Question 1

Patients suffering from schizophrenia may experience both positive and negative
symptoms. All of the following are negative symptoms EXCEPT:

a) Anhedonia

b) Hallucinations

c) Lack of motivation

d) Emotional blunting

e) Alogia

Hallucinations are abnormal perceptions, e.g. hearing voices speaking about the
patient, and/or giving instructions to do certain things. They represent additional
phenomena and, therefore, are classified as positive symptoms. Delusions (false
ideas) is the other major group of positive symptoms. In contrast, each of the other
options represents a loss or diminution of a mental function, e.g. anhedonia is a loss
of capacity for pleasure.

Question 2
Martha was born at 35 weeks gestation. She required phototherapy for jaundice
whilst in hospital. Martha is being breast-fed and is beginning to gain weight. She is
now two months old. Regarding routine childhood vaccination which of the following
statements is CORRECT?

a) Vaccinations due to be given at two months of age should be postponed until
Martha is at least 13 weeks old to allow for her prematurity.

b) Martha's past history of jaundice is not a contraindication to oral polio vaccine.

c) Vaccines for intramuscular injection should be given into the buttock in a
premature baby.

d) Breast-feeding is a contraindication to vaccination.

e) It is not necessary to immunise Martha against hepatitis B.
A history of jaundice after birth is not a contraindication to any of the vaccines in the
standard schedule.
Vaccination should not be postponed because of prematurity. The fact that a child is
breast-fed is not a contraindication to vaccination. Vaccines should never be given
into the buttocks. The anterolateral thigh is the preferred site for vaccination in
infants under 12 months of age. The deltoid region is the preferred site in older
children (those who have commenced walking) and in adults. Martha would be due
to receive vaccination against hepatitis B at the age of two months according to the
current standard vaccination schedule.

* Question 3
Maud is a 70 year old who presents with acute peri-umbilical abdominal pain
gradually increasing in intensity. She is vomiting profusely and develops watery
diarrhoea with flecks of blood after an hour of pain. Examination of the abdomen
reveals localised periumbilical tenderness with some rigidity. Rectal examination is
normal. An irregular pulse is noted and an ECG is recorded (shown below).

The MOST LIKELY diagnosis is:

a) Acute appendicitis

b) Acute pancreatis

c) Perforated peptic ulcer

d) Biliary colic

e) Mesenteric artery occlusion
The clinical presentation is typical of mesenteric artery occlusion. This occurs most
commonly in patients with atrial fibrillation leading to embolism. The ECG shows
atrial fibrillation. Arteriography will show the vascular occlusion.
* Question 4 A 15 year old male has sudden onset of severe pain in his right lower
abdomen commencing 2 hours ago. He has vomited several times in the last hour.
He is rolling on the bed, stating that the pain is going down into his groin. T 37.1
degrees Celcius, P 110min, BP 135/ 80. Abdomen - soft, no rebound. Tender right
testicle. Your immediate management is:

a) i/v fluids and antibiotics

b) arrange urgent ultrasound examination

c) i/v metoclopramide (maxolon)

d) refer for emergency surgery

e) arrange for a KUB Xray

The sudden onset of severe pain in the lower abdomen, groin or scrotum, in a young
male under 25 years, should be considered to be testicular torsion until proved
otherwise. This is a surgical emergency, as infarction of the testis can occur quickly,
and surgical exploration should be undertaken urgently. This patient has no fever,
nor tenderness of the epididymis to indicate epididymo-orchitis. Antibiotic treatment
will not help. Colour doppler ultrasound may show increased blood flow in infection
and the absence of flow in advanced torsion. However, these are not reliable
findings, and the investigation would waste valuable time. The vomiting is related to
the pain, and would be alleviated by appropriate analgesia. Metoclopramide is not an
immediate priority. The clinical picture is highly suggestive of testicular torsion rather
than renal colic, thus IVP is not the appropriate immediate management.

* Question 5
In a 3 year old child with signs and symptoms suggestive of bacterial meningitis,
which of the following is the BEST initial management?

a) Erythromycin IV

b) Gentamicin IV

c) Ceftriaxone IV

d) Phenoxymethylpenicillin oral

e) Amoxycillin oral
If bacterial meningitis is suspected clinically it is vital to immediately administer an
appropriate antibiotic prior to urgent transfer to hospital, as meningococcal
meningitis may be rapidly fatal. The drug of choice would be benzylpenicillin
60mg/kg up to 3g IV or IM, or ceftriaxone 50mg/kg up to 2g IV in patients
hypersensitive to penicillin or when further drug treatment may be delayed.

Question 6
Atypical antipsychotic drugs (eg. olanzapine) have certain advantages compared to
the typical antipsychotic drugs (eg. chlorpromazine) in the treatment of
schizophrenia. All of the following are advantages of atypical drugs EXCEPT:

a) Improved therapeutic effect on positive symptoms

b) Improved therapeutic effect on negative symptoms

c) Reduced potential for acute extrapyramidal symptoms

d) Reduced potential for longer-term extrapyramidal symptoms

e) Improved therapeutic effect in some treatment-resistant patients

Both the typical and atypical antipsychotic drugs have a beneficial effect on positive
symptoms in schizophrenia. However, they differ with regard to negative symptoms.
Atypical antipsychotics are much better at combating these. The other options are
true for the atypical drugs.
Question 7
Which of the following statements regarding undescended testes is CORRECT?

a) The testes are undescended at birth in 40% of boys.

b) Once the testis is palpable in the scrotum it will remain so.

c) Descent is unlikely to occur after 1 year of age.

d) Orchidopexy should be delayed until late childhood.

e) The undescended testis is at reduced risk of malignancy.

Testes which are undescended at birth may well descend into the scrotum during the
first two weeks of life, however descent is unlikely to take place after the age of one
year. 2% of boys born at full-term, and 20% of premature males, have undescended
testes. A testis which was palpable in the scrotum in infancy may ascend and
become impalpable due to failure of the spermatic cord to elongate at the same rate
as body growth. Orchidopexy is best performed by 12-18 months of age as
spermatogenesis in the undescended testis is impaired after the age of two years.
The undescended testis is at 5-10 times greater risk of developing malignancy
(seminoma).

Question 8
A 34 year old woman presents with an acutely painful swollen knee. Synovial fluid
aspirate shows the following:
WCC 4100/uL (NR < 2000/uL), 80% polymorphonuclear lymphocytes
red blood cells ++
no crystals
no organisms cultured
What is your interpretation of these results?

a) Inflammation is more likely

b) Gonococcal arthritis

c) Viral arthritis

d) Tuberculous arthritis

e) Traumatic tap

Normal synovial fluid contains less than 2000 white blood cells per microlitre.
Inflammation causes counts of 3000 or higher. Inflammation can also cause red
blood cells to migrate into the joint fluid.
Viral arthritis - usually symmetrical polyarthritis, predominantly lymphocytic effusion
TB arthritis - chronic presentation with WCC >10,000/uL, 50% PMNLs, culture
positive in 50%
Gonococcal arthritis - WCC >10-20,000/uL

Question 9
Concerning prostate cancer, which ONE of the following is INCORRECT?

a) The majority of carcinomas arise in the peripheral zone of the gland

b) The prostate specific antigen (PSA) is elevated in all prostate cancers greater
than 1.5 cm

c) If metastasis occurs, pelvic lymph nodes are involved early

d) Radionuclide bone scan is a sensitive but not specific method of detecting bony
metastases

e) Prostate cancers usually appear as hypoechoic nodules on transrectal
ultrasound
A normal PSA occurs in up to 20% of cancers, including tumours greater than 1.5
cm. Prostate cancer is the second most common cause of cancer deaths in men in
Australia. The majority of prostate cancers- usually adenocarcinomas- arise in the
peripheral zone of the gland, and metastasise early to pelvic lymph nodes. Bony
metastases are also common. Bone scan is unreliable at detecting bony metastases
when the prostate specific antigen (PSA) is <20ng/ml. The commonest pattern for
prostate cancer on transrectal ultrasound is of hypoechoic nodules. This pattern may
also be seen in prostatic hypertrophy or prostatitis.

Question 10
Which ONE of the following atypical antipsychotic drugs is optimal as first line
therapy in managing the first episode of schizophrenia in a patient?

a) Risperidone

b) Olanzapine

c) Quetiapine

d) Amisulpride

e) Clozapine
Olanzapine is the drug of choice for treatment of first episode schizophrenia, since it
does not cause extrapyramidal symptoms at therapeutic doses, and is useful for
combating affective symptoms, including depression. Its major disadvantage is
weight gain. The other drugs listed carry a greater risk of extrapyramidal symptoms
and other side effects.

Question 11
Ara, 5 years old, presents with a painless limp. You suspect Perthes' disorder. Which
of the following statements is CORRECT?

a) Hip mobility is usually reduced, particularly adduction and external rotation

b) Ultrasound is required to make a definitive diagnosis

c) The white cell count and C reactive protein (CRP) are usually raised

d) Progress is assessed with serial radiological examination

e) Osteotomy is the treatment of choice
Perthes' disorder is most common in 4-8 year olds. On examination hip mobility is
reduced, particularly abduction in flexion. Xray confirms the diagnosis showing
widening of the joint space, decalcification of the metaphysis and a dense slightly
flattened femoral head. There is no need for testing white cell count or CRP as these
are normal. In most cases the prognosis is excellent and the only requirement is to
avoid prolonged walking or exercise. Progress is assessed by clinical examination and
serial radiological examinations. Where there are severe changes containment of the
femoral head is the treatment of choice and this usually requires a plaster cast or
orthosis. Osteotomy of the pelvis or femur is only rarely required.

Question 12
Susie is 16, and has had a lingering cough following an apparent viral bronchitis. Her
doctor referred her for a chest X ray which has shown a mass in the antero-superior
mediastinum. Which of the following is NOT a likely diagnosis?

a) teratoma

b) thymoma

c) retrosternal thyroid

d) bronchogenic cyst

e) lymphadenopathy
Bronchogenic cysts are mostly found in the posterior mediastinum, and only rarely in
the anterior mediastinum All of the others are likely diagnoses. Approximately half of
all mediastinal masses are asymptomatic and discovered on a 'routine' X Ray.
Lesions in young people, and lesions which produce symptoms are more likely to be
malignant.
(Tjandra J, Clunie G, Thomas R. (2001) 'Textbook of Surgery' Blackwell Science Asia,
Melbourne p 625 )


Question 13
In Australia, all of the following are risk factors for suicide, EXCEPT:

a) Schizophrenia

b) Family history of suicide

c) Social disadvantage

d) Being female

e) Youth

Males, particularly young men and elderly single men, are at greater risk of
completed suicide than women however women may be more likely to attempt
suicide.

(Guidelines for preventive activities in general practice. (2002) Updated 5th ed.
Australian Family Physician, Special Issue, SI, 45 )
* Question 14
A 15kg child with a known food allergy to peanuts suddenly develops anaphylaxis.
The RECOMMENDED immediate management is:

a) 0.1ml of Adrenaline 1:1000 by deep intramuscular injection

b) 0.1ml of Adrenaline 1:10,000 by deep subcutaneous injection

c) 0.15ml of Adrenaline 1:1000 by deep intramuscular injection

d) 0.15ml of Adrenaline 1:1000 by subcutaneous injection

e) 0.15ml of Adrenaline 1:10,000 by deep intramuscular injection

Adrenaline 1:1000. is recommended as it is readily available, and this concentration
contains 1mg of adrenaline per ml. The recommended dose of 1:1000 adrenaline is
0.01mg/kg body weight by deep intramuscular injection, so a 15kg patient would
require 0.01 X 15 = 0.15ml i.m.

(Robinson MJ, Robertson DM. (2003), Practical Paediatrics, 5th ed, Churchill
Livingstone, Sydney, p 415-416 )
Question 15
Which ONE of the following is a mass population screening test which has been
demonstrated to significantly reduce cancer mortality?

a) annual faecal occult blood testing in the over 50 age group

b) annual colposcopy in sexually active women

c) annual plasma CA125 in post menopausal women

d) annual colonoscopy in siblings of patients with colon cancer

e) 2 yearly mammography in women in the 35-45 age group

There have been at least 3 randomised control screening trials conducted which
show that faecal occult blood testing every 1-2 years in the over 50 year population
reduces the mortality from colorectal cancer by around 20%. Colposcopy is a
diagnostic, not a screening test. The appropriate screening test for cancer of the
cervix in sexually active women is the Papanicolaou (Pap) smear. Plasma CA125
levels may be raised in asymptomatic women with ovarian cancer but there is not, as
yet, any evidence for its benefit as a mass screening measure. Colonoscopy for
siblings of patients with colorectal cancer may reduce their mortality, but this is
'selective' screening, by targeting a high-risk group.
While mammography in the 50-70 age group has been shown to reduce mortality
from breast cancer by around 30%, the benefit for women in the 40-50 age range is
quite small, and there is little evidence for benefit in still younger women.

(Semmens, J,Platell,C. 'Bowel Cancer' Australian Family Physician vol 30 no 6p,539 )

(Quinn, M. 'Screening for Ovarian cancer' Australian Family Physician vol 30 no6
p530 )

(Harrison's Online
Available: www.accessmedicine.com/content.aspx?aID=60590 )
Question 16
All of the following groups are at higher risk than average of depression, EXCEPT:

a) Women

b) Postpartum women

c) Young rural males

d) Urban males

e) Adolescents

Men living in urban areas are not especially at risk of depression. However, young
men living in rural areas are at greater risk because of social isolation. Women,
particularly in the postpartum period, and adolescents are also more vulnerable to
depression.

(Guidelines for preventive activities in general practice. (2002) Updated 5th ed.
Australian Family Physician, Special Issue, SI, 44 )

(Harrison's Online
Available:
www.accessmedicine.com/content.aspx?aID=109349 )
Question 17
Fourteen month old Mark has had a high fever and mild coryza for three days but
has still been quite active. Mark's temperature has returned to normal today but he
has now developed a red maculopapular rash on his trunk. The MOST LIKEY
diagnosis is:

a) Measles

b) Chicken pox

c) Erythema infectiosum

d) Rubella

e) Roseola infantum

Roseola infantum is a viral infection usually affecting children between the ages of 6-
18 months. The patient typically develops high fever up to 40 degrees Celsius, but is
otherwise not particularly unwell. There may be mild cervical lymphadenopathy and
pharyngitis. After three days the temperature usually returns suddenly to normal and
the patient develops a red macular or maculopapular non-desquamating rash which
is truncal, usually sparing the face and limbs. The rash abates within two days.

(Murtagh, J. (2003), General Practice, Third edition, McGraw-Hill, Sydney, Chap 81,
p 907 )

(Robinson MJ, Robertson DM. (2003), Practical Paediatrics, 5th ed, Churchill
Livingstone, Sydney, p 362 )

(Merck Manual
Available: www.merck.com/mrkshared/mmanual/tables/265tb8.jsp )
* Question 18
A 50 year old woman has had major abdominal surgery yesterday. You are called to
see her urgently as she has symptoms of shock. Which ONE of the following
examination findings is of MOST concern?

a) the patient is restless and confused

b) Temperature 39.2 degrees Celsius

c) pulse 130, sinus tachycardia

d) urine output over past 4 hours of 120ml

e) BP 80/45 mm Hg
The above signs taken together describe a picture of shock. Hypotension (defined as
systolic BP <90mm Hg, or >40mm Hg fall from baseline level) is a sinister
development and requires urgent attention. It is often a LATE manifestation of
circulatory failure. Thus it is the most alarming of these findings, and the one most
indicative of the urgency of this situation.


Question 19
Arthur is a 74 year old man who presents reluctantly because his wife feels 'he has
not been himself since he came home and is not sleeping properly.' His appetite is
poor and he has lost 6 kg in weight since discharge from hospital eight weeks ago
following treatment for myocardial infarction. He has lost interest in his hobbies and
is not taking his medications. He has been a type 2 diabetic for 12 years. On
examination he shows signs of mild cardiac failure. The result of an HbA1C test is
10.5% (target <7%). Which ONE of the following is the MOST likely cause of Arthur's
condition.

a) Senile dementia

b) Uncontrolled diabetes

c) Depression

d) Silent reinfarction

e) Chronic fatigue syndrome

Arthur is showing several typical features of depression, viz insomnia, loss of interest
in pleasurable activities, loss of appetite and loss of weight. Depression following
myocardial infarction is well recognised and increases the risk of complications and
death. Such patients are less likely to observe instructions regarding medications,
making their situation worse. Arthur's diabetes is poorly controlled, as shown by the
elevated HbA1C level but this is insufficient to explain his condition. The other
options could contribute to the clinical picture shown by Arthur but are less likely to
be the cause of his condition.

Question 20
Aidan, a 3 month old boy, presents with paroxysms of coughing associated with
cyanosis, lethargy and poor feeding for several days. On examination, between
episodes of coughing, he is afebrile and examination is normal. What is the NEXT
step in management?

a) Admission to hospital

b) Nasopharyngeal aspirate and review in 24 hours

c) Immunisation at this visit with DTP and review in 24 hours

d) Erythromycin syrup and review in 24 hours

e) Trial of salbutamol by mask
The clinical picture suggests respiratory infection with Bordetella pertussis. The
history of cyanosis associated with the coughing suggests the need for admission to
hospital but, in addition, children under 6 months of age usually require admission
for pertussis because of the risk of complications. Complications include respiratory
arrest, bacterial pneumonia and encephalitis.
Salbutamol has not been shown to be helpful in a child of this age and is of no
benefit. Immunisation at a later date should be encouraged even if the child has had
pertussis. Erythromycin is not curative but may reduce infectivity.

Question 21
Simon aged 4 months is diagnosed with pertussis. What is the MOST APPROPRIATE
management of Simon's parents to reduce their risk of infection?

a) Immediate booster immunisations for pertussis

b) A 10 day course of erythromycin

c) Commence a 3 dose pertussis revaccination schedule

d) Arrange nasopharyngeal swabs

e) Immediate immunisation with pertussis immunoglobulin
Fifty percent of babies with pertussis are infected by their parents. All household
contacts of patients with pertussis should receive erythromycin for 10 days to
prevent further spread of the disease. Cotrimoxazole is recommended for those
intolerant of erythromycin.
An initial or booster dose of pertussis vaccine should be considered for children aged
up to 8 years. A booster vaccine is now available for adults and children > 8yrs who
have had the initial course. It is recommended for children 15-17 yrs of age, parents
planning their first pregnancy, adults working with young children or at 50 years of
age. Babies under 2 months of age who have been exposed are best vaccinated
early.
Passive immunisation with pertussis immunoglobulin is not effective in the
prevention of pertussis. Isolation is not required for household contacts.

(Merck Manual
Available: www.merck.com/mrkshared/mmanual/section19/chapter265/265a.jsp )
Question 22
Which of the following conditions is the COMMONEST anxiety disorder encountered in
general practice?

a) Generalised anxiety disorder

b) Phobic disorder

c) Obsessive compulsive disorder

d) Panic disorder

e) Post-traumatic stress disorder
Generalised anxiety disorder is the commonest anxiety disorder seen in general
practice. It has an insidious onset, usually having been present 5 to 10 years before
diagnosis. It occurs more commonly in women and the frequency increases with age.
(Generalised anxiety disorder (2002) Depression Awareness Journal, 11: 16-18 )

Question 23
Which of the following is NOT a diagnostic feature accompanying anxiety in
generalised anxiety disorder (GAD)?

a) Restlessness

b) Fatigue

c) Difficulty concentrating

d) Muscle tension

e) Loss of appetite
Loss of appetite is not a feature of GAD. The DSM-IV criteria include 3 or more of the
following in addition to anxiety and worry: restlessness, fatigue, difficulty
concentrating, irritability, muscle tension, and sleep disturbance.

Question 24
Martin, aged 50 years, complains of insomnia for two weeks. He says this relates to
anxiety about problems at work which surround the end of the financial year. While
he is describing his problem, he is excited and agitated. On examination, his pulse
rate is 75/min and BP 135/95 mm Hg. Which of the following behavioural therapies
would be MOST helpful to Martin?

a) Cognitive therapy

b) Sleep restriction therapy

c) Stimulus control therapy

d) Relaxation therapy

e) Interpersonal therapy

The successful treatment of insomnia depends on both behavioural and
pharmacological approaches. Relaxation therapy would be the most useful
behavioural therapy for Martin, because he displays exaggerated arousal -
emotional, cognitive and physiological, shown by his mental approach when
describing the problem and his physiological response in terms of pulse rate and BP.
Progressive muscle relaxation aims to reduce somatic arousal and attention
focussing techniques (e.g. on tranquil situations) to reduce cognitive and emotional
arousal. (See reference for descriptions of other options, except interpersonal
therapy which is not an accepted form of behavioural therapy.)

(Grunstein R (2002) Insomnia: diagnosis and management. Australian Family
Physician, 31: 995-1000
Available:www.racgp.org.au/document.asp?id=9029
Available:www.racgp.org.au/afp/downloads/pdf/november2002/20021101grunstein.
pdf )
Question 25
Doris is a 74 year old woman whose husband has died suddenly a week ago. She
seeks your help in dealing with insomnia which has been troubling her since her
husband's death. She has tried an over-the-counter preparation which she obtained
at the local pharmacy but has not found it helpful. Which of the following drugs
would you offer to prescribe for Doris?

a) Temazepam

b) Zopiclone

c) Zolpidem

d) Amitriptyline

e) Any of the above
There is a well defined role for short-term use of a hypnotic medication in a situation
like sudden bereavement. None of the drugs listed stands out as the best hypnotic
with few side effects. Temazepam is the most often prescribed hypnotic in Australia.
However, benzodiazepines have generally fallen from favour because of their
addictive properties if taken for more than several weeks. Zopiclone and zolpidem
share some of the properties of benzodiazepines but have fewer adverse effects.
Amitriptyline is a tricyclic antidepressant which is a useful hypnotic in lower doses
than are used for depression.
Question 26
Insomnia is defined as inability to:

a) Fall asleep

b) Maintain sleep

c) Sleep at normal times

d) Obtain good quality sleep

e) Obtain enough sleep

Insomnia is the commonest sleep disorder and is defined as poor quality sleep which
often results in daytime symptoms, including fatigue, irritability, problems with
concentration and memory, and feeling unwell. The other options describe features
of various insomnia syndromes but do not define the overall problem.

Question 27
Mavis is an 83 year old widow who is brought to your consulting room by her
daughter because she 'is not looking after herself properly.' Mavis appears unkempt
and withdrawn and gives monosyllabic answers to your questions. The daughter says
that she 'has been going downhill for a while,' ever since 'she began having problems
with her memory.' Further discussion with the daughter reveals that Mavis is
suffering from fatigue, anorexia and short-term memory loss, and is afraid to leave
her house. She spends much of her day sleeping in front of the television set. Which
of the following is the MOST LIKELY diagnosis?

a) Alzheimer's dementia

b) Vascular dementia

c) Melancholia

d) Psychotic depression

e) Bipolar disorder
Melancholia (previously called endogenous depression) is a severe form of 'biological'
depression due to a primary abnormality of brain neurotransmitter metabolism,
principally involving serotonin. Such severe depression can present as
pseudodementia, mimicking Alzheimer's dementia. Psychotic depression is also a
severe form of biological depression with the additional aspect of psychotic features.
In bipolar disorder there are alternating episodes of depression and mania. Other
possible diagnoses include medical disorders such as hypothyroidism.

(Snowden J (2002) Severe depression in old age. Medicine Today, 3: 41-47 )
Question 28
The prevalence of insomnia in the Australian community is about:

a) 10%

b) 20%

c) 30%

d) 40%

e) 50%

The prevalence of insomnia in Australia is about 30%. The situation is similar in
other industrialised nations. Male sufferers outnumber females by 1.3 to 1 in the 40+
years age group. Other factors which increase the prevalence of insomnia are old
age, unemployment and lower socio-economic status. The majority of patients have
a co-existing disorder, such as depression or generalised anxiety, and often present
with fatigue or daytime sleepiness rather than insomnia.
Question 29
Which of the following is a cause of primary insomnia?

a) Obstructive sleep apnoea

b) Restless legs syndrome

c) Behavioural conditioning

d) Sleep phase disorder

e) Bereavement
In primary insomnia there is no pre-existing cause of sleep disorder as there is, for
example, in obstructive sleep apnoea, restless legs syndrome, sleep phase disorder
and bereavement. With behavioural conditioning or behaviours impairing sleep the
patient has developed a habit of doing things immediately before bedtime which are
not conducive to sleep, such as sitting in bed watching television. With the other
options there is another established condition or situation which disrupts sleep.
Hence insomnia is regarded as secondary in these cases.


Question 30
Patients suffering from generalised anxiety disorder (GAD) often go undiagnosed for
years because they:

a) Deliberately conceal their anxiety

b) Inadvertently play down their anxiety

c) More often present with somatic complaints

d) Are misdiagnosed as having depression

e) Tend to keep away from doctors

Patients with GAD are frequently not diagnosed for years because they tend to
present with associated somatic complaints, such as asthma, back pain, migraine,
allergies, and gastrointestinal disorders and often consume a large amount of
medical resources before the diagnosis is made. They are not deliberately concealing
things from their doctors - they simply do not appreciate the significance of their
feelings. Patients with GAD may also have clinical depression which can further
complicate the issue.


Question 31
All of the following are effective first line topical treatments for severe dandruff
EXCEPT:

a) Selenium sulphide

b) Zinc pyrithione

c) Betamethasone

d) Miconazole

e) Ketoconazole

Dandruff, pityriasis capitis and seborrhoeic dermatitis are related conditions on a
continuum of severity. Pityrosporidium ovale is a fungus which has been implicated
in the development of these conditions. Eradication of the fungus has been shown to
relieve the symptoms of the condition. Selenium sulphide, zinc pyrithione,
miconazole and ketoconazole are all first line treatments which can be used once
weekly to daily depending on severity. Topical application of betamethasone lotion is
effective but only considered if there has been little response to the first line
treatments.


Question 32
Amy, a young girl, is worried about a rash on her face which has been there for a
few weeks. It is mildly itchy and has slowly increased in size. On examination it is a
circular lesion which looks scaly around the edges with the center appearing
normal(see figure).

The MOST LIKELY diagnosis is:

a) Tinea corporis

b) Impetigo

c) Pityriasis versicolor

d) Psoriasis

e) Dermatitis

In children, tinea commonly involves the hair, face and body. Tinea corporis is
recognised by its scaly, erythematous edge with clearing centre. Dermatitis and
psoriasis can mimic tinea and where the clinical picture is uncertain a fungal scraping
may confirm tinea. Impetigo may present with blisters that leave a brown crust, or
erosions with yellow crusts but without blistering. Pityriasis versicolor presents as
well demarcated pale or tan-coloured macules usually on the upper trunk.


Question 33
After referral to a paediatric oncologist, Bronwyn is diagnosed as having acute
lymphoblastic leukaemia (ALL). Both her parents are very distressed and visit you to
find out more about this condition. Which of the following statements about acute
lymphoblastic leukaemia is INCORRECT?

a) 75% of children with ALL are cured

b) An initial intense course of treatment lasting approximately 4-6 weeks is
required

c) Intrathecal therapy is required only if the disease has spread to the spine

d) Relapse rates are of the order of 30%

e) Remission rates are of the order of 95%

Intrathecal therapy is now given to all children with ALL. Prior to blanket intrathecal
therapy, up to 60% of children had a relapse due to CNS disease. The use of blanket
CNS therapy has reduced the CNS relapse rate to less than 10%.

* Question 34
Mary is an attendant at a local accommodation centre and has an intensely itchy
rash on her wrists and arms that has been present for the past few days (see figure).

She has recently bought a new watch and wonders if this is the cause of the
problem. The MOST LIKELY diagnosis is:

a) Papular urticaria

b) Tinea

c) Contact dermatitis

d) Eczema

e) Scabies

Scabies is a skin infestation by the mite Sarcoptes scabei. It is generally spread by
skin to skin contact such as in crowded areas, poverty, sexual contact and casual
contact. The mite can live for 2 days outside the human body, so infection by contact
with bed linen and other infected material is possible. Intense itch is characteristic of
the condition - if it is not itchy, it is not scabies. Distinct erythemato-papular itchy
nodules are due to an allergic reaction to the mite, its faeces and its larvae. 0.5-
1.0cm "burrows" can often be found on the fingers and wrist. Contact dermatitis to
her watch would produce a local contact dermatitis.


Question 35
Which of the following statements about routine immunisation is CORRECT?

a) If more than 3 months elapses between triple antigen injections the series
should be restarted to obtain adequate immunisation

b) The first triple antigen injection should always be half dose (1/2 cc) to reduce
allergic reactions

c) A convulsion following acellular pertussis triple antigen vaccine (DTPa) does not
contraindicate its further use

d) Tetanus booster injections should be repeated every 3 years

e) Measles vaccine should be given at 6 months of age to protect the child as
soon as possible

A convulsion, in the presence or absence of fever, occurring after DTPa vaccination,
does not contraindicate completion of the course with DTPa-containing vaccine. The
only adverse events which contraindicate further doses of pertussis containing
vaccine are:
encephalopathy within 7 days and
an immediate severe allergic reaction.
It is now recommended that, after a full primary course of childhood vaccination, a
single booster of tetanus toxoid is administered at age 50 years only (unless required
sooner for managing a tetanus-prone wound). Measles, mumps and rubella
immunisation is recommended at 12 months of age. Triple antigen immunisation is
recommended at 2, 4, and 6 months of age with a booster at 15-17 years of age
(Boostrix). The first dose should not be reduced.


* Question 36
The MOST appropriate treatment for first degree atrioventricular (AV) heart block is:

a) An artificial pacemaker

b) Isoprenaline hydrochloride (Isuprel)

c) Atropine

d) Digoxin

e) Requires no treatment
First degree AV block often does not require any treatment. Acute treatment of
extreme bradycardia or second degree AV block (Mobitz type II) may require
atropine or isoprenaline, but temporary pacing is the preferred treatment. Permanent
pacing is recommended for distal block (Mobitz type 2) because of frequent early
progression to third-degree atrioventricular block. Most patients with third degree
(complete) AV block will require permanent cardiac pacing. Drugs such as digoxin
may be the cause of an AV block and should be ceased or the dose reduced.


Question 37
Melissa, a 49 year old woman, presents with loss of libido which has been worsening
over the past 12 months. She takes a combined oral contraceptive tablet, and a
selective serotonin reuptake inhibitor (SSRI) for depression. She is a non smoker but
drinks 1-2 glasses of wine a night. Which of the following advice would you offer
Melissa to help her regain her libido?

a) Change to a progestagen only oral contraceptive

b) Change to an oestrogen only oral contraceptive

c) Reduce her alcohol intake

d) Change antidepressant medication

e) Undertake cognitive behavioural therapy

Various medications may cause loss of libido, including antidepressants like the
SSRIs. The remedy is to change to a different class of antidepressant. Excess alcohol
consumption can have a deleterious effect on libido, however Melissa's intake is
within recommended limits for adult females. Changing the oral contraceptive would
be unlikely to help. Cognitive behavioural therapy would be the next step if suitable
pharmacotherapy cannot be established.
Question 38
In assessing a patient for adult-onset asthma, which of the following is FALSE?

a) There is usually a history of past or present cigarette smoking

b) There is usually a long history of atopic disease

c) Attacks can be triggered by chemical and physical agents

d) The asthma tends to be more chronic than episodic

e) The associated cough can be harsh, suffusing and non-productive

Adult onset asthma is non-atopic, although patients can have attacks precipitated by
aspirin, viruses, cold air and coughing itself. A history of smoking is nearly
ubiquitous, but the connection to the development of adult-onset asthma is not yet
understood. Patients tend not to have long spells of being 'puffer free', but regular
inhaled steroids are very effective in controlling the condition. The cough can keep
the patient awake all night, along with the rest of the family.

Question 39
A 61 year old farmer with a history of hypertension presents with an amnesic
episode of sudden onset. When assessed he is perplexed and bewildered, and
repeatedly asks where he is and how he comes to be there. He has short term
memory loss but knows his identity and is fully conscious. He recovers from his
memory loss after 6 hours. Neurological examination is normal. His blood pressure is
165/96 sitting. The MOST LIKELY diagnosis is:

a) Hypertensive encephalopathy

b) Richardson-Steele syndrome

c) Alzheimer's disease

d) Transient global amnesia

e) Complex partial seizure

The most likely diagnosis is transient global amnesia. This is a syndrome in which a
previously well person suddenly becomes confused and amnesic. The attacks are
usually spontaneous. The patient appears bewildered and repeatedly asks questions
about present and recent events. Orientation for person and sometimes place is
preserved but recent memory is impaired and the patient cannot recall new
information after a few minutes delay. Attacks usually last 24 to 48 hours. Recovery
is complete and recurrence occurs in about 20% of patients. The cause is a mystery.
Complex partial seizures are brief and the individual loses conscious contact with the
environment. Post-ictal amnesia is common if the seizure becomes generalised.
Richardson Steele Syndrome (or progressive supranuclear palsy) resembles
Parkinson's disease in that there is a disturbance of balance and gait, with rigidity of
the trunk and neck muscles. Alzheimer's disease is a progressive form of dementia
which does not resolve. Hypertensive encephalopathy is an acute syndrome where
severe hypertension is associated with headache, vomiting, convulsions, confusion,
stupor and coma.



Question 40
Which of the following factors would NOT be a poor prognostic indicator for joint
replacement in hip osteoarthritis in a 65 year old man?

a) Age

b) A BMI of 33

c) Associated diabetes

d) Presence of osteoporosis

e) A previous joint replacement
Poor prognostic indicators for joint replacement include: age less than 50 years,
diabetes, obesity, high demand, poor bone quality, previous joint surgery and poor
general health. Since Michael is 65 years old his age would not be a poor prognostic
indicator.


Choose the MOST APPROPRIATE response. Grave's disease:
a. is a condition affecting bony growth at the metaphysis
b. is a form of hyperthyroidism which involves diffuse thyroid enlargement and
ophthalmopathy
c. is a chronic granulomatous condition of the distal ileum
d. is a form of post-partum hyperthyroidism
e. presents with enophthalmos and ptosis
The correct answer is (b).
Alternatively, an extrapolation or further understanding may be required.
Example 2
Considering exophthalmic Grave's disease, which of the following is LEAST LIKELY?
a. it is present in 50% of patients when first seen
b. it can develop even after successful treatment
c. it is more common in cigarette smokers
d. it is usually painless
e. it may precede the development of thyrotoxicosis by many years
The correct answer is (d).
Mastery questions
Mastery questions take the knowledge further; they assess your knowledge in a
critical situation such as:
a "life or death" decision
a situation where a patient could be harmed by a wrong decision
a situation where a patient could be exposed to unnecessary anxiety, life-
style disruption, surgery or expense by a wrong decision based on inadequate
knowledge
a patient could cause unnecessary expense or consumption of scarce
resources because of inappropriate referral for a harmless condition.
Mastery questions are "flagged" by the presence of an asterisk in front of the
question number.
*Example 3
A patient arrives in the Emergency Department and is found to be febrile, agitated
and confused with tachycardia. He has recently had a "bad dose of the flu"; you
notice he has exophthalmos and is quite thin. The MOST APPROPRIATE immediate
management would be:
a. take blood for culture and order Chest X-ray
b. Serenace 5mg as a bolus IV dose
c. administration of fluids, antibiotics, propanolol and rectal carbimazole
d. obtain urine for illicit drug screening
e. aggressive treatment of malignant hyperthermia with ice and cold IV fluids
The correct answer is (e)
Mastery questions are also used to distinguish between the most appropriate
management of what appears to be similar conditions:
*Example 4
A patient presents with a 5mm ulcerated Basal Cell Carcinoma on the left cheek. The
MOST appropriate management would be:
a. elliptical excision clear of the margin and primary closure
b. removal by curettage associated with three freeze/thaw cycles with liquid
nitrogen
c. removal by laser
d. wide excision with patch skin graft
e. referral to a Plastic Surgeon for a Moh's procedure.
In this question, the answer is (a), because the lesion is ulcerated and not
superficial. However, if the question were re-phrased:
A patient presents with a 5mm ulcerated Basal Cell Carcinoma in the left naso-labial
groove. The MOST APPROPRIATE management would be:
The problem is entirely different, and (e) is the only
correct answer.
This is the most straight-forward type of question, and is generally phrased to
encourage you to search for a true statement. Questions may contain the words
"true", "most appropriate", "correct", "most common", "best" etc.
Example 5
From the choices below, the BEST initial treatment of a burn is:
a. flushing with cold sterile saline solution
b. application of ice packs to the skin
c. provide adequate pain relief
d. flooding with cold water
e. clean with warm, soapy water
The correct answer is (d). The examiner will place three or four choices around the
correct answer - these are called "distractors" because they are there to distract your
attention away from the correct answer by sounding very plausible and shaking your
confidence in the answer you originally thought was correct. Candidates who know
their work really well can still be led to an incorrect answer by a cleverly worded
distractor.


Negative Questions
Negative questions work by unsettling your way of thinking. In day-to-day
conversation, we generally use positive terminology, not negative.
i.e: "Do you think it will be fine today?"
- a positive question - compared with:
"Do you think it will not rain today?"
which uses a negative term for "fine" ...... "not rain".
In normal use of language, we tend to use positive statements much more frequently
than negative, and so when it comes to answering multiple choice questions, we tend
to automatically choose an answer which would be the response to a positive
question, even though the question may be a negative one.
Typical words used in a negative question are "least likely"; "seldom": "rarely"; "not
often"; "unlikely"; "not associated" "worst" and "never".
So Example 5 would be re-presented as a negative question as:
From the examples below, the WORST initial treatment of a burn is:
and the same choice of five answers could be given. In the hurried, stressful
environment of an exam, with this question placed between totally unrelated topics,
the automatic preference for a candidate is to nominate (d) as the answer, as that is
the action we routinely carry out for burns. It feels almost abnormal to answer (e),
even though that is what the question required as an answer.
The principal difference between a positive question and a negative question is that
the POSITIVE question asks you to identify ONE TRUE statement out of the options
given (where the rest will be false or wrong) and a NEGATIVE question asks you to
identify the ONE FALSE or LEAST applicable statement out of the options where the
rest are TRUE or most applicable.
It would be well worth your while to look through the many examples of multiple
choice questions, simply to be able to identify those that are positive and and those
that are negative, and to familiarize yourself with the varying wording which is used
for each type of question. This way, loss of marks in an exam will be more likely to
be due to lack of knowledge of the topic rather than the accidental loss caused by
not understanding the question properly.
Double negative questions
Double negative questions are very difficult, and are recognized as a "dirty trick"
used by the examiner to confuse a candidate into a wrong answer. They are not a
true test of what a candidate knows, and tend not to be used nowadays. They are
extremely difficult to write well, and tend to be very convoluted in their wording. In
general, they are typified by a negative statement in the question, and a negative
statement in one or more of the "detractors".
Example 6
The LEAST LIKELY cause of an itchy erythemopapular rash on the penis is
a. a condition sexually transmitted between homosexual men
b. a condition not likely to be highly contagious
c. a condition transmitted by casual contact
d. a condition which occurs in all age groups
e. a condition unassociated with personal hygiene
The question is quite a straightforward one about scabies, but it has been made
difficult by the negative wording in the main question and a few negatives ("not
likely" in "b" and "unassociated" in "e").
Double negatives are worthwhile looking for if you come across a question which
seems wordy, out of place or difficult to make sense of. They are not likely to be
common, so do not waste much time on them. Recognizing them will enable you to
keep a positive "rhythm" going during the exam.
"None of the above" and "All of the above" distractors
With "all of the above" as one of the options, all you have to do is recognize if one of
the other distractors is wrong thereby eliminating both and only leaving the rest to
choose from - ie you may have reduced your choices from five down to three. If,
however, you recognize two other options as being true, then the likelihood that "all
of the above" is correct is very high.
"None of the above" questions are only applicable if, by reasoning, you can eliminate
all of the other detractors. It is a much more "black or white" option than "all of the
above". However, they are more common than the positive "all of the above". If you
see it in a question which asks for the "most likely" or the "most correct" - in other
words, if a question implies that the options vary in their degree of correctness, it is
an unlikely choice - unless the question is factual and a computation yields an
answer which is not listed.
Confusing, isn't it??
Example 7 may clear the air.
Bridie is an asthmatic child whose best predicted peak flow is 4L/sec. She should see
you if her peak flow falls below
a. 4.25 L/sec
b. 3.85L/sec
c. 3.5Lsec
d. 3.38L/sec
e. none of the above
Present recommendations are that people with asthma should see their doctors if
their peak flow is below 80% of predicted. With this knowledge, you can calculate
that Bridie should see you if her peak flow falls below 3.2L/sec, so "none of the
above" would be correct.
There has been a rumour circulating the studying adult circuit that these types of
detractor ("all" or "none") were always the correct choice when they appeared. That
is not true as a rule, and one still should read and interpret these questions with full
attentiveness.
Clarifying the question
Questions can sometimes be quite wordy, making them difficult to understand. It is
worthwhile to "re-write" the question in your own mind (and maybe translate it to
your native language) in such a form as to make the intent of the question clear.
Some examples from the Brief Test:
* 9. In acute asthma in childhood, the LEAST APPROPRIATE treatment would be:
a. Inhaled salbutamol
b. Inhaled salmeterol
c. Inhaled budesonide
d. Intravenous aminophylline
e. Subcutaneous adrenaline
Could be re-written as "The wrong drug for acute asthma is"
*5. A 3 year old child is admitted to A&E with a history of rapid onset of sore throat,
pain on swallowing, high fever and a low pitched grunting noise while breathing. The
child appears toxic, is sitting forward and is drooling excessively. There is no
significant cough and only mild chest recession. The most appropriate management
would be:
a. Carefully inspect the pharynx for evidence of tonsillitis or foreign body
b. Insert an intravenous cannula to obtain blood samples and start IV fluids
c. Send to X-Ray for inspiratory and expiratory CXR to exclude an inhaled
foreign body
d. Ask the anxious parents to leave the room as they may upset the child
e. Give oxygen
Could be summarized as: "toxic child with upper airways obstruction suggestive of
epiglottitis - I must...
*20. Concerning coronary artery bypass grafting (CABG), which of the following is
TRUE?
a. it is indicated for crescendo (pre-infarct) angina
b. it is indicated for congestive heart failure
c. it is not indicated for chronic disabling angina
d. it is associated with a 10% operative mortality rate
e. it is only indicated if significant triple vessel disease is demonstrated on
angiography.
The question is much clearer if expressed as 'Coronary bypass grafting is...'
*26 Which of the following screening tools for osteoporosis is currently
recommended for all menopausal women?
a. Lateral Thoracic spine X-ray
b. Dual-energy X-ray absorptiometry
c. Bone densitometry
d. Radio nucleotide bone scan
e. Periodic health maintenance visits
This is clearer if expressed as 'The most cost-effective screening tool for osteoporosis
in menopausal women is.....'
4. A 26-year-old patient has had three consecutive spontaneous abortions early in
the second trimester. Which would be the LEAST useful investigation?
a. Hysterosalpingogram
b. Chromosomal analysis of the couple
c. Endometrial biopsy in the luteal phase
d. Post-coital test
e. Thyroid function test
Could be rewritten as "The least useful test for a woman with recurrent 2
nd
trimester
abortions is...
Altering the point of the question
As in Q4 above, you can make it a positive question by asking for the most
appropriate test.
Answer is (a) - Hysterosalpingogram
You now have two facts about 2
nd
trimester abortions - and it is now well worthwhile
to look up the book and find out more.
With conversion of a positive question to a negative question and vice versa, you can
sometimes get a new perspective and understanding of the clinical condition under
consideration - it doesn't work all the time, and sometimes you will have to look up a
book to find the answer; within a previously negative question, you should find at
least two to four true facts about the topic you can use.
Checking out the distractor
What other good can be made of them?
Check Q24
The MOST COMMON pathogen causing urinary tract infection in pregnancy is:
a. Pseudomonas aerugenosis
b. Proteus mirabilis
c. Haemophilus influenzae
d. Escherichia coli
e. Klebsiella pneumoniae
So we select one out as the right answer, but what would the questions be if each of
the other distractors were to be the correct answer?
Similarly, you may come across a distractor you had not seen before - it is a great
opportunity to learn something new, and it may give you a greater insight into
something you already know.
Some distractors are nonsense and require no further checking out - like felodipine
increasing GSR!
New question
A six-month old infant has eaten a diet with the following content and intake for the
past five months:
Protein 4% of Calories
Fat 50% of calories
CHO 46% of calories
Calories 105/kg wt/day
The child is MOST LIKELY suffering from:
a. rickets
b. merasmus
c. obesity
d. tetany
e. kwashiorkor
Is the answer b) or is it e)?
Merasmus is due to calorie lack with resulting catabolism of muscle - hence the
cachectic child. In kwashiorkor, there are sufficient calories, but insufficient protein,
especially albumin, hence the little pot-bellied oedematous child.
But ....check out the other distractors! How much do you know about rickets? How is
obesity defined in a child this age? What could cause a child to develop tetany? Good
questions, all worth finding solutions for.
One of the most useful habits you can develop to help your life-long medical career
is to become a chronic question asker!
Checking your answer
There are two basic types of MCQ tests - those that give an "annotated" answer, and
those that give a simple "right or wrong" answer. Annotated types give you the right
answer, WHY it is right and usually, (but not always), why the distractors are
incorrect. Your GPEA site gives annotated answers, checked against the best possible
sources.
For every question you do, regardless of source, you should check your answer to
see if you got it right for the correct reason! In other words, that it simply wasn't a
good guess. This is the only way to ensure that you possess the knowledge to
answer the same question again correctly. It also provides a further "building block"
to a complete understanding of a topic. If you did get it right for the right reason, it
re-enforces your confidence in your knowledge of the subject. A "lucky guess" is a
great indicator of where you are lacking knowledge - you don't know enough about
the subject to know if it is either right or wrong!
Annotated answers will allow you to check immediately. Try not to fall into the trap
of not checking questions that are not annotated - the effort of checking your answer
out in a textbook is well worth it. Twenty questions assessed and worked through
thoroughly is much more valuable than working through fifty quickly to see if you
can score twenty-five or better. Do your time trials as you get within a month of the
exam.
Enforcing and directing study by scores
You may be able to "batch" some questions into similar groups - say "cardiology" or
"pregnancy" or "diabetes" etc. Some of these questions may deal with pathogenesis,
symptoms, "normal" or therapeutics. If you do a group, then score yourself, it is
most important that you find out your areas of weakness. For instance, you might do
50 questions on paediatrics and find that you did well in areas of childhood infections
and oncology, but poorly in normal developmental milestones and neonatology. This
should direct you to spending some time reading the textbook on the areas you got
wrong, and going "easy" on the areas you got right.
If you were to fill out a study timetable for the week and marked it "Paediatrics", it
would be well worthwhile putting aside two hours or so to equip yourself with 50-100
questions at random from various sources to give yourself a "pre-test". At the end of
your study period for that subject, repeat the test using the same questions. This will
give you a good indication of the effectiveness of your study, and indicate the areas
that need more work.
The program for this course has "topics" set for each week except those weeks
where you allowed time to address your personal study needs. There are 30
questions each week, but not all 30 questions are strictly related to that topic. For
instance, week 2 is based around the haemopoeitic system, but 10 of the questions
are on paediatric aspects. This is designed to not only test the "area of interest" for
the week, but to help you factor in review of areas of weakness that may be
highlighted by the "out of type" questions.
I hope the sections above have helped you to realize that there is much more to
multiple choice questions than just answering them, especially if you are sitting for
an exam like the AMC. Going through the questions using this approach is time
consuming, especially initially, but it will provide benefits. This must be balanced
with two important factors:
you still have to do text book study and review
you still have to do "time trials" - use your own watch or do the "time trials"
in the USMLE web site (groups 1 and 2) (www.USMLE.org).
Before the exam
Relax (if you can!): try breathing meditation, a solitary walk, a non-exam chat with
friends; pat a cat; pray; sing; say poetry out loud (no-one will come near you). I
always found a bit of under-the-breath swearing useful, but each to their own.
Avoid highly anxious people who want to check on the molecular weight of amyloid
and who otherwise want to damage your confidence. Similarly, avoid confident,
boisterous people who want to ask you "What is the most appropriate voltage setting
for Electroconvulsive Therapy in a 40 year-old woman with a BMI of 38?" and expect
you to know the answer. Ignore them! If they are encouraged, they breed!
Mentally rehearse: imagine yourself walking into the exam room calmly, filling out
your name and number on the exam sheets in your best handwriting, and
confidently opening the first page when the bell rings and "getting on with it".

In the exam
Cover the answers with your hand or a piece of paper.
Read the question and make sure it is clear in your mind
Read the answers deliberately but quickly
If the answer is obvious, mark it down on the answer sheet carefully and
move onto the next question. Do not check until you have completed the
whole paper.
If you simply have no idea, take a foolhardy, gallant guess, mark it on the
answer form (you don't have to be careful), leave it in the past, and move on
to the next question. Your chances of getting it right are still much better
than your winning the lotto!
If you think you may know the answer, re-read the answers. Do not re-read
the question as your reading of the answers will colour or distort your re-
reading of the question.
Adopt a quizzical look, poke your tongue out at the right angle, select the
answer you are happy with and congratulate yourself. Mark it carefully on the
answer sheet, move on and forget it. Review when you have finished all other
questions.
While you are doing all the above, watch the time!

After the exam
Go home, relax with the family, and put the exam behind you. You can ring your
friends tomorrow and go through the exam question by question, but today, you
have been through enough torture.
All at the RACGP wish you the very best in your exams.
Impossible questions
Every one of us has had the disheartening experience in a multiple choice exam of
coming across a question where we had simply no idea what the answer was. We
then tend to waste time trying to make sense of it. It is a good idea to look on these
questions not as a stumbling block but as a "gift" from the examiner - you know you
will not get it right, so jump in and have a brave guess (much like lancing a quinsy!),
and use the time more advantageously on another question.
"It's not English.......it's Australian English!"
The above statement was made by an exam candidate whose English was excellent,
but who had difficulty with understanding some questions in the exam. Apart from
having an "Introduction to Australian English" course run by Dame Edna Everidge,
there appears to be no easy solution. However, it may be worthwhile reviewing
MCQs from different places, such as the following:
"CHECKUP" programs (CDROM) - RACGP - Australian
USMLE - books and Internet (www.USMLE.org) - USA
Davison's and other texts - Great Britain
This may help to acquaint you with the varying forms of English MCQs. It is also
worthwhile to review these questions to distinguish their varying content.
The CHECKUP questions are similar in some aspects of content and style to the AMC
questions, but are heavily clinical in nature, with few simply factual questions.
USMLE questions tend to be scientific and factual, and there are obvious differences
in content. If you look critically, you will be able to discern questions which are of no
use to you in your AMC preparation, and will be able to leave them and concentrate
on more relevant material.
The differences in content reflect the differing emphases placed on areas of concern
in each place. For instance, you will find quite a few questions on "crack" cocaine in
the USMLE questions, whereas Australian questions tend to be more concerned
about the adverse health effects of alcohol abuse.