Exam recall 2019 - RURAL GP, GENMED, PSYCH, GERRIES, PALL CARE.

Question 1

Which one is a negative symptom of schizophrenia?
- Apathy
- Blunted affect

Answer 1

Both apathy and blunted affect are negative symptoms of schizophrenia. However, if you need to choose just one, blunted affect (reduced emotional expression) is the more specific term for a negative symptom, while apathy can also be considered one but is sometimes seen in other conditions as well.

Question 2

Highest risk factor for developing an eating disorder?
- Weight loss
- Perfectionism

Answer 2

Perfectionism is the highest risk factor for developing an eating disorder. Individuals with perfectionistic tendencies may have higher levels of self-criticism and pressure to meet unrealistic standards, which can contribute to the development of eating disorders. Weight loss can be a consequence of an eating disorder but is not necessarily a risk factor for developing one.

Question 3

Management of acute mania?
- Clonazepam
- Olanzapine

Answer 3

For the management of acute mania, Olanzapine is generally preferred. It is an antipsychotic medication that can help stabilize mood and manage symptoms of mania.

Clonazepam, a benzodiazepine, may be used as an adjunctive treatment to help with agitation or sleep disturbances, but it is not the primary treatment for acute mania.

Question 4

Man likes to walk 400m instead of taking a taxi thinks he sees people in the shadows but when he looks just realizes its shadows?
- Panic
- Illusion
- delusion

Answer 4

The situation described is best characterized as an illusion.

• Illusions involve misinterpretations of real external stimuli (e.g., misperceiving shadows as people but realizing they are just shadows upon closer inspection).
• Delusions are strongly held false beliefs that are resistant to reasoning or contrary evidence (e.g., believing that someone is plotting against you when there is no evidence to support it).
• Panic refers to a sudden feeling of intense fear or anxiety, often accompanied by physical symptoms, but it does not specifically pertain to the misinterpretation of sensory input.

Question 5

A lady who hears rustling of trees but they sound like voices to her.
- Illusion?
- Delusion?
- Hallucination?
- Sensory disturbance?

Answer 5

= Illusion - an instance of a wrong or misinterpreted perception of a sensory experience.

Question 6

Substance associated with highest degree of burden in people who already have a mental illness?
- Smoking
- Alcohol
- Opioids
- Benzos

Answer 6

Alcohol is associated with the highest degree of burden in people who already have a mental illness. Alcohol use can exacerbate existing mental health conditions, lead to more severe psychiatric symptoms, increase the risk of self-harm or suicide, and contribute to a range of physical health problems. It can also interact negatively with medications used to treat mental illness, complicating treatment and recovery.

Question 7

Dynamic risk factor associated with suicide?

Answer 7

= Psychosis

• A dynamic risk factor associated with suicide is one that can change over time and may influence a person’s risk of suicide. An example of a dynamic risk factor is:
• Recent life stressors: Such as job loss, relationship breakdown, or significant changes in life circumstances.
• Dynamic risk factors can be modified or managed, and monitoring these factors is crucial in suicide risk assessment and intervention.
• Other dynamic factors include substance abuse, recent psychiatric hospitalization, and acute suicidal ideation.
• Static risk factors would be variables that the provider would be unable to change, while dynamic factors can be modified in some way. Into the static category go gender, race, age, personal history of suicide attempt, and family history of suicide.

Question 8

Lady says she wants to kill her husband but is not depressed or psychotic and is adamant she is going to what do you do?
- Inform her that you have to tell the police and tell them
- Consult a colleague
- Nothing it is confidential

Answer 8

Inform her that you have to tell the police and tell them

Question 9

Which drug most likely to cause neck spasm, oculogyric crisis (Acute dystonia symptoms)?
- Haloperidol
- Quetiapine
- Other atypicals

Answer 9

Haloperidol is most likely to cause neck spasm and oculogyric crisis, which are symptoms of acute dystonia.
- Haloperidol: It is a typical antipsychotic and is known to cause extrapyramidal side effects, including acute dystonia, which can present as neck spasms, oculogyric crisis, and other involuntary muscle contractions.
- Quetiapine: It is an atypical antipsychotic and is less likely to cause these types of acute dystonic reactions compared to typical antipsychotics like haloperidol.
- Other atypicals: Generally, atypical antipsychotics have a lower risk of causing acute dystonia compared to typical antipsychotics.

If acute dystonia occurs, treatment often involves anticholinergic medications like benztropine or diphenhydramine.

Question 10

Drug to prevent relapse of alcohol abuse?

Answer 10

The drug commonly used to prevent relapse of alcohol abuse is Disulfiram (Antabuse).

Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, which leads to the accumulation of acetaldehyde when alcohol is consumed. This results in unpleasant reactions such as flushing, nausea, and palpitations, which serve as a deterrent to drinking.

Other options for relapse prevention include:
- Naltrexone: An opioid antagonist that reduces cravings for alcohol.
- Acamprosate: Helps to restore the balance of neurotransmitters in the brain and reduces cravings.
The choice of medication can depend on individual patient needs, side effect profiles, and the presence of any co-occurring conditions.

Question 11

Intervention with the most evidence for treatment of ADHD?
- CBT
- Schooling
- Stimulants

Answer 11

Stimulants have the most evidence for the treatment of ADHD. Medications such as methylphenidate (Ritalin) and amphetamines (Adderall) are well-established in their efficacy for reducing the core symptoms of ADHD, including inattention, hyperactivity, and impulsivity.

While Cognitive Behavioral Therapy (CBT) and school-based interventions can be beneficial as part of a comprehensive treatment plan, especially for addressing behavioral strategies and academic challenges, stimulant medications remain the primary and most evidence-supported treatment for managing ADHD symptoms effectively.

Question 12

Most common schizophrenia symptom?
- Lack of insight
- Delusions
- Apathy

Answer 12

The most common symptoms of schizophrenia are delusions and hallucinations. Among these, auditory hallucinations are often the most frequently experienced symptom. These can include hearing voices that others do not hear. Delusions, which are false beliefs not based on reality (such as believing one has special powers or is being persecuted), are also a central feature of the disorder.

Both symptoms are key in the diagnosis of schizophrenia and are central to understanding the impact of the disorder on an individual’s perception and cognition.

Question 13

Adverse effect associated with MAOIs like phenelzine?

Answer 13

Phenelzine, a monoamine oxidase inhibitor (MAOI), can cause a hypertensive crisis, especially when consumed in conjunction with foods high in tyramine. Tyramine is an amino acid found in various aged, fermented, and processed foods. When MAOIs inhibit the breakdown of tyramine, it can lead to excessive levels in the body, resulting in a hypertensive crisis.

To manage and prevent hypertensive crises in patients on MAOIs like phenelzine, it is crucial to adhere to a tyramine-restricted diet and be aware of possible interactions with other medications. Symptoms of a hypertensive crisis include severe headache, chest pain, neck stiffness, and confusion, and it requires immediate medical attention.

Question 14

Adverse effect of clozapine?

Answer 14

Clozapine, an atypical antipsychotic, is known to be associated with seizures. It has a dose-dependent risk of seizures, with the likelihood increasing at higher doses. The risk of seizures can be managed by gradually titrating the dose and monitoring the patient closely. If a seizure occurs, clozapine may need to be adjusted or discontinued, and alternative treatments for managing the patient’s condition should be considered. Other antiepileptic drugs might also be used to control the seizures if necessary.

Question 15

What symptoms might a patient taking amitriptyline develop?

Answer 15

anticholinergic

Question 16

Screening for a 32-year-old man in a stable relationship (long-term) with female partner?
- STI
- BP?
- fasting BSL?

Answer 16

= BP

Question 17

Lady wants influenza vaccination at 16 weeks gestation is it safe?
- Wait till third trimester?
- Okay to have influenza now?
- Advise not to have?

Answer 17

Okay to have it now - It is generally safe and recommended for pregnant women to receive the influenza vaccination at any stage of pregnancy, including at 16 weeks gestation. Influenza vaccination during pregnancy helps protect both the mother and the baby from the flu and its complications.
Safety: The flu vaccine is safe during all stages of pregnancy and does not harm the fetus.
Effectiveness: Early vaccination provides the best protection throughout the flu season, including the third trimester.
Recommendations: Health authorities, such as the CDC and WHO, recommend that pregnant women get the flu vaccine as soon as it becomes available in the flu season.

Question 18

Hep B vaccine for infants? What should Infants born to hepatitis B surface antigen (HBsAg)–positive mothers receive?

Answer 18

Hep B vaccine (dose 1 or 0) should ideally be given to all infants within 24 hours of birth, but at most within seven days of birth. Infants born to hepatitis B surface antigen (HBsAg)–positive mothers should be given hepatitis B immune globulin (HBIG) and a
dose of monovalent hepatitis B vaccine on the day of birth (preferably within 12 hours of birth and certainly within 48 hours).

Question 19

Pregnant lady with child with vesicular rash she is Ig negative what to do?
- MMR vaccination
- Ig Varicella
- some other options???

Answer 19

= Ig Varicella

For a pregnant woman who is IgG negative for varicella (chickenpox) and has been exposed to a child with a vesicular rash (likely varicella), the appropriate management is:
- Administer Varicella-Zoster Immune Globulin (VZIG): This is recommended if the exposure occurred within 96 hours. VZIG can help reduce the severity of chickenpox in those who are susceptible and at risk.
- MMR Vaccine: This is not appropriate for pregnant women. The MMR vaccine is contraindicated during pregnancy due to the risk of live attenuated viruses affecting the fetus.
- Avoidance of Varicella Vaccine: The varicella vaccine is also a live attenuated vaccine and should not be given during pregnancy.
Therefore, the correct action would be to administer Varicella-Zoster Immune Globulin (VZIG) if exposure was within the recommended timeframe.

Question 20

Most common cause of death on farms in children <4 years?
- Drowning
- Quad bikes
- Falls from heights

Answer 20

= Drowning

Question 21

Man, with chemical injury to the eye on a farm what do you tell him?
- Get his wife to bring bicarbonate?
- Wash eye in water trough?
- Go to house immediately and wash for 15 mins?
- Go to ED?

Answer 21

Go to house immediately and wash for 15 mins

Question 22

Picture of impetigo how do you manage?
- Topical steroids?
- Topical antifungal?
- Topical antibiotic?

Answer 22

For managing impetigo, which is a bacterial skin infection typically caused by Staphylococcus aureus or Streptococcus pyogenes, the best treatment option is:
- Topical antibiotics, such as mupirocin or retapamulin, are commonly used for localized impetigo. These antibiotics help eliminate the bacteria causing the infection and are applied directly to the affected skin.
- Topical steroids: These are used for inflammatory skin conditions but are not effective against bacterial infections like impetigo. In fact, they can worsen the infection by suppressing the local immune response.
- Topical antifungal: These are used for fungal infections, not bacterial infections like impetigo.

For extensive or severe cases of impetigo, or if there is no improvement with topical treatment, oral antibiotics might be necessary. It’s also important to practice good hygiene and keep the affected area clean and covered.

Question 23

What is the diagnosis?

Answer 23

Scabies

Question 24

Management of scabies?

Answer 24

Prevention of transmission and reinfection
1. Wash all clothing and bedding in hot water ≥ 50°C (≥ 122°F).
2. Treat all of the following individuals simultaneously with the patient: Household members within the last month, Sexual partners within the last two months
3. Advise household members to avoid direct, prolonged contact with the patient’s skin, bedding, and clothing until treatment completion.
4. In the event of a suspected outbreak:
- Notify the local health department.
- Increase surveillance to identify new cases.

Question 25

Splenectomy- what vaccinations do they need? (5)

Answer 25

1. Hib (Haemophilus influenzae type b) vaccine 2. Influenza vaccine 3. Meningococcal vaccines (MenACWY, MenB) 4. Pneumococcal vaccines 5. Respiratory syncytial virus (RSV) vaccine

Question 26

Lady has non-healing lesion, area where she had a previous burn, not healing, requiring lots of dressings what is this? - Angiosarcoma? - Squamous cell carcinoma?

Answer 26

A non-healing lesion in an area of previous burn injury is most likely to be: **Squamous cell carcinoma (SCC)** Chronic ulcers or non-healing lesions in areas of previous burns or scars can develop into squamous cell carcinoma due to the long-term irritation and damage to the skin. This is known as Marjolin's ulcer. Angiosarcoma is a rare and aggressive cancer of the blood vessels that can also occur in chronic wounds or areas of previous radiation or trauma, but it is less common than squamous cell carcinoma in this context. Given the history of a previous burn and a non-healing lesion, SCC is the more likely diagnosis.

Question 27

Guy with discharge what is the best empirical management? - IM ceftriaxone - IV azithromycin - Some other ones

Answer 27

The most appropriate empirical treatment for common STI-related discharge, the combination of IM Ceftriaxone and Oral Azithromycin is generally recommended.

Question 28

Erythema multiforme - What is it? What does it look like?

Answer 28

Question 29

TIA- stenosis 25% whats the management?

Answer 29

**= Low dose aspirin** - Surgical or Endovascular Interventions: For 25% stenosis, surgery (like carotid endarterectomy) or stenting is generally not recommended unless there are other complicating factors or higher degrees of stenosis. These interventions are typically considered for more severe stenosis (usually >70%).

Question 30

Zoonoses EMQ - What is the diagnosis: a) Guy with a cough/respiratory symptoms, something about a bird? b) Guy with the cattle with flu like illness? c) Marathon runner in water d) Lady struck by “creature”, friend says she should “get some needles”? e) Some rogue one about some guy with a lesion down to his dermis when travelling?

Answer 30

a) Guy with a cough/respiratory symptoms, something about a bird = **Psittacosis (Ornithosis)** – This is often associated with exposure to birds, especially parrots, and can present with respiratory symptoms like cough. b) Guy with the cattle with flu like illness - **Q Fever** – This is caused by Coxiella burnetii and is associated with exposure to cattle, sheep, or goats. c) Marathon runner in water = **Leptospirosis** – This disease is often contracted through contact with water contaminated by animal urine, particularly in areas with poor sanitation. d) Lady struck by “creature”, friend says she should “get some needles” = **Rabies** – The "creature" could be a bat or another animal, and “get some needles” refers to rabies post-exposure prophylaxis (PEP) which involves a series of injections. e) Some rogue one about some guy with a lesion down to his dermis when travelling = **Cutaneous Leishmaniasis** – This disease causes skin lesions that can extend into the dermis and is often seen in travelers to endemic regions.

Question 31

Lady who was in a car accident, front seat of car, internal rotation and leg shortening and adduction, hip slightly forward what is it? - Posterior dislocation - Anterior dislocation - NOF - Femoral fracture

Answer 31

The description of the injury—internal rotation, leg shortening, adduction, and the hip being slightly forward—suggests a **posterior dislocation of the hip**. - In a posterior hip dislocation, the affected leg often appears shortened, internally rotated, and adducted. The position of the hip being slightly forward can also be indicative of a posterior dislocation. - Anterior dislocation typically presents with the leg in external rotation and abduction. - NOF (Neck of Femur) fracture usually results in leg shortening and external rotation. - Femoral fracture might cause shortening but does not typically present with the described positioning of the hip.

Question 32

Girl with nephrotic syndrome what is most appropriate management?

Answer 32

Corticosteroids: Initial Treatment: The first-line treatment for nephrotic syndrome, especially in children, is corticosteroids such as prednisone. This treatment helps reduce inflammation and proteinuria.

Question 33

Weak shoulders, wasting of muscles, UMN signs below lesion, LMN at the lesion, pain on neck turn? - Cervical spondylitis? - Polymyositis? - Syringomyelia??

Answer 33

The symptoms described—weak shoulders, muscle wasting, upper motor neuron (UMN) signs below the lesion, lower motor neuron (LMN) signs at the lesion, and pain on neck turn—are most consistent with **syringomyelia**.

Question 34

Lady with stress incontinence and positive for UTI but no dysuria or frequency what do you do? - Don’t treat - treat UTI

Answer 34

= Do not treat - Asymptomatic bacteriuria Stress incontinence not usually caused by UTI

Question 35

Man, with big skull, big calves, lytic lesions on skull?

Answer 35

Paget’s

Question 36

What nerve is responsible for external sphincter in urination for women?

Answer 36

External Sphincter - Pudendal Internal Sphincter = Hypogastric Nerve: This nerve carries sympathetic fibers that are responsible for the contraction of the internal urethral sphincter. Sympathetic stimulation maintains the internal sphincter in a contracted state to prevent involuntary leakage of urine.

Question 37

Pes cavus deformity? (hereditary neuromuscular disorder)

Answer 37

Charcot-Marie Tooth

Question 38

Best discriminatory initial investigation for a patient presenting with ascending muscle paralysis post viral illness? - LP - Muscle conduction studies - Some others

Answer 38

Suspected Guillian Barre - Do an LP In summary, lumbar puncture is the most discriminatory initial investigation for confirming a diagnosis of GBS in the context of ascending muscle paralysis following a viral illness.

Question 39

ABG showing alkalosis, which isn’t this representative of? Calculate A-a gradient

Answer 39

answer was hyperventilation

Question 40

Most common presentation for DKA? - Steroid use - Foot infection - Non-compliance with insulin - Non-diagnosed Insulin dependent diabetes

Answer 40

Non-compliance with insulin

Question 41

Guy with worsening back pain not responsive to opioids what is this? - Impending spinal cord compression - Opioid tolerance

Answer 41

Given the rapid worsening of pain and lack of response to opioids, impending spinal cord compression is a more pressing concern and should be evaluated urgently. Diagnostic imaging, such as MRI of the spine, would be necessary to assess for spinal cord compression and guide appropriate management.

Question 42

Family wants to stop feeding patient in terminal phase is this appropriate?

Answer 42

Yes - usually they will not eat and drink much anyway???

Question 43

What directs best treatment for palliative care patients? - Close family and friends - Nurses input - Advanced health directive - Legal will

Answer 43

The best treatment direction for palliative care patients is primarily guided by: **Advanced Health Directive**: An advance health directive (or advance directive) outlines the patient’s preferences for medical treatment and care if they become unable to make decisions for themselves. It reflects the patient’s wishes about their care and should be the primary guide for treatment decisions in palliative care.

Question 44

Patient with spinal mets has neuropathic pain already on pregabalin, opioid, paracetamol, what initial adjunct should be given? - Dexamethasone - Amitriptyline - NSAID

Answer 44

Question 45

Patient with increasing abdominal pain with ascites whats the best immediate treatment? - Drainage - Spironolactone

Answer 45

= Drainage

Question 46

Best option for opioid driven nausea? - Promethazine - Haloperidol etc.

Answer 46

Metoclopramide would be best but wasn't an option??

Question 47

Sudden onset severe abdominal pain in a diabetic smoker, but then she had a soft mildly tender abdomen. What is the cause? a) Acute vascular event b) Peptic ulcer

Answer 47

a) Acute vascular event

Question 48

Post proctectomy erectile dysfunction – most likely nerve? a) Splanchnic nerve b) Ilioinguinal nerve c) Dorsal nerve of penis

Answer 48

a) Splanchnic nerve??

Question 49

Patient found to be drinking fluids within 2 hours of surgery. Which is most likely to cause operation to be cancelled? a) Coke b) Lemonade c) Water d) Tea with milk e) Orange juice

Answer 49

= Tea with milk

Question 50

Patient with high output stoma – requires IV fluids. What should they be given a) Hartmanns (not CSL this time) b) Weird combination of Na & dextrose

Answer 50

= Isotonic solutions - NS, CSL or Hartmanns. Initial fluid replacement typically involves isotonic solutions to restore volume and maintain fluid balance. Normal saline (0.9% sodium chloride) or Lactated Ringer’s solution can be used as they are effective in replacing lost fluids and electrolytes.

Question 51

Patient has come into hospital say that she has swallowed 5 razor blades. This in confirmed on CXR, with the blades sitting in her stomach. How should they be dealt with? a) Upper GI removal via upper GI scope b) Laparotomy c) Ipecac

Answer 51

Upper GI removal via upper GI scope

Question 52

Lady had an open abdominal surgery. Since she’s been home she has been coughing heaps. CT of abdomen shown. What has happened? a) Rectus sheath haematoma b) Ovarian something c) AAA

Answer 52

For a patient who has undergone open abdominal surgery and is now experiencing significant coughing, and with a CT of the abdomen showing findings, the most likely issue is: - Rectus Sheath Hematoma.

Question 53

Old lady falls and hits their forehead. Finds it difficult to lift herself back up and on examination is found to have 2+ power on wrist extension andsome other movements, also absent triceps reflex. Following day she develops hyperreflexic lower limbs and slightly reduced power. What type of injury is this? a) Cervical nerve root b) Brachial plxus c) Central cord d) Frontal lobe

Answer 53

**Central Cord Syndrome**: This condition is often associated with cervical spinal cord injury, particularly in older adults with pre-existing cervical spondylotic changes. It typically presents with: Weakness predominantly in the upper limbs compared to the lower limbs (as seen with 2+ power on wrist extension and difficulty lifting herself up). Hyperreflexia in the lower limbs, which indicates upper motor neuron involvement. Reduced power and other symptoms in the lower limbs may develop as the condition progresses or if there is significant spinal cord involvement.

Question 54

Best medication for initial management of metastatic brain lesions? a) Dexamethasone b) Mannitol c) Hypertonic saline

Answer 54

Dexamethasone

Question 55

Lady post appendicectomy. Has temperature of 39.5. Medial end of the wound is red with fluctuant mass underneath. How do you manage? a) IV fluclox b) IV gent c) Wound aspirate d) CT image e) Wound drainage

Answer 55

In a patient post-appendicectomy with a fever of 39.5°C, redness at the medial end of the wound, and a fluctuant mass underneath, the most appropriate management step is: Wound Drainage.

Question 56

Female has a breast lump that was FNA’ed – this demonstrated green fluid. This lump is no longer palpable. How should she be managed? a) Send fluid for cytology b) Refer to surgeon c) Excise the cyst capsule d) Do nothing

Answer 56

For a female with a breast lump that was aspirated and yielded green fluid, and where the lump is no longer palpable, the appropriate management is: Do Nothing

Question 57

Most common cause of primary hyperparathyroidism? a) Single adenoma b) Multiple adenoma c) Hyperplasia

Answer 57

a) Single adenoma

Question 58

Lady with a 2cm thyroid nodule that was iodine cold. How do you manage? a) FNA b) Iodine Ablation c) Thyroxine d) Partial Thyroidectomy

Answer 58

For a 2 cm thyroid nodule that is "iodine cold" (meaning it does not take up iodine on a radioactive iodine scan, which suggests it is less likely to be hyperfunctioning and may be malignant), the most appropriate management is: FNA (Fine Needle Aspiration).

Question 59

Patient has had a closed NOF. The next day on the ward she is hypotensive and tachycardic and has a Petechial rash. What is the likely diagnosis? a) PE b) Fat embolism c) Blood Loss

Answer 59

In a patient who has had a closed neck of femur (NOF) fracture and presents the next day with hypotension, tachycardia, and a petechial rash, the likely diagnosis is: **Fat Embolism.**

Question 60

Patient with DVT extending up popliteal vein. How should they be managed a) SC heparin b) IV heparin c) Oral warfarin d) Aspirin

Answer 60

b) IV heparin

Question 61

Elderly woman has fallen over at home and is no longer weight bearing. What does her leg likely look like? a) No change b) Externally rotated, adducted, shortened c) Externally rotated, abducted, shortened d) Internally rotated, adducted, shortened e) Internally rotated, abducted, shortened

Answer 61

Suspected NOF - Externally Rotated, Abducted, Shortened

Question 62

Patient is due for an op. What would help determining how much he could bleed? a) Bleeding time b) Clotting time c) Number of platelets d) Past bleed Hx e) APT

Answer 62

To help determine how much a patient might bleed during an operation, the most relevant test would be: **Number of Platelets.**

Question 63

Patient has GCS 9 post MVA plus tracheal deviation to the right, with dullness to percussion on the left. X-ray is suggestive of a haemothorax. What’s the most appropriate initial management. a) Intubate b) Explorative lap c) Fluids d) Drain the haemothorax

Answer 63

For a patient with a Glasgow Coma Scale (GCS) score of 9 post motor vehicle accident (MVA), tracheal deviation to the right, dullness to percussion on the left, and an X-ray suggestive of a hemothorax, the most appropriate initial management is: **Drain the Hemothorax.**

Question 64

What would you expect as a result of compression of the sciatic nerve roots a) Faecal incontinence b) Loss of knee jerk reflex c) Sensory loss over knee d) Sensory loss over lateral calf e) Weakness of leg adductors

Answer 64

Sensory Loss over Lateral Calf

Question 65

Increasing dysphagia and regurgitation of foul smelling partially digested food. Birds-beak sign noted?

Answer 65

= Achalasia

Question 66

Most common cause of post-op restlessness a) Pain b) Hypoxia c) Urinary retention

Answer 66

Pain

Question 67

Development of a non-painful lump on wrist. What is this likely to be?

Answer 67

Ganglion cyst

Question 68

Man who’s had a TURP and is now hyponatraemic. What is the cause?

Answer 68

a) Dilutional effect from fluids

Question 69

Patient a with bleeding breast lesion, most likely diagnosis?

Answer 69

Ductal Papilloma

Question 70

22 year old guy with v typical IBS picture with normal sigmoidoscopy a) IBS b) Coeliac

Answer 70

IBS

Question 71

Microcytic anemia, what cancer will cause this?

Answer 71

Caecal

Question 72

Fasting protocols a) No food overnight b) 6 hours for solids, four hours for clear fluids c) 6 hours solids, 2 hours clear fluids

Answer 72

The commonly accepted fasting protocols for elective surgery or procedures that require anesthesia are: - 6 hours for solids, 2 hours for clear fluids.

Question 73

Patient feeling very weak, trouble standing up or putting her arms up to the washing line. What investigation should be done? a) CK b) ESR c) ANA

Answer 73

or a patient feeling very weak, having trouble standing up, and difficulty with activities such as putting her arms up to the washing line, the most appropriate initial investigation is: **CK (Creatine Kinase).**

Question 74

Management of SLE a) Hydroxychloroquine b) Pred

Answer 74

Hydroxychloroquine: This is often used as a first-line treatment for SLE, especially in managing symptoms and preventing flares. It helps reduce disease activity and can improve overall symptoms, including skin rashes and joint pain. Prednisone (Pred): This is a corticosteroid used for managing acute flares or severe symptoms of SLE. It is effective in reducing inflammation and controlling symptoms, but due to potential long-term side effects, it is usually used for shorter durations or in conjunction with other medications.

Question 75

What is not seen in Sjogrens? a) ANA b) Ro c) La d) DsDNA e) RF

Answer 75

In Sjögren's syndrome, the following are typically seen: 1. ANA (Antinuclear Antibodies) 2. Ro (SSA) Antibodies 3. La (SSB) Antibodies 4. RF (Rheumatoid Factor) dsDNA (Double-Stranded DNA) antibodies are not typically associated with Sjögren's syndrome. They are more commonly associated with systemic lupus erythematosus (SLE). So, the answer is: dsDNA

Question 76

Patient with AS presents with back pain, not managed adequately by NSAIDs and exercise. What’s the best management? a) Methotrexate b) Anti-TNF c) Sulfasalazine

Answer 76

For a patient with ankylosing spondylitis (AS) who presents with back pain that is not adequately managed by NSAIDs and exercise, the best management option is: Anti-TNF (Tumor Necrosis Factor) agents.

Question 77

Which bone is felt in the anatomical snuff box?

Answer 77

Scaphoid

Question 78

What’s the best initial management in septic arthritis? a) IV Abx b) Washout c) Hydration d) Analgesia

Answer 78

The best initial management for septic arthritis is: IV Antibiotics

Question 79

13-year-old buy presenting with knee pain, limp and normal knee exam a) SUFE b) Perthes c) Osgood-Schlatter

Answer 79

= SUFE

Question 80

**Slipped capital femoral epiphysis (Juvenile femoral head detachment, Juvenile epiphyseal detachment)** - Summary? - Epidemiology? - Aetiology? (4) - Pathophysiology?

Answer 80

**Epidemiology** - Prevalence: most common hip disorder in adolescents - Peak incidence: 10–16 years (often occurs during a growth spurt) - Sex: ♂ > ♀ **Aetiology** - The exact etiology is still unknown. However, there are some risk factors that increase the likelihood of SCFE: 1. Obesity 2. Family history 3. Endocrine or hormonal factors (e.g., hypothyroidism, pituitary tumors, down syndrome, renal osteodystrophy, craniopharyngioma) 4. Trauma (e.g., sports-related injury or fall)

Question 81

**Slipped capital femoral epiphysis (SUFE)** - Summary? - Clinical features?

Answer 81

Question 82

**Slipped capital femoral epiphysis (SUFE)** - Diagnosis? - Treatment? (3) - Complications? (3)

Answer 82

**Treatment** 1. Avoid weight bearing before stabilization 2. Urgent surgical internal fixation with pinning of the femoral head 3. Prophylactic fixation of the contralateral hip **Complications** 1. Avascular necrosis of the femoral head 2. Early hip osteoarthritis 3. Chondrolysis of the hip: rapid degeneration of articular cartilage

Question 83

Old bloke has bilateral forefoot pain, particularly around the MTP. High serum urate and high creatinine. What’s the best management? a) Celecoxib b) Colchicine c) Allopurinol

Answer 83

= b) Colchicine - but need to lower the dose in renal failure pts.

Question 84

Woman has RA and is managed with methotrexate. She wants to have a child and stops Rx but symptoms worsen. What should she do? a) Stop methotrexate b) Switch to NSAIDs c) Switch to sulfasalazine

Answer 84

The best management for a woman with rheumatoid arthritis (RA) who wants to conceive, stops methotrexate, and experiences a worsening of her symptoms is: Switch to sulfasalazine.

Question 85

Patient with knee pain, palpable popping on flexion, medial joint line tenderness + effusion. a) Medial Meniscus b) MCL injury

Answer 85

Medial Meniscus injury.

Question 86

**Rheum EMQ** - RA, SLE, SJogrens, PMR, Ankylosing spondylitis, reactive arthritis, gout, pseudogout, psoriatic arthritis, dermatomyositis 1) Patient with pain in hands, knee and foot. Recalls having a rash on his belly 2 weeks ago with a fever? 2) Patient with pain in her DIPS and PIPS. Worse in her right hand. There is evidence of deformity at these joints. Father has psoriatic arthritis? 3) Patient had gastro 2 weeks ago, now presenting with asymmetrical oligoarthritis - reactive arthritis 4) Post surgical, wrist swelling, Positively birefringent – pseudogout 5) Answer was Dermatomyositis, don’t recall the stem

Answer 86

1) Patient with pain in hands, knee and foot. Recalls having a rash on his belly 2 weeks ago with a fever = **viral arthritis** 2) Patient with pain in her DIPS and PIPS. Worse in her right hand. There is evidence of deformity at these joints. Father has psoriatic arthritis = **psoriatic arthritis** 3) Patient had gastro 2 weeks ago, now presenting with asymmetrical oligoarthritis - **reactive arthritis** 4) Post surgical, wrist swelling, Positively birefringent – **pseudogout** 5) Answer was Dermatomyositis, don’t recall the stem

Question 87

Healthy young female with new anosmia and change in taste a) Covid swab b) MRI c) CT

Answer 87

The best initial step for a healthy young female with new anosmia and change in taste is: **Covid swab.** - Anosmia (loss of smell) and changes in taste are common symptoms of COVID-19. Given the current pandemic context, a COVID-19 infection should be ruled out first. - MRI and CT could be useful if there are other concerning neurological symptoms or if the anosmia persists after ruling out infection, but the first-line investigation for new anosmia and taste changes should be a COVID test.

Question 88

Patient presents to your ED up north with unilateral facial palsy (they included a pic) – and all potential causes are excluded. How should they be managed? a) Immediate steroids b) Eye patch c) Anti-viral d) Refer to ENT

Answer 88

a) Immediate steroids

Question 89

Patient with tracheostomy becomes short of breath – what is the next step in management a) Follow bedside tracheostomy guidelines? b) Apply O2? c) Suction the tracheostomy?

Answer 89

Follow bedside tracheostomy guidelines

Question 90

Truck driver with BMI of 42 presents because of loud snoring and difficulty staying awake while driving. He has a crowded oropharynx & big tonsils. How should he be immediately managed? a) CPAP b) Tonsillectomy c) Weight loss d) Oral appliance

Answer 90

CPAP (Continuous Positive Airway Pressure).

Question 91

Patient presents with discharging lump in the midline of his neck that moves up and down when he sticks his tongue out. What is the likely diagnosis? a) Thyroglossal cyst b) Branchial cyst c) Cystic hygroma

Answer 91

a) Thyroglossal cyst

Question 91

Patient presents with 6 months of hoarse voice – no weight loss, haemoptysis or other symptoms. Laryngoscopy shows this (picture shown) on vocal cord. What is the likely diagnosis? a) Laryngeal SCC b) Laryngeal papillomata

Answer 91

= Laryngeal SCC **Clinical features of Laryngeal Carcinoma** 1. Hoarseness/change in voice 2. Foreign body sensation 3. Dyspnea 4. Dysphagia 5. Stridor (due to airway narrowing) 6. Aspiration while eating or drinking 7. Unexplained hoarseness for longer than 3 weeks should always be investigated by laryngoscopy!

Question 92

A 28-year-old woman presents with a unilateral blocked ear for two days. Ear exam normal, wax removed. How should she be further investigated? a) Audiogram b) MRI c) Tympanogram d) CT

Answer 92

Audiogram - suspect SSNHL

Question 93

Patient presents with white plaques noted on the tympanic membrane. What is the diagnosis?

Question 94

Baby presents with fever of 39 and discharge in the ear canal. The post-auricular aspect of the ear is tender and red. What is the likely diagnosis? a) Acute mastoiditis b) Acute otitis media

Answer 94

Acute mastoiditis

Question 95

A man presents with headache and feeling off. He has a clear unilateral nasal discharge. This all started after his football match last week. Partner says he is “not himself” What is the like cause? a) CSF leak b) Sinusitis c) Allergic rhinitis

Answer 95

CSF leak

Question 96

Patient has had 7 days of facial pain, mucopurulent nasal discharge and has taken the last two days of work. How will you manage them? a) Topical nasal saline b) Antibiotics c) Swab

Answer 96

For a patient with 7 days of facial pain, mucopurulent nasal discharge, and taking the last two days off work, the likely diagnosis is acute bacterial sinusitis. The appropriate management would be: Antibiotics.

Question 97

A patient has fractured their nose – how do you manage them a) Refer them to be seen by ENT today b) Refer them to be seen by ENT in 7-10 days c) Refer them for rhinoplasty

Answer 97

Refer them to be seen by ENT in 7-10 days

Question 98

Patient now presents with signs of meningitis and brain abscess. What was the primary cause? a) Cholesteatoma b) Membrane Rupture

Answer 98

Cholesteatoma

Question 99

Kid with sore throat, SOB and sitting with neck extended, fully vaccinated (basically textbook description)?

Answer 99

Epiglottitis

Question 100

Patient has been constantly using nasal decongestants and now finds they are not having any effect for her recent episode of congestion. a) Acute sinusitis b) Rhinitis medicamentosa

Answer 100

Rhinitis medicamentosa

Question 101

Cause of cavernous sinus thrombosis a) Epistaxis b) Sinusitis

Answer 101

**Sinusitis** - pecifically, acute or chronic bacterial sinusitis can lead to cavernous sinus thrombosis. The infection can spread from the sinuses, particularly the ethmoid or sphenoid sinuses, into the cavernous sinus, leading to thrombosis. This condition can cause serious complications due to the proximity of the cavernous sinus to critical structures like the cranial nerves and the internal carotid artery. **Epistaxis**: Although epistaxis (nosebleed) can be a symptom or consequence of nasal and sinus issues, it is not a direct cause of cavernous sinus thrombosis.

Question 102

Most important factor for management of chronic tonsillitis in 47ish year old with one larger than the other a) Number of episodes tonsilitis in a year b) Chronic fatigue c) Asymmetry of tonsils d) Throat Swab

Answer 102

Asymmetry of tonsils.

Question 103

Risk factor for exostoses?

Answer 103

Cold water

Question 104

Patient with long history of painful smelly leg ulcer. Dr thinks it sounds venous. What investigation should be done before applying compression bandage? a) Biopsy of edge b) Arteriogram c) Duplex U/S d) Arterial Pressure Duplex

Answer 104

Biopsy of edge = gold

Question 105

Young aboriginal girl with bilateral OME for 4 weeks. 25db hearing loss – how should she be managed? a) Wait 6 weeks and reassess b) Immediate myringotomy & grommets c) Myringotomy, grommets and adenoids d) Oral antibiotics

Answer 105

- Oral antibiotics For children at low risk of CSOM, tympanostomy tube (grommet) insertion is strongly recommended, if the child has persistent OME or OME and hearing loss greater than 30 dB and/or speech and language delay. Any child at high risk of CSOM should be referred for tympanostomy tube insertion if the child has bilateral persistent OME and/or speech and language delay, and if surgery is consistent with parental preferences.