Maple (AKT) Flashcards
(17 cards)
Q u e s t i o n 1
Jock Do, a 58-year-old mechanic, attends requesting medication for erectile dysfunction. He has had
erectile dysfunction for several years, but in the last few months, he has not had any early morning
erections. Jock is worried because this has been putting a strain on his relationship. He has type 2
diabetes managed with metformin 1g PO BD and sitagliptin 100mg PO OD. He also has episodes of
exertional angina, for which he takes sublingual glyceryl trinitrate spray PRN. He has heard about
alprostadil (Caverject) intracavernosal injections and is concerned about the potential for priapism, so he
is reluctant to try it. He has heard his mates talk about ‘the little blue pill’ which can help him.
What is the MOST appropriate advice to give to Jock today?
A. Sildenafil is safe for him to use once a day as long as he can walk 20 steps
B. Sildenafil is contraindicated for him due to his use of nitrates
C. Sildenafil is contraindicated for him due to the presence of chronic ischaemic heart disease
D. Sildenafil causes a similar risk of priapism to intracavernosal therapy
E. Counselling rather than medication to address psychological causes is first-line therapy for
erectile dysfunction
B. Sildenafil is contraindicated for him due to his use of nitrates
Q u e s t i o n 2
Sigmund Roberts, a 35-year-old teacher and his wife Paula present for advice regarding conception.
They have been trying to conceive a child for the last 2 years. Paula has a 4-year-old son from a previous
relationship. Her history, examination and investigations have been unremarkable. Sigmund has never
fathered a child; he has no history of testicular surgery or other significant past medical history. His
physical examination is unremarkable. You organise initial investigations for Sigmund, which are as shown
below.
Serum Testosterone 6.1 (3-12ng/mL)
FSH 5.2 (2.2-10IU/L)
Semen Analysis:
Volume 2.4 (>1.5mL)
pH 7.4 (>7.2)
Sperm Concentration 12.4* (>15 million/mL)
Total Sperm Count 23 (>39 million)
Total Motility 60 (>40%)
Progressive motility 40 (>32%)
Vitality 70 (>58%)
Normal Morphology 7 (>4%)
Leukocytes 0.5 (<1.0 x 10^6/mL)
Serum Testosterone 6.1 (3-12ng/mL)
What is the MOST appropriate next step?
A. Refer endocrinologist
B. Refer urologist
C. Urine microbiology and culture
D. Urine chlamydia and gonorrhoea PCR
E. Semen microbiology and culture
F. Repeat semen analysis at a specialised lab
G. Transrectal ultrasound of ejaculatory ducts
H. MRI of ejaculatory ducts
1. Testicular biopsy
J. Genetic testing
K. Anti sperm antibodies
L. Scrotal ultrasound
F. Repeat semen analysis at a specialised lab
Q u e s t i o n 3
Quentin Wang, a 28-year-old physiotherapist, presents with an episode of painless blood-stained
ejaculate. Quentin reports he had one episode of blood-stained ejaculate a week ago, and it has since
returned to its usual colour. There has been no urethral pain or penile discharge. He denies any weight
loss or bone pain. Quentin is in a stable relationship with a male partner. Quentin’s last sexually
transmitted infection screen was normal 2 months ago. On examination, his temperature is 36.5°C, BP
126/80mmHg, HR 70bpm, genital and prostate examinations are normal. FBE and coagulation studies
are within a normal range.
What is the MOST appropriate next step in Quentin’s management?
A. Reassure and review in 2 weeks
B. Organise a renal tract ultrasound
C. Organise a scrotal ultrasound
D. Organise a CT IV pyelogram
E. Refer to a urologist for a cystoscopy
F. Refer to a urologist for a prostate biopsy
G. Order PSA
H. Order Urine MCS and cytology
1. Order Urine acid fast bacilli
J. Order Schistosomiasis serology
K. Order Semen analysis
H. Order Urine MCS and cytology
Q u e s t i o n 4
Mabel Stern, a 67-year-old female, presents to your clinic for follow-up urine test results. Mabel initially
presented 2 days ago with dysuria, urinary frequency, urgency and double voiding. She has a history of
hypertension on irbesartan 75mg OD, type 2 diabetes on metformin 1g PO BD and linagliptin 5mg OD
and dyslipidemia on atorvastatin 40mg OD. Based on her presentation and urinalysis at the time, she was
commenced on trimethoprim 300mg PO nocte. There has been no fever, vomiting or flank pain. Mabel
reports an improvement in her symptoms, which she attributes to the two doses of trimethoprim she has
had thus far, as well as her regular use of Ural. The results of her urine test are as shown below.
Urine Microscopy and Culture
Leucocytes 4 5 2 <10x10%/L|
Erythrocytes <10x10%/L|
Epithelial cells 89 <10x10%/L
Culture E.colil
Sensitivities Amoxicillin - Sensitive
Amoxicillin/Clavulanic Acid - Sensitive
Cephalexin - Resistant
Nitrofurantoin - Sensitive
Trimethoprim - Resistant
Which of the following is the MOST appropriate management for Mabel?
A. Cease linagliptin
B. Change antibiotic to nitrofurantoin
C. Change antibiotic to amoxicillin
D. Continue trimethoprim for 1 further dose
E. Extend course of trimethoprim for a total of 7 days given urine test results
F. Cease Ural as concomitant use with trimethoprim can cause crystalluria
G. Cease Ural as it can reduce the efficacy of trimethop
D. Continue trimethoprim for 1 further dose
Question 5
Zoltan Jonas, a 56-year-old road traffic controller, presents with intermittent pelvic discomfort over the
last 3 months. The pain occasionally radiates to the scrotum and is associated with dysuria, urinary
urgency and a weak urinary stream. On examination, his temperature is 37°C, his abdomen is soft, and a
digital rectal examination reveals a mildly tender prostate. Zoltan’s investigations are shown below.
Post prostatic massage urine microscopy and culture
Leucocytes 80* (<10x10^6/L)
Erythrocytes 9 (<10x10^6/L)
Epithelial cells 1 (<10x10^6/L)
Culture E. coli
Pathology Results
Sodium 135 (135-145 mmol/L)
Potassium 4.5 (3.5-5.2 mmol/L)
Chloride 95 (95-110 mmol/L)
Bicarbonate 31 (22-32 mmol/L)
Urea 16.0 (3.0-10.0 mmol/L)
eGFR 85 (>60 ml/min)
Creatinine 120 (40-90 umol/L)
PSA 1.8 (<4.5ng/ml)
Renal Tract Ultrasound
Mild prostatomegaly with no focal lesion or other abnormalities found
What is the MOST appropriate management?
A. Nitrofurantoin 100 mg oral QID for 4 weeks
B. Cefalexin 500 mg oral BD for 4 weeks
C. Trimethoprim 300mg oral daily for 2 weeks
D. Ciprofloxacin 500 mg oral BD for 4 weeks
E. Norfloxacin 400 mg oral BD for 2 weeks
F. Amoxicillin 500 mg oral TDS for 7 days
G. Azithromycin 1g oral stat
H. Ceftriaxone 1g IV stat
I. Tamsulosin 0.4mg oral daily
J. Finasteride 5mg oral daily
K. Tamsulosin/Dutasteride 0.4/0.5mg oral daily
L. Repeat urine microscopy culture and sensitivity
M. Refer urologist for transrectal prostate biopsy
D. Ciprofloxacin 500 mg oral BD for 4 weeks
Q u e s t i o n 6
Irving Adler, age 17 years, has come to see you with trouble gaining weight. He has been going to the
gym for strength training five days a week with his friends, but he has not put on muscle mass like his
friends have, despite taking workout supplements. Irving is currently working as a part-timer waiter after
dropping out of school last year. He admits to dropping out as he was struggling to keep up with the
academics of school. On examination, he is a tall and slender young man. He has approximately 4cm of
firm tissue behind both nipples. His testicles are approximately 4mL in volume each. You organise blood
tests to confirm your diagnosis.
Which of the following investigation findings is consistent with the MOST likely diagnosis?
A. Decreased thyroid stimulating hormone, increased T4, raised sex hormone binding globulin
B. Normal testosterone, normal ostradiol, normal luteinising hormone
C. Raised testosterone, raised oestradiol, raised human chorionic gonadotropin
D. Raised ostradiol, reduced luteinising hormone, normal testosterone
E. Reduced total testosterone and elevated luteinising hormone and follicle stimulating hormone
F. Reduced total testosterone and reduced luteinising hormone and follicle stimulating hormone
G. Normal total testosterone, luteinising hormone and follicle stimulating hormone
H. Elevated ostradiol, reduced luteinising hormone and follicle stimulating hormone
I. Elevated ostradiol, elevated luteinising hormone and follicle stimulating hormone
J. Karyotype shows 45
E. Reduced total testosterone and elevated luteinising hormone and follicle stimulating hormone
Q u e s t i o n 7
Basil Sharrad, 74 years old, presents with a 12-month history of a slow urinary stream, a feeling of
incomplete emptying and waking up 3-4 times at night to urinate. This is despite reducing caffeine,
alcohol and evening fluid intake. Basil is finding his symptoms are particularly bothersome as he finds it
hard to settle back to sleep after waking to urinate. On examination, Basil’s HR is 80bpm and BP
136/86mmHg. His abdomen is soft and non-tender; a rectal examination reveals a uniformly enlarged
prostate. His latest PSA is 2.3 (normal range <4.5). Renal function is normal, and urinalysis is clear. Renal
ultrasound shows a moderately enlarged prostate.
What is the MOST appropriate next step in Basil’s management?
A. Further reduction of fluid intake
B. CT IV Pyelogram
C. CT Kidney Ureter Bladder
D. Trimethoprim 300mg oral daily for 14 days
E. Prazosin 0.5mg oral BD
F. Tamsulosin MR 400mcg PO OD
G. Reassure and review in 6 months
H. Reassure and repeat PSA in 6 months
1. Referral to urologist for prostate biopsy
J. Referral to urologist for transurethral resection of prostate
F. Tamsulosin MR 400mcg PO OD
Q u e s t i o n 8
Corrina Westelle, a 50-year-old office manager, presents for the results of her recent investigations for
haematuria. Corrina has been postmenopausal for the past two years and was very surprised by the
visibly blood-stained urine in the toilet bowl when she passed urine the other day. Corrina denies any
urinary frequency, dysuria or abdominal pain. Her blood tests show normal full blood count and renal
function. Her urine test results are shown below.
SPECIMEN: Urine
Microbiology Culture No Growth
Microscopy
Leucocytes 8×10^6/L (< 10)
Erythrocytes 180×10^6/L (< 10)**
Epithelial Cells Nil
Chemistry pH 7.0
Protein Nil
Glucose Nil
Blood +++
Red Cell Morphology: Non-glomerular pattern
What is the MOST appropriate next step?
A. Trimethoprim 300mg PO for 3 days
B. Reassurance and review in 3 months
C. Ultrasound renal tract
Repeat urine microscopy, culture and sensitivities
E. CT intravenous pyelogram
F. Refer for cystoscopy
G. Repeat urine red cell morphology
H. CT Kidney Ureter Bladder
I. Coagulation studies
J. Pelvic Ultrasound
K. Urethral swab for microscopy, culture and sensitivities
E. CT intravenous pyelogram
Q u e s t i o n 9
Karlos Rudas, a 38-year-old real estate agent, presents with a one-week history of lower abdominal pain.
He reports associated dysuria, urinary urgency and frequency. His father passed away from prostate
cancer in his early 70’s and he recalls how traumatic it was. Karlos has also noted that his urinary stream is
weaker than usual, and he has been dribbling urine at the end of voiding, causing him great distress as
he feels he is too young to start having prostate issues like his father. On questioning, Karlos states he has
not been sexually active since his divorce 2 years ago. At the time, he had an STI screen which was
negative. On examination, his temperature is 37.8°C, HR80b/m, BP 128/78mmHg, and there is mild
suprapubic tenderness. On per rectal examination, he has tenderness to prostate palpation. You organise
an urgent urine MCS.
What is the MOST appropriate next step?
A. Trimethoprim 300mg oral daily for 7 days
B. Trimethoprim 300mg oral daily for 14 days
C. Cephalexin 500mg BD for 7 days
D. Urgent referral to urologist
E. Simple analgesia until urine MCS results are available
F. Refer emergency department for IV antibiotics
G. Transrectal ultrasound of prostate
H. Refer for prostatic biopsy
I. Prostate specific antigen (PSA)
J. Nitrofurantoin 100mg oral QID 5 days
B. Trimethoprim 300mg oral daily for 14 days
Q u e s t i o n 1 0
Rosalinda Thomas, an anxious 16-year-old high school student, attends your clinic for the first time as she
is worried she may have contracted a sexually transmitted disease. She is too embarrassed to see her
regular doctor as they look after her whole family, and they do not know she has a boyfriend. Rosalinda
has recently become sexually active with her boyfriend of three months. He is her first sexual partner, and
he has told her that he has had no other sexual partners before. She is concerned as she has recently
heard rumours that he had been sexually active with his previous girlfriend. Rosalinda has not had any
discomfort or discharge. Her results are as shown below. Given her results you obtain a swab for
gonococcal culture as well which has been sent off today, the results are pending.
Neisseria Gonorrhoeae By NAAT
Collection Site Vaginal
N. gonorrhoeae Positive
What is the MOST appropriate treatment?
A. Amoxycillin 500mg oral three times a day for 5 days
B. Benzylpenicillin 1.2g IM stat
C. Ceftriaxone 1g IM stat
D. Azithromycin 1g oral stat then repeat in 1 week
E. Azithromycin 2g IM stat
F. Doxycycline 100mg daily oral for 7 days
G. Ceftriaxone 500mg IM stat then repeat in 1 week
H. Ceftriaxone 500mg IM in 2mL of 1% lignocaine and azithromycin 1g oral stat
I. Ceftriaxone 1g IM in 2mL of 1% lignocaine and metronidazole 400mg oral stat
H. Ceftriaxone 500mg IM in 2mL of 1% lignocaine and azithromycin 1g oral stat
Q u e s t i o n 1 1
Lachlan Reed, a 20-year-old university student, presents with a 3-day history of dysuria, urethral irritation and
discharge. On further history, Lachlan tells you he has been engaging in unprotected intercourse with multiple
partners, both men and women, in the last few months. He declined a physical examination. You request a first void
urine specimen, commence him on appropriate treatment and asked him to return for a review.
Which of the following pathogens is LEAST likely to cause his symptoms?
A. Neisseria gonorrhoea
B. Chlamydia trachomatis
C. Mycoplasma genitalium
D. Adenovirus
E. Herpes simplex 1 virus
F. Herpes simplex 2 virus
G. Ureaplasma urealyticum
G. Ureaplasma urealyticum
Q u e s t i o n 1 2
Victoria Lee, a 21-year-old engineering student, presents with a two-day history of a red right eye with
small amount of sticky discharge that bothers her most in the morning. She denies any inciting trauma,
vision loss, pain or photophobia. She does not have a history of eye problems. You diagnose her with
conjunctivitis and commence her on chloramphenicol 0.5% eye drops four times a day. She represents 2
days later as her right eye feels worse despite applying the eye drops you have prescribed. On further
history, she tells you that a week prior to the onset of symptoms, her boyfriend’s ejaculate got into her
eye and she wonders if this has caused her problem. You collect swabs of the conjunctiva for microscopy,
culture and sensitivity and PCR which returns a positive result for chlamydia.
What is the MOST appropriate treatment based on your provisional diagnosis?
A. Azithromycin 1g PO stat
B. Azithromycin 1g PO daily for 3 days
C. Azithromycin 500mg IV/IM stat
D. Flucloxacillin 500mg PO QID
E. Flucloxacillin 2g IV OID
F. Cephalexin 500mg PO QID
G. Cephalexin 1g IV TDS
H. Framycetin 0.5% eye drops TOP 1 drop into right eye, QID
1. Chloramphenicol 0.5% eye drops TOP 1 drop into right eye every 2 hours for the next 48hours
J. Chloramphenicol ointment 1% TOP in addition to regular 0.5% eye drops
K. Advise symptomatic management with cool compress and regular saline wash
A. Azithromycin 1g PO stat
Q u e s t i o n 1 3
Yvette Dagonhurst, a 19-year-old university student, presents to your metropolitan practice with her 20-
year-old boyfriend, James. Yvette and James have come for advice about a sexually transmitted disease
(STD) screen prior to engaging in unprotected intercourse. They are both asymptomatic. They have both
been sexually active in previous relationships, Yvette has had one male partner, and James has had two
female partners in the past. They both report condom use with their previous partners. They deny any
high-risk behaviours such as intravenous drug use. They have both had all their childhood vaccinations.
What is the MOST appropriate advice to give Yvette and James?
A. B. No screening is required as they are both asymptomatic
Offer James and Yvette full screening including HIV, hepatitis B, hepatitis C, syphilis, chlamydia,
gonorrhoea and mycoplasma genitalium
C. Offer James and Yvette chlamydia and gonorrhoea screening and cervical screening test for
Yvette
D. Offer James and Yvette testing for HIV and syphilis via a blood test and chlamydia and
gonorrhoea testing via first-pass urine for James and self-collected vaginal swab for chlamydia
and gonorrhoea for Yvette
E. F. Screen both for chlamydia and gonorrhoea with first-pass urine, anorectal and pharyngeal swabs
Screen both for chlamydia, James with first-pass urine and Yvette with self-collected vaginal swab
and consider further testing based on risk assessment
G. Screen both for chlamydia, James with a urethral swab and Yvette with first-pass urine and
consider further testing based on risk assessment
D. Offer James and Yvette testing for HIV and syphilis via a blood test and chlamydia and
gonorrhoea testing via first-pass urine for James and self-collected vaginal swab for chlamydia
Q u e s t i o n 1 4
Alma Mouston, a 29-year-old primary school teacher, attends for the results of her recent pathology. The
tests were performed at Alma’s request, having recently separated from her long term partner of seven
years after finding out he had been unfaithful to her. Alma is up to date with her cervical screening, has
never had a sexually transmitted infection and has not noticed any pelvic pain or per vaginal discharge.
Alma has a Mirena intrauterine device in situ, which is due for removal in the next five months. Apart from
the results below, the rest of her results are normal.
Chlamydia Trachomatis By NAAT
Collection Site Vaginal
C. trachomatis Positive
What is the MOST appropriate next step?
A. Amoxycillin 500mg PO TDS for 5 days
B. Benzylpenicillin 1.2g IM stat
C. Ceftriaxone 1g IM stat
D. Azithromycin 1g IM stat
E. Ceftriaxone 1g IM stat then repeat in 1 week
F. Doxycycline 100mg oral daily for 5 days
G. Azithromycin 1g PO stat then repeat in 1 week
H. Advise no sexual contact for 7 days after treatment has commenced
I. Advise Alma she requires a test of cure 1 month post treatment
J. Urgent removal of Mirena
H. Advise no sexual contact for 7 days after treatment has commenced
Q u e s t i o n 1 5
Patsy Radecki, a 27-year-old primary school teacher, comes in for an urgent appointment on a Monday morning. She
is very upset because she missed her combined oral contraceptive pill (levonorgestrel/ethinylestradiol 150/30 mcg)
on Saturday night and Sunday night. She only realised this morning, and she took the two missed pills this morning
as soon as she realised. She is due to start the non-hormone pills in the next 4 days. She has not had unprotected sex
in the last 72 hours. She is very anxious to avoid pregnancy.
What is the MOST appropriate next step?
A. Continue taking the pill as usual
B. Continue taking the pill as usual and also use condoms for the next seven days
C. Continue taking the pill as usual and perform a pregnancy test in three weeks
D. Skip the non-hormone pills this month and also use condoms for the next seven days
E. Prescribe levonorgestrel 1.5 mg orally as a single dose, continue taking the pill as usual
F. Prescribe levonorgestrel 1.5 mg orally as a single dose, skip the non-hormone pills this month and also use
condoms for the next seven days
G. Stop taking the pill this month and use condoms until her next period
D. Skip the non-hormone pills this month and also use condoms for the next seven days
Q u e s t i o n 1 6
Samira Pines, a 20-year-old call centre worker, presents with a painful rash at the top of her lips. The rash was
preceded by a tingling, itchy sensation two days ago. This is on a background of known herpes simplex type 2
infection. Her examination is as shown in the image below. Samira is otherwise well and has been eating and
drinking as normal. Her initial episode of herpes simplex was 2 months ago. She had a confirmatory swab and was
treated with valaciclovir 1g PO BD for 7 days with near immediate results. Samira is upset by the unsightly lesion and requests another script for valaciclovir to fast track the healing process. This is her second occurrence of herpes
simplex.
What is the MOST appropriate next step?
A. Lignocaine 2% viscose applied TOP to lesion TDS for 5 days
B. Aciclovir 5% cream TOP 5 times daily for 5 days
C. Valaciclovir 1g PO BD for 3 days
D. Famciclovir 500 mg PO BD for 7 days
E. Aciclovir 1g PO stat
F. Commence aciclovir 400mg PO BD for 6 months as prophylaxis
B. Aciclovir 5% cream TOP 5 times daily for 5 days
Q u e s t i o n 1 7
Sylvia Radford, a 36-year-old trans female, presents for her annual influenza vaccination. During the
consultation, she reports that over the past few months, she has commenced a new relationship with a cis
male and she has been having penis-in-vagina intercourse with him. He works interstate, and they try to
meet up every three weeks. Sylvia began her gender affirmation process 5 years ago, starting with social
affirmation by using her pronouns and changing her name, and 12 months ago underwent gender-
affirming surgery with orchidectomy and vaginoplasty. She uses a transdermal ostradiol patch 100
microg/24 hr changed twice weekly, which she commenced 3 years ago. Sylvia otherwise has no
significant past medical history and takes no regular medications. Sylvia is up to date with her COVID-19
vaccines, but otherwise has not had any vaccinations since her routine childhood vaccinations. Her last
sexually transmitted infection (STI) screen was 12 months ago.
What is the MOST appropriate next step?
A. Recommend self-collected vaginal swab for chlamydia and gonorrhoea PCR
B. Recommend first-pass urine specimen for chlamydia and gonorrhoea PCR
C. Recommend self-collected vaginal, anal and oropharyngeal swabs for chlamydia and gonorrhoea
PCR
D. Recommend Sylvia commence on-demand HIV pre-exposure prophylaxis treatment
E. Sylvia should undergo cervical screening testing 5 years from the date of her gender-affirming surgery
B. Recommend first-pass urine specimen for chlamydia and gonorrhoea PCR
