AMC MCQ Practice Test 3 — Questions and Answers
Question 1: A 70-year-old woman on warfarin presents with an INR of 8.0 but no bleeding. What is the most appropriate management?
- Withhold warfarin and give oral vitamin K (Correct answer)
- Continue warfarin unchanged
- Give fresh frozen plasma
- Administer prothrombinex immediately
Correct answer: Withhold warfarin and give oral vitamin K
For a high INR without bleeding, withholding warfarin and giving low-dose oral vitamin K is appropriate.
Question 2: A 28-year-old pregnant woman at 30 weeks presents with a blood pressure of 160/110 and proteinuria. What is the diagnosis?
- Pre-eclampsia (Correct answer)
- Gestational hypertension
- Chronic hypertension
- Eclampsia
Correct answer: Pre-eclampsia
New-onset hypertension with proteinuria after 20 weeks defines pre-eclampsia.
Question 3: A 50-year-old man has sudden onset of a painful, swollen, red first metatarsophalangeal joint. Joint aspiration shows negatively birefringent needle-shaped crystals. What is the diagnosis?
- Gout (Correct answer)
- Pseudogout
- Septic arthritis
- Rheumatoid arthritis
Correct answer: Gout
Negatively birefringent needle-shaped crystals confirm monosodium urate deposition, i.e. gout.
Question 4: A 3-year-old child swallows a button battery seen lodged in the oesophagus on X-ray. What is the most appropriate management?
- Urgent endoscopic removal (Correct answer)
- Observe and repeat X-ray in 24 hours
- Give oral laxatives
- Reassure and discharge
Correct answer: Urgent endoscopic removal
An oesophageal button battery requires urgent endoscopic removal to prevent caustic mucosal injury.
Question 5: A 40-year-old woman presents with fatigue, constipation, dry skin, and cold intolerance. Her TSH is elevated and free T4 is low. What is the diagnosis?
- Primary hypothyroidism (Correct answer)
- Secondary hypothyroidism
- Subclinical hyperthyroidism
- Sick euthyroid syndrome
Correct answer: Primary hypothyroidism
A high TSH with low free T4 indicates primary hypothyroidism.
Question 6: A 19-year-old presents with a non-blanching purpuric rash, fever, neck stiffness, and photophobia. What is the most urgent first action?
- Administer IV/IM benzylpenicillin or ceftriaxone immediately (Correct answer)
- Arrange CT brain first
- Take blood cultures and wait for results
- Give oral paracetamol and observe
Correct answer: Administer IV/IM benzylpenicillin or ceftriaxone immediately
Suspected meningococcal meningitis requires immediate parenteral antibiotics before further investigation.
Question 7: A 55-year-old man presents with painless obstructive jaundice, weight loss, and a palpable non-tender gallbladder. Which finding is described as Courvoisier's sign?
- Palpable non-tender gallbladder with jaundice (Correct answer)
- Right upper quadrant tenderness
- Murphy's sign positivity
- Rebound tenderness
Correct answer: Palpable non-tender gallbladder with jaundice
Courvoisier's law states a palpable non-tender gallbladder with jaundice is unlikely to be due to gallstones, suggesting malignancy.
AMC MCQ Practice Test 3
A 70-year-old woman on warfarin presents with an INR of 8.0 but no bleeding.
What is the most appropriate management?