Gp Practice Exam

84 Questions | Total Attempts: 110

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Gp Practice Exam

These are the questions from AFP, answers from them too.   Except for getting this journal I'm not affiliated with it otherwise. There are a few double ups, and more questions will be added when I get a chance.


Questions and Answers
  • 1. 
    Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother.   Lola is suddenly irritable and crying after playing in the garden.  You have seen her mainly for eczema.  She is hypertensive and appears to have a painful left foot.  You consider spider bite as one of your differential diagnoses. Terminology around spider bites can be confusing.  Select the correct definition:
    • A. 

      Toxindrome refers to symptoms and signs of a medically significant spider bite

    • B. 

      Neurotoxic effects are typically caused by toxins released by Loxosceles species

    • C. 

      Cytotoxic effects are typically caused by toxins released by Latrodectus species

    • D. 

      Araneism refers to the local clinical signs resulting from a spider bite

    • E. 

      Arachnidism refers to an irrational fear of spiders

  • 2. 
    Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother.   Lola is suddenly irritable and crying after playing in the garden.  You have seen her mainly for eczema.  She is hypertensive and appears to have a painful left foot.  You consider spider bite as one of your differential diagnoses. If Lola does have red spider bite envenomation when would antivenom be indicated:
    • A. 

      All children require immediate antivenom

    • B. 

      Antivenom is not suitable or approved for use in children

    • C. 

      If Lola’s pain is not controlled by simple analgesia

    • D. 

      If Lola has systemic signs of envenomation that are not adequately managed by IV fluids

    • E. 

      Antivenom is not recommended in atopic people as allergy is very common

  • 3. 
    Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago.  He complains of fever, headache and severe myalgia that started 3 days ago. You arrange investigations for Michael.  Select the best option:
    • A. 

      Serum dengue PCR can detect virus between day 7 and 14 of the illness

    • B. 

      Serum IgG becomes positive after 4 – 5 days of infection

    • C. 

      No cross reactivity occurs between other flavivirus IgG

    • D. 

      Three blood films are important investigations for Michael

    • E. 

      Full blood count is not useful as Michael is already at day 4 of his illness

  • 4. 
    Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago.  He complains of fever, headache and severe myalgia that started 3 days ago. You note a petechial rash and consider dengue fever as a differential diagnosis.  Select the most accurate option about the rash:
    • A. 

      Petechiae indicate dengue haemorrhagic fever which requires hospitalisation

    • B. 

      Petechiae indicate significant thrombocytopenia requiring platelet transfusion

    • C. 

      Petechiae may occur in uncomplicated dengue fever

    • D. 

      Thrombocytopenia occurs in around 75% of cases of dengue fever

    • E. 

      Thrombocytopenia occurs mainly in patients with a past history of malaria

  • 5. 
    Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago.  He complains of fever, headache and severe myalgia that started 3 days ago. Michael’s IgG and IgM are both positive for dengue, he has mild thrombocytopenia and other investigations are normal.  This indicates Michael:
    • A. 

      Is likely to be currently infected with another flavivirus

    • B. 

      Has dengue haemorrhagic fever

    • C. 

      Is immune to dengue and does not currently have the disease

    • D. 

      Has immunity to all four arbovirus serotypes

    • E. 

      Likely has infection by a second dengue serotype

  • 6. 
    Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother.   Lola is suddenly irritable and crying after playing in the garden.  You have seen her mainly for eczema.  She is hypertensive and appears to have a painful left foot.  You consider spider bite as one of your differential diagnoses. Lola becomes agitated, is sweating profusely and drooling, and her mother brought in the spider shown as a suspected culprit.  Select the best option about this spider and your management of Lola now:
    • A. 

      Envenomation by this spider is usually mild, although it has 88% homology with venom from a more dangerous spider

    • B. 

      A pressure immobilisation bandage and immediate transfer to hospital is required

    • C. 

      Envenomation by this spider causes similar effects to lacrodectism and should be considered if she fails to respond to red back spider antivenom

    • D. 

      This spider occurs throughout mainland Australia

    • E. 

      Fasciculation are very rate manifestations of envenomation by this spider

  • 7. 
    Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago.  He complains of fever, headache and severe myalgia that started 3 days ago. Michael’s IgG and IgM are both positive for dengue, he has mild thrombocytopenia and other investigations are normal. Michael’s condition rapidly deteriorates and you arrange transfer to hospital.  Which of the following is NOT a ‘red flag’ that indicates more severe disease:
    • A. 

      A drop of haematocrit by > 20% from baseline

    • B. 

      Platelet count < 80 000 cells per cubic mm

    • C. 

      Postural hypotension

    • D. 

      Development of severe abdominal pain

    • E. 

      Development of significant bleeding

  • 8. 
    Randy Simpson, 4 years of age, lives on a local farm.  He is brought in by his father with an injured left arm and hand, consistent with an animal bite. Select the correct statement about the background and risk factors of dog bite:
    • A. 

      < 25% are unprovoked attacks

    • B. 

      > 75% are unprovoked attacks

    • C. 

      > 75% are by a dog known to the victim

    • D. 

      Female unsterilized dogs are higher risk

    • E. 

      Children less than 5 years of age are at higher risk

  • 9. 
    Randy Simpson, 4 years of age, lives on a local farm.  He is brought in by his father with an injured left arm and hand, consistent with an animal bite. Randy reports his 6 year old sister Maddison inflicted the bites.  Select the correct statement:
    • A. 

      An intercanine distance of 3 – 5 cm is suggestive of a child bite

    • B. 

      Human bites have high complication and infection rates than animal bites

    • C. 

      HIV prophylaxis should be administered in all human bites

    • D. 

      Hepatitis B immunoglobulin should be administered in all human bites

    • E. 

      Most human bites are complicated by infective endocarditis

  • 10. 
    Randy Simpson, 4 years of age, lives on a local farm.  He is brought in by his father with an injured left arm and hand, consistent with an animal bite. You consider the organisms that cause infection with different animal bites.  Select the correct statement about the oral flora of the common animal culprits:
    • A. 

      Staphylococcus aureus are flora of humans and dogs

    • B. 

      Pasturella aerogenes are flora of pigs and cats

    • C. 

      Actinobacillus are flora of cows and rodents

    • D. 

      Clostredium tetani are flora of monkeys

    • E. 

      Streptobacillus moniliformis are flora of dogs

  • 11. 
    Randy Simpson, 4 years of age, lives on a local farm.  He is brought in by his father with an injured left arm and hand, consistent with an animal bite. Certain wounds are at high risk of infection.  Which of the following does NOT increase the risk of wound infection:
    • A. 

      Wounds over a prosthetic joint

    • B. 

      Wounds on the trunk

    • C. 

      Wounds with delayed presentation by more than 8 hours

    • D. 

      Puncture and crush wounds

    • E. 

      Wounds to the genitals

  • 12. 
    Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders.  You consider bed bug bites. Which of the following is a common signs of bed bug infestation:
    • A. 

      Dark spotting on the bed from blood spillage

    • B. 

      Dark spotting on the bed from faecal deposition

    • C. 

      Presence of the small oval, winged insects themselves

    • D. 

      Typical distribution over trunk and feet

    • E. 

      Typical distribution in lattice pattern

  • 13. 
    Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders.  You consider bed bug bites. Select the correct statement about reactions to bed bug bites
    • A. 

      Reactions always occur within 3 days

    • B. 

      Most bites occur in a linear pattern

    • C. 

      The classic wheal reaction is < 1cm diameter

    • D. 

      Bullous eruptions are very uncommon

    • E. 

      Numerous bites can present as urticaria or an erythematous rash

  • 14. 
    Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders.  You consider bed bug bites. Jacinta worries about the secondary effects on her and her family.  You explain:
    • A. 

      Anaphylaxis is a common reaction

    • B. 

      Secondary infection is very uncommon

    • C. 

      Although itchy, ulceration from scratching does not occur

    • D. 

      Fever and malaise may occur in some individuals

    • E. 

      Infections such as malaria and HIV are common sequelae

  • 15. 
    Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders.  You consider bed bug bites. Jacinta asks about treatment options.  You explain:
    • A. 

      There are no treatments available

    • B. 

      Bed bugs are easily killed with simple home insect sprays

    • C. 

      Symptomatic treatment with antihistamines and topical steroids is useful

    • D. 

      Bed bugs infestations cannot be treated, necessitating all new furnishings

    • E. 

      Commercial personal lice treatment is sufficient in the majority of cases

  • 16. 
    Janelle Philips, 46 years of age, is a housewife.  She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Janelle was very happy with the procedure but has recently noticed reflux, especially at night, epigastric pain and difficulty eating solids.  The most likely explanation is:
    • A. 

      A port complication

    • B. 

      Erosion of the band into the stomach cavity

    • C. 

      Acute food bolus obstruction

    • D. 

      Acute slip with obstruction and ischaemia

    • E. 

      Symmetrical pouch dilatation

  • 17. 
    Janelle Philips, 46 years of age, is a housewife.  She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Janelle was very happy with the procedure but has recently noticed reflux, especially at night, epigastric pain and difficulty eating solids. Regarding appropriate investigation or management for Janelle’s symptoms, which of the following is true:
    • A. 

      Barium swallow is indicated

    • B. 

      Gastroscopy is indicated

    • C. 

      The volume of fluid within the system should be checked repeatedly

    • D. 

      A carbonated beverage may provide relief

    • E. 

      No investigation is indicated

  • 18. 
    Janelle Philips, 46 years of age, is a housewife.  She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Janelle was very happy with the procedure but has recently noticed reflux, especially at night, epigastric pain and difficulty eating solids. You appropriately investigate and manage Janelle’s situation but decide to learn about taking fluid out of the LABG system in case you need to do this in the future.  Regarding the process of removing fluid from the system, which of the following is true:
    • A. 

      A normal 19 gauge needle can be used

    • B. 

      You enter at 45 degrees to the skin to access the port

    • C. 

      A Huber tipped needle is preferred

    • D. 

      You feel the upper border of the port with the needle

    • E. 

      The port must never be accessed except by the managing surgeon

  • 19. 
    Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain.  You suspect inflammatory bowel disease (IBD) and arrange emergency review. Select the best option in regard to diagnostic tests for IBD:
    • A. 

      Anti-saccharomyces cerevisiae antibody (ASCA) is specific to Crohn disease (CD)

    • B. 

      Atypical perinuclear antineutrophil cytoplasmic antibody (p-ANCA) is specific to ulcerative colitis (UC)

    • C. 

      ASCA and p-ANCA cannot differentiate CD from UC

    • D. 

      Calprotectin is a faecal marker specific to CD

    • E. 

      Lactoferrin is a faecal marker specific to UC

  • 20. 
    Janelle Philips, 46 years of age, is a housewife.  She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Over 12 months following LABG, patients such as Janelle can expect:
    • A. 

      To lose 30% of their excess weight

    • B. 

      To lose 50 - 60% of their excess weight

    • C. 

      To lose 50 - 60% of their weight

    • D. 

      To lose 70 - 90% of their excess weight

    • E. 

      To lose 70 - 90% of their weight

  • 21. 
    Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain.  You suspect inflammatory bowel disease (IBD) and arrange emergency review. Vince is diagnosed with UC and is later commenced on a 5-amino salicylic acid drug (5-ASA).  Select the best option about this group of medications:
    • A. 

      5-ASA drugs are poorly tolerated

    • B. 

      5-ASA drugs have low compliance rates

    • C. 

      5-ASA drugs have a high incidence of adverse effects

    • D. 

      5-ASA drugs are more effective orally than rectally for UC proctitis

    • E. 

      The use of 5-ASA drugs is best established in CD

  • 22. 
    Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain.  You suspect inflammatory bowel disease (IBD) and arrange emergency review. Vince is diagnosed with UC and is later commenced on a 5-amino salicylic acid drug (5-ASA). You see Vince 2 months later with a possible flare up of UC.  Select the best option about the use of C-reactive protein (CRP) levels in this setting:
    • A. 

      CRP does not correlate to disease activity

    • B. 

      Persistently elevated CRP correlates to a lower relapse rate

    • C. 

      Persistently elevated CRP correlates to a lower response to infliximab

    • D. 

      Some patients do not mount a CRP response to intestinal inflammation

    • E. 

      CRP is a useful indicator if it is in the normal range

  • 23. 
    Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain.  You suspect inflammatory bowel disease (IBD) and arrange emergency review. Vince is diagnosed with UC and is later commenced on a 5-amino salicylic acid drug (5-ASA). You see Vince 2 months later with a possible flare up of UC. Several years later Vince’s UC becomes difficulty to control and you refer him back to his gastroenterologist.  Select the correct option about infliximab in this setting:
    • A. 

      Infliximab has no efficacy for UC

    • B. 

      Infliximab is funded by the PBS for use in UC

    • C. 

      Infliximab must be given by subcutaneous injection

    • D. 

      Infliximab is used monthly for maintenance treatment

    • E. 

      Infliximab binds tumour necrosis factor alpha

  • 24. 
    Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. Angelica has heard conflicting stories about the aetiology of IBS.  Which of the following has NOT been implicated as a possible aetiological factor in IBS:
    • A. 

      Abnormalities of central pain processing

    • B. 

      Postsurgical changes

    • C. 

      Genetic factors

    • D. 

      Sensory dysfunction

    • E. 

      Postinflammatory changes

  • 25. 
    Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. Angelica tried 1 month of probiotics but found no improvement in her symptoms.  You explain:
    • A. 

      Different strains of probiotics appear to target different dominant symptoms

    • B. 

      The probiotic species are now part of her permanent bowel flora

    • C. 

      There is no evidence that probiotics are useful for abdominal pain

    • D. 

      There is no evidence that probiotics are useful for global IBS symptoms

    • E. 

      There is no evidence that probiotics are useful for abdominal bloating

  • 26. 
    Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. You discuss peppermint oil as a possible treatment and Angelica asks about the side effects and contraindications.  Select the best option:
    • A. 

      Perianal staining from the oil is a common side effect

    • B. 

      Peppermint oil is known to be safe during pregnancy

    • C. 

      Reflux may occur due to oesophageal sphincter relaxation

    • D. 

      Peppermint oil is contraindicated in people with asymptomatic gallstones

    • E. 

      Peppermint oil is contraindicated in all forms of liver disease

  • 27. 
    Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. Angelica’s main complaints are of pain and constipation.  She wants to discuss the use of soluble fibre in her diet.  Select the best option about the use of soluble fibre in IBS:
    • A. 

      There is no evidence the soluble fibre improves IBS related abdominal pain

    • B. 

      There is no evidence that soluble fibre improves IBS related constipation

    • C. 

      There is no evidence that soluble fibre improves global IBS symptoms

    • D. 

      Soluble fibre is not fermented or digested in the gut

    • E. 

      Soluble fire acts by retaining water thereby increasing stool bulk

  • 28. 
    Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.You consider food intolerance as a contributing factor.  Select the correct statement about the processing of carbohydrate:
    • A. 

      Fructose requires fructase in the brush border for digestion

    • B. 

      Fructose absorption is impaired by luminal glucose

    • C. 

      Fructose is absorbed via a low capacity carrier mediated facilitated diffusion

    • D. 

      Lactose absorption is increased by luminal glucose

    • E. 

      Some individuals have no lactase present and therefore cannot digest lactose

  • 29. 
    Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.Which of the following foods has the highest lactose load:
    • A. 

      100mL regular milk

    • B. 

      50g swiss cheese

    • C. 

      200g cottage cheese

    • D. 

      100g yoghurt

    • E. 

      50g ice-cream

  • 30. 
    Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.Joseph asks about other potential food intolerances.  Select the best option about the content of different food:
    • A. 

      Sorbitol is a synthetic sweetener added to many foods

    • B. 

      Sorbitol rarely occurs in fructose containing foods

    • C. 

      Fructans are storage carbohydrates in Graminaceae plant species, such as wheat

    • D. 

      Fructans are in high concentrations in corn and rice

    • E. 

      Fructans are storage carbohydrates in Compsitae plant species, such as asparagus

  • 31. 
    Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.You ask Joseph about the presence of alarm symptoms.  Which of the following is not considered an alarm symptom:
    • A. 

      Alternating bowel habit

    • B. 

      Rectal bleeding

    • C. 

      Anaemia

    • D. 

      Weight loss

    • E. 

      None of the above

  • 32. 
    Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes.  Talay immigrated from Turkey 8 years ago.  Together you plan how to monitor and protect her vision.Select the correct NHMRC recommendation about retinal screening for diabetic retinopathy (DR0 for different groups of people with diabetes:
    • A. 

      Women with gestational diabetes require yearly screening

    • B. 

      Women with diabetes who become pregnant require screening each trimester

    • C. 

      Those with renal disease require yearly screening

    • D. 

      Those with proliferative DR require ophthalmology review within 1 week

    • E. 

      Those with nonproliferative DR require review within 4 weeks

  • 33. 
    Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes.  Talay immigrated from Turkey 8 years ago.  Together you plan how to monitor and protect her vision.Talay asks about how visual loss occurs and how common it is.  You tell her:
    • A. 

      The commonest mechanism is proliferative DR

    • B. 

      The commonest mechanism is macular oedema

    • C. 

      She has approximately a 25% chance of having DR now

    • D. 

      50% of people in her position will require treatment to prevent visual loss

    • E. 

      None of the above

  • 34. 
    Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes.  Talay immigrated from Turkey 8 years ago.  Together you plan how to monitor and protect her vision.Talay wants to reduce her likelihood of developing DR.  You explain that:
    • A. 

      The duration of diabetes is the strongest predictor of DR

    • B. 

      Co-existent hypertension is the strongest predictor of DR

    • C. 

      Diabetic control is the strongest predictor of DR

    • D. 

      Blood pressure control has not been found to reduce DR

    • E. 

      Tight diabetic control has been found to reduce DR

  • 35. 
    Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes.  Talay immigrated from Turkey 8 years ago.  Together you plan how to monitor and protect her vision.When Talay presents for diabetes review 6 months later, her blood pressure is 150/95.  You recheck this a week later and it is 145/95.  Mild hypertensive retinopathy:
    • A. 

      Is characterised by optic disc swelling

    • B. 

      Is characterised by early neovascularisation

    • C. 

      Is characterised by cottonwool spots

    • D. 

      Must be screened for yearly in patients with hypertension

    • E. 

      Is predictive of adverse cardiovascular outcomes

  • 36. 
    Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss.Alphons suffers from migraines.  Select the best statement about visual loss from migraine:
    • A. 

      Visual loss is commonly associated with classic migraine

    • B. 

      Occipitobasal headaches with visual loss are typical of migraine

    • C. 

      Tunnel vision may occur

    • D. 

      Aura classically beings temporally

    • E. 

      Typical negative scotoma includes zigzag lights

  • 37. 
    Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss. Which of the following features on history is most suggestive of giant cell arteritis (GCA):
    • A. 

      Onset of visual loss over several hours

    • B. 

      Visual loss preceded by flashing lights

    • C. 

      Visual loss progresses like a 'curtain' from the periphery

    • D. 

      Unexplained weight loss

    • E. 

      Recent ophthalmic surgery

  • 38. 
    Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss.Alphons suffers from migraines.You consider nonmigraine causes.Alphons has some concerning features suggestive of GCA.  Select the most accurate statement about appropriate investigation:
    • A. 

      Thrombocytopenia increases the probability of GCA 6-fold

    • B. 

      Temporal artery biopsy must be performed before commencement of therapy

    • C. 

      ESR is the most sensitive diagnostic test for GCA

    • D. 

      An ESR of < 29 would be considered normal for Alphons

    • E. 

      A normal ESR excludes GCA in Alphons' case

  • 39. 
    Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss.Alphons suffers from migraines.You consider nonmigraine causes.Alphons has some concerning features suggestive of GCA.Alphons asks if he requires a CT scan.  Which of the following examination features is not a commonly agreed indication for a CT brain and orbits:
    • A. 

      Temporal artery tenderness

    • B. 

      Proptosis

    • C. 

      Papilloedema

    • D. 

      Homonymous field defect

    • E. 

      Eye movement disorders

  • 40. 
    Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes.  He presents with sudden visual loss.You make a thorough assessment.  Select the most accurate statement about fundoscopy:
    • A. 

      Retinal pallor may indicate retinal detachment

    • B. 

      Dilated vessels may indicate retinal artery occlusion

    • C. 

      A cherry red macular is a normal finding

    • D. 

      A cherry red macular may indicate papilloedema

    • E. 

      Widespread nerve fibre layer haemorrhages may indicate retinal artery occlusion

  • 41. 
    Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes.  He presents with sudden visual loss.Haemorrhage is unlikely given that Sydney has no known proliferative retinopathy.  However, it is an important differential diagnosis of sudden visual loss.  Which of the following is true:
    • A. 

      Vitreous haemorrhage typically produces a discrete black scotoma

    • B. 

      Subhyaloid haemorrhage typically presents as a 'shower of black dots'

    • C. 

      Subretinal haemorrhage typically presents as a discrete brown scotoma

    • D. 

      Vitreous haemorrhage is typically painful

    • E. 

      Subhyaloid haemorrhage typically produces a mobile scotoma

  • 42. 
    Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes.  He presents with sudden visual loss.If you diagnosed retinal artery occlusion, what investigation would be the first line for Sydney:
    • A. 

      Transoesophageal echocardiogram

    • B. 

      CT angiography

    • C. 

      Fundus fluorscein angiography

    • D. 

      CT brain and orbits

    • E. 

      ESR and CRP

  • 43. 
    Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes.  He presents with sudden visual loss.You consider that retinal detachment is the most likely diagnosis in Sydney.  Which of the following is true:
    • A. 

      A 'curtain' descending over the visual field is typical

    • B. 

      Central vision preservation requires especially urgent referral

    • C. 

      The pupil must not be dilated as this will exacerbate the detachment

    • D. 

      Urgent ultrasound imaging is essential for all patients

    • E. 

      Detachment can be treated in the ophthalmology clinic with laser

  • 44. 
    Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence.  During the assessment you find concerning visual impairment.Visual impairment is defined as:
    • A. 

      Visual acuity worse than 6/12

    • B. 

      Visual field of < 10 degrees or less in the better eye

    • C. 

      Visual field of < 20 degrees or less in the better eye

    • D. 

      A and B are correct

    • E. 

      A and C are correct

  • 45. 
    Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence.  During the assessment you find concerning visual impairment.You consider cataract as a differential diagnosis for Tony's visual impairment.  Which factors may be associated with cataract formation:
    • A. 

      UV exposure is strongly associated with subcapsular cataract

    • B. 

      UV exposure is strongly associated with cortical cataract

    • C. 

      Corticosteroid use is strongly associated with cortical cataract

    • D. 

      There is a strong association between smoking and nuclear sclreos

    • E. 

      Diabetes is strongly associated with cortical cataract

  • 46. 
    Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis.You consider investigation in Phillip's case.  Which of the following is true about appropriate investigations:
    • A. 

      No investigations are necessary in typical cases

    • B. 

      Thyroid functions tests are required in all cases

    • C. 

      Full blood count and examination is required in all cases

    • D. 

      Chest x-ray is required in all cases

    • E. 

      B and C are both correct

  • 47. 
    Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence.  During the assessment you find concerning visual impairment.You also consider age related macular degeneration (ARMD).  Select the best response:
    • A. 

      Approximately 2% convert from dry to wet forms per year

    • B. 

      Dry ARMD involves a choroidal neovascular membrane

    • C. 

      Early ARMD causes distortion or scotoma of central vision

    • D. 

      Wet ARMD involves gradual deterioration of the retinal pigment epithelium

    • E. 

      Wet ARMD involves predominantly peripheral visual loss

  • 48. 
    Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis.Phillip wants to know about the treatment options for palmoplantar hyperhidrosis.  You discuss this with him and explain:
    • A. 

      Antibacterial wash is a first line treatment

    • B. 

      Antiperspirants are effective in the majority of cases

    • C. 

      Iontophoresis provides adequate symptoms control if performed weekly

    • D. 

      Botulinum toxin injection is well tolerated

    • E. 

      Surgical management may be complicated by compensatory hyperhidrosis

  • 49. 
    Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence.  During the assessment you find concerning visual impairment.You confirm ARMD.  Tony asks what his family could do to reduce their chances of this condition.  You explain:
    • A. 

      The Amsler grid helps to identify disease onset

    • B. 

      Smoking increases the risk of ARMD 2 - 3 times

    • C. 

      Dietary antioxidants have been shown to reduce risk

    • D. 

      Zinc supplements have been shown to delay onset of ARMD

    • E. 

      UV protection significantly reduces the risk of wet ARMD

  • 50. 
    Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis.  Which of the following statements is a common diagnostic criteria:
    • A. 

      Asymmetrical presentation - dominant side usually more affected

    • B. 

      Persistence of sweating even during sleep

    • C. 

      Persistence of sweating beyond 6 months

    • D. 

      Onset typically after the age of 25 years

    • E. 

      Does not impair daily activities

  • 51. 
    Olivia Chang, 61 years of age, is a typist who you see regularly.  She has noticed problematic tremor.You consider Olivia may have essential tremor.  Select the correct statement
    • A. 

      Essential tremor is usually asymmetrical

    • B. 

      Essential tremor can be postural or kinetic

    • C. 

      Essential tremor is exacerbated by alcohol

    • D. 

      Essential tremor can be caused by propranolol

    • E. 

      The incidence of essential tremor reduces with age

  • 52. 
    Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis.You also consider a diagnosis of pitted keratosis.  Select the appropriate statement about this condition:
    • A. 

      Small pits are often present on the nails beds

    • B. 

      There is often a characteristic 'cheesy' smell

    • C. 

      It is due to a fungal infection of the stratum corneum

    • D. 

      It is due to infection with Mycobacterium sedentarius

    • E. 

      It is unrelated to the diagnosis of palmoplantar hyperhidrosis

  • 53. 
    The Babic family come to see you as they all have persistent sore feet.Ana, 32 years of age, is a regular cross country runner and has increasing pain in the ball of her foot.  You consider bone stress as a diagnosis.  Select the most accurate option:
    • A. 

      X-ray is often normal and therefore should not be ordered in this case

    • B. 

      Sesamoiditis can be readily managed with steroid injection

    • C. 

      Internal fixation is required for more forefoot stress fractures

    • D. 

      Jones fractures are prone to delayed healing

    • E. 

      Bone scan is the first line imaging to delineate the severity of fracture

  • 54. 
    The Babic family come to see you as they all have persistent sore feet.Ana, 32 years of age, is a regular cross country runner and has increasing pain in the ball of her foot.  You consider bone stress as a diagnosis.Ana later develops low tendon pain and you diagnose Achilles tendinopathy.  You explain:
    • A. 

      X-ray is not indicated for Ana

    • B. 

      Anti-inflammatory medications are rarely helpful

    • C. 

      Strengthening is the mainstay of treatment

    • D. 

      Offloading with a Cam walker or cast is a critical part of treatment

    • E. 

      Topical glyceryl trinitrate is a first line treatment

  • 55. 
    The Babic family come to see you as they all have persistent sore feet.Mato, 36 years of age, has plantar heel pain.  Which of the following is accurate in regards to the possible diagnosis of plantar fasciitis:
    • A. 

      'tiptoe' bouncing does not induce pain

    • B. 

      Pain is typically worse at night

    • C. 

      Palpation is usually clearly diagnostic

    • D. 

      'gel pain' typically occurs with first 'foot to floor'

    • E. 

      X-ray demonstrating 'heel spur' is not diagnostically significant

  • 56. 
    Olivia Chang, 61 years of age, is a typist who you see regularly.  She has noticed problematic tremor.Olivia is concerned about the possibility of Parkinson disease.  Select the correct statement about parkinsonian tremor
    • A. 

      It is typically a high frequency rest tremor

    • B. 

      It does not involve the head or face

    • C. 

      There may be a postural tremor after a latent period

    • D. 

      There may be a postural tremor immediately after adopting a new posture

    • E. 

      The tremor improves with propranolol

  • 57. 
    Joe Boffa, 48 years of age, is a road worker who you treat for carpal tunnel syndrome.  His work involves jack-hammering and re-laying asphalt.Joe applies for workers' compensation.  Select the correct statement about your role in this process:
    • A. 

      For Joe to successfully claim you must confirm his work is responsible for 50% of his impairment

    • B. 

      You should not make any comment about the contribution of Joe's work to his symptoms

    • C. 

      CTS is a constitutional condition, hence Joe has no claim for workers' compensation

    • D. 

      You can make a judgement about whether Joe's work is a substantial contributing factor to his CTS

    • E. 

      Joe's hobbies and lifestyle are of no relevance to his work related claim

  • 58. 
    The Babic family come to see you as they all have persistent sore feet.Elena, 11 years of age, has heel pain exacerbated by activity.  Select the best statement about her pain:
    • A. 

      Calcaneal traction apophysitis is likely and should soon resolve with apophysial closure

    • B. 

      The possibility of osteochrondrosis can be confidently excluded by plain x-ray

    • C. 

      An 'accessory navicular' is unlikely as this is typically worse at rest

    • D. 

      Tarsal coalition results in limited eversion of the ankle

    • E. 

      Immature posture contributes to pain such as Elena's until after hte age of 12 years

  • 59. 
    Olivia Chang, 61 years of age, is a typist who you see regularly.  She has noticed problematic tremor.You consider the possibility of cerebellar tremor.  Select the correct statement
    • A. 

      Cerebellar tremor is a pure rest tremor with low frequency

    • B. 

      Cerebellar tremor is regular in amplitude

    • C. 

      Cerebellar tremor is typically unilateral

    • D. 

      Cerebellar tremor is always associated with other cerebellar signs

    • E. 

      Cerebellar tremor is usually absent at rest

  • 60. 
    Joe Boffa, 48 years of age, is a road worker who you treat for carpal tunnel syndrome.  His work involves jack-hammering and re-laying asphalt.Select the most correct statement about carpal tunnel syndrome (CTS):
    • A. 

      CTS is 4 - 5 times more common in males

    • B. 

      CTS involves the dominant

    • C. 

      The pain and numbness of CTS will not radiate past the elbow

    • D. 

      CTS is most common in the 20 - 40 years of age group

    • E. 

      Most cases of CTS are constitutional in origin

  • 61. 
    Joe Boffa, 48 years of age, is a road worker who you treat for carpal tunnel syndrome.  His work involves jack-hammering and re-laying asphalt.You consider if Joe's CTS is occupational.  Which of the following is NOT a key risk for work related CTS:
    • A. 

      Work in hot environments

    • B. 

      High range wrist action

    • C. 

      Use of hand held vibratory equipment

    • D. 

      Extreme wrist extension

    • E. 

      Frozen food work

  • 62. 
    Joe Boffa, 48 years of age, is a road worker who you treat for carpal tunnel syndrome.  His work involves jack-hammering and re-laying asphalt.There are several contributing metabolic and endocrine factors for CTS.  Which of the following is LEAST LIKELY to be contributing to Joe's symptoms:
    • A. 

      Iron deficiency

    • B. 

      Acromegaly

    • C. 

      Diabetes mellitus

    • D. 

      Obesity

    • E. 

      Thyrotoxicosis myxoedema

  • 63. 
    Olivia Chang, 61 years of age, is a typist who you see regularly.  She has noticed problematic tremor.You consider the possibility of drug induced tremor.  Select the correct statement
    • A. 

      Caffeine typically produces an intention tremor

    • B. 

      Metoclopramide typically produces a postural tremor

    • C. 

      Lithium typically produces a tremor at rest

    • D. 

      Neuroleptics typically produce a rest tremor

    • E. 

      Thyroid hormones typically produce a rest tremor

  • 64. 
    Eric Lee, 40 years of age, is a theatre technician who migrated from China 3 years ago.  He has been treated by your colleague for bronchitis but his productive cough has persisted for 4 weeks.  You consider, among other conditions, the diagnosis of tuberculosis (TB).Eighty-five percent of new Australian cases occur in people born overseas.  Which of the following 'country of origin' does NOT represent a significant part of the Australian TB caseload:
    • A. 

      India

    • B. 

      Vietnam

    • C. 

      China

    • D. 

      Indonesia

    • E. 

      Ethiopia

  • 65. 
    Eric Lee, 40 years of age, is a theatre technician who migrated from China 3 years ago.  He has been treated by your colleague for bronchitis but his productive cough has persisted for 4 weeks.  You consider, among other conditions, the diagnosis of tuberculosis (TB).Which of the following is the biggest known risk factor for TB in Australia:
    • A. 

      Household contact with TB

    • B. 

      Returned traveller from country with high prevavlence

    • C. 

      HIV infection

    • D. 

      Contact with local migrant community

    • E. 

      Residence for > 3 months in country with high prevalence

  • 66. 
    Eric Lee, 40 years of age, is a theatre technician who migrated from China 3 years ago.  He has been treated by your colleague for bronchitis but his productive cough has persisted for 4 weeks.  You consider, among other conditions, the diagnosis of tuberculosis (TB).Which of the following scenarios should raise clinical suspicion of TB in patients with epidemological risk factors:
    • A. 

      Cough for > 2 - 3 weeks

    • B. 

      Loss of > 5% body weight

    • C. 

      Unexplained new onset fever

    • D. 

      Acute shortness of breath

    • E. 

      Acute chest pain

  • 67. 
    Astrid Bernhardt, 49 years of age, is a telecommunications manager who you diagnosed with HIV 7 years ago.  She sees a HIV specialist but prefers to see you for her regular check ups and general care.Astrid was coping well with her diagnosis and management but has recently noticed some forgetfulness at work.  You assess her further and explain:
    • A. 

      HIV associated dementia is very common and the most likely cause of her symptoms

    • B. 

      Her symptoms may be due to depression

    • C. 

      She must cease her medications as they are the likely cause of her symptoms

    • D. 

      Her symptoms are most likely due to excessive alcohol intake

    • E. 

      Her symptoms are likey to be related to illicit drug use

  • 68. 
    Eric Lee, 40 years of age, is a theatre technician who migrated from China 3 years ago.  He has been treated by your colleague for bronchitis but his productive cough has persisted for 4 weeks.  You consider, among other conditions, the diagnosis of tuberculosis (TB).You arrange investigation for Eric.  Which of the following would best increase the chance of a timely diagnosis:
    • A. 

      Evening sputum collection

    • B. 

      2 - 3 sputum collections for TST examination

    • C. 

      2 - 3 sputum collections for AFB examination

    • D. 

      QuantiFERON-TB Gold skin prick testing

    • E. 

      QuantiFERON-TB Gold assay

  • 69. 
    Sharon Ng, 35 years of age, is a previously well outward bound instructor who presents with acute arthralgia, myalgia and fatigue.You consider mosquito borne illness and ask about her personal protective strategies.  Which of the following would most reduce her risk:
    • A. 

      Wearing dark coloured clothing

    • B. 

      Using insect repellent

    • C. 

      Wearing strong perfume

    • D. 

      Extra care during the hottest part of the day

    • E. 

      Extra care during the night

  • 70. 
    Sharon Ng, 35 years of age, is a previously well outward bound instructor who presents with acute arthralgia, myalgia and fatigue.Sharon works mainly in Northern NSW and you consider Ross River virus (RRV).  Select the correct statement about the other differential diagnoses for Sharon's illness:
    • A. 

      Barmah Forest virus has more prominent joint pains than RRV

    • B. 

      Japanese encephalitis usually causes severe encephalitis

    • C. 

      Dengue fever is not transmitted in Australia currently

    • D. 

      Infectious mononucleosis is an unlikely diagnosis

    • E. 

      Systemic lupus erythematosus is a possible diagnosis

  • 71. 
    Sharon Ng, 35 years of age, is a previously well outward bound instructor who presents with acute arthralgia, myalgia and fatigue.There are numerous symptoms of RRV.  Which statement about the frequency of symptoms is accurate:
    • A. 

      Joint swelling occurs in around 50% of cases

    • B. 

      Joint pain occurs in around 50% of cases

    • C. 

      Tiredness occurs in around 50% of cases

    • D. 

      Rash occurs in around 20% of cases

    • E. 

      Depression occurs in around 20% of cases

  • 72. 
    Astrid Bernhardt, 49 years of age, is a telecommunications manager who you diagnosed with HIV 7 years ago.  She sees a HIV specialist but prefers to see you for her regular check ups and general care.Astrid has been on combination antiretroviral therapy (cART) for 3 years.  You discuss her cardiovascular risk explaining:
    • A. 

      It is more common in HIV positive people of African descent

    • B. 

      It is only elevated in patients taking protease inhibitors

    • C. 

      It is only elevated in patients taking abacavir

    • D. 

      Smoking is less common in patients with HIV

    • E. 

      HIV itself increases cardiovascular risk

  • 73. 
    Sharon Ng, 35 years of age, is a previously well outward bound instructor who presents with acute arthralgia, myalgia and fatigue.Sharon runs equestrian camps during the holidays and wonders if this is related to her current illness.  Which of the following is true about reservoir hosts for RRV:
    • A. 

      Possums and horses are important hosts in rural areas

    • B. 

      Birds and flying foxes are important hosts in rural areas

    • C. 

      Human-mosquito-human transmission cannot occur

    • D. 

      Kangaroos and wallabies are the main hosts

    • E. 

      Cats and dogs are important hosts in urban area

  • 74. 
    Astrid Bernhardt, 49 years of age, is a telecommunications manager who you diagnosed with HIV 7 years ago.  She sees a HIV specialist but prefers to see you for her regular check ups and general care.You previously advised Astrid about the recommended vaccinations and she is up-to-date with these.  Which statement is correct about vaccinations for HIV positive people:
    • A. 

      Annual influenza vaccination is recommended at any age

    • B. 

      5 yearly pneumococcal vaccines are recommended after 50 years of age

    • C. 

      Hepatitis B vaccination is ineffective

    • D. 

      Varicella vaccination is not recommended if CD4 count is < 400

    • E. 

      Oral polio vaccines are safe if CD4 count is > 400

  • 75. 
    Sean O'Loughlan, 60 years of age, is a parks officer who presents for his regular scripts.  He attends infrequently - you discuss several preventive health issues and complete a skin check.'Red flags' can alert to high risk patients.  Which is NOT a recognised 'red flag' for basal cell carcinoma (BCC):
    • A. 

      Organ transplant recipient

    • B. 

      Presence of numerous naevi

    • C. 

      Previous multiple solar keratoses

    • D. 

      History of large sun exposure

    • E. 

      Lesion in area of previous skin cancer treatment

  • 76. 
    Astrid Bernhardt, 49 years of age, is a telecommunications manager who you diagnosed with HIV 7 years ago.  She sees a HIV specialist but prefers to see you for her regular check ups and general care.Which of the following is part of your regular recommended monitoring for Astrid:
    • A. 

      Yearly Pap tests

    • B. 

      3 monthly fasting glucose

    • C. 

      3 monthly cholesterol, LDL, HDL and TGs

    • D. 

      Monthly HIV viral load

    • E. 

      6 monthly CD4 count

  • 77. 
    Skye White, 13 years of age, is a student who has recently become lacto-vegetarian.  Her mother has brought her in today to ensure they both understand how to meet her nutritional needs with her new diet.Skye is a keen rower and wants to make sure she has plenty of iron to maximise her performance in the upcoming season.  You inform her:
    • A. 

      Nonhaem iron is better absorbed by the body

    • B. 

      Vitamin C increases the absorpition of nonhaem iron

    • C. 

      Phytates in wholegrains increase the absorption of nonhaem iron

    • D. 

      Tannins in tea increase the absorption of nonhaem iron

    • E. 

      Iron deficiency is more common in vegetarians than meat eaters

  • 78. 
    Skye White, 13 years of age, is a student who has recently become lacto-vegetarian.  Her mother has brought her in today to ensure they both understand how to meet her nutritional needs with her new diet.You discuss protein intake and explain to Skye that:
    • A. 

      Vegetarian diets usually fall below protein requirements

    • B. 

      Strict protein combining is necessary to ensure she has a balanced amino acid intake

    • C. 

      Soy protein has a protein digestibility corrected amino acid score similar to meat

    • D. 

      Eggs are an appropriate source of protein for Skye

    • E. 

      Soy products do not contain readily digestible proteins

  • 79. 
    Skye White, 13 years of age, is a student who has recently become lacto-vegetarian.  Her mother has brought her in today to ensure they both understand how to meet her nutritional needs with her new diet.Skye is not aware of the need for vitamin B12.  You discuss this and explain:
    • A. 

      Mushrooms are reliable source of B12

    • B. 

      250mL of fortified soy beverage would provide her daily needs

    • C. 

      Animal and dairy products do not provide B12

    • D. 

      Supplements of around 2mg may be useful as large doses are required to ensure adequate intake and bioavailability

    • E. 

      Doses of 2 microgram supplements can be useful as bioavailability decreases with increasing intake

  • 80. 
    Sean O'Loughlan, 60 years of age, is a parks officer who presents for his regular scripts.  He attends infrequently - you discuss several preventive health issues and complete a skin check.You biopsy a suspicious area on Sean's cheek.  The pathology demonstrates a BCC.  BCCs with 'aggressive' growth patterns are characterised by:
    • A. 

      Thin cords of basaloid cells

    • B. 

      Thin cords of fibrotic stroma

    • C. 

      Small clusters of fibrotic stroma

    • D. 

      Homogenous changes to basaloid cells

    • E. 

      Pallisading cords of mixed cells

  • 81. 
    Skye White, 13 years of age, is a student who has recently become lacto-vegetarian.  Her mother has brought her in today to ensure they both understand how to meet her nutritional needs with her new diet.Skye's mother is worried about her calcium intake and asks what constitutes one serve.  All of the following equal one serve of calcium except:
    • A. 

      30g of cheese

    • B. 

      250mL of milk or calcium fortified soy beverage

    • C. 

      3 tablespoons unhulled tahini

    • D. 

      1.5 cups Asian greens

    • E. 

      1 cup almonds

  • 82. 
    Sean O'Loughlan, 60 years of age, is a parks officer who presents for his regular scripts.  He attends infrequently - you discuss several preventive health issues and complete a skin check.You biopsy a suspicious area on Sean's cheek.  The pathology demonstrates a BCC.Sean weights his treatment options.  What do you tell him about Mohs surgery?  It:
    • A. 

      Is readily available in any rural centre with a pathologist

    • B. 

      Involves vertical 'bread loaf' tissue slicing techniques

    • C. 

      Is rapidly performed by most practitioners

    • D. 

      Has a better cure rate than standard surgery

    • E. 

      Is inappropriate for recurrent skin tumours

  • 83. 
    Sean O'Loughlan, 60 years of age, is a parks officer who presents for his regular scripts.  He attends infrequently - you discuss several preventive health issues and complete a skin check. You biopsy a suspicious area on Sean's cheek.  The pathology demonstrates a BCC. Sean weights his treatment options.Sean asks about radiotherapy.  You explain radiotherapy:
    • A. 

      Is usually spread over 6 months

    • B. 

      Requires up to 20 daily fractions over 1 month

    • C. 

      Results in immediate complications but no delayed complications

    • D. 

      Offers lower recurrence rates than surgical management

    • E. 

      Is mostly used in young patients

  • 84. 
    Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother.   Lola is suddenly irritable and crying after playing in the garden.  You have seen her mainly for eczema.  She is hypertensive and appears to have a painful left foot.  You consider spider bite as one of your differential diagnoses.Select the best option about red back spider bite envenomation.  Lactrodectism:
    • A. 

      Slows sodium current inactivation resulting in exhaustion of neurotransmitters

    • B. 

      Causes synaptic vesicle exocytosis resulting in catecholamine release

    • C. 

      Causes severe and rapid life threatening systemic envenomation

    • D. 

      Lasts a median of 1 week with around one-third of cases lasting over 1 month

    • E. 

      Causes noncardiogenic pulmonary oedema in around 70% of children