FRACGP Practice and Application 3 — Questions and Answers
Question 1: A 22-year-old university student presents requesting a medical certificate for exam deferral due to anxiety. The GP has only seen them once before. What is the most appropriate approach?
- Issue the certificate immediately to avoid distress
- Assess the clinical situation thoroughly before deciding whether a certificate is appropriate (Correct answer)
- Refuse as it is outside the GP's scope
- Contact the university directly without the patient's consent
Correct answer: Assess the clinical situation thoroughly before deciding whether a certificate is appropriate
GPs must clinically assess the patient before issuing a certificate, as certifying without adequate assessment is unprofessional conduct.
Question 2: A 65-year-old man with atrial fibrillation has a CHA₂DS₂-VASc score of 3. Which management is most appropriate?
- Aspirin 100 mg daily for stroke prevention
- Oral anticoagulation with a DOAC or warfarin (Correct answer)
- Rate control only with no anticoagulation required
- Electrical cardioversion as first priority
Correct answer: Oral anticoagulation with a DOAC or warfarin
A CHA₂DS₂-VASc score ≥2 in males warrants anticoagulation; DOACs are preferred over aspirin for stroke prevention in AF.
Question 3: A breastfeeding mother asks whether she can take ibuprofen for post-partum perineal pain. What is the most accurate advice?
- Ibuprofen is contraindicated and should be avoided entirely during breastfeeding
- Ibuprofen is compatible with breastfeeding at standard doses due to low milk transfer (Correct answer)
- Ibuprofen should be replaced with high-dose aspirin as a safer alternative
- All NSAIDs are equally unsafe; only paracetamol may be used
Correct answer: Ibuprofen is compatible with breastfeeding at standard doses due to low milk transfer
Ibuprofen has very low transfer into breast milk and is considered compatible with breastfeeding at standard doses.
Question 4: A GP is reviewing a 70-year-old woman's medications and identifies potential prescribing cascade. Which scenario best illustrates this concept?
- Prescribing two antihypertensives simultaneously
- Prescribing a proton pump inhibitor to treat NSAID-induced dyspepsia (Correct answer)
- Reducing metformin dose due to declining renal function
- Adding a statin after a new cardiovascular risk assessment
Correct answer: Prescribing a proton pump inhibitor to treat NSAID-induced dyspepsia
A prescribing cascade occurs when a side effect of one drug is misidentified as a new condition and treated with another drug.
Question 5: During a home visit, a GP discovers a patient's advance care directive refuses blood transfusions. The patient is now unconscious following trauma. What should the GP do?
- Administer the transfusion as the patient cannot consent in the moment
- Respect the directive as a valid expression of the patient's autonomous wishes (Correct answer)
- Contact next of kin to override the directive
- Disregard the directive because the patient's life is at risk
Correct answer: Respect the directive as a valid expression of the patient's autonomous wishes
A valid advance care directive representing a capacitated decision must be respected, even if this leads to the patient's death.
Question 6: A 50-year-old male smoker with a 30 pack-year history presents for a health check. He has no respiratory symptoms. What lung cancer screening is currently recommended in Australia?
- Annual chest X-ray for all smokers over 45
- Low-dose CT chest as part of a funded national screening program
- No routine lung cancer screening is currently recommended in Australia (Correct answer)
- Sputum cytology every 2 years for heavy smokers
Correct answer: No routine lung cancer screening is currently recommended in Australia
Australia does not yet have a funded national lung cancer screening program, although evidence supports low-dose CT in high-risk individuals.
Question 7: A GP is managing a patient with major depressive disorder who has not responded to two adequate antidepressant trials. What is the most appropriate next step?
- Increase the current antidepressant dose to maximum possible level
- Refer to a psychiatrist for assessment of treatment-resistant depression (Correct answer)
- Discontinue all medications and monitor for 3 months
- Add a benzodiazepine for adjunctive treatment
Correct answer: Refer to a psychiatrist for assessment of treatment-resistant depression
Failure to respond to two adequate antidepressant trials meets criteria for treatment-resistant depression, warranting psychiatric referral.
FRACGP Practice and Application 3
A 22-year-old university student presents requesting a medical certificate for exam deferral due to anxiety.
The GP has only seen them once before.
What is the most appropriate approach?