AMC CAT MCQ Exam — Questions and Answers

Question 1: A 30-year-old man presents with painless, firm swelling of the left testis. Serum alpha-fetoprotein is markedly elevated. What is the most likely diagnosis?

Testicular torsion
Classical seminoma
Epididymo-orchitis
Yolk sac tumour (non-seminomatous germ cell tumour) (Correct answer)

Correct answer: Yolk sac tumour (non-seminomatous germ cell tumour)

Markedly elevated AFP is characteristic of non-seminomatous germ cell tumours, particularly yolk sac tumours. Pure seminomas do not produce AFP. Epididymo-orchitis presents with pain and tenderness. Testicular torsion is an acute painful emergency, not a painless swelling.

Question 2: Which best describes the ethical principle of 'justice' in clinical practice?

Telling the truth at all times
Fair distribution of resources and equitable treatment of patients (Correct answer)
Avoiding harm to patients
Always doing what the patient wants

Correct answer: Fair distribution of resources and equitable treatment of patients

Justice concerns fairness and equitable allocation of healthcare resources and treatment.

Question 3: A 55-year-old man presents with sudden severe pain, redness and swelling of the first metatarsophalangeal joint. What is the most likely diagnosis?

Acute gout (Correct answer)
Rheumatoid arthritis
Septic arthritis
Osteoarthritis

Correct answer: Acute gout

Acute podagra of the first MTP joint with rapid onset is classic for gout.

Question 4: A 30-year-old woman has symmetrical pain and stiffness of the small joints of both hands, worse in the morning for over an hour. What is the most likely diagnosis?

Psoriatic arthritis
Gout
Osteoarthritis
Rheumatoid arthritis (Correct answer)

Correct answer: Rheumatoid arthritis

Symmetrical small-joint involvement with prolonged morning stiffness suggests rheumatoid arthritis.

Question 5: A woman at 38 weeks has spontaneous rupture of membranes with green-stained liquor. What does this indicate?

Meconium-stained liquor requiring closer fetal monitoring (Correct answer)
Normal amniotic fluid
Oligohydramnios
Maternal infection only

Correct answer: Meconium-stained liquor requiring closer fetal monitoring

Green liquor indicates meconium passage, which may signal fetal compromise and warrants continuous monitoring.

Question 6: A 25-year-old presents with painless cervical lymphadenopathy, fever, night sweats, and weight loss. Biopsy shows Reed-Sternberg cells. What is the most likely diagnosis?

Non-Hodgkin lymphoma
Infectious mononucleosis
Hodgkin lymphoma (Correct answer)
Sarcoidosis

Correct answer: Hodgkin lymphoma

Reed-Sternberg cells are pathognomonic of Hodgkin lymphoma, which typically presents with B symptoms and mediastinal or cervical lymphadenopathy.

Question 7: A terminally ill patient with capacity completes an advance care directive refusing CPR. They later arrest. What governs your action?

Perform CPR only briefly
Ignore the directive and perform CPR
Honour the valid advance care directive and withhold CPR (Correct answer)
Ask the family to override it

Correct answer: Honour the valid advance care directive and withhold CPR

A valid advance care directive made by a competent patient must be respected.

Question 8: A 35-year-old sex worker presents with a painless indurated genital ulcer with rubbery inguinal lymph nodes. Dark-field microscopy shows spirochetes. What is the first-line treatment?

Benzathine penicillin G 2.4 million units IM once (Correct answer)
Doxycycline 100 mg twice daily for 14 days
Azithromycin 1 g orally once
Ceftriaxone 250 mg IM once

Correct answer: Benzathine penicillin G 2.4 million units IM once

Primary syphilis is treated with a single intramuscular dose of benzathine penicillin G 2.4 million units.

Question 9: A doctor has a sexual relationship with a current patient. Under professional codes this is:

Only a problem if the patient complains
Acceptable if both consent
Acceptable after one consultation
A serious breach of professional boundaries and notifiable conduct (Correct answer)

Correct answer: A serious breach of professional boundaries and notifiable conduct

Sexual relationships with current patients are a serious boundary violation and constitute notifiable conduct.

Question 10: A 22-year-old man presents with frank haematuria 1-2 days after an upper respiratory tract infection. What is the most likely glomerular diagnosis?

Post-streptococcal glomerulonephritis
IgA nephropathy (Correct answer)
Goodpasture syndrome
Minimal change disease

Correct answer: IgA nephropathy

Synpharyngitic haematuria occurring concurrently with a URTI is characteristic of IgA nephropathy.

Question 11: A relative risk of 1.0 with a 95% confidence interval of 0.85 to 1.18 indicates the association is:

Strongly protective
Strongly harmful
Confounded by age
Not statistically significant (Correct answer)

Correct answer: Not statistically significant

A confidence interval crossing 1.0 means the result is not statistically significant.

Question 12: A 72-year-old retired farmer presents with a slowly growing lesion on his nose that has been present for over a year and occasionally bleeds. Which of the following descriptions is most characteristic of a nodular basal cell carcinoma?

A rapidly growing, ulcerated nodule with a central keratin core
A pearly, translucent papule with telangiectasia and a rolled border (Correct answer)
A flat, scaly, erythematous patch on a sun-exposed area
An irregularly pigmented macule with significant colour variation

Correct answer: A pearly, translucent papule with telangiectasia and a rolled border

The classic clinical presentation of nodular basal cell carcinoma (BCC), the most common subtype, is a pearly or translucent papule or nodule that often features fine, superficial blood vessels (telangiectasia) and a distinct, raised, or 'rolled' border. [17, 21, 31] A rapidly growing nodule with a keratin core is more suggestive of a keratoacanthoma or squamous cell carcinoma (SCC). A flat, scaly patch suggests actinic keratosis or superficial BCC. An irregularly pigmented macule is highly suspicious for melanoma.

Question 13: Which liver function pattern best indicates obstructive (cholestatic) jaundice?

Markedly raised ALP and GGT with milder transaminase rise (Correct answer)
Very high AST and ALT with normal ALP
Low albumin alone
Isolated raised bilirubin only

Correct answer: Markedly raised ALP and GGT with milder transaminase rise

Cholestasis produces disproportionately elevated ALP and GGT relative to transaminases.

Question 14: A 6-year-old has an itchy, well-demarcated honey-coloured crusted lesion around the nose and mouth. What is the most likely diagnosis?

Impetigo (Correct answer)
Eczema herpeticum
Atopic dermatitis
Tinea corporis

Correct answer: Impetigo

Honey-coloured crusting is the classic appearance of impetigo, usually caused by Staphylococcus aureus.

Question 15: A 38-year-old with recurrent sinusitis presents with nasal polyps, bronchial asthma, and develops bronchospasm after taking aspirin for a headache. What is this triad called?

Wegener's granulomatosis
Churg-Strauss syndrome
Kartagener syndrome
Samter's triad (aspirin-exacerbated respiratory disease) (Correct answer)

Correct answer: Samter's triad (aspirin-exacerbated respiratory disease)

Samter's triad (aspirin-exacerbated respiratory disease) consists of asthma, nasal polyps, and aspirin/NSAID sensitivity caused by aberrant arachidonic acid metabolism.

Question 16: A 50-year-old farmer presents with fever, headache, myalgia, and a 'rose-thorn' eschar after a tick bite in rural Queensland. Which organism is responsible?

Coxiella burnetii
Anaplasma phagocytophilum
Rickettsia australis (Correct answer)
Borrelia burgdorferi

Correct answer: Rickettsia australis

Rickettsia australis causes Queensland tick typhus, presenting with an eschar at the tick bite site, fever, and rash.

Question 17: A woman at 30 weeks reports reduced fetal movements. What is the appropriate first-line assessment?

Reassure without testing
Immediate caesarean section
Cardiotocography and ultrasound assessment (Correct answer)
Induction of labour

Correct answer: Cardiotocography and ultrasound assessment

Reduced fetal movements warrant CTG and ultrasound to assess fetal wellbeing.

Question 18: A patient requests a treatment that you believe is not clinically indicated and may cause harm. What should you do?

Provide it but document your objection
Decline to provide non-beneficial or harmful treatment while explaining your reasoning and alternatives (Correct answer)
Refer them away without explanation
Provide it because the patient is autonomous

Correct answer: Decline to provide non-beneficial or harmful treatment while explaining your reasoning and alternatives

Autonomy does not compel a doctor to provide treatment that is harmful or not clinically indicated.

Question 19: A 40-year-old with deep vein thrombosis is found to have Factor V Leiden mutation. What does this mutation cause?

Reduced thrombin generation
Resistance to activated protein C (APC resistance) (Correct answer)
Deficiency of antithrombin III
Overproduction of plasminogen

Correct answer: Resistance to activated protein C (APC resistance)

Factor V Leiden mutation results in a factor V that is resistant to cleavage by activated protein C, predisposing to venous thromboembolism.

Question 20: Which is the most common type of gallstone in Western populations?

Pigment stones
Struvite stones
Cholesterol stones (Correct answer)
Calcium carbonate stones

Correct answer: Cholesterol stones

Cholesterol stones are the most common gallstone type in Western countries.

Question 21: What is the first-line investigation for suspected polycystic ovary syndrome alongside clinical features?

CT abdomen
Laparoscopy
Pelvic ultrasound and hormonal profile (Correct answer)
Endometrial biopsy

Correct answer: Pelvic ultrasound and hormonal profile

PCOS diagnosis uses the Rotterdam criteria, supported by pelvic ultrasound and hormonal testing.

Question 22: A patient undergoes a bone marrow biopsy showing hypercellular marrow with >20% blasts. Flow cytometry reveals CD13, CD33, and MPO positivity. What is the diagnosis?

Myelodysplastic syndrome
Chronic myeloid leukaemia (CML)
Acute myeloid leukaemia (AML) (Correct answer)
Acute lymphoblastic leukaemia (ALL)

Correct answer: Acute myeloid leukaemia (AML)

AML is characterised by ≥20% myeloid blasts in the bone marrow with expression of myeloid markers (CD13, CD33) and myeloperoxidase (MPO).

Question 23: A mother brings her 18-month-old son for a developmental check. She is concerned about his progress. Which of the following findings would be considered a 'red flag' for developmental delay at this age, warranting further investigation?

He is not yet walking independently.
He cannot build a tower of more than 4 blocks.
He does not use any single, meaningful words. (Correct answer)
He is not yet able to run.

Correct answer: He does not use any single, meaningful words.

While there is a range for achieving milestones, the absence of any single, meaningful words by 18 months is a significant language delay and a developmental red flag. Most children are walking by 15-16 months, but not walking at 18 months, while requiring assessment, is less concerning than a complete lack of single words, especially if other motor skills are present. Running and building a tower of more than 4 blocks are milestones typically expected closer to 24 months.

Question 24: A child presents with a 'slapped cheek' facial rash followed by a lacy reticular rash on the limbs. What is the causative organism?

Varicella zoster virus
Parvovirus B19 (Correct answer)
Measles virus
Group A streptococcus

Correct answer: Parvovirus B19

Erythema infectiosum (fifth disease) causing slapped-cheek appearance is due to parvovirus B19.

Question 25: During a surgical procedure, a swab is inadvertently left inside a patient's abdomen. The error is discovered on a post-operative X-ray the next day, and the patient requires a second procedure for its removal. The patient makes a full recovery. According to the Australian Open Disclosure Framework, which of the following is an essential and early component of the open disclosure process with the patient?

Providing the patient with the names of all staff involved in the initial surgery.
Assurance that the hospital's legal team accepts full liability.
An apology or expression of regret for the harm that occurred. (Correct answer)
A detailed explanation of the root cause analysis findings.

Correct answer: An apology or expression of regret for the harm that occurred.

The Australian Open Disclosure Framework is a nationally consistent approach to communicating with patients after an adverse event. A core principle is an early and sincere apology or expression of regret (e.g., "we are sorry") for the harm suffered by the patient. This should be done alongside a factual explanation of what happened. While a root cause analysis is important for systems improvement, its detailed findings come later. Disclosing staff names may not be appropriate, and discussions of legal liability are separate from the initial open disclosure process.

Question 26: A 60-year-old man with recurrent renal colic passes stones that are radiolucent on plain X-ray. His urine is persistently acidic. What is the most likely stone composition?

Calcium oxalate
Struvite
Uric acid (Correct answer)
Cystine

Correct answer: Uric acid

Uric acid stones are radiolucent and form in persistently acidic urine.

Question 27: A 3-year-old child presents with a purpuric, non-blanching rash, fever of 39.5°C, and neck stiffness. She appears unwell and drowsy. What is the most critical immediate action?

Blood cultures then await results
CT head before any treatment
IV benzylpenicillin (Correct answer)
Lumbar puncture

Correct answer: IV benzylpenicillin

This presentation is highly suspicious for meningococcal meningitis/septicaemia. IV benzylpenicillin must be given immediately without waiting for investigations as delay increases mortality. Lumbar puncture and CT may follow after stabilisation and treatment have been initiated, and blood cultures should be taken but must not delay antibiotics.

Question 28: A 60-year-old patient on warfarin presents with an INR of 8.5 and minor bleeding. What is the most appropriate management?

Hold warfarin and administer oral vitamin K 1–2.5 mg (Correct answer)
Administer prothrombin complex concentrate (PCC)
Administer fresh frozen plasma (FFP)
Continue warfarin and recheck INR in 48 hours

Correct answer: Hold warfarin and administer oral vitamin K 1–2.5 mg

For elevated INR with minor bleeding, withholding warfarin and giving low-dose oral vitamin K (1–2.5 mg) is appropriate to reverse anticoagulation safely.

Question 29: A 68-year-old man presents with new-onset confusion, fever, and a productive cough. His CURB-65 score is 3. What is the most appropriate management setting?

Outpatient review in one week
Observation in the waiting area
Discharge home with oral antibiotics
Hospital admission, consider ICU (Correct answer)

Correct answer: Hospital admission, consider ICU

A CURB-65 score of 3 indicates severe pneumonia warranting hospital admission and ICU consideration.

Question 30: An 82-year-old man with metastatic lung cancer and a valid Advance Care Directive (ACD) is admitted with sepsis from a urinary tract infection. The ACD clearly states he refuses all life-sustaining treatments, including intravenous antibiotics and admission to an intensive care unit. The patient is now delirious and lacks decision-making capacity. His family is adamant that he should receive antibiotics, stating, "He wouldn't want to die from a simple infection." What is the most appropriate and legally defensible course of action for the treating doctor?

Seek an urgent ethics committee review before making a decision.
Follow the family's wishes and commence intravenous antibiotics.
Uphold the patient's refusal of treatment as stated in the valid ACD. (Correct answer)
Provide palliative care but administer antibiotics for comfort.

Correct answer: Uphold the patient's refusal of treatment as stated in the valid ACD.

In Australia, a valid and specific Advance Care Directive (ACD) is a legally binding document that represents the patient's wishes. When a patient loses decision-making capacity, the instructions in the ACD must be followed, even if they conflict with the wishes of the family or the treating team's clinical judgment about what might be 'best'. The refusal of IV antibiotics is a specific instruction for a life-sustaining treatment, which must be respected. Seeking an ethics review is a good step in complex cases but does not override the legal standing of the ACD. Administering antibiotics against a valid refusal would constitute medical battery.

Question 31: A 45-year-old woman presents with a 3-month history of fatigue, weight gain, constipation, and cold intolerance. Her TSH is 18 mIU/L and free T4 is low. What is the most appropriate initial treatment?

Carbimazole
Prednisolone
Levothyroxine (Correct answer)
Radioactive iodine

Correct answer: Levothyroxine

The clinical picture and biochemistry are consistent with primary hypothyroidism (elevated TSH, low free T4). Levothyroxine (synthetic T4) is the standard first-line replacement therapy. Carbimazole and radioactive iodine are used for hyperthyroidism; prednisolone would not address the thyroid hormone deficiency.

Question 32: A patient's adult child demands information about the patient's diagnosis. The competent patient has not consented. What should you do?

Share only the diagnosis but not the prognosis
Demand the child prove their identity then share
Share freely with close family
Maintain confidentiality unless the patient consents or a legal exception applies (Correct answer)

Correct answer: Maintain confidentiality unless the patient consents or a legal exception applies

Patient confidentiality must be maintained without consent, even with close relatives.

Question 33: A young patient collapses and the monitor shows a broad-complex regular tachycardia at 180 bpm with a pulse and stable blood pressure. What is the first-line pharmacological agent?

Amiodarone (Correct answer)
Digoxin
Adenosine bolus repeated indefinitely
Verapamil

Correct answer: Amiodarone

Stable monomorphic ventricular tachycardia with a pulse is treated with intravenous amiodarone.

Question 34: A 70-year-old woman presents with bilateral shoulder and hip girdle pain and stiffness, with a markedly raised ESR. What is the most likely diagnosis?

Fibromyalgia
Osteoarthritis
Polymyositis
Polymyalgia rheumatica (Correct answer)

Correct answer: Polymyalgia rheumatica

Proximal girdle stiffness with high ESR in an elderly patient suggests polymyalgia rheumatica.

Question 35: Lead-time bias most commonly causes screening programs to falsely appear to:

Reduce disease incidence
Lower test specificity
Increase mortality
Improve survival time (Correct answer)

Correct answer: Improve survival time

Earlier detection lengthens the apparent survival from diagnosis without changing the actual time of death.

Question 36: An elderly man develops fluctuating cognition, recurrent visual hallucinations and spontaneous parkinsonism. What is the most likely diagnosis?

Lewy body dementia (Correct answer)
Alzheimer's disease
Vascular dementia
Normal pressure hydrocephalus

Correct answer: Lewy body dementia

Fluctuating cognition, vivid visual hallucinations and parkinsonism are the core features of Lewy body dementia.

Question 37: A 6-week-old presents with non-bilious projectile vomiting and a palpable olive-shaped epigastric mass. What is the most likely diagnosis?

Gastro-oesophageal reflux
Pyloric stenosis (Correct answer)
Malrotation with volvulus
Duodenal atresia

Correct answer: Pyloric stenosis

Non-bilious projectile vomiting with a palpable olive in a baby around 4-8 weeks is classic for hypertrophic pyloric stenosis.

Question 38: A 72-year-old man presents with a pulsatile abdominal mass, hypotension, and sudden severe abdominal pain. What is the most likely diagnosis?

Acute pancreatitis
Perforated peptic ulcer
Ruptured abdominal aortic aneurysm (Correct answer)
Renal colic

Correct answer: Ruptured abdominal aortic aneurysm

A pulsatile mass with hypotension and pain indicates a ruptured abdominal aortic aneurysm.

Question 39: What is the most reliable clinical sign of established compartment syndrome in a limb?

Pain on passive stretch out of proportion to injury (Correct answer)
Skin pallor only
Absent distal pulses early
Reduced capillary refill alone

Correct answer: Pain on passive stretch out of proportion to injury

Pain on passive stretch is the earliest and most reliable sign; pulselessness is a late finding.

Question 40: What is the most appropriate first investigation when a young child presents with a first febrile urinary tract infection?

CT abdomen
Urine culture before starting antibiotics (Correct answer)
Cystoscopy
Renal biopsy

Correct answer: Urine culture before starting antibiotics

A clean urine sample for microscopy and culture should be obtained before antibiotics to confirm the diagnosis.

Question 41: Which is the most common cause of primary postpartum haemorrhage?

Genital tract trauma
Retained placenta
Uterine atony (Correct answer)
Coagulopathy

Correct answer: Uterine atony

Uterine atony accounts for around 70% of primary postpartum haemorrhage cases.

Question 42: A 58-year-old presents with progressive distal weakness, fasciculations and brisk reflexes, but no sensory loss. What is the most likely diagnosis?

Motor neurone disease (amyotrophic lateral sclerosis) (Correct answer)
Guillain-Barré syndrome
Peripheral diabetic neuropathy
Multiple sclerosis

Correct answer: Motor neurone disease (amyotrophic lateral sclerosis)

Combined upper and lower motor neurone signs without sensory involvement are characteristic of motor neurone disease.

Question 43: A 72-year-old woman with hypertension and atrial fibrillation is brought in confused and unable to speak. CT head is normal. Her symptoms began 90 minutes ago. What is the most appropriate next step?

Aspirin 300 mg orally
Urgent MRI brain
Anticoagulation with heparin
IV tissue plasminogen activator (tPA) (Correct answer)

Correct answer: IV tissue plasminogen activator (tPA)

This presentation is consistent with acute ischaemic stroke within the thrombolytic window (within 4.5 hours of onset). CT has excluded haemorrhage. IV tPA is the recommended treatment. Aspirin alone is not adequate in the acute thrombolytic window; heparin is not first-line for acute stroke; MRI is not necessary before thrombolysis if CT is clear.

Question 44: A 32-year-old woman with depression on a high-dose SSRI is started on tramadol and develops agitation, clonus, hyperreflexia, tremor and fever. What is the most likely diagnosis?

Alcohol withdrawal
Neuroleptic malignant syndrome
Serotonin syndrome (Correct answer)
Anticholinergic toxicity

Correct answer: Serotonin syndrome

Clonus, hyperreflexia and agitation after adding a serotonergic drug indicate serotonin syndrome.

Question 45: A patient has signs of malignant hyperthermia under general anaesthesia. What is the specific treatment?

Adrenaline
Atropine
Dantrolene (Correct answer)
Naloxone

Correct answer: Dantrolene

Dantrolene is the specific antidote for malignant hyperthermia, alongside stopping triggers and active cooling.

Question 46: A 58-year-old diabetic woman presents with epigastric discomfort, nausea and fatigue but no chest pain. ECG shows new ST depression. What is the most likely diagnosis?

Cholecystitis
Anxiety attack
Atypical acute coronary syndrome (Correct answer)
Gastro-oesophageal reflux

Correct answer: Atypical acute coronary syndrome

Women and diabetics often present with atypical ACS symptoms such as epigastric pain and fatigue.

Question 47: Which of the following is a notifiable disease that doctors in Australia are legally required to report to public health authorities?

Osteoarthritis
Tuberculosis (Correct answer)
Essential hypertension
Type 2 diabetes

Correct answer: Tuberculosis

Tuberculosis is a nationally notifiable communicable disease requiring mandatory reporting.

Question 48: Hypercalcaemia due to PTHrP secretion is most classically associated with which lung cancer type?

Small cell carcinoma
Squamous cell carcinoma (Correct answer)
Large cell carcinoma
Adenocarcinoma

Correct answer: Squamous cell carcinoma

Squamous cell lung carcinoma is the type most associated with PTHrP-mediated hypercalcaemia.

Question 49: Which clinical sign indicates a tension pneumothorax requiring immediate decompression?

Bilateral wheeze
Clubbing
Tracheal deviation away from the affected side with hypotension (Correct answer)
Productive cough

Correct answer: Tracheal deviation away from the affected side with hypotension

Tension pneumothorax causes mediastinal shift with tracheal deviation, hypotension and distended neck veins, requiring emergency decompression.

Question 50: A 50-year-old develops sudden severe vertigo, ipsilateral facial numbness, Horner's syndrome and contralateral limb sensory loss. Which artery is most likely involved?

Middle cerebral artery
Posterior inferior cerebellar artery (Correct answer)
Anterior cerebral artery
Ophthalmic artery

Correct answer: Posterior inferior cerebellar artery

These lateral medullary (Wallenberg) signs result from posterior inferior cerebellar artery territory infarction.

Question 51: A 68-year-old presents with splenomegaly, elevated RBC count, haematocrit of 58%, and JAK2 V617F mutation. What is the diagnosis?

Polycythaemia vera (Correct answer)
Essential thrombocythaemia
Myelofibrosis
Secondary polycythaemia

Correct answer: Polycythaemia vera

Polycythaemia vera is a myeloproliferative neoplasm characterised by elevated RBC mass, splenomegaly, and JAK2 V617F mutation in >95% of cases.

Question 52: A child with a sandpaper-like rash, strawberry tongue, fever and a recent streptococcal pharyngitis most likely has which condition?

Roseola
Kawasaki disease
Scarlet fever (Correct answer)
Measles

Correct answer: Scarlet fever

A sandpaper rash with strawberry tongue following streptococcal throat infection is scarlet fever.

Question 53: An elderly patient with polymyalgia rheumatica develops a new headache and jaw claudication. What complication must be excluded urgently?

Giant cell (temporal) arteritis (Correct answer)
Trigeminal neuralgia
Migraine
Cluster headache

Correct answer: Giant cell (temporal) arteritis

Headache and jaw claudication signal giant cell arteritis, which can cause irreversible blindness.

Question 54: When obtaining valid informed consent for surgery, which element is NOT required?

The patient having capacity
A guarantee of a successful outcome (Correct answer)
Disclosure of material risks
Voluntariness free from coercion

Correct answer: A guarantee of a successful outcome

Consent requires capacity, adequate information, and voluntariness, but no doctor can guarantee outcomes.

Question 55: Which nerve is most commonly injured in a mid-shaft humeral fracture?

Ulnar nerve
Median nerve
Radial nerve (Correct answer)
Axillary nerve

Correct answer: Radial nerve

The radial nerve runs in the spiral groove and is at risk in mid-shaft humeral fractures, causing wrist drop.

Question 56: A patient's records are subpoenaed by a court. What is the correct response?

Comply with the valid legal order while disclosing only what is required (Correct answer)
Destroy the records
Refuse to release anything to protect confidentiality
Release everything to everyone who asks

Correct answer: Comply with the valid legal order while disclosing only what is required

A valid court order is a legal exception to confidentiality, and you should disclose only the information required.

Question 57: A 32-year-old woman at 34 weeks' gestation presents with a persistent headache and visual disturbances. Her booking blood pressure was 110/70 mmHg. Today, her blood pressure is 150/95 mmHg. A urine dipstick shows 2+ proteinuria. According to the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) guidelines, which of the following is the most likely diagnosis?

Chronic hypertension
Pre-eclampsia (Correct answer)
Gestational hypertension
Eclampsia

Correct answer: Pre-eclampsia

The patient meets the diagnostic criteria for pre-eclampsia, which is defined as new-onset hypertension (≥140/90 mmHg) after 20 weeks' gestation accompanied by evidence of maternal organ dysfunction or uteroplacental dysfunction. In this case, she has new-onset hypertension plus proteinuria and neurological symptoms (headache, visual disturbances). Gestational hypertension is high blood pressure without proteinuria or other signs of organ dysfunction. Chronic hypertension would have been present before 20 weeks. Eclampsia involves the development of seizures in a woman with pre-eclampsia.

Question 58: A vaccine trial reports a relative risk reduction of 80%. If the unvaccinated risk is 10%, what is the absolute risk reduction?

80 percentage points
20 percentage points
2 percentage points
8 percentage points (Correct answer)

Correct answer: 8 percentage points

Absolute risk reduction equals relative risk reduction times baseline risk, so 0.80 × 10% = 8%.

Question 59: A 70-year-old man is on day one post-sigmoid colectomy. The nursing staff report he is hypotensive with a blood pressure of 90/50 mmHg, a heart rate of 115 bpm, and a urine output of less than 20 mL/hour for the past two hours. There is no evidence of active bleeding. What is the most appropriate initial intravenous fluid for resuscitation?

4% Albumin solution
0.9% Sodium Chloride (Correct answer)
Packed red blood cells
5% Dextrose in water

Correct answer: 0.9% Sodium Chloride

The patient is exhibiting signs of hypovolemic shock, likely due to third-space fluid losses post-operatively. The immediate priority is to restore intravascular volume. According to resuscitation guidelines, an isotonic crystalloid solution, such as 0.9% Sodium Chloride (Normal Saline) or Hartmann's solution, is the first-line choice for initial volume expansion in non-hemorrhagic shock. 5% Dextrose is rapidly metabolised, leaving free water which does not effectively expand the intravascular space. Albumin is a colloid and not typically used for initial resuscitation. Packed red blood cells are only indicated if there is evidence of significant hemorrhage and a low haemoglobin level.

Question 60: A 68-year-old man on metformin undergoes a contrast CT and develops oliguric acute kidney injury 48 hours later. What is the most likely cause?

Glomerulonephritis
Rhabdomyolysis
Contrast-induced nephropathy (Correct answer)
Renal vein thrombosis

Correct answer: Contrast-induced nephropathy

Iodinated contrast can cause an acute tubular injury within 48-72 hours, especially in those with pre-existing renal impairment.

Question 61: A 55-year-old male is diagnosed with hypertension during a routine check-up. His clinic blood pressure is consistently 165/100 mmHg. He has no other medical conditions and his cardiovascular disease risk is assessed as low. According to the National Heart Foundation of Australia's 2016 guidelines, what is the most appropriate initial step in management?

Arrange for 24-hour ambulatory blood pressure monitoring before starting treatment
Recommend lifestyle modifications only and review in 3-6 months
Commence immediate dual antihypertensive therapy
Commence monotherapy with a thiazide diuretic or ACE inhibitor (Correct answer)

Correct answer: Commence monotherapy with a thiazide diuretic or ACE inhibitor

According to the 2016 National Heart Foundation of Australia guidelines, for a patient at low absolute cardiovascular disease risk with persistent blood pressure ≥ 160/100 mmHg, antihypertensive drug therapy should be started. The guidelines recommend initiating treatment with a single first-line agent, such as an ACE inhibitor, ARB, calcium channel blocker, or thiazide diuretic. Dual therapy is typically reserved for those with significantly higher BP or who do not respond to monotherapy. Lifestyle modification alone is insufficient for this level of hypertension. While ambulatory monitoring is useful to confirm the diagnosis and rule out 'white coat' hypertension, the guidelines recommend starting therapy for persistent BP at this level in low-risk individuals.

Question 62: A study finds an association between coffee drinking and lung cancer, but smoking is more common among coffee drinkers. Smoking is best described as a:

Mediator
Collider
Confounder (Correct answer)
Effect modifier

Correct answer: Confounder

Smoking is associated with both the exposure and the outcome and is not on the causal pathway, making it a confounder.

Question 63: A patient with chronic myeloid leukaemia (CML) is found to have the Philadelphia chromosome t(9;22). Which molecular target does imatinib inhibit?

CD20
BCR-ABL tyrosine kinase (Correct answer)
VEGFR
BCL-2

Correct answer: BCR-ABL tyrosine kinase

Imatinib is a selective BCR-ABL tyrosine kinase inhibitor that blocks the constitutively active kinase produced by the Philadelphia chromosome translocation in CML.

Question 64: What is the most serious complication of untreated Kawasaki disease?

Coronary artery aneurysms (Correct answer)
Hearing loss
Liver cirrhosis
Renal failure

Correct answer: Coronary artery aneurysms

Kawasaki disease can cause coronary artery aneurysms, which is why prompt treatment is essential.

Question 65: What is the first-line treatment for minimal change nephrotic syndrome in children?

Diuretics alone
ACE inhibitors
Corticosteroids (prednisolone) (Correct answer)
Cyclophosphamide

Correct answer: Corticosteroids (prednisolone)

Most childhood minimal change nephrotic syndrome responds to a course of oral corticosteroids.

Question 66: What is the most appropriate prophylaxis for a woman with previous early-onset pre-eclampsia in her next pregnancy?

Bed rest from 20 weeks
High-dose folic acid
Low-dose aspirin from the first trimester (Correct answer)
Routine antihypertensives

Correct answer: Low-dose aspirin from the first trimester

Low-dose aspirin started before 16 weeks reduces recurrence risk in women with prior pre-eclampsia.

Question 67: A 58-year-old man with a long history of GORD undergoes a surveillance endoscopy. Biopsies from a 4 cm segment of columnar-lined oesophagus confirm Barrett's oesophagus with low-grade dysplasia. The finding of low-grade dysplasia is confirmed by a second specialist pathologist. According to Australian guidelines, what is the most appropriate next step in management?

Refer for endoscopic radiofrequency ablation.
Commence annual endoscopic surveillance.
Repeat endoscopy with Seattle protocol biopsies in 6 months. (Correct answer)
Repeat endoscopy with biopsies in 2-3 years.

Correct answer: Repeat endoscopy with Seattle protocol biopsies in 6 months.

According to Australian guidelines for the management of Barrett's oesophagus, if low-grade dysplasia is confirmed by a second pathologist, the recommended action is to repeat the endoscopy in 6 months with meticulous Seattle protocol biopsies (quadrantal biopsies every 1 cm). This is to closely monitor for progression to high-grade dysplasia or adenocarcinoma. Annual surveillance may be considered later if subsequent endoscopies are negative for dysplasia. A 2-3 year interval is appropriate for long-segment Barrett's without dysplasia. Endoscopic ablation is typically reserved for confirmed and persistent high-grade dysplasia or early adenocarcinoma.

Question 68: A 75-year-old develops gradual cognitive decline with prominent early memory loss and no focal neurological signs. What is the most likely diagnosis?

Lewy body dementia
Alzheimer's disease (Correct answer)
Vascular dementia
Frontotemporal dementia

Correct answer: Alzheimer's disease

Insidious progressive memory loss without early focal deficits is most consistent with Alzheimer's disease.

Question 69: The fat RQ is ____________

one
less than one (Correct answer)
more than one
infinity

Correct answer: less than one

The Respiratory Quotient (RQ) for fats is typically less than one (around 0.7). This is because fats have a lower oxygen content relative to their carbon and hydrogen atoms compared to carbohydrates, meaning more oxygen is required for their complete oxidation, resulting in a lower CO2 produced to O2 consumed ratio.

Question 70: The incidence of a disease is 5 new cases per 1000 person-years and the average duration is 4 years. What is the approximate prevalence?

About 5 per 1000
About 40 per 1000
About 20 per 1000 (Correct answer)
About 1.25 per 1000

Correct answer: About 20 per 1000

Prevalence approximately equals incidence multiplied by duration, giving 5 × 4 = 20 per 1000.

Question 71: In heavy smokers, the alveoli become enlarged and damaged due to a reduction in surface area. This is referred to as ___________.

Bronchitis
Emphysema (Correct answer)
Silicosis
Asthma

Correct answer: Emphysema

Emphysema is a chronic obstructive pulmonary disease (COPD) primarily caused by smoking, where the walls of the alveoli are progressively destroyed. This destruction leads to enlarged, inefficient air spaces and a significant reduction in the surface area available for gas exchange, permanently impairing lung function.

Question 72: A child with generalised oedema, heavy proteinuria, hypoalbuminaemia and normal blood pressure most likely has which condition?

Heart failure
Acute pyelonephritis
Acute glomerulonephritis
Minimal change nephrotic syndrome (Correct answer)

Correct answer: Minimal change nephrotic syndrome

Massive proteinuria with hypoalbuminaemia and oedema in a young child is typical of minimal change nephrotic syndrome.

Question 73: A patient develops a sudden severe headache, neck stiffness, photophobia and a third nerve palsy. What is the most likely underlying cause?

Tension-type headache
Ruptured posterior communicating artery aneurysm (Correct answer)
Migraine with aura
Cluster headache

Correct answer: Ruptured posterior communicating artery aneurysm

A painful third nerve palsy with meningism strongly suggests a posterior communicating artery aneurysm causing subarachnoid haemorrhage.

Question 74: A patient with sickle cell disease presents in vasoocclusive crisis with severe pain. Which medication reduces the frequency of crises by increasing foetal haemoglobin (HbF)?

Penicillin V
Erythropoietin
Hydroxyurea (Correct answer)
Deferoxamine

Correct answer: Hydroxyurea

Hydroxyurea increases production of foetal haemoglobin (HbF), which inhibits HbS polymerisation and reduces vasoocclusive crises in sickle cell disease.

Question 75: When closing the fascial layer of a midline laparotomy, a surgeon requires a suture material that provides long-term tensile strength and has a low risk of harbouring bacteria. Which of the following is a non-absorbable, monofilament suture commonly used for this purpose?

Catgut
Polyglactin 910 (Vicryl)
Silk
Polypropylene (Prolene) (Correct answer)

Correct answer: Polypropylene (Prolene)

Polypropylene (e.g., Prolene) is a synthetic, non-absorbable, monofilament suture. Its non-absorbable nature provides permanent tensile strength, which is crucial for fascial closure to prevent incisional hernia formation. Its monofilament structure presents a smooth surface, which is less likely to harbour bacteria compared to braided sutures. Polyglactin 910 (Vicryl) and Catgut are both absorbable. Silk is non-absorbable but is a braided suture, which increases its potential to act as a nidus for infection.

Question 76: A 25-year-old presents with fever, sore throat, lymphadenopathy, and a positive heterophile antibody (Monospot) test. Which virus is responsible?

Cytomegalovirus
Human herpesvirus 6
Adenovirus
Epstein-Barr virus (Correct answer)

Correct answer: Epstein-Barr virus

Epstein-Barr virus causes infectious mononucleosis, characterized by the triad of fever, pharyngitis, and lymphadenopathy with a positive Monospot test.

Question 77: A 45-year-old immunocompromised patient develops a vesicular rash in a dermatomal distribution with severe pain. Which antiviral should be started within 72 hours?

Lamivudine
Ribavirin
Valacyclovir (Correct answer)
Oseltamivir

Correct answer: Valacyclovir

Valacyclovir started within 72 hours of herpes zoster onset reduces duration and severity, including post-herpetic neuralgia.

Question 78: A 68-year-old presents with sudden right-sided weakness and expressive aphasia that resolves completely within 45 minutes. CT brain is normal. What is the most appropriate immediate management?

Commence aspirin and arrange urgent specialist assessment (Correct answer)
Reassure and discharge as symptoms resolved
Repeat CT in 24 hours only
Commence warfarin immediately

Correct answer: Commence aspirin and arrange urgent specialist assessment

A resolving focal deficit is a transient ischaemic attack, requiring antiplatelet therapy and urgent assessment to prevent stroke.

Question 79: Which test is most sensitive for the diagnosis of active tuberculosis in a sputum sample?

Tuberculin skin test (Mantoux)
Interferon-gamma release assay (IGRA)
Ziehl-Neelsen stain
Mycobacterial culture (Correct answer)

Correct answer: Mycobacterial culture

Mycobacterial culture (Lowenstein-Jensen or liquid MGIT) remains the gold standard for diagnosing active TB due to its highest sensitivity.

Question 80: A research participant wants to withdraw from a clinical trial midway. What is the correct response?

Charge them for costs incurred
Allow withdrawal only with investigator approval
Allow withdrawal at any time without penalty or impact on their care (Correct answer)
Refuse, as they committed to the trial

Correct answer: Allow withdrawal at any time without penalty or impact on their care

Participants may withdraw from research at any time without penalty or effect on their ongoing care.

Question 81: A 32-year-old has a positive 75g OGTT at 26 weeks. What is the most appropriate initial management?

Immediate insulin therapy
Dietary modification and blood glucose monitoring (Correct answer)
No intervention until symptoms appear
Metformin and induction at 34 weeks

Correct answer: Dietary modification and blood glucose monitoring

First-line management of gestational diabetes is dietary modification with self-monitoring of blood glucose before pharmacotherapy.

Question 82: When a doctor conscientiously objects to a procedure such as termination of pregnancy, they must still:

Report the patient to authorities
Persuade the patient against it
Inform the patient and refer them to another practitioner who can assist, in a timely manner (Correct answer)
Refuse and provide no further help

Correct answer: Inform the patient and refer them to another practitioner who can assist, in a timely manner

Conscientious objection requires the doctor to disclose the objection and facilitate timely access to another provider.

Question 83: A 25-year-old childcare worker is diagnosed with scabies after presenting with an intensely pruritic rash that is worse at night, affecting her finger web spaces and wrists. What is the most crucial component of her management plan to prevent re-infestation and spread?

Washing all bed linen and clothing in cold water with standard detergent
Applying topical permethrin cream only to the visibly affected areas of skin
Prescribing a course of oral antibiotics to prevent secondary infection
Simultaneously treating all household members and close contacts, regardless of symptoms (Correct answer)

Correct answer: Simultaneously treating all household members and close contacts, regardless of symptoms

Effective management of scabies requires the simultaneous treatment of the infected individual and all of their close household and sexual contacts, even if they are asymptomatic. [7, 12, 30] This is because contacts can be infested but remain in the asymptomatic incubation period (which can be several weeks), acting as a reservoir for re-infestation. Topical treatment must be applied to the entire body, not just affected areas. Linen should be washed in hot water. Antibiotics are only used for secondary bacterial infections, not the primary infestation.

Question 84: A primigravida at 39 weeks has not progressed beyond 4 cm over 4 hours despite regular contractions. What is the term for this?

Failure to progress (labour dystocia) (Correct answer)
Latent phase
Braxton Hicks contractions
Precipitate labour

Correct answer: Failure to progress (labour dystocia)

Inadequate cervical dilatation despite adequate contractions defines failure to progress.

Question 85: A 40-year-old patient is diagnosed with primary adrenal insufficiency (Addison's disease). Which of the following electrolyte patterns is most characteristically seen in this condition?

Hypernatraemia, hypokalaemia, metabolic alkalosis
Hypernatraemia, hyperkalaemia, metabolic alkalosis
Hyponatraemia, hyperkalaemia, metabolic acidosis (Correct answer)
Hyponatraemia, hypokalaemia, metabolic acidosis

Correct answer: Hyponatraemia, hyperkalaemia, metabolic acidosis

Primary adrenal insufficiency (Addison's disease) involves the destruction of the adrenal cortex, leading to a deficiency of both cortisol and aldosterone. Aldosterone deficiency impairs the kidney's ability to reabsorb sodium and excrete potassium and hydrogen ions. [5, 29] This results in the characteristic electrolyte disturbances of hyponatraemia (low sodium), hyperkalaemia (high potassium), and a non-anion gap metabolic acidosis. [5, 36]

Question 86: Which tumour marker is most useful for monitoring treatment response in colorectal cancer?

PSA
CA 125
CEA (carcinoembryonic antigen) (Correct answer)
AFP

Correct answer: CEA (carcinoembryonic antigen)

CEA is the primary tumour marker for monitoring recurrence and treatment response in colorectal cancer.

Question 87: A junior doctor is asked by a senior to perform a procedure beyond their competence. What should they do?

Perform it to avoid conflict
Refuse and refuse to discuss it further
Attempt it and hope for the best
Decline and seek appropriate supervision or escalate, prioritising patient safety (Correct answer)

Correct answer: Decline and seek appropriate supervision or escalate, prioritising patient safety

Practising within one's competence and seeking supervision protects patient safety.

Question 88: What is the most appropriate initial management of a small bowel obstruction with no signs of strangulation?

Broad antibiotics alone
Oral laxatives
Immediate laparotomy
Nasogastric decompression, IV fluids, and nil by mouth (Correct answer)

Correct answer: Nasogastric decompression, IV fluids, and nil by mouth

Uncomplicated SBO is managed conservatively with 'drip and suck' before considering surgery.

Question 89: A 70-year-old man presents with an irregularly irregular pulse and palpitations. ECG shows absent P waves and irregular R-R intervals. What is the diagnosis?

Ventricular tachycardia
Atrial fibrillation (Correct answer)
Atrial flutter
First-degree heart block

Correct answer: Atrial fibrillation

Absent P waves with irregularly irregular rhythm is characteristic of atrial fibrillation.

Question 90: In Bradford Hill's criteria for causation, a dose-response relationship refers to:

Biological plausibility
Greater exposure producing greater risk (Correct answer)
Temporal sequence of exposure
Consistency across studies

Correct answer: Greater exposure producing greater risk

A biological gradient or dose-response means increasing exposure is associated with increasing disease risk.

Question 91: Which mechanism allows Staphylococcus aureus to resist beta-lactam antibiotics in MRSA?

Production of extended-spectrum beta-lactamase (ESBL)
Outer membrane impermeability
Altered penicillin-binding protein (PBP2a) encoded by mecA gene (Correct answer)
Efflux pump overexpression

Correct answer: Altered penicillin-binding protein (PBP2a) encoded by mecA gene

MRSA resistance is mediated by the mecA gene encoding PBP2a, which has low affinity for beta-lactam antibiotics.

Question 92: A 55-year-old patient develops a fever of 38.5°C on post-operative day 1 following an open cholecystectomy. Chest auscultation reveals decreased breath sounds at the lung bases. Which of the following is the most common cause of fever in the first 48 hours after major surgery?

Atelectasis (Correct answer)
Urinary tract infection
Deep vein thrombosis
Surgical site infection

Correct answer: Atelectasis

The most common cause of fever within the first 48 hours post-operatively is pulmonary atelectasis (the 'Wind' of the '5 Ws' mnemonic for post-op fever). Inadequate lung expansion due to pain, anaesthesia, and immobilisation leads to alveolar collapse, which can cause a low-grade fever. Surgical site infections ('Wound') typically manifest later, around day 5 to 7. Urinary tract infections ('Water') and deep vein thrombosis ('Walking') are also possibilities but are statistically less frequent causes of fever in this very early post-operative period.

Question 93: Parents of a 6-year-old ask about tonsillectomy after their child had 7 documented episodes of streptococcal tonsillitis in the past year, each requiring antibiotics. According to the Paradise criteria, is this child a candidate for tonsillectomy?

Yes — 7 episodes in one year meets the threshold for tonsillectomy consideration (Correct answer)
Yes — but only if adenoidectomy is performed simultaneously
No — requires 10 episodes in one year
No — tonsillectomy is not indicated before age 7

Correct answer: Yes — 7 episodes in one year meets the threshold for tonsillectomy consideration

The Paradise criteria recommend tonsillectomy for 7 or more documented tonsillitis episodes in one year, 5 or more per year for two consecutive years, or 3 or more per year for three consecutive years.

Question 94: A 28-year-old traveler returns from Southeast Asia with fever, chills, and rigors every 48 hours. Blood film shows ring forms and banana-shaped gametocytes. Which Plasmodium species is most likely responsible?

Plasmodium ovale
Plasmodium falciparum (Correct answer)
Plasmodium malariae
Plasmodium vivax

Correct answer: Plasmodium falciparum

Plasmodium falciparum produces banana-shaped (crescent) gametocytes and is the most dangerous malaria species.

Question 95: A 61-year-old smoker presents with 8 weeks of progressive hoarseness. Flexible laryngoscopy reveals a lesion on the left true vocal cord with impaired mobility. What is the single most important next step in management?

Voice rest for 4 weeks and reassessment
Antifungal therapy for presumed candidiasis
Microlaryngoscopy and biopsy under general anaesthesia (Correct answer)
Proton pump inhibitors for suspected laryngopharyngeal reflux

Correct answer: Microlaryngoscopy and biopsy under general anaesthesia

Persistent hoarseness beyond 3 weeks in a smoker with a laryngeal lesion requires urgent microlaryngoscopy and biopsy to obtain histological diagnosis and exclude laryngeal carcinoma.

Question 96: A 34-year-old woman is diagnosed with her first episode of moderate Major Depressive Disorder. She has no other medical or psychiatric comorbidities and is not pregnant. According to the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines, which of the following is considered an appropriate first-line treatment option?

Lithium carbonate.
A selective serotonin reuptake inhibitor (SSRI) such as sertraline. (Correct answer)
Electroconvulsive therapy (ECT).
A benzodiazepine such as diazepam.

Correct answer: A selective serotonin reuptake inhibitor (SSRI) such as sertraline.

For moderate Major Depressive Disorder, RANZCP guidelines recommend either an evidence-based psychotherapy (like CBT or IPT) or a recognised antidepressant as first-line treatment. Selective serotonin reuptake inhibitors (SSRIs) are a common and appropriate first-line pharmacological choice due to their efficacy and tolerability profile. ECT is reserved for severe, treatment-resistant, or psychotic depression. Benzodiazepines are not a first-line treatment for depression and are used for short-term management of anxiety. Lithium is primarily a mood stabiliser used for bipolar disorder.

Question 97: What is the recommended first-line management of a small, stable, postoperative seroma?

Pressurised irrigation
Observation as most resolve spontaneously (Correct answer)
Immediate surgical exploration
High-dose IV antibiotics

Correct answer: Observation as most resolve spontaneously

Most small seromas reabsorb spontaneously and need only observation.

Question 98: A 58-year-old with poorly controlled diabetes presents with new retinal vessels and a recent vitreous haemorrhage. What stage of diabetic retinopathy does this represent?

Severe non-proliferative retinopathy
Diabetic maculopathy
Mild non-proliferative retinopathy
Proliferative diabetic retinopathy (Correct answer)

Correct answer: Proliferative diabetic retinopathy

Proliferative diabetic retinopathy is defined by neovascularization (new vessel formation) on the retina or disc, which can rupture and cause vitreous haemorrhage or lead to tractional retinal detachment.

Question 99: A child presents with palpable purpura over the buttocks and lower limbs, joint pain, abdominal pain and haematuria. What is the most likely diagnosis?

Idiopathic thrombocytopenic purpura
Henoch-Schönlein purpura (IgA vasculitis) (Correct answer)
Haemolytic uraemic syndrome
Meningococcaemia

Correct answer: Henoch-Schönlein purpura (IgA vasculitis)

Palpable purpura on the legs/buttocks with arthralgia, abdominal pain and renal involvement defines HSP.

Question 100: Which study design follows exposed and unexposed groups forward to measure disease incidence?

Cohort study (Correct answer)
Ecological study
Cross-sectional study
Case-control study

Correct answer: Cohort study

A cohort study follows groups defined by exposure status over time to compare incidence of outcomes.

Question 101: A 55-year-old presents with sudden painless monocular vision loss described as a 'curtain descending from above.' There is no pain or redness. What is the most likely diagnosis?

Central retinal vein occlusion
Retinal detachment (Correct answer)
Vitreous haemorrhage
Optic neuritis

Correct answer: Retinal detachment

Retinal detachment classically presents as a shadow or 'curtain' advancing across the visual field, representing progressive separation of the retina from the underlying retinal pigment epithelium.

Question 102: What is the most appropriate timing for prophylactic antibiotic administration in clean-contaminated surgery?

24 hours before surgery
Only if infection develops
At induction, within 60 minutes before incision (Correct answer)
Immediately after skin closure

Correct answer: At induction, within 60 minutes before incision

Prophylactic antibiotics are most effective when given within 60 minutes before incision to ensure adequate tissue levels.

Question 103: What is the first-line treatment for ileocolic intussusception in a stable child without peritonitis?

Nasogastric decompression alone
Immediate laparotomy
Oral rehydration and observation
Air or contrast enema reduction (Correct answer)

Correct answer: Air or contrast enema reduction

Non-operative reduction with an air (pneumatic) or contrast enema is first-line when there are no signs of perforation or peritonitis.

Question 104: A 22-year-old presents with painful genital ulcers and bilateral inguinal lymphadenopathy. PCR confirms herpes simplex virus type 2. What is the first-line treatment?

Ganciclovir
Valacyclovir (Correct answer)
Foscarnet
Cidofovir

Correct answer: Valacyclovir

Valacyclovir (or acyclovir) is first-line therapy for primary genital herpes simplex infection.

Question 105: According to the National Bowel Cancer Screening Program in Australia, what is the recommended screening method and interval for an asymptomatic 55-year-old person at average risk of colorectal cancer?

Biennial immunochemical faecal occult blood test (iFOBT). (Correct answer)
Colonoscopy every 10 years.
Annual immunochemical faecal occult blood test (iFOBT).
Flexible sigmoidoscopy every 5 years.

Correct answer: Biennial immunochemical faecal occult blood test (iFOBT).

The current Australian National Bowel Cancer Screening Program recommends biennial (every two years) screening with an immunochemical faecal occult blood test (iFOBT) for asymptomatic people at average risk, starting from age 50 and continuing to age 74. Recent guideline updates also support starting iFOBT screening from age 45. Colonoscopy is the investigation for a positive iFOBT or for those at higher risk, not for primary screening in the average-risk population.

Question 106: Which contraceptive method is most appropriate for a breastfeeding woman 4 weeks postpartum?

High-dose oestrogen patch
Combined vaginal ring
Combined oral contraceptive pill
Progestogen-only pill or implant (Correct answer)

Correct answer: Progestogen-only pill or implant

Progestogen-only methods are preferred in breastfeeding as oestrogen may reduce milk supply and increase VTE risk.

Question 107: A 16-year-old requests contraception and refuses to involve her parents. Under Australian law, what principle determines whether you can prescribe?

Parental consent is always mandatory under 18
Gillick competence / mature minor assessment of her understanding (Correct answer)
You must refuse until she turns 18
Court approval is required for all minors

Correct answer: Gillick competence / mature minor assessment of her understanding

A mature minor who demonstrates sufficient understanding (Gillick competence) may consent to treatment without parental involvement.

Question 108: A case-control study reports an odds ratio of 3.2 for smoking and a rare disease. What does this odds ratio best approximate?

The relative risk of the disease (Correct answer)
The attributable fraction in the population
The number needed to treat
The absolute risk reduction

Correct answer: The relative risk of the disease

For rare diseases the odds ratio closely approximates the relative risk because the disease odds approximate the disease risk.

Question 109: Which skin finding is characteristic of dermatomyositis?

Malar butterfly rash
Erythema migrans
Honey-coloured crusting
Heliotrope rash on the eyelids (Correct answer)

Correct answer: Heliotrope rash on the eyelids

A violaceous heliotrope rash over the eyelids is a hallmark of dermatomyositis.

Question 110: What is the recommended timing for routine anti-D prophylaxis in a rhesus-negative pregnant woman without sensitising events?

Weekly from 20 weeks
Only at delivery
At around 28 weeks (and at 34 weeks if two-dose regimen) (Correct answer)
At 12 weeks only

Correct answer: At around 28 weeks (and at 34 weeks if two-dose regimen)

Routine antenatal anti-D prophylaxis is given at around 28 weeks (with a second dose at 34 weeks in two-dose regimens).

Question 111: A 60-year-old with long-standing alcohol use presents confused, with ophthalmoplegia and ataxia. What is the most appropriate immediate treatment?

Oral folic acid
Benzodiazepine sedation only
Intravenous glucose alone
Intravenous thiamine before any glucose (Correct answer)

Correct answer: Intravenous thiamine before any glucose

Wernicke's encephalopathy requires parenteral thiamine before glucose to avoid precipitating irreversible damage.

Question 112: A healthcare worker is exposed to a needlestick from an HBeAg-positive patient. The worker is unvaccinated. What is the most appropriate immediate management?

No intervention needed
Hepatitis B immune globulin (HBIG) plus hepatitis B vaccination (Correct answer)
Hepatitis B vaccination alone
Tenofovir prophylaxis

Correct answer: Hepatitis B immune globulin (HBIG) plus hepatitis B vaccination

Post-exposure prophylaxis for hepatitis B in unvaccinated individuals requires both HBIG (immediate passive immunity) and hepatitis B vaccine.

Question 113: A GP has been treating a patient for several years. The patient sends the GP a 'friend request' on a personal social media account. The GP's profile contains photos of their family and social activities. According to the Medical Board of Australia's Code of Conduct and guidelines on professional boundaries, what is the most appropriate response?

Accept the request but change privacy settings to limit what the patient can see.
Ignore the request and do not mention it at the next consultation.
Politely decline the request, explaining the need to maintain a professional doctor-patient relationship. (Correct answer)
Accept the request, as declining could damage the therapeutic relationship.

Correct answer: Politely decline the request, explaining the need to maintain a professional doctor-patient relationship.

The Medical Board of Australia's 'Good Medical Practice: A Code of Conduct for Doctors in Australia' requires doctors to maintain professional boundaries. Interacting with current patients on personal social media blurs these boundaries and is strongly discouraged. The most appropriate action is to politely decline and, if necessary, explain that this is standard professional practice to keep the doctor-patient relationship clear and therapeutic. Accepting, even with modified privacy settings, can still lead to boundary violations.

Question 114: Which nutritional route is preferred in a postoperative patient with a functioning gut?

Prolonged IV dextrose only
Withholding all feeds for a week
Total parenteral nutrition
Enteral nutrition (Correct answer)

Correct answer: Enteral nutrition

Enteral feeding maintains gut integrity and has fewer complications than parenteral routes when the gut works.

Question 115: A 24-year-old with known asthma presents with a silent chest, exhaustion, and SpO2 of 88% on air. What is the most appropriate immediate management?

Oral prednisolone and discharge
IV antibiotics alone
Reassurance and peak flow diary
Nebulised salbutamol, oxygen, IV hydrocortisone and call for senior/ICU help (Correct answer)

Correct answer: Nebulised salbutamol, oxygen, IV hydrocortisone and call for senior/ICU help

A silent chest with hypoxia indicates life-threatening asthma requiring oxygen, nebulised bronchodilators, systemic steroids and urgent senior/ICU involvement.

Question 116: A 50-year-old woman with a thyroid nodule has a suppressed TSH and an increased radioactive iodine uptake confined to the nodule. What is this lesion most likely to be?

Multinodular goitre
Toxic adenoma (Correct answer)
Papillary carcinoma
Hashimoto thyroiditis

Correct answer: Toxic adenoma

An autonomously functioning ('hot') nodule with increased focal uptake and suppressed TSH is a toxic adenoma and is almost always benign.

Question 117: A 72-year-old man presents with a 2-year history of progressive difficulty with his mobility. His wife reports he has a persistent tremor in his right hand which is most noticeable when he is watching television but improves when he reaches for his cup. On examination, you note a lack of facial expression, a slow, shuffling gait, and 'cogwheel' rigidity in his right arm. Which of the following is the most likely diagnosis?

Essential tremor
Parkinson's disease (Correct answer)
Multiple system atrophy
Drug-induced parkinsonism

Correct answer: Parkinson's disease

This patient presents with the classic triad of Parkinson's disease: a resting tremor, bradykinesia (slowness of movement, evidenced by shuffling gait and lack of facial expression), and rigidity. The asymmetric onset and the nature of the tremor (present at rest, improving with action) are highly characteristic of Parkinson's disease. Essential tremor is an action tremor. While drug-induced parkinsonism can present similarly, the progressive history without a clear offending medication makes it less likely. Multiple system atrophy often has more prominent autonomic features early on.

Question 118: A patient presents with a tender, irreducible inguinal hernia with overlying erythema and vomiting. What is the immediate concern?

Lipoma
Strangulation (Correct answer)
Reducible hernia
Hydrocele

Correct answer: Strangulation

An irreducible, tender hernia with systemic signs suggests strangulation requiring urgent surgery.

Question 119: A child has a confluent maculopapular rash starting at the hairline and spreading downward, with cough, coryza, conjunctivitis and Koplik spots. What is the diagnosis?

Roseola
Rubella
Measles (Correct answer)
Scarlet fever

Correct answer: Measles

The 3 Cs (cough, coryza, conjunctivitis) with Koplik spots and a top-down rash are diagnostic of measles.

Question 120: A public health program offers free influenza vaccinations to all healthcare workers before the flu season begins. This initiative aims to prevent the workers from contracting influenza and spreading it to vulnerable patients. Which level of prevention does this activity represent?

Primary prevention (Correct answer)
Secondary prevention
Tertiary prevention
Primordial prevention

Correct answer: Primary prevention

This is an example of primary prevention. Primary prevention aims to prevent the onset of disease before it occurs. Vaccination provides immunity to prevent the initial infection, thus stopping the disease process from starting.

Question 121: Which organism is the most common cause of pelvic inflammatory disease in young sexually active women?

Gardnerella vaginalis
Chlamydia trachomatis (Correct answer)
Escherichia coli
Candida albicans

Correct answer: Chlamydia trachomatis

Chlamydia trachomatis is the leading cause of PID, often asymptomatic until complications arise.

Question 122: A 45-year-old man with bipolar disorder on lithium presents with coarse tremor, ataxia, confusion and vomiting. What is the most appropriate first step?

Withhold lithium and check serum lithium level (Correct answer)
Add an antipsychotic and continue lithium
Start an antiemetic and continue lithium
Increase the lithium dose

Correct answer: Withhold lithium and check serum lithium level

These signs suggest lithium toxicity, so lithium should be stopped and the level urgently measured.

Question 123: A child with drooling, high fever, muffled voice and a tripod posture who avoids lying flat most likely has which condition?

Epiglottitis (Correct answer)
Croup
Bronchiolitis
Asthma

Correct answer: Epiglottitis

Toxic appearance, drooling, muffled voice and tripod positioning suggest acute epiglottitis.

Question 124: A patient presents with blood pressure of 220/130 mmHg, headache, and papilloedema. What is this emergency called?

Hypertensive emergency (malignant hypertension) (Correct answer)
White coat hypertension
Essential hypertension
Orthostatic hypotension

Correct answer: Hypertensive emergency (malignant hypertension)

Severe hypertension with acute end-organ damage such as papilloedema is a hypertensive emergency.

Question 125: Which investigation is most useful to confirm a diagnosis of gout in a swollen joint?

Plain X-ray
Joint aspiration with polarised microscopy (Correct answer)
ESR
Serum uric acid level

Correct answer: Joint aspiration with polarised microscopy

Negatively birefringent needle-shaped urate crystals on aspirate confirm gout.

Question 126: What does a rising serum lactate in a postoperative patient most strongly suggest?

Tissue hypoperfusion (Correct answer)
Hypothermia alone
Adequate oxygen delivery
Normal recovery

Correct answer: Tissue hypoperfusion

Elevated lactate reflects anaerobic metabolism from tissue hypoperfusion and warrants resuscitation review.

Question 127: What is the standard treatment for Kawasaki disease?

Broad-spectrum antibiotics
Intravenous immunoglobulin and aspirin (Correct answer)
Antiviral therapy
Corticosteroids alone

Correct answer: Intravenous immunoglobulin and aspirin

IVIG with aspirin within the first 10 days reduces the risk of coronary aneurysms in Kawasaki disease.

Question 128: A 60-year-old presents with altered bowel habit, iron-deficiency anaemia, and weight loss. What is the most important diagnosis to exclude?

Irritable bowel syndrome
Coeliac disease
Colorectal carcinoma (Correct answer)
Haemorrhoids

Correct answer: Colorectal carcinoma

Change in bowel habit with iron-deficiency anaemia in an older adult mandates exclusion of colorectal cancer.

Question 129: Which organism is the most common cause of community-acquired pneumonia requiring hospitalization in adults?

Mycoplasma pneumoniae
Legionella pneumophila
Haemophilus influenzae
Streptococcus pneumoniae (Correct answer)

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia requiring hospitalization.

Question 130: A patient on long-term corticosteroids is at greatest risk of which musculoskeletal complication?

Osteoporosis (Correct answer)
Gout
Rheumatoid arthritis
Septic arthritis

Correct answer: Osteoporosis

Chronic corticosteroid use accelerates bone loss, increasing osteoporosis and fracture risk.

Question 131: A 55-year-old man has a clinic blood pressure of 165/100 mmHg on three separate occasions. According to standard guidelines, what is the first-line lifestyle and pharmacological approach for stage 2 hypertension?

No treatment until end-organ damage occurs
Immediate intravenous antihypertensives
Lifestyle modification alone for 12 months
Lifestyle modification plus antihypertensive medication (Correct answer)

Correct answer: Lifestyle modification plus antihypertensive medication

Stage 2 hypertension warrants both lifestyle changes and pharmacotherapy.

Question 132: A young woman presents with hypertension, hypokalaemia and metabolic alkalosis but with LOW aldosterone and low renin. Genetic testing confirms a sodium channel mutation. What is the diagnosis?

Conn syndrome
Gitelman syndrome
Bartter syndrome
Liddle syndrome (Correct answer)

Correct answer: Liddle syndrome

Liddle syndrome is an inherited gain-of-function of the epithelial sodium channel causing hypertension with suppressed renin and aldosterone.

Question 133: A patient with systemic lupus erythematosus has low C3 and C4 levels. Which component of the immune system is primarily responsible for this finding during active disease?

Natural killer cell activation
T-cell mediated cytotoxicity
Complement consumption via immune complex deposition (Correct answer)
Mast cell degranulation

Correct answer: Complement consumption via immune complex deposition

In SLE, immune complexes deposit in tissues and activate the classical complement pathway, consuming C3 and C4.

Question 134: What is the correct immediate management of a suspected tension pneumothorax?

Start oral antibiotics
Await a chest X-ray before acting
Immediate needle or finger thoracostomy (Correct answer)
Urgent chest CT first

Correct answer: Immediate needle or finger thoracostomy

Tension pneumothorax is a clinical diagnosis requiring immediate decompression before imaging.

Question 135: A 68-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with a 2-hour history of central crushing chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. According to the 2025 Australian clinical guidelines for the management of acute coronary syndromes, what is the most appropriate immediate management step?

Administer a loading dose of clopidogrel and await troponin results
Arrange for urgent primary percutaneous coronary intervention (PCI) (Correct answer)
Administer intravenous thrombolysis
Perform an urgent echocardiogram to assess for wall motion abnormalities

Correct answer: Arrange for urgent primary percutaneous coronary intervention (PCI)

The 2025 Australian clinical guidelines for diagnosing and managing acute coronary syndromes strongly recommend urgent primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI), now termed acute coronary occlusion myocardial infarction (ACOMI), if it can be performed in a timely manner. The ECG findings are consistent with an inferior STEMI/ACOMI, which is a time-critical medical emergency requiring immediate reperfusion to restore blood flow and salvage myocardial tissue. While thrombolysis is an option if PCI is not available within the recommended timeframes, PCI is superior. Awaiting troponin results would cause an unnecessary and harmful delay in treatment. An echocardiogram is useful for diagnosis and assessing complications but should not delay reperfusion therapy.

Question 136: Bedwetting (nocturnal enuresis) in an otherwise well 6-year-old with no daytime symptoms is best initially managed by which approach?

Immediate desmopressin for all
Long-term antibiotics
Reassurance and behavioural advice (fluid timing, enuresis alarm) (Correct answer)
Renal ultrasound and referral

Correct answer: Reassurance and behavioural advice (fluid timing, enuresis alarm)

Primary monosymptomatic enuresis is initially managed with reassurance and behavioural measures, with alarms as first-line active treatment.

Question 137: A 30-year-old of Mediterranean descent has a haemoglobin of 85 g/L, MCV of 62 fL, normal iron studies, and elevated HbA2 on electrophoresis. What is the most likely diagnosis?

Beta-thalassaemia trait (Correct answer)
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning

Correct answer: Beta-thalassaemia trait

Beta-thalassaemia trait presents with mild microcytic anaemia, normal or elevated HbA2 (>3.5%) on haemoglobin electrophoresis, and normal iron studies.

Question 138: A 62-year-old man is scheduled for an elective inguinal hernia repair. He has no known drug allergies. According to Australian Therapeutic Guidelines for surgical prophylaxis, what is the optimal timing for the administration of intravenous antibiotics to prevent a surgical site infection?

At the time of skin closure
In the post-anaesthesia care unit (PACU)
Within 60 minutes prior to skin incision (Correct answer)
Two hours prior to skin incision

Correct answer: Within 60 minutes prior to skin incision

To be effective in preventing surgical site infections (SSIs), prophylactic antibiotics must be present in the tissues at a bactericidal concentration at the time of the initial incision. The standard recommendation is to administer the intravenous antibiotic dose within the 60 minutes preceding the skin incision. This ensures peak tissue levels are achieved when the wound is created and the risk of bacterial contamination begins. Administering it too early (>120 minutes) may lead to sub-therapeutic levels, while administration after the incision is made is not considered prophylactic.

Question 139: Which feature most strongly suggests septic arthritis requiring urgent joint aspiration?

Heberden nodes
Bilateral symmetrical joint stiffness
A hot, swollen joint with fever and inability to bear weight (Correct answer)
Morning stiffness lasting 10 minutes

Correct answer: A hot, swollen joint with fever and inability to bear weight

An acutely hot, swollen, painful joint with fever is septic arthritis until proven otherwise.

Question 140: What is the first-line investigation when pulmonary embolism is suspected in a haemodynamically stable patient with normal renal function?

CT pulmonary angiography (Correct answer)
Bronchoscopy
Spirometry
Sputum culture

Correct answer: CT pulmonary angiography

CT pulmonary angiography is the investigation of choice for diagnosing pulmonary embolism.

Question 141: A 28-year-old presents with unilateral progressive sensorineural hearing loss, constant tinnitus, and mild vertigo. MRI reveals an enhancing lesion at the right cerebellopontine angle. What is the most likely diagnosis?

Labyrinthitis
Vestibular schwannoma (acoustic neuroma) (Correct answer)
Meniere's disease
Cholesteatoma

Correct answer: Vestibular schwannoma (acoustic neuroma)

Vestibular schwannoma presents with unilateral progressive sensorineural hearing loss, tinnitus, and vertigo, and appears as an enhancing cerebellopontine angle mass on gadolinium-enhanced MRI.

Question 142: Which scoring system uses CRP and is commonly applied to assess acute pancreatitis severity at 48 hours?

Rockall score
Child-Pugh score
Alvarado score
Glasgow (Imrie) criteria (Correct answer)

Correct answer: Glasgow (Imrie) criteria

The Glasgow/Imrie criteria stratify pancreatitis severity, and CRP >150 supports severe disease.

Question 143: A 45-year-old woman presents with episodic palpitations, headache, and sweating with paroxysmal hypertension. Which diagnosis should be considered?

Essential hypertension
Panic disorder
Hyperthyroidism
Phaeochromocytoma (Correct answer)

Correct answer: Phaeochromocytoma

The triad of headache, palpitations, and sweating with paroxysmal hypertension suggests phaeochromocytoma.

Question 144: Hemoglobin cannot transport carbon dioxide.

A) False (Correct answer)
B) True

Correct answer: A) False

Hemoglobin can indeed transport carbon dioxide, although it is not its primary function. About 10-20% of CO2 is transported bound to the amino groups of hemoglobin, forming carbaminohemoglobin. The majority of CO2 is transported as bicarbonate ions.

Question 145: A 55-year-old man presents with urinary hesitancy, a PSA of 18 ng/mL, and a hard irregular prostate on digital rectal exam. Biopsy shows adenocarcinoma, Gleason score 7. What is the initial management for localised disease?

Radical prostatectomy or external beam radiotherapy (Correct answer)
Chemotherapy with docetaxel
Immediate androgen deprivation therapy (ADT)
Watchful waiting only

Correct answer: Radical prostatectomy or external beam radiotherapy

Intermediate-risk localised prostate cancer (Gleason 7, elevated PSA) is treated with curative intent via radical prostatectomy or external beam radiotherapy.

Question 146: A pregnant woman at 12 weeks has hyperemesis gravidarum. What complication should be screened for?

Electrolyte disturbance and ketosis (Correct answer)
Gestational diabetes
Placental abruption
Pre-eclampsia

Correct answer: Electrolyte disturbance and ketosis

Severe vomiting in hyperemesis causes dehydration, electrolyte imbalance and ketosis requiring correction.

Question 147: A patient with CKD has a corrected calcium of 1.9 mmol/L, phosphate of 2.4 mmol/L and a markedly raised PTH. What is the underlying mechanism?

Vitamin D toxicity
Secondary hyperparathyroidism from low calcitriol and phosphate retention (Correct answer)
Primary hyperparathyroidism
Hypoparathyroidism

Correct answer: Secondary hyperparathyroidism from low calcitriol and phosphate retention

Reduced renal calcitriol synthesis and phosphate retention drive compensatory secondary hyperparathyroidism in CKD.

Question 148: A 30-year-old man with schizophrenia on haloperidol develops fever, muscle rigidity, autonomic instability and a markedly raised creatine kinase. What is the diagnosis?

Serotonin syndrome
Malignant hyperthermia
Acute dystonia
Neuroleptic malignant syndrome (Correct answer)

Correct answer: Neuroleptic malignant syndrome

Fever, rigidity, autonomic instability and raised CK in a patient on antipsychotics indicate neuroleptic malignant syndrome.

Question 149: A patient with coeliac disease should avoid which dietary component?

Fat
Lactose
Fructose
Gluten (Correct answer)

Correct answer: Gluten

Coeliac disease is an immune reaction to gluten, requiring lifelong gluten-free diet.

Question 150: A 38-year-old man presents after a seizure. He has been drinking alcohol heavily for years and stopped two days ago. What is the most likely cause of the seizure?

Epilepsy
Hypoglycaemia
Alcohol withdrawal (Correct answer)
Brain tumour

Correct answer: Alcohol withdrawal

Seizures occurring within 6-48 hours of alcohol cessation are typically due to alcohol withdrawal.

AMC CAT MCQ Exam

The Australian Medical Council Computer Adaptive Test assesses internationally trained medical graduates across core clinical disciplines for eligibility to practise medicine in Australia.

150

Questions

210 min

Time Limit

50%

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