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AMC MCQ Mock Exam 2

Question 1

Prolonged neurological sequelae in infants can occur if the mother has taken which of the following in
the third trimester?

a) Antipsychotics
b) Tricyclic antidepressants
c) Anticonvulsants
d) Benzodiazepines
e) Opioids

* Question 2

A 21 year old man walks into your surgery with his head tilted sideways, his eyes rolled up and his
tongue sticking out. He speaks with difficulty but says that he has been 'stuck' in this position since
taking a new medicine a few hours ago 'for his nerves'. You should administer:

a) Diazepam
b) Benztropine
c) Chlorpromazine
d) Phenytoin
e) Haloperidol

Question 3

Mr Brown is 70 years old and suffers with severe pain in his back from osteoarthritis. He also suffers
with emphysema and has had prednisolone for exacerbations of this disease. He is currently on
warfarin for a cardiac arrhythmia and is also taking lansoprazole as a maintenance dose after a
duodenal ulcer was diagnosed 4 years ago. Which of the following DOES NOT increase the risk of
gastrointestinal side effects from non-steroidal anti-inflammatory drugs (NSAIDs)?

a) Concurrent use of prednisolone


a) Previous duodenal ulcer
b) Concurrent use of anticoagulant
c) The fact that he is over 70 years of age
d) Male gender

Question 4

Coral is 55 years old. Her periods ceased 8 years ago. She now presents with vaginal itch, discharge
and soreness. The MOST LIKELY cause is:

a) Candida infection
b) Vaginal atrophy
c) Vaginal dermatoses
d) Gardnerella infection
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e) None of the above

* Question 5

You are called to see a 78 year old woman with a three-week history of headaches and depressive
symptoms. She relates that 24 hours ago the vision in her right eye suddenly dimmed. Today the
visual acuity in the eye is limited to perception of hand movements only, compared with 6/6 in the left
eye. She is not known to be a diabetic and her blood pressure is only minimally elevated. Which of the
following possible causes of her visual loss require IMMEDIATE investigation and treatment to prevent
blindness in the other eye?

a) Detached retina
b) Central retinal artery occlusion
c) Central vein occlusion
d) Acute glaucoma
e) Temporal arteritis

* Question 6

Which of the following is INCORRECT?

a) The incidence of haemochromatosis in Australia is 1:200


b) C282Y homozygotes account for more than 90% of haemochromatosis in Australia
c) The majority of patients with one copy each of the C282Y and H63D mutation never develop
haemochromatosis
d) 90% of C282Y homozygotes develop symptoms of the disorder at some stage in their lives
e) Carriers of one copy of the altered gene are generally healthy

Question 7

22 year old Melanie presents with a 2 day history of a vaginal discharge, urinary frequency and
dyspareunia. Which organism is the MOST LIKELY cause of this presentation?

a) Gardnerella
b) HIV
c) Chlamydia trachomatis
d) Giardia lamblia
e) Hepatitis B

Question 8

The interossei of the hand are supplied by:

a) The radial nerve


b) The median nerve
c) The ulnar nerve
d) All of the above
e) None of the above
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Question 9

A 55 year old woman presents with an itchy purple papular rash on her wrist. She is not on any
medications. This is MOST LIKELY to be:

a) Lichen Planus
b) Lichen Simplex Chronicus
c) Lichenoid eruption
d) Lichen Sclerosus
e) Lichenification

* Question 10

A 21 year old female patient presents with lower abdominal pain and tenderness at 14 weeks of
gestation. Her temperature is 38.5 degrees Celsius. The most important diagnosis to EXCLUDE is:

a) Pyelonephritis
b) Threatened abortion
c) Ectopic pregnancy
d) Degeneration of a uterine fibroid
e) Appendicitis

* Question 11

A 42 year old man presents with a recurrent severe hemicranial nocturnal headache which lasts for 60
minutes and occurs regularly every 3 weeks. The headache is accompanied by a blocked nose and
watering eye. The MOST LIKELY diagnosis is:

a) Chronic paroxysmal hemicrania


b) Migraine variant headache
c) Chronic sinusitis
d) Cluster headache
e) Trigeminal neuralgia

Question 12

An elderly patient with rheumatoid arthritis has been on prednisolone in a dose of 12.5 mg daily for 8
years. After a fall, she complains of severe pain over her lower thoracic spine and is found to be very
tender over T11 and T12. A radiograph shows 'cod-fish' vertebrae, with generalised radiolucency of
bones and collapse of two vertebral bodies. Examination of her serum is MOST LIKELY to show:

a) High calcium, low phosphate, raised alkaline phosphatase


b) Low calcium, high phosphate, normal alkaline phosphatase
c) Low calcium, low phosphate, raised alkaline phosphatase
d) Low calcium, normal phosphate, normal alkaline phosphatase
e) Normal calcium, normal phosphate, normal alkaline phosphatase
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Question 13

Which of the following may be a good reason for stopping breast feeding:

a) Inverted nipples
b) Cracked nipples
c) Engorged breasts
d) Mastitis
e) Breast abscess

Question 14

A 40 year old physician has had muscle twitching for one year. The twitching occurs predominantly in
the lower extremities. A neurological and general physical examination is negative except for these
twitchings. What is the MOST LIKELY diagnosis?

a) Benign fasciculations
b) Hypoparathyroidism
c) Amyotrophic lateral sclerosis
d) Paramyoclonus multiplex
e) Dystrophia myotonica

Question 15

Which of the following is of LEAST value in assessing the level of active joint inflammation ('disease
activity') in rheumatoid arthritis?

a) Duration of morning stiffness


b) Presence of tiredness, malaise and weight loss
c) Degree of elevation of the erythrocyte sedimentation rate (E.S.R.)
d) Presence of rheumatoid factor in the blood
e) Strength of hand grip

Question 16

In a couple trying to conceive, intercourse should take place:

a) As soon as there is a rise in basal temperature


b) 14 days after the onset of the next period
c) On alternate days prior to the basal temperature rise
d) On alternate days after the basal temperature rise
e) Daily after the basal temperature rise
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* Question 17

Sudden onset of unilateral orbital pain, photophobia, lacrimation and blepharospasm suggests a
diagnosis of:

a) Open-angle glaucoma
b) Anterior uveitis
c) Temporal arteritis
d) Unilateral blepharitis
e) Vitreous haemorrhage

Question 18

A patient presents with acute gout but has a low serum uric acid. Which of the following drugs can be
responsible for a low serum uric acid?

a) Colchicine
b) Prednisolone
c) Indomethacin
d) Naproxyn
e) Salicylates

Question 19

The 'benign' jaundice that occasionally occurs in the third trimester of pregnancy is most CLOSELY
related to:

a) Decreased circulating amounts of albumin to bind bilirubin


b) A specific defect in glucuronide conjugation
c) An autoimmune process
d) High oestrogen and progesterone levels
e) The use of diuretics in the third trimester of pregnancy

Question 20

Accommodation of the eyes to NEAR objects is accompanied by:

a) Loss of binocular vision


b) Constriction of the pupils
c) Divergence of the visual axes
d) Decreased refractive (dioptric) power
e) Relaxation of the ciliary muscles
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Question 21

The serum phosphate is MOST LIKELY to be low in which of the following disorders:

a) Osteoporosis
b) Osteomalacia
c) Multiple myeloma
d) Polymyalgia rheumatica
e) Paget's disease

Question 22

Which of the following is NOT TRUE regarding asymptomatic bacteriuria in pregnant women?

a) The incidence is 3-7% of all pregnancies


b) Defined arbitrarily as greater than 100,000 bacteria/ml
c) One of the common organisms is Streptococcus Faecalis
d) Responds to a short course of oral antibiotics
e) Is a clinically unimportant phenomenon

* Question 23

Which finding in this report of a cerebrospinal fluid (C.S.F.) examination is INCONSISTENT with the
other results?

a) Elevated protein
b) Normal chloride
c) Elevated glucose
d) No red cells
e) Gross excess of polymorphonuclear leucocytes

Question 24

With regard to Tietze's syndrome, which of the following statements is INCORRECT? Tietze's syndrome
is:

a) Painful, tender swelling of one or more costochondral joints


b) The cause of up to 30% of chest pain presentations to emergency departments
c) Most commonly diagnosed before the age of 40 years
d) Sometimes associated with the development of rheumatoid arthritis later in life
e) Often associated with repeated minor chest trauma such as harsh coughing
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Question 25

A mother develops a fever of 38.2 degrees Celsius 3 days after the delivery of her baby. Which of the
following is the MOST LIKELY cause?

a) Endometritis
b) Dehydration
c) Breast engorgement
d) Deep venous thrombosis
e) Urinary tract infection (UTI)

Question 26

In which spinal cord segments are the motor neurones responsible for the knee-jerk located?

a) L1,L2
b) L2,L3
c) L3,L4
d) L4,L5
e) L5,S1

Question 27

Marion aged 56 years complains of constipation, tiredness, lethargy and lack of energy. She looks
puffy in the face, is faintly yellowish in colour and has a pulse of 56 beats/minute regular. Her full
blood count shows her haemoglobin is 9.7 g/dl, she has a macrocytosis, lymphocytosis and a raised
erythrocyte sedimentation rate (ESR). The MOST LIKELY diagnosis is:

a) Pernicious anaemia
b) Carcinoma of the bowel
c) Alcoholism with malnutrition
d) Hypothyroidism
e) Lymphocytic leukaemia

Question 28

In which of the following conditions of the colon is malignant change MOST LIKELY to occur?

a) Adenomatous polyp
b) Melanosis coli
c) Diverticulitis
d) Familial polyposis coli
e) Ulcerative colitis
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Question 29

A 25 year old epileptic woman who had been in good health was admitted to hospital in a comatose
condition after the ingestion of 2.0 g of phenobarbitone. On examination, most reflexes appeared to be
intact and there was no depression of respiration. Which of the following forms of therapy would be
MOST appropriate?

a) Urgent peritoneal dialysis


b) Alkalinisation of urine
c) Prophylactic antibiotics
d) Administer analeptics
e) Give IV corticosteroids

Question 30

A 32 year old man with ankylosing spondylitis presents to you for management of his disease. Which
of the following clinical features is he LEAST LIKELY to complain about?

a) Sudden development of dull low back pain


b) Attacks of pain and photophobia in one eye
c) General malaise, fatigue and weight loss
d) Morning stiffness lasting a few hours
e) Bilateral hip and shoulder pain

Question 31

In men less than 35 years of age the MOST COMMON causative organism in epididymitis is:

a) Mumps virus
b) Escherichia coli
c) Chlamydia trachomatis
d) Neisseria gonorrhoeae
e) Streptococcus faecalis

* Question 32

Jane is brought into the surgery after being struck in the eye with a tennis ball. On examination you
note blood in the anterior chamber of the eye. Which of the following statements regarding her
management is INCORRECT?

a) Aspirin and non-steroidal anti-inflammatories drugs (NSAIDs) are contraindicated


b) The main treatment goal is prevention of secondary haemorrhage and glaucoma
c) Topical mydriatics should be used to permit examination of the posterior chamber
d) Tranexamic acid (Cyklokapron) may be used to stabilise clot formation and prevent rebleeding
e) Urgent ophthalmological review is necessary to exclude other ocular damage
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* Question 33

The MOST LIKELY venous source of fatal pulmonary embolism is:

a) Iliofemoral
b) Subclavian
c) Saphenous
d) Pelvic
e) Popliteal

Question 34

A patient with moderate to severe emphysema would demonstrate all of the following physical signs
EXCEPT:

a) Distant heart sounds


b) A prominent pulmonary second sound
c) A narrow intercostal angle
d) Prolonged expiration
e) Hyperresonance to pulmonary percussion

Question 35

Mrs Leung, aged 68 years, has Type 2 diabetes for which she takes metformin 850mg tds and
gliclazide 160mg bd. Her blood pressure is well controlled on candesartan 16mg daily. She has no
evidence of heart failure and is otherwise well. Her HbA1c is now 9.2% (nondiabetic range <6%).
Which of the following strategies would NOT be an appropriate next step?

a) Commence isophane insulin 10 units before bed


b) Commence rosiglitazone 4mg daily
c) Refer for dietary and diabetes education to review lifestyle factors
d) Increase her dose of metformin to 1 gram tds
e) Increase her dose of gliclazide to 160mg tds

Question 36

In trigeminal neuralgia all of the following statements are true EXCEPT:

a) It is most common in middle-aged and elderly persons


b) Multiple sclerosis must be considered in younger people
c) There is an associated weakness in the muscles of mastication
d) The severe, lancinating pain may last for up to two minutes
e) It usually responds well to regular carbamazepine
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* Question 37

A 40 year old Vietnamese man who arrived in Darwin 6 weeks prior, presents with 5 days of headache,
fever and malaise. What is the MOST LIKELY diagnosis?

a) Malaria
b) Typhoid fever
c) Dengue fever
d) Filariasis
e) Meningococcal meningitis

Question 38

Peter presents with a painful left eye associated with a sudden loss of vision. Which of the following
conditions is NOT usually associated with pain in or around the eye?

a) Amaurosis fugax
b) Retrobulbar neuritis
c) Acute angle closure glaucoma
d) Temporal arteritis
e) Anterior uveitis

Question 39

A 62 year old housewife presents because of pain in her left cheek precipitated by eating or touching
her face just under the left eye. This pain lasts for 30 to 60 seconds. The patient is most likely to
benefit from:

a) Dental attention
b) Penicillin
c) Blockade of the infraorbital nerve
d) Carbamazepine
e) Corticosteroids

* Question 40

The most important muscle used for inspiration is:

a) External intercostals
b) Diaphragm
c) Scalenes
d) Rectus abdominis
e) Internal intercostals
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Question 41

Complications of a major burn include all of the following EXCEPT:

a) Fluid loss
b) Myocardial depression
c) Myoglobinuria
d) Increased immunocompetence
e) Peptic ulceration

Question 42

The MOST COMMON cause of intellectual disability in Australian children is:-

a) Birth hypoxia
b) Down Syndrome
c) Intrauterine Growth Retardation
d) Fragile X Syndrome
e) Rett Syndrome

* Question 43

Peta, aged 3, presents distressed with an acute attack of asthma. She is treated with salbutamol via
MDA and face-mask. She improves symptomatically, but becomes breathless and wheezy again after
90 minutes. The next MOST APPROPRIATE step in management would be:-

a) Double the dose of Salbutamol


b) Repeat Salbutamol and commence oral steroids
c) Assess with spirometry
d) Measure Oxygen saturation to determine need for hospitalization
e) Commence I.V. Aminophylline

Question 44

Mary-Jane Reid, aged 17, commenced the combined oral contraceptive pill nine weeks ago. She did
not have a withdrawal bleed after the first packet. She presents now, seven days after the end of the
active pills in her second packet, having not had a withdrawal bleed. The MOST APPROPRIATE advice
you could give would be:-

a) Should change to a less progestogenic pill


b) Continue taking the present pill
c) Cease the lactose pills and try for a withdrawal bleed after 4 months
d) Have a pregnancy test
e) Check FSH, LH and prolactin levels
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Question 45

With regard to children in Australia who are infected with HIV, all of the following are true EXCEPT:-

a) Annual influenza vaccination is advisable


b) IPV is preferred to OPV
c) They should have Pneumococcal vaccine
d) They require BCG vaccination if the environmental risk is high
e) CD4 counts should be check prior to varicella and MMR vaccines

* Question 46

A 58 year old lady presents with painless jaundice. Physical examination of the abdomen is
unremarkable. The results of her blood tests are:

Liver function tests: Bilirubin 90 umol/L (<21), ALP 650 U/L (30-115), GGT 540 U/L (<31), ALT 55 U/L
(<41), AST 45 U/L (<41), alb 35g/L (35-50)

Full blood Count, Electrolytes, Urea and Creatinine are normal.

The next most useful investigation would be:

a) Abdominal CT scan
b) Oral cholecystogram
c) Upper abdominal ultrasound
d) ERCP
e) Assay conjugated/unconjugated bilirubin

* Question 47

On the second post operative day following a right hemicolectomy, a 68 year old patient has a urine
output of 10mls per hour over the past 5 hours. On examination he is alert, T37.5 degrees Celcius,
P105, BP110/70. Abdomen is soft and nontender. All other examination findings are unremarkable and
the catheter isn't blocked. Intial management would be to:

a) Check the patient's Electrolytes, Urea and Creatinine


b) Remove the catheter
c) Increase IV Fluid rate
d) Give 40mg IV Frusemide and check urine output again in one hour
e) Commence him on oral fluids
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* Question 48

Mr George Black, aged 76, presents to Emergency with shortness of breath. He is afebrile, pulse
108reg, gallop rhythm, BP150/72, with no cyanosis or peripheral oedema. His Chest X-ray is shown
above. The MOST APPROPRIATE initial management would be:-

a) Morphine and a beta-blocker


b) Oxygen by mask 4L/min and IV frusemide
c) Captopril 2.5mg b.d. and bed rest
d) Nitrites and a calcium channel blocker (nifedipine)
e) Commence IV erythromycin and ceftriaxone

Question 49

Which of the following is least likely to be associated with increasing the risk of squamous cell
carcinoma of the oesophagus?

a) Achalasia
b) Alcohol ingestion
c) Plummer-vinson syndrome
d) Tobacco consumption
e) Barrett's oesophagus
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Question 50

Causes of pre term labour include all of the all of the following EXCEPT:

a) Cervical incompetence
b) Oligohydramnios
c) Multiple pregnancy
d) Pregnancy induced hypertension
e) Premature rupture of membranes

* Question 51

Peter is a 16 year-old who realizes he is gay. He confides this to his best friend, who rejects him. His
parents, whose relationship is strained, separate soon after he tells them. Peter looses interest in
school, starts drinking alcohol, and engages in risk-taking behaviour. When consulting with him, the
factor you would consider MOST IMPORTANT would be:-

a) The degree of danger his risk-taking activity involves


b) His awareness and knowledge of safe-sex practices
c) His feelings of guilt
d) His suicide risk
e) His feelings of anger and rejection

Question 52

Lance, a happy three year-old, is bought to see you by his father. For the previous three days, Lance
has been passing large, pale, offensive stools containing undigested vegetable material. He is
otherwise well. This is MOST SUGGESTIVE of:-

a) Cystic fibrosis
b) Giardia
c) Excessive orange juice in his diet
d) Blastocystis hominis
e) Pinworm infestation

* Question 53

A 6 week old baby with a 36 hour history of projectile vomiting is at risk of which of the following
electrolyte and acid/base disturbances?

a) Hypochlaraemic metabolic acidosis


b) Hypokalaemic metabolic acidosis
c) Hypochloraemic metabolic alkalosis
d) Hypernatraemic metabolic alkolosis
e) None of the above

Question 54
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Retroperitoneal fibrosis COMMONLY presents as:-

a) Ureteric obstruction
b) Bilateral leg lymphoedema
c) Bilateral thigh claudication
d) Testicular pain
e) Central abdominal pain radiating from the back while standing

Question 55

Regarding suspected appendicitis in late pregnancy, which of the following is TRUE?

a) It is the most prevalent extra-uterine indication for laparotomy


b) Pregnancy increases the risk of appendicitis
c) The foetus is placed at extra risk by laparotomy, so management should include extended
observations
d) Laparascopic appendicectomy increases the risk of increasing both maternal and fetal and
mortality rates
e) There is a direct correlation with maternal age

* Question 56

When assessing a patient in Emergency with suspected diabetic ketoacidosis, which of the following is
NOT true:-

a) Ketoacidosis may occur with infection only in the presence of fever


b) Nausea and vomiting are common presentations
c) Abdominal pain can be so severe as to suggest an acute surgical abdomen
d) Hypotension and tachycardia can be present
e) Kussmaul breathing is a classical sign

* Question 57

George Weston is a 48 year old man who has a strong family history of premature death from
myocardial infarction in the males on his father's side. He has been treated for hypertension for the
past 2 years. For the past 2 years his blood pressure had been well controlled with a healthy diet,
regular excercise and an ACE inhibitor. However, when he comes for a 6 month review and renewal of
his prescription, his blood pressure is noted to be 150/90. The blood pressure is noted to be high on 3
separate occasions. All of the following are possible causes for loss of control of his blood pressure
except:

a) He has been taking diclofenac over the past 2 weeks for an ankle sprain
b) He recommenced smoking since he lost his job 2 months ago
c) He has gone back to heavy alcohol ingestion
d) He has been on sibutramine to help him lose weight
e) He has been having trouble sleeping since he lost his job and has been taking temazepam
prescribed by another doctor
Question 58
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Which of the following statements concerning secondary dysmenorrhoea is TRUE?

a) It usually affects women in the older age groups


b) The pain is due to the release of high levels of endometrial prostaglandins
c) Nausea, diarrhoea or constipation are common associated symptoms
d) The pain usually peaks at 24 hours and then subsides after 48 hours
e) It is rarely associated with organic disease

* Question 59

Ms Bowden presents with her two year-old daughter, Melanie, who has recently spent a week at her
father's farm. She has been troubled by intense itching of her arms, trunk and buttocks. The
appearance of the rash is shown in the photograph above. Other members of Melanie's father's family
have similar troubles, and are being treated by the naturopath with a grass seed ointment. The MOST
LIKELY diagnosis is:-

a) Atopic eczema
b) Ringworm (tinea corporis)
c) Contact dermatitis
d) Scabies
e) Flea bites

Question 60
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Which of the following types of lipid profiles is considered the MOST LIKELY to result in premature
coronary artery disease and premature death from myocardial infarction?

a) Increased cholesterol, normal HDL; high LDL, normal or increased triglycerides


b) Slightly increased cholesterol, low HDL, increased chylomicrons, very high triglycerides
c) Normal cholesterol, VLDL increased, chylomicrons increased, HDL decreased, triglyceride slightly
increased.
d) Slightly increased cholesterol, VLDL increased, HDL reduced, triglycerides greatly increased.
e) Dysfunctional Apolipoprotein E, high VLDL, very high cholesterol, very high triglycerides; low LDL
and low HDL

Question 61

The MOST COMMON fracture to occur in a baby during birth is:-

a) Humerus
b) Femur
c) Clavicle
d) Pelvic
e) Cervical spine

Question 62

Secondary amenorrhoea in adolescence can be due to all of the following EXCEPT:-

a) Anorexia nervosa
b) Hypothalamic-pituitary disorders
c) Pregnancy
d) Oral contraceptive pill
e) Imperforate hymen

* Question 63

From birth to four years of age, the MOST LIKELY setting for childhood injury is:-

a) Home
b) Child Care Centre
c) Motor Vehicle
d) Community recreational venues (i.e. parks and gardens)
e) Non-child safe residences (i.e. grandparent 's homes)

Question 64
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Jenny is 32 years old and requires a splenectomy for idiopathic thrombocytopaenic purpura. The MOST
IMPORTANT factor in pre-operative preparation is:-

a) Cross matching enough blood


b) Provision of pneumococcal, meningococcal and HiB vaccination
c) Assessment of bone marrow function
d) Correction of thrombocytopaenia
e) Exclude the presence of ectopic spleen

Question 65

All of the following are non-metastatic extrapulmonary manifestations of bronchial carcinoma except:

a) Nephrotic syndrome
b) Finger clubbing
c) Hypertrophic pulmonary osteoarthropathy
d) SIADH
e) Hypercalcaemia

* Question 66

When taking a history regarding tinnitus, which of the following is MOST SIGNIFICANT?

a) Is it rhythmical
b) Does it change with posture?
c) Is it affected by hot or cold fluids?
d) Does it disappear while sleeping?
e) Is there a family history?

Question 67

Thyroglossal cysts:-

a) Usually present in the fourth decade of life


b) Are derived from embryonic ectoderm
c) Are always sited as a midline neck swelling
d) Are surgically unrelated to the hyoid
e) Move upwards on protrusion of the tongue

Question 68
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The LEAST LIKELY cause of isolated posterior cervical lymphadenopathy is:-

a) Tuberculosis
b) Toxoplasmosis
c) Ticks embedded in the occipital skin
d) Metastatic malignancy
e) Lymphoma

* Question 69

Mr Scott is a 58 year old diabetic patient with a BP of 150/95 and BMI of 29. All of the following are
true except

a) An ACE inhibitor would be the first choice as an antihypertensive agent


b) His blood pressure should be reduced to less than 140/90
c) He should have an annual spot urine test to check for microalbuminuria
d) Target HBA1C is less than 7%
e) Metformin is the most appropriate oral hypoglycaeimic for this patient

* Question 70

Bill Randall, a 58 year-old interstate truck driver, presents because of sudden onset of diplopia and
pain in the right orbit. His BP is 138/88, BMI is 32, and his abdominal girth is 124cm. Examination
reveals right sided ptosis and ophthalmoplegia, with normal pupillary constriction to light. The MOST
APPROPRIATE initial investigation is:-

a) CT Head
b) Carotid duplex ultrasound
c) 24hr ambulatory BP assessment
d) Random glucose
e) VDRL and TPHA

* Question 71

"Alarm" symptoms for complications of gastro-oesophageal disease include all of the following
EXCEPT:-

a) Dysphagia
b) Haematemesis
c) Odynophagia
d) Weight loss
e) Waterbrash

Question 72
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Ms Elaine Landy, aged 56, has undergone Right breast lumpectomy for a mass which appeared
suspicious clinically and on mammography. The histology reports the tumour is "oestrogen receptor
positive". Clinically, this means that:-

a) There is also a high risk of ovarian secondaries


b) There is a high risk of bony metastases
c) Cytotoxic chemotherapy should be commenced
d) The tumour will respond to hormonal manipulation
e) It is irrelevant as she is post-menopausal

* Question 73

Regarding the Heimlich Manoeuvre, which of the following is CORRECT?

a) It is used to remove foreign bodies from the trachea failure


b) It is performed by standing behind the patient, encircling the chest with your arms, and
forcefully compressing the chest
c) It should cause broken ribs if done properly
d) It is performed by forcefully compressing the epigastrium from behind
e) It only works if the patient is unconscious

* Question 74

Early warning signs of snake bite envenomation include all of the following EXCEPT:-

a) Headache
b) Diplopia or ophthalmoplegia
c) Bleeding from the bite
d) Vomiting
e) Abdominal pain

Question 75

Which of the following statements is TRUE?

a) Concrete thinking is typical of mid-adolescence


b) Boys and girls have growth spurts at about the same time
c) The average duration of puberty in Australia is 5 years
d) Gynaecomastia is relatively rare in adolescent boys
e) Menarche is preceded by at least two years of breast development.

Question 76
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The MOST COMMON reported pathogen involved in childhood acute otitis media is:-

a) Streptococcus pyogenes
b) Moraxella catarrhalis
c) Streptococcus pneumoniae
d) Staph aureus
e) Corona viruses

Question 77

The X-ray above shows appearances typical of:-

a) Right pleural effusion


b) Right middle lobe pneumonia
c) Mesothelioma
d) Ruptured oesophagus
e) Right lower lobar pneumonia

* Question 78

Jane is 15 years old and has not yet had a menstrual period. She denies any sexual activity.
Examination reveals breast and pubic hair development consistent with her age, and normal genitalia.
The MOST APPROPRIATE management would be:-

a) FSH/LH, prolactin; ultrasound pelvis


b) Reassurance that development is normal and cycles should commence soon
c) Commence the oral contraceptive pill to induce the HPO axis to cycle
d) Check karyotype
e) Inquire about behaviour associated with eating disorders

Question 79
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Diastolic heart failure may be present in all of the following EXCEPT:-

a) Hypertensive cardiomyopathy
b) Restrictive cardiomyopathy
c) Acute myocardial infarction
d) Ventricular aneurysm
e) Constrictive pericarditis

Question 80

Georgina Hassard is a 47 year old woman who presents with menorrhagia of four cycles duration. Her
initial management would include all of the following EXCEPT:-

a) Transvaginal ultrasound
b) FBC, Iron studies and TFT 's
c) Referral for Hysteroscopy and endometrial biopsy
d) Prescription for combined oral contraceptive pill
e) Advice that the cause of the bleeding may not be found

* Question 81

Menorrhagia is defined as:-

a) Painful, prolonged periods


b) Passage of fresh blood and large clots
c) Loss of more than 80mls of blood per cycle
d) Loss of more blood that the individual feels comfortable with
e) Bleeding to the extent that it can flood through clothing

Question 82

Mary gave birth to her first child 1 week ago and presents with difficulty breast feeding. She complains
of tiredness and left breast pain for days. On examination her temperature is 38 degrees Celsius and
the upper outer quadrant of her left breast is red and tender. Management would include all of the
following except:

a) Commencement of flucloxacillin
b) Paracetamol
c) Treatment of cracked nipples
d) Assessment of support at home
e) Continue breast feeding from the right breast until left breast pain resolves

Question 83
23
Disseminated Intravascular Coagulopathy may occur in pregnancy in association with all of the
following EXCEPT:-

a) Placenta praevia
b) Placental abruption
c) Sepsis
d) Amniotic fluid embolus
e) Retained dead foetus

Question 84

Considering Type 2 diabetes, which of the following is TRUE?

a) Insulin secretion initially increases in response to peripheral insulin resistance


b) Beta cells are unable to secrete enough insulin in the presence of increased adipocytes
c) Beta cell destruction and loss is a feature of type two diabetes
d) The insulin resistance of type 2 diabetes causes Syndrome X
e) Chronic hyperglycaemia does not affect beta cell function

Question 85

The patient (whose C.T. is shown above) presented with weight loss, malaise and night sweats for four
months. The lesion (arrowed) would be MOST consistent with:-

a) Mediastinal lymphoma
b) Bronchogenic carcinoma
c) Mesothelioma
d) Psittacosis
e) Farmer's lung

Question 86
24
Which of the following types of hernia follows the path of a congenital tract which fails to close?

a) Femoral hernia
b) Indirect inguinal hernia
c) Direct inguinal hernia
d) Umbilical hernia
e) Perineal hernia

Question 87

Carcinoma-in-situ refers to a malignant group of cells which are:-

a) Localized to the organ of origin


b) Confined to normal basement membrane
c) Showing significant dysplasia but no aplasia
d) Showing no microscopic haematological or lymphatic spread
e) Are minimally invasive of the sub-mucosa

Question 88

An anaesthetist may become aware of inadequate depth of anaesthesia in a patient if examination of


the patient reveals:-

a) Constricted pupils
b) Bradycardia
c) Hypotension
d) Tears
e) Hypoventilation

* Question 89

Which of the following statements regarding cervical intraepithelial neoplasia (CIN) is FALSE?

a) Risk is increased if first intercourse occurs at an early age


b) HPV types 16 and 18 are causative agents
c) Cigarette smoking increases risk
d) All women who show squamous metaplasia will go onto develop CIN
e) Peak incidence of CIN is between ages 30 and 40

* Question 90
25
Sally Hyde's mother noticed a "lump" on her back when she bent forwards to pick up her beach towel.
Sally is 14 years old, and your examination revealed an obvious Right sided protrusion of ribs and
scapula with forward flexion. X-ray verified bone age of 14yrs, and a 25 degree scoliosis between T4
andL1. The MOST APPROPRIATE management is:-

a) Observe and review in one year


b) Commence a guided exercise programme
c) Have a body brace fitted
d) Referral to specialist Back School
e) Referral to Scoliosis Clinic for assessment

Question 91

The MOST COMMON cause of acute scrotal pain in young boys is:-

a) Strangulated inguinoscrotal hernia


b) Torsion of testis
c) Epidydimo -orchitis
d) Mumps orchitis
e) Trauma

Question 92

April Jones, aged 28, presents for a Life Insurance Medical for her business. Her history and
examination are normal. Her ECG is shown above. This shows:-

a) LBBB
b) RBBB
c) Left anterior hemi block
d) Wenckebach effect
e) Torsades de Points

Question 93
26
The MOST APPROPRIATE management of diastolic heart failure is:-

a) Digoxin
b) ACE inhibitor
c) nifedipine
d) Pacing
e) Beta-blocker

Question 94

Concerning anti-anginal drugs, which of the following is TRUE?

a) Nitrates dilate both venous and arterial vessels


b) Non-selective beta-blockers cause coronary vasodilation
c) Nifedipine can cause bradycardia in the elderly
d) Calcium channel blockers are preferable in co-morbid left ventricular dilation
e) A long acting nitrate is the drug of first choice

* Question 95

Which of the following statements regarding Methicillin-resistant Staphylococcus aureus is FALSE?

a) It is almost endemic in modern hospitals


b) Most patients acquire the infection while in hospital
c) MRSA is more virulent than flucloxacillin-resistant Staph. Aureus
d) Long-stay surgical patients are at high risk
e) Failure of eradication is largely due to poor barrier nursing

Question 96

Mid-line submental swellings:-

a) Should be viewed as suspicious until proven otherwise


b) If cystic, are usually thyroglossal cysts
c) Can track through to behind the sternomastoid muscle
d) Are a common presentation of carcinoma of the thyroid isthmus
e) Require ultrasound-guided FNA for diagnosis

* Question 97
27

The neonate whose x-ray is shown above presented with vomiting and irritability. The film strongly
suggests:-

a) Duodenal atresia
b) Pyloric stenosis
c) Jejunal atresia
d) Inefficient burping
e) Malrotation with volvulus

Question 98

Anita is six years old and presents with pubic hair and accelerated breast bud development. You
suspect she has precocious puberty, which is verified by elevated gonadotrophins. Concerning her
situation, which of the following is FALSE?

a) She may have a cerebral tumour


b) At the stage of 6 she will be tall for her age
c) She may become sexually precocious
d) Oestrogens will cause premature closure of the epiphyses
e) She is likely to have an oestrogen secreting tumour

* Question 99
28
Helen Jones is a 19 year-old secretary who presents with a one year history of painless post-coital
bleeding. She takes a tri-sequential contraceptive pill. Clinical examination is normal except for a
degree of cervical erosion. Her Pap smear is reported as "inflammatory". The MOST APPROPRIATE
management is:-

a) Repeat smear after treatment with triple-sulpha cream


b) Change OCP to a more oestrogenic balance
c) Reassure, but review in six months
d) Refer for colposcopy
e) Change OCP to a more progestagenic balance

* Question 100

The LEAST LIKELY problem a woman with fibroids is likely to suffer from is:

a) Abnormal uterine bleeding


b) Pelvic pain
c) Urinary retention
d) Constipation
e) Reproductive dysfunction

Question 101

Which of the following can be exacerbated pre-menstrually?

a) Epilepsy
b) Migraine
c) Hay fever
d) Breast pain
e) All of the above

Question 102
29

Mr George Smith, aged 68, presented complaining of backache. Clinical examination was unhelpful,
but blood tests revealed a normochromic anaemic and elevated ESR of 104. His skull X-ray is shown
above. The MOST APPROPRIATE investigation to order next is:-

a) Urinary Bence-Jones protein


b) Haemoglobin electrophoresis
c) PSA
d) Chest X-Ray
e) Bone scan

Question 103

A 31 year old woman presents for a 6 week postnatal check. She had a normal vaginal delivery with
no complications during the pregnancy. She is breastfeeding, normotensive and no abnormalities are
found on pelvic examination. When discussing contraception, all of the following methods could be
discussed as a possible option except:

a) Combined oral contraceptive pill


b) Diaphragm
c) Intrauterine device
d) Depo provera
e) Implanon

Question 104
30
Angie, aged 20, is seen at 8 weeks amenorrhoea and has a positive urine pregnancy test. She
develops nausea and vomiting over the next five weeks to the extent that she lost 6kg weight.
Metoclopramide is ineffective. Her electrolytes and urine m/c/s are normal. The MOST APPROPRIATE
initial investigation would be:-

a) Ultrasound for gallstones


b) Pelvic ultrasound
c) Quantitative HCG
d) Psychological counselling
e) Serum alpha-fetaprotein

Question 105

Abdominal radiotherapy is associated with all of the following EXCEPT:-

a) Malabsorption
b) Intussusception
c) Ulceration
d) Fistula formation
e) Perforation

* Question 106

Mr Brown presents complaining of blood in his toilet bowl after defaecation. Digital rectal examination
detects a mobile mass and proctoscopy reveals a 1.5cm x 2.0cm sessile polyp. Colonoscopy reveals
the rest of the colon is clear. The polyp is completely removed by snare diathermy, and histology
reveals a villous adenoma. The MOST APPROPRIATE recommendation re further management is:-

a) Review colonoscopy in 12 months


b) Re-excision with wide margins
c) AP resection
d) Anterior resection of the rectum
e) Sigmoidoscopy with wide, superficial diathermy of the area

Question 107

Damage to the recurrent laryngeal nerve during thyroid surgery can cause:-

a) The ipsilateral cord to assume a paramedian position


b) Severe hoarseness with intermittent loss of speech
c) A reduction in tidal volume with respiration
d) The contralateral cord to assume a more lateralized position
e) Paralysis of the Right cord more frequently than the left.

Question 108
31
Timothy is 12 months old and is presented for his MMR (Measles, Mumps, Rubella) vaccination. His
parents are concerned that he does not appear interested in standing and grasps his food with his
whole hand. His clinical examination is otherwise normal. The MOST APPROPRIATE management is to:-

a) Reassure his parents he is normal


b) Review his development in 3 months
c) Refer for further developmental assessment
d) Omit measles vaccination
e) Ask about the development of other siblings and parents

Question 109

The Intra-Uterine Device is an unsuitable form of contraception for all of the following EXCEPT:-

a) A woman who became pregnant on a previous IUD


b) A woman with Pelvic Inflammatory Disease
c) A patient with bifid uterus
d) A patient with valvular heart disease
e) Dysmenorrhoea requiring regular anti-prostaglandin therapy

Question 110

Common male causes of infertility include all of the following EXCEPT:-

a) Oligospermia
b) Azoospermia
c) Erectile failure
d) Varicocoele
e) Undescended testes

Question 111
32

The patient whose fundus is shown above:-

a) Probably came with a letter from his optometrist


b) May have lost central vision on visual field testing
c) Will present with pain and photophobia
d) Would need reading glasses
e) Suffers from uncontrolled severe hypertension

* Question 112

The most sensitive indicator of future risk of insulin resistance in males is:-

a) Body Mass Index


b) Family History
c) Random glucose
d) Diet with greater than 30% fat content
e) Hip-waist ratio

Question 113

Penetration below the level of the muscularis mucosae by malignant colonic cells means that:-

a) Local excision is curative


b) Hemicolectomy is the treatment of choice
c) Post-surgical radiotherapy is indicated
d) The potential for metastases exists
e) Defunctioning colostomy is indicated

Question 114
33
Betty Cummins presents with her three year old son, Roger. Her mother, Muriel, was concerned that
Roger's foreskin would not retract, and forcefully retracted it "for cleanliness". Roger now has redness,
oedema and pain of the foreskin, which is trapped proximal to the glans. This condition is called:-

a) Phimosis
b) Paraphimosis
c) Balanitis
d) Balanitis sclerotica obliterans
e) Epispadias

* Question 115

The MOST APPROPRIATE first line of treatment of Roger's condition is:-

a) Ice packs
b) Gentle manipulation of the foreskin distally
c) Amoxicillin and clavulinic acid
d) Nil - it settles spontaneously if left alone
e) Referral to paediatric surgeon

Question 116
34

The woman shown above has mucocutaneous lesions present and has a past history of repeated bouts
of abdominal pain. These lesions and abdominal symptoms are also present in other family members.
She should have a regular:-

a) Colonoscopy
b) Echocardiography
c) Photography of the lesions
d) EEG
e) Blood glucose

Question 117

John Major, aged 39, suffered a prolapse of L5/S1 with resultant Left sciatica. Unfortunately, operative
management did not cure his sciatic pain. He presents complaining of inability to sleep because of the
pain, with early feelings for reduced hope and anhedonia. He is taking combination paracetamol and
codeine tablets. The MOST APPROPRIATE medication to add to his treatment would be:-

a) An SSRI at night
b) A tricyclic antidepressant at night
c) A hypnotic benzodiazepine at night
d) Morphine sulphate day and night
e) Carbamazepine day and night

Question 118
35
Omeprazole facilitates gastric and duodenal ulcer healing by:-

a) Providing a direct cytoprotective effect to the mucosa


b) Enhancing the function of gastric mucus
c) Inhibiting reproduction of H.pylori
d) Inhibiting the proton pump of parietal cells
e) Inhibiting gastrin release

* Question 119

Splenectomy as early management for ITP should be avoided in which of the following groups of
patients:-

a) Those with normal marrow function


b) Children
c) Those who fail to respond to corticosteroids
d) Those with a very large, vascular spleen
e) Those with selective IgA deficiency

* Question 120

A patient has persisting symptoms of regurgitation despite healing of his oesophageal ulcers after 12
weeks of omeprazole therapy. The MOST APPROPRIATE management would be:-

a) Advise further dietary modification


b) Double the dose of omeprazole
c) Recommend fundoplication
d) Suggest a trial of alginate "raft " therapy
e) Add cisapride 20mg twice daily

* Question 121

Andrew Singh, aged 15, presents three days into the acute phase of Infectious Mononucleosis. He is
having great difficulty swallowing solid food because of pain but is tolerating regular small sips of
fluids. Prednisone is indicated in the management of I.M. when:-

a) There is threatened airway obstruction


b) Dehydration may occur
c) The atypical lymphocyte count is greater than 18,000
d) Dysphonia develops
e) Odynophagia develops

* Question 122
36

Joshua, aged 4 months, presents unwell with multiple vesicles, pustules and erosions on his face and
in the napkin and flexural areas. His mother has a cold sore last week. The MOST APPROPRIATE
management is:-

a) Twice daily saline soaks and oral antibiotics


b) Topical application of aqueous cream
c) Oral acyclovir
d) Oral flucloxacillin and topical mupirocin
e) Admission to hospital

* Question 123

On review of a three year old child, all of the following would be considered appropriate EXCEPT:-

a) The parents think he's not saying as much as he used to


b) He falls over when he kicks a ball sometimes
c) He displays little imagination or "make-believe" play
d) His word count is just over 200
e) He demonstrates poor representational drawing of people and faces

Question 124
37
Ben Adams was born 12 weeks premature, and has had a stormy course with Respiratory Distress and
a large ventral hernia. Concerning his vaccinations, which of the following is TRUE?

a) Initial doses should be half of the standard dose


b) Vaccination should be based on gestational age
c) He should not have OPV until he leaves hospital
d) Immunocompetence is delayed in premature infants
e) He should not be given live vaccines on the same day

* Question 125

The MOST COMMON cause of failure to thrive in Australian infants is:-

a) Underfeeding
b) Infectious diarrhoea
c) Gastro-oesophageal reflux
d) Inherited metabolic disorders
e) Inadequate parenting

GOODLUCK
38

AMC MCQ Mock 2 answers

47- c 94- a
1- a 48- b 95- c
2- b 49- e 96- b
3- d 50- b 97- a
4- b 51- d 98- e
5- e 52- b 99- d
6- d 53- c 100- d
7- c 54- a 101- e
8- c 55- a 102- a
9- a 56- a 103- a
10- e 57- e 104- c
11- d 58- a 105- b
12- e 59- d 106- a
13- e 60- a 107- a
14- a 61- c 108- c
15- d 62- e 109- a
16- c 63- a 110- c
17- b 64- a,b,c,d 111- a
18- e 65- a 112- e
19- d 66- a 113- d
20- b 67- e 114- b
21- b 68- d 115- b
22- e 69- b 116- a
23- c 70- d 117- b
24- d 71- e 118- d
25- a 72- d 119- b
26- c 73- d 120- c
27- d 74- c 121- a
28- d 75- e 122- e
29- b 76- c 123- a
30- a 77- b 124- c
31- c 78- b 125- e
32- c 79- d
33- a 80- d
34- c 81- c
35- e 82- e
36- c 83- a
37- a 84- a
38- a 85- a
39- d 86- b
40- b 87- b
41- d 88- d
42- b 89- d
43- b 90- e
44- d 91- b
45- d 92- b
46- c 93- e