FACRRM Practice and Application 3 — Questions and Answers
Question 1: A 45-year-old Indigenous woman presents with a deep facial laceration sustained in a remote community. She refuses suturing for cultural reasons. What is the most appropriate response?
- Respect her decision, document it, and offer wound closure alternatives such as steri-strips (Correct answer)
- Insist on suturing as it is medically necessary
- Sedate her to perform the procedure
- Discharge her without any wound care
Correct answer: Respect her decision, document it, and offer wound closure alternatives such as steri-strips
Informed refusal must be respected in a competent adult; offering culturally acceptable alternatives demonstrates patient-centered care.
Question 2: A child is brought to a remote clinic with burns covering approximately 15% BSA. Using the Parkland formula, what IV fluid should be given in the first 8 hours?
- Half of the total 24-hour Ringer's lactate calculated as 4 mL × kg × %BSA (Correct answer)
- The entire 24-hour volume of normal saline
- 5% dextrose at maintenance rate only
- No IV fluid until arrival at a burns unit
Correct answer: Half of the total 24-hour Ringer's lactate calculated as 4 mL × kg × %BSA
The Parkland formula gives 4 mL × kg × %TBSA of Ringer's lactate over 24 hours, with 50% in the first 8 hours post-burn.
Question 3: A patient in a rural community presents with a snakebite and progressive coagulopathy. The nearest antivenom is 2 hours away. Which immediate action is most important?
- Immobilize the limb with a pressure immobilization bandage and arrange urgent transfer (Correct answer)
- Apply a tourniquet to the affected limb
- Incise and suction the bite wound
- Administer heparin to prevent clot formation
Correct answer: Immobilize the limb with a pressure immobilization bandage and arrange urgent transfer
Pressure immobilization bandaging slows lymphatic spread of venom; tourniquet and incision are contraindicated in Australian snakebite management.
Question 4: A rural GP reviews a patient with poorly controlled type 2 diabetes (HbA1c 10.5%) who is reluctant to start insulin. What is the most appropriate approach?
- Explore barriers to insulin use, optimize oral agents, and set a shared glycemic goal with a clear review plan (Correct answer)
- Immediately commence insulin without further discussion
- Accept current control as the patient's choice and make no changes
- Refer only to an endocrinologist and provide no interim management
Correct answer: Explore barriers to insulin use, optimize oral agents, and set a shared glycemic goal with a clear review plan
Shared decision-making that addresses patient concerns while optimizing available therapy is the cornerstone of chronic disease management in rural practice.
Question 5: You are the only clinician when a patient in a remote location goes into cardiac arrest. Your automated external defibrillator (AED) indicates a shockable rhythm. What is the correct sequence?
- Deliver shock immediately, then resume CPR for 2 minutes before re-analyzing (Correct answer)
- Analyze rhythm for 3 minutes before shocking
- Give 3 stacked shocks before starting CPR
- Start CPR for 5 minutes before using the AED
Correct answer: Deliver shock immediately, then resume CPR for 2 minutes before re-analyzing
Current ALS guidelines recommend immediate defibrillation for shockable rhythms followed by 2 minutes of CPR before rhythm re-analysis.
Question 6: A 70-year-old man in a remote community presents with acute urinary retention. You have a urinary catheter kit available. After a failed attempt, what is the safest next step?
- Perform suprapubic catheterization if trained, or arrange urgent transfer (Correct answer)
- Repeat urethral catheterization attempts indefinitely
- Prescribe tamsulosin and discharge home
- Insert a nasogastric tube into the bladder
Correct answer: Perform suprapubic catheterization if trained, or arrange urgent transfer
If urethral catheterization fails in acute retention, suprapubic catheterization is the appropriate rescue if the clinician is competent; otherwise urgent transfer is required.
Question 7: Which of the following best describes the role of the Rural Generalist in the Australian health system?
- A doctor with broad generalist skills plus an advanced skill set relevant to their community's needs (Correct answer)
- A specialist who has retrained to work only in emergency medicine
- A GP restricted to primary care consultations only
- A doctor who works exclusively in Indigenous health
Correct answer: A doctor with broad generalist skills plus an advanced skill set relevant to their community's needs
The Rural Generalist model combines comprehensive general practice with community-specific advanced skills such as anaesthesia, obstetrics, or emergency medicine.
FACRRM Practice and Application 3
A 45-year-old Indigenous woman presents with a deep facial laceration sustained in a remote community.
She refuses suturing for cultural reasons.
What is the most appropriate response?