. loses its effectiveness over the time
b. Is non-addictive
c. works better in women than men
d. Interaction with NSAIDS causes increase in lithium levels
e. Lithium toxicity

14.Cognitive therapy has good results in:

a. depression
b- chronic pain
c. social phobia
d. bulimia
e. all of the above

15. Many psychopharmacologic substance are lipophilic. The advantage is:

a. better absorbed with meals
b. promptly bind to free fatty acids
c. more resistant to be metabolised by the liver they pass rapidly to the blood and to the brain
e. a drug has a long life and needs to be given once a day only

16. Psychiatric treatment in women is more commonly found in:

a. first trimester of pregnancy
b. second trimester
c. third trimester
d. puerperium
e.6 weeks after the first control


17.Regarding depression, what is true?

a. onset in winter, disappear in summer
b. -onset in autumn, disappear in summer
c. onset in summer; disappear in winter
d. onset in summer, disappear in autumn
e. onset in spring, disappear in winter

18. Despite obvious to the contrary, a 16 w old female with anorexia nervosa, thinks she is overweight. This is an example of :

a. delusion
b. obsession
c. over valued idea
d. rumination
e. hallucination


19. A 35 year old female secretary, unmarried, complains of feeling of mass or lump on her neck:

a. psychological (Globus Hystericus)
b. inflamed tonsils
c. lingual thyroid
d. hyperthyroidism
e. goitre

20.In generalized anxiety disorder, what Will develop in the next follow :

a. Schizophrenia
b. bipolar manic depression.
depressive illness
mania
phobia.


21. Using the WHO criteria, what is the most common symptoms of schizophrenia?

a. Flat affect
b. Auditory Hallucination
c. Visual hallucination
d. Lack of insight
e. Suicidal ideation

22. Exposure to stimuli and response prevention is the treatment of

a. Obsessive-compulsive disorder
b. Agoraphobia
c. Depression
d. Bipolar manic depression
e. Schizophrenia

23.Morbid jealousy, associated with:

a. alcoholism
b. schizophrenia
c. depression
d. obsessive compulsive
e. mania


24.WOF may be treated with ECT

a. puerperal depression
b. catatonic schizophrenia
c. mania
d. acute schizophrenia
e. all of the above


25.A 1 yr old child of normal intelligence becomes withdrawn and shows deterioration in his school work. What is most likely:

a. schizophrenia
b. response to stress *in the family
c. normal variance of adolescence
d. Migraine

26. Anorexia nervosa is characterized by all of the following except.

1. 90% of those affected are females
2. raised FSH is pathognomonic
3. not eating or recognizing hunger

27. Fluoxetine is a new antidepressant unrelated to TC.A but with similar pharmacologic action. What is its mechanism of action?

a. inhibits uptake of dopamine
b. inhibits uptake of norepephrine
c. inhibits uptake of serotonin
d. inhibit uptake of epinephrine


28.Apatient maintained on lithium carbonate was given an NSAIDS and developed then Most likely explanation for this :

- lithium toxicity
- toxicity to NSAIDs


29. In married couple, the most likely cause of inhibited sexual excitement is?

a. fear of pregnancy
b. marital discord
c. empty nest syndrome
d. organic disorder

30.A Malaysian university student who is working as a waiter, whose girlfriend went home to attend her father's funeral became irritable, restless and unable to sleep. He complains that his companions are talking behind his back and plotting against him what is your diagnosis?

a. reactive psychosis
b. grief reaction
c. onset schizophrenia
d. suspicious cannabis
e. panic psychosis

31. A 45 yr old salesman comes to you with complaints of difficulty of getting to sleep, waking up with nightmares & loss of weight. What is your diagnosis'?

- anxiety
- depression


32. The most common cause of vaginismus :
-- Phobia
- schizophrenia

33. In borderline personality. What is correct?

a. antisocial with difficulty in establishing a relationship
b. histrionic personality
c. social withdrawal
d. identification problem –
e. tendency to self harm

34. What is correct of obsessive rumination?

a. compulsive hand washing
b. repetitive, persistent sexual fantasy c.


35. A 35 yr old man maintained on lithium was admitted for an infection. HIV test taken and done without his consent turned up positive. What is correct in this case?

a. stop lithium and start AZT
b. Tell the patient he has AIDS and extract a history of his sexual contacts/partners
c. It is unlawful to do the test without consent and pre treatment counselling
d. Inform the staff of the patient condition



36. A 65 yr old Greek lady living in Australia since 34 yrs ago has been living alone. She now seems to answer voices and does strange things. The most likely

a. paranoid delusions
b. migrant psychosis
c. Capgras syndrome
d. Paraphilia
e. Frigoli

37. A 23 yr old male unemployed is complaining about his nose. He says that he can't get a good job because of his nose. He also said he can't get a girl friend , and is demanding about a reduction of his nose. The doctors an opinion is that the nose looks normal. What is your management?

a. refer to p1'astic surgeon
b. refer to psychiatry
d. try a short course of...
e. explain him very gently that his nose looks normal and try to find out what social causes and difficulties about his work.

38. What is delusion?

a. False Belief
b. False thought
c. Sexual Fantasy

39. Most appropriate re ost partum psychosis is:-

a. family counselling
b. ask mother to stop breastfeeding
c. admit to hospital
d. psychiatric treatment to the mother
e. treat and send home

40. A 85 YO old man with progressive loss of memory for recent events, unable to do any calculations is disoriented for time, WOF is correct?

1. frontal lobe tumour
2. Alzheimer’s
3. Multi infarct Dementia
4. Due to old age

41. A young girl with running nose; diarrhoea. sweating; lacrimation, and abdominal pain. WOF is the cause'?

a. heroin withdrawal
b. cocaine
c. LSD
d. marijuana
e. amphetamine


42. Endogenous depression. WOF is true?

a. Early morning waking
b. Difficulty in initial sleep
c. Dreams with content involving death patient
d. Somnolence in the early part of day
e. None of Above


43. Basis of Dopamine theory of Scz:

a. Phenothiazine can cause Parkinson like syndrome
b. Amphetamine can cause schizophrenia
c. Anticholinergic drug can cause delirium.
c. Tricyclic Antidepressants have anticholinergic effects.
d. Imipramine helps in obsessive neurosis.

44 Acute alcoholic hallucination can be differentiated from delirium tremens by the fact that:

A. It occurs following ingestion of small amount of ethanol whereas DT is a withdrawal syndrome.
c. Unilateral tinnitus is pathognomic of alcohol hallucination.
d. Unilateral auditory hallucination is path gnomic of alcoholic, hallucination.
e. The sensorial remain clear despite the presence of terrifying auditory hallucination.
f. The hallucination of alcoholic is visual and unpleasant.


45. WOF is characteristic of schizophrenia'?

a auditory hallucination
b. Depersonalisation
d. antisocial behaviour
e. flight of ideas
f. all of the above

46 A 70 yr old male taking Aldomet for hypertension for the last 10 Years starts to isolate himself and is suffering from deafness: He feels that people are speaking about him. What is most likely diagnosis:

a. Symptoms of Aldomet
b. reaction to deafness
c. atherosclerotic dementia
d. senile dementia
e. senile paraphrenia

[walid51]

MEDICINE

1. In dislocation of shoulder, which nerve is liable to be injured?

a. Radial
b. Axillary
c. Musculocutaneous
d. Ulnar
e. Brachial plexus


2. Which of the following is likely to damage an artery?

a. Anterior Dislocation shoulder
b. Posterior dislocation shoulder
c. Anterior dislocation hip
d. Posterior dislocation hip
e. Posterior dislocation knee


3. In Colles Fracture, the distal segment is displaced:

a. Backwards and ulnarwards
b. Backwards and radially
c. Forwards and ulnarwards
d. Forwards and radially
e. Minimally displaced

4. An 18-month-old is brought to you by the mother for breast enlargement. Tanner 3. No pubic hair or axillary hair is seen. No other abnormality is seen. What is your diagnosis?

a. Precocious puberty
b. Idiopathic thelarche


c. Congenital adrenal hyperplasia
d. Breast tumour
e. Mastitis

5. A 21-year-old child is brought to you for having loose motions for 3 days. The stool contains undigested food material. No vomiting. Thriving well. What is he suffering from?

a. Cystic fibrosis
b. Coeliac disease
c. Gastroenteritis
d. Toddlers diarrhoea
e. IBS


6. A large man presents with big face broad hands thick and oily skin and hoarse voice. What is the initial investigation of choice?

a. GTT + GH
b. Insulin challenge test + GH
c. GH+ cortisol
d. GH
e. GTT


7. Regarding heparin induced thrombocytopenia, what is true?

a. Purpura
b. Joint bleeding
c. Ecchymosis
d. Thrombosis
e. Hematuria

8. Regarding ADHD, what is correct?

a. Age 5-7 years
b. Reading difficulties
c. Social withdrawal
d. Females affected more than Males
e. Prevalence is 15%

9. All the following can cause dysphagia except:

a. Oesophageal cancer
b. Achalasia
c. Oesophageal varices
d. Barrett’s oesophagus
e. Hiatus hernia

10.A 6 week old is brought to you for not having passed motion for last 4 days. He has been feeding well, and is gaining weight. Otherwise well and active. What is the most probable explanation?

a. Hirsprung’s disease
b. Normal variant
c. Hypothyroidism
d. Acquired constipation
e. Foreign body

11. A man returns after a trip to India. Now has 3 days diarrhoea with blood in stools. Looks run out and dehydrated. Noted to have fever. What is most correct?

a. Giardia infection
b. Amoebiasis
c. E. coli gastroenteritis
d. Viral diarrhoea
e. Cholera

12. In a 40 years old lady, all the following may be the cause of menorrhagia except:

a. Hormonal response to uterus
b. Subserous fibroid
c. Intermural fibroid
d. Adenomyosis
e. Endometriosis

13. 3 month old comes with unilateral eye discharge. What is the most possible cause:

a. Chlamydia infection
b. Gonococcus
c. Ophthalmia neonatorum
d. Blocked nasolacrimal duct
e. Normal variant

*14. A 6-month-old presents with SOB. There was a birthday party at home yesterday. On examination, child is wheezing. What is most initial investigation?

a. Sweat test
b. Bronchogram
c. CXR
d. Inspiratory and Expiratory Rontogram
e. PEFR measurement

15. A mother brings her 3-year-old baby girl with unilateral nasal discharge off and on for last 3 months. Secretion is foul smelling and at times copious. Baby is uncooperative. What is the initial investigation of choice?

a. CXR
b. indirect laryngoscopy
c. Examination under GA

16. A 6-year-old girl wakes up at night c/o sever pain in her calves. Mother rubs her calves and she feel fine, goes to sleep. This has been happening for a number of days now. At daytime she is active and playing. All of the following are true except:

a. Ca and CK will be abnormal
b. No investigations are needed
c. Family Hx will be positive
d. Reassurance is the treatment.

17. Which vaccination should not be given to a child who is under remission on chemotherapy for CLL?

a. Polio
b. MMR
c. HiB
d. DPT

18.Solitary mobile carcinoma breast lump. No axillary lymphadenopathy. Which of the following is a prognostic marker?

a. Age > 45
b. Neu2 / HER oncogene status
c. Oestrogen level

19. All can occur with chronic limb ischemia except:

a. Great Toe gangrene
b. Pallor
c. Ulcer on medial side of leg above malleolus
d. Rest pain
e. Intermittent claudication

*22. 40 year old with acute painful testis:*

a. Varicocele
b. Hydrocele
c. Epididymoorchitis
d. Torsion
e. Tumour

23. WOF is true regarding a 2cm kidney stone in the pelvis seen in KUB examination.:

a. Expectant treatment is right
b. It is a urate stone
c. Lithotripsy
d. Open surgery

24. Patient can’t dorsiflex or evert his foot. What is wrong?

a. L4
b. L5
c. Tibial nerve
d. Peroneal nerve
e. Sciatic nerve

25. Body dysmorphia is seen in AOF except:

a. Anorexia nervosa
b. Acromegaly
c. Non dominant parietal lobe lesion
d. Dominant parietal lobe lesion
e. Narcissistic personality disorder

26. 6 year old child comes to you with up rolling if eyes, neck stiffness, protruded tongue, rigid body and face tilted to one side. Had vomiting and was being treated by the GP. What is the cause?

a. Huntington’s chorea
b. Epilepsy
c. Reaction to metoclopramide
d. Gastritis

27. Lung cancer associated with non-smokers:

a. Sq. cell Ca.
b. Adenocarcinoma
c. Small cell Ca.
d. Oat cell Ca.
e. Large cell Ca.

28. All of the following cause gynecomastia except :

a. spironolactone
b. cimetidine
c. digoxin
d. alpha methyldopa
e. labetolol

29.A young female presents with 24 hour h/o sore throat. Later she develops proteinuria and some hematuria. What is the most probable cause?

a. Glomerulonephritis
b. IgA Nephropathy
c. Nephrotic syndrome
d. HTN

30.What is the most important step in psychotherapy?

a. Detailed history
b. Isolation
c. History from friends and relatives.
d. Developing relationship
e. Investigations

31. When do we use Psychodynamic Psychotherapy?

a. Obsessive Compulsive Disorder
b. Bipolar Disorder
c. Schizophrenia
d. Depression
e. Anorexia Nervosa

32. You are asked to examine a person. He is cut off from the world since he was teen. Lives alone and wants to be alone. No friends. Family wants to support but he refuses to get any help. He doesn’t have any thought disorder or perceptional symptoms, but his affect is blunt. What would be the most probable diagnosis?

a. Chronic schizophrenia
b. Major depression
c. Narcissistic Personality
d. Bipolar disorder

33.Regarding Billing’s method of contraception, AOF are true except:

a. Cervical mucus has to be palpated
b. Unsafe sex, if it becomes more
c. Safe sex after 2-3 days of becoming more
d. Since it considers the cervical mucus, it is same contraception in regular, irregular and lactational menstrual periods.

34.Regarding Levonorgestral containing IUCD, AOF are true except:

a. Light periods
b. Amenorrhoea
c. Decreased risk of cervical carcinoma
d. Decreased risk of sexually transmitted diseases
e. Decreased risk of ectopic pregnancy

35.Spleenectomy in spherocytosis will do all the following except:

a. Normalize anaemia
b. Normalize spherocytosis

36. An 8-year-old child presents to the ED with bilateral tonsillitis with greyish white exudates. He has cervical lymphadenopathy, fever and hepatosplenomegaly. What is the probable cause?

a. EBV
b. CMV
c. Diphtheria
d. Bacterial

37. A young child with 2-week h/o dry cough with whop, and some times vomits. What is true about this patient?

a. Will have cough for the next 4 weeks
b. Amoxicillin should be started
c. D & T vaccine should be given immediately

38. A patient with pyloric stenosis, vomiting for 4 days now presents to ED with mother. He is dull lethargic, skin turgor is lost, and BP is 90/50. What is the most initial choice of fluid in this patient?

a. Normal saline
b. Hartman’s solution
c. Ringer’s lactate solution
d. Dextrose 5% and Normal saline

39.Regarding diffuse fibrosing alveolitis what is true?

a. Decreased FEV1 / FEV
b. Decreased TLC
c. Decreased Expansion
d. Decreased O2 tension
e. Hypercarbia

40.Psychiatric side effect of corticosteroids?

Withdrawal causes delirium

41. A patient is suffering from cyclical mastalgia. Routine treatment fails. What is your next management?

a. NSAID
b. Bromocriptine
c. Danazol
d. Progesterone
e. Lasix

42.Regarding CPR, WOF statement is most correct?

a. Adrenaline should be given every 10 minutes
b. Bicarbonate is mandatory
c. ECM only pumps ½ of the cardiac output in one stroke
d. ECG is necessary before cardio-version.


43. Patient with grandiose character. Doesn’t care about others. Feels himself to be unique:

a. Histrionic personality
b. Schizoid
c. Narsistic
d. Delusional
e. Borderline


44.Picture of CT Scan showing two white spots just lateral to the midline. A patient 59 year old presents with sudden onset of left hand weakness. What could be the possible cause?

a. SDH
b. SAH
c. Intra cerebral haemorrhage
d. Cerebral infarct

45. WOF has the least risk of having congenital malformation at birth.

a. Chromosomal abnormality AD, AR, Sex linked recessive
b. Rubella at 18 weeks


46. What is the most likely cause of post coital bleeding?

a. Endometrial Carcinoma
b. Vaginal candidiasis
c. Cervical polyp
d. Fibroid

47. Regarding thyroid cancer, all are true except:

a. Enlarged thyroid
b. Solitary nodule
c. Hot nodule
d. Change in voice
e. Tracheal compression


48. Patient presents with fever, tachycardia (Pulse 110/mt), Tremors, and palpable & tender thyroid. On investigation, there is no radioactive iodine uptake. What is the possible treatment?

a. Carbimazole
b. I131
c. Beta-Blocker + Paracetamol
d. Thyroxine

49. A women has bilateral suppurative inflammatory lesion on the axilla and groin. What is true?

a. Actinomycosis
b. Fungal infection – Mycosis Fungoides
c. Suppurative Hidradenitis
d. Multiple lymphadenopathy with abscess
e. Pilonidal sinus


50. An old man who was operated for aortic aneurysm 3 weeks ago, presents to the ED with irregular pulse, restlessness, abdominal distension and not having passed flatus and motions for last 2 days. WOF is the most possible cause?

a. Rupture of suture site
b. Mesenteric artery embolism
c. Urinary retention
d. Diverticulosis

51 Why do we do an ultra sound in a patient with sign symptoms of biliary disease?

a. To visualize stones in the GB or CBD
b. To visualize pancreatic cancer
c. To see the dilation of bile tree
d. To locate the hepatic cancer
e. To visualize the GB pathology


52. A seventy-year lady who is alcoholic and smokes > 20 cigarettes a day, presents to you with tiredness and fatigue. She also complains of weakness in limbs. Her Hb was 98, MCV 110, and platelets were decreased. What is the most possible cause?

a. AoCD
b. IDA
c. Alcoholism
d. Pernicious Anaemia
e. Auto immune Haemolytic Anaemia


53. A young female on oral contraceptive misses one tablet while in the mid cycle. Had coitus the same day, and takes the ‘missed’ tablet 12 hours later. Then continues with rest of her tablets. She has spotting on the third day of coitus. What will be your advice?

a. Continue with the OCP.
b. Change to different contraceptive drug.

54. AOF are the features of basal ganglion except:

a. Ataxia
b. Tremor
c. Bradykinesia
d. Chorea
e. Rigidity


55.Most common cause of bowel obstruction in Australia assuming that he as not undergone any abdominal surgery, is:

a. Volvulus
b. Intersuseption
c. Groin hernia
d. Internal hernia
e. Tumours


56. A patient presents with wasting of small muscles of hand with thenar sparing. What is the most probable diagnosis?

a. Ulnar N
b. Median N
c. Axillary N
d. Musculocutaneous N

57. Picture on Page 206 of AMC. Picture of scalp showing white scaly lesion.

a. Psoriasis
b. Alopecia Areata
c. Pediculosis
d. Tinea Capitis

58. A young couple wants to adopt abstinence as contraception. Assuming the female is having a regular monthly cycle of 28 days, you would advice them to avoid sex on AOF days except:

a. Day 4 – 17
b. Day 8 – 17
c. Day 10 – 19
d. Day 12 – 19
e. Day 17 - 21

59. Most common cause of cholecystitis in Australia

a. Gall stone at out flow
b. Gall stone in CBD
c. Pancreatitis
d. Tumour
e. Hepatitis

60.WOF is expected to happen after splenectomy for spherocytosis?

a. RBC life span improves
b. Leukopenia
c. Reduction in anaemia
d. Reduction of spherocytes
e. Reduction in fragility of RBCs.


61.What is the cause of majority of HbsAg patients in Chinese population?

a. Blood product
b. IVDU
c. Child birth
d. Sexual spread
e. Haemophilia

62. A 60 years old female patient of RA takes 5mg of Prednisolone tabs BD for last 10 years. Now she comes to you complaining sudden onset of pain and swelling of her right knee, which is warm and tender. Your management would be:

a. Increase dose of NSAID
b. Decrease dose of NSAID
c. IV Antibiotics & hospitalisation
d. Knee X Ray for unrecognised trauma
e. Knee aspiration for cytology.

63. A 12 year old is having pain in his hip. His mother noticed a limp. He is afebrile, and the general examination is normal. What is the most probable cause of his symptoms?

a. Slipped upper femoral epiphysis
b. Perthes disease
c. Non specific synovitis
d. Osteomyelitis

64. Photo of viral wart on the eyelid of a young female.

a. Wart
b. Molluscum contagiosum
c. Herpes simplex
d. Skin tag

65. AOF cause gynecomastia, except:
a. Spironolactone
b. Digoxin
c. Methyldopa
d. Labetolol

66. A 41 week primi comes to you complaining of no fetal movements for last 24 hrs. FHS is 140/mt, CTG is normal, and rest of the examination is normal. You send her home. Next day she rings you stating that there is again no fetal movement for the last 24 hrs. What will be you next step of management?

a. Tell her that all her examinations are fine, & she should not worry
b. Ask her to wait for another 24 hrs.
c. Admit labour ward and induce labour.
d. Immediate LSCS

67. Picture of supracondylar fracture (AMC Book): A young girl fall on her out stretched hand. What will be your management?

a. Neurological study to check the Median Nerve involvement
b. Fasciotomy
c. # Reduction and assessment of circulation
d. Back slab and review in 24 hours

68. Many people attended a dinner party on a week end. 10% had diarrhoea. Most of them recovered spontaneously, but few needed hospitalisation for severe dehydration. What is the most probable cause?

a. Giardia
b. Salmonella
c. Clostridium
d. Shigella

69.Complication of # of epiphyseal plate

a. Retardation of longitudinal growth
b. Joint stiffness
c. Malunion
d. Non-union
e. Avascular necrosis

70.4 day old full term baby normal at birth. Suddenly collapse at cot. O/E baby is peripherally cyanosed , no pulse and respiratory distress. Diagnosis?

a. Pulmonary Hypertension
b. Fallot’s Tetralogy
c. PDA
d. CHD
e. Lt Heart hyperplasia.
f. Transposition of great vessels

[walid51]

SURGERY , OBSTETRICS AND PSYCHIATRY

1. An elderly woman can read the newspaper, but has halos in bright sunlight.

A. Cataract

B. Glaucoma

C. Presbyopia

D. Macular Degeneration

2. Which of the following drugs decrease renin:

A. Beta Blockers

B. ACE Inhibitors

C. Spironolactone

D. Hydralazine

E. Centrally acting antihypertensives.


3. Newborn with respiratory distress , faint breath sounds on the left and with a scaphoid abdomen

A. Meconium aspiration syndrome

B. Situs inversus

C. Diaphragmatic hernia


4. Which nerve gives the sensation of taste to the anterior 2/3rd of tongue.

A. Trigeminal nerve

B. Facial nerve

C. Hypoglossal nerve

D. Glossopharyngeal nerve



5. A Patient who underwent a cholecystectomy, now comes with jaundice .what is the investigation of choice.

A. Oral cholecystogram

B. CT scan

C. Ultrasound

D. Sr. Creatinine

E. Upper GI Studies


6. Regarding pseudobulbar palsy AOF is true …except

A. Wasting and fasciculation of tongue

B. Jaw jerk decreased

C. Loss of sphincter control

D. Gag reflex present


7. Regarding ACE Inhibitors, which is not true :

A. Used in the treatment of heart failure

B. Used as first line in the treatment of Hypertension

C. Used in Diabetics

D. Cannot be used in the treatment of Aortic stenosis.


8. Regarding CRF and Calcium metabolism

A. Ca is decreased

B. Ca is increased

C. There is no relation between CRF and Ca

D. Causes Osteomalacia.




9. Most significant complication of massive blood transfusion. ( *)

A. Pulmonary oedema

B. Change in acid base balance

C. DIC and coagulation defect

D. Increased CVP


10. Regarding CRF and Potassium all of the following reduce potassium except (treatment of hyperkalemia) *

A. Calcium Carbonate

B. Glucose and Insulin

C. Dialysis

D. Resonium

E. Sodium Bicarbonate


11. 55year old patient with dysphagia for solids with a previous history of reflux

A. Carcinoma oesophagus

B. Stricture

C. Scleroderma

D. Achalasia \

E. Raynaud’s syndrome


12. An infant came with pneumonia , X ray showed consolidation of a lobe with round translucencies and a small pleural effusion. What is the treatment of choice?

A. Crystalline penicillin

B. Flucloxicillin

C. Amoxicillin / clavulanic acid

D. Tetracycline

13. A new born was peripherally cyanosed and crying lustily ..the axillary temperature recorded was 37.2degrees what would be the next step( *)

A. Take an x ray

B. reassure

C. oxygen

D. urine culture


14. 34 year old lady on phenytoin wants to take OCP’S what can be prescribed

A. Microgynon 30

B. Microgynon 50

C. Triphasic

D. Oetradiol patches

E. Progesterone only pill


15. 6 months old boy brought by his mother with a temperature of 38.9degrees with bilateral wheezing .his resp. rate was 36/min .other members in the family had a h/o similar illness. There is family h/o asthma. What is the diagnosis?

A. Asthma

B. Foreign body

C. Bronchiolitis

D. Pneumonia


16. 16 weeks p

regnant lady came for a check up ,for the diagnosis of foetal anencephaly all are true except

A. increased alpha feto protein

B. increased beta HCG

C. nuchal thickness

D. decreased alpha fetoprotein
17. Regarding tubal pregnancy most suggestive is (*)

A. –ve beta HCG

B. ultrasound showing empty uterus

C. ultrasound showing tubal mass

D. CT scan

18. 10 weeks old child with persistent unilateral eye discharge responding to antibiotics but recurring

A. nasolacrimal duct obstruction

B. gonococcus

C. Chlamydia

19. unilateral foul smelling ,bloodstained discharge from nose

A. foreign body

B. nasal polyps

C. Atopy

D. Rhinitis


20. 10 year old came to your surgery with scrotal pain .on examination both testis are in the scrotum , next management :

A. do an ultrasound

B. arrange surgery

C. write some analgesic and send him home

D. do nothing it will go away

E. tell his mother to review back again when the pain recurs



21. 19 year old girl had a binge of drinking the previous night with lower abdominal tenderness and all investigations and testis are normal (*)

A. treat as gastroenteritis

B. tell her it is due to alcohol

C. not sure of diagnosis ;come back for review

D. Give analgesic and antiemetic and send her home.



22. Reversal of non depolarising skeletal muscle blockade

A. Pyridostigmine

B. Neostigmine

C. Atropine

D. Benzhexol



23. differentiation between schizophrenia and shcizophreniform disorders is by (*)

A. affective symptoms

B. duration of symptoms

C. lack of insight

D. female and male ratio



24. A lady with a previous divorce now comes to you with a seductive behaviour

A. Narcicistic

B. Histrionic

C. Borderline


25. In Australia bush fires are common either accidentally or due to some people lighting fire deliberately, which is true regarding pyromaniacs.

A. Done for notoriety and publicity

B. To hide their acts

C. As they like to play with fire

D. Set fire and get panic attacks

E. For satisfaction.



26. People living near airport have(*)

A. Explosive personality

B. Insomnia

C. Agitated

D. Depression



27. Regarding panic attacks all are true except (*)

A. 20% have had at least one attack in their lifetime.

B. With out agoraphobia it is equal in male and female

C. Always avoid precipitating factors

D. Usually occurs in the twenties



28. Regarding treatment of chronic duodenal ulcer

A. eradication of H pylori

B. H2 blockers

C. PPI

D. Selective vagotomy



29. 4 year old boy with fever and malaise , lymphocyte count –normal, platelets decreased ,Hb decreased

A. ALL

B. Infectious mononucleosis

C. Hodgkin’s disease


30. Pregnant lady with Group B strep infection, what is true.

A. Penicillin to be given as prophylaxis

B. Bolus dose of penicillin before labour

C. Take a swab and if B strep present then treat.


31. Regarding MI , maximum deaths occur in (*)

A. with in 1st 2 hrs

B. 2 to 12hrs

C. 12 to 24hrs

D. 2 to 7days

E. after discharge


32. A case of stable angina with chest pain. On examination enzymes, ECG are normal but as you were examining him he belches and says he feels better - what would you do (*)

A. Admit to coronary care Unit and do ECG monitoring.

B. send him home with appointment to cardiologist

C. refer to gastroenterologist

D. if enzymes normal then probably no cardiac



33. With regard to primary health care all are true except(*)

A. 1/3rd of population come to a GP with psychiatric symptoms.

B. Most patients are psychotic

C. Only few are referred to psychiatrists

D. Alcoholics and drug abuse frequently overlooked by GP’s



34. A patient with known Parkinson’s disease for 2 yrs on long term treatment now comes with tongue protruding out. What would you do ?

A. Decrease levodopa +carbidopa

B. Increase levodopa + carbidopa

C. Stop levodopa +carbidopa

D. Treat with chlorpromazine



35. In a case of twin pregnancy all are true except

A. asymmetrical growth retardation

B. anaemia in pregnancy

C. premature labour

D. acute polyhydramnios

E. 2nd twin foetal malformation.


36. 60 yr old female with diarrhoea and profuse mucous discharge .what could be the cause

A. Cron’s disease

B. ulcerative colitis

C. villous adenoma

D. rectal Ca

E. acute mesenteric ischaemia



37. How do you differentiate between anorectal and colorectal cause of bleeding(*)

A. Blood mixed with stools

B. Fresh bright bleeding

C. Mucoid discharge

D. Pain during defecation


38. most common cause of severe chest pain in pericarditis

A. viral pericarditis

B. tuberculosis

C. Mycoplasma

D. Uraemia

E. MI



39. all of the following are causes of supraclavicular mass except (*)

A. stomach Ca

B. cervical rib

C. breast Ca

D. subclavian thrombosis

E. subclavian artery aneurysm



40. which of the following has worst prognosis

A. advanced breast Ca

B. choriocarcinoma

C. Hodgkin’s lymphoma

D. Non-Hodgkin lymphoma

E. Prostate carcinoma



41. Which of the following does not metastasise to brain

A. Malignant melanoma

B. Prostatic Ca

C. Lung Ca

D. Breast Ca



42. 40 yr old lady with a 2 cm palpable breast lump on the right side .What is the next step.(*)

A. FNAC

B. Ultrasound

C. Lumpectomy

D. Mammography

E. Radical mastectomy



43. A lady with a palpable breast lump, FNAC showed few malignant cells regarding conservative surgery what is true? (*)

A. Assess for oestrogen receptors

B. Bone marrow biopsy

C. Axillary lymph node sampling

D. Mammography


44. A lady with a breast cancer on left side operated 2yrs ago now detects a small lump on the right side .how do you explain the lump

A. Cancer arising de novo

B. Fibroadenoma

C. Metastasis from the previous one


45. facial nerve palsy can be associated with all of the following except

A. chronic parotitis

B. Ca parotid

C. Acoustic neuroma

D. # base of the skull

46. A middle aged woman with deafness and loss of corneal reflex but with no tinnitus

A. vestibular neuronitis

B. Meniere’s disease

C. Acoustic neuroma

D. Multiple sclerosis


47. Ptosis ,dysphagia ,ataxia ,on the same side and spinothalamic loss on the opposite side:

A. vertebral artery occlusion

B. basilar artery occlusion

C. MS – midbrain

D. Posterior communicating artery syndrome (PICA)



48. 22yr old lady with diplopia. On closing the right eye ,the medial side of the image is lost ( i.e diplopia on looking laterally ) what is the diagnosis

A. left 6th nerve palsy

B. left 3rd nerve palsy

C. right 6th nerve palsy

D. posterior cranial fossa tumour



49. Regarding a patient with hepatoma , which of the following is least likely

A. Hepatitis B

B. Hepatitis C

C. Hemochromatosis

D. CMV

E. Alcoholic cirrhosis


50. In which of the following cell mediated immunity is lost first followed by loss of humoral immunity (*)

A. CLL

B. HIV

C. RA


51. which of the following is not a carcinogen (*)

A. EBV

B. CMV

C. Hep C

D. HIV


52. Picture of a lesion at the lateral angle of the eye what is the treatment ( it’s a BCC) :

A. Surgical removal

B. Excision and radiation

C. Cryotherapy

D. Chemotherapy

E. Local steroids


53. Picture of swelling at the outer angle of the eye .it is described as being hard and present since birth:

A. Osteoma

B. Sebaceous cyst

C. Lipoma
54. picture of a large swelling on the back near the left scapula

A. lipoma

B. sebaceous cyst

C. 2ndary breast


55. Picture of the face with a non itchy rash like lesion on the cheeks, forehead.

A. SLE

B. Seborrheic dermatitis

C. Acne rosacea

D. Dermatomyositis


56. post operative specimen ( testicle with epididymis )

A. TB

B. Epididymoorchitis

C. Teratoma

D. Torsion of testis

E. seminoma


57. A chest x ray of a child showing consolidation > neutrophils increased. What could be the cause

A. Klebsiella pneumonia

B. Group B streptococcus

C. Staphylococcus

D. Mycoplasma pneumonia



58. A lesion (looks like an ulcer) diagnosis?

A. Amelanotic melanoma

B. Implantation dermoid

C. Basal cell carcinoma



59. ECG- patient is a diabetic and he is dyspnoeic .diagnosis(*)

A. Inferior wall MI

B. Anterior wall MI

C. Pericarditis

D. WPW syndrome

E. Pulmonary embolism



60. ECG patient has palpitations, otherwise normal (*)

A. Atrial fibrillation

B. Atrial flutter with variable block

C. WPW syndrome with accelerated beats


61. ECG patient comes with sweating , palpitations

A. Ventricular ectopic

B. Ventricular tachycardia

C. Atrial fibrillation

D. RBBB


62. How do you treat WPW in a patient with a previous history of collapse?

A. Beta blockers

B. Cardioversion

C. Radiofrequency ablation abnormal tract

D. Surgical ablation
D. Long term verapamil


63. 40 yr old man with SVT 160/min ..Patient not arousable , Treatment is

A. cardioversion

B. adenosine

C. procainamide

D. verapamil

E. take an ECG


64. A child with heart rate of 220/min otherwise normal , how do you manage

A. cold stimulus

B. Valsalva

C. Verapamil

D. DC shock


65. All of the following are side effects of depot medroxyprogesterone , except(*)

A. Amenorrhoea

B. Weight gain

C. Depression

D. Used with oestrogen causes stratification and cornification of vagina

E. hypotension


66. 20yr old man came with pain referring from groin to loin to tip of penis brought a sample of urine mixed with blood and asks for a shot of pethidine to relieve his pain. What is the next step

A. give him an injection of pethidine to relieve his pain

B. KUB

C. Ultrasound abdomen

D. Examine fresh urine sample

67. 12yr old boy with bee sting with wheeze ,with swollen lips ,tachycardia , restless, immediate treatment(*)

A. adrenaline IM

B. hydrocortisone IV

C. oxygen

D. antihistamine

E. give NSAID and send him home


68. Young man with tachycardia, BP 90/70,Pulse 140 difficulty in breathing (*)

A. start two IV line to Hartmann

B. wide bore needle

C. tube drainage


69. RTA respiratory distress mediastinal shift to opposite side with emphysema in the neck .what is the diagnosis

A. Tension pneumothorax

B. Hemothorax

C. Cardiac tamponade

D. Bronchial tear


70. Newborn male with normal genitalia , which is true

A. 47xxy

B. 46xy with androgen insensitivity

C. mother treatment with cyproterone from 8 weeks


71. 16yr old girl came with her mother with no menstrual , breast development is normal (testicular feminisation)

A. 45xo

B. 46xy

C. Turner syndrome


72. After MVA a patient is dyspnoeic BP 100/70, HR 110/min, Breath sounds decreased on left side, heart sounds normal, JVP raised, next step in management (*)

A. IV fluids

B. Wide bore thoracostomy

C. Tube thoracostomy

73. A patient with excruciating chest pain and a diastolic murmur .what does the X-ray show (*)

A. widening of mediastinum

B. increased left ventricular size

C. trachea shifted to left


74. A child with fever malaise, sore throat …white papillae on the tongue and later a sandpapery rash...what is the diagnosis

A. measles

B. rubella

C. scarlet fever


75. A child with fever of 3 days duration and a rash develops when fever subsides

A. Rubella

B. Roseola

C. Erythema multiforme




76. An unconscious man (a known COPD case) was brought to the emergency, on examination there was a bruise on the parietal area and needle mark in the cubital fossa. His ABG was as follows (PH: 7.26, PCO2: 60, PO2: 50) His previous ABG showed (PH: 7.35, PCO2: 30, PO2: 60) .what is the diagnosis? (*)

A. Narcotic

B. Subdural haemorrhage

C. Subarachnoid haemorrhage


77. 16 weeks pregnant woman with proteinuria 3 +, hematuria, and hypertension (*)

A. PIH

B. Pre-existing renal disease

C. Essential hypertension

D. Pregnancy will continue until term


78. Which of the following is familial

A. papillary carcinoma

B. medullary carcinoma

C. follicular Ca

D. anaplastic

E. secondary Ca of thyroid


79. A patient with HIV and cough (respiratory symptoms) has a Mantoux 5mm +ve , what is the next step

A. INH prophylaxis

B. Zidovudine

C. Interferon


80. Patient with HIV +ve status ..what is true (*)

A. Life long infectivity

B. He has AIDS

C. Can transmit through saliva

D. He should avoid sexual intercourse


81. Tremor can be present in all of the following except

A. hyperthyroidism

B. hypothyroidism

C. benign essential tremor

D. Parkinsonism

E. chronic liver disease

82. A lady with tremor on lifting the phone and disappears when she looks at her hand with mild rigidity of the hand but no cogwheel rigidity. What is the treatment?

A. Propranolol

B. Benzhexol

C. Levodopa

83. Complication of # of epiphyseal plate

A. retardation of longitudinal growth

B. joint stiffness

C. malunion

D. non-union

E. avascular necrosis



84. which of the following does not have any interaction

A. warfarin & Isosorbitrate

B. verapamil & metoprolol

C. erythromycin & terfenadine

D. digoxin & amiodarone


85. 12yr old child weight 90th percentile with a limp

A. Perthes’s disease

B. slipped capital femoral epiphyses

C. tibial synovitis


86. 13yr old child which would be the appropriate bone age for a normal adult height

A. 9yr old

B. 13yr old

C. 18yr old


87. Regarding mammography, what is true?

A. It is painless

B. Can diagnose breast Ca earlier than self-examination

C. More diagnostic for 70yr old

D. Definitive diagnosis of Ca breast


88. 10 days old boy with vomiting, serum potassium is 7.7; serum Na is 118.what is the diagnosis.

A. Pyloric stenosis

B. congenital adrenal hyperplasia

C. SIADH

D. Posterior cranial fossa tumour



89. A young boy has fever and limp. There is tenderness at one point in the tibia; all movements are full except flexion which is restricted to 30degrees. what is the diagnosis?

A. Septic arthritis

B. Osteomyelitis

C. Perthes disease


90. 6 hours after difficult catheterisation, a patient developed fever with chills

A. suppurative urethritis

B. gram negative septicaemia (bacteremia)

C. haemorrhage


91. Regarding hemochromatosis , diagnostic investigation is

A. Sr. ferritin

B. Transferrin

C. Sr .Iron

D. Liver biopsy



92. In Australia the common cause of iron deficiency is

A. Nutritional deficiency

B. Malabsorption

C. Diarrhoea


93. most common cause of bleeding P/R in children

A. fistula in ano

B. fissure in ano

C. haemorrhoid


94. Patient with depression is treated with antidepressants; following a course of treatment she now wants to stop the drug .What do you advice?

A. Follow up every week

B. Follow up every month

C. Admission to hospital


95. Child with abdominal mass and with metastasis to skull

A. neuroblastoma

B. Willm’s tumour

C. retinoblastoma


96. A child babbles , sits for sometime unsupported ,stands with support and holds an object by the palm .what is the age (*)

A. 5 months

B. 7 months

C. 1year

D. 18 mon.



97. A patient with dysthymia for 2years ..treatment is (*)

A. SSRI + SSRI+ benzodiazepine

B. SSRI cognitive + behaviour therapy

C. SSRI

D. Antipsychotics +SSRI


98. A young patient vomits 1Litre of blood and has 2 times malaena. what is next appropriate step

A. Gastroscopy

B. Immediate surgery

C. Barium meal



99. old lady with knee swelling and has weekly positive birefringent crystals ,the crystals contain

A. calcium pyrophosphate dihydrate

B. calcium hydroxyapatite

C. urate


100. A patient is worried about the (sexual dysfunction and depression) side effects of sertraline. What would be the advice regarding the same to the patient?

A. It is only side effect of antidepressant

B. both these side effects are not related to sertraline


101. Young man after a RTA was found unconscious only responds to painful stimuli and eye cold stimuli what is the GCS score

A. GCS >3

B. 3 to 6

C. 6 to 9

102. child with fever and blisters in the palm and sole and mouth ,there is lymphadenopathy

A. Coxsackie’s

B. Kawasaki

C. Herpes

103. All of the following are scaly lesions except

A. Keratoacanthoma

B. Squamous cell Ca

C. Pityriasis rosea

D. Psoriasis


104. Rash similar to syphilis except

A. Infectious mononucleosis

B. Atopic eczema

C. Discoid eczema

D. Tinea corporis


105. Pregnant lady with carpel tunnel syndrome .what is true?

A. Surgical intervention is rarely needed

B. Splinting in hyperextension

C. Surgical correction


106. what is typical feature of carpal tunnel syndrome

A. severe pain awakening the patient at night

B. pain in the ring and little finger

C. paresthesia restricted to median nerve

D. history of myxedema


107. 3rd day blues what is correct? (*)

A. Occurs at least in 50% after delivery

B. More common following “C “section

C. Always lead to psychosis

D. Results in more premature malformed children


108. regarding child abuse

A. more common in deformed ,premature and LBW children

B. toddlers are more commonly affected

C. majority patients would have a psychiatric disorder

D. other children in the family wont get affected



109. confidentiality can be broken in which of the following situations

A. child abuse

B. when the police comes to ask

C. insurance matters


110. all are hepatotoxic except

A. paracetamol

B. OCP’S

C. Halothane

D. INH


111. carcinomatous change can occur in all except

A. Sjogren’s syndrome

B. thyrotoxicosis

C. coeliac disease


112. 2yr old child with chronic respiratory infection, what would you do?

A. Sweat chloride test

B. X ray chest

C. Barium meal


113. Child with chronic cough and rectal prolapse, diagnosis?

A. Congenital megacolon

B. Cystic fibrosis

C. Whooping cough


114. 6 weeks old child on breast feeding with 4 days constipation and thriving well diagnosis? (*)

A. Hirschsprung’s disease

B. normal variant

C. hypothyroidism

D. acquired constipation


115. Which of the following is not associated with brain metastasis?

A. Small cell Ca

B. Breast Ca

C. Renal Ca

D. Lung Ca


116. An elderly patient ,known case of Ca rectum , on morphine has chronic constipation and was treated with lactulose but was not responding .what is the next step

A. Arrange a surgical consultation

B. Enema

C. P/R examination

D. Modify diet

117. All of the following are associated with Raynaud’s except

A. RA

B. SLE

C. Scleroderma

D. Dermatomyositis

E. Ankylosing spondylitis



118. cause of diarrhoea in an old bed ridden patient

A. faecal impaction

B. Carcinoma

C. Constipation


119. Haemolytic anaemia all are true except

A. Increased urobilinogen

B. Icterus and clear urine

C. MCV decreased


120. A child ingested washing powder half an hour ago next management(*)

A. Admit to hospital and possible endoscopy

B. Charcoal

C. Sent him home

D. Syrup of ipecacuanha

E. Observe

121. Mother of an 18 month child was concerned as it was not babbling .audiological assessment was done when he was 10 months old .what is the next step

A. Arrange audiometry

B. Repeat hearing test

C. Reassure the mother


122. 71/2 yr old girl attained menarche; her mother noticed the breast growth and axillary hair growth 6 months ago.

A. premature puberty

B. undiagnosed congenital adrenal hyperplasia

C. turner syndrome


123. In a young female patient what is the most common cause of subarachnoid haemorrhage?

A. Ruptured aneurysms

B. Av malformations

C. Mycotic aneurysms

D. trauma


124. A neonate few hours after birth developed cyanosis which was not responding to oxygen. NO murmer is there. Diagnosis? (*)

A. Transposition of great vessels

B. Tetralogy of fallot’s

C. VSD

D. ASD


125. Lung Carcinoma seen in non smokers

A. Adenocarcinoma

B. Squamous cell carcinoma

C. Small cell ca.

D. Basal cell ca.



126. A child has facial movements and it is increased on watching TV (question on tics). They are present even during examination.

A. Myoclonic epilepsy

B. Tics

C. Partial complex epilepsy

D. Panic attack
127. In TNM staging which has a better prognosis

A. T1 N0 M0

B. T1 N1 M0

C. T1 NI MI



128. 60 yr old female patient had repeated bilateral thrombophlebitis and DVT cause

A. pancreatic Cancer

B. ovarian cancer

C. protein c deficiency



129. Most common cause of central cyanosis

A. Left to right shunt

B. Right to left shunt

C. CO poisoning



130. Regarding immunology what is correct?

A. Ig G associated with atopic eczema

B. Delayed hypersensitivity is T cell mediated



131. Why is it difficult to differentiate beta HCG and LH

A. FSH high

B. LH high

C. Prolactin high

D. Progesterone low



132. Young hypertensive male with proteinuria, hematuria and upper respiratory infection for 2 days .Diagnosis?

A. Ig A nephropathy

B. Glomerulonephritis

C. Nephrotic syndrome

D. Acute pyelonephritis

E. Membrane nephropathy


133. All of these can cause gynecomastia except

A. Spironolactone

B. Cimetidine

C. Labetolol

D. Digoxin

E. methyldopa


134. which of the following is least likely associated with primary hypothyroidism

A. 72y/o with multinodular goitre

B. 28 y/o with menorrhagia

C. 9y/o with retarded bone age

D. 16y/o with anovulatory cycles


135. which of the following is incorrect :

A. alcohol reduces triglycerides

B. olive oil decreases HDL

C. increased LDL/HDL ratio is good

D. Taking 300 gms of fish daily does not reduce cholesterol



136. Point prevalence in schizophrenia means the

A. Current cases at that time

B. Cases in one year

C. The total number of cases


137. Regarding Diabetes mellitus what is true? (*)

A. At least take 100gms of carbohydrate everyday to prevent ketonuria.

B. If one parent has diabetes there is 1:8 chance of getting affected.

C. You can’t give insulin until level comes to normal.


138. Regarding diabetic foot ,all are true ,except (*)

A. 50% mortality following amputation

B. If the pulse is present patient is unlikely to have it.

C. To have diabetic foot controlling glucose level can help


139. Regarding 80% carotid artery stenosis. What is true? (*)

A. The incidence of stroke will be halved

B. 40% stroke with out treatment

C. 50% incidence of stroke after endarterectomy

D. 40% death will occur within 30days


140. Spiral # of humerus which nerve damaged

A. Radial

B. Ulnar

C. Median

D. Volkmann’s ischemia contracture



141. 50 yr old patient wakes up at night due to pain in the calf which is relieved by walking. What is the cause?

A. Ischemic pain

B. Raynaud’s phenomenon

C. Muscular cramps

D. DVT

E. Intermittent claudication


142. A patient with pain in the calf worsened by elevation of feet

A. Ischemia

B. Nocturnal cramps

C. DVT


143. Which of the following feature is unlikely to be due to arterial ischemia

A. Pain along the buttock and thigh after exertion

B. Weakness of the buttock and thigh

C. Shooting pain from buttock and thigh

D. Leg paralysis



144. Most common feature of rectal carcinoma

A. Tenesmus

B. Bleeding

C. Incomplete defecation

D. rectal prolapse

145. A patient after MVA sustained a pelvic # and has blood in the external meatus ,initial investigation of choice is (*)

A. Urethrogram

B. CT scan

C. Cystoscopy

D. Catherisation

E. IVU


146. Regarding uncomplicated haemorrhoids all are true except

A. Pain

B. Pruritus

C. Bleeding

D. Prolapse

E. Mucus discharge


147. Regarding PMS what is true?

A. 5% have very severe symptoms

B. 40% have PMS

C. all patients with PMS always have dysmenorrhoea


148. Patient mechanic with penetrating hand injury. What is true? (*)

A. Drainage should be done from extensor surface

B. It indicates that there is extension of the palmar abscess into extensor aspect

C. The swelling is due to oedema

D. It indicates the involvement of extensor tendons

149. Apathetic and dull are the negative symptoms of schizophrenia. Which is the other negative symptom (*)

A. Catatonia

B. Blunted affect

C. Cataplexy


150. A patient who is aware about his own problems during treatment .what is it ? (*)

A. Instinct

B. Insight

C. Pseudo altruism

D. Intellectualisation


151. In chronic liver failure (obstructive jaundice) what’s true

A. Vitamin K absorption is reduced

B. Prothrombin cannot be converted to thrombin

C. Chronic hepatitis


152. In hemochromatosis after venesection all are true except

A. Skin pigmentation becomes normal

B. Cardiac siderosis is reversible

C. Hepatoma can be cured


153. In hemochromatosis

A. size of the liver is decreased following treatment


154. A patient with perforated peptic ulcer all are correct except

A. Patient remembers exactly the moment of rupture

B. Back pain

C. Vomiting

D. Board like rigidity

E. Guarding


155. Concerning cluster headache all are correct except

A. vomiting

B. treat with methysergide

C. occurs after 3-4 hrs of falling asleep

D. occurs at the same time of the day


156. A young man with throat infection in child hood and was treated with penicillin ..He now comes with a fear of developing a rash due to penicillin as he was influenced by his friends words. What does he have?

A. Induced delusion

B. Hypochondriasis



157. young man with needle marks and pin point pupils ,gag reflexes are normal ,no extensor plantar reflexes(*)

A. opiate ingestion

B. temporoparietal #


158. A young man with left sucking wound in the chest .After initial airway resuscitation and circulation management what is the next step(*) C.

A. Debridement and closure

B. Pressure bandage

C. IV fluids



159. Which infection is least likely during childbirth?

A. Syphilis

B. Gonorrhoea

C. Streptococcal

D. HIV

E. Herpes



160. Appropriate Estimation of the foetal gestational age is by (*)

A. Transvaginal ultrasound at 8 weeks

B. Bimanual examinations at 8 weeks

C. Ultrasound at 18 weeks

D. Transvaginal ultrasound at 18 weeks


161. Regarding OCP what is the absolute contraindication?

A. Focal migrainous hemiplegia

B. Hypertension

C. Diabetes

162. Regarding OCP what is correct? (*)

A. All the progesterone’s except cyproterone have derived from testosterone

B. Derive from oestrogen

C. Derive from progesterone



163. Young man with severe joint pain and profuse bleeding from venipuncture site. Diagnosis? (*)

A. DIC

B. Thrombophlebitis

C. Clotting defect

164. All are true regarding DIC except (*)

A. Fibrin decreased

B. FDP decreased

C. PTT increased
165. intermittent claudication commonest site

A. profunda femoris

B. superficial femoral artery

C. posterior tibial artery

D. bifurcation of abdominal aorta

E. external iliac artery


166. Which defence mechanism is mature?

A. Denial

B. Projection

C. Introjection

D. Humour



167. Undescended testis is most commonly associated with (*)

A. Torsion of testis

B. Spermatogenesis will be perfect if the operation is done before 3 years

C. Development delay of the child

D. Acute epididymitis

E. Hernia



168. G3P0 pregnant lady came to you at 16 weeks pregnancy .She had two spontaneous abortions at 17 and 18 weeks in the previous pregnancies .how do you treat?

A. Chromosomal analysis

B. Cervical stitch

C. Complete bed rest


169. Regarding Mullerian agenesis all of the following is true except

A. Short vagina

B. Normal breast development

C. X linked recessive



170. What would be the most likely cause for bloody discharge from the nipple in a 50 year old lady?

A. Intraductal papilloma

B. Intraductal carcinoma

C. Paget’s disease

D. Fibrocystic disease


171. The relative marker in Hepatocellular carcinoma is

A. PSA

B. CA125

C. CEA

D. CA153

E. AFP


172. Treatment of seminoma stage 2 with metastasis to the para-aortic lymph nodes

A. Radio therapy to testis and nodes

B. Surgery and radiation to Para aortic nodes

C. Chemotherapy

D. Surgery


173. 70 year old woman with vaginal prolapse with ring pessary what is the complication (*)

A. atrophic vaginitis

B. cervical carcinoma

C. decubitus ulcer

D. carcinoma of vagina


174. After splenectomy you expect all of the following except (*)

A. Life long increased risk of infection

B. Transient increased platelets to predispose to thrombosis

C. Persistent decrease of RBC life span

D. Decrease in anaemia


175. Diabetic mother after prolonged labour delivered a jittery baby which responds to oxygen ..what is the diagnosis

A. Hyperglycaemia

B. Hypoglycaemia

C. Meconium aspiration

D. Hyperbilirubinemia


176. Splenectomy is most beneficial in which of the following

A. Haemophilia

B. Chronic ITP

C. Myelofibrosis



177. A middle aged man unable to fall asleep has night mares and remembers his daily activities diagnosis?

A. Anxiety disorder

B. Depression

C. OCD

D. Insomnia

178. Alcoholism is associated with all of the following except

A. Substance abuse (benzodiazepine)

B. Depression

C. OCD

179. Proteinuria is seen in all of the following except

A. congenital nephritis

B. RPGN

C. UTI

D. RA

E. Horseshoe kidney



180. Tourette syndrome ; all are correct except

A. Motor and vocal tics are seen

B. 2 or more bouts per day

C. the person is not distressed with vocal tics

D. coprolalia is less than 10%

E. onset always less than 18 years of age



181. A 35 year old lady has a grey greenish vaginal discharge, microscopy shows clue cells, and she responded well to metronidazole .diagnosis (*)

A. Chlamydia

B. Bacterial vaginosis

C. Trichomoniasis

D. Moniliasis



182. Regarding stammering which is correct

A. spontaneous resolution at 16years

B. resolution after 2 year.

C. No resolution in life

D. Operative measure


183. Still birth after a normal delivery. all of the following tests are done except

A. Kleihaur test

B. Chromosomal analysis

C. Foetal parts

D. Maternal antibodies

E. Foetal post-mortem


184. Polyhydramnios all are true except

A. Rh incompatibility

B. Oesophageal atresia

C. bladder neck obstruction

D. Anencephaly


185. Polyhydramnios see in all except

A. Diabetes

B. Multiple pregnancy

C. Cardiac anomalies

D. Hydrops fetalis



186. Child with greyish tonsillar exudate and atypical lymphocytes

A. Infectious mononucleosis

B. CMV

C. ALL


187. Urge incontinence all are true except (*)

A. Colposuspension

B. Taping the vagina

C. Pelvic exercise

D. Weighted vaginal cones


188. (Regarding Rubella and pregnancy) a kindergarten teacher 6 weeks pregnant had one of her student with rubella .all are true except

A. immunoglobulins

B. IgG is increased initially then IgM

C. Antibody measure and repeat SRH after 10 days

D. If mother infected early then child can have microcephaly, seizures and cataracts


189. A patient with pyloric stenosis vomiting a lot and vomitus contains undigested food material taken 2 days back. What is the initial management?

A. Normal saline

B. Hartmann’s

C. Ringer lactate


190. daily requirement of potassium

A. 50mmol

B. 1gm

C. 30mmol

191. In pyloric stenosis vomiting is

A. Intermittent

B. Occurs 1hour after food

C. 2 days after food



192. A man with abdominal pain x ray showed multiple fluid levels .what is the management

A. 2 litres RL

B. 2 litres Hartmann’s before surgery

C. 2 litres Hartmann’s after surgery

D. 2 litres Hartmann’s after surgery



193. regarding antibiotic prophylaxis what is true

A. single dose is sufficient when compared to multidose

B. urologic surgery needs a culture for the specific antibiotic



194. 4 year old child constipated ,rectum empty and sphincter tone lax ,mass at the apex of rectum

A. Hirschsprung’s

B. acquired megacolon

C. hypothyroidism


195. hypercalcemia seen in all except

A. hyperparathyroidism

B. pancreatitis

C. RTA

196. 3 year old girl with periorbital oedema ,protein 3+, all are true except

A. prednisolone will impr

[walid51]

1-b
2-c or e
3-e
4-a
5-???
6-b
7-a
8d
9-d
10-e
11-a
12-a
13-b and d
14-c or e
15-????
16-d
17-a
18-c
19-a
20-C ??
21-d
22-a
23-a
24-???
25-IS the age 10, if yes then i think the answer is b
26-b
27-c
28-litiunm toxicity
29-b
30-a
31-anxiety
32-phobia
33-d and e
34-b
35-c
36-????
37-b or e
38-a
39-c
40-2
41-a
42-a or b
43-a
44-A???
45-a???
46-b????

[walid51]

answers..psychiatry
1...b
2...e
The diagnostic criteria for pyromania are:

deliberate and purposeful firesetting on more than one occasion;
tension or emotional arousal before the act;
intense interest, curiosity or fascination about fire (which can include fire equipment and the consequences of fire);
pleasure, gratification or relief when setting or witnessing fires and their aftermath;
the firesetting is not done for another motive such as financial gain, anger or revenge, to gain recognition or to relieve boredom, and is not done in response to a delusion or hallucination or due to impaired judgment (such as through intoxication); and
the firesetting is not better accounted for by conduct disorder, antisocial personality disorder or a manic episode.
3...c
4...a
5...d
6...b
7...b
8...d
9...a
10...c
11...f
12...a
13...b
14...e
15...e
16...e 6 weeks post partum
17...b...not sure ,this is what happens in seasonal dysthymic disorder
18...a Delusion

A delusion is commonly defined as a fixed false belief and is used in everyday language to describe a belief that is either false, fanciful or derived from deception.
19... :roll:
20...e
21...d
22...a
23...b...also in alcoholism and cocaine addiction
24...e
25...b
26...b
27...c
28...developed what :?
29...a????
32....fear is a common cause
33...a
35...c
37...b
38...a
39...d
41...a
43...a
44...a
45...a
46...b

[walid51]

MEDICINE
1...b....in ant.dislocations
3...c
4...c
5...d
6...a
7...d
8...a
9...c
10...b
11...c
12...b
13...d
14...d
15...c
16...b
17...b
18...c
19...c
22...c
23...c
24...d
26...c
27...e...
28...e
29...a
30...d
31...e....not sure
32...b.......not sure
34...d
35...b
36...c
37...a
38...d
39...c
41...c
43...c
44...c
46...c
47...c
48...c
49...c
50...b
51...c
52...d...????
53...advice to stop taking pills from the this pack that will initiate bleeding and start another .
54...a
55...c
56...a
57...d
58...c
59...a???
60...c
61...???
62...e
63.

63...a
65...d
66...c ....its 41 weeks!
67...c..b/c volkmann contractures r common in this injury
68...b
69...a though all epiphyseal # dont cause growth retardation..it depends on severity of injury, invovement of growth plate
70...e....if it is "hypoplasia"


.. [/B]

[walid51]

MEDICINE, SURGERY , OBSTETRICS AND PSYCHIATRY
1...b
2...a
3...c
4...b
5...c...US ?????
6...all r false except d
7...d...afterload reducers r not used in AS.
8...d
9...b
10...a
11...a
12...c caused in this age group by S. pnemoniae, H.influenzae and staphlococcus.
13...b...excessive crying causes cyanosis
14...b
15...c????
16...c
17...c???
18...a
19...a
20...b...b/c the most common cause of scrotal pain in infants and children is torsion f testes
22...b ...
23...b
24...b
25...c
26...b
28...d????
30...b

31...a
32...c ????? anyone??
33...b
34...c
35...e
37...b
38...e
39...d
40...a
41...b
42...a
43...c
44...a
45...a


46...d ...c can also be true b/c sometimes acoustic neuroma patients dont complain of tinnitis.
47...D
PICA =posterior inf cerebellar artery .
Lateral medullary syndrome (also called Wallenberg's syndrome and posterior inferior cerebellar artery syndrome) is a disease in which the patient has difficulty with swallowing or speaking or both owing to one or more patches of dead tissue (known as an infarct) caused by interrupted blood supply to parts of the brain.
This syndrome is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the infarct and sensory and motor deficits affecting the face and cranial nerves on the same side with the infarct. Other clinical symptoms and findings are ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia and dysphagia. The cause of this syndrome is usually the occlusion of the posterior inferior cerebellar artery (PICA) at its origin.

The affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, and slurred speech (dysphonia, dysarthria). Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex.

The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia.
48...c
49..d
50...b

[walid51]

46...d ...c can also be true b/c sometimes acoustic neuroma patients dont complain of tinnitis.
47...D
PICA =posterior inf cerebellar artery .
Lateral medullary syndrome (also called Wallenberg's syndrome and posterior inferior cerebellar artery syndrome) is a disease in which the patient has difficulty with swallowing or speaking or both owing to one or more patches of dead tissue (known as an infarct) caused by interrupted blood supply to parts of the brain.
This syndrome is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the infarct and sensory and motor deficits affecting the face and cranial nerves on the same side with the infarct. Other clinical symptoms and findings are ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia and dysphagia. The cause of this syndrome is usually the occlusion of the posterior inferior cerebellar artery (PICA) at its origin.

The affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, and slurred speech (dysphonia, dysarthria). Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex.

The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia.
48...c
49..d
50...b

51...b
52...a
54...a
57...d???
62...c
63...a
65...e
66...d
67...O2 then adrenaline
69...a


A chest x ray of a child showing consolidation > neutrophils increased. What could be the cause

A. Klebsiella pneumonia

B. Group B streptococcus

C. Staphylococcus

D. Mycoplasma pneumonia [/quote]

57...if the child is upto 2 months old its group B strep.
if he is older then staph is the right answer



74...c
75...b
76...a
77...b
78...b
79...a
80...a
81...b
82...a
83...a
84...a
86...b
87...b
88...b
89...b
90...b [/COLOR]

[walid51]

AMC Handbook of Clinical Assessment (2007)




[Only Registered Users Can See Links] ([Only Registered Users Can See Links])


AMC Handbook of Clinical Assessment



Publisher: Australian Medical Council | Language: English |


ISBN:1875440380 ([Only Registered Users Can See Links]) | 770 pages | Data: 2007 | PDF | 13 Mb




[Only Registered Users Can See Links] ([Only Registered Users Can See Links])

[Only Registered Users Can See Links] ([Only Registered Users Can See Links])

[walid51]

Annotated Multiple Choice Questions: Australian Medical Council



[Only Registered Users Can See Links]
Authors:V. C. Marshall ([Only Registered Users Can See Links]), A. Lindesay Clark ([Only Registered Users Can See Links]), A. J. Buzzard ([Only Registered Users Can See Links]) ([Only Registered Users Can See Links])
Publisher: Wiley-Blackwell ([Only Registered Users Can See Links])
Keywords: medical ([Only Registered Users Can See Links]), council ([Only Registered Users Can See Links]), australian ([Only Registered Users Can See Links]), questions ([Only Registered Users Can See Links]), multiple ([Only Registered Users Can See Links]), choice ([Only Registered Users Can See Links]), annotated ([Only Registered Users Can See Links])
Number of Pages: 432
Published: 2008-02-02
List price: $104.95
ISBN-10: 0867933771
ISBN-13: 9780867933772
Book Description:



The Australian Medical Council (AMC) has prepared this book to assist overseas-trained doctors who are preparing for the AMC AMCQ examination. This book will be a valuable guide and self-assessment tool to assist in sitting for this exam. It also illustrates the best-practice principles for a wide range of medical conditions found in the Australian community. All medical students will find this book an invaluable aid as an educational resource in preparation for their clinical assessments, as should postgraduate trainees preparing for higher degrees across the spectrum of general and specialist practice. The questions are representative of curricula of medical schools at universities across Australia.




[Only Registered Users Can See Links]=onepage&q&f=false ([Only Registered Users Can See Links]=onepage&q&f=false)

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[allord]

شكرا كتير كتير كتير كتير كتير اخي وليد عن جد ما بعرف شو بدي قللك الله يجزيك الخير يعني هي الملفات صارلي شهرين عم دور عليها و ما كنت لاقي شي مفيد مثل هيك .
انا لقيت رابط لكتاب
anothology medical conditions
شكرا كتير مرة ثانية

[allord]

هاد رابط لكتاب anothology medical conditions
[Only Registered Users Can See Links]

[allord]

الرابطين اللي فوق لنفس الكتاب

[walid51]

Thanks

My regard

[walid51]

May 2007 MCQ Exam
1.A piicture of Dupuytren contracture. Cause:

A. Use of chronic vobrating tools
B. Chronic alcoholism


2. Picture of Bowen disease from Anthology. Dx?

3. Picture of perianal haematoma. Mn?


4. Features of complex partial seizure given. Rx?


5. A 60 yo man, commercial driver has had a recent stroke. He has left hemiparesis and left homonymous hemianopia. What advice you will give him regarding driving in the future?

A. never drive again
B. Have an occupational driving test done

6. A sudanese boy came to you after administration of Co-timoxazole with the complaints of pallor and increasing darkness of colour of urine. his reticulocyte count was 8%. His Coomb's test was negative, no family history and on electrophoresis Type A hb was detected. What is the Dx?

a. Hereditary Spherocytosis
b. G6PD def
c. Autoimmune HA
d. Sickle cell anaemia
e. thalassaemia

7. What is the use of Psychodynamic psychotherapy in Australia ?

A. Phobia
B. Anxiety disorder
C. schizophrenia
D. OCD

8. A boy came with fever and pain in the right leg. he hardly moves the leg and does not allow you to move it either. He refuses to carry weight on that leg. What could be the dx?

A. Septic arthritis of hip
B. OM of femur
C. D. E. could be excluded easily



9. one of your colleague is taking anti psychotic medication for her own psychiatric illness. what should be your advice to her??


A. she should refrain from seeing pt. until she is asymptomatic
B. she should take specialist review
C. you should contact the medical advisory board

10. What is the most common association of childhood obesity in Australia ?

A. Above average height
B. Hypercholesterolaemia
C. DM
D. cataract

11. What will be the first S/S when a plaster is too tight?

A. Pain
B. Change of colour
C. Swelling
D. Stiffness

12. which nerve regenerates most after taumatic laceration?

A. ulnar n.
B. Median n.
C. Digital n.
D. sciatic n
E. Common peroneal n.

13. A patient came with 12 hr H/O severe vomiting. Pain in upper abdomen which is now constant in the epigastrium. There is rigity and guarding in the abdomen. Dx?

A. ac. pancreatitis
B. Perforated DU
C. perforated GU

14. A pt came with an ill defined mass in the RIF and loose watery stools. He has fever and has lost 6 kgs of weight recently. Dx?

A. Crohn disease
B. Meckel diverticulitis
C. UC
D. Ca large gut

15. Most common S/S assoc. with ca rectum?

A. altered bowel habit and tenesmus

16. A patient came with a pus discharging bead at 5 o'clock position at the anal verge. on probing there was a track discovered which extended in the rectum for 15 cm. (these were the exact words). DX?

A. Crohn dis
B. Ankylostomiasis
C. Ca rectum
D. Haemorrhoids

17. A badly injured patient who takes anti psychotics is on the verge of collapse. but he is violent and refuses all treatment. what do you do?

A. restrain him and treat

18. A patient opens his eyes to pain, withdraws to painful stimulus ans is unable to answer ant questions. What is his GCS?

A. 7-9
B. 10-12
C. 3-5
C. 13-15

19. An old man who suddenly collapsed was unconscious for three minutes following which he recovered fully. 5 ECG rhythm strips given. Which could possibly explain his situation?

A. 1st deg. HB
B. 2nd deg HB
C. VF
D. Complete HB
D. LBBB

20. One ECG which has digitalis effect on it. DX?

1.A piicture of Dupuytren contracture. Cause

alcoholism



3. Picture of perianal haematoma. Mn?

incision under local

5. A 60 yo man, commercial driver has had a recent stroke. He has left hemiparesis and left homonymous hemianopia. What advice you will give him regarding driving in the future?


[Only Registered Users Can See Links]
page 71 stroke is mentioned & they said pt cant drive for 1 months after & 3 if SAH but if dense hemiplegia then he cant drive before specialist & assesor asses him so i will chose the 2nd option

A sudanese boy came to you after administration of Co-timoxazole with the complaints of pallor and increasing darkness of colour of urine. his reticulocyte count was 8%. His Coomb's test was negative, no family history and on electrophoresis Type A hb was detected. What is the Dx?

G6pd, he is black as he is from suddan & he was give sulpha containing medication

7. What is the use of Psychodynamic psychotherapy in Australia ?

used allover the world for panic attacks so i guess anxiety disorder would be the one


8. A boy came with fever and pain in the right leg. he hardly moves the leg and does not allow you to move it either. He refuses to carry weight on that leg. What could be the dx?

A. Septic arthritis of hip
B. OM of femur ****
C. D. E. could be excluded easily

OM should be excluded as per AMCQ book


10. What is the most common association of childhood obesity in Australia ?

A. Above average height
B. Hypercholesterolaemia
C. DM
D. cataract

dont know at all,any help plz
11. What will be the first S/S when a plaster is too tight?

A. Pain ******
B. Change of colour
C. Swelling
D. Stiffness

if there a discomfort option i would have choosen it
12. which nerve regenerates most after taumatic laceration?

A. ulnar n.
B. Median n.
C. Digital n. *****
D. sciatic n
E. Common peroneal n.

not sure why

13. A patient came with 12 hr H/O severe vomiting. Pain in upper abdomen which is now constant in the epigastrium. There is rigity and guarding in the abdomen. Dx?

A. ac. pancreatitis
B. Perforated DU
C. perforated GU

all of them can have these symptoms,its missing some info,which way of sitting that help the pt relief the pain,age of pt ,previous history ,i would go for Acute pancreatitis cuz there s no shoulder tip pain,nothing said about bowel sounds

14. A pt came with an ill defined mass in the RIF and loose watery stools. He has fever and has lost 6 kgs of weight recently. Dx?

A. Crohn disease
B. Meckel diverticulitis
C. UC
D. Ca large gut

UC bloody diarrhea & no masses
never heard about a meckel on the right
Ca usualy have histoy of bowel habits change but wt loss support that

crohns would be my choice
as emerck online say about crohns

The most common initial presentation is chronic diarrhea with abdominal pain, fever, anorexia, and weight loss. The abdomen is tender, and a mass or fullness may be palpable


16. A patient came with a pus discharging bead at 5 o'clock position at the anal verge. on probing there was a track discovered which extended in the rectum for 15 cm. (these were the exact words). DX?

A. Crohn dis
B. Ankylostomiasis
C. Ca rectum
D. Haemorrhoids

crohns diz
merck says
Abscesses are common, and fistulas often penetrate into adjoining structures, including other loops of bowel, the bladder, or psoas muscle; fistulas may even extend to the skin of the anterior abdomen or flanks. Independently of intra-abdominal disease activity, perianal fistulas and abscesses occur in 1⁄4 to 1⁄3 of cases; these complications are frequently the most troublesome aspects of Crohn's disease.


18. A patient opens his eyes to pain, withdraws to painful stimulus ans is unable to answer ant questions. What is his GCS?

A. 7-9
B. 10-12
C. 3-5
C. 13-15


eye on pain 2
withdraw to pain 5
unable to answer quz 1

so 7-9

11. What will be the first S/S when a plaster is too tight?

A. Pain******
B. Change of colour
C. Swelling
D. Stiffness

this is from Toronto notes

clinical signs and symptoms
early
pain
• greater than expected for injury
• not relieved by analgesics
• increase with passive stretch of compartment muscles
pallor
• palpable tense, swollen copmparment
late
• paralysis (inability to move limb - late)
• pulses are usually still present
• paresthesias
NOT pulslessness
• most important feature found on physical exam is PAIN out of
proportion to injury (the other signs are ‘late signs’)

4.a lady with sore throat, a week later developed a swelling which moves with deglutition

1 solitary thyroid nodule
2 MNG
3 thyroglossal cyst
4 cervical lymph node


The diagnosis is usually established by observing a 1- to 2-cm, smooth, well-defined midline neck mass that moves upward with protrusion of the tongue. Routine thyroid imaging is not necessary, although thyroid scintigraphy and ultrasound have been performed to document the presence of normal thyroid tissue in the neck. Treatment involves the "Sistrunk operation," which consists of en bloc cystectomy and excision of the central hyoid bone to minimize recurrence.1 Approximately 1% of cysts are found to contain cancer that is usually papillary (85%). Squamous, Hürthle cell, and anaplastic cancers also have been reported, but are rare. Medullary thyroid cancers are, however, not found in thyroglossal duct cysts.

I forgot to mention the relation to infection ...

Thyroglossal duct cysts present as midline masses of the anterior neck (Figure 25–4. ). Like branchial cleft cysts, they may be asymptomatic and only appear when they become infected in the setting of an upper respiratory tract infection...Current

thats a good was of practcisng but ur getting most questions statments wrong ,like there was never written a mass in midline moved wit hdegulttaion ,and i dnt think there is conncetion bw thyroglossal cyst and throat infection ,anywayz may be it was written midline i dnt rember exactly may be ur rite and one of the choice for the other question was pilonidal sinus tract and it was at 3 o clok position or it was the other question i dnt rember exactly

1. A patient with acute myocardial infarction used heparin; which of the following methods is used for monitoring:
a. BT
b. PT
c. ARTT
d. INR
e. Fibrinogen

2. A patient has a mitral valve stenosis – all of the following signs are correct EXCEPT:
a. AF
b. S 1 increased
c. Palpitation increased S 2 in apex
d. S 3
e. Presystolic murmur

3. In a patient with myocardial infarction was found a new systolic murmur on examination. Cardiac ejection fraction was 55%. Which of the following is MOST probable cause:
a. Aortic regurgitation
b. Papillary muscle dysfunction
c. Mitral valve stenosis
d. Papillary muscle rupture
e. Tricuspid valve regurgitation

4. A young woman has hypertension with fibrosing stenosis of renal artery (60%) which of the following is the MOST appropriate treatment:
a. Renal artery angioplasty
b. ACE Inhibitors
c. Antihypertensives
d. Diuretics
e. Arteries dilation drugs

5. An obese patient with diabetes mellitus is under anti-hypertension treatment. His blood pressure is 160/100mmBg on examination. Which of the following is your INITIAL consideration for this patient:
a. Decreased protein in his diet
b. Concurrent hypertensive therapy
c. Give diuretics
d. Control sugar intake in the diet
e. Ideal weight

6. At which level of cholesteral you consider to give lipid-lowering statins (eg, simvastatin, pravastatin)
a. 6 mmol/l
b. 5.5 mmol/l
c. 5 mmol/l
d. 4.5 mmol/l
e. 4 mmol/l

7. Patient with coronary heart disease and xanthoma along the Achilles tendons. Which of the following is THE MOST LIKELY diagnosis:
a. Familial hypercholesterolaemia
b. Familial combined hyperlipidaemia
c. Remnant removal disease
d. Hypolipoproteinaemia

8. Which of the following examination supports the diagnosis of pulmonary thromboembolism:
a. Chest PA X-rays
b. Pulmonary Doppler
c. Blood gas
d. Pulmonary ventilation perfusion mismatched on pulmonary scan
e. Lung function measurement

Contagious diseases

9. Which of the following is the MOST COMMON characteristic of pleura effusion of TB:
a. Glucose decreased or absent
b. Monocyte
c. Blood stained
d. Protein <2g
e. Find TB bacillus

10. Which following group is the MOST at RISK OF HIV infection:
a. Heterosexual
b. Homosexual
c. Intravenous drug user
d. Blood transfusion
e. Haemophilias

11. Which of the following group is LEAST LIKE of infection of HIV:
a. Heterosexual
b. Blood Transfusion
c. Homosexual
d. Haemodialysis
e. Haemophiliacs

13. A farmer has suddenly had undulant fever for 2-3 days with abruptly headache severe myalgia, jaundice and petechial rash on the skin; liver and spleen enlargement. Which of the following is the diagnosis:
a. Brucellosis
b. Yellow fever
c. Leptospirosis
d. Malaria
e. Anthrax

14. Dengue fever, all followings are correct EXCEPT:
a. Arbovirus
b. Mosquito transmission
c. Children get least severe illness
d. There is no specific treatment
e. Air droplet infection


15. A patient with mycobacteria infection which of the following is most appropriate treatment
a. cotrimoxazole
b. tetracycline
c. Amoxycilline
d. Metronidazole
e. Erithromycin


16. What is compatible with critical illness:
a. Increased cortisol , increased TSH
b. Both cortisol and TSH decreased
c. Increased cortisol, decreased TSH
d. Decreased cortisol, increased TSH
e. Normal cortisol, increased TSH



17. A 65 year old man has ‘bulk” diarrhoea with “oil”. He drinks alcohol for many years . Which of the following is your investigation
a IV pancreagraph
b Endoscopy pancreagraph
c. Abdominal X-ray
d Ultrasound
e Enema

18.For an elderly man, which above following blood sugar level need further investigation
a. 5 mmol/l
b. 5.5 mmol/l
c. 6 mmol/l
d. 6.5 mmol/l
e. 7 mmol/l

19.Side effective of corticosteroids including all the following EXCEPT
a Lymphocytosis
b. Lymphopenia
c. Hirsutism
d. Osteoporosis
e. Weight gain

20. A patient has headache, prominent supraorbital ridge prognathism teeth spacing increased,thick spade-like hands and seborrhoea and coarse oily skin. Which of the following is BEST investigation to establish diagnosis:
a. Insulin-glucose
b. X-ray of pituitary test
c. Cranial CT scan or MRI scan
d. SERUM T4+PRL+growth hormone level
e. Oral glucose tolerance test (OGTT)

21.Which following patient is LEAST LIKELY to suffer primary hypothyroidism:
a. 65 year old female with goitre
b. 35 year old female with depression
c. 28 year old female with 3 years menorrhagia
d. 18 year old boy with relative less age
e. 32 year female with anaemia unresponsive to iron, B 12and folate

22 Patient has a single lump on one side of the thyroid, all following situation s suggest malignant EXCEPT
a. Single nodule
b. US showed a solid nodule
c. Thyroid scan show “HOT’ lump
e. Associated with increased serum thyroglobulin
f. Associated with hoarseness

1. A patient with acute myocardial infarction used heparin; which of the following methods is used for monitoring:
a. BT
b. PT
c. ARTT
d. INR
e. Fibrinogen

C) APTT


2. A patient has a mitral valve stenosis – all of the following signs are correct EXCEPT:
a. AF
b. S 1 increased
c. Palpitation increased S 2 in apex
d. S 3
e. Presystolic murmur


D) S3

3. In a patient with myocardial infarction was found a new systolic murmur on examination. Cardiac ejection fraction was 55%. Which of the following is MOST probable cause:
a. Aortic regurgitation
b. Papillary muscle dysfunction
c. Mitral valve stenosis
d. Papillary muscle rupture
e. Tricuspid valve regurgitation

D) PMR

4. A young woman has hypertension with fibrosing stenosis of renal artery (60%) which of the following is the MOST appropriate treatment:
a. Renal artery angioplasty
b. ACE Inhibitors
c. Antihypertensives
d. Diuretics
e. Arteries dilation drugs

a) Renal art angio
as per emedicine

[Only Registered Users Can See Links]

5. An obese patient with diabetes mellitus is under anti-hypertension treatment. His blood pressure is 160/100mmBg on examination. Which of the following is your INITIAL consideration for this patient:
a. Decreased protein in his diet
b. Concurrent hypertensive therapy
c. Give diuretics
d. Control sugar intake in the diet
e. Ideal weight

cuz of the word initial i went through the answers more than one time
he is diabetic ,obese with uncontrolled htn ,after that reading of his blood pressure i think the correct answer would be b) but u never know ,i need input of the other members plz in that quest

6. At which level of cholesteral you consider to give lipid-lowering statins (eg, simvastatin, pravastatin)
a. 6 mmol/l
b. 5.5 mmol/l
c. 5 mmol/l
d. 4.5 mmol/l
e. 4 mmol/l

b)5.5
despite that the new aussie guidlines have more details that that but i would still choose 5.5


7. Patient with coronary heart disease and xanthoma along the Achilles tendons. Which of the following is THE MOST LIKELY diagnosis:
a. Familial hypercholesterolaemia
b. Familial combined hyperlipidaemia
c. Remnant removal disease
d. Hypolipoproteinaemia

its commonly associated with hyperlipidaemia type 2 not sure which one of those but i would choose b) need some help in that one


8. Which of the following examination supports the diagnosis of pulmonary thromboembolism:
a. Chest PA X-rays
b. Pulmonary Doppler
c. Blood gas
d. Pulmonary ventilation perfusion mismatched on pulmonary scan
e. Lung function measurement

D) V/Q

9. Which of the following is the MOST COMMON characteristic of pleura effusion of TB:
a. Glucose decreased or absent
b. Monocyte
c. Blood stained
d. Protein <2g
e. Find TB bacillus

nothing is most characteristis really but finding a TB bacillus is very exclusive i think

[Only Registered Users Can See Links]


10. Which following group is the MOST at RISK OF HIV infection:
a. Heterosexual
b. Homosexual
c. Intravenous drug user
d. Blood transfusion
e. Haemophilias

b) homosexuals
as per merck
The sexual practices with the highest risks are those that produce mucosal trauma, typically intercourse. Anal-receptive intercourse poses the highest risk

11. Which of the following group is LEAST LIKE of infection of HIV:
a. Heterosexual
b. Blood Transfusion
c. Homosexual
d. Haemodialysis
e. Haemophiliacs

b. Blood Transfusion


13. A farmer has suddenly had undulant fever for 2-3 days with abruptly headache severe myalgia, jaundice and petechial rash on the skin; liver and spleen enlargement. Which of the following is the diagnosis:
a. Brucellosis
b. Yellow fever
c. Leptospirosis
d. Malaria
e. Anthrax

a)brucellosis

i had to dig hard for that answer
check
[Only Registered Users Can See Links]

14. Dengue fever, all followings are correct EXCEPT:
a. Arbovirus
b. Mosquito transmission
c. Children get least severe illness
d. There is no specific treatment
e. Air droplet infection

i think it was mosquito bites not droblets so e) is my answer


15. A patient with mycobacteria infection which of the following is most appropriate treatment
a. cotrimoxazole
b. tetracycline
c. Amoxycilline
d. Metronidazole
e. Erithromycin

e) Erithromycin

A patient with acute myocardial infarction used heparin; which of the following methods is used for monitoring:
a. BT
b. PT
c. ARTT ////////////////////
d. INR
e. Fibrinogen

2. A patient has a mitral valve stenosis – all of the following signs are correct EXCEPT:
a. AF
b. S 1 increased
c. Palpitation increased S 2 in apex
d. S 3 ////////////////////
e. Presystolic murmur

3. In a patient with myocardial infarction was found a new systolic murmur on examination. Cardiac ejection fraction was 55%. Which of the following is MOST probable cause:
a. Aortic regurgitation
b. Papillary muscle dysfunction
c. Mitral valve stenosis
d. Papillary muscle rupture ////////////////
e. Tricuspid valve regurgitation

4. A young woman has hypertension with fibrosing stenosis of renal artery (60%) which of the following is the MOST appropriate treatment:
a. Renal artery angioplasty /////////////////
b. ACE Inhibitors
c. Antihypertensives
d. Diuretics
e. Arteries dilation drugs

5. An obese patient with diabetes mellitus is under anti-hypertension treatment. His blood pressure is 160/100mmBg on examination. Which of the following is your INITIAL consideration for this patient:
a. Decreased protein in his diet //////////////
b. Concurrent hypertensive therapy
c. Give diuretics
d. Control sugar intake in the diet
e. Ideal weight

6. At which level of cholesteral you consider to give lipid-lowering statins (eg, simvastatin, pravastatin)
a. 6 mmol/l
b. 5.5 mmol/l /////////////
c. 5 mmol/l
d. 4.5 mmol/l
e. 4 mmol/l

7. Patient with coronary heart disease and xanthoma along the Achilles tendons. Which of the following is THE MOST LIKELY diagnosis:
a. Familial hypercholesterolaemia ///////////////
b. Familial combined hyperlipidaemia
c. Remnant removal disease
d. Hypolipoproteinaemia

8. Which of the following examination supports the diagnosis of pulmonary thromboembolism:
a. Chest PA X-rays
b. Pulmonary Doppler
c. Blood gas
d. Pulmonary ventilation perfusion mismatched on pulmonary scan ///////////////
e. Lung function measurement

Contagious diseases

9. Which of the following is the MOST COMMON characteristic of pleura effusion of TB:
a. Glucose decreased or absent
b. Monocyte ( lymphoctosis)/////////////
c. Blood stained
d. Protein <2g
e. Find TB bacillus

10. Which following group is the MOST at RISK OF HIV infection:
a. Heterosexual
b. Homosexual ////////////( 1:50-150)
c. Intravenous drug user
d. Blood transfusion
e. Haemophilias

11. Which of the following group is LEAST LIKE of infection of HIV:
a. Heterosexual
b. Blood Transfusion /////////////////////
c. Homosexual
d. Haemodialysis
e. Haemophiliacs

13. A farmer has suddenly had undulant fever for 2-3 days with abruptly headache severe myalgia, jaundice and petechial rash on the skin; liver and spleen enlargement. Which of the following is the diagnosis:
a. Brucellosis
b. Yellow fever
c. Leptospirosis ////////( this scenario mixes both brucellosis and leptosiprasis, because undulant fever and splenomeagaly is in brucellosis , but no jaundice and rash is there)
d. Malaria
e. Anthrax

14. Dengue fever, all followings are correct EXCEPT:
a. Arbovirus
b. Mosquito transmission
c. Children get least severe illness
d. There is no specific treatment
e. Air droplet infection ///////////////


15. A patient with mycobacteria infection which of the following is most appropriate treatment
a. cotrimoxazole
b. tetracycline
c. Amoxycilline
d. Metronidazole
e. Erithromycin //////////////////////


16. What is compatible with critical illness:
a. Increased cortisol , increased TSH
b. Both cortisol and TSH decreased
c. Increased cortisol, decreased TSH
d. Decreased cortisol, increased TSH ///////////
e. Normal cortisol, increased TSH



17. A 65 year old man has ‘bulk” diarrhoea with “oil”. He drinks alcohol for many years . Which of the following is your investigation
a IV pancreagraph
b Endoscopy pancreagraph
c. Abdominal X-ray
d Ultrasound
e Enema ( ans should be feacal fat for malabsorbption)**************

18.For an elderly man, which above following blood sugar level need further investigation
a. 5 mmol/l
b. 5.5 mmol/l ///////////////////////
c. 6 mmol/l
d. 6.5 mmol/l
e. 7 mmol/l

19.Side effective of corticosteroids including all the following EXCEPT
a Lymphocytosis //////////////////////
b. Lymphopenia
c. Hirsutism
d. Osteoporosis
e. Weight gain

20. A patient has headache, prominent supraorbital ridge prognathism teeth spacing increased,thick spade-like hands and seborrhoea and coarse oily skin. Which of the following is BEST investigation to establish diagnosis:
a. Insulin-glucose
b. X-ray of pituitary test
c. Cranial CT scan or MRI scan
d. SERUM T4+PRL+growth hormone level
e. Oral glucose tolerance test (OGTT) (GH+OGTT)///////////////

21.Which following patient is LEAST LIKELY to suffer primary hypothyroidism:
a. 65 year old female with goitre//////////
b. 35 year old female with depression
c. 28 year old female with 3 years menorrhagia
d. 18 year old boy with relative less age
e. 32 year female with anaemia unresponsive to iron, B 12and folate

22 Patient has a single lump on one side of the thyroid, all following situation s suggest malignant EXCEPT
a. Single nodule
b. US showed a solid nodule
c. Thyroid scan show “HOT’ lump //////////////////
e. Associated with increased serum thyroglobulin
f. Associated with hoarseness

Thanks guys..I ve got just 2 diff.

17. A 65 year old man has ‘bulk” diarrhoea with “oil”. He drinks alcohol for many years . Which of the following is your investigation
a IV pancreagraph
b Endoscopy pancreagraph
c. Abdominal X-ray *****
d Ultrasound
e Enema

Its most likley Ch.Pancreatits...So x-ray for any calcification ..Not definitive dx..
If pancratic enzyme was there would be the answer.

18.For an elderly man, which above following blood sugar level need further investigation
a. 5 mmol/l
b. 5.5 mmol/l
c. 6 mmol/l
d. 6.5 mmol/l
e. 7 mmol/l

indication of GTT

More thoughts welcomed

23. Uveitis is MOST COMMONLY found in which of th e following diseases:
a. Reiter’s disease
b. Rheumatoid arthritis
c. Ankylosing spondylitis
d. Sjogren’s syndrome
e. Psorisis


25. Eradication of HELICOBACTER PYLORI for duodenal ulcer:
a. Increase ulcer healing rate
b. Influence relapse rate
c. Decrease rate of gastric lymphoma
d. Decrease local gastritis
e. Decrease cimetidine dosage

26 A young patient comes from overseas with diarrhoea, no blood. Temperature 37.9C, stool examination showed few Salmonellas. What is your management:
a. Observation and repeat stool examination 3 days later
b. Broad spectrum antibiotic like amoxicillin
c. Trimethoprine plus sulphasalazine
d. Cotrimoxazole plus trimethoprim
e. Reassure

27. Which of the following is MOST RELATED to adenoma/carcinoma of the colon:
a. Aspirin can caused
b. Low fibre diet
c. Saturated fat more than the unsaturated fat in the diet
d. Alcohol
f. Smoking


28. A 28-year-old policeman on sulphasalazin therapy for ulcerative colitis, Right hypochondrial pain. SGPT and alk, phosphatase increased, bilirubin mild increased, SGOT normal and liver aminotransferase enzymes normal (?) which of the following is THE MOST LIKELY diagnosis:
a. Primary biliary cirrhosis
b. Side effect of sulphasalazin
c. Sclerosing cholangitis
d. Cholangitis
e. Acute viral hepatitis

29. Patient with supposed hepatoma. Which of the following questions is MOST helpful for diagnosis:
a. Present liver cirrhosis
b. Alcohol liver disease
c. Acute hepatitis
d. Cholangitis
e. Family history of liver hepatoma

30. Ascitis
a. _______
b. Bilateral abdominal varicosis
c. Peri-oral teleangiectasia
d. Jaundice and palmar erythema
e. Dupytren’s contracture

HAEMATOLOGICAL DISEASE

31. In anaemia patent with increased transferrin. All of the following is correct EXCEPT:
a. Increased serum ferritin
b. Decreased serum ferritin
c. Increased total iron binding capacity
d. Increased transferrin
e. Decreased serum iron

32. An anaemic patient with increased transferrin. All following are correct EXCEPT:
a. Thalassemia major
b. Chronic disease
c. Iron deficiency
d. Sideroblastic anaemia
e. Haemolysis


Good Luck

23. Uveitis is MOST COMMONLY found in which of th e following diseases:
a. Reiter’s disease
b. Rheumatoid arthritis
c. Ankylosing spondylitis
d. Sjogren’s syndrome
e. Psorisis


25. Eradication of HELICOBACTER PYLORI for duodenal ulcer:
a. Increase ulcer healing rate
b. Influence relapse rate
c. Decrease rate of gastric lymphoma
d. Decrease local gastritis
e. Decrease cimetidine dosage

26 A young patient comes from overseas with diarrhoea, no blood. Temperature 37.9C, stool examination showed few Salmonellas. What is your management:
a. Observation and repeat stool examination 3 days later
b. Broad spectrum antibiotic like amoxicillin
c. Trimethoprine plus sulphasalazine
d. Cotrimoxazole plus trimethoprim
e. Reassure

Travel Diarrhae

27. Which of the following is MOST RELATED to adenoma/carcinoma of the colon:
a. Aspirin can caused
b. Low fibre diet
c. Saturated fat more than the unsaturated fat in the diet
d. Alcohol
f. Smoking


28. A 28-year-old policeman on sulphasalazin therapy for ulcerative colitis, Right hypochondrial pain. SGPT and alk, phosphatase increased, bilirubin mild increased, SGOT normal and liver aminotransferase enzymes normal (?) which of the following is THE MOST LIKELY diagnosis:

a. Primary biliary cirrhosis
b. Side effect of sulphasalazin
c. Sclerosing cholangitis
d. Cholangitis
e. Acute viral hepatitis

29. Patient with supposed hepatoma. Which of the following questions is MOST helpful for diagnosis:

a. Present liver cirrhosis
b. Alcohol liver disease
c. Acute hepatitis
d. Cholangitis
e. Family history of liver hepatoma

Not Sure

30. Ascitis
a. _______
b. Bilateral abdominal varicosis ??/
c. Peri-oral teleangiectasia
d. Jaundice and palmar erythema
e. Dupytren’s contracture

I Dont know!!! I guess all associated with liver disease

HAEMATOLOGICAL DISEASE

31. In anaemia patent with increased transferrin. All of the following is correct EXCEPT:
a. Increased serum ferritin
b. Decreased serum ferritin
c. Increased total iron binding capacity
d. Increased transferrin
e. Decreased serum iron

32. An anaemic patient with increased transferrin. All following are correct EXCEPT:
a. Thalassemia major
b. Chronic disease
c. Iron deficiency
d. Sideroblastic anaemia
e. Haemolysis

[walid51]

1.A mother of 9 came to your practice c/o frequent headache for one year. It was Migraine

2.A mother of10 wks old child came to your practice c/o crying continuously specially at evening for most of the days since birth. Your colleague has seen the child last week but could not find anything but the mother was not satisfied with him so she came back to see you not your colleague for her child. It was infantile colic.

3.A mother of 8 months of child came to see you because her son is not sitting and when trying to sit he always lay down. All other developmental milestones were normal. on exam increased reflexes and tone in all limbs. It was cerebral palsy.

4.25 year old lady came to your practice for 18 months amenorrhoea and high prolactin level. Manage the case.

5. 23 years old lady came to you for advice about depot provera and she is on ocp but she forgets to take pills and has breakthrough bleeding. Tell her about depot and other hormonal methods and talk to her.She was planning to get pregnant within a year. So after explaining all hormonal methods I told her that these are for long term and would not suitable for her and advice her for temporary methods like condom or continue pill but with high oestrogen pill.

6. A 36 weaks pregant lady came to you because she gained 2 kg in 2 days. On history and examination everything was normal and normal urine. She has only oedema in both legs. I don,t know what it was.

7.A 20 year old man came to you c/o SOB. He had a MVA 1 month back with ribs #. It was PTSD.

8.A 45 year old lady came to you for some paper about housing. She has c/o her neighbour and she was divorced and thinks that her husband has said her neighbour to through rubbish to her house and she needs to clean those again and again and had dermatitis of hand. Do mental state examination and give your d/d.

9.Explain a CT scan report to patient and furher management. It was hepatic metastasis.

10. A 45 year old lady came to you for aches and pains for more than a month. She has travelled overseas but she has this complaint before travelling and she has been taking doxycycline for malaria prophylaxis. She lost 2 killos and has night sweats and cough with sputum. On exam no lymph node but dull on percussion and crackles and spleen palpable. Diagnosis and Management.

11.A 25 year old man c/o joints pain with a picture showing maculopapular rash. He travelled qld recently. Diagnosis and management.

12.A 26 year man had a MVA but now in stable condition in ED. Do head and cranial nerve examinations and explain your finding to examiner.

13. A lady with a mobile nontender (5 cm) breast has done an usg, explain usg findings and further management.

14.A 40 year old man with BMI 30, father had CABG operation recently and mother has high BP. Discuss the cholesterol report(High) and manage him.

15.A 25 year old man with diarrhoea for one year . Take history and ask p/e and order necessary investigations. It was IBD.

16.A 48 year old man came to you last week for bloating you ordered an USG which shows gall stones. Explain the pt about usg and manage the patient . Only referral would not sufficient you have to tell what specialist will do.




retest
retest sydney 12th march
1.lower limb cellulitis
2.58 y old dvt on HRT
3.35 Y Old lady requesting tubal ligation
4.1 day old child with signs of intestinal obstruction
5.testicular CA councelling
6.prostate CA with bone mets councel
7.27 y old man with a headache-meningitis
8.24y old nurse with post traumatic stress d

[walid51]

clinical examination perth
perth clinical exam
1.SOB
2.Myopia
3.Constipation
4.MI
5.Anaemia and pregnancy
6.Child abuse



1. Child abuse v vulvovaginitis (4 yo girl BIB mother separated with husband, started to live with boyfriend 3 months ago. Girl has symptoms for 1 m)
2. Renal coic - do abdo exam, Mx
3. Consell anxious mother of 18 yo acutely psychotic male (2 to drugs). Confidentiality issues.
4. Postmenopausal vaginal bleeding in female. Lasted 1 day. Candidiasis. Rule our DM, cancer
5. AMI
6. Autologous blood transfusion councelling (lady have elective surgery in 6 weeks, wants your advice)
7. Iron deficiency in 30 weeks pregnant vegetarian. Mx, Q re blood transfusion
8. Hip osteoartritis
9. Father worries about 2,5 yo son. Dietary advice, normal growth and development
10.Anorexia
11. SOB in smoker for 2 month. Rule out cancer (mesetelioma) and pneumonia with plreural effusion
12. Laxative abuse in 60 yo lady. All normal (bloods and colonoscopy)
13. Visual exam - myopia



1) A man came with chest pain. Take history, examination findings and management
Management of MI, cardiac arrest, indication of thrombolysis, contraindiations, ALS
2) A father complaining of loss of apetite and growth retardation in his 3 years old son.
Child growth, use of normograms and importance of balanced diet
3) A 60 yrs old man complaining of long standing backache and new onset hip pain.
Osteoarthritis and rule out PVD and Ca Prostate
4) FBC results-- microcytic and hypochromic RBCs in a 30 week pregnant vegetarian lady.
Counselling of Iron deficiency anemia. Its impacts on mother and fetal health. Treatment
5) A 17 yrs old boy complaining of vision problem. Rule out serious eye condition.
Examine eye and visual acuity. Counsel about myopia.
6) A girl of 17 yrs brought by her mother who is concerned about her weight.
Diagnosis of anorexia nervosa. Urgent management. Refer to hospital. patient refused to go to hosp. Use mental health act.
7) 18 yrs old male complaining of swollen rt arm for 1 week. Basketball player.
Axillary/subclavian vein thrombosis. referal to hospital and start heparin prophylactically without waiting for the transfer.
3 yrs boy. Cousin had lymphoma. Mother noticed swelling in neck. Counselling.
Lymph nodal swelling. usually benign. Rarely can be due to cancer. Basic blood tests and follow up after 1 week and reassurance.
9) Female sterilization counselling
10) Counselling for autologus blood transfusion
11) A 65 yrs old lady, smoker having long standing cough. Present with SOB for 2 months. History, examination and management.
Rt pleural effusion. causes and management
12) A 60 yrs old lady complaining of constipation. All investigations normal including upper and lower GI endoscopy. Differential Diagnoses and management. IBS, low roughage in diet, hypothyroidism, and hyper calcemia etc
13) Suspected Sex abuse in a girl. Management
14) Psychotic man. Has used cannabis. Requested you not to tell family of his drug addiction. Confidentiality. Don't tell the mother. Just say I don't know when she asks.
15) Lt sided abdo pain. D/D and emergency ward management.
16) Vaginal Candidiasis in an elderly. Must rule out Diabetes mellitus.



The written component has two segments:

* The applied knowledge test (AKT) consists of 150 multiple choice questions that must be completed in 4 hours.
* The key feature problems (KFP) test consists of 26 cases that must be completed in 3.5 hours. The cases contain a mix of completion items and items requiring written response.
* The clinical component consists of 14 clinical cases, with a number of rest stations interspersed into the rotation. It takes approximately 4 hours to complete

Examination centres for the written component have been arranged in Adelaide, Brisbane , Bundaberg, Canberra, Darwin, Dubbo, Hobart, Melbourne, Newcastle, Perth, Sydney and Townsville.

Candidates who live in rural and remote areas may apply to sit the written component under supervision in the rural or remote areas – conditions exist for these arrangements and these are outlined in Section 7 of the handbook.

Examination centres for the clinical component have been arranged in Adelaide, Brisbane, Canberra , Darwin*, Launceston, Melbourne, Perth, Sydney and Townsville.

* Darwin’s operation as a clinical examination venue is conditional upon sufficient enrolments.



Perth exam Sept
Some recall for you guys:
1.Physical exam for Tia as previous
2.Xray pleural effusion with needed questions linking previous abdominal surgery as a cause.
3.Hydrocele as previous exams
4.Jaundice in a young man.
5.Child with AGE and full history with mother not giving vaccination.
6.Adenomyosis
7.Asherman syndrome
8.Low mood in a female
9.HIV pretest counselling
10.Management of snake bite
11.Weight loss
12.Chronic asthma in child
13.Migraine
14.Diabetes in adolescent
15.Memory loss in alcoholic

[walid51]

clinical exam melbourne october10,2010
the exam is not easy,some examiners are helpful,give you hints and some are not.

i'll post the questions here today

1.67 year old man,3days post op,delirium,temp-38.3,alcohol liver enzymes raised(long stem),tell your registrar the findings and what further would you do?

2.you had excised a lesion on the rt temple of a farmer-turned out SCC, on histology extending to the margins,discuss the results with the patient and answer his questions.


3.20 something year old nullipara,previous h/o DVT 2 years ago,pre pregnanacy counselling

4.37 year old female c/o vaginal discharge,take history,ask examiner the findings and discuss with the patient the management.

5.20 something lady with 1 year amenorrhoea,history and discuss d/d with patient and management

6.man with swelling of joints of hands,examine the hands

7.20 year old man with pain rt groin for a few days,brief history,examine(genital area normal),discuss wth the patient.

8.father of 3 year old with jar of urine having blood,history,findings from examiner and discuss with parent

9.mum here to discuss the results of bloods done by your collegue a few days ago,18 month old child,results conistent with iron deficiency

10.man with binge drinking here with son 10 year old who hd sprained his ankle .you had discussed re binge drinking last tme with him and had asked him to follow up in 2 weeks which he didnot do.discuss today with him.

11.37 year old female,sudden shortness of breath while in a conference 2 days ago,now sob when walks uphill,histroy for 5 mins,exam fidings from eaminer and diagnosis

12.60 year old man with h/o weakness of rt arm and leg x 1 day,improved,history,examination findings,discuss d/d and further management.

13.mum here saying her 6 year old son not using his rt knee and c/o pain in the knee,history,findings from examiner,discuss with mum the d/d

14.35 year old schizophrenic x 15 years,recently changed medication,now c/o weight gain,counsel the patient.

15.40 year old lady had uri,took antibiotics,went to malasiya for 3 weeks,was on doxy for malarial prophylaxisis,now c/o generalised weakness x 1 week,lethargy.take history,findings from examiner and discuss d/d

16.Patient on ocp's for 2 years,BP been high on 3 occasions,discuss with the patient

[walid51]

AMC clinical adelaide march 21 2009
hi guys and gals i appeared in the Adelaide exam and passed it. This exam was a mix of cases , some easy and some difficult but as usual all the clinical scenarios has direct bearing with Murtagh. so read murtagh well along with your AMC clinical handbook.

the clinicAL scenarios are as follows:
case 1: a 6 months old child recently came from overseas trip has low haemoglobin and 6 weeks history of diarrhoea. take history , ask for examination findings and counsel mother.

buddies whenever dealing with a paediatric case always remember three things to ask : immunization, growth chart and diet history.

the child had anemia with falling off the weight for age.
fully immunized. very fussy in eating. diarrhoea started 6 weeks ago and is continuing. stools semiformed in nature with no blood. stools not bulky.
no history of any recurrent infection, genetic disorder in the family.

examination findings : pallor ++, no organomegaly, protuberant abdomen with muscle wasting. no findings in urine.

choice of investigation: CBE, sweat chloride test, Hb electrophoresis to rule out thal., stool microscopy and culture to rule out any parasitic infection.

Differential diagnosis:
1. dietary anemia secondary to poor oral iron intake.
2. protein energy malnutrition( unlikely)
3. parasitic infestation (recent oversease trip to tropics).
4. cystic fibrosis
5 malabsorption syndrome ( unlikely as it doesnt give anemia).

guys i will post details of all the cases over time as i gotta work now. i have a off on monday so will post more details.
anyways i am posting all the cases which came.

case 2 : examination of a swelling on the face , just anterior to right ear , dermoid.
case 3: 23 year old girl with RIF pain, beta HCG positive, simple cyst 5.5cm on right ovary.
case 4: postnatal depression (typical from AMC book).
case 5: 6 weeks old child with 1 day history of diarrhoea, counsel father.
case 6: 24 year old female, LMP 20 weeks back, uterine size 30cm, was on overseas trip, no investigations done. counsel and manage.
case 7: caeliac disease.
case 8: bitemporal hemianopia, eye examination.
case 9: anorexia nervosa
case 10: 59 year old man with prostatism , undergoing TURP, counsel.
case11: 6 year old child with limping , perthe's disease vs transient synovitis of hip.
case12: pneumothorax (typical from AMC book).
case13: 60 year old lady with lethargy, history and examination findings, investigate ( wait till monday as this one was tricky and it was not hypothyroidism).
case14: 60 year old recently diagnosed with rheumatic arthritis , violin player, counsel.
case 15: 22year man, fell off from motor bike, 15 mins unconcious, perform primary survery and counsel the patient and organize relevant investigation.
case 16: 62 year old lady, profuse vaginal discharge , brownish yellow( case of atrophic vaginitis but rule out malignancy by hysteroscopy).




case scenerio 2
case 2 discussion:
6 month old baby, presented to ED after having diarrhoea. take relevant history , ask for examination finding and counsel the mother.

This case was not as straight forward as it looks like and as i had mentioned before that whenever there is a paediatric ase always take proper history.

the history is that 6 month old baby has been having diarrhoea for past 2 days, listless, fussy, crying and difficult to handle. feeding fine.60th percentile for weight and length.
diarrhoea profuse , 8 to 10 motions. no blood.
2 siblings had mild diarrhoea 3 days back but self limiting.
baby is fussy but drinking fine and not lethargic.
BUT THERE IS A DECREASE IN NUMBER OF NAPPIES CHANGED SINCE YESTERDAY.

when asked for immunization BABY IS NOT IMMUNIZED AS SOMEONE TOLD THE MOTHER THAT HOMEOPATHIC VACCINES ARE AS POTENT AS NORMAL VACCINE.

EXAMINATION FINDINGS:
FUSSY BABY.
VITALS NORMAL.
SKIN TURGOR NORMAL, FONTENELLE NOT DEPRESSED AND EYES NOT SUNKEN.
MUCOUS MEMBRANES DRY.
REST OF THE GENERAL PHYSICAL EXAMINATION UNREMARKABLE.

URINE DIPSTICK: KETONE POSITIVE

in this case i counselled the mother that baby has to have immunization and i will refer the case to immunization nurse.
also baby is mildly dehydrated secondary to rota virus infection and can be managed at home but since there is suspected decrease in urine output as well as urine ketone positive so i will not be very comfortable at sending him home at this moment but will monitor his urine output along with hospital based rehydration and if everything is normal he can be sent home.
also, there is no danger to baby's life if water, salts are replaced appropriately as virus wont pose a danger to his life but dehydration will.

then when i asked her do u have any more questions : she asked " would immunization could have prevented this episode?"
i said no but immunization is important as it prevents other more life threatening diseases.




case scenerio 3
case 3: 23 year old female , 20 weeks pregnant, has been overseas with no investigations done in the past. the current uterine size is 30cm, rest of the general physical examination normal. talk to mother and manage.

well guys the basic mistake which we all do in this case is that we assume that its polyhydroamnios and formulate a plan according to that and thus we are given a unsatisfactory mary, which doesnt mean a fail, but increase the chances of fail if we commit further mistakes.

now whenever dealing with a aussie pregnant female always remember following things:
always ask blood group.
always ask about immunization.
always ask weather the pregnancy was planned or unplanned.
always ask weather she had any antenatal checkup and if not then organize blood group, CBE, rubella antibodies level, VDRL, gonorrhoea serology, HIV and if Rh negative then get a coomb's indirect and urine microscopy and culture.
always ask about previous pregnancies and outcomes.

now this female is 20 weeks pregnant, not been investigated and has a uterine size of 30cm, thus she is large for gestational age and not polyhydroamnios.

i told the mother that your uterine size is greater than expected for this gestational age and most common case for this is wrong dates. ( with this statement the examiner was overtly happy as if became so emotional that she was about to kiss me and say bless you my child "bravo" haha).

now i told that but we have to rule out more sinister causes which can give you the increased uterine size :
polyhydroamnios secondary to neural tube defects, GI abnormalities, infection.
Blood group mismatch giving hydrops fetalis ( unlikely as mother is O positive and its her first pregnancy)
twin pregnancy
diabetes
uterine fibroids

first thing is that since you havent had any investigations done i would like to do all the antenatal investigations .
secondly i need to organize a ultrasound to rule out twins, hydrops, fibroids.
will do a glucose challange test to check for deranged BSL.

will review in few days time , as soon as the blood results and ultrasound are back and if required refer you to obstetrician.

[walid51]

Sydney Nov 7 2009 Clinical Recall - Detailed recall
This one is a detailed recall of my test, I promised to post it earlier but did not get to recall the whole lot. Now that I have done it here it is. Hope you find it useful.

AMC CLINICAL – NOV 7, 2009 SYDNEY


1.8 Week old child complain of crying
Task – Take detailed history for 6 minutes
Advise mother about management
Young mother first born. Complaining that child is crying a lot. More during the night. Feeding alright. Some amount of vomitting after feeds. No fevers. Growth and development satisfactory. No
concerns during pregnancy and post pregnancy till birth.
I asked all the history related to the baby.
Physical examnination: all normal. No abnormalities. No signs of injuries.
I had almost exhausted all my history. The role player was a young girl however she did not give me any hits. The examiner was also just a passive spectator.
Suddenly I realised that I had forgotten to ask about the mother. I asked her – how she was coping. She said she was doing alright. However she feels that the baby is not feeding well.So she is feeding the baby several times of the day. She even got up and fed the baby. She had no signs of depression.
I wanted to ask more. However ran out of time.
Other history – supportive family, no depression, no h/o mental illness, no suicidal ideation.

I failed this case. I should have explored the mother's angle as well.
People who treated this case as Post natal depression/blues/maladjustment failed either.

Mother was coping well. However being the first born mother was overtly anxious.

AMC – Irritable baby – History (Paediatrics)

Essentially normal baby with maternal anxiety.
Essentially a paediatric case but have to r/o psychiatric aspect too.

From other candidates who passed -
Key issues are her husband just left her after birth, and her breastmilk not enough.
Solutions are: if not support (only her mother), social worker support, and community nurse coming home to teach techniques of breastfeeding.
Show your empathy and supportive attitude, baby is fine, nothing wrong



2.24 Year old female complains of vaginal bleeding. 8 weeks amenorrhoea.
Task – take history, Physical examination, investigation, management.
Same case as in recalls.
8 weeks amenorrhoea. Bleeding post amenorrhoea. Small amount. Asked if any clots, patient was not sure. Symptoms of pregnancy positive. Not trying to get pregnant. Not on OCPs or contraception either. No pain or cramping sensation. No sex or trauma involved. No signs of haemodynamic compromise. Blood group A +ve.
Periods normally irregular once in 2 months or more. No breast tenderness or other signs of pregnancy – morning sickness etc.
Urine Beta HCG positive. 10,000 units or something like that. Can't remember.
Physical examination: When I asked how the patient was – haemodynamic compromise: examiner said the patient is the way she is sitting in front of you.
P/A: soft non tender.
P/V no active bleeding. Cervix closed. I forgot to ask about adnexal tenderness. (might have been tender in the right).
Other examination unremarkable. No breast tenderness.
I said the urine Beta HCG is positive. So it means that she could be pregnant. I will do some blood tests – Serum Beta HCG and arrange for an ultra sound. If the ultrasound confirms pregnancy then it is pregnancy and she will be treated as pregnancy. I she is pregnant then we will have to do all other tests that are done as a part of the antenatal work up.
The role player asked me about ultrasound. What will I be looking for in ultrasound. I said it will be
abdominal and transvaginal. Was not sure what she wanted.
For some other candidates – the examiner gave Ultrasound finding saying a cyst in ovary.
Anyway, I said it could be threatened haemorrhage but we will have to wait for the investigations.
However I failed this case.
I think I did not rule out and say ectopic pregnancy as one of the causes PV bleed which is important.
AMC Diagnosis – PV bleed.

3. 50 year old man with red painful leg. Picture provided.
Task- take history, explain your management to the patient.
50 year old man. Developed red patch on the right leg and he feels it is hot. No history of wound, injury or trauma. Not a diabetic, but has not had a blood test in a while. Feels feverish. This started 3 days ago. No complaint of any bleeding, discharge or itching from the spot. No swelling, numbness or pain in the calves. No history of DVT. No similar complains in the past. There is family history of diabetes. No other complains.
On examination – a picture was provided with a red patch on the right leg on the anterior and medial aspects. The margins were clear. It was clearly a case of cellutitis.
The examiner told that there is local rise in temperature. Rest of the findings as in the picture.
No calf tenderness. Pulses palpable.
He told me to the condition and management to the patient.
I said that it is most likely to be cellulitis. However we have to rule out DVT. He would benefit from hospital admission for investigation and IV antibiotics. It is most likely to be caused by Staphylococcus. I asked him if he was allergic to anything. He said no. I said I will take bloods – FBC, CRP, ESR, Blood culture and also do Blood sugar, lipids and EUC. To rule out diabetes and since he had not had a check up. USG to r/o DVT. Also would start him on IV Flucloxacillin. He would need it for a 3-4 days and depending upon the inflammatory markers and clinical condition he can be shifted to oral antibiotics to complete the course of a minimum of 2 weeks.
He was doubtful about getting admitted. But I said that it would be better for him to get admitted for IV antibiotics. I asked him if he had any family. He said he lived alone. I told him that he would benefit from at least 1-2 days of hospital stay. If he wants after the investigations are complete we can send him home on IV antibiotics under community nursing. But it would be ideal for him to get admitted. And that I would need to review him again with all he blood results and to check the progress. He was happy with management and was ready to get admitted. He said – 'Give me some time to pack my bags'.
Diagnosis – Cellulitis Lower Limb

4. 26 year old woman complains of hardness of hearing after delivery of her baby.
Task – take brief history for 1 minute, physical examination, management.
Finds difficult to hear since delivery. It is in both ears. Finds that she has to turn the TV vol up to hear better. Asked whether she heard better in noisy surroundings, she said no. No history of trauma, ear infections or use of medications like gentamicin. Family history of similar problems is positive – sister has similar problems
Examination – there were 4 tuning forks that we had to choose from. I chose the 256 hz one.
Performed Rinne's test – air conduction lesser than bone conduction. Not able to hear the tuning fork when placed near the near canal but can hear when placed on mastoid.
Weber's test – Equal in both ears.
Otoscopy – not done but asked to look for wax and tympanic membrane. The examiner said Okay.
( note – when you try to activate the tuning fork, it is better to strike it on the heel of your shoe and test it by placing against your ear, striking it against your palm or elbow may not work and it might be painful)
Explained to the patient that she had conduction deafness most probably – otosceloris. Explained it by drawing a diagram.
Told her the need to confirm diagnosis by doing a audiogram and ENT specialist consultation who might decide to do a surgery – prosthesis with vein graft.
She asked whether this problem will get better with itself or by medications – No.
Will her children get it – autosomal dominant, so a genetic pattern to it is seen.

Diagnosis: Otosceloris/ Hearing Loss

5. Mother comes to you complaining that her 18 month old child is not talking well.
Task – take further history, physical examnination, management plan to the mother.
18 month old child not talking. Mother anxious. Child just muttering a few unintelligible phrases. Growth and development normal till now. No infections. No ear infections, no history of trauma or accidents. No ear injury.
Antenatal history – No use of any drugs or any illness in the mother. Asked about rubella and gentamicin
Post natal – premature baby. Requiring phototherapy. Had jaundice.
One sibling. Normal. Not problems. I was not sure about the normal milestones. So I asked the mother about the first child. She said the first child started talking at 12 months of age and she said that this child has not yet started talking.
No family history of deafness or any speech disorders.
Mother was concerned about Autism.
Physical examination: Normal healthy looking baby.
Growth chart given when asked. Normal.
Ear – dull tympanic membrane. No wax.
Nose and throat – NAD
Other systems – normal.
Management- told the mother that the child's speech is delayed possibly because there is some problem with the child. This could be because of the hearing defect. I will have to arrange the baby to have a formal audiogram and also referral to a ENT specialist.
Mother wanted to know that could jaundice after birth have caused it. I said yes.
Could it be autism? I said at this stage it looks like the baby has some hearing problems that has delayed speech.
She wanted to know if it could be cured. I said we have to wait for the investigations and the opinion of the specialist. He will be able to advice about further management.
Diagnosis: Hearing Loss or Autism.

6. 30 year old man went to donate blood. BP was found to be elevated BP 170/100.
Three consistent readings were elevated. Patient smokes ten cigarettes a day and moderate drinker of alcohol. Not on any medication. Family history of heart disease and hypertension.
(long stem – cannot recollect the entire stem, details of family, social and occupational history were given).
Task – perform focussed physical examination
Explain further management to the patient.
I was not at all organised. However the examiner was very helpful and was observing my every step.
I gave a commentary as I went along as best as I could.
I performed general examination – looking for BMI. Pulse rate. BP in all four limbs.
Checked the CVS
Endocrine – Thyroid and cushings.
Eyes – fundoscopy.
Urine dipstick – looking for glucose, protiens.
ECG

Finally after I had finished examination, the examiner asked me to advise the patient. I said we have to do some investigations – EUC, Blood glucose, Lipid profile, TFTs, serum cortisol level etc.
If no cause is found then it meant that it is essential hypertension. The patient wanted to know if we will start medications. I said we will try to control it with diet and exercise. And if that fails then we may have to consider medication. But that will be later.
I was not at all satisfied with the way I went. I was not organised but I guess I covered everything. The examiner was a nice person and tried to help me and put me back on the track when I started doing some unecessary examinations.
I passed this case.
Diagnosis - Hypertension

7. 50 year old female complains of dizziness and dysphasia. Weakness in the right upper and lower limbs. Symptoms have resolved while waiting in the GP clinic.
Task – Perform focussed physical examination.
At the end of 6 minutes the examiner will stop you. Explain your diagnostic impression and management plan to the patient.
Same case as in the AMC hand book. Did P/E as per the handbook.
However forgot to do co-ordination tests and gait and balance.
All findings were normal. No bruit in carotid arteries and no sensory loss or weakness. Cranial n. 5,6, 7, 8. 9. 10 normal. No e/o horners sydnrome.
At the end of 6 minutes the examiner stopped me and asked what was my management. I told her that she had what we call a 'TIA'. A mini stroke. The symptoms have resolved. But she needs to get admitted to Hospital for investigation. We will do a CT scan of the brain and also blood tests – FBC, Euc, Blood sugars, Lipids. Carotid dopplers. And we will also start her on Aspirin and a statin. Also the neurologist will come and review her. Further management would be on the basis of the investigation findings.
Diagnosis – Dysphasia and upper limb weakness.
Essentially TIA.

8. 24 year old female patient calls you at 4 a.m in the hospital ward complaining of abdomen pain. She has been seen by your registrar regarding this and no cause was found. She is insisting that her pain can get relieved by only morphine and she is insisting that she be given it for her pain.
Task – Talk to the patient – history and further management
It was a young Chinese girl. I started by introducing myself and asked her what was wrong and what woke her up at 4 a.m? She told me that she has severe pain in her tummy. When asked about the PQRST of the pain she said it is generally all over and it is pretty bad. She has had it for 2 years now. She takes morphine and it settles. She said that each time she has such a pain, she goes to the medical centre and the doctor gives her script of morphine and then she is alright. I asked her whether she was investigated for this pain. She said that she had all tests including colonoscopy and they were all normal. I asked her whether she has the reports. She said yes. Her bowel function was normal. She had no regular GP.
Physical examination done by Registrar was normal.
I told her that the senior doctor has examined her and he feels that there is no obvious cause for this pain. I told her that her body had become dependant on morphine and so she was experiencing this sort of pain. She got angry and asked me – Am I a junkie? I said no. Her pain is genuine and we need to solve it and sort it out. I further asked her about any addiction. None at all. Her family – she had a daughter but she does not live with her. She lives with her grandmother. She is single and is on a pension. I told her I emphatise with her condition and that her problem is genuine. I will organise for her to get investigated to find the cause of the pain. At the same time we need to address the issue of morphine. I said that there is a group of specialists who will deal with this. I avoided mentioning Drug and Alcohol. I said they will devise a plan for you to bring you off the dependance of morphine. She asked me that is for later, what about the pain for now. I said that I will not give her morphine. However there are other non opiate analgesics that will help with the pain. I said we will try NSAIDS and I will give her an injection of Ketorolac ( toradol ). This may give her some relief. I will review her some time later to see how she is going. I further said that her pain is genuine and we will try to help her in every way possible. I asked her how does that sound. She said that is fair enough and is willing to give it a try.
AMC Diagnosis – Chronic Pain.
I dealt this case as Chronic pain with opiate dependance.

9. 60 year old female has come to you about a lump in the right breast.
Picture provided. Right breast higher than the left. Nipple inverted. No signs of lyphoedema in the picture
Task – History, Ask for Physical examination findings, Talk about your management plan.

There was a picture of the the breast outside the room. The right breast higher than the left. The nipple was inverted and there seemed to be some amount of lyphoedema changes but not clear. I asked history. Important points was that this had started slowly. Never had a mammogrom or breast check up. Family history positive. Said she had been getting increasingly short of breath. The patient was very afraid and kept on asking me from time to time whether it was serious. She also said that there is family history of heart disease.
I asked further examination findings. The examiner asked me to say what I saw in the picture.
No axillary lymphadenopathy. I asked about the other finding. The examiner said you tell that patient what you will do. I said that I will do a thorough physical examination. Starting with the breasts. Since she was short of breath. I will check her CVS and Respiratory system. Looking for signs of any heart failure pedal oedema etc.
She was very afraid and said that she is all alone, no family. She asked me if anything could be wrong with her heart.
I said that I can understand her worries. I am there for her for support.
I will arrange investigations like ultrasound, mammogram and then biopsy. If the biopsy it positive for breast cancer then we will have to do a CT scan for further staging. I said that I will be referring her to a specialist for further assessment. She asked me whether it was breast cancer. I said possibly but we have to wait for the investigation results. Till that time I cannot say anything in definite. She said that she was afraid. I said I will arrange support for her and I will be there with her all through this difficult period of her life.
The examiner and role player were happy. He said Shukriya ( thank you in Hindi ) as I was leaving the room.
AMC – Advanced breast cancer.

10. 23 year old female come to you with pain abdomen lower abdomen radiating to the groin. Pain is subsided now. A CT was done.
Task – Interpret the CT scan. Talk to the patient about your diagnostic impression and management plan.

Same case as in the recalls. The CT scan showed a horse shoe shaped kidney.
The examiner wanted me to explain the CT scan. Which I did.
The role player asked me if it could be cancer. I said not likely.
I said that the pain could have been because of a stone that you would have passed.
However we will do some tests like EUC, TFTs and CMP.
The patient should be aware and the abnormally positioned kidney. She should be careful especilally with contact sports. The examiner asked what sort of contact sports. I said – kick boxing. They both started laughing. The examiner asked me so what if I have a million dollars. Can I give it to her. I said by all means. She will be very lucky. There was still some time. So we made some small talk and when the bell rang I went out. Everyone seemed to be in a good mood in this station.
Diagnosis – Congenital renal abnormality

11. 45 year old female complaining of pain abdomen. Presented in ED.
Task – take further history. Physical examination findings, talk about management plan.
Same case as in previous recalls.
Right upper quadrant pain. With some nausea and vomitting. Now settled. No radiation. Constant. No aggravating or relieving symptoms. No such pain in the past. No history of gall stones till now. No ulcers. No history of heart disease.
Pain still there, about 6/10. Started suddenly. Did not eat a heavy meal. No chest pain. No SOB.
Physical examination: Pain right upper quardrant. Tender. No rigidity, no gaurding.
ECG – Normal.
I said that it looks like acute cholecystitis. We will have to get the surgeons to come and see her. We will keep her nil by mouth. Put a canula and take baseline bloods and start her on fluids.
Arrange for a ultrasound abdomen.
The surgeon may decide to do a surgery to take the gall bladder out. It may be most probably by lapsoscopy. It depends upon the surgeons assessment.
I asked if any concerns. She said no.
AMC Diagnosis – Upper Abd pain and rigors.

12. A 20 year old patient has been brought to your GP practice by his parents. He says that he has a specific information for the US president.
Task – Take history, Present your diagnostic impression and finding(mental state
examination) to the examiner with DD.
20 year old boy brought to GP practice by the parents. He was very agitated. He had been to a music festival yesterday and it suddenly dawned on him that he has this mission to save the US president. Continuously talking. Saying that he had some important information for the american president and he had to go.
He was answering questions but was really agitated. No insight and judgement. No suicidal intent or ideation.
When I asked about drug usage he was not clear and became annoyed.
I told the examiner – 20 year old boy agitated. Dishivelled and untidy to look at. Continuously talking. Unable to obtain full history. No insight or judgement.
DD – Acute psychosis secondary to most possibly drug usage.
Mania, Bipolar illness, Pre existing mental illness – schizophreniform disorder.
AMC Diagnosis – Elevated Mood assessment


13. 10 year old boy presented to GP practice with headache.
Task – take further history from the father, physical examination findings (only those
specific investigation finding that you ask for will be givne) , explain management plan
to the father.
Headache since the past few weeks. Mostly in the mornings. With vomitting. No fever, no visual disturbances. No aura. Growth and development normal. No other medical illnesses. No history of trauma or head injury. Family history of migraine positive.
Physical examination: Healthy looking child alert oriented. Obs stable. Afebrile.
I asked for Fundoscopy: Given a picture of the fundus – it did not look normal. ? Papilloedema.
ENT – Normal.
CVS – Normal.
No rash neck rigidity.
Management: I told the father the the fundus did not look normal. It looked like papilloedema. But I will get it confirmed by the senior doctor here.
The examiner asked me if I was sure about this. I said that I am a junior but this does not look normal so I will get the findings confirmed.
The examiner asked me to tell the father the plan – I said that the fundus looks abnormal. If my senior confirms that it is papilloedema. Then it might be because of raised intracranial hypertension. We need to take a CT scan. And further referral to a neurologist. It could be serious.

The examiner asked me what if normal. I said if the fundus is normal then it could be migraine and we need to keep a watch on the headache. I will also give some pain relief since paracetamol was not helping, I will give something stronger like nurofen or paracetamol with codiene (painstop syrup). We also need to study the pattern of the headache.
However I said that we need to rule out the serious cause by taking CT scan.
I asked the father how does this plan sound. He said, that seems reasonable.
The examiner was alright.
I was worried because I wasn't sure about the papilloedema, but I passed the case.
I guess, it was because I did say that I will rule out papilloedema, intracranial hypertension and do a CT scan. Thus keeping the patient safe.
AMC Diagnosis – Child headache raised ICP

14. 24 year old woman has presented to your GP practice with 12 month amenorrhoea.
Task – take further history
physical examination findings
Management
History of 12 months of amernorrhoea. Periods have been normal prior to that. Complaint of some pain in the tummy. Dull pain. I asked if there is any pattern to it. She said it comes every month. I asked whether it was approx at the same time as when she got her periods previously. She said yes. Also some amount of slight brownish discharge. No complain of excessive hot or cold. Not on any medications. No breast tenderness.
No history of pregnancies in the past. History of D and C more than a year ago. Feels that the period have stopped after that.

Physical examination: P/A – slight tenderness lower abdomen.
PV – NAD
Urine dipstick – Beta HCG negative.
Other examination unremarkable.
I said that most possibly the periods have stopped because she might have developed adhesions post D and C which is called Asherman's syndrome. However we need to confirm the diagnosis by doing a ultrasound of the uterus. If the diagnosis is confirmed the we need to refer her to a gynaecologist who will do a hysteroscopy for further management.
AMC Diagnosis – Secondary Amenorrhoea

15. 35 year old woman comes to your GP practice complaining of tiredness.
Your colleague ordered some blood tests. The reports are here.
FBC – HB (decreased), MCV (decreased) and blood film report provided. No other
reports are available. She has come to you today to discuss the blood reports.
Task - take further detailed history for 6 minutes.
Explain management plan to the patient.
Same case as in previous recalls – Fe deficiency anaemia.
I ruled out hypothyroidism, any bleeding – from the gut and excessive periods, diet and cancers.weight loss. Diabetes and dementia.
I said that we need to do some investigations FBC, EUC, TFTs and stool examination (faecal occult blood test).
Also we need to find out the source of bleeding for which we need to do a colonoscopy and upper GI endoscopy.
I will also give her dietary Fe supplements.
I will be reviewing her regularly with all the the results.
AMC Diagnosis - Anaemia

16. Patient comes to your GP practice with 41 week pregnancy primi. Pregnancy has been uneventful till now. 34 week scan normal. All antenatal blood tests normal. No DM/HTN.
GBS swab was done at 34 weeks which was normal. (long stem)
Task – take further history
Physical examination findings
Explain your diagnosis and further management plan to the patient.
Same case as previous recalls.
Post dates pregancies. 41 weeks. Dates confirmed. Pregnancy normal till now. Ultrasound 34 week normal. No big baby or CPD. No fibroids. No malpresentation. Baby kicking.
P/E – Normal lie presentation. Fetal heart sounds normals. No signs of poly hydramnios or oligo hydramnios.
CTG – reactive.
Management: I said that it is already 41 weeks. We will have to deliver the baby because it is post dates. We will have to admit the mother in hospital. Arrange for a USG to r/o big baby, placental abnormalities or CPD. If everything is normal the delivery will be induced using prostaglandits to ripe the cervix. I asked her whether she had bronchial asthma or any other medical problems – nil. There is no point in prolonging the delivery. We will keep a watch of meconium staining of liquor in which case we will have to suction the nose and mouth and oropharynx and visualise the vocal cords.
If everything is well then the delivery will go uneventfully and everything will be fine.
The mother agreed to get admitted to the hospital.
AMC Diagnosis – Post date pregnancy.

I passed in 14 out of the 16 stations. I failed Irritable baby and PV bleed cases.

Good luck to everyone. You need to be very thorough with all the recalls. This is not an easy exam. The cases are mostly repeated but we need to be very thorough. We have to have all the facts on the tips of our fingers. So that we can recall them inside the room during the 8 minutes. Only repeated study and role play will help. We need to constantly go through the cases in our mind.

[walid51]

retest sydney 12th march

1.lower limb cellulitis
2.58 y old dvt on HRT
3.35 Y Old lady requesting tubal ligation
4.1 day old child with signs of intestinal obstruction
5.testicular CA councelling
6.prostate CA with bone mets councel
7.27 y old man with a headache-meningitis
8.24y old nurse with post traumatic stress



1- dvt councelling
2- pal care pain control counceling
3- strong headache in ed-management
4- tubal ligation advise (i missed out the main issue completellyand tried to convince her about other methods...when started to talk about the surgery...bell rang.)
5-depression in a nurse post stress- management (i was bad in that!hard to talk.i blanked..blunt face of woman`s examiner!..not so happy!)
6-cellulitis management (lovely old man!)
7-baby with meconium ileum - management (doubt if i pass): lots of questions from the examiner, that was not very happy, despite mother looked happy!)
8-testes ca- manag/ advise ( doubt in one question from the examiner at the end..despite 90% of advise was ok!)

[walid51]

AMC Clinical Examination Melbourne - 27 Oct 07
Melbourne clinical exam 27 Oct 2007

1. Emergent post coital pill
2. post natal depression
3. recurrent candidiasis
4. Down Syndrome
5. foreign body (sharp pin) swallowed by 4 year old boy
6. 11year old has fracture of lateral epicondyle
7. stroke
8. generalized weakness
9. CT show kidney problem
10. daughter can’t speak after mother diagnosis with cancer
11. breath holding attack
12. peptic ulcer
13. chest pain
14. seminoma
15. ?
16. ?




Mel 27 Oct feedback
AMC CLINICAL EXAMINATION
Melbourne 27 October 2007

(The diagnosis within brackets is AMC diagnosis from the feedback)


Paediatrics
1. (Breath holding attack): You are working in ED. An anxious parent brought his 2 yo child Justin, who suddenly became unconscious an hour ago. The child looks normal now and resists examination.
Task: Take relevant history (no examination required)
Talk to parent about further management
The anxious looking young father describes that his son was in a car, he banged to the car door, then cried, trembled his arms, stopped breathing and turned blue, wasn’t responding. The whole thing lasted for about a minute or so. No past or family history of epilepsy. The boy looks ok now, but sore in his fingers.
(I missed the diagnosis because of the fast, anxious accent of the role-player, and I went along the pathway of epilepsy – so I failed this station).

2. (Ingested foreign body): You are working in ED. Mum brought her 4 yo son who has swallowed a drawing pin.
Task: Take a relevant history
Ask examiner any investigation you want
Talk to mother about management
Mum says that her son swallowed a drawing pin (umbrella shaped board pin) an hour ago while playing with his elder sister, who is 7. Mum has brought the pack of pin to show to doctor. The boy has been behaving normally, no vomiting, choking or breathing difficulty happened. I asked the examiner for abdo X-ray, he pulled it out from the drawer which clearly shows the pin passed the stomach. I didn’t know the exact answer but told mum that it’s good the pin has already passed the stomach in an hour. So it’s quite likely that it will pass thru the gut embedded in faeces without affecting him. We can do X-ray daily to see the progress. It would be reassuring if the pin passes the narrowest part of the gut – the ileocaecal junction (drew picture to explain mum). Also told her that this is my understanding, but I am calling the surgical doctor who is the right person to assess him and explain properly to mum. If he thinks it’s risky to leave a sharp in the gut, he will probably take it out by an endoscope. I asked mum if she has any question - she said no. I then looked at the examiner and said - I finished. He smiled and said, “It’s a short station, isn’t it?”
(I said yeh, and by that I knew I passed this station).

3. (Down syndrome): You are working as GP in a rural hospital. A 23 yo lady has delivered a term baby today. You have examined the baby and found features of Down’s syndrome (photo outside room: characteristic facies, single palmar crease).
Task: Talk to mother
I congratulated mum and said the baby looks very pretty. Also asked if she has a name for the baby. Then asked for history. This was her first pregnancy, no pre-existing illness, and normal antenatal check up and tests. No problem was anticipated. Normal delivery, baby is fine, sucking at breast. Then I told her that I have examined the baby, looks otherwise healthy but sorry to say that some of the external features suggest he might have a condition called ‘Down’s syndrome’ – does she know about it? She said no. Her partner was not here. So I explained that this is a genetic or chromosomal disorder that affects about 1 in 700 of all pregnancies. This is not her or her partner’s fault (she asked how it happened). I drew picture and said that normal cell has 23 pair of chromosomes, 23 from mum and 23 from dad. Most of the time in Down syndrome, what happens is that during cell division for growth in the womb, the 21st pair has an extra chromosome by a natural error/anomaly when the features develop. I explained the features to mum. Reassured her that he doesn’t have obvious heart problem or low tone (got the finding from examiner). He is sucking well which is good. The initial problems are poor feeding due to low tone, and later may be prone to respiratory infection. In future they would have lower than normal IQ, so will be lagging behind in education/learning and may require special schooling. But they are usually very social, love music and have very pleasant personality. I will call the Paediatrician to have a more detailed assessment and organize some tests like karyotype, echo, TFTs etc. I said to mum that although the features are quite suggestive but only karyotype or chromosome study can confirm the diagnosis. I mentioned that there are lot of support groups and resources in the coming days which I would provide her with and continue to liaise/coordinate with the multidisciplinary team. Said I will explain to her partner when he comes in and meanwhile if she has any concern any time re feeding or anything else, she can call me. Also, in future whenever she becomes pregnant there are tests to predict the risk and confirm the diagnosis of Down syndrome early and there are options of termination of pregnancy. Finally I asked mum if she has any more question - she said no.
(Both mum and the examiner looked happy, I probably talked more than expected)

O & G
4. (Incomplete abortion): You are working as a GP. A 25 yo lady has come to you with 8 wk H/o amenorrhoea and PV bleeding.
Task: Take relevant history
Ask examiner any examination finding you want
Talk to patient
I greeted the patient, asked quickly how severe was the bleeding. She said started yesterday, like a period, small clots passed, feeling weak. Pregnancy test positive. I asked examiner for vitals – P100, BP 90/50, T37. On speculum exam – os open, clot lying in the os. I said I would remove the clot now with sponge-holding forceps. Started IV fluid to combat shock and call ambulance. Then I explained to mum (partner was not here). Sorry to say that there has been a miscarriage which is incomplete, needs to be evacuated completely in hospital, otherwise risk of bleeding and death, also requires IV fluid. I took previous history at that time. First pregnancy, planned, no illness or medication. Well before this event. Stable relationship, good support. Didn’t take HPV vaccine (Gardasil). I said I will inform the ED and talk to O & G Registrar and keep in touch with them to know how she was going. She asked why it happened. I said it’s hard say definitely, but most of the time early miscarriage like this is due to some major chromosomal abnormalities, and it is the nature’s way of handling it – aborting anomalous/malformed baby. Also mentioned that with subsequent pregnancies, she needs to be in touch regularly from the beginning. I asked patient if she has any question - she said no. I looked at the examiner - finished early.
(I completely forgot to ask about blood group, which should have been a critical error, and was surprised to see that I passed this station. The examiner looked & sounded like a Serbian/Bosnian lady, was smiling all the time. Very kind!)

5. (Recurrent monilial vaginitis): You are working as GP. A 25 yo lady has come to you with vaginal discharge and itchiness. This is the 3rd presentation in 3 months with similar problem. Last time you diagnosed her as vaginal moniliasis.
Task: Take focused history
Ask examiner any examination finding and investigation you want
Talk to patient
The lady was worried because the medications aren’t curing her, last time she was prescribed a cream. She doesn’t have Sx of UTI or diabetes. Single, stable partner. On OCP, normal periods. Hasn’t taken HPV vaccine (she looked at examiner for the answer). No ongoing medical condition. Non-smoker, minimal alcohol, no illicit drug. O/E – slightly red introitus with characteristic candidial discharge. I told the examiner that I would check the blood glucose level and the LFTs before I start the Rx. Told patient that this the same monilial infection that she had before but is occurring repeatedly, either because of resistance or some unexplained reason. For this she has to continue oral medication for a prolonged period like 6 months or so. I gave the script to her. She asked if she is going to be cured. I said hopefully she is, with the oral long term medication. Explained the side effects of medication and the need for doing blood tests. Also said I would see her in 6-8 weeks time for review, or earlier if any concern. I asked patient if she has any question - she said no.

6. (Ruptured condom): A 20 yo woman has come to your general practice. She had an unprotected sex (condom ruptured) last night and wants contraception.
Task: Talk to her (no need for physical examination)
The young lady told that she is a student, had an unprotected sex with a new partner whom she knows recently. She has regular periods, no medical condition, and uses condom as contraception. Has multiple sexual relationship, hasn’t taken HPV vaccine. Non-smoker, casual alcohol, no illicit drug. I explained to her about STD risks associated with casual sex and failure rate of condom. I offered her another session to discuss the options of contraception (took brief history re contraindications of OCP). Mentioned that OCP will not protect against STD, so use of condom is important. Advised for partner to follow the instruction for using condom. Gave post-coital pill, instructions for use and mentioned the success rate. Asked her to come back in a week if misses next period. Offered STD screen if she thinks the current partner is not reliable. Examiner asked if I would give prophylactic antibiotic. I said no, unless she has positive tests or symptoms. Finally I asked patient if she has any other question - she said no.

Psychiatry
7. (Postnatal depression, moderate): GP setting. A young lady comes to you few weeks after delivery- not feeling well.
Task: Talk to mother
Typical case, feeling tired and helpless, sometimes irritated. No hallucination, delusion, suicidal ideation. Baby is breastfeeding, gaining weight, 2nd baby. No other medical condition, not on medication. Older child goes to school, supportive husband. No other family-friend /relative to help. Explained about PND, outcome, medication, respite care, supports. Gave script and asked to come with partner. She said she feels very tired and off. Then I offered hospitalization in mother-baby unit, explained what are the advantages and what is going to be done in the hospital. She agreed and became happy.

8. (Psychogenic dysphonia): A young girl, who is a strict catholic, conducts the family prayer for her mother. Mother has a metastatic cancer. The girl has suddenly lost her voice when she heard her mother screamed in pain from another room.
Task: Take further history
Do appropriate examination (you will be provided with necessary equipment)
Manage the case
Old scenario, the girl was answering by nodding the head, or by writing on a paper. I sympathized for her mother and hoped for the best. Then took a brief history. No past or ongoing medical condition, especially of the throat, mouth or nervous system. No weakness or impaired sensation in any part of the body. Not on any medication. It didn’t happened to her before. No other stress apart from mum’s illness. Studying in Uni with good result. Examined the throat with tongue depressor (was on the table), checked movement of palate, uvula. Then explained to patient that sometimes emotional stress can lead to physical symptom without having any abnormality/disease of the part involved. She will not require any medication, needs relaxation – her mother is still with them as before. Before she gets her voice back, someone else in the family can conduct the prayer for her. She asked by writing on paper how long it would take for her to become normal again. I didn’t have any exact timeframe, but said hopefully few days and suggested some relaxation tips. Also told that I would review her in 2-3 days, if not improved would refer to psychologist for psychotherapy. I asked patient if she has any other question - she said no.

Medicine/Surgery
9. (Fever of undetermined cause): GP setting. A middle aged woman has been feeling tired for 2 weeks.
Task: Take relevant history
Ask examiner for physical findings you want
Discuss possibilities with the examiner
41 year old executive, previously well, has been feeling unwell and tired for last 2 weeks. No fever recorded, but sometimes feel feverish, no cough or respiratory symptom, no symptoms of UTI, hypothyroidism, diabetes, depression or Addison’s disease. No family H/O haemochromatosis. Appetite slightly reduced, no loss of weight. Normal bowel movement. No H/O recent travel. Supportive family, no stress at work. Normal periods, sexually active, on OCP, no other medication. I didn’t find any clue until this point. Asked examiner for examination finding- pale but not unwell looking, normal pulse, RR & BP, T37.6, no lymph nodes, thyroid not palpable, ENT normal. Liver/spleen not palpable, lungs clear, dual heart sounds, systolic murmur in R 2nd ICS and diastolic murmur in L 2nd ICS. I was puzzled matching the two murmurs. I couldn’t fit into one diagnosis, but I asked for character of pulse (?slow rising) & signs of infective endocarditis – all negative. (Also asked patient at this point if she had H/O rheumatic fever- said no). I told the examiner that I would do some investigations, but he asked what are the DDs. I said aortic stenosis plus pulmonary regurgitation, so infective endocarditis possible (I felt myself stupid because I couldn’t come a single diagnosis- thought am I missing something?), viral infection (but then how to explain murmurs- now while typing this feedback I think viral myocarditis is a possibility which can explain everything). The examiner, a young Indian or subcontinental who appeared to be a bit harsh asked which was my first diagnosis – I said infective endocarditis, then viral infection. I also added that I would admit her for investigations and observation (although management was not the task).
(From the appearance of the examiner and the way of cross questions, I thought I was going to fail this station, but I passed- don’t know why and don’t know the diagnosis yet).

10. (Incidental congenital renal anomaly): ED setting. A 56 yo lady comes for investigation results; she was seen 2 days ago for atypical ureteric colic. Plain x-ray didn’t show any stone. A CT scan (picture outside room) was done because of microscopic haematuria. Radiologist is unavailable to report the film, which is sent to you.
Task: Read the CT scan to examiner
Tell the result to patient (no history or examination)
Outline further management
(I failed this station, because I couldn’t figure out the findings [are we supposed to interpret a renal CT scan?]. I said it might be an ectopic kidney or a renal tumour, referred to urologist. Actually this was a horse-shoe kidney).

11. (Recurrent lower limb weakness in a diabetic): GP setting. A middle aged man with type1 diabetes and hyperlipidaemia comes with recurrent weakness of leg on one side.
Task: Take relevant history
Ask examiner for physical findings you want
Talk to patient
40 yo man having type 1 diabetes for 12 years, well controlled on insulin (I asked for the diabetic book), has H/O recurrent weakness of one leg over past few months. Persists few hours and then goes off by itself. In between he remains well. No other symptoms of stroke like hemiparesis, dysarthria, and loss of consciousness. No visual disturbances. No other medical condition, on insulin only. His lipid levels are within normal limits now with dietary manipulation. No eye, renal or neuro complications of diabetes. Examination findings are all normal now (I included carotid auscultation, funduscopy and neuro exam of limbs). I explained this was a TIA, which is a mini stroke (drew picture to explain vascular narrowing) and can lead to a complete stroke. So needs hospitalization for investigation and observation. Will call the medical Registrar and arrange bed.

12. (Chest pain and faintness): GP setting. A 42 yo man presents with central chest pain for one week.
Task: Take history
Ask examiner for physical findings you want
Talk to patient
Before entering into the room, my DD were AMI, pericarditis, PE, pneumothorax, peptic ulcer, pancreatitis etc. The man said he is ok to tell the history without analgesia, so I went ahead (didn’t ask examiner about vital signs). He has pain in upper chest centrally for last 1 week, radiating towards neck, not to upper limbs. It was dull, started gradually and then increasing over past few days. It’s not related to time of the day, food intake or his position. No vomiting or fever. He doesn’t have any breathing difficulty, but says feels tired. Hasn’t taken any medication for this pain. Didn’t have similar pain in the past, but has reflux for last few years for which he takes Ranitidine on and off- it helps to some extent. Normal appetite, no loss of weight. No stress at work or home. Non-smoker, casual alcohol, no illicit drug. I couldn’t come to a conclusion from history, asked about urinary symptoms- no, bowel- black for last few days. Asked patient how he was feeling- said had fainting on and off for last 24 hours. Immediately asked examiner about exam findings- pale looking, P100, BP 90/55, T37, RR18, no oedema or jaundice, no hepatosplenomegaly, no signs of chronic liver disease, lungs clear, no murmur. I was puzzled. Said it’s a bleeding from upper gut, stomach or above- probably due to bleeding peptic ulcer. Patient will need immediate hospitalization for blood transfusion, IV fluid, investigation and further treatment. I will contact the hospital, call an ambulance and open an IV line to start fluid before transfer.
(I failed this station, as expected. I don’t know yet what exactly it was).

13. (Duodenal ulcer): A 43 yo man, who is a busy courier had an upper g.i. endoscopy done for abdominal pain. Test for H. pylori was positive. The gastroenterologist has sent the endoscopy picture (photo outside room) to you which shows a duodenal ulcer.
Task: Take relevant history
Explain the condition to patient & manage
The diagnosis was given, so this was a communication station. I took brief history re the symptoms, covering the risk factors for peptic ulcer, complications and treatment received in the past. Outlined the treatment plan and things to avoid. Gave pamphlet and follow up plan. The examiner asked me the drugs of triple therapy including the dosage and duration.

14. (Recent orchidectomy for a testicular neoplasm): A 22 yo man had his R testicular lump (picture of the lump attached with portion of spermatic cord outside room) removed by surgeon 4 weeks ago. The patient has moved to your state after the operation. The surgeon didn’t get time to explain the histology and follow up plan to him and he has sent the report to you, which revealed a seminoma.
Task: Explain the management and follow up to the patient
Answer his questions (no history taking or examination)
I asked the young man if he knew the diagnosis/histopath result. He said yes the surgeon has told him that he had cancer of testis but it was removed. I said surgical removal is part the treatment of testicular tumour. He had seminoma on histopath and the good news is that seminomas are extremely radiosensitive and the cure rate is >95%. I explained that he would require radiotherapy which is like an X-ray beam given to the testis area. This is to kill any remaining cancer cells in the area. Mentioned the side effects of radiotherapy. Advised preserving sperm in sperm bank for future fertility in case it is affected. Examiner asked when to start radiotherapy- I said now. The patient asked one of his friends had testicular tumour removed by scrotal incision, but in his case it was it was groin incision, why? I asked if he had undescended testis on that side- said no. I said this is to prevent intraoperative spread of cancer cells. Referred to radiotherapist and arranged follow up. Emphasized regular self-examination for early detection of relapse. I finished the station before the bell rang.

15. (Acute vertigo): You are working in ED. A 50 yo man is brought in by his wife with 1 day H/O sudden onset vertigo, numbness of one side of face, drooping of one eyelid and weakness of one side of the body. He has unremarkable past history. His vertigo is much settled now, but his wife insists hospital admission.
Task: Take relevant history
Ask examiner for physical findings
Answer examiner’s questions
Before entering into the room I was a bit confused because I didn’t find any scenario from the recalls having lateral medullary syndrome and hemiparesis at the same time, but I read topic from Snell. Anyway, the story was that he suddenly developed vertigo (tilted to R as well) last night along with ptosis of R eye, numbness of R side of face and also weakness of the L side of the body. Previously well, F/H of stroke. Non-smoker, reasonable alcohol use, no illicit drug. No difficulty in speech or swallowing, no nasal regurgitation of fluid. Vertigo much improved now, still can’t walk because of hemi-weakness. When asked examiner gave long list of findings from her paper- Conscious, GCS15, vitals normal, no dysarthria. Left side- ptosis, impaired pain & touch on face, constricted pupils, hoarse voice. R side- spastic paresis of upper & lower limbs, brisk tendon jerks, impaired pain, temp and proprioception (position, vibration). No ataxia now. Examiner asked where the lesion is. I took the opportunity to explain:- on R side Horner’s syndrome, trigeminal, vestibular & vagus nerve involvement, along with contralateral pain and temp sensation lost – so it’s R lateral medullary syndrome (posterior inferior cerebellar or vertebral artery occlusion). On L side contralateral pyramidal tract (spastic paresis) and medial lemniscus involvement (proprioception) – so it’s R medial medullary syndrome (anterior spinal artery occlusion). (I forgot to ask about ipsilateral hypoglossal nerve involvement). That means lateral and medial medullary syndrome of R side. This is a brainstem stroke and patient will require hospitalization. The examiner looked very happy, nodding her head while I was giving the logical explanation.
(I don’t know if lateral and medial medullary syndrome together was given in previous exams, but the lesion is best explained in Snell’s Neuroanatomy Page195).

16. (Suprachondylar fracture humerus): You are working in ED. An 11 yo boy has had a fall and injury to R arm. X-ray is done (picture outside room).
Task: Explain the X-ray to mother
Outline the management (no need for physical examination)
Q from mother: Is it going to be operated? How long will he have to take leave from school?
Q from examiner: What are the associated injuries? Which one is more important? Which nerve is particularly affected?

This was a typical X-ray of suprachondylar fracture. I asked about analgesia, she said yes. I asked the nurse for that. Then I explained the x-ray to mum, told her that this will be fixed be orthopaedic doctor under regional nerve block (called Bier’s block), then a plaster will be put on the arm. She has to bring her son for recheck after 24 hr. Meanwhile, signs of complications should be looked for- mainly increased pain/swelling, colour change of fingers- when she needs to bring her son back immediately. The plaster will be there for 4-6 weeks. Mum asked if it’s going to be operated- I said with nerve block the area will be numbed, then will be fixed without operation). Mum asked about leave from school (I forgot to mention). I told few days (mistake!). Then she asked what about writing? I said oh it’s on R arm, so has to be the whole period. Then examiner asked about associated injuries. I said vascular and nerve injuries. He asked which one is more serious? I said brachial artery. He asked which nerve? I said radial. He asked any other nerve? I said no. Finished my station.

(I failed this station too, probably because I didn’t arrange for theatre immediately, didn’t mention about internal fixation [mum wanted to prompt], wasn’t detail in explaining the management to mum [including leave] and hesitant in answering examiner’s questions, probably wrong as well)



(As you see, I succeeded very luckily by the Grace of Almighty, as I failed stations 1, 8, 11, 16. This exam is a lottery – one may fail with very good preparation or one can pass with very marginal preparation! It’s hard to perform well if you can’t figure out what to do before you enter the room. Good Luck for the lottery!)

[walid51]

16 may brisbane
1 ingunial hernia
2 ca colon
fussy eater
spont pnemothorax
alc
endometrial ca
breech with placenta previa
elderly who tripped
PTSD
stress coz of husbands psychi illness
rt iliac fossa pain
breast lump
delirium..hip replacement
HTN ocp
child abuse




brisbane 16 may
1) child with spiral fracture of humerous
2) 2.5 year old ,mother complains of loss of appetite,weight and height provided,if you ask they give you the growth chart which was normal ,the only problem was that the child eating junk food
3)child under 12 month with inguinal and umbilical(1cm)
4)lady 18 month post menopause with vaginal bleeding,nothing in history
5)34 month pregnant with breech presentation and placenta previa living 100 km from nearest hospital
6)20 year old with breast lump in left breast ,no other symptom,mother had a cancer
7)lady with bipolar husband and teenager at home ,cant cope any more
8)25 year old with panic attacks after recent car accident(PTSD)




9)alcoholic guy concerned about drinking similar to AMC book case
10)70 year old with resent falls,history :drinks alcohol,history of MI
11)25 year old with HTN she is taking OCP
12)delirium case similar to AMC book
13)pneumothorax in a young boy(i could not find in CXR?)
14)LLQ pain in young girl,appendicitis
15)70 year old lady with stricture in barium enema of colon
16)young boy with sliding hiatus hernia similar to AMC book case




1. mother of 2 ½ y.o kid came to your GP c/o child not eating well. Height and weight given.
Tasks
1. history
2. advise mother about management
(this station will require you to plot growth only if you ask though)
2. 20 y.o Uni student has episodes of SOB, using Ventolin she got over the counter
Tasks:
1. ask her about history/ SOB
2. tell patient probable diagnosis
3. manage
3. 34 wks AOG placenta praevia major and breech presentation. You’re a GP in a remote clinic. Tertiary hospital 225 kms away
Tasks:
1. tell px about diagnosis
2. manage
4. 25 y.o. man w/ sudden SOB, hand over of colleague, said normal chest findings. Still a bit breathless.
Tasks
1. get history
2. ask investigations done
3. tell patient diagnosis and manage
5. 5 month boy with symptom of intermittent inguinal mass. Normal PE. Mass at external inguinal ring. Also has 1 cm umbilical hernia
Tasks:
1. Tell mum about the diagnosis
2. Advise on management
6. 50 something male patient came to you about his alcohol intake because he saw commercials on tv about alcohol. You saw him last week and did tests. MCV 106, GGT 85.
Tasks:
1. tell him the results
2. get history
3. counsel
7. 72 male h/o fall. General health ok. Daughter lives nearby
Tasks:
1. get history
2. summarize to examiner
3. advise patient about management
8. 52 y.o woman had changes in bowel habits, bleeding per rectum, weight loss. You did barium contrast study. X-ray taped outside. Picture of possible colon cancer
Tasks:
1. explain xray to patient
2. advise about possible diagnosis and management
9. 25 y.o male has reflux symptoms. Not overweight. Endoscopy done showing oesophagitis and severe reflux, no ulcerations, has small sliding hiatus hernia
Tasks:
1. Explain results to patient
2. advise about management
10. 30 something lady, RIF pain. Stable obs for now.
Tasks:
1. history
2. manage px
11. 5 month baby preterm, unwanted pregnancy, 19 y.o mum, lives w/ boyfriend who is not the father of the baby. Mum works part time and sometimes leaves baby with BF. Baby cries when arm moved. X-ray- spiral fracture of the upper humerus.
Tasks:
1. explain x-ray to Mum
2. advise re: diagnosis and management
12. Delirium in a post-op patient. Very very long stem. Same as AMC delirium case though.
13. 25 y.o woman noticed 2 cm mass on the R breast
Tasks:
1. take history
2. advise about diagnosis and management
14. 45 y.o. woman not coping. Comes to your GP. Has a husband with bipolar and has a 16 year old daughter.
Tasks:
1. take history
2. tell patient possible problem
3. counsel
15. 54 y.o woman complaining of 18 months of amenorrhea after cessation of menses at 52 y.o.
tasks:
1. take history
2. ask examiner about PE and investigations
3. tell px about management
16. 20 y.o. has 3 measurements of high BP
tasks:
1. take history
2. manage

[walid51]

PAST AMC CLINICAL QUESTIONS
THERE MIGHT BE SOME TYPING ERRORS SO BEAR WITH THE TYPIST (GOOD SAMARITAN FROM MELBOURNE )

(Perth Oct 2005)...
1) 60 y/o man comes to you with severe chest discomfort, take history..and present to examiner..tell examiner what investigations...u would do...Examiner then gave me a ECG to read..the patient also said that he was recently injected with some steroids for joint pain..i.e pain could be ulcer related..as a differential ( i think...there was ST elevation in leads I II and AVF ...he wanted to know what type of infarct..i wasnt sure..inferior infarct)


2) Mother comes to you to see about her 5 yr old son who is fine but with blood test showing glucose at 21 and some ketones in urine...discuss short term management(need to be admitted to hospital ..) and long term management ( explain about diabetes and care needed with it..) with mother..

3) 50 y/o man comes to you complaining of on going hoarseness for the last 3 weeks..take appropriate history and discuss investigation and management with examiner

4)a man comes to you (emergency department doctor) saying that his wife who recently gave birth has started to act strange..accuses baby of being evil (child of satan)..wants your help..

5) a married woman mid 20's comes to you (GP) with 8 weeks of amenorrhoea and suddden onset of period..take history and discuss with patient..(allowed to ask examiner for investigations) diagnosis andmanagement

6) 60 yr old woman comes to you (GP) with feeling unwell, dull pain in left lumbar region...take history and ask examiner for findings..discuss management and diagnosis with examiner

7) a father comes to see you (GP) about his child (i think 5 yr old child) who has a known murmur and is well, was advised by previous GP that the murmur is benign and to have annual check up...the father is to take the son to the dentist next week.(murmur is 4/6, parasternal heave,)..child is well with no complaints. Discuss diagnosis and management with patient.

8) a man in his 20's comes to see you (GP) about a tense scrotal swelling in his left testis. it is transilluminable and you cant feel the testis separately.Discuss investigations and diagnosis and management

9)a lady comes to see you (GP) mid 20's, she suffers from epilepsy and is on phenytoin..has been seizure free for the last 2 years .She is keen to get pregnant and would like to discuss this with you.you need to give her pre-pregnancy counselling

10) a university student comes to see you(GP) ..finding it difficult to concentrate on studying always checking her work..and submitting papers late...Please take history and discuss differential diagnosis and manageemnt with examiner

11) A man comes to you (GP) with a flu like illness and a rash on his chest..he also has palpable lymphadenopathy and hepato-splenomegaly..take history and disccuss potential diagnosis and management of this patient(going in i thought this might be epstein barr, the catch here is that this man is gay, and that this could potentially be HIV)

12) a woman comes to you (GP) with a complaint that her baby keeps banging her head in the cot when she sleeps at night.ask examiner for investigations (all normal)...
(this one was tricky..i had no idea why this was happening from the history , her partner left her and she has no financial support..so i thought a cry for help.. maybe...once i finished exam and checked up there is a thing called benign rolandic epilepsy that happens only when babies sleep..so i feel i failed this station)

13) a woman comes to yo(GP) u after you referred her to gynaecologist for menorrhagia (hysteroscopy, pap smear..normal)..now suffering from menorrhagia again ,Hb 70 ..discuss management with patient

14) a man comes to you (GP) with lower left quadrant pain..feeling unwell please perform abdominal examination...and discuss management with examiner
(so ur standard abdominal examination...hands,face,abdomen..the actor was tensing up his abdomen ..so when i started his deep palpation i couldnt get him to relax i stopped and told examiner this man has a rigid abdomen i explained what i would do in terms of completing my examination but there was no point as u cant palpate anything with a rigid abdomen...and he needs hospital admission with surgical evaluation..disccussed this with the examiner)

15) a woman postmenopausal comes to you (GP) after having lumbar xrays( vertebrae fracture) and dexa scan showing -3.0..i.e osteoporosis..take appropriate history and discuss diagnosis / differential and management with patient

16) a woman comes to you with a complaint of nervousness ..take history and ask examiner for examination and explain to patient diagnosis and management.

1) myocardial infarct
2) diabetes
3) lung cancer..hoarseness of throat the cancer has invaded recurrent laryngeal nerve..poor prognosis
4) peuperal psychosis
5) spontaneous abortion
6) UTI/pyelonephritits/cholecystitis
7) this murmur..could be VSD..realy not sure recomended peadiatrician to see since patient recently moved here (for specialist assesment..made a mention about prophylaxis for endocarditis)
8) orchitis ? cancer...
9)Would need to stop phenytoin / change but advised discussing with neurologist and getting his opinion ..and all the other prepreganancy stuff..immunisations/alcohol/smoking /etc
10) OCD
11)HIV
12) ? rolandic epilepsy / social worker needed
13)OCP pill for temporary management , will probably need transfusion since she was symptomatic, refer back to gynae
14)acute abdomen..diverticulitis.IV antibiotics vs Surgery
15)HRT,calcium,vit d..suppose potential differential would be mets to bone / multiple myeloma but she had no hx of cancer
16) hyperthyroidism..goitre



Clinical exam April 04 Perth

1 a mother comes to you regarding her 8 yr son’s deteriorating school
performance of last 6 month; take the history and dd, diagnosis, child hood depression, phobia

2 21 year uni student deteriorating performance at class the to delayed
submission of assignment for last 3 month OCD

3 48 year old man old CIA/FBI following him co dizziness after taking
riseperidon 2 days ago, take focused history, management, side effects, anti depressant

4 48 year old female BMI 27, smoker, came for endoscope report, shows reflux oesohpagitis, examine, management

5 55 female had difficulty swallowing was treated with omeprazole, felt
better with it, now it does not help; now difficulty with solid, swallowing
last week, take the history, investigation, management, ca esophagus

6 45 male his brother had bypass surgery came, for check up, assess the risk factor BMI 28, smoker, office job and council the patient, man died of heart attack at 55 years

7. 65 of female post op day 5 L THR c/o chest pain SOB on heparin 500 u bd, post op task, take the history, dd, investigation,

8 28 year female with a history of 3 year, amenorrhea, patient asked will I be pregnant, take the history, ask examiner test result, management agree


9 37 female primigravida 8/52 amenorrhea 2 wks history of vomiting take the history investigation, management, count the patient don’t forget about Downs syndrome

10 26 female 10 days post parturition of 2nd normal delivery time and with sudden onset of vaginal bleeding 1 day history. Take history, management, patient wanted to know do I need blood transfusion

11 40 year female, found a murmur 2 yrs ago during a routine check up,
patient asymptomatic, since she was diagnose with murmur, comes to you, examine the CVS and tell the findings, give running commentary- MR

12 23 yr female with history of dry cough not relieved, take the history,
examine, giving running commentary, examiner asked what investigation, you will do and the management

13 42 year female with history of leg pain when she walks 100 meter relieved by rest, examine the leg, give running commentary, examiner asked what test you will do

14 19 female, single mum with her 6 month old baby, has fever, vomiting,
irritability baby was seen by colleague 2 hrs ago found swelling R humerus, and bruise on cheek requested x-ray, showed spiral fracture R humerus, mother came to you to know about x-ray, task explain x-ray finding, management

15 mum came to you with her 18 year old girl who has T 38, urine shows
numerous leucocytes, child is otherwise ok, take history management mum wanted to know whether I am going to give antibiotics


1 primary postpartum hemorrhage
2 pre pregnancy advice for a lady who had DVT and PE postpartum 2 yrs ago
3 missed abortion diagnosis management ant treatment
4 croup diagnosis management
5 functional constipation in a 6 year old boy diagnosis and management and
history
6 behavioral disorder ADHD
7 mumps orchitis diagnosis management
8 Bells palsy management
9 hepatitis c management
10 herpes zoster diagnosis and management
11 dizziness in schizophrenic on risperidone management
12 PVD examination and diagnosis
13 loss of voice in a 17 year old history
14 acute abdomen exam and diagnosis
15 distal humerus fracture in a 11 year old diagnosis management
16 Tiredness and weight loss in a 60 year old

Clinical exam in Sydney stage 2 may 2002

1 F /30s acute appendicitis diagnosed by an intern occupation lawyer very
busy management: d/d what if dx is incorrect, types of appendicitis,
possible findings of chest x-ray in appendicitis.

2 M/50s post op anuria possible causes, p/examination, review U/S, fluid
chart, then management, write down your prescription

3 F/20s mother died of heart attack since then she has developed chest pain
palpitation circumoral tingling sense, spasms of hands, clinical management,
hypocalcaemia clinical management.

4. M/20s injury to left knee relevant history p/ exam, then I was asked what
structures are damaged.

5 F/20s family history of breast ca the patent has cyclical mastalgia,
reassure, primrose oil, management, included interpretation of u/s FNA as
well as explanation to patient, is this condition related to Br ca (danazol
bromocriptin tomoxifen, t4, FNAB c5 ca c4 suspicion/ probable ca c3
suspicion/ probably benign c2 benign c1 inadequate sample

6 F/20s regarding alcohol drinking e peer performance in the work place,
history, management, short term and long term problems, safe level of
alcohol drinking for women

7 M/50s black colored patient with a long history of alcohol drinking p/
exam this is a real patient, elicit & demonstrate relevant physical finding
alcoholic cirrhosis on eye exam nystagmus on lateral gaze was revealed

8 M/20s with occipital injury do cranial nerve test

9 M/30s with pain on the soles of both feet
History, pt management, x-ray, plantar fascitis

10 M/20s DVT developed following a long hauled flight, explanation,
management, risk factors, prevention, treatment, then write down your
investigations prescription on day 1 in hospital heparin 15000 unit /12 hrs
via pump compression, uss

11 M/20s presents with pain around the wrist management, history and
pat/examination revealed that the patient has De Quervain tenosynovitis
physical signs the tendon involved



12 M/40s with IDDM narrowly escaped a car crash this morning he as and
insulin injection this morning as usual without taking meals because of
running out of time management

[walid51]

AMC clinical Melbourne may 2005

1 History of 3 year old boy of viral infection 2 weeks ago blood result
pancytopaenea.Management, talk to father

2 Henoch scholien purpura, 5 year old boy, photo shown, urine protein ++,
rbc++,
Management.

3 SIDS, baby 3 month old died, history of viral upper respiratory infection
2 days ago, talk to the sister of baby’s father.

4 24 weeks ADG, 20 years old, lives 80 kms from the city very much worried because her first pregnancy was OP position with prolonged labor, delivered by forceps, now she is very worried, history and management

5 20 year old lady, 20 weeks pregnancy, had previous history of herpes
simplex, now she has developed ulcer on labia, not much painful, history
management of recurrent herpes simplex

6 a lady delivered a baby 4 days ago, now developed fever, mastitis, history management investigations.

7 20 year old man, wanted to lift a very heavy object, to sever pain in his
shoulder task examine R shoulder, history for diagnosis of rotator cuff tear or shoulder dislocation

8 40 year old male going to overseas, gp found a heart murmur, examine the CVS of patient and comment to examiner

9 a lady 60 year old, had bowel operation 6 weeks ago, now suddenly she has developed R sided pluritic chest pain, tasks describe cxr and management pleural effusion

10 40 year old has action tremors for last 20 years, father had Parkinson
disease, task history, management, investigation, diagnosis, benign
essential tremor

11 25 year old had mump 2 weeks ago, now he develop orchitis, his sons also had mumps, he is very worried about orchitis, future fertility, sexual life,task, management worried about 3 years old son because he might get mumps

12 a unistudent checking his study all the time, cannot study, failed in the
examination d/d OCD, delusional disorder history d/d talk to examiner

13 a 20 year old lady came back from overseas long hall flight develops pain in R leg, uss, DVT task, history, management

14 49 year old male complains of pain in R upper abdomen with rigors and fever, and mild jaundice, tasks, history, management, investigations,
diagnosis, ascending cholangits

15 a 50 year old lady had colonoscopy, showed colonic polyps, with mid
dysplasia, which were removed, task follow up, talk to patient

16 daughter of a 65 year old mane with Alzheimer’s disease comes to see you, she is very much concerned about his father, he lives alone, impairment of cognition, is wandering around houses, council daughter about the management of her father

[walid51]

Sydney may 2003

Station 1 h/o DVT management write prescription down
Station 2 low back pain examine lower back
Station 3 young female on ocp, bp, 160 /105 management
Station 4 fibula fracture management
Station 5 rest
Station 6 renal colic management
Station 7 Woman young excessive alcohol for last 6 month dd post traumatic stress disorder, depression, alcoholism
Station 8 examination hand H/o arthritis
Station 10 young female patient comes to you in tell her about the report
FNAC shows papillary carcinoma of thyroid
Station 11 young male patient with history of asthma comes to you because he bad allergic reaction atopic dermatitis management
Station 12 55 yr old male patient comes with long standing COPD council him about management, also instruct how to use of bronchodilator inhaler



OSCE’s

1.8 yrs old john come to see you and his mother for last few days is
complaining of bad pain all exam
Urine NAD
Task relevant history
Discuss with mother about diagnosis and management

2.65 female come to your practice for her x-ray report. x-ray shows
compressed fracture T11 no neurological deficit x-ray provide
Task: take relevant history
Discuss with patient about x-ray finding
Discuss the management with the patient

3.You are working in emergency department in a tertiary hospital a 32 week primi-gravida presents to you after a MUA no injury found
Task: take relevant history
Ask examiner about exam investigation he will only tell you if you ask.
Discuss your management with the patient

4. You are about to see a patient in ED brought by friend from hostel who
has found him unconscious. He has just come to the hostel. The person who brought him does not know him at all
Examination time 4 min rest 4 min for d/d and inv
Do appropriate e exam narrate it to examiner or tell him at the end of exam
Tell the examiner d/d
Tell the examiner appropriate investigation and why you’re doing it.

5. GP 23 year old accountant comes to you has found elixir of life wanting
to tell it everybody cam to you so that you can help him to distribute his
elixir of life
Task: take relevant psych history
Tell 4 dd’s to examiner
Management to plan

6.4 yr old boy brought in by anxious father the boy the father both had
lower resp tract infection 10 days ago now father is ok but the boy is
coughing for last 10 days. He has a 2 yr old son also. x-ray, spirometery
and chest x-ray and sputum Normal
Tasks take relevant history
Discuss management with father.

7. 32 years old women comes to you of SOB and palpitations for last few
weeks she has been involved in MVA few months ago General examination
Take relevant history as k the examiner examination finding discuss the
diagnosis and management with patient
8. 28 year old primi-gravida 12 weeks pregnant work as prostitute came to visit you seen by your colleagues 1 week back and done some inv she wants to know the result
Take relevant history ask the examiner about exam he will only answer if
asked. Discuss management with patient.

9. ED 20 year old man come to see you with rash snap shot supplied he was seen by a gp 1/52 back of sore throat
Take relevant history 4 min
Ask examiner about inv and exam he will only answer if you ask
Discuss your management with patient

10. 36 years old lady long standing mild hypertension and type 2 DM comes to you for visual loss temporary on rte y. she is on perindopril 2 mg glicalzide
Task: take relevant history 23 min as the examiner about the examination finding 2 mins
Ask the examiner about examination if discuss tithe patient about what
investigation you are going to do and management plan

11 4 years old lady come to you found to have fist blood sugar 15 bp 150/96 mild obese
Take relevant history 4 months
Ask the examiner about exam finding
Discuss with patient inv and management

12 40 year old man comes to you with cp which wakes him up at 2 am
Relevant history ask the examiner about examination
Discuss with patient about inv

13 40 year old lady comes to you with PR bleeding exam 2 hemorrhoids
Relevant history
Discuss with patient about her further management

14 anxious mother came to you because her 4 years old son in bed wetting
general exam
Urine nad
Relevant history
Discuss management plan with mother

15. a young lady come to see you she is going to Europe for a month long holiday on her way she will stop over in Thailand for 2 /5 days
Task discuss immunization answer her questions

16. Anxious mother came to you with her 12 years old daughter she has
started her periods which is to going to last 10 days
Tasks relevant history
Ask examiner about exam and invest finding
Discuss with mother about management


Adelaide 2001

Management DVT and anti coagulants knee examination of a rugby player
injured
Management of urinary tract infection and write a prescription
Appendicitis operation advice
Carpal tunnel patient examination and causes of thenar muscle atrophy
Examine abdomen liver cirrhosis
Pain right upper quadrant Examine abdomen us supplied diagnosis gall bladder
stone cholelcytitis
CVS examination and pansystolic mummer
Or tem r
Advice HRT effect on br cancer
Int claudication examiner and manage


Sydney 2001

1.Examine CVS VSD v wave r and PS heave pansystolic murmur tapping apex ,diagnosis mitral regurge dd MR

2.Examine GIT nad history varices hepatospleenomegaly had chr Liver disease

3.Young girl high blood pressure history investigation and management OC pill and smoking most for cv risk, stop ocp advice stop smoking

4.Renal colic diagnosis explain investigation management ivp given and stag horn stone

5.video tape 3 min watch patient and mental exam
dd anorexia bulimia nervosa

6.Examine comatosed patient

7.History and management rectal bleeding patient 23 history father died of bowel cancer 57

8.Picture of left supra clavicular node exam and investigate report given FNAB squamous cell ca dd skin GIT malignancy lung ca

9.Wrist injury with tile cutter examine hand diagnosis ulnar nerve injury ,
tendon - branch flexor carpi ulnaris injury

11.Examine breast lump formal breast examination in a normal acting patient dd fibroeadenma now cyst cancer history breast cancer family ovarian cancer

12.Examine diabetic patient for review 6 months and mention any bruit neck chest heart kidney abdomen of AAA then I did p vascular examination Left limb then I did neurological examination on Left limb

13.Exam abdomen and history for right hypochondrial pain acute cholecytitis


Melb 2002

1 55 65 year old male drinking alcohol in past examine him examination
revealed a large distended abdomen bulging in the R side with old scar. What is the diagnosis?

2 32 year female picked or pulled up heavy things1/52 ago now she has got shoulder pain examine and diagnose

3 32 y female past history of knee trauma medial side with tenderness
examine diagnosis and management

4 33 year old female police officer refer to you for diagnosis what is wrong with her She is not good in her job always drinking drowsy not doing her job well drinking 8-9 glass wine every day management otherwise losing her job do u get withdrawal if u don’t drink

5 45 y old IDDM 3d episode of hemiplegia and slurred speech
history, management TIA

6 32 year old female has checked BP 150/110 she is on the pills management (pill e BP)

7 lump in the back of her hand diagnosis and management gangelion breast

8 45 y of female had leukemia 1 year ago had chemotherapy now `10% wbc.She is crying refusing chemotherapy management

9 cxr diagnosis pneumothorax history 3 yrs ago which had was running p/w SOB

10 28 year old male after death of father not sleeping diagnosis


Management

1. 65 years old male with back pain x-ray shows t12 density decreased BPH 32 year ago operated smoking

2. 35 year old male testicular swelling 2 weeks ago

3. Young man severe asthma attack

4. Migraine

5. Difficulty of urination

6. 50yral old male good health father died of heard attack worried take
sleeping pills before to see you BP 150/89


7 60 year old male with heart failure and AF on warfarin for 3 months has
had cholesterol 6.5 and on lipid lowering tablets he was also on digoxin
tablet INR 25. Today planning to have a long flight travel worried to have
DVT candidates have been asked lots of question regarding anticoagulation therapy complication contraindication interaction with other drugs etc you are not allowed to ask more questions

8 20 -25 year old female notices an upper outer quarter breast lump the lump was 2 cm by 2 cm non tender lobullated firm she felt it about 2 months ago no significant change in the last 2 month a few small ancillary lymph nodes palpable last period 3 weeks ago no family history of breast cancer on OCP discuss your management plan of the patient

9 65 year old male ultrasound found 6 cm 2 week ago and 7 cm today of his abdominal aorta please discuss his management plan

10 4.45 year old male complains of chronic abdominal pain, endoscopy found duodenal ulcer H pylori and discuss your management plan

11 50-60 year old female who underwent laparoscopic cholecystectomy a week ago developed sudden onset to breathlessness 2 hours ago in ICU now suspected as having PE x-ray, ecg and lung scan shows V/Q mismatch she is on O2, IVF, heparin informed the surgeon who is on his was asap non smoker no previous medical problem once drinker married with 2 children lives close to husband the husband very distressed wants to know how is his wife is it serious condition upset that the surgeon did inform that it couldn’t be a complication of surgery wants to sue the surgeon. Also discuss how could it be prevented in the future
Acknowledge his distress risk factor prognosis anticoagulation warfarin INR precautions monitoring prevention

12 42 year old man married with 2 daughters school teacher occasionally
takes alcohol no smoker found to have BP 160/95 mm with he win tot donateblood at red cross camp to see you a gp clinic with BP lying 165/90 and standing 150/85 fundi exam normal CVS exam normal urinalysis normal no secondary cause of hypertension ,glucose 6.8 (not fasting) cholesterol 5.5 (not fasting) ecg norm BMI 31 24 hour monitoring 160-185/90-105 family history father had coronary angioplasty mother type 2 diabetes and angina you see him for review discuss management

12 50 year old male had colon cancer diagnose with colonoscopy biopsy
results adenocarcinoma. he was on waiting list for operation the specialist
will remove cancer within is locate in 17 cm above anum and temporary stoma
P/H healthy F/H father had bowel cancer mother had heart problem smoker and social alcohol the examiner kept asking he is on waiting list how to quit smoking? what would happen before operation? (DVT, bowel problems, medications).

13 35 year old male known to your surgery whose father died 3 days ago of a massive myocardial infarction. He is worried about the possibility of the same happening to him. Also concerned about his mother who does not seem to coping very wellnote I explained to him what myocardial infarction is and I went through the cardiovascular risk factor and advised him regarding them I offered a consultation with his mother but she was not keen to come to the surgery so I suggested a home visit at the end of the case the observer examiner asked me about the causes of sudden death

14.A 26 year old women presenting to you after her father sudden death 1 month ago at the age of 57 years which was completely unexpected because he neither complained nor visited a doctor in the last 20 years he was not smoker did not drink alcohol did not have any know risk factor for cardiovascular disease postmortem examination proved massive myocardial infarction her mother is patent of yours for 20 year visited you just before the death of her husband and her medical check up was normal the woman presenting to you today wants to wants to enquire about the reason of her father death and also she is concerned about her mother who is still in shock she thinks that her mothers grief may has exceeded limits because she claims seeing and having her husband feeling of blame

15.45 year old man bleeding after opening his bowel

16.40 year old man has observe bright red blood on his feces he had a back injury some years ago and is taking pain tablets which he buys over the counter

Second stage

1 . 24 years old female present d to your surgery after an eversion injury
to left ankle today she has limited rage of an active and passive movement
especially lateral flexion. There is swelling & tenderness crepitus on
lateral malleolus, other examination are limited because of pain. You have
an urgent x-ray of left ankle AP and lateral
Your task View the x-ray that you have ordered
Explain for the examiner about finding and management plan
Advise the patient (a comminuted fracture of distal fibula. how long it take
to heal how long it takes to move? does she need physiotherapy what is you first management now)

2 a video showing 42 year old lady being interviewed, the lady was saying
that she has erratic eating and binge eating since aged 15 year your task to tell the examiner about her mental status. Answer the examiner and give your provisional & differential diagnosis. The examiner asked me what are the other things you want to know and not present in this video. (Patient rapport?? examiner every thing is guarded I would like to ask about suicidal attempt, hallucination) provisional diagnosis is bulimia nervosa next question what other physical problem you have to exclude

3 A Victorian police officer 31 is your patient for a long time, presented
by her senior officer because of changing behavior, less performance at work having sick leave in beginning of each roaster she also starts drinking alcohol in the last few months. Your task is take further relevant history and give 3 differential diagnosis
answer the examiner question from the history she had two accident one of her colleague died in front of her and another of fire shooting accident.
She didn’t have counseling after that she complains of insomnia, poor
concentration, loss of appetite, drinks 6-8 glasses of wine/ day feels
depressed and lives alone she has history of depression and feels life is
not worthy of living provisional diagnosis PTSD leading to depression and
alcohol abuse examiner asks about short term effects of alcohol and normal limit of alcohol drinking per day and week

4 a young patient presents to you with injury to rt writ your task take
further relevant history, examine the patient, explain diagnosis, exact
injury

5 a 35 year old female presented to you with dysuria, frequency and burning sensation you have ordered dipstick of urine for her, which shows protein urea and nitrate. Your task is explain the diagnosis what is your advice for the patient about management write a prescription

6 35 years old female in general medical ward she has long history of
controlled NIDDM your task is examine the patient tell the examiner about
your findings a sgyo go she has peripheral neuropathy with two rounded red smooth and non ulcerating skin patches you are not allowed to take further history

7 24 years old presented to you with repeated increase in bp it was checked two times in the last few weeks and you check it today is still the same reading which was 150/105 she does not have any complaints, on physical examination she was normal her bp was checked once years ago it was 130/80 when her previous gp commenced her on ocp your task is take further relevant history explain your management plan to the patient

8 a 60 year old female patient complaining of backache. her x-ray showed osteoporosis which was confirmed by low bone densitometery scan take further relevant history examine patient the diagnosis, advise her patient about you management plan, the patient asked about HRT, what are the contraindication, if she should not take the HRT what other tablets she should take

9 a 35 yr old male presented to you with backache after lifting heavy weight at work your task is to examine the patient give your diagnosis the patient has L5 nerve root compression

10 a 45 year old male alcoholic presented to with you, real patent, your
task is to examine the abdomen of this patient, tell the examiner about your finding as you go, patient has hepatomegaly with ascites

11 a 25 year old male a basket ball player presented with anterior shoulder dislocation while he was playing basket ball, the dislocated shoulder was reduce by another gp the patient has history of previous anterior shoulder dislocation before two months, he has history of loss of sensation in other part of the arm your tasks is to perform relevant physical examination, tell the patient about your management and answer the examiner questions, which nerve is affected by anterior dislocation, can be always posterior dislocation do you need any further investigation
What will be the further management for this player?

12 a 18 year old female present to you by her brother, she had RTI 3 days ago, temp 40 she is drowsy and lethargic your are unable to communicate to her o/e no neck stiffness has had a rash (the picture will be shown to you in examination room) your task is give the brother your diagnosis what are your advice regarding further management the examiner asked what would you do to this patient before sending her to hospital antibiotics what type what is the dose.

Brisbanse 29th October

1) My first case was a snake bite . How do you manage it? in the ankle,
pateint stable, young, bitten 30 minutes back

2) A 3 yr kid with previous dx of asthma, hospitalized for a week , he is
going to get discharged, Talk to the father (counselling) Spacer counselling

3) Liver metastaisis, counsel, and tell about the diagnosis and
investigations (repeat from adelaide)

4) A patient with known hemaoohoids 65 yrs, comes with left illaic fossa
pain pain and discomfort, in further talking we realise that his father has
colon cancer, talk to him about his investigation. He was tired, no waight
loss, no colonscopy done before. Might be cancer so rule that out

5) Patient with known 1.5 cm breast mass, FNAC diagnosis cancer, patient
asked what the specialist will do? Cure rate No lymph node clinically
palpable. Discuss about tt

6) young girl with severe headache from yesterday morning, furter
photophobia, neck stiffness, ask for CT scan and admit to hospital with dx
of subacranoid hemorrhage. Slight fever so rule out meningitis also.

7) 30 hour newbornwith jaundice but parents have noticed jaundice before 24 hours as well : ABO incompatiblity, pt is well but yellow manage and counsel father. Mother 0 + and baby A+

8).Girl caring for a end stage cancer mother, all of sudden she lost her voice. Funny station. Ask about HEADSSS, she could only nod yes or no. Asked about
suicide, and finally I get her to answer me by writting, but the time run
out when I had asked just two questions to be written including her name.

9) Examination of diabetic foot. No finding except glove and stocking
sensory neuropathy. No motor, no pulse. basically normal person acting as a diabetic.Vibration was ok.

10) young 40 yr od man , first time UTI manage it, Since it is first in male
below 60 he sould be investigated. He was asking why should I get
investigations. What antibiotics > trimethoprim.

11) Patient has huge pneumothorax, without symptoms, first episode. Young male. Hat to do, when someone else asked about aspiration he was asking are you sure. I just managed conservatively.

12) Recurrent abortion at 8 weeks and 10 weeks andeveryting else including all imaginable investigations were normal. Including blood : anti
phospholipids, USG, chromosomal, hisograms. pt asked about cerclage, but I refused as it is not 2nd trimester abortion. Referred to get rid of the case

13) 5 yr old boy, with fever and leg pain, slightly under the knee. without
any other problem, Possible osteomyleitis, Xray and DD

14) gestational hypertension : 34 weeks now. 150 / 100. Rcollege of obst
says that follow with freq checkings, no drugs , I did that. no proteinuria,
no odema.

15) 55 yr old female with incontinence what to do. Investigations ordered
and asked to do pelvic excercise.

16) Schizophrenic with olanzapine complaining of weight gain, talk ask and investigate., also ask about diabetis.

Queries welcome, will post more details if anyone wants to ask specific
question you are welcome, But remember if you get help from here try to help people later after your exam.....

AMC PART –II CLINICAL EXAMINATION

MELBOURNE 26TH FEB 2005

OSCE



1) You are GP in town, and 38-year-old female presents to your practice c/o
“heart turns”. She has heard that you are very good and wants to talk to
you. She is worried about her heart and describes these as runs of fast
heartbeats, which is pounding and loud enough to be heard. This has been
happening for 6 months every now and then. Your fellow colleague had seen her 2 weeks ago when he did basic blood tests including sugar, Hb,
Electrolytes, Renal and Thyroid Function tests and ECG. All have come
normal. Task: Please take relevant history and tell the diagnosis to the
patient. Answer her questions.

2) You are medical officer in an Emergency Department and a young
19-year-old boy is brought in by the ambulance who was found unconscious in his flat. His flat mate has only recently moved in to his flat and hence has no idea about his past life. In ED, the Airway, Breathing and Circulation has been assessed and secured. Task: Please assess his level of Consciousness (GCS) and other relevant areas to suspect the cause. At the end the examiner would ask you four causes of coma probable in his case.

3) A 24-week pregnant lady comes to your practice who is curious about
circumcision. She wants her son to be circumscribed but has heard both, good and bad about it. Task: Please answer her queries.

4)Your next patient is a 32-year-old lady having 3 kids and wants
sterilization operation on her. She already has discussed this with her
husband and they have agreed to it. Task: Please take relevant history and counsel her regarding sterilization.

5) A 42-year-old patient has come to see you. He is your old patient, had a Bowel Carcinoma 2 years back was operated for the same and was doing well until 3 weeks ago when he developed Ac Intestinal Obstruction and was taken to ED. Laprotomy was performed to see that the cancer has spread beyond pelvis, into the mesentry, liver, para-aortic LNs, peritoneum. Grossly adhered loops and obstructive growth recurrence was cleared with great difficulty, and an end-to-end enterostomy was performed. Now his bowel function is normal. On discharge he was given Panadol 1G q4h for pain, which is not doing enough. He has come for pain in pelvis. Also he is worried and wants to know about his disease and condition. Task: Please tell the patient his condition, and develop a plan for him. Answer any questions he has to
ask.

6)A man comes to you c/o tired ness, week ness and problem with his water works. Task: Please take history from the patient, give your differential diagnosis to the examiner and answer any question he has to ask.

7) Photograph of Alopecia Areata. This gentle man comes to your practice
with c/o hair loss over a period of 4 weeks. Now he is worried about his
condition. Task: Please tell the patient the diagnosis and answer any
question he has to ask.

You are in ED as medical officer, and a father bring his 2-year-old son who was unwell for last 2 days with ear infection, and had a fit today morning at home which lasted for 5 min. When you examine him, he is playing and looks alert and cheerful. The father is worried about his son. Task: Please explain to him what is going on, and answer his questions.
You are night intern and are call by the surgical ward nurse to see a
patient who had undergone a laparotomy 6 hours ago for a perforated peptic ulcer. She is worried that he hasn’t passed any urine since the surgery. He has a temp of 37.8, Pulse of 110, and a BP of 124/82. He has a NGT in place, which has drained 350 mls of bilious fluid from his stomach. He has been receiving Dextrose 5% 1L over 6 HRS, which is about to finish now. Task:
Please examine the patient, find out the cause of anuria, and write down a
management plan including fluid order for this patient. The examiner will
then ask you some questions

9) A 35-year-old lady comes to your surgery and wants to see you to get a letter to the Ministry of Housing to enable her to change her location. Her worry is that her neighbours are playing games with her. Task: Please take proper history and give the differential diagnosis to the examiner.

10) You are medical officer in Obs and Gynae ward and are stitching an
episiotomy of a young woman who has just delivered a healthy 3.5 KG boy by forceps. This was her first pregnancy. Suddenly she has generalized convulsions and becomes unconscious. Task: Please ask for examination finding from the examiner (No history please), and tell the lady’s husband who is sitting outside the labour room, as to what has happened. Answer any questions he has to ask. The examiner will then ask you to manage this patient.

11) A 55-year-old taxi driver comes to your practice c/o very severe pain in his right great toe for last 2 days. He denies and injury. He takes
indepamide for BP, smokes 20 cig / day and drinks about 3-4 beers / day. You find that his great toe is swollen, red and tender. Task: Please tell the
patient the diagnosis and what investigations you would do. Also plan a
management for him.

12) A 36 week pregnant lady comes to your surgery because she is puzzled, if
breast-feeding is better or not than formula feeding. Her friends have told
her that breast-feeding causes anemia in child and also that it causes
breasts to hang down, obesity and weakness. She is very health conscious and educated lady. Task: Please tell her which is the best option and why, and also answer her questions. Also explain to her the steps of safe formula feeding.

13) A young female of 25 years comes to the ED, where you are MO, with
severe pain on the right side of her abdomen. Task: Please take relevant
history ask the examiner for physical finding and to provide differential
diagnosis. You will be asked about management.

14) A 27 years old 30-week pregnant female comes to you with h/o sudden pain
abdomen with some bleeding P/V 2 hrs ago. Now she is settled. Task: Please take relevant history, ask for physical findings, do proper investigations and reach a diagnosis. Examiner will then ask you further questions regarding management.

15) A 65 years man comes to your surgery with c/o gradual onset of pain in shoulders and pelvis over last 6 months. Task: Please take relevant h/o, ask for physical findings, and investigations, and give differentials. You may
be asked about management.

Answers:

1. Anxiety

2. REST

3. Coma (GCS) assessment

4. Circumcision in New born

5. Sterilization in 32YO F

6. Advance Bowel Carcinoma

7. REST

8. BPH

9. Alopecia Areata

10. Febrile convulsion

11. Post op Fluid balance

12. REST

13. Paranoid Schizophrenia

14. Post Partum Eclampsia

15. Gout

16. Breast Feeding Vs Formula Feeding

17. REST

Brisbane
1. pyloric stenosis
2. 40 weeks fetal death in utero
3. 28 weeks pregnant with ovarian cyst
4. 4. hyperprolactinemia noral FSH LH 28 years
5. OM serious
6. Tx of RA
7. sexual abuse
8. abdominal plain with jaundice increase ALT UTI in 6 month dd and tx


Adelaide
Carpal tunnel examine the hand
Counsel for appendectomy
GIT exam of chronic liver disease
25 year girl with recurrent UTI
Rugby player with knee injury complaining of knee pain
CNS exam
Woman on the HRT counseling
Male intermittent claudication
Acute cholecytectomy surgical counseling
Male gp cvs murmurs systolic as
Female with DVT management
Hand exam osteoarthritis

pediatric

5 y/o wheezing
Eczema on hand
Soiling
16 year with DM sugar 5 taking thiazide


Sydney stage 2

80 year male going overseas gp found murmur systolic know causes usually as

70 yrMale admitted previously with 2 episodes of hematemisis

Examine GIT liver spleen know borders and technique
peptic ulcer
portal hypertension
White nail
Duputyrens(negative)
Hepatomegaly (positive)
tremor (negative)
jaundice (negative)
What invention FBC LFTS clotting studies
Chronic liver diseases can’t be ruled out might have ruptured esophageal
varices

Female on pill of 3 years diastolic BP 105 mmHg
Kidney problem
polyurea
Known causes of high BP discuss factors long term management stop ocp and
other forms of contraception diagnosis fibromuscular dysplasia because she
still young

Video about a woman talking and about eating problem what is your dd
anorexia & bulimia

Renal colic explain to patient the condition long term management pain
relief very important
Investigations IVU

Patient with RUQ pain his five jaundice (negative) exam in abdomen acute
cholecystitis and then explain why

60 year old woman diabetic for 5 years in hypoglycemia
Discuss risk factor of diabetes
What are the hypoglycemic drugs suited for him advice

Girl in coma brought in ED by flat mate who did not know anything what to do
abc Glasgow coma scale
pupils
FBC
blood culture
bsl
ct scan
parent look stable in observation room what you ddx
drugs dose epilepsy diabetes

Boy at work cut right wrists palmer examine ulnar nerve damage flexor
digitorum profundus superficailis

Breast exam technique
dummy breast on table but still treat it as a person introduce yourself and
explain what you are about to do
FNA lump on neck Bx result SCC where do think the primary lesion anything
around month neck chest
Investigation CT scan MRI Lymphoma Virchows node lf supraclaivular fro GIT
metastasis

PR bleeding for 3 week s 28 yrs father with colon ca d I am considering
colonic a I would like to request t for FBC colonoscopy if old do
sigmoidoscopy then proctoscopy

[walid51]

Stage 2 Melbourne 2002 April

1 36 year old female pre examination PR bleeding please take the history and outline the management positive family history of bowel cancer mother died of it at the age of 46

2 25 year old non smokers complaining of sudden onset of exertional dyspenia please take the relevant history outline the management and prevention (look in CVS and RS examination x-ray explain)

3. Young girl present to ED complaining of RIF pain of 1 day duration
surgical registrar made the diagnosis is acute appendicitis you are the
intern please take the history relevant examine and do necessary
investigation. counsel the patient regarding the surgical complications

4 27 year old female in OCP of HBP find BP 135 /104(or 150/100) mm hg
checked you on 3 different occasions you did urine ecg and chest x-ray all
normal please manage the patient

5 18 yr old boys mother died of 2 months ago with cardiac rest now he can’t sleep lack of concentration during daytime he is law student please take brief history and counsel patient

6 60 year old lady 2 year ago had leukemia and treated of the last 20 month her blood count checked is normal her last blood count however showed increase she has another relapse your task is to tell the patient about the relapse of symptoms patient was crying the whole time refusing the chemotherapy management

7 4 year old police women was sent by her supervisor to you regarding her recent poor performance eat work he also noticed about her recent alcohol intake please take the history and out line the management

8 20 year old boy had sustained shoulder joint injury 2-3 week ago now he complains of pain please examine the patient give your diagnosis rotator cuff lesion painful abduction 60-120

9 20 year old boy sudden knee join injury 2-3 weeks ago now present of pain of left internal knee joint please examine the patient diagnosis and
management medial collateral and meniscus tear

10 55 year old male presents of lump on the back of the neck lipoma please examine outline the management now to do fine needle aspiration and cytology excision biopsy

11 45 year old male heavy alcoholic present to ED complain of hematemesis please do relevant examination and out line the management



12 50 year old male now present to left leg weakness NIDDM I week ago he had similar episode associate expressive dysphsia please examine the leg (neurology 0 where else would you like to examine the patient what are the investigation give 2-3 main advise to the patient

mcat sept 2001

1. History give pain tingling R hand especially at right for 3/52 exam and
counsel patient carpal tunnel syndrome (thickening of flexor retinculam
trapped median nerve in the carpal tunnel)

2. Exam this patients hand give a differential diagnosis how to investigate
and manage osteoarthritis

3. Pt presents to ED after vomiting 500 ml of fresh blood had previous
history of hematemeis and found to have esophageal varices on endoscope he has history of alcohol abuse exam the appropriately

4. Pt presented to ED after a fall on occipital region had short duration of
LOC how You have examined her and found marked tenderness at R
hypochondrium. temp 38 pulse 100/min BP 140/90 you have ordered an us exam please look at the us counsel pt appropriately acute hepatitis


Management cases

24 year old man single urethra discharge culture G diplococcus discuss drug course route screen other STD prevention prognosis fowl up
Bowel ca resect rectum now recurrent

25 y/o wants vasectomy

Respiratory COAD, asthma show to resolve pneumonia coin lesion on x-ray
Cardiology palpitation atrial fibrillation angina myocardial infarct his
blood pressure
Neurology TIA completed stoke migraine carpal tunnel SAH
Endocrine diabetic new diagnosis IDDM migraine diabetes random elevated
sugar hyperthyroid
Rheumatology got osteoarthritis rheumatoid arthritis
Gastroentology Diarrhea irritable bowel constipation hepatitis duodenal or
gastric ulcer
Psychiatry depression anxiety bereavement
Renal hematuria
Renal colic
Vascular surgery claudication TIA abdominal aneurysm
GI surgery gall stone colonic ca
Genetics x linked autosomal dominant and recessive

[walid51]

the mcats part of the clinical examination

1.the task is to comment on the mental state and the differential diagnosis
of as woman after watching a recorded videotape of and interview by her
psychiatrist. The sound quality was really bad but the woman looked a bit
disorganized in appearance with slight hysterical feature and the subject of the interview was about bulimia nervosa

2.a woman with diabetes mellitus has come to you for medical cure up
systemic exam is normal complete the check up and your advise to the patient

3.a 23 year old female was found unconscious examine her and asses the
degree of coma Then give the differential diagnosis this was solely a role
play station

4.a 26 year of man has come to you complains of renal colic and the
examiner hand and an IVU showing a filling defect in renal pelvis explain to the patient to you management

5.a 24 year old female present to you because of her blood pressure with
was 140 /104 on 2 occasions measure by a nurse and today is 140/100. Explain your management to the patient.

6.a 54 year old male presenting with acute severe epigastric pain that
faded over the last couple of hours. he had fever 38 and tenderness on the upper abdomen examine the abdomen and give your diagnosis

7.a 46 year old man consulting you before his overseas travel and you
discovered a murmur on his chest he had normal water hammer pulsation and visible neck pulsations and faint diastolic murmur best heard on the aortic area and on leaning downward during expiration examine the CVS

8.examine the GIT system of this man who is 58 years old alcoholic

9.examine this man who sustained and injury to his wrist during his work
with a sharp instrument a role player with band on his wrist than I was
asked not to remove examination revealed a median nerve injury and injury to ulna half of flexor digitorum profundus then I was asked about how to mange such a case

10.a 25 year old male complain of passing blood after passing stool my task was to take a history and to mange the case.

11.10 month old baby girl with recurrent URTI in between episode she has a moist young developed a dry cough that age of 5 months now there is a
medical problem no failure to thrive and passing one broken stool a day the with history of mild asthma she is in day care 3 days a week immunization up to date


step 2 mcats

1. 75 year old male with murmur examine his cardiovascular system

2. 55 year old male with 2 episode of hametemesis advised to stop drinking
examine his GIT

3 42 year old male with renal colic explanation and long term management

4 3 minute duration video of male talking about eating patterns then asked
of and mental state to the patient

5 27 year old male with history of per rectal bleeding

6 breast examination in a model and in a patient

7 male with lump in base of neck who had fine needle aspiration with c
return squamous cell ca examine him and give differential diagnosis

8 27 year old female on the pill for 3 years. in a routine check up she has
been found to have diastolic of 105 mmHg management

9 male with injury to his left wrist deep laceration examine his and tell
what has been damaged it was ulnar nerve flexor tendons

10 55 year old female non insulin dependant for 5 years controlled by diet
and oral hypoglycemics follow up examination of relevant systems

11 male in his 50s with pain in the upper quadrant for 3 days also pyrexia
and vomited once take a brief history at the same time you examine him
explain your differential diagnosis and management

12 21 year old female brought to emergency department by her flat mate found
to be unconscious there is no history no personal details what are you going
to do in the emergency department asked about causes of coma relevant
investigation and also coma scale she had a GCS of 12 over 15 then.



Stage 2

Station 1 70 year old lady with SOB examine her cardiovascular system
comment on your findings as you got through pacemaker present mitral
regurgitation aortic stenosis mild JVP elevated

Station 2 read and proceed
Laminate a4 paper
This 40 year old man attending the ED with vomiting of small amount of fresh blood he had similar episode in the past but treated conservatively now she is hemodynamically stable he also says that he is unable to give up drinking in spite of repeated advice examine this patient
relatively obvious case of chronic liver disease with evidence of portal
hypertension spider neavi gynecomastia distended abdomen with loss of male distribution of hair with abodmen and axilla testicular atrophy left side testes is very small soft and atrophic just like birdseed liver 4 cm below costal margin spleen just palpable ascites pr not allowed no ankle edema no fetor hepaticus no flapping tremor

Station 3 resting station

Station 4 Read and proceed this 26 year old girl thought to have high blood pressure of 150/105 on a routine examination the pressure was checked on repeated occasions and still found to be high she is on pill combined for the last 3 years but BP was normal 3 years ago before her first prescription. The previous doctor could not find any abnormality on physical examination your task is to take a relevant history examine
discuss how are you going to proceed further history did not give any clue
of a secondary cause physical examination and office test did not show organ damage

Hence mentioned about the investigations

FBC
ecg
LFTs
TFT
24 her urine for vma
cxr
us scan
kub
bsi

Station 5

introduction by the psychiatrist

in this station a 3 minute interviews will be played in the video your task
is to do a mental state examination of the patient and come to a reasonable diagnosis with other differentials you will give 2 minute to prepare your self and use this pen and pad of any notes with you ready this video will be displayed
Interview
Female patient but her statements were not very clear but few clues were
thereStill at night time I tend to eat more but I try to bring it out doctor
Sometime I us purgativesI lost 5 kg but not very happy still

For mental state examination follow the below mention rule

Appearance (clothing, hygiene, makeup)
Behavior (posture eyes contact etc)
Conversation (rate tone content flow of ideas)
Affect mood suicidal thoughts
Perception
Cognition
M memory shot and long term memory
O Orientation
A Attention
T Thought process

Judgment how well responding to demands in society the is patient a thereat
to self or to others
Insight about his illness
Rapport

Dd
Bulimia nervosa
Depression
Anorexia
Endocrine thyroid

Station 6
This 25 year old male patient suffered an episode of abdominal pain which
radiated from right loin to groin and was shooting down his scrotum now he is pain free.Task come to a reasonable diagnosis explain and discuss about your management
Discuss Ureteric colic is the most likely diagnosis
Principles of management
Investigation to find out the cause FBC EVC blood calcium phosphate uric
acid us can IVU x-ray KUB.
If it is at one establish the size already existing damage wheter
intervention necessary at this stage
How to tackle the pain if it recurs
Pain relief indocid suppositories other analgesics to take home if
If intervention necessary they meant the methods available briefly IVU
showed dilated calyces of rt kidney.

Station 7
This 40 year old man came with right hypochondrial pain and fever with chill and rigors
Examine the abdominal system discus your management
On examination icteric febrile 38
RBC positive Murphy’s sign
Pr not allowed
Patient also had obvious clubbing
Discussion could it be ascending cholangitis hence nil orally IV cannula
catheter monitor vitals
Pain relief operates
Antibiotics ampicillin gentamicin metoronidazole
Hydration
Blood FBC EVC LFTs culture
Group and save
Obtain consent in case of cholecystectomy

Station 8 resting station

Station 9 read and proceed this 45 year old lady with diabetes of 65 years
comes to your clinic for a routine check up she is on oral hypoglycemia only take relevant history examine appropriately discuss about your plan
History find out any organ damage eye heart kidney nerves
Go through blood sugar diary BSL was between 4.5 and 6.5 on two occasions it was more than 9.4 and other two occasions she had migraine for the whole day went out for lunch and difficulties or doubt about glucose monitoring.Examination of fundi
BP
Lower limbs neuropathy ulcers callous cones
Urine Albumin
Blood BSL
HbA1C
Lipid Profile
EVC

Station 10

This 60 year old man had a lump as showing the picture (picture showed
enlarged supraclavicular lymph node) the FNAC showed moderately
differentiated squamous cell carcinoma.
Task talk to the patent to clarify and possible caused and perform a
relevant examination explain him about your plan
Most likely cause is brochogenic carcinoma or skin cancer ca esophagus very rarely, asked about
hemoptysis cough
Smoking etc examination
Hands
Clubbing
Nicotine stain
T1 lesion
Wrist tenderness pulmonary osteoarthropathy
Face Horner’s syndrome
Lungs pleural effusion etc
Tests cxr bronchoscopy etc

Station 11

Read proceed
This is a 26 year old female lives in a flat but the flat mate does not know
about their occupant as she moved in last week only. This morning she was found on the floor unconscious flat mate called the ambulance and sent to the hospital airway and circulation are stable

Now consider you are the doctor on duty and show the examiner what you would do
Call for help: blue code
Immediate assessment cannula bloods cardiac monitor pulse oximeter finger prick BSL catheter PRN
Shake the patient gently because she is a role player
Say open your eyes for do know where your are
Pinch gently she opened her eyes and closed it again put you legs/ hands up Pupils reactive
GCS was 7-8
Look of indication marks drug addicts
Search of head injury
Neck stiffness Kernig’s signs
then proceed to do CUS RS and CNS
Examiner asked what should be the cause of this state
Toxin poisonous opiates/drugs organophosphorus
Infection septicemia meningitis esp. meningococcal examine specifically
asked
The patient mimicked of having neck stiffness
The antibiotics would be ceftrixone benzyl penicillin
Then depending on the two reports choose one of the two
Blood urine CSF for polymerase chain reaction PCR
Head injury CT
Hypoglycemia

Station 12 read and proceed
This 25 year old man complain of bleeding pr on and off for there weeks
Task take a relevant history
Counsel the patient regarding further examination
History fresh blood after defecation
Bright red in color other features to suggest any management of infective
process. Further analysis father had ca colon at the age of 52 and had some surgery but lived up to the age of 80 years
Two brother healthy
Examination of patent not allowed
This patient needs referral to a gasteroentologist
Colonoscopy flexible sigmoidoscopy
Follow up and screening to be began before the age of 46 year
Include his brother as well of screening program
Screening includes fecal occult blood testing and colonoscopy or Ba enema
Trace his fathers pathology report if possible
Diet advice
Presently the problem may well be due to hemorrhoids which needs appropriate treatment but because of the family history of ca colon he needs a through
investigation.

Station 13 resting station

Station 14 role playing patient with crepe bandage around the right wrist
This is 18 year old boy sustained a cut injury on the ventral aspect of
right wrist. Examine his hand
Look of damage to blood vessels
Radial and ulnar arterial pulses
Capillary refilling time
Damage to nerves motor and sensory function ulnar medial cranial nerves
Skin sensation of pin prick
Patient demonstrates ulna nerve damage ulnar claw impaired pin prick over
little and ring fingers
Examiner observes how to check for never functions and asked about ulnar
paradox
Tendon damage
Other questions asked the small muscle supplied by the median nerve action
of lumbrical muscle

Station 15 a breast prosthesis was kept on the table examiner asked to
examine this breast prosthesis and find out the lump well defined 0.5 cm
lumpFirm in consistency now examine this male patent but consider him as a female the a real of the lump is marked on his right chest show us how you will examine this patient routine breast examination.





2001 oct stage 2 mcats

1 a 75 year old male with murmur or a 46 year old man consulting you before his overseas travel and you discovered a murmur on his chest he had normal water hammer pulsation and visible neck pulsations and a faint diastolic murmur best heard on the aortic area and on leaning forwards during expiration examine his cardiovascular system

2 55 year old male with 2 episode of hematemis advised to stop drinking
examine his gastro intestinal system.

3. A 42 year old male with renal colic explanation and long term management the examiner handed me on IVU showing a filling defects in renal pelvis

4 3 minute duration video of a female about eating patterns then asked of
did and mental state of the patent. The sound quality was really bad but the woman looked a bit disorganized in appearance with slight hysterical feature and the subject to the interview was about eating patterns. Then asked of
differential diagnosis and mental state of the patient. The sound quality
was really bad but the women looked a bit disorganized in appearance with slight hysterical features and the subject of the interview was about
bulimia nervosa

5 27 year old male with history of per rectal bleeding this is to take a
history and to mange the case.

6 Breast examination in a model in patient that was a funny case I was asked to examine a lump in the breast model and in a patient that wand describe its characters which was supported by joined in 26 year blood female and then I was asked to give the differential diagnosis of the lump next I was asked to examine the patient on a male who was male role play a female

7 A 53 year old male smoker with lump in the neck role play who had fine
needle operation which turned as squamous cell carcinoma examine and give differential diagnosis to identify the primary

8 27 year old female on the pill for 3 years in a routine check up she has
being found to have a diastolic of 105 mmHg 140/ 104 on 2 occasion measured by the nurse and today it is 140/100 management

9. Male with injury to his left wrist deep laceration examine him and tell
what has been damaged ulnar and flexor tendons on examination this man who sustained an injury to his wrist during his work with a ship instrument a role player with a band on his writ that I was asked not to removeExamination revealed a median nerve injury and an injury to ulnar half of flexor digitorum profundus and then I was asked about how to manage such a case.

10 55 year old female non insulin dependant of 5 years she is controlled any diet and oral hypoglycemia has come to you for medical check up systematic review is normal complete the checkup and you advice to the patient or your follow up and examination of the relevant systems

11 Male in his 50s which pain in right upper quadrant for 3 days. Also
pyrexia and vomited once. Take a brief history at the same time you examine him. Explain your diagnosis differential and management

12 21 year old female brought to ED by her flat mate found unconscious there is no history no personal details what are you going to do in the emergency department asked about the causes of coma. Relevant investigations and Glasgow coma scale (she had GSC of 12/15 then the examiner asked me whether intubations is appropriate (abcd and neurological) this is a role play station


AMC mcat sept 2001

[walid51]

Common cardiovascular OSCEs


Guys, these are some recalled cases from different OSCEs. Would be of great help to familiarise yourself on these topics...



William Hartman is a 46 year old man who comes to your office with chest pain. In the next ten minutes take focused history and address his concerns. (Chest pain).

Michael McCarthy is 52 year old man, who is a known case of hypertension. He came to your office for his annual check up. In the next ten minutes perform a complete physical examination. On the eighth minute the examiner will stop you and ask you questions. (Hypertension).

Melissa Pilgrim is a 27 year old woman who has come to your office because oh heart racing. In the next ten minutes take focused history and talk to her about a possible management plan. (Palpitation).

Dan Greenspan is a 68 year old man who had brought to the emergency because he passed out earlier today at home. In the next ten minutes perform a complete physical examination. On the eighth minute the examiner will stop you and ask you questions. (Syncope).

Jenny Davidson is a 23 year old girl who suddenly lost her consciousness today and fainted. In the next ten minutes take focused history and address her concerns. (Syncope).

Lenny Sullivan is a 56 year old man who got a sudden bad chest pain when he was having lunch with his family. He was brought to emergency few minutes ago. In the next ten minutes manage him. (MI).

Alfred Sabitto is a 53 year old man who comes to your office because ho got swelling of his legs. In the next ten minutes take focused history and address his concerns. (heart failure).

David Perry is a 54 year old diabetic man who came to your office because of leg pain after walking. In the next ten minutes take focused history and perform a focused physical examination. (Claudication).

Eric O'Malley is a 51 year old man who came to emergency because of chest pain and palpitation. In the next ten minutes take focused history and address his concerns. (Chest pain/ Atrial Fibrillation).

Sandra Anderson is 81 year old woman who was brought to emergency by ambulance semiconscious, hypotensive and bradycardia. In the next ten minutes manage him. (Digoxin intoxication).

Andrew McDonald is 60 year old man who has a cardiac arrest while the ambulance is rolling into the emergency. He is quickly brought into the resuscitation room. In the next ten minutes run code blue and manage him. (Cardiac arrest).

Tina White is a 22 year old woman who was referred to you by a community nurse because of high blood pressure. In the next ten minutes take focused history and talk to her about a possible management plan. (Hypertension/ Pheochromocytoma).

Tim Brown is a 39 year old male who came to emergency because of sharp chest pain. He feels unwell and trouble breathing. In the next ten minutes take focused history and perform a focused physical examination. (Pericarditis).

[walid51]

A must know cardio cases for OSCE 's:


Chest pain.

Myocardial ischemia/infarction: ER management.

Cardiac arrest.

Palpitation.

Atrial fibrillation.

Syncope.

Hypertension.

Hypotensive shock: ER management.

Digoxin toxicity.

Pericarditis.

Infective endocarditis.

heart failure/ generalized edema/ ankle swelling.

Intermittent claudication.

Acute/ chronic leg pain.

Deep venous thrombosis.

Complete cardiovascular examination.

ECG interpretation.

Drug counselling for post MI prior to hosp discharge, etc



Hope this helps...

[walid51]

common respiratory osces





Asthma: in all scenarios: Acute ER setting management, Worsening follow up, After attack follow up, Consult.
Wheezes.
Pneumonia, typical and atypical.
Chest pain.
Cough.
Coughing up blood (Haemoptysis).
COPD: in all scenarios: Acute ER setting management, Worsening follow up, After attack follow up, Consult.
Shortness of breath.
Chronic shortness of breath.
Pulmonary embolism in ER setting.
Bronchiectasis.
Pleural effusion.
Interstitial lung disease, occupational cough/SOB.
Solitary pulmonary nodule on X-ray.
Pneumothorax in ER setting.
Rhinorrhea / Sore throat.
Sinusitis.
Chest X-ray interpretation.
Pulmonary Function Tests interpretation.
Arterial blood gases interpretation.
Smoking consult.
Respiratory system examination.

[walid51]

How to study




[Only Registered Users Can See Links]!download|365tl3|131424931|How_to_study.rar|105|R ~0D24E635A5178AE7E926FD91990BE720

[walid51]

Brisbane cond
5. counselling daughter of patient with early dementia
6. Parent of child with asthma
7. History pleural effusion
8. l5 disc prolapse
9. History - inflammatory bowel disease
10. Request for morning after pill
11. prepregnancy councelling - post partum DVT and PE
12. Child with new onset faecal soiling
13. Perferated viscous



1. Abnormal liverfunction tests
2. Acute abdomen
3. Anorexia nervosa
4. Cardiac murmur
5. Circucision (Paed)
6. Contraception request (O&G)
7. Eclampsia (O&G)
8. DM type I juvenile - counselling ( Paed)
9. Dysphasia & UL weakness
10. Lethargic febrile 2 yr olad (Paed)
11. Nut induced anaphylaxis
12. Pre-pregnancy counselling - diabetic (O&G)
13. Psychotic episode with violence - crisis management
14. Fracture clavicle

Stations failed

1. Pleuritic CP
2. Subcutaneous lump



disc prolapse
dvt and embolism and pregnancy
perforated abdomen
breast milk jaundice
functional constipation
pph
anxiety neurosis
plueral effusion
chronic diarrhea
acute asthma
fibular syndrome
hiv gonorrhea and clamydia
bronze diabetes
psoriatic arthropathy
alzhiemers
bells palsy




1 a pt of incontinence
2 a pt. of H.I.V.
3 a pt of anaemia
4 a pt of diarrhoea
5 a pt of neonatal jaundice
6 a pt of hand injury
7 a pt of cervical spondylosis
8 a 16 yr girl who ingested her mother's vallium counselling regarding mother to be informed or not.

[walid51]

AMC of 2006 in Adlaid.




Can somebody post AMC of 2006 in Adlaid? Many thanks.

Recalls of AMC on 25th Feb, 2006, Brisbane.

I started from station 20.

1. You are working in a district hospital as an RMO. You live about 10’ drive away from the hospital. At night you are called by the midwife saying a patient had about 1250ml bleeding PV. The patient delivered a baby today which lasted about 10 hours. Initially, she bled about 250ml.

Tasks: talk to the midwife over the phone and ask about patient’s situation and tell the Mx.

2. A 52 year old retired pharmacist came to see you with tiredness for about 1 moths.

Tasks: take history, physical examination, investigations, and Mx. (haemochromotosis).
Skin pigmentation, I forgot to ask about Iron study.

3. Brest milk jaundice. Hx, PE, Ix, Mx. Know the significance of conjugated and nonconjugated bilirubin.
4. fracture of left distal fibula and dislocation of the talus. Read xray, and Mx.
5. A woman with chronic diarrhea with blood and mucus for years. Brother has similar problem.
6. An old man’s daughter came to see you about her father’s dementia. CT generalized atrophy. I failed this one. Why?
7. Postnatal DVT. To have another baby. Counseling.
8. Hand examination: O/A. Heberden;s nodes in both hands. Otherwise ok. Associated with SLE. Dermatosclerosis?
9. a lady took Diclofenac for back injury and has sudden onset of epigatric pain in ED. Examine the abd and tell the Dx and Mx.
10. a fit young man with pain in the left buttock and left leg after lifting a heavy object. Take hx, Mx. Ix.
11. a child with wheezes, had a previous episode before. Had mild eczema. Family history positive. T 37.5. Hx, Mx. The diagnosis is asthma not viral bronchiolitis.
12. postnatal panic attacks. No depression, no suicidal ideation, had agrophobia. Hx, Dx and Mx,
13. a girl had sex with a boy whom she encountered last night. The condom was broken without knowing until 30 minutes later. She is concerned about pregnancy. Take history and Mx.
14. Bell’s Palsy. A middle age women with left face paralysis. Before that she had some pain behind the left ear. Ear chech up normal. Dx is Bell’s palsy. Talk to the patient about Dx and Mx. Reassure and no need for CT and referral. Make sure you check the eye. If it can shut or dry. May need patch or artificial tear to protect the eye; facial massage. Take steroid for about 10 days.
15. boy of 6 years of age, with soiling at daytime. Eats less vegetable. Drinks enough fluid and exercise. Anal fissure?

16. a middle aged man with SOB. Questions about SOB: onset, side, chest pain, cough, fever. Asked questions about anemia, depression, hypothyroidism. SH: heavy smoker. PE: dullness in right side. Dx; lung cancer.




man presented with pain in the chest, sweating, and shock. He was treated with cardio version with DC shock 100 Joules, 200 Joules & 360 Joules. Pt. Still on fibrillation. What you will you do next?
a) Repeat 360 Joules DC shock
b) I/V Lignocaine
c) I/V Adrenaline
d) I/V atropine
e) Mouth to mouth resuscitation


b) I/V lignocaine

If patient is haemodianamiccaly stable (which is true in this case) we go for second option after D/C cardioversion ie I/v lignocaine





Recalls of AMC on 25th Feb, 2006, Brisbane.

I started from station 20.

1. You are working in a district hospital as an RMO. You live about 10’ drive away from the hospital. At night you are called by the midwife saying a patient had about 1250ml bleeding PV. The patient delivered a baby today which lasted about 10 hours. Initially, she bled about 250ml.

Tasks: talk to the midwife over the phone and ask about patient’s situation and tell the Mx.

2. A 52 year old retired pharmacist came to see you with tiredness for about 1 moths.

[walid51]

MEDICINE


AMC PART 1 exam important questions 2010



1. Hepatitis C in Australia mainly spread by

1. heterosexual
2. homosexual
3. intravenous drug users
4.blood products
5.

2. Anterior uveities most commonly seen in
1. Rheumatoid Arthritis
2. SLE
3. Ankylosing spondilitis
4. .

3. Women presented with bleeding. She has a family history of bleeding (brother, father).
1. Haemophylia
2. Deficiency XII
3. Von Willebrand’s disease
4. .
5. .Christmas disease

4. Patient – pulmonary embolism
1. cyanosis
2. tachycardia
3. hypotension
4. haemoptysis
5.

5. Granuloma Anulare
1. premalignant
2. itch
3. irregular raised edge
4. oral antifungal treatment
5.

6. HLA typing most useful in
1. Renal Transplantations
2. Cardiac transplantataions
3. .
4. .
5. .

6. For organ donation how to diagnose brain death

1. No EEG recording
2.
3.
4.
5.

7. Myelofibrosis
1. tear drop cells
2. .
3. .
4. .
5. .

8.Young man – Ferritin slightly elevated,
1. Acute blood loss
2. Heamoglobinopathy
3. .
4. .
5. .

9.Which does not transmit HIV
1. Cryopresipitate
2. .
3. .
4. .
5. .

10. Woman taking progesteron complaines of a headache in the afternoon. Paracetamol did not help.

1. stop progesterone
2. start ergotamine
3. Relaxation method
4. .
5. .

11. Numbness of mouth . which nerve leision
1. VII
2. V
3. II
4. .
5. .

12.
12. Woman (old) , history of tremor- increase when reach for an object. Treatment
1. propranolol
2. levedopa and carbidopa
3. .
4. .
5. .

13. Parkinsonism
1. loss of postural reflexes
2. .
3. .
4. .
5. .

14. women present with
1. cervical spondilosis
2. .
3. .
4. .
5. .

15. Which arthritis heals completely
1. Rheumatic fever
2. Rheumatiod arthritis
3. .
4. .
5. .

16. What type of renal calculi seen if urine is acidic
1. oxalate
2. uric acid
3. .
4. .
5. .

17. How to confirm gout
1. check synovial fluid for crystals
2. .
3. .
4. .
5. .

18. Asthmatic patient – which is not a proper management
1. taking prednisolone for every attack
2.
3.
4.
5.

19. Red painful eye dilated pupil
1. Glucoma
2. .
3. .
4. .
5. .

20. bulging eardrum –what is true
1. spontaneous rupture relives pain.
2. .
3. .
4. .
5. .

21. Spont. Pneumothorax
1. needle aspiration
2. .
3. .
4. .
5. .

22. Patient had a fall from a roof. BP –reduced, RR- increased

1.
2.
3.
4.
5.

23. In duodenal ulcer – not seen
1. Anorexia
2. .
3. .
4. .
5. .

24. cellulitis
1. group A streptococci
2. .
3. .
4. .
5. .

25. SLE

1. > 90% patients has DNA antibodies
2. > 50% has renal involvement
3. .
4. .
5. .

26. Patient with Rheumatic fever developed a new murmur- lower end of the sternum
1. Aortic regurgitation
2. Pulmonary regurgitation
3. Rupture of
4.
5.

27. Patient with a carotid stenosis > 80%
1. with out surgery her chances of having a stroke in next 3 months is more
2. .
3. .
4. .
5. .

28. Phenytoin and warrfarin
1. if serum level –half of the needed therapeutic dose then double the dose
2. .
3. .
4. .
5. .

29. Hypercalcemia occurs ecxept
1. chronic pancreatitis
2. .
3. .
4. .
5. .

30. In Australia –why women live longer than men
1. genetics and biological reasons
2. use of more medicare
3. men are more violent
4. .
5. .

31. In Digoxin toxicity seen ecxept
1. nodular rytham
2. ventricular trachacycardia
3. Atrial tachycardia
4. .
5. .

32. woman with R haemiparesis and loss of vision in the L eye
1.left anterior
2.left middle
4. middle cerebral

4.
5.

33. 70 years old woman -with 3 week history of confusion. Increased Phosphate, increased calcium.
1.paget disease
2. renal failure
3. .
4. .
5. .

34. Pituitary tumor
1. Bitemporal hemianopia
2. .
3. .
4. .
5. .

35. Emphysema – not true

1.
2.
3.
4.
5.

36. ITP

1. Extensor surfases
2. Splenomegaly
3. Rash
4. Haemorrage –fundoscopy
5. .



37. Mycoplasma Pneumonia

1. wrong antibiotic
2. .
3. .
4. .
5. .

38. Pressure gradient more than 50
1. you do surgery
2. .
3. .
4. .
5. .

39. Obstructive cardiomyopathy . RX
1.
2.
3.
4.
5.

40. All causing hypoglycemia ecxept
1. Prolactin inducing tumour
2. .
3. .
4. .
5. .

41. Meningitis complication except
1. Cephalohematoma
2. .
3. .
4. .
5. .

42. 34 year old women got 4-5 patches on the head
1. scraping under KOH
2. .
3. .
4. .
5. .

43. Pleural effusion in TB
1. lymphocytosis
2. redused sugar
3. transudate
4. .
5. .

44. man developed a rash on palms and the soles . Anal ------
1. second syphylis
2. yaws
3. .
4. .
5. .

45. Atopic eczema except
1. use soap and water
2. .
3. .
4. .
5. .

46. Pulmonary Embolism

1. Tachypnoea
2. Cyanosis
3. Hypotension
4. .
5. .

47. In gross Acites
1. cannot palpate liver
2. .
3. .
4. .
5. .

48. In kernicteros

1. Increased in total bilirubin
2. Inreased in uncongugated bilirubin
3. Increased in congugated biluribin
4. .
5. ,

49. Obstructive cardiomyopathy RX

1.
2.
3.
4.
5.
50. All causing hypoglycemia ecxept

1. prolacting inducing tumour
2. .
3. .
4. .
5. .

51. Meningitis complication except

1. cephalohaematoma
2. .
3. .
4. .
5. .

52. L5 L4 affected
1.absent knee jerk
2. absent ankle jerk
3.
4.
5.

53. Acromegaly Ix
1. Oral and GH
2. .
3. .
4. .
5. .

54. All the following anomalies are corrected surgically except

1. fallots tetralogy
2. patent ductus
3. VSD
4. Transposition of great vessels
5. .

55. Man present with a ureteric colic and brought a sample of urine which contained blood and asks for pethidine. On examination NAD. Urine sample containes blood.
Rx.
1. take a another urine sample for blood
2. give him pethidine
3. .
4. .
5. .
56. patient presents with (night time) paresthesia and waisting of thenar muscles

1. carpal tunnel syndrome
2. ulnar nerve
3. .
4. .
5. .

57. to reduce staph. Infections
1. Rx all the carries
2. .
3. .
4. .
5. .

58. ACE inhibitors
1.increase afterload
2. increase preload
4. decrease afterload
5. decrease preload
5.

59. WOF cross the blood brain barrier
1. lipid soluble
2. low molecules
3. .
4. .
5. .

60. Patient Rx with warfarin now present with loss of consciousness.

1. extradural haematoma
2. subdural haematoma
3. .
4. .
5. .

61. Vascular dementia
1.
2.
3.
4.
5.

62. Diabetic patient taking morning and evening doses. He wakes up at night with sweating
1. reduce evening dose
2. .
3. .
4. .
5. .

63. woman with ulcerative colitis
1.SCLEROSING CHOLANGITIS
2.
3.
4.
5.

6. Women presented with bleeding. She has a family history of bleeding (brother, father).
6. Haemophylia
7. Deficiency XII
8. Von Willbird
9. .
10. .Christmas disease


64. same pt.going for surgery give
1. give factor VIII
2.
3.
4.
5.

65. “De ja vu” experience in
1.
2.
3.
4.
5.

[walid51]

Paediatrics

66. (overweight )Boy aged 12 years presents with a limp.
1. Perths disease
2. Slipped upper femoral epiphysis
3. .
4. .
5. .

67. Most common cause of bleeding in childhood
1. anal fissure
2. hemorroids
3. .
4. .
5. .

68. Child present with moring vomiting . She also have headaches.

1. Migraine
2. Medulloblastoma
3. .
4. .
5. .

69. Iron deficiency anaemia in a 4 year old most common cause
1. diet mainly milk
2. increased consumption of fruit juices
3. .
4. .
5. .

70. Child (7 years) presents with a high temparature and with a sore throat. He cannot swallow.
1. Intubation
2. Antibiotics
3. .
4. .

71.What age a child can talk with short sentences and follow simple commands.
1. 18 months
2. 2 years
3. 3 years
4. .
5. .

72. Increased HBS2 found in
1. Iron deficiency anaemia
2. B thalassemia
3. Sickle cell
4. .
5. .

73. Febrile convulsions
1. last less than 15 min
2. 30% family history
3. .
4. .
5. .

74. 7 year old boy refused to go to school
1. separation anxiety
2. sign of mental retardation
3. .
4. .
5. .

75. Speech delay after a period normal speech ,. Other aspects of development were normal.
1. deafness
2. mental retardation
3. autistic
4. .
5. .

76. Child with a swollen eye lid. Eye movements are ok.
1. B heam.strep. A
2. B heam.strep. B
3. .
4. .
5. .

77. what is dangerous
1.rash on buttocks
2.bruise on the cheek
3.
4.
5.

78. cerebral palsy
1.
2.
3.
4.
5.

79. Pain in the knee
1. acute osteomyelitis
2. .
3. .
4. .
5. .

80. 3 months old baby with purulent discharge from eye. Increased neutrophils.

1.gonococcal
2.duct stenosis
3.chlamydia
4.
5.

81. In a 12 month old which spontaneously closures
1.VSD
2.ASD
3.
4.
82. 2 year old child marked failure to thrive and history of dyspnoea and cough and wheeze.

1. sweat chloride
2. antigliadin antibodies
3. .
4. .
5. .

83. Lymphoadenopathy and fever
1. Infectious mononucleosis
2. .
3. .
4. .
5. .

84. Haemophilia
1.
2.
3.
4.
5.

85. Pain , pallor, screeming
1. Intussuception
2. .
3. .
4. .
5. .

86. 11 year old with torsion of the testes
1. surgical exploration
2.
3.
4.
5.

87. child with a foreign body in her nose
1.removal under GA
2.
3.
4.
5.

88. History of vomiting
1. pyloric stenosis
2. .
3. .
4. .
5. .

89. When mother comes girl was watching the TV
1. panic attack
2. .
3. .
4. .
5. .

90. ---month old don’t babble
1. Audiogramme
2. .
3. .
4. .
5. .

91. Lactating women eating a well balanced diet. What is the defficient
1.Vit c
2.Vit K
3. Vit D
4.
5.

93. Most common cause of loss of consciousness except
1. petit mal
2.
3.
4.
5.


94.Child with 20% of burn –Rx. Except
1. skin graft
2. .
3. .
4. .
5. .

94. Serous otitis media
1.
2.
3.
4.
5.

[walid51]

SURGERY
1.After appendectomy. There is a swelling. Rx.
1. Remove the sutures
2. .
3. .
4. .
5. .

2. Picture varicocele

3. Picture Pyloric obstruction-(Xray). Hx of vomiting. Initial Rx.

1. .9% Nacl
2. Hartman Solutuion
3. 5% dextrose
4. 5% dextrose and N.saline

5. Same patient (Q. 3) how much K+ need for the next 24 h

1.less than 50 mmol
2. more than 50 mmol
3. 50 mmol
4. .
5. .


6. Picture Xray of the hand- Rx scaphoid fracture
1.
2.
3.
4.
5.

7. Complication of colles fracture
1. non union
2. mal union
3. .
4. .
5. .

8. Picture –leg- blue black –discoloration
1. Venous hypertention
2. Clostridium Welchii
3. .
4. .
5. .

9.Pt. admitted with a crush injury to his lower abdomen and pelvis. On examination he has fresh blood at the external ureathal meatus.
1. Pass a catherter
2. Excretion urethrogram
3. Arrange urethroscopy
4. Urethrography
5. .

9. Picture with a mammogram and aultrasound of the breast.

1. cyst
2. .
3. .
4. .
5. .

10. which one of the following associated with a family history

1. Follicular carcinoma
2. Medullary carcinoma
3. Thyroiditis
4. .
5. .

11. Patient presents with severe vomiting – with emphysema. Cause
1. eosophagal rupture
2. .
3. .
4. .
5. .

12. Picture- woman with a red patch on her face

1. haemangioma
2. teleangiectasis
3. .
4. .
5. .

13. extra orbital cellulitis.

1. flucloxacillin
2. .
3. .
4. .
5. .

14. Hx. Of a snake bite. On examination a scratch mark only. No other symtomps. Rx.
1. Observe
2. .
3. .
4. .
5. .

15. Gas Gangreen
1.
2.
3.
4.
5.

16. hemiplegic man with incontinence Rx.
1. insert a permanent catheter.
2. .
3. .
4. .
5. .

17. A man with uncomplicated first degree haemorrhoids
1. High fiber diet
2. Emergency surgery

GYN/OBS
1. Pregnant women – how to diagnose that she will have a premature delivery after another 4 weeks.
1. cervix mesure 3.8 cm long
2. external os one finger open but internal os closed
3. cervix firm and 5 cm long
4. .
5. .

2. Twin pregnancy
1.
2.
3.
4.
5.

3. Pregnant woman aborting at 17 weeks. Least likely
1. ectopic pregnancy
2. .
3. .
4. .
5. .

4. woman –36 weeks preg. Complains of abdominal pain. Pulse rate increased. What is not seen

1. BP increased
2. .
3. .
4. .
5. .

6. FH rate –CTG

1. less than 5 variation
2. .
3. .
4. .
5. .

6. 16 yr old girl . with breast budding sparse axillary, pubic hair. Which investigation is least likely

1. CT-head
2. Pelvic ultrasound
3. FSH
4. LH
5. Prolactin level

7. Ovarian stimulating is least likely
1. Human menopausal hormone
2. HCG
3. Clomephene
4. GH analogue
5. GnRh analogue
8. Couple want to get pregnanant. Best way for them to find the time of ovulation
1. progest
2. LH urine level every day
3. Basal temperature
4. .
5. .

9. What is the best way to prevent cervical cancer in Australia
1. increase colposcopic clinic and Rx CIN I
2. cervical smear more available
3. develop a vaccine against human papilloma virus
4. .
5. .

10.Puperal psychosis
1. >50% get
2. .
3. .
4. .
5. .

11. Endometrial ablation. Except
1. Eostrogen alone therapy not enough
2. .
3. .
4. .
5. .

12. PV bleeding for 2 days started OC pills.
1. continue oc
2. .
3. .
4. .
5. .

13. Girl -high prolactin level. TSH normal. Found pituitary adenoma size 1.8 cm 3 cm extending to chiazma. What is your first initial management
1. bromocriptine
2. .
3. .
4. .
5. .

14. 68 yr. Woman recently started on warfarin and Pv bleeding. All true except
1. bleeding because cervical cancer
2. .
3. .
4. .
5. .

15. Twin pregnancy- should not do
1. External cephalic version
2. .
3. .
4. .
5. .
16. In a older women malodour discharge- all true except

1. foreign body
2. .
3. .
4. .
5. .

17. not true-
1. ACE should not give in pregnancy
2. .
3. .
4. .
5. .

18. 34/52 preg. All Rx true except
1. Corticosteroid should be given
2. .
3. .
4. .
5. .

19. Breast feeding and OCP
1.
2.
3.
4.
5.

20. Woman with Cystic fibrosis want to get pregnant what advise can be given
1. can deliver
2. should not encourage to get pregnant
3.
4.
5.

21. Recurrent Candidiasis. Which drug is not useful.

1. Metronidazole
2. .
3. .
4. .
5. .

22. In which case IVF useful – all true except
1.
2.
3.
4.
5.

23. OCP –which effect is seen with progesterone only pill as compaired with eostrogen
1. low density lipid ……..
2. .
3. .
4. .
24. woman pregnant with her 2nd child . 1st pregnancy baby bw 4.5 kg and during the birh fractured the clavicle. Ix.

1. 3hr glucose tolerance test
2. test urine for glucose. Ketone
3. .
4. .
5. .

25. Painless dilatation of bladder
1. chronic retention
2. pregnancy
3. .
4. .
5. .

26. pregnant woman eating a balanced diet- what supplement need
1. Zn
2. Ca
3. Vit c
4. .
5. None of the above

27. In Ectopic pregnancy rupture at 14/52 likely in located in
1. .isthmus
2. .cervix
3. .abdomen

28. Mammography screening program-
1. detect small cancers early
2. .
3. .
4. .
5. .

29. Hypertensive patient well controlled with ACE. She wanted to get pregnant. What advise you would give
1. Continue ACE
2. Rx with methyldopa and diuretics
3. .
4. .
5. .

30. What is the contraceptive pill for a woman who takes phenytoin
1.Microgynon 30
2. Microgynon 50
3. Diane
4.
5.

Psychiatry

1. What is “TESTAMENTARY CAPACITY”
1. ABLE TO MAKE A WILL
2. Able to give evidence in a court
3. .
4. .
5. .

2. Couple wants to get pregnant. But concerned because grandmother has bipolar disorder. What advise
1. not to get pregnant
2. Refer to genetic study
3. <10%
4. .
5. .

3. Dejavu seen in temporal lobe epilepsy
1.
2.
3.
4.
5.

4.Obssesive conpulsive disorder associated with
1. hypochondrasis
2. paranoid
3. dementia
4. .
5. .

5. Social phobia
1.
2.
3.
4.
5.

6. Serotonin Syndrome
1.
2.
3.
4.
5.

7. man wears womaen’s cloths
1. transsexualism
2. .
3. .
4. .
5. .

8. Man presents with impotence what is least likely to given as a initial treatment
1. Viagra
2. .
3. .
4. .
5. .

9. Negative symptoms in sciczophrenia
1. blunted effect
2. catatonia
3. delusion
4. .
5. .

10. Canabis
1. increasesd with ingestion
2. less likely to have withdrawal symptoms
3. .
4. .
5. .

11. HIV Dementia

1. toxoplasmosis
2. .lymphomaa
3. .
4. .
5. .

12. Woman acting and appearance – seductive

1. histrionic personality
2. hypomania
3. .
4. .
5. .

13. Vascular Dementia
1.
2.
3.
4.


14. Bulimia nervosa
1.
2.
3.
4.
5.

15 ADHD –cause
1. not known
2.


15. Maternal blue
1. > 50%

16. For new antidepression drug trial what is required
1. permission and ethical clerance
2. .


17. difference between psychosis
1. sensory loss
2. .
MCQ Recall Paper October 2000

[walid51]

MEDICINE

1. All of the following are true about duodenal ulcer, EXCEPT:
a) Hunger pain
b) Loss of appetite
c) Weight gain
d) Relapse and remissions
e) Reversed by antacids

2. A patient presents with a history of 2 episodes of Left eye blindness, Right hemiplegia, and transient speech difficulty, which lasted 20 minutes each. Which is the most possible site of obstruction?
a) Left middle cerebral artery
b) Right middle cerebral artery
c) Left anterior cerebral artery
d) Right anterior cerebral artery
e) Posterior cerebral artery

3. In which disease is anterior uveitis most commonly associated?
a) Reiter’s disease
b) Ankylosing spondylitis
c) Syphilis
d) Gout
e) Rheumatoid arthritis

4. Which is the most common mode of transmission in Hepatitis C infection?
a) IV drug users
b) Homosexual active males
c) Heterosexual
d) Vertical Transmission
e) ?

5. Mycoplasma pneumoniae infection has which of the following characteristics, EXCEPT:
a) Cough is unusual
b) Pleural effusion is a characteristic feature
c) ESR is always high
d) Very severe headache
e) Responds to tetracycline treatment

6. A patient present with Haematuria. About 24 hours ago he had a sore throat. Which is the most likely diagnosis?
a) IgA nephropathy
b) Post-streptococcal glomerulonephritis
c) Membranous glomerulonephritis
d) Nephrotic syndrome
e) Acute pyelonephritis
f) Acute pyelonephritis

7. Which of the following is true about Tuberculous Pleural Effusion ?
a) Blood stained always
b) Acid-fast bacilli are always found
c) Most likely cells are lymphocytes
d) It is transudate
e) Glucose is normal or decreased

8. Acute attacks of asthma can best be treated with:
a) Inhaled Salbutamol
b) Oral steroids
c) Inhaled steroids
d) Oral theophylline
e) PEFR measured at home

9. A young man present with Pleuritic chest pain and cough. On percussion there is dullness over the right base. There are no breath sounds in the right lower zone, but bronchial breathing is noted in the right middle zone. Which is the most likely diagnosis?
a) Right lower lobe consolidation
b) Right lower lobe collapse
c) Pleural effusion
d) Right pneumothorax
e) Left tension pneumothorax

10. All of the following are true about Emphysema, EXCEPT:
a) Clubbing is present
b) Distant heart sounds
c) Diffusion capacity is decreased
d) Total lung capacity is increased
e) Hyperinflation of the lungs

11. Photosensitivity is present in:
a) Amiodarone treatment
b) SLE
c) Niacin deficiency
d) Thiamine deficiency
e) ?

12. In a patient with massive ascites, all are possible findings except:
a) Hepatomegaly
b) Shifting dullness
c) Eversion of umbilicus
d) Dullness to percussion
e) ?

13. Which of the following drugs can give Nephrotoxicity?
a) Gentamycin
b) Gold
c) Digoxin
d) Sulphonamides
e) Mefanamic acid

14. A 65 year old woman became confused. Laboratory findings were; Calcium 4.8, increased Calciuria, decreased Phosphate. Which is the most likely diagnosis?
a) Malignancy (osteolytic metastases)
b) Primary hyperthyroidism
c) Idiopathic hypercalcaemia/hypercalciuria
d) Paget’s disease
e) Multiple myeloma

15. Papillary necrosis is caused mostly by;
a) Diabetes
b) Alcohol
c) Analgesic nephropathy
d) Medullary sponge kidney
e) Sickle cell crisis

16. In a patient with acidic urine, which are the most commonly found stones?
a) Uric acid
b) Cystine
c) Calcium oxalates
d) Calcium carbonate
e) Xanthine

17. In patients with chronic renal failure:
a) Most patients develop osteoporosis
b) Bone dystrophy is present
c) ?
d) ?
e) ?

18. In rheumatic fever arthritis, which is the most typical finding?
a) Heals without deformities
b) Affects small joints equally as large ones
c) Is confined to one joint
d) ?
e) ?

19. Which of the following drugs most commonly cause prolonged QT interval?
a) Digoxin
b) Procainamide
c) Quinidine
d) Propranolol
e) ?

20. A woman presents with dark colour urine, pruritus and jaundice. Blood examination shows a mild increase in alkaline phosphatase, high AST and ALT. Which is the most likely diagnosis?
a) Viral hepatitis
b) Acute fatty liver
c) Cholangitis
d) Biliary obstruction with cholestasis
e) Cholecystitis

21. Which of the following is true regarding Phenytoin?
a) Should be given three times daily
b) It will decrease the effect of Warfarin
c) It will increase the effect of OCP
d) If given in combination with other drugs, the therapeutic dose should be halved
e) ?

22. Statistically women live longer than men. Which is the reason for this?
a) Females have a genetic advantage
b) Women use the medical system more often than men
c) Men have more stressful jobs than women
d) Men drive more aggressively
e) Women have less accidents

23. Treatment of hypertension is a proven factor in preventing:
a) TIA
b) Ischaemic stroke
c) Coronary artery disease
d) Congestive cardiac failure
e) Atherosclerosis

24. A patient with CRF and hypertension was dialysed. His BP improved after dialysis but he still had 2 episodes of high blood pressure. Which is now the initial step in your management?
a) Decrease protein in his diet
b) Ideal weight should be reached
c) Give Frusemide
d) Give anti-hypertensive therapy prior to dialysis
e) Give anxiolytics prior to dialysis

25. Hepatitis BV has never been found in which of the following blood products:
a) Fresh frozen plasma
b) Cryoprecipitate
c) Whole blood
d) Erythrocytes
e) White blood cells

26. In a woman with splenomegaly, WCC 33,000 and tear drop poikilocytes, which is the most likely diagnosis?
a) CML
b) CLL
c) Hodgkin’s disease
d) Acute lymphoma
e) Myelofibrosis

27. A woman, whose father and brother are haemophilic, has bleeding tendency. She has a history of haemarthrosis and prolonged bleeding associated with dental procedures. Which is the most likely diagnosis?
a) Haemophilia
b) Christmas disease
c) Von Willebrandt’s disease
d) Factor XII deficiency
e) Factor IX deficiency

28. Which of the following are true regarding Atopic Eczema?
a) Soap and water are helpful
b) It is a contraindication for immunization
c) Flexure surfaces are commonly involved
d) Positive family history of asthma and hay fever
e) Moisturizing agents are helpful

29. Which of the following is a feature of Parkinson’s disease?
a) Loss of postural reflexes
b) Hyperreflexia
c) Atactic gait
d) Resting tremor
e) Muscle weakness

30. A diabetic patient is taking insulin twice a day. Before breakfast a combination of L/A and S/A and in the evening one dose of L/A. He complains of sweating in the morning. What alteration in insulin doses needs to be done?
a) Reduce dose of L/A in the morning
b) Reduce dose of S/A in the morning
c) Reduce dose of L/A in the evening
d) Increase dose of L/A in the evening
e) Increase dose of L/A in the morning

31. Which is the most specific antibody in SLE?
a) dsDNA
b) ANA
c) Anti Ro
d) Anti La
e) Anti LKM

32. A 24 year old student complains of 12 days of fever, malaise and sore throat. On examination he has white tonsillar exudates, generalized lymphadenopathy, maculopapular rash on palms and soles and excoriating lesions around the anus. Which is the most likely diagnosis?
a) Glandular fever
b) Syphilis
c) Pemphigus
d) Stevens Johnson syndrome
e) ?

33. Which of the following is true regarding granuloma annulare?
a) Irregular raised margins
b) Is pre-malignant
c) Caused by sun exposure
d) Is autosomal recessive
e) ?

34. A school teacher presents with patches of hair loss on scalp. Skin of the affected area is shiny. All of the following are possible treatment except:
a) Nystatin ointment
b) Metronidazole
c) Ketoconazole
d) Griseofulvin
e) Nystatin cream

35. Which is the most important finding for the diagnosis of gout?
a) Finding birefringent crystals
b) Increased neutrophil count
c) Increased serum uric acid
d) Increased urinary acid
e) ?

36. In a patient with T8 pain and spastic paresis of lower limbs, which is the most likely diagnosis:
a) Herpes zoster
b) Spinal cord compression
c) Syringomyelia
d) Multiple sclerosis
e) ?

37. Digoxin is indicated in all of the following except:
a) Atrial fibrillation
b) Atrial flutter
c) Atrial tachycardia
d) Nodal rhythm
e) SVT dye to AV nodal recovery

38. In a 30 year old patient with iron deficiency but no history f bleeding and whose ferritin level is elevated, which is the next investigation?
a) Gastroscopy
b) Colonoscopy
c) Bone Marrow aspiration
d) Sigmoidoscopy
e) Haemoglobin electrophoresis

39. An overweight patient has had an episode of bulk diarrhoea with steatorrhoea. He has a history of drinking alcohol for many years. Which of the following is the most useful investigation?
a) IV pancreatography
b) Endoscopic pancreatography
c) Abdominal X-ray
d) Ultrasound
e) Faecal fat analysis

40. A young woman who takes oral contraceptive pills, complains of headaches over the last 3 weeks. The frequency of headaches is five days per week. The headaches improve in the afternoon and during the weekend. Which is the most appropriate management?
a) Stop OCP
b) Relaxation techniques
c) Ergotamine
d) Methysergide
e) Sumatriptan

41. Which of the following is the commonest organism that gives cellulitis?
a) Group A streptococcus
b) Group B streptococcus
c) Staphylococcus aureus
d) E Coli
e) ?

42. All of the following can cause glucose intolerance, except:
a) Pituitary tumour
b) Thyrotoxicosis
c) Acromegaly
d) Phaeochromocytoma
e) Pancreatitis

43. Which of the following is the most common complication of Infectious Endocarditis?
a) Mitral stenosis
b) Rupture of chordae tendineae
c) Aortic stenosis
d) Tricuspid stenosis
e) Aortic regurgitation

44. A woman present with tremor of the hands. Which of the following is correct?
a) Disappears when she looks at her hands
b) Treatment of choice is Propranolol
c) Is present when she is on the phone
d) Disappears when she sleeps
e) Benztropine is helpful

45. A 35 year old policeman suffers from ulcerative colitis, and is treated with Sulfasalazine. He drinks 60g of alcohol per day. Laboratory investigations show: serum bilirubin 18mmol/l; increased alkaline phosphatase, GGT and SGOT. The most likely diagnosis is:
a) Fatty liver
b) Alcoholic cirrhosis
c) Biliary stones
d) Sclerosing cholangitis
e) Cholestasis

46. Demential symptoms in an HIV positive patient can be due to all of the following EXCEPT:
a) AZT side effects
b) Interferon side effects
c) Toxoplasmosis infection
d) AIDS dementia
e) Non-Hodgkin lymphoma

47. A patient with rheumatoid arthritis on long-term treatment with naproxen, came complaining of fatigability over the past week. Lab analysis shows decreased Hb, Normal MCV, raised TIBC and ferritin. Which is the most appropriate diagnosis?
a) Anaemic due to blood loss from GIT
b) Anaemia of the chronic disease
c) Iron deficiency anaemia
d) B12 deficiency
e) ?

48. A lesion of spinal cord at L4/L5 level produces:
a) Loss of foot dorsiflexion
b) Absent ankle jerk
c) Loss of sensation of the medial aspect of calf and thigh
d) Absent knee jerk
e) Absence of sensation on the sole of foot

49. The most common cause of neck stiffness is:
a) Meningitis
b) Botulism
c) Phenothiazine toxicity
d) Tetanus
e) Pneumonia

50. A patient present with headache and neck stiffness over a 4 week period. All of the following are possible except:
a) Extradural haematoma
b) Subdural haematoma
c) Lumbar puncture should be done
d) Urgent CT scan should be done
e) ?

51. Which of the following will decrease the gradient in hypertrophic cardiomyopathy?
a) Digoxin
b) Verapamil
c) ACE inhibitors
d) Prazosin
e) Propranolol

52. Which of the following is true regarding aortic stenosis?
a) Sudden death is possible
b) Gradient of over 50% requires surgery
c) Angina suggest coexistent coronary artery disease
d) Doppler ultrasound is not accurate in diagnosis
e) Echocardiography may be used for diagnosis

53. A patient present with headache, prominent supra orbital ridges, prognathism, wide teeth spacing, thick spade like hands and seborrhoeic, coarse, oily skin. Which of the following is the best investigation to establish a diagnosis?
a) Insulin + glucose test
b) X-ray of the pituitary fossa
c) Cranial CT scan or MRI scan
d) Serum T4 + PRL + growth hormone test
e) Oral glucose tolerance test + GH

54. A pregnant lady present with a widely split S2, cardiomegaly, systolic murmur best heard at pulmonary area and a diastolic murmur in tricuspid area. Which is the most likely diagnosis?
a) Atrial septal defect
b) PDA
c) VSD
d) Pulmonary stenosis
e) Aortic stenosis

55. A 45 year old woman about to undergo cholecystectomy, has a history of bleeding tendency, increased bleeding time, but a normal platelet count. Which of the following are indicated prior to surgery?
a) Vitamin K
b) Factor VIII concentrate
c) Fibrinogen
d) Fresh frozen plasma
e) ?

56. Which type of bilirubin can cross the blood brain barrier?
a) Unconjugated
b) Conjugated
c) Biliary salts
d) ?
e) ?

57. A 28 year old female presented with a history of hypertension. Which of the following tests is best for assessing the structure and function of her kidneys?
a) IV pyelogram
b) Renal ultrasound (Doppler)
c) Renal X-ray
d) CT scan
e) MRI

58. In a paraplegic patient suffering from overflow incontinence, which is the best management?
a) Continuous catheterisation
b) Suprapubic catheterisation
c) Intermittent self-catheterisation
d) Permanent cystostomy

59. A patient present with bilateral temporal hemianopia. Where is the lesion?
a) Pituitary fossa
b) Optic chiasm
c) Parietal lobe
d) Temporal lobe
e) Optic nerve

[walid51]

SURGERY

1. Picture: A young female with a bright red area of rash on her right cheek measuring approx. 5cm x 2cm. Which of the following is the most likely diagnosis?
a) Angiosarcoma
b) Hutchinson melanotic freckle
c) Cellulitis
d) Strawberry haemangioma
e) Solar keratosis

2. Picture 1: A mammograph showing a radio-opaque mass with round, clear margins, and approximately 4cm in diameter.
Picture 2: An ultrasonograph showing the same mass as radiolucent and with a size of 5cm x 5cm.
The diagnosis is:
a) fibroadenoma
b) cyst
c) Fat necrosis
d) Lipoma
e) Carcinoma of the breast

3. Picture: A patient with a given history of a fall on his outstretched hand) lesion is shown on X-Ray (scaphoid fracture). Which is the most appropriate management:
a) Open reduction and internal fixation
b) Plaster including wrist and distal interphalangeal thumb for at least 6 months
c) Plaster including wrist and distal interphalangeal thumb joints for at least 3 weeks.
d) Plaster including wrist and elbow joints for at least 6 weeks
e) Plaster including wrist and elbow joints for at least 3 weeks.

4. Picture: left testis with tortuous swelling above and behind. Which of the following is the diagnosis:
a) Teratoma
b) Varicocele
c) Seminoma
d) Epididymal cyst
e) Hydrocele

5. Picture: Barium meal showing obstructed stomach outlet (most probably diagnosis to be interpreted as ‘Pyloric Stenosis”). This patient presented with severe vomiting. Which of the following fluids should be given:
a) Normal saline
b) Dextrose 5%
c) Hartman’s solution
d) Plasma expanders
e) Ringer’s lactate

6. Picture: Same case as in Qs. 5 above (no new picture was given). How much K+ should be given:
a) 5mmol KCl
b) 25mmol KCl
c) 50mmol KCl
d) More than 50mmol KCl
e) Does not need K+

7. Picture: The picture shown is the same as Figure 45 on Page 262 of the AMCQ Book, 1997 Edition (this picture is given in the explanatory commentary to Surgery Qu No 130 and the commentary on page 262 is titled SU-C130). What is the condition?
a) Chronic deep venous insufficiency
b) Arterial ulcer
c) Raynaud’s phenomenon
d) Raynaud’s disease
e) ?

8. A 35 year old female came with complaint of waking up during the night with pain in her hands accompanied by a burning sensation (pins and needles). Examination of her Right hand shows thenar wasting. Which of the following is the diagnosis?
a) Carpal tunnel syndrome
b) Cervical spondylosis
c) Cervical rib
d) Apical tumor of the lung
e) Brachial plexus injury

9. A young female patient after bouts of vomiting presents with suprasternal emphysema, severe epigastric pain and epigastric guarding and mild dyspnoea. Which of the following is the most probable diagnosis?
a) Rupture of the s tomach
b) Rupture of the oesophagus
c) Rupture of the diaphragm
d) Ruptured mediastinum
e) Ruptured pleura
10. A 35 year old man came with an acute painful eye with conjunctival injection. Examination shows a hazy cornea with fixed dilated pupil. Which is the most probable diagnosis?
a) Iritis
b) Glaucoma
c) Foreign body
d) Trachoma
e) Conjunctivitis

11. In a patient who has wasting of the small muscles of the hand with thenar sparing, which nerve is injured?
a) Median
b) Radial
c) Ulnar
d) Lower branch of the brachial plexus
e) T1

12. The commonest complication of Colles fracture is:
a) Malunion
b) Non-union
c) Sympathetic dystrophy
d) Compartment syndrome
e) Carpal tunnel syndrome

13. In a 32 year old man with 1st degree haemorrhoids, which bleeds occasionally, which is the most appropriate treatment?
a) Band ligation
b) High fibre diet
c) Sclerosing therapy
d) Anal dilatation (Lord’s procedure)
e) Sphincterotomy

14. In a patient presenting with a perforated peptic ulcer, all of the following are correct, except:
a) Patient remembers exactly the moment of rupture
b) Back pain
c) Vomiting
d) Board-like abdominal rigidity
e) Guarding

15. Regarding pancreatic pseudocyst, which is the most correct statement:
a) It is lined with squamous epithelium
b) It can resolve spontaneously
c) It arises in the first 24 hours after an episode of acute pancreatitis
d) It has a connection with the pancreatic duct
e) It drains in the stomach

16. After falling from 6m high scaffolding, a patient presents with pelvic injuries and blood at the external urinary meatus. Which is the most appropriate management?
a) Cystoscopy
b) Urethroscopy
c) IVP
d) Suprapubic catheterisation
e) Urethrography

17. A 35 year old woman has a painless bladder up to the level of her umbilicus. Which is the correct diagnosis?
a) Acute urinary retention
b) Chronic urinary retention
c) Pregnancy
d) Neurogenic bladder with incontinence
e) ?

18. A middle aged man present with severe shock (BP 80/60, HR 120/min), back pain and slight abdominal guarding. Which of the following is the most likely diagnosis?
a) Acute pancreatitis
b) Acute myocardial infarction
c) Leaking aortic aneurysm
d) Perforated peptic ulcer
e) Acute cholecystitis

19. A seamstress which working pierced the proximal interphalangeal crease of her left index finger with a needle. On examination the whole finger was swollen and she experiences pain upon extending the finger. Which of the following is the most likely diagnosis?
a) Cellulitis
b) Tenosynovitis
c) Palmar fascial abscess
d) Osteomyelitis
e) Carpal tunnel syndrome

20. HLA is done for transplantation in Australia. For which of the following is HLA assessment most commonly and widely used?
a) Kidney transplant
b) Liver transplant
c) Brain transplant
d) Heart transplant
e) Lung transplant

21. A patient presents one week after appendicectomy which high fever and a red fluctuating swelling on the medial aspect of the wound. Which is the most appropriate management?
a) Release suture to prevent sinus formation
b) Drain the abscess
c) Give broad spectrum antibiotics
d) Abdominal CT
e) Abdominal X-ray

22. A patient wakes up during the night with sever bilateral calf pain. He has to get out of bed and walks around for a while to relieve the pain. The most likely diagnosis is:
a) Ischaemic pain
b) Rest pain
c) Muscle cramps
d) Intermittent claudication
e) Sciatic pain

23. Which of the following symptoms in a patients’ limb is an un-----ocal indication for urgent intervention?
a) Pain
b) Pallor
c) Paraesthesia
d) Temperature
e) Loss of sensation

24. In a lesion between L4 and L5, which of the following will occur?
a) Loss of ankle reflex
b) Loss of knee reflex
c) Impossible dorsiflexion
d) Loss of sensation along the medial aspect of the calf
e) Loss of sensation along the lateral aspect of the calf

25. In case of an emergency, you can safely give a blood transfusion with:
a) Blood group O Rh negative
b) Blood group O Rh positive
c) Blood group AB Rh +ve
d) Blood group AB Rh –ve
e) Blood group A Rh +ve

26. A young male walks into your surgery complaining of severe ureteric colic. Apparently a sample of urine that he has brought with him is blood stained. He requests a shot of pethidine to relieve his pain. What is your next step?
a) Give him 50mg pethidine IV to relieve his pain
b) Give him 100 mg IM to relieve his pain
c) Ask for a fresh urine sample
d) Send him an urgent IVP
e) Arrange hospital admission

27. A 40 year old male present with an acute onset of pain and swelling of the left testicle over the last 2 days. Which of the following is the most likely diagnosis?
a) Varicocoele
b) Acute epididymitis
c) Testicular torsion
d) Teratoma
e) Spermatocoele

28. A patient is brought with a flail chest and haemothorax. His BP is 90/40 mmHg and HR is 140/min. What is your initial management?
a) Endotracheal intubation
b) Nasogastric tube
c) IV fluids
d) Wide bore chest drain
e) Immediate thoracostomy

29. For a 65 year old female with TIA, who was diagnosed as having 85% stenosis of the carotid artery, which is the most correct statement?
a) Aspirin is the best treatment
b) Endarterectomy will decrease by more than 50% the chance of stroke
c) Endarterectomy is contraindicated 9there is a 70% chance of death within 30 days)
d) Do nothing as she is going to die anyway
e) ?

30. A young woman present with a solitary nodule in the anterior triangle of the neck. Histological examination reveals normal thyroid cells. Which if the following is the most likely diagnosis?
a) Aberrant thyroid tissue
b) Thyroid malignancy
c) Normal lymph node
d) Hashimoto’s thyroiditis
e) ?

31. Which of the following is hereditary?
a) Papillary carcinoma of thyroid
b) Follicular carcinoma of thyroid
c) Medullary carcinoma of thyroid
d) Anaplastic carcinoma of thyroid
e) Grave’s disease

32. In a young person with a left sucking wound of the chest, which is the most appropriate management after managing the airway, pulse and circulation?
a) Debridement and closure of the wound
b) Pressure bandage
c) Lage bore drainage tube
d) Needle thoracotomy
e) Open thoracotomy

33. Ischaemic pain is suggested by all the following except;
a) Pain in the thigh on walking
b) Pain in the calf on walking
c) Localized ankle pain
d) Pain on walking relieved by rest
e) Rest pain

34. A 65 year old man present with fever of 40C and chills 6 hours after urethral instrumentation. Which if the following is the most likely cause?
a) Acute pyelonephritis
b) Suppurative urethritis
c) Gram negative bacteraemia
d) Ruptured bladder
e) Cystitis


35. In a patient with splenectomy and spherocytosis which will be the most probable finding?
a) Leucocytosis
b) Increased number of platelets
c) Hepatomegaly
d) Number of spherocytes is below normal
e) Fragility test remains positive

36. All of the following symptoms are present in an extradural haemorrhage except:
a) Bradycardia
b) Hypotension
c) Focal neurological signs
d) Dilated pupil
e) ?

37. What would be the best reason to make a screening program more available to the public?
a) Possibility of early diagnosis
b) It is required for research purposes
c) It improves the treatment’s prognosis
d) Specialised treatment is available
e) It can lower the death rate from the disease

38. Hypercalcaemia will be present with all the following findings except;
a) Lytic bone lesions
b) Hypercalcinosis
c) Diarrhoea
d) Depression
e) Hypercalciuria

39. Which of the following electrolytes is lost after ileostomy:
a) Na
b) Cl
c) HCO3
d) K
e) Ca

40. Which is the best indicator for the depth of a burn:
a) Anaesthesia of the wound
b) Increased blistering
c) Oozing is seen in deep burns
d) Scalds are prone to deeper burning
e) ?

41. A woman present with an ulcer on the loser third of the medial side of her left leg. All of the following are appropriate treatments except:
a) Compression stockings
b) Bed rest with the elevation of the leg
c) Local antibiotics
d) ?
e) ?

42. Regarding clostridial myonecrosis:
a) Gas is always present on X-ray
b) Surgical excision is a part of the treatment
c) Hyperbolic oxygen will invariably reduce the need for surgery
d) ?
e) ?

43. Best management of a major trauma would be:
a) Debridement of the necrotic tissue
b) Proper apposition of the sutured skin flaps
c) Use of antibiotics
d) Use of proper surgical techniques
e) ?

44. All of the following can be done to reduce nosocomial infections except:
a) Staff with active infection should not be allowed to deal directly with the patients
b) Staff members who are carriers of Staphylococcus aureus in their noses should not be allowed to work with the patients
c) Staff members should wash their hands between dressing
d) Staff members should have prophylactic antibiotics policy
e) ?

[walid51]

OBSTETRICS AND GYNECOLOGY

1. A 17 year old girl was commenced on OCP (microgynon 30). She had two periods in the first month, one lasted 2 days and the other one lasted 4 days. What would you advise her?
a) Change over to Microgynong 50
b) Continue on Microgynon 30 for another 2 months
c) Stop OCP and use some other form of contraception
d) Use POP (Progesterone only Pill)
e) ?

2. A 25 year old female present with galactorrhoea and amenorrhoea. On CT scan there was a pituitary adenoma that was 3mm from the optic chiasm, but there was no visual disturbance. Prolactin level was 1000. Which will be the most appropriate management?
a) Trans-frontal surgery
b) Trans-nasal surgery
c) Bromocriptine
d) Clomiphene
e) Oestrogen 85 micrograms

3. The most appropriate OCP for a 24 year old woman on Phenytoin is:
a) Microgynon 30
b) Microgynon 50
c) Diane 35
d) Clomiphene
e) Oestrogen 85 micrograms

4. A woman gave birth to a baby 2 months ago. She has decided to breast feed the baby and is asking for a contraceptive method with a failure rate less than 2%. She wants to have another baby after 12 months. You will advise her all of the following except:
a) POP
b) Depo Provera
c) Combined OCP
d) IUCD (intro-uterine device)
e) Breastfeeding will provide the best contraception and thus she doesn’t need another contraceptive method.

5. For the treatment of infertility, to induce ovulation, you will give all of the following except:
a) Beta-hCG
b) Human menopausal gonadotrophin
c) Clomiphene Citrate
d) GnRH agonist + hCG
e) Gonadotrophin releasing hormone

6. A pregnant woman is 34 weeks of gestation present with ante-partum haemorrhage (about 100 ml). She is in shock. You diagnose abruptio placentae. All of the following findings are possible except:
a) Tender uterus
b) Shock out of proportion with the bleeding
c) BP 180/110 mmHg
d) Head high in the pelvis (not engaged)
e) Dead foetus

7. A woman present 3 days after she gave birth to a baby complaining of irritability and tearfulness. Which of the following is correct?
a) Postpartum blues predisposed to postpartum psychosis
b) More than 50% pf women suffer from postpartum blues
c) She requires anti-psychotic medication
d) She requires ECT
e) Postpartum blues last for at least 3 months

8. A 30 year old woman is in labour for 8 hours. Despite rupture of the membranes the cervix is still dilated at 4cm. Obstructed labour is diagnosed. All of the following are true EXCEPT:
a) Oedema of the anterior lip of the cervix
b) Face presentation (mento-anterior)
c) Foetal head is palpable 1cm above the ischial spine
d) Foetal head is palpable 4cm in abdomen, vertex is 1cm below the ischial spine
e) Foetal tachycardia (168/min)

9. In twin pregnancy, after delivery of the first twin you will do all of the following EXCEPT:
a) Vaginal examination
b) External version is the second twin is breech
c) Oxytocin infusion if contractions don’t start
d) Check foetal heart rate
e) Check position of the second twin

10. A pregnant female came to see you for her first antenatal check. She has a good balanced diet. What would you recommend for her as dietary supplements?
a) Calcium
b) Vitamin B12
c) Phosphorus
d) Iron
e) None of the above

11. A 13 year old girl is brought to you by her mother. The girl has slightly developed breast, sparse axillary hair, but she has never menstruated. She is shy and does not allow you to examine her genitalia. All of the following tests are appropriate, EXCEPT:
a) Chromosomal analysis
b) Prolactin levels
c) CT scan
d) Pelvic ultrasound
e) FSH levels

12. A couple came to you for IVF. She is 22 years old and he is 26 years old. All of the following are indications for IVF, EXCEPT:
a) Husband is azoospermic
b) She has anovulatory cycles with normal levels of FSH, LH and prolactin
c) They have not been able to conceive for two years
d) Bilateral obstructed tubes
e) Endometriosis diagnosed a few months ago

13. A couple comes to you for advice. The husband’s mother has bipolar disorder. They want to know what are the chances for their baby to inherit the disorder. What would be your advice?
a) Less than 10%
b) They should not conceive because the chance is too high for the aby to have the same disorder
c) They should have chromosomal analysis done to determine if they carry the gene
d) Amniocentesis should be done at Wk 16 of pregnancy to determine to see if the foetus is affected
e) ?

14. Which is the most reliable test to determine the time of ovulation:
a) Progesterone levels from the 21st day (in a 28 day cycle)
b) Serial urinary LH levels
c) Self assessment of cervical mucus changes
d) Body temperature charting
e) Estimation of FSH levels

15. A woman came to you 2 years after her menopause asking for something to relieve her postmenopausal symptoms. You decide to give her combined HRT: Oestrogen for 28 days and progesterone for the last 12 days of the cycle to oppose the action of oestrogen. You are going to explain to her the effects of progesterone, which are all of the following, except:
a) She will have pre-menstrual like symptoms
b) She will have withdrawal bleeding every month
c) Progesterone will oppose the action of oestrogen on the endometrium
d) Progesterone will potentiate the action of oestrogen in increasing HDL levels
e) Progesterone will augment the action of oestrogen for prevention of osteoporosis

16. A 16 weeks pregnant female comes to see you for her first antenatal check up. She tells you that she had previously given birth to a baby, who was 4.8kg at birth; she had a difficult labour, the baby was forceps delivered and had a broken clavicle, and she suffered multiple vaginal lacerations. How would you manage her in this pregnancy?
a) Urine examination for glucose, ketones and proteins
b) 2 hours serum glucose test
c) Glucose tolerance test
d) Ultrasound pelvimetry
e) Abdominal X-ray in the last trimester

17. A 26 weeks pregnant female came to see you, complaining of slight vaginal bleeding and uterine contractions. Which of the following is an indication of pre-term labour?
a) Raised AFP (alpha-feto proteins) levels
b) Ruptured membranes, with closed cervix
c) Cervix of normal length, internal os closed, external os admits one finger
d) Foetal fibronectin at the cervix
e) ?

18. A 17 weeks pregnant female has acute right iliac fossa pain. Which is the least likely cause of this pain?
a) Pyelonephritis
b) Red degeneration of a fibroid
c) Ectopic pregnancy
d) Acute appendicitis
e) Torsion of an ovarian cyst

19. Which of the following CTG patterns indicate foetal distress?
a) Accelerations with foetal movements
b) Early decelerations with uterine contractions
c) A beat to beat variability < 5 beats/min
d) Decelerations when the foetus is sleeping
e) Accelerations on sound stimulation

20. Regarding endometrial ablation, all of the following are true EXCEPT:
a) 30-60% of women will be amenorrhoeic
b) Oestrogen alone can be given safely as HRT
c) 15% of women will need to repeat the procedure or have an hysterectomy
d) The basal layer of endometrium is destroyed
e) It is one of the treatments for dysfunctional uterine bleeding

21. A young obese female, with hirsutism, oligomenorrhea and irregular periods was found to have endometrial hyperplasia (benign) on curettage. All of the following are appropriate treatments, EXCEPT:
a) Progesterone from 14th to 21st day of each cycle
b) Diane35
c) Clomiphene citrate on the 4th and 9th days of the menstrual cycle
d) Progesterone + oestrogen (OCP)
e) Oestrogen alone

22. A 65 year old female was prescribed Warfarin recently for atrial fibrillation. Now she present after a brief period of vaginal bleeding. Which is the least likely cause for this?
a) Endometrial carcinoma
b) Cervical carcinoma
c) Atrophic vaginitis
d) Anticoagulant therapy

23. Which of the following measures would have the most dramatic impact on preventing and reducing the mortality from cervical carcinoma?
a) Usage of condom in cases of extramarital intercourse
b) Papilloma virus vaccine
c) Improving pap smears
d) Improving screening methods for early detection
e) Making colposcopy more available

24. In a pregnant female with multiple pregnancy you will advise all of the following EXCEPT:
a) More frequent antenatal checking
b) Iron and folic acid supplements
c) More frequent Ultrasonograms
d) Give a corticosteroid injection at 34 weeks of pregnancy, as she has an increased chance of pre-term labour
e) Induced delivery before term

25. A 26 weeks pregnant female had a BP of 140/90mmHg on her first antenatal visit. Four weeks later the blood pressure was 140/100. Which of the following is contraindicated:
a) ACE inhibitors
b) Methyldopa
c) Labetolol
d) ?
e) ?

[walid51]

PAEDIATRICS

1. A 6 week old baby presents with unilateral eye discharge since birth. A pathology result shows polymorphonuclear cells. Which is the most likely diagnosis:
a) Gonococcal infection
b) Chlamydial infection
c) Syphilitic infection
d) Imperforated lacrimal duct
e) Herpetic infection

2. Which of the following will resolve spontaneously in 30% of newborns?
a) Small VSD in a year old
b) PDA in a 3 year old
c) Coarctation of aorta in a pre-term baby
d) ASD in an 8 month old baby
e) Congenital heat block

3. A 5 year old girl has headaches and morning vomiting for 3 weeks. She is well otherwise. Which is the most likely cause:
a) Migraine
b) Medulloblastoma
c) Sinusitis
d) Hydrocephalus
e) Wilson’s disease

4. All of the following are correct about atopic eczema in children, EXCEPT:
a) It is very itchy
b) Usually involves flexor surfaces
c) Topical steroids are helpful
d) First episode in early childhood
e) It is a contraindication for DTP vaccination

5. A 2 years old boy has purulent unilateral nasal discharge and occasional bleeding, for 2 weeks. He has had a course of antibiotics with no improvement. On examination he is very irritable and doesn’t allow you to examine his nostrils. What is your further management?
a) Repeat course of antibiotics
b) Topical antibiotics
c) Carefully examine is nose under general anaesthesia
d) Refer him to an ENT specialist
e) Change the antibiotics

6. Which is the most common cause of death in a child with beta-thalassemia:
a) Cardiac failure
b) Renal failure
c) Hepatic failure
d) Infection
e) Haemorrhage


7. All of the following are false regarding cerebral palsy, EXCEPT:
a) 90% progress to severe mental retardation
b) 80%of the children have an IQ of 70
c) Is frequently associated with Down Syndrome
d) 70% will have moderate handicap
e) 10% will improve

8. A 2 year old boy is brought to you by his parents. He doesn’t speak as he should for his age, but his hearing is adequate. When he was 1 year old he could babble a few words. Which of the following is your further management?
a) Arrange audiometry
b) Check the hearing system
c) Check his development
d) ?
e) ?

9. Regarding febrile convulsions, which of the following is true:
a) There is always a family history
b) Commonly occur between 3-5 years
c) Focal seizures are present
d) Usually last less than 15 minutes
e) Most will develop epilepsy later in life

10. A 3 year old girl presents with 3cm x 3cm erythematous area on the upper eyelid, the oedema, congestion of conjunctiva and normal eye movement. Which is the correct treatment:
a) IV flucloxacillin and cephalosporin
b) Topical chloramphenicol
c) Topical steroids
d) Surgical intervention
e) Topical gentamycin

11. The most common cause of iron deficiency in Australian children is:
a) GIT bleeding
b) Lack of fresh fruit and vegetables
c) Malabsorption
d) Recurrent infections
e) Cow’s milk diet

12. Which of the following is the cause of kernicterus in children:
a) total bilirubin
b) Conjugated bilirubin
c) Haptoglobin
d) Cholestasis
e) ?

13. A 3 year old boy present with fever (380C), difficulty in breathing and difficulty in swallowing fluids. Which is the most appropriate management?
a) Prepare for intubation or tracheostomy
b) Treatment with oral penicillin
c) Nebulised Salbutamol
d) Reassure mother and send her home
e) Examine throat

14. A 7 years old boy fell from a tree. After 7 days he present with pain and swelling of one knee, and fever of 38C. Which is the most likely diagnosis?
a) Acute leukaemia
b) Osteomyelitis
c) Osteogenic sarcoma
d) Perthe’s disease
e) Still’s disease

15. A fully breast-fed baby, from a mother on a healthy balanced diet, can suffer from which vitamin deficiency?
a) Vit A
b) Vit B complex
c) Vit C
d) Vit D
e) ?

16. A 5 year old child present with extremely painful ears. The eardrums are red and protruding. Which of the following is correct?
a) tetracycline is the treatment of choice
b) Broad spectrum antibiotics should be administered as ear drops
c) If the eardrums ruptured spontaneously, it will provide immediate pain relief
d) Tympanotomy will lead to life lone ear discharge
e) Antihistamines can improve the drainage of the middle ear

17. At what age can a normally developed child speak simple phrases and understand simple verbal commands?
a) 1 year
b) 2 years
c) 3 year
d) 4 years
e) 5 years

18. The most common cause of rectal bleeding in a child is:
a) Intussusception
b) Gastroenteritis
c) Fissure in ano
d) Meckel’s diverticulum
e) Haemorrhoids

19. A mother brought her 12 year old child with hip pain and limping. He is in the 19th percentile of weight. Which is the most likely diagnosis?
a) Hip arthroses
b) Perthe’s disease
c) Transient synovitis
d) Slipped upper femoral epiphysis
e) Tuberculosis

20. In a boy weighing 4 kg, who suffered 20% burns, you will do all of the following, EXCEPT:
a) Skin graft
b) Fluid replacement of 1500ml over the first 24 hours
c) Assessment of depth by examining for pain sensation
d) IV narcotics for pain relief
e) Urinary catheterisation

21. A previously well 12 year old girl, while she was watching TV, had a sudden attack of difficult breathing. All the examinations were normal and she was not dyspnoeic anymore. Which would be the most probable diagnosis?
a) Asthma
b) Panic attack
c) Pneumothorax
d) Epilepsy
e) Ketoacidosis

22. A 12 year old boy presents to the emergency department with a 4 hour history of severe Right testicular pain, with an acute onset. On examination the scrotum is swollen and extremely tender. Which is the most appropriate management?
a) Surgical exploration of the scrotum
b) Confine him on antibiotics and scrotal support (elevation)
c) Do a urine ward examination
d) No treatment, only observe
e) Reassure and send him home

23. Which is the most common form of epilepsy that occurs between 4-10 years old?
a) Infantile spasm
b) Myoclonic attacks
c) Breath-holding attacks
d) Petit mal seizures
e) ACTH dependent seizures

24. A 3 year old presents with persistent cough. On examination he has rhonchi and crepitations. He also has diarrhoea and has lost weight. Which would be the most correct management?
a) Treat empirically with antibiotics
b) Do a sweat X-ray
c) Abdominal ultrasound
d) Full blood examination
e) ?

25. A child present with scattered bruises all over his body. He is well otherwise. Which of the following is the most correct management?
a) Admit the patient to the ward, contact social work department and other authorities
b) Give IV antibiotics
c) Reassure the parents and send the child home
d) Do a full blood examination
e) Do a clotting profile

26. A child is brought to you after being bitten by a snake two hours ago. The child is well except a small scratch on the lateral aspect of his Right leg. Which is the most appropriate next step?
a) Observe him for 24 hours
b) Admit him and give polyvalent anti-snake venom immediately
c) Reassure and send him home
d) Clear the wound with antiseptic and start antibiotics
e) Do clothing profile and give anti-snake venom

27. All of the following are complications of meningitis except:
a) Hydrocephalus
b) Cerebral abscess
c) Subdural haematoma
d) Subarachnoid haematoma
e) Subdural effusion

[walid51]

PSYCHIATRY


1. All of the following can be a cause of psychosis in a HIV positive patient except:
a) Toxoplasma infection
b) Zidovudine therapy
c) Non-Hodgkin lymphoma
d) AIDS itself
e) Interferon therapy

2. Which of the following is correct regarding “Baby Blues”?
a) Is present in more than 50% of women
b) Is associated with breastfeeding
c) Predisposes to post-partum psychosis
d) ?
e) ?


3. Which of the following is correct regarding OCD (Obsessive Compulsive Disorder)?
a) It is associated with borderline personality disorder
b) It is associated with acute myocardial infarction
c) It is associated with substance abuse
d) It is associated with epilepsy
e) It is associated with dementia


4. Which of the following is most commonly associated with bulimia nervosa?
a) Morbid obesity
b) Hyperkalaemia
c) Depression
d) Female gender
e) Improvement with dietary advice


5. Which of the following are well known causes of ADHD (Attention Deficit Hyperactivity Disorder)?
a) Fragile X syndrome
b) ?
c) ?
d) ?
e) ?


6. Which of the following is a negative symptom of schizophrenia?
a) Auditory hallucinations and delusions
b) Blunt affect
c) Visual hallucinations
d) Catatonia
e) Thought disorder


7. A 16y old female is brought to you after attempted suicide. She is reluctant to take any drug, as are her legal guardians. What would you do?
a) Admit her to hospital (involuntary admission)
b) ?
c) ?
d) ?
e) ?


8. Testamentary capacity means
a) Fitness to plead in court
b) Capacity to make a valid will
c) No mental disorder is present
d) Capacity to swear an oath on the Bible
e) Not responsible for criminal actions in the past


9. In a patient who comes to you complaining of impotence, you advise all of the following except:
a) Trial of Viagra
b) Take a good history of his sexual behaviour
c) Explain to him that this happens to a certain percentage of the male population
d) Find out whether he has any cardiac or endocrine conditions
e) Find out whether he is taking any drugs which can cause the problem


10. If you want to do a trial of a new drug, which of the following is essential?
a) Use a placebo group as control
b) Ask the Helsinki Human Rights Commission for permission to test it on humans
c) Ensure the patients are financially compensated for loss of time due to trial procedures
d) Obtain permission from the Medical Ethics Committee
e) ?


11. All of the following can cause serotonin syndrome except:
a) Haloperidol
b) L tryptophan
c) Clonazepam
d) Moclobemide
e) Dextromorphan


12. In which of the following conditions will you find “déjà vu” ?
a) Occipital lobe tumour
b) Temporal lobe tumour
c) Korsakoff’s syndrome
d) Raised intracranial pressure
e) Frontal lobe tumour


13. A lady came to you looking for counselling after her second marriage break-up. She was severely depressed and anxious but very seductive during the interview. She was very suggestive when she was talking about her previous sexual relationships. Her behaviour is most probably due to:
a) Borderline personality
b) Histrionic personality
c) Antisocial personality
d) Dependent personality
e) Substance abuse


14. All of the following psychoses are fully reversible except:
a) Mania
b) Factitious disorder
c) Severe sensory deprivation
d) Amphetamine abuse
e) ?


15. Panic disorder without agoraphobia:
a) Is more frequent in men
b) Is more frequent in women
c) Is equally frequent in men and women
d) Starts in the 20s
e) Patients should avoid trigger factors

[walid51]

recomended books for AMC medical council exam

Well friends, i wonder really to hear same questions again and again from you guys.I request you all to read the previou posts thoroughly,and after that if u have some confusion,then u can ask.Regarding books, i would like to say again that AMC has send me the preliminary application form for this AMC exam.In their letter,they themselves have recomended two books for studying ie
1)Anothology of Medical Conditions. The price of this books is 176AUD. You can get this book by an order to amc@amc.org.au,adn address is: PO Box 4810,Kingston ACT 2604,Australia.
2)Annotated Multiple Choice Questions. The price of this books is 104AUD. You can get this book by an order to blackwellpublishingasia.com, and address is: Blackwell Publishing Asia,PO Box 378,Carlton South Vic 3053,Australia.
The Australian Medical Council has published this book to assist overseas trained doctors who r prep for AMC exam.It is prepared by an expert panel of AMC board of Examiners.
I can understand that these books r lil expensive,but if u guys r soooo much interested in AMC exam then u ppl can collect money with sharing and order one pair of book,and can get its photocopied.Thats what i think,will be a lil cheaper to u guys. But other refernces books r the same,which we do study during our MBBS studies.
I am again posting the same thing,regarding the procedure of applying for this exam.Hope that will help.




1-Begin the process by submitting to the AMC a preliminary application form and the $100.00 GP application fee. You can submit this Form via the Internet through the AMC website or you can contact the AMC to obtain the preliminary application form by post.
2-Once you have submitted the preliminary application form, either through the internet or post, the $100.00 fee is processed. A GP pack (containing Form A, Information Booklet for Candidates, and associated information) is then forwarded to you.
3-Once you have received the GP pack, you must carefully read the Information Booklet for Candidates, which informs you of the documentation required for the application process. This booklet also lists the persons accepted to witness your documentation. It is very important that you submit the required documentation with correct certification. You must fill in the Form A and submit the relevant documentation in order for the application process to commence.
4-The non-specialist application process takes between 4 – 6 weeks. It is important that the Form A and documentation are submitted to the AMC before the ‘new assessment closing date’ in order for an applicant to be assessed as eligible to sit the next available MCQ examination.
5-Once the application has been completed, a letter regarding the outcome will be forwarded to you in the post. If you are eligible to undertake the AMC examination process, a Form C-1 application will be included with the assessment letter and you can then apply for the next available MCQ examination. If you are not eligible, the letter will state what is still required by the AMC to complete the application process.

there has been quite a few changes in the application forms and the fees and the rules....
1. AMC APPLICATION and ASSESSMENT FEES

New arrangements will apply from 1 July 2005 for the payment of certain AMC application and assessment fees for both non-specialist [AMC examination] and specialist assessment.

Candidates will no longer be required to pay the full assessment fee when they lodge their preliminary application form.

From 1 July 2005 the following fees will apply:

Preliminary Application Fee

To obtain application materials including Information Booklets and Application Form A or SA to determine eligibility for examination or specialist assessment
$ 45.00

AMC Examination Assessment Fee

To be lodged with Form A to determine eligibility to sit the AMC examination for non-specialist registration
$ 100.00

Specialist Assessment Fee
To be lodged with Form SA to determine eligibility for assessment for registration as a specialist
$ 250.00

Combined Assessment Fee

To be lodged with Forms A and SA for both assessment to sit the AMC examination and specialist assessment
$ 250.00

Applicants who have paid the full assessment fee prior to 1 July 2005, must lodge their Form A or Form SA by 30 June 2005.


NOTE: Current arrangements for paying fees and lodging applications for Area of Need specialist assessment will continue for the time being.

The Area of Need Specialist Assessment Fee of $250.00 must be paid at the time Form AON-SA and other documents are lodged.



2. ENGLISH LANGUAGE PROFICIENCY REQUIREMENTS

The State and Territory Medical Boards have agreed on a uniform national standard for English language proficiency for the registration of overseas trained doctors. With effect from 1 July 2005 the following provisions will apply: Please click here to view the full English Language Proficiency Requirements as of 1 July 2005.

Medical Boards will require an applicant for registration to have completed the International English Language Testing System (IELTS) examination (Academic module) with a minimum score of 7 in each of the 4 components.

Alternative English proficiency tests that will be accepted are:

A pass in the Occupational English Test (OET) administered by the Centre for Adult Education with grades A or B only in each of the 4 components
A pass in the English language component of the United States Medical Licensing Examination [USMLE – previously ECFMG] but not the TOEFL component of the current USMLE
A pass in the Professional Linguistic Assessment Board (PLAB) examination in the United Kingdom; or
A pass in the English language proficiency component of the New Zealand Registration Examination (NZREX).

These English language proficiency standards will apply to all applicants for assessment through the AMC

[walid51]

AMC QUESTION BANK CLINICALS MCQS




[Only Registered Users Can See Links]

[midoxxxxxx]

الرابطين اللي فوق لنفس الكتاب
نعم للاسف كتاب Annotated Multiple Choice Questions: Australian Medical Counci
غير موجود ارجوا الرد للاهميه وشكراااااااا:36_1_6:l

[walid51]

[Only Registered Users Can See Links]=onepage&q&f=false