AMC Active Recall

Question 1

AAA Surveillance Duration

Answer 1

US is preferred over CT

Question 2

AAA Surveillance Duration

Answer 2

US is preferred over CT

Question 3

AAA Surveillance Duration

Answer 3

US is preferred over CT

Question 4

AAA Surveillance Duration

Answer 4

US is preferred over CT

Question 5

Fundoscopy Spot Diagnosis

Answer 5

Chronic simple glaucoma

1. Increased cup:disc ratio
   - Normal range: 0.2 to 0.3
   - Increased IOP can cause ratio to increase to >0.5
2. Atrophic optic disc due blood vessel damage

Question 6

Type 1 HIT
(Heparin-Induced Thrombocytopaenia)

Onset
Mechanism of Action
Course of Illness

Answer 6

Onset: Within 2 days of Heparin exposure
MOA: Non-immune pathophysiology

Course of Illness: Usually self-resolving even with continued Heparin treatment

Question 7

Type 2 HIT
(Heparin-Induced Thrombocytopaenia)

Onset
Mechanism of Action
Course of Illness

Answer 7

Onset: Occurs 4-10 days after Heparin exposure
MOA: Immune-mediated pathophysiology

Course of Illness: Life and limb-threatening thrombotic complications

Question 8

Type 2 HIT
(Heparin-Induced Thrombocytopaenia)

Treatment Considations [3]

Answer 8

1. Most important step is to stop Heparin immediately
2. Avoid Warfarin as it can lead to micro-thrombosis
3. Limit platelet transfusions to severe thrombocytopaenia with ongoing bleeding / invasive procedures only, otherwise it may increase thrombogenic effect

Question 9

Child Asthma Control

Answer 9

Question 10

Child Asthma Control

Answer 10

Question 11

Child Asthma Control

Answer 11

Question 12

Child Asthma Ladder

Answer 12

Regular treatment with a theophylline is not recommended routinely for children.

For monoclonal antibodies or other fancier treatment, refer to specialist

Question 13

Child Asthma Ladder

Answer 13

Question 14

Alcohol Consumption Guidelines

Answer 14

Men
2 standard drinks per day
2 alcohol-free days per week

Women
1 standard drinks per day
2 alcohol-free days per week

Question 15

Notifiable Conduct [4]

Answer 15

1. Practicing while intoxicated
2. Sexual misconduct related to work
3. Impairment that leads to risk of public harm at work
4. Significant departure from accepted professional standards, that leads to risk of public harm

Question 16

Spot Diagnosis

Eye strain
Difficulty seeing in dim light
Problems focusing on small objects or fine print
Vision improves when looking through 1mm pinhole

Answer 16

Presbyopia

Question 17

Spot Diagnosis

Cannot see distant objects
Can see near objects

Answer 17

Myopia

Question 18

Spot Diagnosis

Monocular sudden-onset decrease in visual acuity
Floaters
Not painful
Normal eye inspection

Answer 18

Retinal Detachment

Question 19

Spot Diagnosis

Slow progressive visual loss
Insidious onset
Usually in elderly patient

Answer 19

Age-Related Macular Detachment

Question 20

Vit A deficiency can lead to which breast disease?

Answer 20

Periductal mastitis
aka subareolar abscess

Question 21

Auditory Test Functions

Pure Tone Audiometry

Answer 21

Objectively distinguishes between conductive hearing loss and sensori-neural hearing loss

Question 22

Auditory Tests Functions

Speech Discrimination Test

Answer 22

Essentially, tests integrity of cochlear nerve
Good for screening for acoustic neuroma
Helps to determine if patient will benefit from hearing aid

Question 23

Auditory Test Functions

Electrocochleography

Answer 23

Measures electrical potentials generated in the inner ear as a result of sound stimulation

Helps to determine if there is excessive amount of fluid pressure (eg Meniere’s Disease, endo-lymphatic hydrops)

Question 24

Spot Diagnosis
Investigations (2)

Dysarthria
Confusion
Wide-Based Gait

Answer 24

Wilson’s Disease

Look for Serum Copper (will be high in Wilson’s) and Caeruloplasmin (will be low in Wilson’s)

Question 25

Absolute Contraindications to ACE-Is [4]

Answer 25

1. History of angio-oedema, regardless of cause 2. Pregnancy (due to harm to foetus) 3. Bilateral renal artery stenosis 4. Previous allergic reaction to ACE-Is

Question 26

Relative Contraindications to ACE-Is [2]

Answer 26

1. Aortic stenosis 2. Hypertrophic cardiomyopathy

Question 27

Spot Diagnosis 3- to 6-weeks old baby Projectile vomit then demands to be re-fed ("hungry vomiter") Palpable olive-like abdominal mass

Answer 27

Infantile hypertrophic pyloric stenosis

Question 28

Spot Diagnosis Eating Disorders

Answer 28

Question 29

Spot Diagnosis Eating Disorders

Answer 29

Question 30

Spot Diagnosis Eating Disorders

Answer 30

Question 31

Indications for Teriparatide in osteoporosis treatment [3]

Answer 31

1. BMD T-Score ≤ -3 2. ≥ 2 minimal-trauma fractures 3. ≥ 1 symptomatic new fracture after at least 12 months of anti-resorptive agent

Question 32

Spot Diagnosis & Treatment Generalized lymphadenopathy Splenomegaly Haematological derangement

Answer 32

Chronic Lymphoblastic Leukaemia (CLL) Treatment 1st Line: Fludarabine 2nd Line: Chlorambucil Prednisolone is used for cytoreduction

Question 33

Spot Diagnosis Painless, rubbery, nonerythematous, nontender lymphadenopathy - Clasically cervical and supra-clavicular B-Symptoms

Answer 33

Hodgkin's Lymphoma

Question 34

Contraindications to POP Contraceptive "PUB LAH"

Answer 34

Pregnancy Undiagnosed genital tract bleeding Breast cancer Liver cirrhosis Active liver disease History or risk of ectopic pregnancy

Question 35

Spot Diagnosis Unruly / argumentative behaviour Attitude towards authority At least 6 months

Answer 35

Oppositional Defiance Disorder (ODD)

Question 36

Spot Diagnosis Ritualistic behaviour Pre-occupation with activities / objects Poor communication skills Delayed speech development

Answer 36

Autism (Asperger's is similar, but with normal language development)

Question 37

Characteristics of physiological innocent murmurs "7S"

Answer 37

1. Sensitive - Changes with position or respiration 2. Short duration - Not pan-systolic 3. Single - No clicks 4. Small area - No radiation 5. Soft 6. Sweet - Not harsh sounding, no thrill 7. Systolic

Question 38

HIV Opportunistic Infections & Prophylaxis

Answer 38

Question 39

HIV Opportunistic Infections & Prophylaxis

Answer 39

Question 40

HIV Opportunistic Infections & Prophylaxis

Answer 40

Question 41

Spot Diagnosis Fear of abandonment You are hero or zero Impulsive actions

Answer 41

Borderline Personality Disorder

Question 42

Spot Diagnosis Sense of self-importance Fantasy of success Anger towards criticism

Answer 42

Narcissistic Personality Disorder

Question 43

Spot Diagnosis Colourful, exaggerated behaviour Shallow expression of emotions Want to be centre of attention Sexually seductive

Answer 43

Histrionic Personality Disorder

Question 44

DSM-5 Diagnosis of Schizophrenia [5]

Answer 44

1. Delusions 2. Hallucinations - Almost always auditory 3. Disorganized speech 4. Disorganized or catatonic behaviour 5. Negative symptoms At least 2 symptoms required At least 1 of the symptoms musst be #1-3

Question 45

Psychotherapies

Answer 45

Question 46

Psychotherapies

Answer 46

Question 47

Psychotherapies

Answer 47

Question 48

Colles Fracture Cast Regime

Answer 48

- Wrist should be fixed in partial flexion, with ulnar deviation - Forearm should be in slight probation - Below-elbow cast for 4-6 weeks

Question 49

Significance of Coombs Positive

Answer 49

High chance that a haemolytic anaemia is autoimmune in nature

Question 50

Spot Diagnosis Female patient Sudden onset unilateral LOV Ipsilateral headaches Hip and shoulder pain / stiffness

Answer 50

GCA with associated PMR

Question 51

Gonorrhoea Treatment

Answer 51

IM Ceftriaxone ONCE + PO Azitromycin ONCE

Question 52

Puerperal Haematoma Management Size Criteria and Options [2]

Answer 52

<3cm : Analgesia, ice packs >3cm: Surgical excision and evaluation

Question 53

Benign ECG Changes in Digoxin Use [4]

Answer 53

1. TWI 2. QT shortening 3. Scooped ST segment, with ST depression 4. Increased amplitude of U-wave

Question 54

Toxic Level ECG Changes in Digoxin Use [5]

Answer 54

1. Frequent PVCs 2. SVT 3. 1st degree heart block (prolonged PR) 4. Junctional escape rhythms 5. Bidirectional VT with alternating axis of QRS [Rare but most specific sign]

Question 55

Bisphosphonate Treatment Duration

Answer 55

5-7 years

Question 56

After 20 weeks' gestation, fundal height correlates with gestational age. A discrepancy of >2cm is significant. Causes of fundal height being LESS than gestational age include... [4]

Answer 56

1. Dating error 2. Oligohydramnios 3. Transverse / oblique lie 4. Small for gestational age

Question 57

After 20 weeks' gestation, fundal height correlates with gestational age. A discrepancy of >2cm is significant. Causes of fundal height being MORE than gestational age include... [5]

Answer 57

1. Dating error 2. Large for gestational age 3. Multiple pregnancy 4. Polyhydramnios 5. Molar pregnancy

Question 58

License to drive after seizure - Standard criteria for private driver [3]

Answer 58

1. Seizure-free for 12 months 2. Adherence to treatment 3. Annual review by licensing authority Different rules apply for commercial drivers

Question 59

Indications for Group B Strep treatment during labour [5]

Answer 59

1. Maternal history of GBS disease 2. GBS+ swab or urine culture 3. PROM > 18hrs or unknown duration 4. Maternal pre- or intra-partum fever 5. Unknown status of GBS colonization Treat with prophylactic IV Penicillin

Question 60

CRC Screening

Answer 60

Question 61

CRC Screening

Answer 61

Question 62

CRC Screening

Answer 62

Question 63

CRC Screening

Answer 63

Question 64

Predisposing Factors to Postpartum Haemorrhage [5]

Answer 64

1. Antepartum haemorrhage (including placenta abruption, placenta praevia) 2. Previous postpartum haemorrhage 3. Placenta accreta 4. Multiple pregnancy 5. Coagulopathy

Question 65

Croup Severity Grading

Answer 65

Question 66

Croup Severity Grading

Answer 66

Question 67

Croup Severity Grading

Answer 67

Question 68

Red Flags for Renal Masses [3] (Suggestive of Malignancy)

Answer 68

1. Completely solid lesion 2. Mixed solid and cystic lesion 3. Contrast-enhancing cystic lesion

Question 69

Suspected Renal Malignancy Indications for Total Nephrectomy [5]

Answer 69

1. Tumour size ≥ 7cm 2. Central location 3. Suspected lymphnode involvement 4. Associated venous thrombus 5. Direct extension into ipsilateral adrenal gland

Question 70

Pancreatic Pseudocyst Indications for Laparatomy [6]

Answer 70

1. Compression of large vessels 2. Gastric or duodenal outlet obstruction 3. CBD stenosis from compression 4. Infected pseudocyst 5. Haemorrhagic pseudocyst 6. Pancreatico-pleural fistula

Question 71

Contraindications to HRT Absolute [2], Relative [4]

Answer 71

Question 72

HRT Comparisons in Menopause (Hot Flushes)

Answer 72

Question 73

HRT Comparisons in Menopause (Hot Flushes)

Answer 73

Question 74

HRT Comparisons in Menopause (Hot Flushes)

Answer 74

Question 75

Types of Spontaneous Abortion Threatened Abortion - Any bleeding? - Cervix open or closed? - Visible POC on pelvic exam? - Fetal heart rate present?

Answer 75

Question 76

Types of Spontaneous Abortion Inevitable Abortion - Any bleeding? - Cervix open or closed? - Visible POC on pelvic exam? - Fetal heart rate present?

Answer 76

Question 77

Types of Spontaneous Abortion Incomplete Abortion - Any bleeding? - Cervix open or closed? - Visible POC on pelvic exam? - Fetal heart rate present?

Answer 77

Question 78

Types of Spontaneous Abortion Complete Abortion - Any bleeding? - Cervix open or closed? - Visible POC on pelvic exam? - Fetal heart rate present?

Answer 78

Question 79

Types of Spontaneous Abortion Missed Abortion - Any bleeding? - Cervix open or closed? - Visible POC on pelvic exam? - Fetal heart rate present?

Answer 79