2017

Question 1

28yo M, acute psychosis admitted to psych ward for tx for 10 days, sudden intense painful neck muscle cramping/ stiffness and forward flexion of head. what drug is most likely to cause this sx.?

Benztropine
Fluoxetine
Haloperidol
Lithium
Olanzapine

Answer 1

haloperidol

Question 2

67yo Female with recurrent depressive episodes with psychosis presents to ED, where she had and ECG.
Which ECG change is of increased of harm from anti-psychotic medication?
Bifid P
prolonged QRS
prolonged QT
Shortened PR
Shortened ST

Answer 2

prolonged QT

Question 3

45yo male presents with increasing SOB. Had AMI 2 years ago, is currently on aspirin, metoprolol and frusemide. Ejection fraction on echo is 29%. BP 130/80, HR 80 with occasional ventricular ectopics. What would be the most appropriate thing to add to his management?

perindopril
warfarin
Bi-ventricular pacing
spironolactone
digoxin
cardiology referral

Answer 3

perindopril

Question 4

what would you prescribe for trichomonas vaginalis

Answer 4

metronidazole 2g oral single dose

Question 5

7yo F brought into ED by her parents overnight w/ SOB and wheeze. RR 40 HR O2 sats 92%
what should you do next?
A. CXR to exclude foreign body
B. ABG in case of CO2 rtn
C. commence SABA and high flow O2
D. give something else and MAST stabilizer and make asthma action plan

Answer 5

commence SABA and high flow o2

Question 6

Very long stem about 35y F mother of 3 boys with basically every feature of SADFACES with an uncle with Bipolar. Also had early morning wakening and thought she was a bad mum, plus 4kg of weight loss?

Bipolar 1 in depressive phase
MDD with melancholic features
MDD with psychotic features
MDD with a side serve of anxiety

Answer 6

MDD w/ melancholic features

Question 7

baby born to mum who tested +ve for Hep B surface Ag- what should you do?

a. give hep b hyperimmunoglobulic to mum
b. vaccinate baby and mum
c. nothing as baby is likely to have contracted hep B in utero
d. give baby hep B Ig and vaccination
e. give mum hep B vaccine and baby hep B Ig

Answer 7

give baby hep B Ig and vaccination

Question 8

man diagnosed w/ exertional angina and had AMI 2 years ago. Which is indicator for the worst outcome/ prognosis?
a. LV failure on echo
b. resting BP of >170
c. cholesterol >7
d. ST depression on exercise stress test
e. ST depression on pharmacological stress test

Answer 8

LV failure on echo

Question 9

An 8 year old girl presents with difficulty hearing. On tuning fork vibration, she hears it more when placed on her mastoid processes than at the meati. Normal careless whisper test. Additionally, when the fork is placed on her forehead, she hears the voice louder on her left side. What type of hearing loss is present?
A. Bilateral conductive loss worse on left
B. Bilateral conductive loss worse on right
C. Bilateral sensorineural loss with R conductive loss
D. Bilateral sensorineural loss worse on L side
E. R sided conductive loss

Answer 9

bilateral conductive loss worse on L

Question 10

19y.o dance receptionist presents to her GP reporting fatigue. She is thin with a BMI of 17.2. What is the most important q to ask to diagnose her with anorexia nervosa?

Her perception of body image
Menstrual cycle changes
Purging
Infection

Answer 10

perception of body image

Question 11

When admitting a patient under the Mental Health Act. We subsequently do the meetings with the psychiatrist and the lawyer because: What is the ethical principle that applies to this?

a. autonomy and informed consent
b. justice for all
c. respect for human rights
d. least restrictive care
e. nonmaleficence

Answer 11

nonmaleficence

Question 12

25F irregular periods and galactorrhea for past 8 months.
Watery nipple discharge.
OE BMI 19 normal breasts + pubic hair
A) PCOS
B) Anorexia
C) Hypothyroid
D) Prolactinoma
E) Pregnancy

Answer 12

prolactinoma

Question 13

An 85 year old woman with a history of hypertension and ischaemic heart disease is taking aspirin, amlodipine, enalapril, indapamide and metoprolol. She has become increasingly confused.

On investigation:
creatinine mildly elevated, sodium 115, potassium 3.5.

Her confusion can be attributed to which medication?

Metoprolol
Amlodipine
Indapamide
Enalapril
Aspirin

Answer 13

indapamide- thiazide diuretic which is most likely to cause hyponatremia which is a commonc ause of confusion especially in the elderly pop’n

Question 14

what is indapamide

Answer 14

thiazide diuretic

Question 15

Baby can roll from front to back, sit with support, transfers hand to hand, but doesn’t have pincer grip and babbles, holds bottle when feeding, turns to name, no stranger anxiety or words.
A. 3 Months
B. 6 months
C. 9 Months
D. 12 Months
E. 18 Months.

Answer 15

6 months

Question 16

5 year old lady. On OCP. Recent period of immobility. Hot, swollen, painful lower leg. Most appropriate Ix?
CTPA
USS femoral and popliteal aa’s
Amputation

Answer 16

USS femoral and popliteal pulses

Question 17

87yo M, inpatient of high dependency dementia unit, significant cognitive and behavioural changes. Lately has been more irritable/angry with nursing staff, shouting “deutschland erwache”, particularly when he is being dressed or they are undertaking hygiene activities. It has also been noted that he has been walking around the unit less frequently, and appears to be grimacing when he does so. Which initial medication is most appropriate?
Analgesia
Antipsychotic
Sertraline (/another SSRI)
Cholesterase inhibitor
Anxiolytic

Answer 17

analgesia

Question 18

Woman in late 40’sG3P3 with heavy menstrual bleeding, she had the same thing in her 20’s. What is the most likely complication of this?

Chronic renal failure
Iron deficiency anaemia

Answer 18

Fe deficiency anaemia

Question 19

Mum brings her 3 month old baby girl in. Baby being breastfed. Says had small amount of blood and clear mucus from vagina in nappy.

Reassure mother
Paeds referral
Pelvic US
Vaginal swab for MC&S

Answer 19

paeds referral

Question 20

what differentiates bullimia from anorexia nervosa?

bingeing
self-induced vomitting
normal weight
amenorrhoea
purging

Answer 20

normal weight

Question 21

47yo F presents with 3 months lower back pain. Radiouptake scan confirms bony metastases. Which primary cancer is most likely to metastasise to bone?

Breast adenocarcinoma
Cervical
Colon adenocarcinoma
Melanoma
Pancreatic

Answer 21

breast adenocarcinoma

(remember breast, prostate and lung)

Question 22

40yo M, acute SOB sats 98%,
RR 24, R tension pneumothorax??
what is management?

a. intercostal catheterization
b. posterior pleural aspiration
c. IV morphine
d. biPAP
e. reassure

Answer 22

intercostal catheterisation

Question 23

7yo well, asymptomatic girl has loud pansystolic murmur, palpable thrill at left sternal edge.
Routine check. Heart sounds and apex beat otherwise normal.
A. Ventricular Septal Defect
B. Functional (flow) murmur
C. Coarctation of aorta
D. Rohm’s cardiomyopathy
E. Patent Ductus Arteriosus

Answer 23

ventricular septal defect

Question 24

26 yo PhD student is planning to present her paper at a conference in 4 months’ time but has a fear of flying. What treatment would you prescribe?

Alprazolam for the flight
Diazepam for the flight
Busipirone for the flight
Cognitive Behavioural Therapy

Answer 24

CBT

Question 25

A 34yo F came in to DEM. Had a hx of amphetamine use + depression in the context of her friend’s death due to overdose. She is on sertraline (not effective), so her GP has prescribed her with mirtazapine & quetiapine. The combination is energising. She reports feeling agitated, having shivers & stomach rumbling. On examination her temp is 38.5C & restless. Think she had some twitching too. Most likely cause of this presentation?

a. grief
b. neuroleptic malignant syndrome
c. serotonin syndrome
d. mania
e. stimulant substance use

Answer 25

serotonin syndrome (as it is after taking mirtazapine= tetracyclic and quetiapine= atypical antipsychotic)

Question 26

what is neuroleptic malignant syndrome

Answer 26

• rare, life-threatening
  -idiosyncratic reaction to neuroleptic med.s (haloperidol, 2nd gen e.g. olanzapine, antiemetic e.g. metoclopramide, promethazine)
  -fever, muscular turgidity, altered mental status and autonomic dysfunction

Question 27

A 6 month child came in for immunisation, has a fever of 37.8 degrees, have a cold for 2 days. What should you do?

Wait until she gets well completely.
Gives all the needles except Pertussis
Wait a month, and then give all the immunisation
Wait two weeks, and then give the immunisations.
Give all the immunisations today.

and why

Answer 27

give all immunisations today
- recommended if fever above 38/5 then wait

Question 28

A 20 year old apprentice cut his hand with a chisel. He cannot elevate the thumb from the palmar plane. Sensation intact. Which tendon did he cut?
A. Abductor pollicis longus
B. Abductor pollicis brevis
C. Extensor pollicis longus
D. Flexor pollicis longus
E. Flexor pollicis brevis

Answer 28

abdutor pollicis brevis

Question 29

Pregnant lady with UTI

Trimethoprim
Amoxycillin
Cephalexin
Ceftriaxone
Ampicillin

Answer 29

cephalexin

Question 30

30y/o lady, G2P2, comes in with 6 week old son for routine appt, symptoms of poor concentration, sleep, fatigue, LOW to below pre pregnancy weight. Vehemently denies being depressed, didn’t feel that way with first child.

Post natal depression
Post natal psychosis
Adjustment disorder
Baby blues
Persistent depressive disorder

Answer 30

post natal depression

Question 31

Q55: 80. (Guy presents for colonoscopy after PR bleeding) What lesion has greatest malignant potential?
A. Hyperplastic polyp (non-neoplastic)
B. Tubular adenoma
C. Solitary rectal ulcer
D. Angiodysplasia
E. Villous adenoma

Answer 31

villous adenoma

Question 32

The paediatrics RMO is conducting a baby check on a 3 day old baby prior to discharge. The baby was born by normal vaginal delivery. On examination she had a short webbed neck, widely spaced nipples and low set ears.
What is the most appropriate next investigation?

Neck ultrasound
FISH for Himmler’s syndrome
Full genome sequencing
Karyotype
Normal child

why- what is the syndrome described

Question 33

Guy in his 20s, brought into ED by housemates. Rapid speech but could be interrupted. Thought the Prime Minister was a robot sent from the future, like terminator, to kill him and then destroy the human race.
Mengele alogia
B.Grandiose Delusion
C. Persecutory delusion
D.formal thought disorder
E. projection

Answer 33

persecutory delusions

Question 34

50 y.o. Female with history of increasing right hand clumsiness, present at all times but worse at night. Also swelling of hand at night. On examination no thenar wasting, negative phalens, postive tinels. positive goebbels.History of type 2 diabetes.

A.Carpal Tunnel
B. Cervical stenosis
C. Gout of MCP joints
D. Mononeuropathy

Answer 34

carpal tunnel

Question 35

73. 2 year old boy brought in by his parents. English speaking, only speaks 20 words, does not play with crayons. Plays alongside but not with other children. When interacting with him he is shy but good at imaginative play. Opens up to you eventually (Prv question)

Hearing Assessment
Normal Child
Global Developmental Delay
Speech Delay
Autism

Answer 35

speech delay or language delay
- by the age of 2 should be using 50 words and putting 2 words together

Question 36

19 yo male comes to GP very distressed. Worried about his nose, think’s it’s big and is very conscious of it and wants to get plastic surgery because he looks at it in the mirror all the time and he thinks the girls won’t likee him because of it.

Body dysmorphic disorder
Illusional disorder
micropenis
OCD
Congenital nasal hypertrophy

Answer 36

body dysmorphic disorder

Question 37

A 23?yo G1P0 presents to antenatal clinic at 12/40. She has a BP of 150/90 and protein on urine dipstick, everything else normal.
A. pregnancy induced htn
B. pre-eclampsia
C. chronic essential htn

Answer 37

chronic essential HTN

Question 38

A 24 year old lady is brought to DEM by her friend after she was found surrounded by empty panadol packets and a bottle of vodka. Currently she is drowsy, states she doesn’t want to be in hospital. It is unclear how long ago she took the pills. She is irritable when approached
Treatment?
A allow her to discharge herself
B flumazenil
C N-acetylcysteine
D naloxone
E sodium bicarbonate

Answer 38

N-acetylcysteine (to prvent liver damage, ASAP after paracetamol OD (acetaminophen)

Naloxone and Flumazenil for opioid OD

Na bicarbonate for some types of OD including tricyclic antidepressants but not paractamol

Question 39

Boy rollerblading fell on to outstretched hand. Snuff box hurts. No signs on x ray

Scaphoid fracture
Colles fracture
Radiodontoid
Tenosynovitis
scapholunate

Answer 39

snuff box= scaphoid

Question 40

90. What is a side effect of long acting progestin contraceptives

Abnormal uterine bleeding
Stroke
Pulmonary fibrosis
Fibroid
Incontinence

Answer 40

abnormal uterine bleeding

Question 41

30 yo lady with BPD in remission, wanting to get pregnant. Which drug is most likely to cause fetal harms?

Carbamazepine
Chlorpromazine
Sodium valproate
Lithium
Olanzapine

and what would it cause

Answer 41

sodium valproate
- high risk of congenital malformations and nuerodveelppmental disorders
- spina bifida (neural tube defects)
- cardiac and craniofacial malformations
- cognitive impairment and developmental delays

Question 42

Lady who enjoyed history being taken and wanted top institution to take care of her and commented on how young the doctor was and was dressed so well but apologised for looking like crap

Histrionic personality disorder
Borderline Personality Disorder
Goering’s disorder
Something

Answer 42

histrionic PD

Question 43

what sx. would be most likely w/ a mid-shaft humerus fracture and why?

Answer 43

wrist drop due to radial n injury (loss of wrist extension and digit extension)
Wrist drop
Loss of grip strength
Sensation loss over palmar side of thumb, index and middle fingers
Sensation loss over palmar side of fourth and fifth fingers
Claw hand

Question 44

Lady with chest pain, multiple presentations(abdo pain etc) in the past for other things. On disability penis because she has all these problems. Doc looks through her records and previous scans(trop, xrays etc) have all been normal.What does she have? Also had intermittent constipation and diarrhoea

Factitious disorder
Somatisation disorder
Depressive disorder

Answer 44

somatisation disorder