FRACGP Core Knowledge and Fundamentals 3 — Questions and Answers
Question 1: A 5-year-old boy presents with a widespread vesicular rash, fever, and intense pruritus. His mother reports he received the first dose of varicella vaccine 2 months ago. The MOST appropriate next step is:
- Symptomatic treatment and advise isolation until all lesions crust (Correct answer)
- Administer a second varicella vaccine dose immediately
- Start IV aciclovir empirically
- Reassure the family that the vaccine prevents all infection
Correct answer: Symptomatic treatment and advise isolation until all lesions crust
Breakthrough varicella in vaccinated individuals is usually mild and self-limiting; management is symptomatic with isolation until lesions crust to prevent spread.
Question 2: Which spirometry pattern is MOST consistent with a diagnosis of asthma that responds to bronchodilator therapy?
- Obstructive pattern with ≥12% and 200 mL improvement in FEV₁ after bronchodilator (Correct answer)
- Restrictive pattern with reduced TLC
- Obstructive pattern with no bronchodilator response
- Normal spirometry with reduced DLCO
Correct answer: Obstructive pattern with ≥12% and 200 mL improvement in FEV₁ after bronchodilator
Asthma is confirmed by a reversible obstructive defect showing ≥12% and ≥200 mL increase in FEV₁ post-bronchodilator according to GINA criteria.
Question 3: A 68-year-old woman with type 2 diabetes and CKD stage 3b (eGFR 32 mL/min/1.73m²) needs glucose-lowering therapy adjustment. Which agent should be STOPPED or avoided at this eGFR?
- Metformin (Correct answer)
- Linagliptin
- Insulin glargine
- Empagliflozin (at lower doses)
Correct answer: Metformin
Metformin is contraindicated when eGFR falls below 30 and should be used with caution below 45 mL/min due to lactic acidosis risk.
Question 4: A 28-year-old woman presents at 10 weeks gestation with nausea, vomiting, and a uterus larger than dates. Her β-hCG is markedly elevated and ultrasound shows a 'snowstorm' appearance. The MOST likely diagnosis is:
- Complete hydatidiform mole (Correct answer)
- Incomplete hydatidiform mole
- Twins with placenta previa
- Hydropic abortion
Correct answer: Complete hydatidiform mole
A complete hydatidiform mole presents with a markedly elevated β-hCG, snowstorm ultrasound appearance, and uterus large for dates due to trophoblastic proliferation.
Question 5: In the management of an acute gout flare in a patient with CKD stage 4, which of the following is the PREFERRED first-line anti-inflammatory treatment?
- Low-dose colchicine (with dose adjustment) or prednisolone (Correct answer)
- Full-dose NSAIDs
- Allopurinol initiation during the acute flare
- Febuxostat at standard dose
Correct answer: Low-dose colchicine (with dose adjustment) or prednisolone
NSAIDs are contraindicated in advanced CKD; low-dose colchicine (renally adjusted) or oral corticosteroids are preferred for acute gout in this setting.
Question 6: A GP is reviewing a 55-year-old man with newly diagnosed hypertension. His BP is 158/96 mmHg on two readings. He has no other comorbidities. According to Australian guidelines, what is the FIRST recommended action?
- Lifestyle modification for 3–6 months before pharmacotherapy if no end-organ damage (Correct answer)
- Immediate dual antihypertensive therapy
- Referral to a cardiologist for further assessment
- 24-hour ambulatory BP monitoring before any intervention
Correct answer: Lifestyle modification for 3–6 months before pharmacotherapy if no end-organ damage
For stage 1–2 hypertension without end-organ damage, Australian guidelines recommend a trial of lifestyle modification (3–6 months) before initiating pharmacotherapy.
Question 7: Which of the following correctly describes the mechanism of action of bupropion when used for smoking cessation?
- Noradrenaline and dopamine reuptake inhibition reducing nicotine cravings (Correct answer)
- Partial agonism at nicotinic acetylcholine receptors
- Full agonism at nicotinic acetylcholine receptors
- Serotonin reuptake inhibition
Correct answer: Noradrenaline and dopamine reuptake inhibition reducing nicotine cravings
Bupropion inhibits noradrenaline and dopamine reuptake, reducing craving and withdrawal symptoms by modulating the reward pathway involved in nicotine dependence.
FRACGP Core Knowledge and Fundamentals 3
A 5-year-old boy presents with a widespread vesicular rash, fever, and intense pruritus.
His mother reports he received the first dose of varicella vaccine 2 months ago.
The MOST appropriate next step is: