AKT Insights Flashcards
(50 cards)
Q u e s t i o n
Bert Weir is a 67-year-old copywriter who presented following his best friend’s recently diagnosed with
prostate cancer. Bert is very concerned and keen to undergo prostate cancer screening. After a careful
history, no lower urinary tract signs can be elicited, and Bert remains well. Following good medical
advice, you discuss the risks and benefits of testing fully, Bert decides to proceed with testing, and you
order a prostate-specific antigen (PSA) test and review him a week later with the result. His PSA result
was 4.1pg/L (<3.0 pg/L).
What is the MOST appropriate next step?
A. Complete a digital rectal examination before making any further decisions
B. Reassurance that no further investigation is required
C. Order a routine ultrasound of the prostate
D. Arrange repeat PSA testing in 6 weeks’ time
E. Urgent urological surgical opinion
F. Refer on for a routine urological opinion
G. Reassure Bert that his PSA is normal in the age group
H. Given his asymptomatic history, avoid causing undue harm and monitor for symptom development
I. Organise a prostate mpMRI (Multi-parametric MRI)
D. Arrange repeat PSA testing in 6 weeks’ time
Q u e s t i o n
Nicola Hansford is a 39-year-old female presenting for her annual influenza vaccination at your rural
practice. Nicola has a well-documented history of asthma that was managed with fluticasone
propionate 250mcg inhaled daily. You notice that her last script was over a year ago, and on further
questioning, you discover poor medication compliance as Nicola has not used her preventer for the
past 6 months or so. She has been using salbutamol 100mg MDI at least once per week in the past
few months. On examination, she has equal chest rise and fall, clear lung fields throughout, normal
resonance and oxygen saturations of 98% on room air.
What is the MOST appropriate pharmacological management of her asthma?
A. Increase salbutamol frequency
B. Add Acidinium 322microg (Genuair) via DPI twice daily
C. Add Fluticasone 100mg (Accuhaler) via inhalation twice daily
D. Prescribe Fluticasone/salmeterol MDI (250/25) (Turbuhaler), two inhalations as required
E. Cease salbutamol due to continuation of symptoms
F. Cease all treatment until formal spirometry can be arranged to elicit a diagnosis.
G. Prescribe budesonide-formoterol 100microg/3microg (Rapihaler) two inhalations as required..
H. Complete respiratory workup with chest X-ray
G. Prescribe budesonide-formoterol 100microg/3microg (Rapihaler) two inhalations as required..
Q u e s t i o n
Alex Pittoni is a 39-year-old physiotherapist who has presented to your practice for the first time. The triage note states irritated and painful eye. After a careful history, Alex describes that the eye pain
began last night after he was working on his car in the garage, grinding sheet metal. He describes some ‘spots’ in his vision. On physical examination, you note the eye as pictured below, and his visual acuity in the left eye is 6/6, and in the right eye, 6/6.
Picture shows subconjunctival haemorrhage + hyphaemia (blood in anterior chamber)
What is the MOST appropriate management?
A. Urgent review by ophthalmologist
B. Reassurance that no further investigation is required
C. Prescribe chloramphenicol 2 drops to affected eye QID.
D. Prescribe topical anaesthetic, oxybuprocaine 0.4%, and review in 5 days
E. Reassure that symptoms will settle spontaneously CADEMI
F. Serial review over the next 5 days to monitor progress
G. Patch affected eye for the next 3-4 weeks
H. Recommend further grinding work be conducted with Australian safety standards approvec
protected eyewear
A. Urgent review by ophthalmologist
Q u e s t i o n
Sarabi Gifford is a 28-year-old female who has presented with a severe facial rash. Sarabi is well known to you for her antenatal care, which so far has been completely normal; she is currently 24 weeks pregnant. When discussing possible causes with Sarabi, she mentions that she suspects it is a new cosmetic facial cream she has just begun using. She has already used topical treatment provided by the pharmacist with minimal effect. A picture is shown below.
Picture shoes erythema + small (<2mm papular/pustular lesions) with scaling adjacent to nose + lips (i.e. periorificial dermatitis)
What is the MOST appropriate pharmacological management?
A. Prescribe topical methylprednisolone aceponate 0.1% ointment daily to the affected area
B. Reassurance that cosmetic cream is unlikely to be causative
C. Prescribe topical hydrocortisone 1% daily to the affected area
D. Prescribe oral erythromycin 250mg daily
E. Prescribe mometasone furoate 0.1% lotion twice daily to the affected area
F. Prescribe oral doxycycline 100mg daily
G. Prescribe pimecrolimus 1% c r e a m o n c e or twice daily
H. Prescribe LPC 3 to 6% + salicylic acid 2 to 6% in aqueous cream once daily to affected area
D. Prescribe oral erythromycin 250mg daily
Q u e s t i o n
Amanda Kelly is a 22-year-old woman who presents to your busy remote and rural general practice for
the first time today. She works remotely as a finance manager and has been extensively training for a
marathon in the last 6 weeks. Her symptoms include a dry cough and right-sided pleuritic chest pain
for the past 3 days. On examination, you note a normal pharynx, good air entry bilaterally, respiratory
rate of 16 breaths/minute, dual heart sounds with no murmur and a pulse of 118 bpm. No other signs
or symptoms are found on physical examination. You ordered an urgent chest x-ray which is normal.
What is the MOST appropriate next step?
A. Prescribe oral diclofenac and review
B. Reassurance that no further investigation is required
C. Order an urgent D-dimer
D. Arrange prescription of PO amoxicillin 1g TDS for 5-7 days depending on response to treatment
E. Organise High-Resolution Computed Tomography (HRCT) of the chest
F. Non-urgent referral to a respiratory physician
G. Dual therapy of PO amoxicillin 1g TDS and doxycycline 100mg daily for 5-7 days, depending on the response t o treatment
C. Order an urgent D-dimer
Q u e s t i o n
Sally Rosewood is a 59-year-old school teacher who has presented to your rural practice for a private
driver’s licence medical exam. Sally is well known to you, and you have managed her hypertension,
hypercholesterolaemia and type 2 diabetes for the past decade. A year ago, following repeatedly high
HbA1c’s, her diabetes management expanded from metformin 1g BD daily, empagliflozin 25mg PO
daily and dulaglutide 1.5mg S/C once weekly to include insulin as part of her treatment regime. Upon
questioning, Sally reports that 3 weeks ago, she had an episode of hypoglycaemia without
awareness and that a colleague had to give Sally glucagon with good effect.
What is the MOST appropriate next step?
A. Counsel Sally to voluntarily hand in her licence
B. Refer Sally to an endocrinologist
C. Provide a conditional licence allowing her to drive to the local supermarket during daylight hours
only.
D. Remove insulin and add in a DPP-4 inhibitor such as sitagliptin 100mg daily.
E. Advise a non-driving period of at least 6 weeks.
F. Prescribe a blood sugar diary and allow Sally to drive if her blood sugar levels are >5.0 mmol/L
G. Complete the driver’s licence as usual since it is a private driver application only.
H. Re-prescribe glucagon and order an HbA1c
E. Advise a non-driving period of at least 6 weeks.
Joseph Taylor is a 44-year-old male presenting for review at your local clinic. He describes an 8-month
history of shortness of breath and persistent cough. In the last few months, he has been using over-
the-counter salbutamol 100mcg MDI via spacer with some benefit. He has smoked 25 cigarettes per
day for the last 24 years. A colleague who saw Joseph last month ordered spirometry with the results
displayed below.
FEV1: Pre-bronchodilator 81% predicted -> Post-bronchodilator 82% predicted
FEV1/FVC Ratio 65%
What is the MOST appropriate management?
A. Increase salbutamol frequency
B. Add Aclidinium 322 mcg via DPI twice daily
C. Add Fluticasone 100mg via inhalation twice daily
D. Add Tiotropium-olodaterol 5+5 mcg via mist inhaler daily
E. Cease salbutamol due to continuation of symptoms
F. Refer for chest physiotherapy as symptoms can be managed non-pharmacologically
G. Cease salbutamol and prescribe nicotine replacement therapy 21 mcg./hr patches
H. Complete respiratory workup with chest X-ray
B. Add Aclidinium 322 mcg via DPI twice daily
Q u e s t i o n
Alan Jones is a 55-year-old male who regularly attends your clinic. For the past 4 four months, he has
presented with urinary frequency, difficulty maintaining a urinary stream and nocturia. At your first
review with Alan, you ordered urine microscopy, culture and sensitivity (MCS), prostate-specific antigen
(PSA) and a prostate ultrasound. A month later, you reviewed Alan and discussed that the urine MCS
and prostate ultrasound were normal. You ordered a second PSA test, both of which are shown below.
Sample 1 - PSA 4.3, Free:Total PSA 10%
Sample 2 - PSA 4.4, Free:Total PSA 10%
What is the MOST appropriate next step?
A. Complete a digital rectal examination with informed consent and refer to urologist if abnormal
B. Repeat a PSA in 6 months to calculate the PSA velocity
C. Complete a thorough family history to stratify his risk of prostate cancer
D. Refer to a urologist for an MRI of the prostate
E. Repeat a PSA in 6 weeks for comparison
F. Regular clinical reviews over the next 12 months to monitor symptom progression
G. Prescribe dutasteride PO 500microg once daily
H. Organise ultrasound-guided transrectal biopsy of the prostate
I. Assess his Prostate Health Index (PHI)
D. Refer to a urologist for an MRI of the prostate
Q u e s t i o n
Rebekah Hart, a 28-year-old woman who is well known to your clinic has arranged an urgent appointment at the start of a busy day. Rebekah is currently 38 weeks pregnant and has been brought
in by a perceived change in foetal movements over the last four hours. Rebekah describes periods where she can feel foetal movements in a rapid/fast manner and periods where she cannot feel any foetal movements at all. All antenatal care up to this point has been normal. Her blood pressure is 118/78mmHg, pulse 85 bpm regular, respiratory rate of 15 breaths/min, temperature 36.5°C. An abdominal examination reveals a soft gravid abdomen with a foetus in a left lateral lie. A Doppler ultrasound reveals a foetal heart rate of 130 bpm.
What is the MOST appropriate next step?
A. Serial reviews over the next 6 hours at your clinic
B. Ensure Rebekah is feeling safe at home and supported by her partner before asking her to return home
C. Refer for a routine ultrasound
D. Arrange for an urgent caesarean section at the local obstetric unit
E. Reassure the patient and recommend a kick-chart
F. Urgent referral to an obstetric unit for cardiotocography
G. Organise a routine referral to the local antenatal clinic
H. Daily reviews at your clinic until the onset of labour
F. Urgent referral to an obstetric unit for cardiotocography
Q u e s t i o n
Liam is a 6-month-old baby boy brought into the clinic by his mother, Amanda, for routine immunisations. Amanda has no concerns about Liam’s health or development. As part of your pre-
vaccination checklist, you perform a physical examination. On pelvic examination, you can only identify a left-sided testicle within the scrotum. Further examination shows a lump in t h e right
inguinal canal that cannot be mobilised into the scrotum.
What is the MOST appropriate next step?
A. Referral to a surgeon for early orchidopexy
B. Routine ultrasound referral to characterise
C. Reassure Amanda that most testes will descend by 12 months of age
D. Routine referral to a surgeon if not descended by 18 months of age
E. Urgent CT KUB to exclude other causes
F. Refer to a local paediatrician for a second opinion
G. Complete routine immunisations and review next week to assess if persistent
H. Refer to Emergency Department of the local hospital for urgent assessment
A. Referral to a surgeon for early orchidopexy
Violet Turner, aged 72 years, is terminally ill with carcinoma of the pancreas and was started on oral morphine four days earlier. She has noticed that the morphine is making her a little sleepy during the day though it is providing her with good pain relief.
What is the MOST appropriate management?
A . A d d caffeine to the medication routine
B. Change to another analgesic
C. Halve the dose of morphine
D. Increase the interval between doses
E . Reassure her that the drowsiness will decrease with continued use of morphine
E . Reassure her that the drowsiness will decrease with continued use of morphine
Q u e s t i o n
Andy Fairweather, 40-year-old retail assistant manager presents for cancer screening advice. His partner, Kate, recently read an online article regarding colorectal cancer and has urged Andy to see you given his family history. Andy’s father was diagnosed with colon cancer 6 months ago at the age of 60 years. His paternal aunt died of colon cancer 2 years ago, she was first diagnosed at the age of 68 years. Andy is currently asymptomatic. He is a non-smoker, and drinks 1 to 2 stubbies of beer during the week and 5 stubbies over the weekend. He states that due to his busy work schedule, he often does not have time to exercise and he regularly eats takeaway meals.
What is the MOST appropriate recommendation for cancer screening based upon this patient’s history?
A. FOBT is recommended every two years from 45-74 years of age
B. FOBT is recommended every two years from 40-74 years of age
C. FOBT is recommended every two years from 45-49 years of age then every year from 50 years of age
D. FOBT is recommended every two years from 40-49 years of age then colonoscopy every two years from 50 years of age
E. FOBT is recommended every two years from 40-49 years of age then colonoscopy every five years from 50 years of age
F. Colonoscopy every 5 years from 50-74 years of age
G. Colonoscopy every two years from 40-74 years of age
H. Refer for genetic screening
F. Colonoscopy every 5 years from 50-74 years of age
Q u e s t i o n
Ethan Papas, a 28-year-old carpet layer, presents with a week’s history of left knee pain and swelling.
Ethan tells you he has recently completed a big commercial project but denies any preceding injury to
his knee. He has been resting, applying ice and compression bandage over his knee, and his symptoms
are gradually improving. However, he is frustrated as his pain and swelling worsen every time he returns
to work. He feels well in himself otherwise. Ethan is a non-smoker, drinks socially, and takes no regular
medications. He has no significant past medical history. On examination, Ethan can bear weight; his
temperature is 36.5°C, heart rate is70b/m, and BP 122/70; his left knee appears mildly swollen; it is
slightly red and tender anteriorly; his knee range of movement is flexion 80°; extension 20°.
What is the most appropriate next step in management?
A. Organise autoimmune screen CADEMY
B. CT left knee for occult fracture
C. Diclofenac 50mg oral TDS for 5 days
D. Flucloxacillin 500mg oral QID for 5 days
E. Pregabalin 50mg oral BD
F. Intra-articular steroid injection
G. Diagnostic knee joint aspiration
H. Commence Allopurinol 300mg oral daily with prednisolone cover
I. Urgent referral to an orthopaedic surgeon for diagnostic knee scope +/- washout
C. Diclofenac 50mg oral TDS for 5 days
Q u e s t i o n
Tania Langford, a 65-year-old registered nurse, has been referred by her surgeon for a follow-up of abnormal investigation results. She was recently discharged from the hospital after a three-week stay for perforated diverticulitis, requiring emergency Hartmann’s procedure and post-op high dependency unit admission. Tania is improving from her surgery and feels well today. She has completed her oral antibiotics regime and is currently on paracetamol 1g OID. Tania has a history of hypertension and gout,
for which she is on perindopril 5mg oral daily and allopurinol 300mg oral daily. On examination, her HR is 70b/m, BP is 128/88, Temperature is 36.5°C, SPO2 is 99% on room air, her abdomen is soft and non- tender, the laparotomy wound is healing well, and the colostomy is functioning. Physical examination is
otherwise unremarkable. See table for investigation results.
Pathology results:
CRP 18 (>10mg/dL)
TSH 9.8 (0.4-4.0 IU/L)
Free T4 1.2 (0.8-1.8ng/L)
What is the most appropriate next step?
A. Repeat TFTs in six weeks.
B. Levothyroxine 25mcg oral daily, adjust dose in 4-6 weeks
C. Levothyroxine 100mcg oral daily
D. Carbimazole 10mg oral TDS, up titrate dose in 4-6 weeks
E. lodine supplement
F. Ultrasound thyroid +/- Fine needle aspiration
G. Radionuclide scan of the thyroid
H. Recommence oral antibiotics, amoxicillin/clavulanate, 875/125mg, 1 tab oral BD for 5 days
I. Refer to ED for IV antibiotics.
A. Repeat TFTs in six weeks
Q u e s t i o n
Trudi O’Brien, 75-year-old retired florist, presents with left wrist pain, weakness and reduced mobility. Trudi sustained a left distal radius fracture 6 weeks ago as a result of a mechanical fall on an
outstretched hand whilst she and her husband were on their camper van holiday in Queensland. She presented to the local emergency department at the time, and her fracture was treated with an application of a plaster back slab. Her wrist was immobilised for 4 weeks and the plaster cast has since been removed. Trudi and her husband returned from their holiday yesterday and have booked in to see you, their regular GP. She has a history of diet control type two diabetes; she is not on any regular
medications. On examination, her wrist appears to be at approximately 5 degrees dorsal tilt, and there is significant tenderness over the distal radius with mild reduced grip strength.
What is the most appropriate next investigation?
A. X ray left wrist
B. X ray left elbow
C. CT left wrist
D. MRI left wrist
E. Ultrasound left wrist
F. Diagnostic aspirate of left wrist
G. Nerve conduction test
H. Bone scan
I. Dual energy X Ray absorptiometry scan
J. No investigation required
A. X ray left wrist
Q u e s t i o n
Mariam Gordon, 78, presents with a worsening chronic cough over the last two months. She describes it as a dry, tickling cough with a small amount of white mucoid sputum. Mariam saw your colleague a month ago and was given oral amoxicillin and a short course of oral prednisolone. She tells you there has been a slight improvement in her symptoms despite completing treatment. Mariam has a history of chronic obstructive pulmonary disease and is currently on tiotropium and PRN salbutamol; she is also a
smoker with a 30-pack-year tobacco smoking history. On examination, her HR is 70 b/m, BP is 130/88, RR is 14b/m, the temperature is 36.8°C, SPO2 is 97%, and the chest is clear on auscultation. A recent chest X-ray is normal. Covid 19 swab is negative.
What is the MOST appropriate next step?
A. Repeat Chest X-ray in 2 weeks
B. CT Chest
C. MRI Chest
D. PET scan
E. DEXA scan
F. CT Pulmonary angiogram
G. Stress echocardiogram
H. No investigations at this stage, follow up in 6 months
Amoxicillin+ clavulanate 875/125mg oral BD for 5 days
J. Refer respiratory physician
B. CT Chest
Peter Simons, aged 20 years, presents with his girlfriend, Sally, who is eight weeks pregnant. Peter is concerned as his mother has Huntington’s disease. Peter has not had genetic testing. They would like to know the risk for their unborn child so they can make an informed decision about continuing the pregnancy. You arrange urgent genetic counselling.
What initial investigation will be MOST appropriate?
A. Chorionic villus sampling
B. Combined first trimester screening
C. Genetic testing of Peter
D. Genetic testing of Sally
E. Non-invasive perinatal testing of maternal serum
C. Genetic testing of Peter
Q u e s t i o n
Chelice Dauphine, a 57-year-old chef, presents with her husband Edgar, as they are both concerned about her. Edgar reports Chelice has been “off” all day today, although he feels she is back to normal
now. Edgar and Chelice had been preparing for a family lunch and were out grocery shopping this morning when Edgar first noticed that Chelice seemed forgetful. She kept asking where they were and placing the same items in the grocery cart when h e directed her to the grocery list. When they were driving home, she kept asking where they were going. When they got home, she recognised where they were, but during meal preparation, Chelice kept stopping and cooking, asking what they were making such a mess for. Edgar states that Chelice seemed t o get better after everyone came over for lunch, but they are concerned as Chelice’s mother had dementia. Chelice is a non-smoker and does not
drink alcohol; she takes no regular medications and i s usually very active with ballroom dancing. On examination, Chelice has a normal neurological examination and an MMSE of 30/30. She is afebrile with a blood pressure of 146/78 mmHg and a heart rate of 84 beats per minute, regular.
Which of the following is the most likely diagnosis for Chelice’s symptoms?
A . Cerebrovascular Accident
B . Complex partial seizure
C . Transient global amnesia
D . Intracranial mass lesion
E . Acute delirium
C . Transient global amnesia
Paul Brown, aged 62 years, has experienced one week of pain which initially began on the front of his upper anterior right thigh and now also involves the back of his calf. The pain is burning in
nature, worse at night and has increased in intensity over the past few days. He has also noticed some weakness in his right upper leg, which is now affecting his walking. He has type 2 diabetes and a
history of mild gout. On examination, he has a mildly reduced knee jerk reflex on the right.
What is the MOST appropriate provisional diagnosis?
A . Amyotrophic lateral sclerosis
B. D e e p vein thrombosis
C. Herpes zoster
D. L4/5 nerve root irritation
E. Mononeuritis multiplex
E. Mononeuritis multiplex
Jason, 22, presents with sudden onset of right wrist drop and pain in his right arm. He noted all his symptoms first thing this morning. He tells you that “he had a big night out last night” and slept on
his right arm. Which of the following is your preferred next step?
A . Urgent referral to surgeon for nerve release
B . Refer him for a nerve conduction study of the right upper limb
C . Reassure the patient that this is called ‘Saturday night Palsy’ and will resolve within a few days
D . Soft tissue ultrasound of right arm
E . CT scan of his right arm
F . Refer him for brain and cervical spine MRI
B . Refer him for a nerve conduction study of the right upper limb
Gabby Wood, aged 67 years, presents with a severe intermittent pain on the left side of her face. The pain is shooting and brief, occurring over her jaw and cheek. It came o n suddenly two days ago and she has no other symptoms.
What is the MOST appropriate initial management?
A. Amitriptyline 50 mg orally nocte
B. Carbamazepine modified-release 100 mg orally twice daily
C. Oxycodone 5 mg orally four times a day if required
D. Prednisone 5 0 mg orally daily
E . Pregabalin 75 mg orally nocte
B. Carbamazepine modified-release 100 mg orally twice daily
Maximilian Sirocco an 85 year old retired geography teacher, is brought in by his daughter Emma today. Emma is concerned that Maximilian h a s become more forgetful since the passing of his wife 3 years ago. Maximilian has recently moved in to live with Emma in the last six months as she has been worried about his ability to care for himself. Last night Maximilian called Emma into his bedroom as he was upset about the two dogs that were in the corner o f his room. Emma reports that there were no dogs, but
Maximilian could not be convinced of this. Emma has also noticed that Maximilian seems to moving slower than he used to, and wonders whether this i s due to his diabetes. Maximilian’s past history includes Type 2 diabetes mellitus, hypertension, hypercholesterolaemia a n d anxiety. His current medications include Metformin 1g BD, Perindopril 5mg PO daily and Atorvastatin 80mg PO daily.
What is the most likely diagnosis for Maximilian’s symptoms?
A . Vascular dementia
B . Alzheimer’s dementia
C . Delirium
D . Schizophrenia
E . Lewy Body dementia
F . Space occupying lesion
G . Cerebrovascular accident
H . Depression
I . Side effect of the atorvastatin
E . Lewy Body dementia
Sachin i s a 45-year-old car mechanic. H e migrated from India t o Australia when h e was 22. Sachin is known t o have epilepsy, which has been well under control for the past 2 years by taking his
antiepileptics. He is currently on reducing the dose of carbamazepine at 200mg/ BD and Levetiracetam at 500mg BD. Sachin is a smoker of 20 pack years. He is keen to stop smoking but failed to respond to Varenicline due t o intolerable side effects. Sachin is overweight with a BMI o f 32 and i s currently on the Dukan diet for weight loss, along with his exercise program. His last health assessment a t your clinic, 2 months ago, revealed only mild hypertension, which you decided t o keep under control with diet,
exercise and monitoring in addition to smoking cessation. Sachin asks you if he can take any medication to help him quit smoking.
Which of the following is the correct answer?
A. He can not use any pharmacological aid considering his medical history
B. Prescribe him with Bupropion for a 9-week course
C. Nicotine replacement therapy is a safe option that he can try
D. Prescribe him with a Nortriptyline at 150mg/day for no longer than 10 weeks in total
E . Ask his neurologist to reduce his dose of carbamazepine before starting him on any medication for
smoking cessation
F . Tell him that h e needs t o completely stop smoking before re-trying Varenicline as t h e side effects
become less tolerable without concurrent smoking
C. Nicotine replacement therapy is a safe option that he can try
Eli Cohen is a 72 years old retired carpenter who has noticed progressive hearing loss in his left ear with no other noticeable symptoms. Eli’s past medical history includes hypertension for which he takes perindopril 5mg/day. Eli is also on Doxycycline 100mg per day for his recurrent rosacea. You have referred him for an audiogram which is shown below. Which of the following would be the most appropriate next step?
Audiogram shows LEFT ear sensorineural hearing loss
A. Reassure him that this is a normal finding for his age
B. Refer him for a head MRI
C. Refer him to audiologist for hearing aid
D. Start him on a course of oral prednisolon
E. Stop his perindopril
B. Refer him for a head MRI
