FACRRM Practice and Application 2 — Questions and Answers
Question 1: A rural GP is the only doctor within 200 km when a patient presents with acute ST-elevation MI. The nearest PCI-capable hospital is 3 hours away. What is the most appropriate initial management?
- Administer thrombolysis immediately if no contraindications (Correct answer)
- Arrange urgent helicopter transfer without any treatment
- Give aspirin only and observe for 30 minutes
- Perform pericardiocentesis to rule out pericarditis
Correct answer: Administer thrombolysis immediately if no contraindications
In STEMI with >2-hour expected transfer time to PCI, thrombolysis is the preferred reperfusion strategy if no contraindications exist.
Question 2: During an outreach clinic in a remote Aboriginal community, you identify a child with rheumatic heart disease. Which ongoing prophylaxis is most strongly recommended?
- Monthly benzathine penicillin G injections (Correct answer)
- Daily oral amoxicillin
- Weekly oral azithromycin
- No prophylaxis is required once the acute episode resolves
Correct answer: Monthly benzathine penicillin G injections
Benzathine penicillin G given every 28 days is the gold-standard secondary prophylaxis for rheumatic fever/rheumatic heart disease.
Question 3: A farmer presents with confusion, excessive salivation, miosis, and bradycardia after working with pesticides. Which antidote should be administered first?
- Atropine (Correct answer)
- Naloxone
- Flumazenil
- N-acetylcysteine
Correct answer: Atropine
Organophosphate poisoning causes cholinergic toxidrome; atropine competitively blocks muscarinic receptors and is the primary antidote.
Question 4: You are conducting a telehealth consultation for a patient 400 km away who describes symptoms consistent with appendicitis. What is the most appropriate next step?
- Arrange urgent retrieval to a surgical facility (Correct answer)
- Prescribe oral antibiotics and review in 48 hours
- Recommend watchful waiting with a clear liquid diet
- Order blood tests only and await results before acting
Correct answer: Arrange urgent retrieval to a surgical facility
Suspected appendicitis requires urgent surgical evaluation; delay risks perforation, and telehealth cannot replace physical examination and definitive surgery.
Question 5: A 60-year-old male in a rural community is found to have a blood pressure of 170/105 mmHg on three separate readings. He has no other comorbidities. Which agent is most appropriate as first-line pharmacotherapy?
- Amlodipine (Correct answer)
- Spironolactone
- Hydralazine
- Clonidine
Correct answer: Amlodipine
Calcium channel blockers such as amlodipine are recommended first-line antihypertensives for uncomplicated hypertension in most guidelines including Australian guidelines.
Question 6: A woman in a remote area at 34 weeks gestation presents with severe headache, visual disturbances, and BP 160/110 mmHg. What is the priority intervention before transfer?
- Administer magnesium sulfate and IV labetalol (Correct answer)
- Perform urgent cesarean section on-site
- Give oral nifedipine only and monitor for 4 hours
- Administer furosemide to reduce blood pressure
Correct answer: Administer magnesium sulfate and IV labetalol
Severe preeclampsia/eclampsia requires magnesium sulfate for seizure prophylaxis and IV antihypertensives to reduce maternal stroke risk before transfer.
Question 7: Which ethical framework is most relevant when a rural doctor must decide whether to perform a procedure outside their usual scope due to the absence of specialist services?
- Expanded scope of practice justified by patient need and competence (Correct answer)
- Strict scope adherence with refusal to perform the procedure
- Delegation to a nurse regardless of their training
- Waiting indefinitely for a specialist to become available
Correct answer: Expanded scope of practice justified by patient need and competence
FACRRM principles recognize that rural doctors may ethically expand scope of practice when patient need is urgent and the doctor has adequate competence.
FACRRM Practice and Application 2
A rural GP is the only doctor within 200 km when a patient presents with acute ST-elevation MI.
The nearest PCI-capable hospital is 3 hours away.
What is the most appropriate initial management?