Mixed Deck — All AMC MCQ Topics Flashcards

A 55-year-old woman with rheumatoid arthritis on long-term NSAIDs develops a rising creatinine, sterile pyuria, eosinophiluria and a rash. What is the most likely renal diagnosis?

Answer: Acute interstitial nephritis

Drug-induced acute interstitial nephritis classically presents with rash, eosinophiluria and rising creatinine.

A 70-year-old woman has a new headache, scalp tenderness, jaw claudication and a raised ESR. What is the most appropriate immediate management?

Answer: Start high-dose corticosteroids immediately

Suspected giant cell arteritis requires immediate corticosteroids to prevent irreversible blindness, without waiting for biopsy.

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?

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.

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?

Answer: Serotonin syndrome

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

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?

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.

In the WHO surgical safety checklist, when is the 'time out' performed?

Answer: Before skin incision

The 'time out' occurs immediately before incision to confirm patient, site and procedure.

A 58-year-old man with type 2 diabetes has an eGFR of 45 mL/min and a urine albumin-to-creatinine ratio of 80 mg/mmol. Which medication class provides the strongest renoprotection in addition to glycaemic control?

Answer: SGLT2 inhibitor

SGLT2 inhibitors slow progression of diabetic kidney disease and reduce albuminuria independent of glucose lowering.

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?

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.

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

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.

A diagnostic test has a positive likelihood ratio of 10. This means a positive result:

Answer: Substantially increases the probability of disease

A likelihood ratio of 10 markedly raises post-test probability and strongly supports the diagnosis.

A young adult presents with an oval 'herald patch' followed days later by a 'Christmas tree' distribution of scaly lesions on the trunk. What is the diagnosis?

Answer: Pityriasis rosea

A herald patch followed by a fir-tree pattern is classic for pityriasis rosea.

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?

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.

According to the Wilson and Jungner criteria, which of the following is an essential principle for a successful and ethical population-based screening program?

Answer: There should be an accepted and available treatment for the condition if detected.

A core principle of screening is that there must be an effective and accessible treatment for individuals diagnosed with the condition. Screening for a disease for which no effective treatment exists would provide little benefit to the individual or the population and could cause unnecessary anxiety and harm.

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

Answer: Tissue hypoperfusion

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

A 50-year-old presents with sudden severe eye pain, nausea, vomiting, and halos around lights. The eye is red with a mid-dilated fixed pupil and corneal haze. What is the immediate first-line management?

Answer: Oral acetazolamide and topical beta-blockers

Acute angle-closure glaucoma is an emergency requiring immediate IOP reduction with systemic acetazolamide and topical agents such as beta-blockers and pilocarpine to prevent permanent vision loss.

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?

Answer: About 20 per 1000

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

A 55-year-old woman presents to her GP with a 4-day history of cough productive of purulent sputum, fever, and right-sided chest pain. A chest X-ray confirms a right lower lobe consolidation. She has no significant comorbidities, has not been hospitalised recently, and has no known risk factors for atypical pathogens. Which of the following is the most appropriate oral antibiotic for the outpatient management of her non-severe community-acquired pneumonia (CAP)?

Answer: Amoxicillin

For non-severe community-acquired pneumonia in an adult without significant comorbidities, Australian therapeutic guidelines recommend amoxicillin as the first-line oral antibiotic. This provides excellent coverage for Streptococcus pneumoniae, the most common causative organism. Doxycycline or a macrolide would be considered if atypical pathogens are suspected or in cases of penicillin allergy. Ciprofloxacin has poor activity against S. pneumoniae and is not recommended for routine CAP management.

What is the recommended door-to-balloon time target for primary percutaneous coronary intervention in STEMI?

Answer: Within 90 minutes

Primary PCI should be performed within 90 minutes of first medical contact for best outcomes.

In the lungs, the partial pressure of oxygen is ______________.

Answer: 100 mm Hg

In the alveoli of the lungs, the partial pressure of oxygen (PO2) is approximately 100 mm Hg. This high partial pressure creates a steep gradient, driving oxygen from the alveoli across the respiratory membrane into the pulmonary capillaries, where the PO2 of deoxygenated blood is much lower.

Which investigation is first-line for a haemodynamically unstable patient with blunt abdominal trauma?

Answer: FAST ultrasound

FAST ultrasound rapidly detects free fluid at the bedside in unstable trauma patients.