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Year 4 exams > 2016 MCQ > Flashcards

2016 MCQ Flashcards

1
Q

. A 20 year old woman, who is a known intravenous drug user, has recently started a methadone
program. She is brought to the emergency department by ambulance unconscious having apparently
taken a drug overdose. The ambulance have given naloxone with no apparent response. She is noted
to have recent injection sites. In the emergency department her GCS is 10. Her partner states on direct
questioning that she had access to and could possibly have taken alcohol, diazepam, heroin,
methadone, and marijuana. What is the most appropriate next step in management?
A. Intubation
B. Repeat naloxone
C. Naltrexone
D. IV Flumazenil
E. Gastric lavage

A

repeat naloxone

naloxone is used to reverse opiod OD

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2
Q

Old F, 5hr onset unilateral weakness, flaccid paresis, dysphasia, CT brain normal and all bloods normal- what is the most appropriate treatment?

a. aspirin
b. alteplase
c. warfarin
d. aspirin and dipyridamole
e. enoxaparin

A

aspirin and dipyridamole

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3
Q

. Large lady, has fallen over, has had a prior fall in the last 3 months. Loves a dart, over-wt, she suffers
from anxiety and HTN. Is on amlodipine and perindopril. What is the most effective immediate reduction
in her risk of falling?
A. Podiatry
B. Review medications
C. Wt loss
D. Stop smoking
E. Prochlorperazine

A

IMMEDIATE= medication review

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4
Q

Dude come in with multiple trauma. Which of the following is your priority in management?
A. Rigid abdomen with peritonitis
B. Hand amputation with vascular compromise
C. Neck bruise with stridor on inspiration
D. Bilateral balls burst rupture
E. Blood and csf flowing down from the ear

A

neck bruise w/ stridor on inspiration
(DRS ABCD)- ensure he has airway patent before treating

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5
Q

19yo sexually active male presents with lower abdominal pain that radiates to scrotum, on
examination, right testes is higher up and exquisitely tender. What is the next step in management?
A. Doppler USS
B. Biopsy
C. Urine MCS
D. Surgical exploration
E. Swab

A

surgical exploration

  • i would be thinking testicular torsion which is a surgical emergency
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6
Q

45 y/o M with increasing SOB. Had an AMI 2 years ago. Currently on aspirin, metoprolol and
frusemide. Has had an echo that showed EF of 29%. BP 130/80 HR 80 with occasional ectopic beats.
What additional medication would you start him on?
A. Perindopril
B. Warfarin
C. Spironolactone
D. Digoxin
E. Biventricular pacemaker

why

A

spirinolactone
- his BP is ok so no need for another BP-lowering medication like perindopril.
- mainly needs diuresis

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7
Q
  1. 60 y/o female with T2DM has sudden onset of shortness of breath presented to the Emergency
    Department. Her BP is 130/80, ECG shows sinus tachycardia. V/Q mismatch on perfusion on one area
    in both lungs. What is the best next step in her management?
    A. Doppler USS of the legs
    B. CTPA
    C. Subcut enoxaparin
    D. Warfarin
    E. Thrombolysis
A

subcut enoxaparin

  • thrombolysis is reserved for patients w/ massive PE
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8
Q

Older man with 10y history of type 2 diabetes. Also has hypertension, increased BMI (32) and heart
failure with reduced ejection fraction (35%). HbA1c 10%. BP ~130/80. Creatinine slightly increased
120.
A. Increase metformin
B. Commence rosiglitazone
C. Commence insulin
D. Lap band
E. Commence Orlistat

A

commence insulin since HbA1c is so high (aim < 5.7)

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9
Q

38 yo F presents with a tender, swollen R) calf after a motorhome holiday. USS confirms a venous
thrombosis extending from the tibial v to the popliteal v. She is otherwise well. She has been started on
subcut enoxaparin .
What is the definitive treatment?
A. Aspirin + clopidogrel for 6 months
B. Enoxaparin for 6 weeks
C. Warfarin for 6 months
D. Aspirin for 6 weeks
E. Warfarin for 6 weeks

A

warfarin 6 months

warfarin (anticoag) appropriate for VENOUS thrombosis

vs
aspirin and clopidogrel= antiplatelet more suited to arterial thrombosis and arterial dx.s NOT venous

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10
Q

. Adult anaphylaxis adrenaline dose:
A. 0.5 ml of 1:1000 IV
B. 1 ml of 1:1000 IV
C. 1 ml of 1: 10000 IV
D. 0.5 ml of 1:1000 IM
E. 0.1 ml of 1:10000 IM

A

D
for anaphylaxis only IM not IV

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11
Q

28yo M with scrotal lump that on USS was hypoechoic and inside the testicle, what is your next
management?
A. Orchidectomy via the inguinal approach
B. Transscrotal core biopsy
C. Transscrotal open biopsy
D. Serum AFP
E. Watchful waiting

A

A

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12
Q
  1. 5yo BIBM with wheezy breathing and cough, ongoing, has had similar presentations previously,
    worsens after URTI, worse at night. Brother has eczema. UTD with immunisations
    A. Asthma
    B. Bronchiolitis
    C. Chronic croup
    D. Pertussis
    E. pneumonia

why

A

asthma

-can be worse at night and Fhx of atopy (eczema)
-UTD w/ vaccinations
-exacerbated after URTI
-vs croup: inspiratory stridor and barking cough

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13
Q

A 35 year old woman presents with a 2 year history of slow growing neck mass. On examination
she has a smooth, mobile nodule in the left lobe of her thyroid. No lymphadenopathy. She is clinically
and biochemically euthyroid. Which of the following is the most likely diagnosis:
A. Hashimoto’s Thyroiditis
B. Multinodular Goitre
C. Simple Thyroid Cyst
D. Thyroid Adenoma
E. Thyroid Cancer

A

simple thyroid cysts (mobile nodule, euthyroid)

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14
Q

Lady Post-thyroidectomy presents three days later with “pins and needles” around her mouth and
pain in her hands when she knits. What is the first thing you would like to do?
A. Palliate
B. Neck USS
C. Check serum Ca

why

A

check serum calcium

pins and needles around moith and fingertips/ toes= low calcium levels in blood which can occur with hypOparathyroidism

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15
Q

Old guy who cannot close his eyelids tightly. Which structure could have been damaged?
A. R Facial motor nucleus
B. L oculomotor nerve
C. L facial nerve, temporal and zygomatic branch
D. Left corticobulbar tract, at internal capsule
E. Right corticobulbar tract at internal capsule

A

right facial motor nucleus

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16
Q

Jared, 25yo barista, is feeling very tired. He had a sore throat for two weeks, with a fever for the
first week. He went out last night with friends but had to home early as he was too tired to stay out. On
examination he has a tippable spleen and a tender liver border. What is the probable cause of his
anaemia?
A. Bone Marrow suppression
B. Iron deficiency
C. Increased red cell destruction
D. B12 deficiency
E. Folate deficiency

A

increase red cell destruction

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17
Q

Man presents with seizure lasting over 30 minutes (status epilepticus). He is not on any
medications. What medication do you give him?
A. Carbamazepine
B. Midazolam
C. Phenytoin
D. Valproic acid
E. Phenobarbital

A

midazolam

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18
Q

55 yo male with sudden onset of chest and upper abdominal pain, and episodes of profuse
vomiting. He dies a few hours later. What is the most likely diagnosis?
A. AAA
B. MI
C. Oesophageal rupture
D. Acute pancreatitis
E. Gastric aspiration

A

oesophageal rupture

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19
Q

What is the most likely side effect of long acting progestins?
A. Stroke
B. Abnormal uterine bleeding
C. Pulmonary fibrosis
D. Fibroid
E. Incontinence

A

abnormal uterine bleeding

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20
Q

9 weeks pregnant, routine ultrasound, ie intrauterine pregnancy, also 4x5mm cystic mass
incidentally found in ovary
A. Luteal cyst
B. Ovarian cyst
C. Serous uterine fibroid
D. Follicular cyst
E. Ovarian teratoma

A

luteal cyst

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21
Q
  1. A women presented with lower abdominal pain, an enlarging mass and weight changes.
    Which of these are associated with late (stage IV) ovarian cancer?
    A. Ascites
    B. Mass in the lower abdomen
    C. Weight gain
    D. Simple ovarian cyst
A

ascites

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22
Q

A G1P0 woman in active labour is referred to the Doctors by the midwives, the baby is in face
presentation. As a Doctor undertaking a vaginal examination, what would you feel?
A. Occiput
B. Mentum
C. Sinciput
D. Large fontanelle
E. Malar eminence

A

Mentum (chin) most prominent in a face presentation where the baby’s head is fully extended

Occiput (back of baby’s head) felt in a normal (vertex) presentation where head is flexed

Sinciput (area of head between frontanelles) more likely to be felt in brow presentation- head partially not fully extended

Large frontanelle hard in face as the head is fully extended

malar eminence (cheek bone) could be felt but mentum is more prominent

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23
Q

21yo presents with vaginal discharge, wet mount slide something had motile flagellates. How do
you treat?
A. Fluconazole
B. Metronidazole
C. Ampicillin
D. Acyclovir
E. Nystatin

A

this is trichomonas so metronidazole

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24
Q

Person with menorrhagia who is Fe deficiency. Has uterine ablation and takes iron supplements -
returns with folate and iron deficiency.
A. Celiac
B. Vegan diet
C. Patient non compliant with the medication
D. Bacterial Overgrowth

A

A

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25
Q

A 50 year old man presented with lesion on right forearm. Lesion appears to be a raised pearly
shaped nodule with central ulceration. There was rapid growth of lesion for the past few months but the
size is slowing reducing.
A. BCC
B. SCC
C. Sebaceous cyst
D. Keratoacanthoma
E. Seborrhoeic keratosis

WHY

A

keratoacanthoma
- rapidly growing w/ central keratin-filled crater (ulceration)
- usually regresses spontaneously

BCC NO
- pearly nodule w/ small blood vessels
- may ulcerate
- do NOT regress spontaneously

SCC NO
- rough, scaly ulcerated
-does NOT regress spontaneously

26
Q

A G1P0 30 weeker, had a symptomatic UTI at 30 weeks with fever and leucs and nitrites in the
urine
A. Ciprofloxacin
B. Cephalexin
C. Trimethoprim
D. Amoxicillin
E. No treatment required

A

cephalexin (cephalosporin), commonly used to treat UTIs in pregnancy (safe)

ciprofloxacin (fluoroquinolone) and trimethoprim (folic acid antagonist) avoided in pregnancy

amoxicillin is safe during pregnancy BUT not effective against many pathogens that cause UTIs

27
Q
  1. Someone presents with 12 hours of chest pain, relieved by leaning forward. There is widespread
    ST elevation on ECG.
    A. Acute Pericarditis
    B. Constrictive pericarditis
    C. Anterolateral STEMI
    D. Inferior STEMI
A

acute pericarditis

28
Q
  1. Diagnosing chronic sinusitis. Asked what is the best evidence based approach to diagnosing?
    A. CT
    B. Facial pain
    C. Pain bending over
    D. Pain on percussion of the sinuses
    E. X-Ray of sinuses
A

pain on percussion of sinuses

29
Q

72yo man, past 3 months agitated, w\ hallucinations of a young woman sitting in a chair. Had
rigidity when you moved his arms and legs.
A. Alzheimers
B. Lewy body dementia
C. Psychotic depression
D. Hydrocephalus

A

lewy body dementia

30
Q

16 year old boy presents with fevers, retro-orbital headache, joint pain, generally unwell. Recently
returned from scout trip in Northern Queensland. On FBE he has low platelets. What is the most likely
cause?
A. Dengue fever
B. Chikungunya
C. Typhoid fever

A

dengue

31
Q

Older man with back pain over 6 months. Some Xray changes given like cortical thickening of
vertebral column and trabecula. PSA normal. Significantly elevated ALP. Normal serum Calcium and
Phosphate
A. Ankylosing spondylitis
B. Paget’s
C. Osteomalacia
D. Osteoporosis
E. Bony mets

A

pagets- cortical thickening but weakening of bone, elevated ALP is a hallmark reflecting increased bone turnover

32
Q

Woman presents with sudden onset acutely painful L sided retro-orbital throbbing headache. Has L
ptosis, L miosis, L anhidrosis L eye is sunken. L vision is impaired. L sided dry head to palpation. I
think maybe had some What is most likely?
A. Migraine
B. Temporal arteritis
C. ICA dissection.
D. Stroke
E. SAH

A

ICA dissection- known cause of Horner’s syndrome due to involvement of sympathetic nerves that run along ICA

SAH- sudden onset thunderclap headache, less likely to= horner’s

migraine= only headache, unlikely to cause horner’s

stroke could= range of neuro deficits but this si characteristic of ICA

33
Q

Something about a young male (?30ish?) who presented over a few months with a gradually
enlarging testicular lump. Which lymph nodes does it drain to?
A. Inguinal
B. Internal iliac
C. External iliac
D. Para-aortic
E. para-rectal

A

para-aortic drains testes

inguinal LNs drain scrotal skin and superficial structures

internal iliac and external iliac LNs drain bladder, prostate, membranous urethra, cervix and upper vagina

pararectal LN associated with lower rectum,

34
Q

21 year old woman presents with irregular shaped, ulcerated, pigmented lesion on her back. The
pathology reports that this is a malignant melanoma. Which of the following is the most important
prognostic factor?
A. The Clark level of the primary lesion
B. The Breslow thickness of the primary lesion
C. The diameter of the primary lesion
D. The patient’s age
E. Ulceration of the primary lesion

A

breslow’s thickness

35
Q

. 80 year old man presents with 6month history of perianal pain. He’s had an increasing lump in his
anus & has had blood on the toilet paper. Colonoscopy shows an ulcerating mass in his anus.
Where does the lymph drain?
A. External Iliac
B. Internal Iliac
C. Inguinal
D. Para-Aortic
E. Peri-Rectal

A

inguinal

anus
below dentate line (more palpable and closer to bum hole) drains into inguinal LN

above dentate line drains into peri-rectal and internal iliac LNs

36
Q

40 yo Man presents to DEM unconscious. Fell and hit his head on the pavement 1 hour ago, was
then fine for 40 minutes until he complained of a headache and lost consciousness. Family then called
ambulance. He was generally healthy before this event.
On arrival BP is 200/110 and HR is 50 bpm. He is intubated with no response to voice. He has R) fixed
dilated pupil and increased tone.
What was the most likely cause:
A. Cerebral contusion
B. Cerebral Haemorrhage
C. Extradural Haematoma
D. Subarachnoid Haematoma
E. Subdural haematoma

A

C

37
Q

. 23yo M presents with L sided headache, occurring when he woke up this morning, with tearing of
the eye. Has had similar episodes for last 3-4 days, and another bout of 3-4 episodes 3 weeks ago. No
significant life stresses. What is the likely diagnosis?
A. Migraine
B. Tension headache
C. Cluster headache
D. Temporal arteritis
E. Acute angle Glaucoma

A

Cluster headache

38
Q

. A 73 year old male is diagnosed with a 4.5 cm abdominal aorta, What is the best mode of
surveillance for this patient?
A. MR angiogram
B. Duplex Ultrasound
C. CT angiogram
D. Percutaneous transluminal angiogram
E. Series of clinical examinations

A

duplex US

39
Q

65 year old woman was walking around her backyard when she was cut by a stick just above her
medial malleolus. An ulcer developed over the site of injury and has not resolved over the past 3
weeks. She has Champagne bottle shaped legs and brown deposits over her lower legs. What is the
most likely cause of her persistent ulcer?
A. Arterial insufficiency
B. Venous insufficiency
C. DVT
D. Neuropathic ulcer
E. Persistent infection

A

Venous insufficiency

40
Q

. 56 year old male presents with 3 month history of painless jaundice and weight loss. He also has a
rash on his leg. On examination, cachexic, thrombophlebitis on the legs and palpable gall bladder.
Which of the following signs is the most related to carcinoma of the head of pancreas ?
A. Weight loss
B. Migrating Thrombophlebitis
C. Palpable Gallbladder
D. Obstructive Jaundice
E. Age

and what is this called?

A

palpable gallbladder= Courvoisier’s sign

41
Q

75 y/o M presenting with 3 months of loss of weight and early satiety with normal abdominal
examination and no hepatosplenomegaly but with a 3 cm supraclavicular mass on the left hand side.
FBC shows a microcytic anaemia. What is the most likely differential?
A. Oesophageal Cancer
B. Gastric Cancer
C. Gastric Lymphoma
D. Pancreatic Cancer
E. Mesothelioma

why

A

gastric cancer

the supraclavicular mass on L= Virchow’s node

42
Q

A 55 year old woman underwent thyroidectomy for toxic multinodular goitre. She was recovery well
in the waiting room. However, 6 hours later she developed acute agitation, confusion and sweating.
Her vitals were: temp 38.8, BP 148/92, HR 128, RR 18, SpO2 99% room air. Wound was clean.
What is the mostly cause?
A. bilateral laryngeal nerve damage
B. Cerebral metastases
C. Laryngeal oedema
D. Malignant neuroleptic syndrome
E. Thyrotoxic crisis

A

thyrotoxic crisis

43
Q

?65 year old gent, presented with some shoulder pain and loss of range of abduction (both passive
and active ) between 45 and 135 degrees. Movement was normal and pain free from 0-45 and
135-180. What is the most likely pathology
A. brachial plexus injury
B. frozen shoulder
C. deltoid muscle injury
D. rotator cuff pathology
E. Glenohumeral joint osteoarthritis

A

rotator cuff pathology

44
Q

Boy kicked in shin during soccer, pain and weakness with dorsiflexion and flexion of lat toes.
Swelling and tenderness over lower leg. Peripheral pulses present. Also had numbness of the lower
leg.
A. Common Peroneal nerve injury
B. Compartment syndrome ?ant. compartment
C. L5 radiculopathy
D. Popliteal artery aneurysm

A

common peroneal n injury

45
Q

55 year old female noticed a lump in her right breast. No history or previous breast problems, no
family history of breast cancer. LMP 7 years ago.
Palpable firm 2cm diameter swelling in right upper outer quadrant
What is likely diagnosis
A. Breast cancer
B. Breast fibroadenoma
C. Breast cyst
D. Fibrocystic change
E. Normal change post-menopause

A

breast cancer

  • firm mass
46
Q
  1. 70 yo male, 6 month (?) history of progressive bilateral leg pain, worse on right side, worse with
    walking, worst when walking uphill relieved by resting. Otherwise well, no back pain, no pain on rest, no
    neurological abnormalities, normal lower limb reflexes, ankle brachial index 0.6.
    What is the most likely underlying cause his pain?
    A. Macrovascular
    B. Microvascular
    C. Peripheral neuropathy
    D. Spinal stenosis
A

macrovascular

47
Q

A 50 year old man with a known history of alcohol abuse presents with repeated vomiting of large
volumes of bright red blood. On examination he is tachycardic and hypotensive. His liver is firm and
palpable 5cm below the right costal margin. The spleen is palpable 10cm below the left costal margin.
What is the most likely diagnosis?
A. Duodenitis
B. Gastric cancer
C. Mallory-Weiss tear
D. Oesophageal varices
E. Peptic ulcer

A

oesophageal varices (related to liver chirrosis)

48
Q

. Woman with gradual onset jaundice and palpable gallbladder. Elevated ALP, ALT & GGT.
Predominant type of bilirubin causing jaundice?
A. Unconjugated
B. Conjugated
C. Faecal bilirubin
D. Urobilinogen
E. biliverdin

A

conjugated (the raised ALP, ALT and GGT indicates obstructive picture)

49
Q

. 60 yoM presents with nodular lesion cystic in appearance with central ulceration and scaling on L
ear which bleeds at night. What is this likely to be?
A. Solar keratosis
B. Keratoacanthoma
C. BCC
D. SCC
E. Chondrodermatitis Helicis

A

BCC

50
Q
  1. A 42 y.o. Previously well woman presented to the Emergency Department with abdominal pain. She
    is given a provisional diagnosis of acute cholecystitis and is awaiting surgical review. She is
    complaining of severe abdominal pain.
    What is the most appropriate analgesic option?
    A. Pethidine
    B. Buscopan (hyoscine)
    C. Morphine
    D. Paracetamol
    E. Withhold analgesia
A

morphine

51
Q

28 yo F presents with non-healing wound on right lateral thigh, previously burnt on right outer thigh
badly enough to be hospitalised but not enough to need a graft.
A. Angiosarcoma
B. BCC
C. Kaposi sarcoma
D. SCC
E. Melanoma

A

SCC

52
Q

. Lady with progressive dysphagia first solids then to liquids, retrosternal chest pain, wt loss and
some funny nerve thing going on in her foot
A. Achalasia
B. Oesophageal cancer
C. Bulbar palsy
D. Pharyngeal pouch

A

oesophageal cancer

53
Q

. 60y/o man presents with one day hx sudden onset floaters in the central vision of his R eye. The
eye is not painful but he feels as though it is “heavy”. He does not smoke and is not on any
medications. He wears glasses. Visual acuity (corrected) is 6/18 in the R eye and 6/6 in the L. Pupillary
reflexes are unaffected. What is the most likely dx?
A. Retinal artery occlusion
B. Retinal vein occlusion
C. Retinal detachment
D. Acute angle glaucoma
E. Hypertensive retinopathy

A

retinal detachment (sudden floaters and visual disturbance)

54
Q
  1. 73 yo woman with fractured neck of humerus. The fracture is minimally angulated. How will you
    manage?
    A. Bed rest and skeletal traction
    B. Open reduction and fixation
    C. Reduction under anaesthetics and put in cast
    D. Shoulder spica
    E. Sling & encourage active movement
A

sling and encourage active movement

55
Q

20 yo male football player comes in after his knee gave way during a match. You lie the patient flat
on his back, slightly flex knee, place one hand on his knee and one on the ankle and move the leg so it
is abducted. There is excessive movement on abduction and the medial side opens up. Where is the
injury?
A. ACL
B. Lateral collateral ligament
C. Medial collateral ligament
D. PCL
E. Medial meniscus

A

medial collateral ligament

56
Q

60yo (he was older i thought, maybe 78) M presents with back pain. Previous prostate cancer, PSA
145 ng/L (normal<0.4ng/l), currently has bony metastasis to vertebrae, Gleason score 8/10
A. Androgen deprivation therapy with LHRH antagonist
B. External beam radiotherapy to prostate
C. External beam radiotherapy to spine
D. Radical prostatectomy
E. Watchful waiting

A

C

57
Q

Mother presented with 15 month old baby worried about developmental delay. He could walk
independently but not run or walk up stairs like his peers. He could babble but unable to speak words.
He was shy in front of others and had stranger anxiety. He could eat and drink out of a sippy cup
independently. He grasped the toy with thumb and index finger the doctor gave him and he smiled at
the doctor.
A. Gross motor development delay
B. Language development delay
C. Social development delay
D. Global delay
E. Fine motor

A

language developmental delay

58
Q

8-week baby with inguinal swelling. Not transilluminable, not tender, baby otherwise healthy. Not
reducible either. What is the next step in management
A. US the other side since bilateral inguinal swellings are common
B. Arrange a non urgent surg review since non-strangulated hernias are unlikely to complicate
C. Arrange an urgent paeds review since they can strangulate quickly
D. Advice mum that hydroceles are common and reassure her

A

arrange urgent surgical referral as hernias can strangulate quickly

59
Q

13 year old girl complains of pain in her right knee when playing sport. She has stopped playing
netball as a result. She experiences no pain at night or at rest. Her is BMI 26.
A. FBC to rule out leukaemia
B. Hip XRAY for Osgood-Schlatter’s disease
C. Hip and knee examination to rule out slipped capital epiphysis
D. Recommend weight loss and increased exercise to the parents for the whole family
E. Reassure parents that growing pains are a normal part of development

A

hip and knee exam to rule out slipped capital epiphysis

60
Q

72 yo lady with previous history of HF, AMI, HTN, Multiple Strokes. Confused for past 10 months.
Usually worse in evening. Shuffling gait. Unsteady going to toilet. Multiple (old) lacunar infarcts on CT.
Poor clock face on MMSE (didn’t draw one side)
A. Lewy body dementia
B. Parkinson’s Disease
C. Vascular dementia
D. Alzheimer’s

A

vascular dementia

61
Q

Concerned mother brings in 8 week old baby to GP due to long history of stridor which is worse
when child is crying or worked up. Stridor was noticed a few weeks after birth. The child is otherwise
well, meeting requirements for developmental and growth milestones - no trouble feeding. The child is
not febrile, not coughing or short of breath. What is the most likely diagnosis:
A. bronchiolitis
B. Spasmodic croup
C. Laryngomalacia
D. Epiglottitis
E. Submucous cleft palate

A

laryngomalacia

Year 4 exams (8 decks)

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