Professional Documents
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C H O I C E Q U E S T I O N E X A M I N AT I O N S P E C I F I C AT I O N S
A u s t r a l i a n
M e d i c a l
C o u n c i l
The purpose of the Australian Medical Council is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian Community.
The purpose of the Australian Medical Council is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community.
September 2008 Edition 7 First Printing ABN 97 131 796 980 ISSN 1325-426X Copyright for this publication rests with the Australian Medical Council Limited Australian Medical Council Limited PO Box 4810 KINGSTON ACT 2604
STATEMENT ON PRIVACY
The AMC is required to observe the provisions of the Privacy Amendment (Private Sector) Act 2000 (effective from 21 December 2001) which sets out the requirements for the collection and use of personal information collected before and after that date. Each of the application forms required by the AMC includes a statement relating to the AMCs privacy procedures. Each must be signed by the applicant to give formal consent for the AMC to collect and hold personal information. If the consent is not provided, the AMC will not be able to process the application.
Table of Contents
GUIDELINES AND SPECIFICATIONS ............................................................... 1
INTRODUCTION ..................................................................................................................1 ASSESSMENT AIMS AND OBJECTIVES ............................................................................1 STRUCTURE OF THE AMC EXAMINATION .......................................................................1 STANDARD OF THE AMC EXAMINATIONS........................................................................2 FORMAT ...............................................................................................................................2 MCQ examination ........................................................................................................2
STRATEGIES FOR ANSWERING MULTIPLE CHOICE QUESTIONS ..............................11 Type A questions (one out of ve correct) ..................................................................11 Photographic or data interpretation questions ...........................................................11 SCHEDULING FOR THE MCQ EXAMINATION.................................................................12 Change of venue ........................................................................................................12 Withdrawal fees ..........................................................................................................12 CONDUCT OF CANDIDATES PRESENTING FOR THE AMC MCQ EXAMINATION .......13 THE AMC COMPUTER-ADMINISTERED MCQ EXAMINATION .......................................13 MCQ RESULTS ..................................................................................................................14 Ofcial transcript of results and feedback on performance ........................................14 REQUEST FOR DUPLICATE COPIES OF AMC RESULTS ..............................................14
APPENDIX A ..................................................................................................... 19
ATTRIBUTES OF MEDICAL GRADUATES ........................................................................19 Knowledge and understanding...................................................................................19 Skills ...........................................................................................................................20 Attitudes as they affect professional behaviour..........................................................21
APPENDIX B..................................................................................................... 22
SAMPLE QUESTIONS .......................................................................................................22 AMC MCQ examination part 1 ................................................................................22 AMC MCQ examination part 2 ................................................................................22 Mastery questions ......................................................................................................22 Photographic questions..............................................................................................22 PART 1 SAMPLE MCQ EXAMINATION ..........................................................................23 PART 2 SAMPLE MCQ EXAMINATION ..........................................................................28 CORRECT RESPONSES FOR SAMPLE PART 1 & PART 2 .............................................34
APPENDIX C..................................................................................................... 35
GLOSSARY OF MEDICAL TERMS USED IN MULTIPLE CHOICE QUESTIONS .............35
APPENDIX D..................................................................................................... 36
ESSENTIAL READING .......................................................................................................36 AMC Handbook of Clinical Assessment (published 2007) .................................................36 AMC Annotated Multiple Choice Questions (published 1997) ...........................................36 AMC Anthology of Medical Conditions (published 2003, reprinted and revised 2008).......36 SUGGESTED TEXTBOOKS ..............................................................................................37 MISCELLANEOUS .............................................................................................................38 JOURNALS .........................................................................................................................39
Candidates should study these guidelines in conjunction with the current AMC publication Application Procedures and Requirements for the AMC Examination, which sets out the formal procedures for the AMC examination.
The objectives (Attributes of Medical Graduates) are listed in APPENDIX A. In undergraduate courses, these are assessed over several years in a variety of ways, whereas the AMC assessment is conducted through a MCQ examination and a clinical examination.
FORMAT
MCQ EXAMINATION
The AMC MCQ examination is an integrated examination over a total of 7 hours, consisting of 300 questions covering a range of conditions in the broad disciplines of: paediatrics medicine obstetrics and gynaecology psychiatry surgery.
Candidates are required to attain a pass standard in the MCQ examination in order to proceed to the clinical examination. The AMC is not able to provide individual supplementary MCQ examinations to candidates who fail to meet the pass standard.
Some questions in the MCQ examination will test basic or essential knowledge and understanding of topics covered by the examination. Other questions will require more insight and will test the candidates capacity to distinguish between the correct diagnosis and plausible alternatives. Questions may contain illustrations of X-rays, electrocardiograms (ECGs), scans, clinical photographs and other visual material. In general, the MCQ examination will test a candidates capacity for reasoning rather than rote learning.
The 60 non-scored questions are used to test and calibrate new questions, which may be used in future examinations, but will not be counted towards the overall score of the candidate. A total of 80 questions within the 240 scored questions (e.g. approximately one-third of the questions) in the examination are mastery questions which are individually identified to candidates throughout the examination. APPENDIX B. The mastery questions are defined as key or critical issue questions which are regarded as critical to the safety or clinical outcome or threat to life for the patient, or are based upon important common conditions and one of: A. B. C. D. Related to life threatening illness; or Critical to safe practice (includes professionalism); or Successful clinical outcome; or Important aspects of public health.
The content of the MCQ examination is determined and set by the AMC Board of Examiners prior to each examination. The following topics illustrate the range of conditions and topics that MAY be covered in the AMC MCQ examination.
2. 3.
nerves, cerebrospinal fluid, spinal cord, peripheral nerves, regional anaesthesia and autonomic nervous system.
4. MUSCULOSKELETAL / ORTHOPAEDICS / RHEUMATOLOGY May include: bones, joints, ligaments, muscles, tendons, physical medicine, trauma, geriatrics, rehabilitation. CIRCULATORY SYSTEM / HEART / VESSELS May include: heart, circulation, hypertension, haemorrhage, shock, pericardium, great vessels, peripheral arteries, veins, lymphatics. RESPIRATORY SYSTEM / LUNGS / CHEST WALL May include:
5.
6.
respiration, mechanics of gas exchange and transport, lungs, bronchial tree, mediastinum, chest, chest wall.
7. GASTROINTESTINAL SYSTEM / ABDOMEN / ABDOMINAL WALL
May include: digestion and excretion, oesophagus and diaphragm, stomach, duodenum, small bowel, colon, appendix, rectum, anus, peritoneal cavity, acute abdomen, liver, biliary tree, pancreas, pelvic floor, perineum, abdominal wall, hernias, inguinoscrotal region.
8. BREAST / ENDOCRINE SYSTEM May include: breast, pituitary, thyroid, parathyroid, calcium, bone metabolism, adrenal, diabetes and pancreatic islets, gut hormones, neuroendocrine interactions, metabolic responses to injury. FEMALE REPRODUCTIVE SYSTEM / OBSTETRICS GYNAECOLOGY
9.
May include: female reproductive system, disorders of uterus, tubes, ovaries, vagina, fertility, contraception, hormones, menstruation, obstetrics, pregnancy, labour, abortion, eclampsia, obstetrical haemorrhage, menopause, pelvic infection, vaginal discharge, pruritus, gynaecological malignancies.
10. HAEMOPOIETIC SYSTEM / HAEMATOLOGY / BLOOD / BLOOD PRODUCTS May include: blood cells, proteins, blood products
and transfusion, fat embolism, bone marrow and blood production, coagulation and anticoagulation, haemolysis, haemostasis, bleeding disorders.
11. RENAL SYSTEM / UROLOGY / MALE REPRODUCTIVE SYSTEM May
include: fluid and electrolyte renal homeostasis, nephrology, renal function, urology, urinary collecting system, disorders of kidneys, bladder, prostate, male reproductive system, disorders of testis, epididymis, penis.
12. MENTAL STATE / INTELLECTUAL FUNCTION / BEHAVIOURAL PROBLEMS May include: mental deficiency, personality disorders,
psychosomatic and psychosocial problems. 13. MAJOR PSYCHIATRIC DISORDERS / DRUG & ALCOHOL ABUSE May include: anxiety disorders, mood disorders, psychosis, organic brain disorders, alcoholism, substance abuse.
14. NORMAL AND ABNORMAL GROWTH AND DEVELOPMENT / CHILD HEALTH / PAEDIATRICS May include: genetics, embryology, normal
normal fluid and electrolyte balance and disorders, acid-base balance and disorders.
16. INFECTIOUS DISEASES May include: bacterial infectious diseases,
pharmacology and pharmacokinetic, psycho-pharmacology, therapeutics, synaptic transmission, toxicity and poisoning.
18. CLINICAL ONCOLOGY May include: histology and ultrastructure,
disordered cell growth, degeneration, calcification, neoplasia, medical and surgical oncology, radiotherapy, chemotherapy, immunotherapy.
19. CLINICAL IMMUNOLOGY May include: lymph nodes and lymphatics,
immunology, transplantation, spleen and reticulo-endothelial system, allergy, immune deficiency disorders.
20. CRITICAL CARE / ANAESTHESIA / EMERGENCY MEDICINE May
include: general, regional and local anaesthesia and analgesia, consciousness, pre- and post-operative care, perioperative pain relief and complications, trauma, emergency medicine, intensive care.
21. GENERAL PRACTICE / PUBLIC HEALTH May include: community,
family and hospital medicine, general practice, demography, statistics, public health, informatics, social and preventive medicine, forensic and legal medicine, health economics and ethics.
The mastery questions are defined as key or critical issue questions which are regarded as critical to the safety or clinical outcome or threat to life for the patient, or are based upon important common conditions and one of: related to life-threatening illness; or critical to safe practice (includes professionalism); or successful clinical outcome; or important aspects of public health.
The performance requirements for the MCQ examination expressed on the AMC scale are as shown below. The actual result Overall and in the Mastery items for each individual candidate is indicated on the performance scale by the arrow:
RESULT OVERALL 240 scored items AMC SCALE RESULT IN MASTERY QUESTIONS 80 scored items
500
500
400
Individual candidates result in the 240 scored questions
400
Individual candidates result in the 80 mastery questions
300
300
200
100
100
A candidates result in the MCQ examination is determined on the basis of the overall result in the 240 scored questions and the score of correct responses obtained in the 80 identified mastery questions, which are part of the 300 scored questions. The number of questions scored correctly is used to determine the AMC score for each MCQ examination. In order to pass the MCQ examination, a candidate is required to obtain an AMC score of 250 or more in the 240 questions that are scored, and an AMC score of 300 or more in the 80 mastery questions. A candidate must complete both Part 1 and Part 2 to obtain an overall score and satisfy the requirements of the MCQ examination.
SCORING OF ANSWERS
The MCQ examination is marked by a national independent educational testing centre on behalf of the AMC. The scoring system for the MCQ examination (Type A questions) is: Correct response Incorrect response = = SCORED NIL SCORE
Each question has a correct response. Marks are not deducted for incorrect answers. A candidate must present for and attempt both Part 1 and Part 2 in order to obtain an overall result in the MCQ examination. A candidate who does not attempt both Part 1 and Part 2 will be considered to have failed to satisfy the MCQ examination requirements of obtaining a result. Each candidate receives a computer-generated transcript of their results and feedback on their performance in the MCQ examination. A sample of the model used is set out in FIGURE 1 (this model is a representative sample only). The feedback model classifies all questions in terms of both the Functions/ Processes that apply to all Systems, such as diagnostic findings, management and prognosis, as well as the individual Systems and Regions in which the conditions present, such as cardiovascular, respiratory, etc. The headings under Functions/Processes refer to the headings in the major textbooks, such as Harrisons Principles of Internal Medicine.
CANDIDATE NUMBER
Each AMC candidate has been given a unique identification number to assist in the processing of their results and to minimise the possibility of error. The candidate number is the same as the AMC file or reference number.
10
11
The following general instructions are provided to candidates for the MCQ examination: There are 300 questions in the MCQ examination. Of these 300 questions, 240 are scored towards your total mark. You should attempt every question. Read each question and the options/answers carefully. It is important to pace yourself and to avoid spending too much time on one question. The AMC website provides a trial computer-based MCQ examination for candidates to familiarise themselves with the computer-administered MCQ examination.
Please note: Each question in the MCQ examination has a correct response. Marks will not be deducted for incorrect answers.
12
CHANGE OF VENUE
A change in venue is not accepted after the examination closing date. A fee is payable if a candidate wishes to change the nominated venue for the examination prior to the examination closing date.
WITHDRAWAL FEES
A withdrawal fee is incurred if a candidate elects to withdraw from an MCQ examination for which the candidate has been scheduled. A withdrawal is not accepted via telephone or email. An AMC MCQ withdrawal form, which is available through the AMC website, must be submitted to the AMC Secretariat. The AMC will refund the examination fee, less the withdrawal fee (for administrative costs), when: the MCQ withdrawal form is received before the close of business on the closing date for the examination; the MCQ withdrawal form is received after the close of business on the closing date, and acceptable certified evidence is submitted. If a candidate withdraws from an MCQ examination after the closing date, the candidate must submit evidence of severe illness or pressing domestic circumstances, in the form of a doctors certificate or statutory declaration.
If the candidate does not attend an examination session, the candidate cannot claim a refund of the examination fee. Examination fees cannot be transferred from one MCQ examination to another.
13
14
MCQ RESULTS
OFFICIAL TRANSCRIPT OF RESULTS AND FEEDBACK ON PERFORMANCE
Each candidate receives a computer-generated transcript of their results and feedback on their performance in the MCQ examination. The expected date of dispatch of results is notified on the AMC MCQ venue notice forwarded to each candidate prior to the examination. A sample of the model of the candidate performance feedback sheet is set out in FIGURE 1 (this model is a representative sample only).
Note: The feedback model is intended as a guide only and care should be taken when using the analysis in preparing for subsequent attempts at the MCQ or clinical examinations. The feedback on performance seeks to provide the maximum information to candidates to assist them with their preparation for future AMC examinations.
The model of feedback classifies all questions in terms of both the Functions/Processes that apply to all Systems, such as diagnostic findings, management and prognosis, as well as the individual Systems and Regions in which the condition presents, such as cardiovascular, respiratory, etc. The headings under Functions/Processes refer to the headings in the major textbooks, such as Harrisons Principles of Internal Medicine. The candidate performance feedback sheet is provided to candidate as a reference for the candidate on their performance in each of the questions, as classified in Systems and Regions. This information is to be used as a review of performance (across the classifications) for preparation for further examinations. The feedback in Systems and Regions cannot be used as a conversion of percentage correct to ascertain the score on the AMC scale of performance between 0 and 500. A listing of successful candidates attaining the pass standard of the MCQ examination is posted on the AMC website (www.amc.org.au) after individual results have been sent to each candidate by post. The successful candidates listing is shown by AMC candidate reference number only no names in compliance with Commonwealth privacy legislation. The listing remains on the AMC website for a period of four weeks.
Figure 1
SAMPLE RESULTS AND PERFORMANCE FEEDBACK
15
AMC SCALE
500
400
Individual candidates result in the 240 scored questions
400
Individual candidates result in the 80 mastery questions
300
300
200
100
100
Scale indicative only DEFINITION OF THE AMC SCALE The parameters of the AMC scale are as follows: AMC score overall [based on 240 scored items] Passing score overall AMC score in mastery questions [based on 80 scored items] Passing score [mastery questions]
250
300
The mastery questions are defined as key or critical issue questions which are regarded as critical to the safety or clinical outcome or threat to life for the patient, or are based upon important common conditions and 1 of: o Related to life threatening illness; or o Critical to safe practice (includes professionalism); or o Successful clinical outcome; or o Important aspects of public health.
DISTRIBUTION OF CANDIDATE RESULTS For comparison purposes the distribution of candidate results overall and in mastery questions is shown in the shaded areas of the AMC scale.
16
In order to provide the maximum feedback to candidates, all scored questions in the MCQ examination have been classified in terms of both the Functions/Processes that apply to all systems, such as Natural History, Clinical Presentation, Diagnostic Findings, Management and Prognosis, as well as the individual Systems and Regions in which the conditions present. The headings under Functions/Processes refer to the headings in the major textbooks such as HARRISON. CANDIDATE NUMBER: PERFORMANCE BY SUBJECT:
SUBJECT MEDICINE OBSTETRICS & GYNAECOLOGY PAEDIATRICS PSYCHIATRY SURGERY TOTAL NUMBER OF QUESTIONS NUMBER OF QUESTIONS 78 35 43 24 60 240 NUMBER CORRECT XX XX XX XX XX XXX
240
XXX
INTEGUMENT/DERMATOLOGY HEAD & NECK/EYE/ENT NERVOUS SYSTEM/NEUROLOGY MUSCULOSKELETAL/ORTHOPAEDICS/RHEUMATOLOGY CIRCULATORY SYSTEM/HEART/VESSELS RESPIRATORY SYSTEM/LUNGS/CHEST WALL GASTROINTESTINAL SYSTEM/ABDOMEN/ABDOMINAL WALL BREAST/ENDOCRINE SYSTEM FEMALE REPRODUCTIVE SYSTEM/ OBSTETRICS/ GYNAECOLOGY HAEMOPOIETIC SYSTEM/HAEMATOLOGY/BLOOD/ BLOOD PRODUCTS RENAL SYSTEM/UROLOGY/MALE REPRODUCTIVE SYSTEM MENTAL STATE/INTELLECTUAL FUNCTION/BEHAVIOURAL PROBLEMS MAJOR PSYCHIATRIC DISORDERS/DRUG & ALCOHOL ABUSE NORMAL AND ABNORMAL DEVELOPMENT/CHILD HEALTH/ PAEDIATRICS NUTRITION/METABOLISM/HOMEOSTASIS INFECTIOUS DISEASES CLINICAL PHARMACOLOGY CLINICAL ONCOLOGY CLINICAL IMMUNOLOGY CRITICAL CARE/ANAESTHESIA/EMERGENCY MEDICINE GENERAL PRACTICE/PUBLIC HEALTH TOTAL SYSTEMS/REGIONS
This examination performance feedback is provided as a reference for performance in each of the questions, as classified in Systems and Regions. This information is to be used as a review of performance [across the classifications] for preparation for future examinations. The number of questions scored correctly is used to determine the AMC score for each MCQ examination but does not convert directly to the score on the AMC scale overall and the AMC scale for mastery items.
General information
17
GENERAL INFORMATION
CHANGE OF ADDRESS
It is important that candidates advise the AMC promptly of each change of address and/or telephone number. This will ensure that contact can be made quickly with candidates as the occasion arises to notify examination venue changes, rule or eligibility changes, or to confirm information provided by the candidate on his or her application forms. Please advise on any changes using the change of address form which can be obtained by contacting the AMC. The change of address form is also available on the AMC website (www.amc.org.au). When advising of a change of address in writing, please include the following details: candidate number full name previous address new address candidate signature consent to collection of information form attached to letter and signed by candidate.
Under the provisions of the Commonwealth Privacy Amendment (Private Sector) Act 2000 (effective from 21 December 2001), the AMC is unable to accept changes of address or other candidate details taken over the telephone or submitted by email.
REQUEST FOR CONFIRMATION OF DATE OF PRELIMINARY APPLICATION WITH THE AMC Section 19 AB of the Health Insurance Act
Please obtain a copy of the form Request for Confirmation of Date of Preliminary Application from the AMC, if you require confirmation in writing of the date your preliminary application was received by the AMC to enable you to apply for an exemption from the Moratorium on the Medicare Provider Number with the Australian Government Department of Health and Ageing. Further information regarding the moratorium can be obtained from the Workforce and Quality Branch of the Department of Health and Ageing. Please complete and return the form to the AMC to enable the secretariat to process the request. Under the Commonwealth Privacy Amendment (Private Sector) Act 2000, the AMC is not able to send these details to anyone but the candidate.
18
Appendix A
19
APPENDIX A
ATTRIBUTES OF MEDICAL GRADUATES
The goal of medical education is to develop junior doctors who possess attributes that will ensure that they are initially competent to practise safely and effectively as interns in Australia or New Zealand, and that they have an appropriate foundation for further training in any branch of medicine and for lifelong learning. Attributes should be developed to an appropriate level for the graduates stage of training. Below is the list of knowledge and understanding, skills and attributes required of graduates completing basic medical education that is included in the AMCs Assessment and Accreditation of Medical Schools: Standards and Procedures.
2.
3.
4. 5. 6.
7. 8. 9.
10. Systems of provision of health care, including their advantages and limitations, the principles of efficient and equitable allocation and use of finite resources. 11. The principles of ethics related to health care and the legal responsibilities of the medical profession.
20
Appendix A
21
22
APPENDIX B
SAMPLE QUESTIONS
This appendix contains sample question items which reflect the format and structure of questions to be used in the MCQ examination. The sample questions are provided as a representative sample only. For the MCQ examination there will be a total of 300 questions: 150 questions in Part 1 and 150 questions in Part 2.
MASTERY QUESTIONS
The mastery questions are defined as key or critical issue questions which are regarded as critical to the safety or clinical outcome or threat to life for the patient, or are based upon important common conditions and one of: related to life-threatening illness; or critical to safe practice (includes professionalism); or successful clinical outcome; or important aspects of public health.
Note: In the sample MCQ examination questions, 24 of the 38 questions have been identified as mastery questions in order to provide a sample of this type of question. In the AMC MCQ examination a total of 80 of the scored 240 questions will be identified as mastery questions.
These mastery questions are individually identified in the examination with an asterisk (*).
PHOTOGRAPHIC QUESTIONS
In the AMC MCQ examination photographic questions may be included in both Part 1 and Part 2.
Appendix B
23
2.*
Mitral valve prolapse A. B. C. D. E. is a sequel of rheumatic fever. is characterised radiologically by calcification of the mitral valve ring. predisposes to bacteria endocarditis. is often accompanied by left atrial thrombus. is associated with an early diastolic murmur.
3.
Secretory otitis media A. B. C. D. E. is rare before the age of 5 years. is most common in summer. can be discounted as cause of learning problems at school. is not associated with otalgia. frequently runs a fluctuating course.
4.
Essential hypertension in pregnancy is A. B. C. D. E. usually diagnosed in the third trimester. usually asymptomatic. common in women under 35 years of age. usually associated with marked proteinuria. uncommonly associated with a family history of hypertension.
24
6.
An infant develops jaundice 6 hours after birth. Which one of the following is the most likely diagnosis? A. B. C. D. E. Haemolytic disease of the newborn. Umbilical sepsis. Physiological jaundice. Atresia of the bile ducts. Neonatal hepatitis.
7.*
Hepatomegaly in the newborn period is a feature of each of the following except A. B. C. D. E. galactosaemia. breast milk jaundice. neonatal hepatitis. Rhesus haemolytic disease. congestive cardiac failure.
8.*
Prolonged treatment with oestrogens (Premarinfi 0.625 mg/day) has which of the following effects? A. B. C. D. E. Suppression of the anterior and posterior pituitary gland. Ovarian enlargement. Stratification with cornification of the vaginal epithelium. Endometrial atrophy. Production of endometrial cancer in at least 20% of patients.
Appendix B
25
9.*
Untreated hypothyroidism in infants is associated with A. B. C. D. E. accelerated linear growth. chromosomal abnormality. eczema. mental retardation. diarrhoea.
10.*
Which one of the following statements is correct of diabetes mellitus in childhood? A. B. C. D. E. It is the commonest cause of childhood nephritic syndrome. It occurs more frequently in obese children. It frequently presents with failing vision. Stable control will become more easily achieved at puberty. Lifelong treatment with insulin will be required.
11.*
Of the following, the only proof of true labour is A. B. C. D. E. a show of blood and mucus per vagina. the presence of palpable uterine contractions. engagement of the fetal presenting part. progressive dilatation of the cervix. rupture of the membranes.
12.*
A women who is 16 weeks pregnant presents with symptoms suggestive of a urinary tract infection. Which of the following is correct? A. B. C. D. E. She should be assured that urinary tract infections are common in pregnancy and require no treatment. A midstream urine should be collected and the bacteriology report awaited. A midstream urine should be collected and a wide spectrum antibiotic prescribed. A self-retaining catheter should be introduced to promote free drainage of urine. A suprapubic bladder tap should be carried out to ensure the collection of an uncontaminated specimen of urine.
26
14.*
To prevent Rhesus iso-immunisation, anti-Rh(D) Gamma globulin should be given after delivery to an A. B. C. D. E. Rh(D) negative mother with anti-D antibodies with an Rh(D) negative infant. Rh(D) negative mother without anti-D antibodies with an Rh(D) negative infant. Rh(D) negative mother with a high titre of anti-D antibodies with an Rh(D) positive infant. Rh(D) negative mother without anti-D antibodies with an Rh(D) positive infant. Rh(D) negative mother in all cases.
15.
The most common cause of dementia in people over the age of 65 in Australia is A. B. C. D. E. Alzheimer disease. alcoholism. multi-infarct encephalopathy. Parkinson disease. hypertensive cerebro-vascular disease.
16.
Which one of the following best describes the daily intake of potassium required by a normal adult? A. B. C. D. E. 5 mmol. 25 mmol. 55 mmol. 155 mmol. 30 g.
Appendix B
27
17.*
Individuals who have taken an overdose of a tricyclic anti-depressant agent are at considerable risk of A. B. C. D. E. hypoglycaemia. cardiac dysrhythmia. cerebral oedema. laryngospasm. oculogyric crisis.
18.
The most frequent type of cancer found in women involves the A. B. C. D. E. cervix. uterine fundus. ovary. mammary gland. vulva.
19.
The lesion depicted (see illustration) appeared spontaneously. The following action should be undertaken. A. B. C. D. E. Reassurance that spontaneous resolution will occur. Incision under local anaesthetic. Application of liquid nitrogen. Review in one month. Plastic surgical referral.
28
21.
A 45-year-old man develops weakness and wasting of the right hand. Which one of the following is least likely to be the cause? A. B. C. D. E. Old injury to the elbow joint. Bronchogenic carcinoma of the right upper lobe. Multiple sclerosis. Syringomyelia. Motor neurone disease.
22.*
In a patient who has suffered persistent asthma over several weeks, the effect of the therapy is best indicated by A. B. C. D. E. relief of dyspnoea. absence of rhonchi arterial blood gas analysis. tests of ventilatory function. exercise capacity.
23.*
A 10-year-old boy presents with a history of central abdominal pain of a few hours duration. On examination he has minimal tenderness in the right iliac fossa and no abnormal findings on rectal examination. Which of the following alternatives should be carried out? A. B. C. D. E. Arrange a barium meal/follow through. Arrange to see the patient later on in the day for review. Send the patient away with instructions to return if the pain becomes worse. Tell the patient to come back in a week. Immediate appendicectomy.
Appendix B
29
24.*
The most common cause of blood-stained stool in an otherwise normal infant is A. B. C. D. E. anal fissure. anal fistula. haemorrhoids. Meckel diverticulitis. intussusception.
25.*
A 65-year-old woman has a two-year history of mucous diarrhoea due to a large villous adenoma of the rectum. She is also taking digoxin and diuretics for chronic congestive failure. Which of the following investigations would be the most helpful prior to surgery? A. B. C. D. E. Serum chloride. Serum digoxin. Serum calcium. Serum potassium. Haemoglobin.
26.
Which one of the following regimens would be the most appropriate initial management of a cirrhotic patient with marked ascites and peripheral oedema? A. B. C. D. E. Ascitic tap and intravenous albumin replacement. Cautious use of frusemide. High protein diet and a thiazide diuretic. Bed rest, strict salt restriction and spironolactone. A combination of frusemide and spironolactone.
27.*
The most common complication seen after splenectomy is A. B. C. D. E. left lower atelectasis. left subphrenic abscess. deep venous thrombosis secondary to thrombocytosis. pancreatic fistula. prolonged paralytic ileus.
30
29.
A 38-year-old woman, who had a subtotal thyroidectomy 8 years previously, is again thyrotoxic. Which one of the following is the most appropriate management? A. B. C. D. E. Perform total thyroidectomy after preparation with carbimazole. Radioactive iodine after preparation with oral iodine treatment. Prescribe immunosuppressive treatment with azathioprine. Control with cardimazole and then administration of radioactive iodine. Short-term treatment with beta blockers until remission occurs.
30.*
A patient, who has had three successive spontaneous abortions, reached the twelfth week of pregnancy on the fourth attempt, when she passed a moderate amount of blood with clots per vaginam and complained of intermittent lower abdominal pain. On vaginal examination, the cervical canal admitted one finger readily and bimanual palpation revealed a uterus compatible in size with a pregnancy of only eight weeks duration. The menstrual cycle had been regular (5/28) before this pregnancy and the duration of pregnancy calculated from the first day of the last menstrual period was definitely known. Which one of the following is the most likely diagnosis? A. B. C. D. E. Threatened abortion. Cervical incompetence. Incomplete abortion. Ectopic pregnancy. Missed abortion.
Appendix B
31
31.*
A primigravida patient at 34 weeks gestation presents with a history of not having felt fetal movements for 24 hours. Which one of the following statements is most appropriate? A. B. C. D. E. She probably has an intra-uterine fetal death. You should immediately arrange transfer to labour ward for early induction labour, providing the baby is still alive. She should have urgent antenatal cardiotocography (CTG). She should have an ultrasound scan. Urgent serum oestriol assay should be arranged.
32.
A 5-year-old presents with a history of urgency of micturition, occasional enuresis, and a slight, non-offensive vaginal discharge for 3 months. She has had no vaginal bleeding. Examination reveals some reddening of the labia majora. Which one of the following is the most likely diagnosis? A. B. C. D. E. Trichomonal infection. Gonorrhoea. Cystitis. Foreign body. Non-specific vulvo-vaginitis.
33.*
A 19-year-old woman, prescribed a triphasic oral contraceptive for the first time one month ago, complains of frequent spotting. Which one of the following is the most appropriate management? A. B. C. D. E. Increase the dose of oestrogen. Increase the dose of progestogen. Advise alternative contraception. Continue the medication and review in two months. Change to biphasic pill.
34.
A 20-year-old woman presents with hypertension. There is a previous history of enuresis and childhood febrile episodes. The history suggests a likely diagnosis of A. B. C. D. E. chronic glomerulonephritis. reflux nephropathy. essential hypertension. polycystic disease of the kidneys. analgesic nephropathy.
32
36.*
A 5-year-old boy is diagnosed in the Emergency Department as having measles, the first symptoms having started 2 days previously. He has a 2-year-old sister, who has received the recommended immunisation schedule. Which one of the following is the most appropriate treatment? A. B. C. D. E. Treat him symptomatically and send him home. Refer him to the infectious diseases hospital. Give him gamma globulin. Give gamma goblin to the sister. Reassure the mother that he is over the worst of it.
37.
The most common primary site of a secondary malignant tumour of the ovary is A. B. breast. pancreas.
Appendix B
33
38.*
A 67-year-old woman recently noticed a non-painful lump in the right breast (see illustration). Which one of the following is the most likely diagnosis? A. B. C. D. E. Subacute mastitis with early abscess formation. Advanced adenocarcinoma of the breast. Early intraduct carcinoma with obstruction of ductal ampullae. Severe fibrocystic disease of the breast (fibroadenosis with multiple cysts). Extensive fat necrosis of the breast.
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Question no.
Correct response
Question no.
Correct response
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
E C E B D A B C D E D C D D A C B D E
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
D C D B A D D A A D C C E D B E A D B
Appendix C
35
APPENDIX C
GLOSSARY OF MEDICAL TERMS USED IN MULTIPLE CHOICE QUESTIONS
The Board of Examiners has prepared the following glossary of suggested definitions and, where appropriate, approximate percentages as a guide to interpretation of questions.
Term Characteristic of, typical of, associated with Uncharacteristic, atypical, not associated with Invariable Essential Necessary Requisite Always Never Nearly always Almost always The majority, many The great majority The minority, few Predominate Usual Unusual Likely Unlikely Probable Improbable More, less Most, least Extremely common Very common Common, uncommon Frequent, rare Often, seldom Can, may, possible To be possible, not impossible More than half Very much more than half Less than half The main element, in the ascendancy More than half Not usual, less than half To be expected Not to be expected More likely than not Not likely Greater or smaller in amount Greatest or smallest in amount Almost always Very much more than half Preferably qualied and used in comparison to other options >50 >80 <50 >50 >50 <50 >50 <50 >50 <50 >90 >80 Variable Variable Variable >0 Definition Significantly more frequent than in the general population; within the definition. Significantly less frequent than in the general population; outside the definition. At all times Indispensable Indispensable Indispensable At all times Not at all At almost all times Approximate Percentage -
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APPENDIX D
Essential Reading
AMC Handbook of Clinical Assessment (published 2007)
This book contains over 150 annotated examples of clinical assessments as utilised in the Clinical (Part Two) Examination for IMG candidates, and is broadly representative of the curriculum. It is recommended as essential reading for the AMC clinical examination. The book provides problembased self-learning exercises to aid preparation for clinical assessments. Self-test clinical competency tasks with performance guidelines and commentaries cover all domains and disciplines for the medical graduate about to enter internship. Overviews are provided covering communication skills, clinical consulting skills, ethics and the law.
The Anthology of Medical Conditions can be ordered from the AMC secretariat via the AMC website for an electronic order or downloading of a hardcopy order form.
Appendix D
37
Suggested Textbooks
There are many medical textbooks available, and most of them are of high standard. They range from quite short texts, which cover essential knowledge, to long and comprehensive treatises which most people use as reference books. The AMC has drawn up the following list as a guide to some useful texts. They are not intended as prescribed reading. AMC examinations are set on the latest editions of the recommended textbooks. It is up to the AMC candidate to obtain the latest information. Material contained in previous editions of the recommended textbooks, or other unspecified textbooks, may not be correct and will not be used to determine the result of AMC examinations. American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th edn text revision. American Psychiatric Association, Washington DC, 2000. ISBN-0890420254 (paperback); ISBN0890420246 (hardback). http://www.psych.org Bloch S, Singh BS, editors. Foundations of clinical psychiatry, 3rd edn. Carlton South, Vic: Melbourne University Press; 2007. ISBN: 0-522-85320-X http://www.mup.com.au Braunwald, E. Harrisons Principles of Internal Medicine, 15th edn. McGrawHill, New York, 2001. ISBN-0070072744 (hardcover). ISBN-0079136869 (hardcover, 2 volume set). ISBN-0071374795 (CD-ROM) http://www.bookstore.mcgraw-hill.com Burkitt HG, Quick CRG. Essential surgery: problems, diagnosis and management, 3rd edn. London: Churchill Livingstone Inc; 2002. ISBN-0443063753. http://www.us.elsevierhealth.com Devitt P, Barker J, Mitchell J and Hamilton-Craig C. Clinical Problems In General Medicine, 2nd edn. Churchill Livingstone, 2003, ISBN-0443073236. www.elsevier.com.au Gelder M, Lopez-Ibor JJ, Andreasen N. The New Oxford Textbook of Psychiatry, Oxford University Press, 2003. ISBN-10: 0198528108 (paperback). http://mnemosyne.oup-usa.org/medical Goldbloom R, Paediatric Clinical Skills, 3rd edn, Churchill Livingstone, 2002. ISBN-0721694756. Boon NA, Colledge N, Hunter JA, Walker B, editors. Davidsons Principles and Practice of Medicine, 20th edn. Edinburgh: Churchill Livingstone; 2006. ISBN: 0443100578. http://www.us.elsevierhealth.com Healey PM, Jacobson EJ. Common medical diagnoses: an algorithmic approach, 4th edn. WB Saunders, 2006. ISBN: 1416025421 http://www.us.elsevierhealth.com Kinirons M, Ellis H. Frenchs Index of Differential Diagnosis an AZ, 14th edn, Hodder Arnold 2005 ISBN-139780340810475. http://www.hoddereducation.com Lau L. Imaging Guidelines, 4th edn. The Royal Australian and New Zealand College of Radiologists, Melbourne, 2001. ISBN 0959285415. http://www.ranzcr.edu.au Lissauer T, Clayden G, Illustrated Textbook of Paediatrics, 3rd edn. Mosby, 2007. ISBN-10: 0723433976 Llewellyn-Jones D. Fundamentals of Obstetrics & Gynaecology. Mosby, London 2004, 8th edn ISBN 0723433291. http://www.mosby.com
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Miscellaneous
Therapeutic Guidelines from Therapeutic Guidelines Limited, North Melbourne, Vic. http://www.tg.com.au Therapeutic Guidelines: Analgesic, version 5, 2007 Therapeutic Guidelines: Antibiotic, version 13, 2006 Therapeutic Guidelines: Cardiovascular, version 4, 2003 Therapeutic Guidelines: Dermatology, version 2, 2004 Therapeutic Guidelines: Endocrinology, version 3, 2004 Therapeutic Guidelines: Gastrointestinal, version 4, 2006 Therapeutic Guidelines: Neurology, version 3, 2007 Therapeutic Guidelines: Oral and Dental, version 1, 2007 Therapeutic Guidelines: Palliative Care, version 2, 2005 Therapeutic Guidelines: Psychotropic, version 5, 2003 Therapeutic Guidelines: Respiratory, version 3, 2005 Therapeutic Guidelines: Rheumatology, version 1, 2006 Management Guidelines: Developmental Disability, version 2, 2005
Manual of Use and Interpretation of Pathology Tests, 2nd edn. The Royal College of Pathologists of Australasia, 1997. ISBN 0959335528. 3rd edn, 2002. ISBN 0646409646. This edition available on CD-ROM or online only. http://www.rcpa.edu.au MIMS Australia. St Leonards, NSW. MediMedia Australia Pty Limited. Subscriptions: ISSN 10355723 (MIMS Australia Bi-monthly), ISSN 07254709 (MIMS Australia Annual), ABNRID 000012656851 (eMIMS CDROM or MIMS on PDA (personal digital assistant)). http://www.mims.com.au
Appendix D
39
Australian Medicine Handbook, 4th edn. 2003 ISBN 0957852126. Online version available via Health Communication Network. http://www.hcn.com.au/products/kro_druginfo.html
Journals
In addition to the major texts, journals should be read selectively, using editorials, annotations and review articles. The following journals are suggested as source material: Australian Family Physician www.racgp.org.au/publications Australian Prescriber www.ustralianprescriber.com British Medical Journal www.bmj.com British Journal of Hospital Medicine http://www.hospitalmedicine.co.uk Current Therapeutics http://www.ctonline.com.au Lancet www.thelancet.com Medical Journal of Australia www.mja.com.au New England Journal of Medicine http://www.content.nejm.org