FRACGP Practice and Application 2 — Questions and Answers
Question 1: A 58-year-old male with type 2 diabetes presents with a foot ulcer. Which feature most indicates the need for urgent hospital referral?
- Superficial ulcer with intact skin margins
- Signs of systemic sepsis with fever and rigors (Correct answer)
- Callus formation around the ulcer edges
- Sensory neuropathy confirmed on monofilament testing
Correct answer: Signs of systemic sepsis with fever and rigors
Systemic sepsis from a diabetic foot infection requires urgent hospitalisation for IV antibiotics and surgical assessment.
Question 2: A GP is prescribing opioids for chronic non-cancer pain. Which practice best aligns with Australian prescribing guidelines?
- Initiate long-acting opioids as first-line therapy
- Set clear functional goals and review regularly for efficacy and harms (Correct answer)
- Avoid urine drug screening as it damages the therapeutic relationship
- Prescribe indefinitely once pain control is achieved
Correct answer: Set clear functional goals and review regularly for efficacy and harms
Australian guidelines recommend setting functional goals, using the lowest effective dose, and regularly reviewing for benefit and harm.
Question 3: During a cervical screening consultation, a 35-year-old woman asks about the new Australian cervical screening program. What is the recommended primary test?
- Annual Pap smear
- HPV DNA test every 5 years (Correct answer)
- Liquid-based cytology every 2 years
- Colposcopy as baseline assessment
Correct answer: HPV DNA test every 5 years
Since 2017, Australia replaced the 2-yearly Pap smear with a 5-yearly HPV DNA test as the primary cervical screening method.
Question 4: A 4-year-old child is brought in with a 2-day history of barking cough and mild stridor at rest. What is the most appropriate initial management?
- Oral amoxicillin for 5 days
- Single dose of oral dexamethasone (Correct answer)
- Immediate hospital admission for nebulised adrenaline
- Chest X-ray to exclude foreign body
Correct answer: Single dose of oral dexamethasone
Mild to moderate croup (stridor at rest without severe distress) is treated with a single oral dose of dexamethasone.
Question 5: A GP suspects elder abuse in a 78-year-old patient whose adult son accompanies all appointments. What is the most appropriate immediate action?
- Immediately contact police without consulting the patient
- Arrange to see the patient alone to assess safety and preferences (Correct answer)
- Document suspicions but take no action to avoid family conflict
- Notify adult protective services without the patient's knowledge
Correct answer: Arrange to see the patient alone to assess safety and preferences
The first step is to see the patient privately to assess their safety, capacity, and wishes while maintaining a therapeutic relationship.
Question 6: A 42-year-old woman presents with a 3-month history of fatigue, weight gain, and cold intolerance. TSH is 12 mIU/L and free T4 is low. What is the most appropriate management?
- Repeat TSH in 6 months before treating
- Commence levothyroxine and titrate to normalise TSH (Correct answer)
- Refer to endocrinology before initiating any treatment
- Prescribe liothyronine (T3) as monotherapy
Correct answer: Commence levothyroxine and titrate to normalise TSH
Overt hypothyroidism with elevated TSH and low free T4 warrants levothyroxine replacement, titrated to achieve a normal TSH.
Question 7: When applying the RACGP 'red flags' framework during a consultation, what is the primary purpose of identifying red flags?
- To justify requesting extensive investigations for all presentations
- To identify features that raise concern for serious underlying pathology requiring urgent action (Correct answer)
- To document medico-legal protection in case of adverse outcomes
- To determine whether referral to a specialist is cost-effective
Correct answer: To identify features that raise concern for serious underlying pathology requiring urgent action
Red flags are clinical features that suggest serious or life-threatening pathology, prompting timely investigation or referral.
FRACGP Practice and Application 2
A 58-year-old male with type 2 diabetes presents with a foot ulcer.
Which feature most indicates the need for urgent hospital referral?