AMC CAT MCQ Exam — Questions and Answers

Question 1: A 19-year-old student has had six months of excessive worry about many areas of life, restlessness, muscle tension and difficulty concentrating most days. What is the most likely diagnosis?

Obsessive-compulsive disorder
Generalised anxiety disorder (Correct answer)
Adjustment disorder
Panic disorder

Correct answer: Generalised anxiety disorder

Persistent, excessive, hard-to-control worry across multiple domains for at least six months defines generalised anxiety disorder.

Question 2: Which antibody is most specific for coeliac disease?

Anti-smooth muscle antibody
ANCA
Antimitochondrial antibody
Anti-tissue transglutaminase (anti-tTG) IgA (Correct answer)

Correct answer: Anti-tissue transglutaminase (anti-tTG) IgA

Anti-tTG IgA is the most sensitive and specific serological test for coeliac disease.

Question 3: A 60-year-old with long-standing alcohol use presents confused, with ophthalmoplegia and ataxia. What is the most appropriate immediate treatment?

Benzodiazepine sedation only
Intravenous glucose alone
Oral folic acid
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 4: A young man presents with elevated mood, grandiosity, reduced need for sleep, rapid speech and reckless spending over the past week. What is the most likely diagnosis?

Generalised anxiety disorder
Major depressive episode
Schizophrenia
Manic episode (Correct answer)

Correct answer: Manic episode

Elevated mood, grandiosity, decreased sleep need and risky behaviour indicate a manic episode.

Question 5: A 28-year-old primigravida attends her first antenatal visit at 10 weeks' gestation. She is interested in screening for fetal chromosomal abnormalities like Down syndrome. According to Australian guidelines, which of the following is the most commonly offered and recommended initial screening test?

Fetal morphology ultrasound at 20 weeks
Amniocentesis at 16 weeks
Maternal serum alpha-fetoprotein (MSAFP) alone
Combined first-trimester screening (nuchal translucency ultrasound and maternal serum markers) (Correct answer)

Correct answer: Combined first-trimester screening (nuchal translucency ultrasound and maternal serum markers)

Combined first-trimester screening (cFTS) is the standard initial screening test for chromosomal abnormalities offered in Australia. It combines a maternal blood test (measuring PAPP-A and free β-hCG) between 9 and 13 weeks with a nuchal translucency (NT) ultrasound scan between 11 and 13 weeks. This combination provides a risk assessment for conditions like Down syndrome (Trisomy 21) and Edwards syndrome (Trisomy 18). Amniocentesis is a diagnostic test, not a screening test, and is offered if screening indicates a high risk. MSAFP alone is part of second-trimester screening, which is less accurate than cFTS. The 20-week morphology scan can detect structural anomalies but is not the primary screening tool for chromosomal aneuploidy.

Question 6: A dying patient asks you to actively end their life. In most Australian jurisdictions with VAD laws, what is required?

It is universally illegal everywhere in Australia
Only family consent is needed
Strict eligibility criteria, multiple assessments, and formal legal process must be followed (Correct answer)
Any doctor may comply immediately on request

Correct answer: Strict eligibility criteria, multiple assessments, and formal legal process must be followed

Voluntary assisted dying, where legal, requires strict eligibility, multiple independent assessments, and legal safeguards.

Question 7: Which drug is given to reduce splanchnic blood flow in acute variceal bleeding?

Propranolol immediately
Tranexamic acid
Terlipressin (Correct answer)
Omeprazole

Correct answer: Terlipressin

Terlipressin causes splanchnic vasoconstriction, reducing portal pressure and variceal bleeding.

Question 8: A 2-year-old boy is brought to the emergency department with a 24-hour history of a harsh, barking cough and noisy breathing. His mother notes the symptoms are worse at night. On examination, he is alert, has a temperature of 38.1°C, and there is prominent inspiratory stridor at rest with moderate subcostal and intercostal retractions. His oxygen saturation is 96% on room air. According to Australian guidelines, what is the most appropriate initial pharmacological treatment?

Intravenous ceftriaxone
Humidified 'blow-by' oxygen
Nebulised salbutamol
A single dose of oral dexamethasone (Correct answer)

Correct answer: A single dose of oral dexamethasone

This child presents with moderate croup, characterized by a barking cough and stridor at rest with respiratory distress. The mainstay of treatment for moderate to severe croup is a single dose of corticosteroids to reduce airway inflammation. Oral dexamethasone or prednisolone are recommended first-line treatments. Nebulised adrenaline is reserved for severe croup. Antibiotics are not indicated as croup is viral. While oxygen may be needed if there is hypoxia, it is not the primary treatment, and corticosteroids should be administered first.

Question 9: A diabetic patient has a HbA1c of 9.5% before elective hernia repair. What is the best action?

Double the insulin only on the operative morning
Defer surgery to optimise glycaemic control (Correct answer)
Proceed immediately regardless
Cancel surgery permanently

Correct answer: Defer surgery to optimise glycaemic control

Poor glycaemic control raises infection and wound risk, so elective surgery should be deferred for optimisation.

Question 10: A child develops acute kidney injury, microangiopathic haemolytic anaemia and thrombocytopenia after bloody diarrhoea. What is the diagnosis?

Haemolytic uraemic syndrome (Correct answer)
Sepsis
Acute glomerulonephritis
Henoch-Schönlein purpura

Correct answer: Haemolytic uraemic syndrome

The triad of AKI, haemolytic anaemia and thrombocytopenia after E. coli O157 diarrhoea is haemolytic uraemic syndrome.

Question 11: Which of the following is a notifiable disease that doctors in Australia are legally required to report to public health authorities?

Essential hypertension
Type 2 diabetes
Osteoarthritis
Tuberculosis (Correct answer)

Correct answer: Tuberculosis

Tuberculosis is a nationally notifiable communicable disease requiring mandatory reporting.

Question 12: 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?

Digoxin
Adenosine bolus repeated indefinitely
Verapamil
Amiodarone (Correct answer)

Correct answer: Amiodarone

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

Question 13: What is the recommended management of a confirmed term breech presentation in an otherwise uncomplicated pregnancy?

Await spontaneous version at term
Offer external cephalic version at 36-37 weeks (Correct answer)
Routine forceps delivery
Immediate caesarean at diagnosis

Correct answer: Offer external cephalic version at 36-37 weeks

External cephalic version is offered from around 36-37 weeks to attempt to turn the fetus to cephalic.

Question 14: Which condition most typically causes a transudative pleural effusion?

Congestive cardiac failure (Correct answer)
Pulmonary embolism with infarction
Pneumonia
Malignancy

Correct answer: Congestive cardiac failure

Congestive cardiac failure raises hydrostatic pressure and produces a low-protein transudative effusion.

Question 15: A junior doctor notices that a senior surgical consultant frequently appears to have tremors and slurred speech during morning rounds, particularly on Mondays. The junior doctor smells alcohol on the consultant's breath on one occasion. When privately asked, the consultant dismisses it as fatigue. According to the Health Practitioner Regulation National Law, what is the junior doctor's primary professional obligation?

Directly report the concerns to the hospital's Director of Medical Services.
Advise the consultant to self-report to the Medical Board of Australia.
Discuss the concerns with other junior doctors to see if they have noticed similar behaviour.
Make a mandatory report to the Australian Health Practitioner Regulation Agency (AHPRA) about potential notifiable conduct. (Correct answer)

Correct answer: Make a mandatory report to the Australian Health Practitioner Regulation Agency (AHPRA) about potential notifiable conduct.

The scenario describes a reasonable belief that a practitioner may be practising while intoxicated, which falls under the definition of 'notifiable conduct' in the National Law. All registered health practitioners have a legal obligation to report notifiable conduct to AHPRA to protect the public from harm. While discussing with a hospital manager (DMS) is a reasonable step, it does not absolve the practitioner of their personal mandatory reporting obligation. Discussing with peers is inappropriate and advising the consultant to self-report does not fulfil the observer's duty.

Question 16: Which of these is an absolute indication for blood transfusion intraoperatively?

Haemoglobin of 110 g/L in a stable patient
Patient anxiety
Symptomatic anaemia with ongoing haemorrhage and hypoxia (Correct answer)
Routine for all major operations

Correct answer: Symptomatic anaemia with ongoing haemorrhage and hypoxia

Transfusion is indicated for symptomatic anaemia with active bleeding and inadequate oxygen delivery.

Question 17: A child with drooling, high fever, muffled voice and a tripod posture who avoids lying flat most likely has which condition?

Bronchiolitis
Croup
Epiglottitis (Correct answer)
Asthma

Correct answer: Epiglottitis

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

Question 18: 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?

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

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 19: A 55-year-old presents with brief episodes of intense vertigo triggered by rolling over in bed, lasting less than one minute. The Dix-Hallpike test is positive. What is the most effective first-line treatment?

Surgical posterior semicircular canal occlusion
Canalith repositioning procedure (Epley maneuver) (Correct answer)
Long-term meclizine (vestibular suppressant)
Intratympanic gentamicin injection

Correct answer: Canalith repositioning procedure (Epley maneuver)

Benign paroxysmal positional vertigo is caused by displaced otoliths in the posterior semicircular canal and is effectively treated with the Epley canalith repositioning maneuver.

Question 20: A teenager presents with a circular, scaly lesion with central clearing and a raised advancing border. What is the most likely diagnosis?

Discoid eczema
Tinea corporis (Correct answer)
Psoriasis
Granuloma annulare

Correct answer: Tinea corporis

An annular lesion with central clearing and a scaly active edge is classic for tinea corporis (ringworm).

Question 21: A 75-year-old develops gradual cognitive decline with prominent early memory loss and no focal neurological signs. What is the most likely diagnosis?

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

Correct answer: Alzheimer's disease

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

Question 22: Which best describes 'non-maleficence' as a core ethical principle?

Acting to benefit the patient
Respecting patient choices
Distributing resources fairly
Avoiding causing harm to the patient (Correct answer)

Correct answer: Avoiding causing harm to the patient

Non-maleficence is the duty to avoid causing harm, captured by 'first, do no harm'.

Question 23: 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 24: 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?

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

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 25: 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 vaccination alone
Hepatitis B immune globulin (HBIG) plus hepatitis B vaccination (Correct answer)
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 26: What is the first-line management of shoulder dystocia?

Forceps delivery
Fundal pressure
McRoberts manoeuvre with suprapubic pressure (Correct answer)
Immediate caesarean section

Correct answer: McRoberts manoeuvre with suprapubic pressure

McRoberts manoeuvre with suprapubic pressure resolves most shoulder dystocias and is the recommended first step.

Question 27: What does a rising serum lactate in a postoperative patient most strongly suggest?

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

Correct answer: Tissue hypoperfusion

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

Question 28: Which condition presents with dysphagia to both solids and liquids and a 'bird-beak' appearance on barium swallow?

Diffuse oesophageal spasm
Achalasia (Correct answer)
Oesophageal carcinoma
Pharyngeal pouch

Correct answer: Achalasia

Achalasia causes failure of LOS relaxation with the classic bird-beak tapering on barium.

Question 29: A 5-year-old presents with periorbital oedema, frothy urine, and heavy proteinuria with hypoalbuminaemia. What is the most likely diagnosis?

Acute tubular necrosis
Post-streptococcal glomerulonephritis
Henoch-Schonlein purpura
Minimal change nephrotic syndrome (Correct answer)

Correct answer: Minimal change nephrotic syndrome

Minimal change disease is the commonest cause of nephrotic syndrome in young children.

Question 30: A 27-year-old woman presents with a productive cough, night sweats, weight loss, and haemoptysis over six weeks. What is the most appropriate initial investigation?

CT pulmonary angiogram
Chest X-ray and sputum for acid-fast bacilli (Correct answer)
Bronchoscopy
Echocardiography

Correct answer: Chest X-ray and sputum for acid-fast bacilli

Chest X-ray and sputum testing for acid-fast bacilli are first-line for suspected tuberculosis.

Question 31: In Bradford Hill's criteria for causation, a dose-response relationship refers to:

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

Correct answer: Greater exposure producing greater risk

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

Question 32: A 58-year-old man presents with crushing central chest pain radiating to the left arm for 40 minutes. ECG shows ST elevation in leads II, III, and aVF. Which artery is most likely occluded?

Left anterior descending artery
Left main coronary artery
Right coronary artery (Correct answer)
Left circumflex artery

Correct answer: Right coronary artery

ST elevation in the inferior leads (II, III, aVF) typically indicates occlusion of the right coronary artery.

Question 33: Which of the following does not belong to the respiratory system's conducting portion?

Nose
Pharynx
Alveoli (Correct answer)
Bronchioles

Correct answer: Alveoli

The conducting portion of the respiratory system includes structures like the nose, pharynx, and bronchioles, which function to transport, warm, humidify, and filter air. The alveoli, however, are part of the *respiratory portion*, where the actual exchange of gases (oxygen and carbon dioxide) between air and blood takes place.

Question 34: What is the initial management priority before surgery in an infant with pyloric stenosis?

Start oral feeds
Immediate pyloromyotomy
Administer antibiotics
Fluid and electrolyte correction (Correct answer)

Correct answer: Fluid and electrolyte correction

Pyloromyotomy is not an emergency; fluid and electrolyte resuscitation must be completed first.

Question 35: A relative risk of 1.0 with a 95% confidence interval of 0.85 to 1.18 indicates the association is:

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

Correct answer: Not statistically significant

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

Question 36: What is the most appropriate timing for prophylactic antibiotic administration in clean-contaminated surgery?

At induction, within 60 minutes before incision (Correct answer)
Only if infection develops
24 hours before surgery
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 37: A woman has a malar 'butterfly' rash, photosensitivity, arthralgia and a positive ANA. What is the most likely diagnosis?

Sarcoidosis
Dermatomyositis
Rosacea
Systemic lupus erythematosus (Correct answer)

Correct answer: Systemic lupus erythematosus

A photosensitive malar rash with arthralgia and positive ANA suggests SLE.

Question 38: 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)
Absent distal pulses early
Reduced capillary refill alone
Skin pallor only

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

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

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

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

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

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

Question 41: True or False: Respiration is a physical process and depends on the principle of diffusion.

A) False (Correct answer)
B) True

Correct answer: A) False

Respiration is a complex biological process that involves both physical gas exchange and biochemical reactions. While the gas exchange aspect (external respiration) relies on the physical principle of diffusion, cellular respiration is a metabolic pathway involving a series of enzymatic reactions to produce ATP. Therefore, stating it is *solely* a physical process dependent *only* on diffusion is incorrect.

Question 42: A patient with idiopathic pulmonary fibrosis is most likely to have which examination finding?

Expiratory wheeze
Fine bibasal end-inspiratory crackles and clubbing (Correct answer)
Bronchial breathing at the apex
Coarse early inspiratory crackles

Correct answer: Fine bibasal end-inspiratory crackles and clubbing

Fine bibasal end-inspiratory crackles with finger clubbing are characteristic of pulmonary fibrosis.

Question 43: Intention-to-treat analysis in a randomised trial means participants are analysed according to:

The treatment they actually received
Their original randomised group (Correct answer)
Their compliance level
Their final clinical outcome

Correct answer: Their original randomised group

Intention-to-treat analyses participants in their assigned groups regardless of adherence, preserving randomisation.

Question 44: Which long-term medication has the strongest evidence for reducing mortality after myocardial infarction with reduced ejection fraction?

Digoxin
Beta-blocker (Correct answer)
Calcium channel blocker
Loop diuretic

Correct answer: Beta-blocker

Beta-blockers reduce mortality post-MI, particularly in patients with reduced ejection fraction.

Question 45: A 29-year-old woman presents with a history of recurrent headaches. She describes them as a severe, unilateral, pulsating pain that lasts for about 8-10 hours. During the headaches, she feels nauseous and prefers to lie down in a dark, quiet room. She denies any preceding visual disturbances. Based on the International Classification of Headache Disorders (ICHD-3) criteria, what is the most likely diagnosis?

Migraine with typical aura
Migraine without aura (Correct answer)
Tension-type headache
Cluster headache

Correct answer: Migraine without aura

The patient's symptoms align perfectly with the ICHD-3 diagnostic criteria for Migraine without aura. These criteria include a duration of 4-72 hours, unilateral location, pulsating quality, moderate or severe intensity, and associated symptoms like nausea and/or photophobia/phonophobia. She specifically denies aura (like visual disturbances), making 'Migraine with aura' incorrect. Tension-type headaches are typically bilateral and non-pulsating, while cluster headaches are extremely severe, shorter in duration, and associated with autonomic symptoms.

Question 46: Which coagulation factor is deficient in haemophilia A?

von Willebrand factor
Factor IX
Factor XI
Factor VIII (Correct answer)

Correct answer: Factor VIII

Haemophilia A is caused by deficiency of factor VIII, resulting in impaired intrinsic pathway coagulation.

Question 47: A 63-year-old heavy smoker and drinker presents with progressive hoarseness, odynophagia, referred otalgia, and a palpable neck mass. Laryngoscopy reveals a supraglottic mass. Which investigation is most important for staging?

MRI of the brain only
Plain chest radiograph alone
Ultrasound of the neck
CT scan of the neck, chest, and upper abdomen with contrast (Correct answer)

Correct answer: CT scan of the neck, chest, and upper abdomen with contrast

Contrast-enhanced CT of the neck, chest, and abdomen is essential for staging laryngeal carcinoma, assessing local tumour extent, regional lymph node involvement, and distant metastases to guide treatment planning.

Question 48: A 68-year-old man is brought to the emergency department with a sudden onset of left-sided facial droop, arm weakness, and slurred speech. The symptoms started 90 minutes ago. He has a history of hypertension. His blood pressure is 170/95 mmHg and his blood glucose is 7.2 mmol/L. According to Australian stroke guidelines, what is the most crucial next step in management?

Administer 300mg of aspirin immediately.
Commence an intravenous infusion of labetalol to lower his blood pressure.
Arrange for an urgent MRI of the brain with diffusion-weighted imaging.
Perform an urgent non-contrast CT scan of the brain. (Correct answer)

Correct answer: Perform an urgent non-contrast CT scan of the brain.

The most critical initial step in managing a patient with suspected acute ischaemic stroke is to perform an urgent non-contrast CT scan of the brain. This is essential to exclude intracranial haemorrhage, which is a contraindication to thrombolytic therapy. Thrombolysis is a time-critical intervention, and imaging should not be delayed. While aspirin is indicated, it is only given after a haemorrhagic stroke has been excluded. An MRI provides more detail but is less readily available and takes longer, potentially delaying treatment. Blood pressure management is important but is secondary to the initial diagnostic imaging.

Question 49: Which drug causes a dose-dependent cardiomyopathy that limits its cumulative lifetime dose?

Doxorubicin (anthracycline) (Correct answer)
Vincristine
Methotrexate
Cyclophosphamide

Correct answer: Doxorubicin (anthracycline)

Doxorubicin causes cumulative dose-dependent cardiotoxicity (dilated cardiomyopathy) due to free radical damage to cardiomyocytes, limiting its total lifetime dose.

Question 50: A 35-year-old HIV-positive patient with CD4 count of 80 cells/µL presents with headache, fever, and meningismus. India ink stain of CSF shows encapsulated yeast. What is the most appropriate treatment?

Amphotericin B plus flucytosine (Correct answer)
Caspofungin
Fluconazole alone
Voriconazole

Correct answer: Amphotericin B plus flucytosine

Cryptococcal meningitis in immunocompromised patients is treated with induction therapy using amphotericin B plus flucytosine.

Question 51: A 52-year-old smoker presents with a firm, painless 3 cm neck mass that has been present for 8 weeks. Fine needle aspiration cytology reveals squamous cell carcinoma. What is the most important next investigative step?

Panendoscopy to identify the primary tumour (Correct answer)
PET-CT scan only
Immediate radical neck dissection
Empirical radiotherapy to the neck

Correct answer: Panendoscopy to identify the primary tumour

Metastatic SCC in the neck requires panendoscopy (examination of the nasopharynx, oropharynx, hypopharynx, larynx, and oesophagus) with biopsies to identify the primary tumour before definitive treatment planning.

Question 52: 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 53: Which measure is most appropriate for comparing the burden of disease accounting for both premature death and disability?

Standardised incidence ratio
Disability-adjusted life years (DALYs) (Correct answer)
Case fatality rate
Crude mortality rate

Correct answer: Disability-adjusted life years (DALYs)

DALYs combine years of life lost and years lived with disability into a single burden measure.

Question 54: A 15-year-old girl attends a GP appointment alone and requests contraception. She is assessed to be a 'Gillick-competent' minor, meaning she has sufficient understanding and intelligence to comprehend the nature and implications of the proposed treatment. Her parents are unaware of the appointment. Which of the following is the most ethically and legally sound action for the GP?

Refuse to prescribe until parental consent is obtained.
Prescribe the contraception as the patient's confidentiality takes precedence. (Correct answer)
Contact the parents to inform them of their daughter's request.
Agree to prescribe only if the patient agrees to inform her parents within one month.

Correct answer: Prescribe the contraception as the patient's confidentiality takes precedence.

In Australia, the principle of 'Gillick competence' (derived from UK common law and accepted in Australia) allows a minor who has sufficient maturity and intelligence to understand the proposed treatment to consent to it without parental knowledge or consent. In this situation, the duty of confidentiality owed to the competent minor patient is paramount. Prescribing contraception is appropriate. Breaching the patient's confidentiality by contacting the parents would be inappropriate and illegal, and making treatment conditional on her telling her parents undermines her autonomy and right to confidential medical care.

Question 55: 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)
Continue warfarin and recheck INR in 48 hours
Administer fresh frozen plasma (FFP)
Administer prothrombin complex concentrate (PCC)

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 56: When CO2 levels in the blood increase, breathing becomes ____________

shallower and deeper
no effect on breathing
faster and deeper (Correct answer)
slow and deep

Correct answer: faster and deeper

When carbon dioxide levels in the blood increase, the blood becomes more acidic, which is detected by chemoreceptors. These receptors signal the respiratory centers in the brain to increase both the rate and depth of breathing. This response helps to expel excess CO2 from the body and restore normal blood pH.

Question 57: 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
Cluster headache
Migraine

Correct answer: Giant cell (temporal) arteritis

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

Question 58: A 35-year-old man presents with sudden severe loin-to-groin pain and microscopic haematuria. What is the most likely diagnosis?

Testicular torsion
Ureteric colic from a renal stone (Correct answer)
Acute pyelonephritis
Appendicitis

Correct answer: Ureteric colic from a renal stone

Colicky loin-to-groin pain with haematuria is the classic presentation of a ureteric calculus.

Question 59: A 78-year-old woman with oesophageal cancer is found to be severely malnourished, having lost 15% of her body weight over 3 months. Pre-operative nutritional support is initiated via a nasogastric tube. The initiation of feeding in this patient must be done cautiously to avoid which of the following life-threatening metabolic complications?

Hypercalcaemia
Refeeding syndrome (Correct answer)
Metabolic acidosis
Hypernatraemia

Correct answer: Refeeding syndrome

This patient is at high risk for refeeding syndrome due to severe malnutrition. This syndrome is a potentially fatal condition caused by rapid shifts in fluids and electrolytes that occur when nutritional support is initiated in a chronically starved patient. The shift from fat to carbohydrate metabolism stimulates insulin release, which drives phosphate, potassium, and magnesium into cells, leading to profound hypophosphataemia, hypokalaemia, and hypomagnesaemia. These electrolyte shifts can cause cardiac, pulmonary, and neurological failure.

Question 60: Which level of disease prevention does cervical cancer screening with Pap testing represent?

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

Correct answer: Secondary prevention

Screening detects disease at an early or pre-clinical stage, which defines secondary prevention.

Question 61: Which ECG feature is diagnostic of complete (third-degree) heart block?

Delta wave
AV dissociation with independent atrial and ventricular rates (Correct answer)
Progressive PR prolongation then a dropped beat
Fixed prolonged PR interval

Correct answer: AV dissociation with independent atrial and ventricular rates

Complete heart block shows atria and ventricles beating independently with no relationship between P waves and QRS complexes.

Question 62: A 70-year-old with atrial fibrillation develops sudden painless monocular vision loss. Fundoscopy shows a pale, oedematous retina with a 'cherry red spot' at the fovea. What is the diagnosis?

Anterior ischaemic optic neuropathy
Central retinal artery occlusion (Correct answer)
Central retinal vein occlusion
Vitreous haemorrhage

Correct answer: Central retinal artery occlusion

Central retinal artery occlusion causes inner retinal ischaemia, producing a pale retina with a cherry red spot at the fovea where the choroidal circulation preserves the thinner foveal tissue.

Question 63: 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?

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

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 64: A 72-year-old complains of central vision distortion and sees straight lines as wavy (metamorphopsia). Fundoscopy reveals drusen deposits and pigmentary changes in the macula. What is the most likely diagnosis?

Optic neuritis
Diabetic maculopathy
Age-related macular degeneration (Correct answer)
Retinal detachment

Correct answer: Age-related macular degeneration

Age-related macular degeneration presents with central vision distortion, metamorphopsia, and drusen deposits on fundoscopy, predominantly affecting patients over 60 years.

Question 65: Which classification grades surgical complications by the therapy required to treat them?

TNM classification
Clavien-Dindo classification (Correct answer)
Glasgow score
ASA classification

Correct answer: Clavien-Dindo classification

The Clavien-Dindo system grades postoperative complications according to the intervention needed.

Question 66: Which feature most strongly suggests septic arthritis requiring urgent joint aspiration?

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

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

Radial nerve (Correct answer)
Ulnar nerve
Median nerve
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 68: 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
Cidofovir
Foscarnet
Valacyclovir (Correct answer)

Correct answer: Valacyclovir

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

Question 69: The Krebs cycle produces which of the following?

ATP
NADH
FADH
All of the mentioned (Correct answer)

Correct answer: All of the mentioned

The Krebs cycle (also known as the citric acid cycle) is a central metabolic pathway that produces several important molecules. It generates reduced coenzymes like NADH and FADH2, which carry electrons to the electron transport chain, and also produces a small amount of ATP (or GTP) directly through substrate-level phosphorylation.

Question 70: Which tumour marker is most useful for monitoring treatment response in colorectal cancer?

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

Correct answer: CEA (carcinoembryonic antigen)

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

Question 71: Which medication is used for medical management of postpartum haemorrhage due to atony when oxytocin is insufficient?

Terbutaline
Nifedipine
Magnesium sulfate
Ergometrine or carboprost (Correct answer)

Correct answer: Ergometrine or carboprost

Ergometrine and carboprost (a prostaglandin) are second-line uterotonics for atonic PPH.

Question 72: Which nutritional route is preferred in a postoperative patient with a functioning gut?

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

Correct answer: Enteral nutrition

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

Question 73: A 19-year-old presents with a non-blanching purpuric rash, fever, neck stiffness, and photophobia. What is the most urgent first action?

Give oral paracetamol and observe
Administer IV/IM benzylpenicillin or ceftriaxone immediately (Correct answer)
Arrange CT brain first
Take blood cultures and wait for results

Correct answer: Administer IV/IM benzylpenicillin or ceftriaxone immediately

Suspected meningococcal meningitis requires immediate parenteral antibiotics before further investigation.

Question 74: 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?

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

Correct answer: Atrial fibrillation

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

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

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

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 76: 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
Primordial prevention
Tertiary 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 77: Which type of shock is characterised by warm peripheries, hypotension and a high cardiac output?

Cardiogenic shock
Septic (distributive) shock (Correct answer)
Hypovolaemic shock
Obstructive shock

Correct answer: Septic (distributive) shock

Early septic shock causes vasodilation producing warm peripheries with a high-output state.

Question 78: 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 79: A 2-year-old presents with intermittent severe colicky abdominal pain, drawing up the legs, and 'redcurrant jelly' stools. What is the most likely diagnosis?

Constipation
Mesenteric adenitis
Appendicitis
Intussusception (Correct answer)

Correct answer: Intussusception

Paroxysmal colic, leg-drawing and redcurrant jelly stool are hallmarks of intussusception.

Question 80: 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:

Confounder (Correct answer)
Collider
Mediator
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 81: 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)
Ceftriaxone 250 mg IM once
Doxycycline 100 mg twice daily for 14 days
Azithromycin 1 g orally 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 82: 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?

Immediate androgen deprivation therapy (ADT)
Chemotherapy with docetaxel
Radical prostatectomy or external beam radiotherapy (Correct answer)
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 83: Which antibiotic class is first-line for treating pertussis?

Penicillins
Cephalosporins
Macrolides (e.g. azithromycin) (Correct answer)
Aminoglycosides

Correct answer: Macrolides (e.g. azithromycin)

Macrolides such as azithromycin are first-line for pertussis and reduce transmissibility.

Question 84: Which investigation is most useful to confirm a diagnosis of gout in a swollen joint?

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

Correct answer: Joint aspiration with polarised microscopy

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

Question 85: On the inner surface of bronchioles and fallopian tubules, epithelial tissues are ________.

Ciliated (Correct answer)
Glandular
Cuboidal
Squamous

Correct answer: Ciliated

Both the inner surface of bronchioles in the respiratory system and the fallopian tubules in the reproductive system are lined with ciliated epithelial tissue. The cilia are hair-like projections that rhythmically beat to move mucus and trapped particles out of the respiratory tract, and to propel the ovum in the fallopian tubes.

Question 86: A 5-day-old, exclusively breastfed, term infant is brought for review due to increasing jaundice. The baby is feeding well, has adequate urine output, and is otherwise well. The mother is blood group O positive and the baby is A positive. A serum bilirubin level is performed. Which of the following features would most strongly suggest a pathological cause for the jaundice, rather than physiological or breast milk jaundice?

The total serum bilirubin is 220 micromol/L.
The conjugated bilirubin component is 35 micromol/L. (Correct answer)
A positive Direct Antiglobulin Test (Coombs' test).
The jaundice was first noticed on day 3 of life.

Correct answer: The conjugated bilirubin component is 35 micromol/L.

A conjugated bilirubin level greater than 20% of the total, or an absolute value >20 micromol/L, is always considered pathological and requires urgent investigation to rule out causes like biliary atresia or neonatal hepatitis. Physiological jaundice typically appears after 24 hours and peaks around day 3-5. Breast milk jaundice can cause a prolonged unconjugated hyperbilirubinaemia but the conjugated fraction remains normal. A positive Coombs' test indicates haemolysis (e.g., ABO incompatibility), which is pathological, but a raised conjugated fraction points towards a different and often more urgent set of cholestatic pathologies. Given the options, cholestasis (indicated by high conjugated bilirubin) is a major red flag.

Question 87: 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 vivax
Plasmodium malariae

Correct answer: Plasmodium falciparum

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

Question 88: A 65-year-old presents with lymphocytosis (lymphocyte count 80 × 10⁹/L), smudge cells on peripheral blood film, and painless generalised lymphadenopathy. What is the most likely diagnosis?

Chronic lymphocytic leukaemia (Correct answer)
Acute lymphoblastic leukaemia
T-cell lymphoma
Hairy cell leukaemia

Correct answer: Chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia (CLL) presents with marked lymphocytosis, smudge cells on blood film, and indolent lymphadenopathy in older adults.

Question 89: A 25-year-old presents with fever, sore throat, lymphadenopathy, and a positive heterophile antibody (Monospot) test. Which virus is responsible?

Human herpesvirus 6
Cytomegalovirus
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 90: What is the first-line treatment for moderate croup?

Oral amoxicillin
Oral or nebulised corticosteroid (dexamethasone) (Correct answer)
Immediate intubation
Nebulised salbutamol

Correct answer: Oral or nebulised corticosteroid (dexamethasone)

A single dose of corticosteroid such as dexamethasone is first-line for croup of any severity.

Question 91: What is the mainstay of management for bronchiolitis in a hospitalised infant?

Supportive care with oxygen and feeding support (Correct answer)
Oral antibiotics
Nebulised salbutamol
Systemic corticosteroids

Correct answer: Supportive care with oxygen and feeding support

Bronchiolitis management is supportive—oxygen, hydration and feeding support—as bronchodilators and steroids are not beneficial.

Question 92: A patient bleeding massively receives a balanced transfusion. What ratio of products is commonly recommended?

4:1:0 red cells to plasma
1:1:1 red cells, plasma and platelets (Correct answer)
Platelets alone
Crystalloid only

Correct answer: 1:1:1 red cells, plasma and platelets

Massive transfusion protocols favour a balanced 1:1:1 ratio to prevent dilutional coagulopathy.

Question 93: A rhesus-negative mother delivers a rhesus-positive baby. What is required to prevent sensitisation?

No treatment is necessary
Exchange transfusion of the baby
Anti-D immunoglobulin within 72 hours (Correct answer)
Maternal blood transfusion

Correct answer: Anti-D immunoglobulin within 72 hours

Anti-D immunoglobulin given within 72 hours prevents maternal alloimmunisation against fetal RhD antigens.

Question 94: 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?

Radioactive iodine
Prednisolone
Carbimazole
Levothyroxine (Correct answer)

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 95: A 70-year-old man has a resting tremor, bradykinesia and cogwheel rigidity that began on one side. What is the most likely diagnosis?

Cerebellar tremor
Idiopathic Parkinson's disease (Correct answer)
Benign physiological tremor
Essential tremor

Correct answer: Idiopathic Parkinson's disease

Asymmetric resting tremor with bradykinesia and rigidity is the classic triad of idiopathic Parkinson's disease.

Question 96: A patient gives you an expensive gift after successful treatment. The most appropriate response is to:

Accept it only if cash
Accept any gift regardless of value
Use professional judgement; small tokens may be acceptable but large gifts risk compromising the relationship and should generally be declined (Correct answer)
Always refuse all gifts rudely

Correct answer: Use professional judgement; small tokens may be acceptable but large gifts risk compromising the relationship and should generally be declined

Modest tokens of thanks may be acceptable, but significant gifts can create obligations and undermine professional boundaries.

Question 97: A 22-year-old presents with foot drop and weakness of ankle dorsiflexion after sitting cross-legged for a prolonged period. Which nerve is most likely affected?

Common peroneal (fibular) nerve (Correct answer)
Tibial nerve
Sciatic nerve
Femoral nerve

Correct answer: Common peroneal (fibular) nerve

Compression of the common peroneal nerve at the fibular head causes foot drop and impaired dorsiflexion.

Question 98: Which medication should be avoided in a patient with an inferior STEMI complicated by right ventricular infarction and hypotension?

Glyceryl trinitrate (Correct answer)
Aspirin
Clopidogrel
Heparin

Correct answer: Glyceryl trinitrate

Nitrates reduce preload and can cause severe hypotension in preload-dependent right ventricular infarction.

Question 99: A 28-year-old at 34 weeks presents with painless, bright red vaginal bleeding. What is the most appropriate next step?

Oxytocin induction
Ultrasound to locate the placenta (Correct answer)
Digital vaginal examination
Immediate artificial rupture of membranes

Correct answer: Ultrasound to locate the placenta

Painless antepartum haemorrhage suggests placenta praevia, where ultrasound localisation must precede any vaginal examination.

Question 100: 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?

Packed red blood cells
0.9% Sodium Chloride (Correct answer)
4% Albumin solution
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 101: 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?

Atypical acute coronary syndrome (Correct answer)
Anxiety attack
Cholecystitis
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 102: A vaccine trial reports a relative risk reduction of 80%. If the unvaccinated risk is 10%, what is the absolute risk reduction?

2 percentage points
80 percentage points
20 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 103: 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?

A detailed explanation of the root cause analysis findings.
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)

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 104: Which paraneoplastic syndrome is most associated with small cell lung carcinoma causing hyponatraemia?

SIADH (Correct answer)
Carcinoid syndrome
Hypercalcaemia from PTHrP
Cushing syndrome from ectopic insulin

Correct answer: SIADH

Small cell lung cancer commonly causes SIADH, leading to hyponatraemia.

Question 105: A colleague appears to be drinking alcohol before clinical shifts and you have witnessed errors. What is your first professional obligation?

Wait for a patient to be harmed first
Address patient safety, which may require a mandatory notification to AHPRA (Correct answer)
Confront them publicly in front of patients
Ignore it to protect the colleague

Correct answer: Address patient safety, which may require a mandatory notification to AHPRA

Patient safety takes priority and impairment risking patients is notifiable conduct.

Question 106: A test's positive predictive value will increase if:

Disease prevalence increases (Correct answer)
Specificity decreases
The population becomes healthier
Sensitivity decreases

Correct answer: Disease prevalence increases

Higher prevalence increases the proportion of true positives among all positive tests, raising positive predictive value.

Question 107: A patient develops a wound dehiscence on day 7 with a 'pink serosanguinous discharge' preceding it. What is the next step?

Apply a tight adhesive dressing only
Start oral antibiotics and observe
Discharge home with reassurance
Cover with saline gauze and return to theatre for resuture (Correct answer)

Correct answer: Cover with saline gauze and return to theatre for resuture

Serosanguinous discharge heralds fascial dehiscence, which requires theatre resuture after a moist sterile dressing.

Question 108: Which prevention strategy targets the whole population rather than high-risk individuals?

High-risk strategy
Screening of contacts
Population (mass) strategy (Correct answer)
Tertiary rehabilitation

Correct answer: Population (mass) strategy

A population strategy aims to shift the entire risk distribution, as described by Geoffrey Rose.

Question 109: Which antibody is most specific for rheumatoid arthritis?

Rheumatoid factor
Anti-cyclic citrullinated peptide (anti-CCP) (Correct answer)
Antinuclear antibody (ANA)
Anti-dsDNA

Correct answer: Anti-cyclic citrullinated peptide (anti-CCP)

Anti-CCP antibodies are highly specific for rheumatoid arthritis.

Question 110: 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 111: A 28-year-old woman at 10 weeks gestation presents with severe nausea, vomiting, a uterus larger than expected for dates, and serum beta-hCG of 350,000 IU/L. Ultrasound shows a snowstorm appearance with no fetal parts. What is the most likely diagnosis?

Twin pregnancy
Partial hydatidiform mole
Choriocarcinoma
Complete hydatidiform mole (Correct answer)

Correct answer: Complete hydatidiform mole

The combination of markedly elevated beta-hCG, hyperemesis, uterus large for dates, and snowstorm appearance on ultrasound with absent fetal parts is classic for a complete hydatidiform mole (46,XX karyotype, entirely paternal origin). Partial moles have fetal/embryonic tissue. Choriocarcinoma typically follows a molar or other pregnancy rather than presenting de novo with this ultrasound pattern.

Question 112: 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)
Refuse to release anything to protect confidentiality
Destroy the records
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 113: Which organism is the most common cause of community-acquired pneumonia?

Legionella pneumophila
Streptococcus pneumoniae (Correct answer)
Mycoplasma pneumoniae
Staphylococcus aureus

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae is the most frequent pathogen in community-acquired pneumonia.

Question 114: Which of the following is considered a primary 'alarm' symptom in a patient with gastro-oesophageal reflux disease (GORD) that warrants urgent endoscopic investigation?

Dysphagia. (Correct answer)
Epigastric burning relieved by antacids.
Regurgitation after meals.
Waterbrash.

Correct answer: Dysphagia.

Dysphagia (difficulty swallowing) is a significant 'red flag' or 'alarm' symptom in patients with GORD. It may indicate a complication such as an oesophageal stricture or malignancy and requires urgent investigation, typically with an endoscopy. While the other symptoms are characteristic of GORD, they are not considered alarm features in the absence of other signs.

Question 115: Which skin finding is characteristic of dermatomyositis?

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

Correct answer: Heliotrope rash on the eyelids

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

Question 116: A 48-year-old presents with a unilateral facial droop affecting the forehead, with no limb weakness. What is the most likely diagnosis?

Bell's palsy (lower motor neurone facial palsy) (Correct answer)
Multiple sclerosis
Myasthenia gravis
Ischaemic stroke

Correct answer: Bell's palsy (lower motor neurone facial palsy)

Forehead involvement indicates a lower motor neurone facial palsy, most commonly idiopathic Bell's palsy.

Question 117: Which addition to standard therapy has been shown to reduce hospitalisation in HFrEF by inhibiting sodium-glucose co-transport?

SGLT2 inhibitor (Correct answer)
Ivabradine
Digoxin
Hydralazine alone

Correct answer: SGLT2 inhibitor

SGLT2 inhibitors such as dapagliflozin reduce heart failure hospitalisation regardless of diabetes status.

Question 118: A pregnant woman at 12 weeks has hyperemesis gravidarum. What complication should be screened for?

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

Correct answer: Electrolyte disturbance and ketosis

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

Question 119: A 16-year-old has recurrent intrusive thoughts of contamination and spends hours washing his hands, recognising the behaviour as excessive. What is the most likely diagnosis?

Schizophrenia
Obsessive-compulsive disorder (Correct answer)
Specific phobia
Generalised anxiety disorder

Correct answer: Obsessive-compulsive disorder

Intrusive obsessions and time-consuming compulsions that the person recognises as excessive define OCD.

Question 120: A patient with X-linked agammaglobulinemia (Bruton's disease) would be most susceptible to which type of infection?

Intracellular viral infections
Fungal infections
Encapsulated bacterial infections (Correct answer)
Parasitic infections

Correct answer: Encapsulated bacterial infections

Bruton's agammaglobulinemia causes absence of B cells and immunoglobulins, impairing opsonization of encapsulated bacteria such as Streptococcus pneumoniae and Haemophilus influenzae.

Question 121: Which finding is most consistent with an anastomotic leak after colorectal surgery on day 5?

Fever, tachycardia and peritonism (Correct answer)
Immediate brisk haematemesis
Isolated hyperkalaemia
Painless jaundice

Correct answer: Fever, tachycardia and peritonism

Anastomotic leaks typically present around day 5 with sepsis signs and peritoneal irritation.

Question 122: In a hospital-based case-control study investigating risk factors for acute pancreatitis, cases are patients admitted with the condition. The investigators select controls from the orthopaedic ward, consisting of patients admitted for elective knee replacement surgery. The study finds a strong association between high alcohol consumption and pancreatitis. Which type of bias is the most significant concern for the validity of these findings?

Selection bias (Correct answer)
Confounding
Recall bias
Observer bias

Correct answer: Selection bias

Selection bias is the most significant concern. The control group (elective knee replacement patients) is not representative of the general population from which the cases arose. This group may have different baseline characteristics, including different rates of alcohol consumption or other health behaviours, compared to the source population of the cases. This systematic difference in the selection of study groups can distort the true association between alcohol and pancreatitis.

Question 123: A 75-year-old woman is newly diagnosed with heart failure with a reduced ejection fraction (HFrEF) of 35%. She has a history of hypertension but no prior myocardial infarction. According to the 2018 National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand guidelines, which combination of medications is recommended as first-line therapy to improve survival?

A diuretic, digoxin, and a beta-blocker
A statin, an ACE inhibitor, and a diuretic
An angiotensin receptor blocker (ARB), a calcium channel blocker, and aspirin
An ACE inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist (MRA) (Correct answer)

Correct answer: An ACE inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist (MRA)

The 2018 Australian heart failure guidelines recommend a three-pronged approach for all patients with HFrEF to reduce mortality and hospitalisations. This includes an ACE inhibitor (or an ARB if not tolerated), a beta-blocker (specifically, carvedilol, bisoprolol, or metoprolol succinate), and a mineralocorticoid receptor antagonist (spironolactone or eplerenone). Diuretics are used for symptom control (fluid overload) but do not have a proven mortality benefit. Digoxin is a second-line agent for symptom control. Calcium channel blockers (like verapamil and diltiazem) are generally avoided in HFrEF. Statins are indicated for atherosclerotic disease, not primarily for HFrEF itself.

Question 124: A patient with cirrhosis develops confusion, asterixis, and elevated ammonia. What is the first-line treatment?

Intravenous albumin
Lactulose (Correct answer)
Spironolactone
Neomycin alone

Correct answer: Lactulose

Lactulose reduces ammonia absorption and is first-line therapy for hepatic encephalopathy.

Question 125: An elderly man develops fluctuating cognition, recurrent visual hallucinations and spontaneous parkinsonism. What is the most likely diagnosis?

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

Correct answer: Lewy body dementia

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

Question 126: 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?

Multiple system atrophy
Parkinson's disease (Correct answer)
Essential tremor
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 127: A child presents limping with hip pain and a recent viral illness, but is afebrile and well. What is the most likely diagnosis?

Septic arthritis
Transient synovitis (Correct answer)
Perthes disease
Slipped capital femoral epiphysis

Correct answer: Transient synovitis

Transient synovitis follows a viral illness, presenting with a limp in a well, afebrile child.

Question 128: A 60-year-old renal transplant recipient presents with fever and a rising serum creatinine 3 months post-transplant. CMV antigenemia assay is positive. What is the treatment of choice?

Acyclovir
Foscarnet
Ganciclovir (IV) or valganciclovir (oral) (Correct answer)
Cidofovir

Correct answer: Ganciclovir (IV) or valganciclovir (oral)

Ganciclovir IV or oral valganciclovir is the first-line treatment for CMV disease in transplant recipients.

Question 129: A trauma patient has distended neck veins, hypotension and muffled heart sounds. What is the diagnosis?

Cardiac tamponade (Correct answer)
Tension pneumothorax
Massive haemothorax
Neurogenic shock

Correct answer: Cardiac tamponade

Beck's triad of hypotension, raised JVP and muffled heart sounds indicates cardiac tamponade.

Question 130: 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?

Chronic myeloid leukaemia (CML)
Acute myeloid leukaemia (AML) (Correct answer)
Myelodysplastic syndrome
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 131: A 3-year-old presents with a 2-day history of vomiting and frequent watery diarrhoea. On examination, he is irritable and restless. His heart rate is 150/min, capillary refill time is 3 seconds, his eyes appear sunken, and he is crying with no tears. His mother reports he has not passed urine in over 10 hours. What is the most appropriate next step in management?

Commence oral rehydration solution at a rate of 10 mL/kg/hr for 4 hours.
Administer an immediate intravenous bolus of 20 mL/kg of 0.9% sodium chloride. (Correct answer)
Advise the mother to give diluted fruit juice and lemonade for rehydration.
Prescribe oral ondansetron and encourage small, frequent sips of clear fluids at home.

Correct answer: Administer an immediate intravenous bolus of 20 mL/kg of 0.9% sodium chloride.

The child is showing clear signs of severe dehydration (or shock), including irritability/lethargy, marked tachycardia, prolonged capillary refill, sunken eyes, absent tears, and oliguria/anuria. This constitutes a medical emergency. The immediate priority is to restore circulatory volume with an intravenous fluid bolus of 20 mL/kg of an isotonic crystalloid like 0.9% sodium chloride. Oral rehydration is appropriate for mild to moderate dehydration but is insufficient for a child with signs of circulatory compromise. Sugary drinks like fruit juice and lemonade are hyperosmolar and can worsen diarrhoea.

Question 132: A 24-year-old woman presents with a history of irregular menstrual cycles, occurring every 3 to 6 months, and significant acne. An ultrasound report notes that both ovaries have multiple small follicles. According to the Rotterdam criteria, which are widely used in Australia, what additional feature is required to diagnose Polycystic Ovary Syndrome (PCOS)?

Insulin resistance on a glucose tolerance test
Evidence of clinical or biochemical hyperandrogenism (Correct answer)
A luteinising hormone (LH) to follicle-stimulating hormone (FSH) ratio greater than 2:1
Body Mass Index (BMI) greater than 30 kg/m²

Correct answer: Evidence of clinical or biochemical hyperandrogenism

The Rotterdam criteria, which are standard for diagnosing PCOS in Australia, require the presence of two out of three of the following: 1) oligo- or anovulation (manifesting as irregular cycles), 2) clinical or biochemical signs of hyperandrogenism (e.g., hirsutism, severe acne, or elevated testosterone), and 3) polycystic ovaries on ultrasound. This patient already has oligo-ovulation (irregular cycles) and polycystic ovaries on ultrasound. Therefore, the third criterion, evidence of hyperandrogenism (in this case, her significant acne serves as a clinical sign), completes the diagnosis. While insulin resistance, an altered LH:FSH ratio, and obesity are common in PCOS, they are not part of the core diagnostic criteria.

Question 133: A 52-year-old woman presents with symmetrical pain and morning stiffness of the small joints of the hands lasting over an hour. Which antibody is most specific for the likely diagnosis?

Rheumatoid factor
Antinuclear antibody
Anti-CCP antibody (Correct answer)
Anti-dsDNA antibody

Correct answer: Anti-CCP antibody

Anti-CCP antibodies are highly specific for rheumatoid arthritis.

Question 134: A haemodynamically unstable patient with atrial fibrillation and hypotension requires which immediate treatment?

Intravenous adenosine
Synchronised DC cardioversion (Correct answer)
Oral digoxin
Watchful waiting

Correct answer: Synchronised DC cardioversion

Haemodynamic instability in AF mandates urgent synchronised electrical cardioversion.

Question 135: A 30-year-old woman presents with weight loss, heat intolerance, palpitations, and a fine tremor. Which finding most strongly suggests Graves disease specifically?

Exophthalmos (Correct answer)
Tachycardia
Weight loss
Warm peripheries

Correct answer: Exophthalmos

Exophthalmos (thyroid eye disease) is specific to Graves disease among causes of hyperthyroidism.

Question 136: A 72-year-old man with a known history of severe COPD is brought to the hospital with increased breathlessness, wheeze, and purulent sputum. He appears drowsy. His initial oxygen saturation on room air is 86%. According to the Thoracic Society of Australia and New Zealand (TSANZ) guidelines for acute oxygen use, what is the recommended target oxygen saturation (SpO2) range for this patient?

94-98%
92-96%
Above 98%
88-92% (Correct answer)

Correct answer: 88-92%

In patients with COPD and other conditions associated with chronic respiratory failure, there is a risk of worsening hypercapnia if excessive oxygen is administered. The Thoracic Society of Australia and New Zealand (TSANZ) guidelines recommend titrating oxygen to a target SpO2 range of 88–92% for these patients. This approach minimises the risk of suppressing the hypoxic respiratory drive and worsening respiratory acidosis, while still providing adequate oxygenation. The higher target of 92-96% is for patients without chronic respiratory failure.

Question 137: Which immunoglobulin class is primarily responsible for the secondary (anamnestic) immune response?

IgE
IgM
IgG (Correct answer)
IgA

Correct answer: IgG

IgG is the predominant antibody of the secondary immune response, providing long-lasting humoral immunity.

Question 138: A child with pyloric stenosis typically shows which biochemical abnormality?

Respiratory alkalosis
Hypochloraemic hypokalaemic metabolic alkalosis (Correct answer)
Metabolic acidosis with high anion gap
Hyperchloraemic acidosis

Correct answer: Hypochloraemic hypokalaemic metabolic alkalosis

Loss of gastric acid through vomiting produces a hypochloraemic, hypokalaemic metabolic alkalosis.

Question 139: Which of the following is the recommended target for low-density lipoprotein cholesterol (LDL-C) for secondary prevention in a patient who has had an acute coronary syndrome, according to the 2025 Australian clinical guidelines?

< 2.5 mmol/L
< 1.8 mmol/L
< 2.0 mmol/L
< 1.4 mmol/L and at least a 50% reduction from baseline (Correct answer)

Correct answer: < 1.4 mmol/L and at least a 50% reduction from baseline

The 2025 Australian clinical guideline for diagnosing and managing acute coronary syndromes recommends a more aggressive LDL-C target for secondary prevention. For patients post-ACS, the target is an LDL-C level of < 1.4 mmol/L and a reduction of at least 50% from the baseline level. This reflects evidence showing further benefit from achieving the lowest possible LDL-C levels in this high-risk population. The other options represent older, less stringent targets.

Question 140: A 29-year-old G1P0 at 40 weeks' gestation is in active labour. The cardiotocograph (CTG) shows a baseline fetal heart rate of 130 bpm, moderate variability, and repetitive, shallow decelerations where the nadir occurs after the peak of each contraction. What is the most appropriate immediate action?

Start an oxytocin infusion to augment labour
Continue routine monitoring as this is a normal pattern
Proceed immediately to an emergency caesarean section
Administer an intravenous fluid bolus and place the mother in a lateral position (Correct answer)

Correct answer: Administer an intravenous fluid bolus and place the mother in a lateral position

The CTG describes recurrent late decelerations, which are a sign of uteroplacental insufficiency and potential fetal hypoxia. The initial management involves intrauterine resuscitation measures aimed at improving placental blood flow and fetal oxygenation. These steps include changing maternal position (to left or right lateral to relieve aortocaval compression), administering an IV fluid bolus, and potentially reducing uterine activity (e.g., by stopping oxytocin if it is running). Immediate delivery is only indicated if these measures fail to resolve the non-reassuring pattern. This is not a normal pattern, and augmenting labour would likely worsen the fetal compromise.

Question 141: A 70-year-old presents with fatigue, bone pain, hypercalcaemia, and serum protein electrophoresis showing an M-spike. Bone marrow biopsy shows 30% plasma cells. What is the diagnosis?

Multiple myeloma (Correct answer)
Monoclonal gammopathy of undetermined significance (MGUS)
Chronic lymphocytic leukaemia
Waldenström macroglobulinaemia

Correct answer: Multiple myeloma

Multiple myeloma is defined by >10% clonal plasma cells in bone marrow plus end-organ damage (hypercalcaemia, renal failure, anaemia, or bone lesions — CRAB criteria).

Question 142: A 45-year-old woman presents with a 2-week history of epigastric pain, nausea, and early satiety. A urea breath test is positive for Helicobacter pylori. She has no known drug allergies. According to current Australian Therapeutic Guidelines, which of the following is the most appropriate first-line eradication therapy?

A proton pump inhibitor, clarithromycin, and metronidazole for 14 days.
Bismuth quadruple therapy for 14 days.
A proton pump inhibitor, amoxicillin, and metronidazole for 7 days.
A proton pump inhibitor, amoxicillin, and clarithromycin for 7-14 days. (Correct answer)

Correct answer: A proton pump inhibitor, amoxicillin, and clarithromycin for 7-14 days.

Current Australian guidelines recommend standard triple therapy as the first-line treatment for H. pylori eradication. This regimen consists of a proton pump inhibitor (PPI) combined with amoxicillin and clarithromycin. The recommended duration is typically 7 to 14 days, with 14 days potentially offering higher eradication rates. While other regimens exist, they are generally considered for second-line therapy or in areas with high clarithromycin resistance.

Question 143: Which finding is most characteristic of severe pre-eclampsia rather than gestational hypertension?

Isolated lower limb oedema
BP 140/90 mmHg with no proteinuria
BP 130/85 mmHg at term
Proteinuria with epigastric pain and visual disturbance (Correct answer)

Correct answer: Proteinuria with epigastric pain and visual disturbance

End-organ involvement such as epigastric pain and visual disturbance with proteinuria signifies severe pre-eclampsia.

Question 144: Which troponin pattern best supports an acute myocardial infarction rather than a chronic elevation?

A troponin that only rises after 24 hours without change
A rising and falling troponin with a significant delta (Correct answer)
An undetectable troponin
A stable persistently elevated troponin

Correct answer: A rising and falling troponin with a significant delta

A dynamic rise and fall in troponin distinguishes acute MI from chronic elevation seen in renal disease or heart failure.

Question 145: 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
Proton pump inhibitors for suspected laryngopharyngeal reflux
Antifungal therapy for presumed candidiasis
Microlaryngoscopy and biopsy under general anaesthesia (Correct answer)

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 146: A child presents with a barking cough, inspiratory stridor and hoarseness, worse at night. What is the most likely diagnosis?

Epiglottitis
Croup (laryngotracheobronchitis) (Correct answer)
Foreign body aspiration
Bacterial tracheitis

Correct answer: Croup (laryngotracheobronchitis)

A barking (seal-like) cough with stridor and hoarseness is characteristic of viral croup.

Question 147: A patient develops oliguria with urine output under 0.5 mL/kg/hr postoperatively. What is the first step?

Restrict all fluids
Start dialysis immediately
Assess volume status and give a fluid challenge if hypovolaemic (Correct answer)
Give a loop diuretic first-line

Correct answer: Assess volume status and give a fluid challenge if hypovolaemic

Postoperative oliguria is most often pre-renal, so volume assessment and a fluid challenge come first.

Question 148: When obtaining valid informed consent for surgery, which element is NOT required?

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

Correct answer: A guarantee of a successful outcome

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

Question 149: What is the first-line investigation for suspected polycystic ovary syndrome alongside clinical features?

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

Correct answer: Pelvic ultrasound and hormonal profile

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

Question 150: A 62-year-old woman, G2P2, who went through menopause 10 years ago, presents with a single episode of vaginal spotting. She is not on hormone replacement therapy and has a BMI of 32 kg/m². What is the most appropriate initial investigation to assess her risk of endometrial carcinoma?

Cervical HPV test
Serum CA-125 measurement
Diagnostic hysteroscopy with endometrial biopsy
Transvaginal ultrasound to measure endometrial thickness (Correct answer)

Correct answer: Transvaginal ultrasound to measure endometrial thickness

Postmenopausal bleeding (PMB) is a red flag for endometrial cancer, which must be excluded. A transvaginal ultrasound is the recommended initial investigation to measure endometrial thickness (ET). An ET of less than or equal to 4-5mm has a very high negative predictive value for endometrial cancer. If the endometrium is thickened, further investigation with an endometrial biopsy is warranted. While a cervical screening test is important, it doesn't assess the endometrium. Direct biopsy is usually a second-line investigation after imaging, and CA-125 is not a screening tool for endometrial cancer.

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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Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

amc.org.au — Eligibility, passing score, retake policy, test delivery, exam format, score validity, fees · verified Oct 2026
candidates.amc.org.au — Exam dates, registration deadline · verified Oct 2026