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Set 1 MCQs Questions Instructions Introduction
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Introduction

Welcome to this multiple choice question (MCQ) activity. It is one of a series of activities designed to give you an opportunity to test your knowledge to help you to identify strengths and gaps, to provide you with answers and reference material for further review and over time give you the opportunity to reflect on your progress.

All Registrars, at all training levels, in GPTQ will be completing these. GPTQ will also review your answers compared to your peers and give you feedback.

In this activity the multiple choice questions are single best answer of five (5) options.

In addition there are two other rating questions for you to complete. They appear after you have chosen your answer to the MCQ.

  1. Option weighting. The first series of questions asks you to weight each answer according to likelihood of being correct (in MCQs options are all possible but some are more likely/correct than others). You need to drag each option slider to identify your perception of the weighting for that option.

  2. Question confidence rating. This rating relates to how confident you are about your answer to the question as a whole. You can click on the rating boxes or use the slider. Your confidence rating will be reviewed at the conclusion of the activity so you can reflect on how confident you were across each question and across the whole activity.

Instructions

In this MCQ activity there are 30 MCQs for you to work through. You can work through them sequentially or choose questions from the menu in any order.

After you complete the MCQ, option rating and question confidence rating you are required to press the submit button to record your answers. Once you press the Submit button you will not be able to change your answers. You will immediately receive the correct answer and feedback so that you can compare them with your own answer. There will also be references provided for further reading.

At the end of the activity there is a conclusion screen that summarises the topic of each MCQ, whether your answer was correct/incorrect, your confidence level and the references for each MCQ. You can also print this summary screen so that you can explore the references at a later date.

Ideally you should complete this activity in one sitting, however you can click 'Save and close' to save and re-open it if you need to complete it in stages.

This activity should take 60 minutes to complete, or longer depending on whether you also explore the reference material at the same time.

Question 1: Freda

Freda is a 40-year-old woman who has had IDDM for 10 years. She sees you today. Her average BP is 135/90 based on home measurements. She is a non-smoker. She has no complications of her diabetes to date. Her last lipid levels 2 months ago were:

  • Total cholesterol 3.1 mmol/l
  • Low density lipoprotein (LDL) 2.1 mmol/L
  • High density lipoprotein (HDL) cholesterol 1.5 mmol/L

What is the most appropriate initial management of her blood pressure?

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Rate your overall level of certainty in answering this question.


Please select:
0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 2: Maggie

Maggie, a 32-year-old, works as a bar attendant at the local rural hotel. She presents with sudden onset of severe shortness of breath and pain on the right side of her chest with deep breathing. She feels lightheaded and is anxious because she can't breathe properly. Maggie is generally in good health and has only previously attended for her 2 yearly Pap smears and repeat oral contraceptive scripts – Yaz (ethinyloestradiol/drospirenone).

Maggie smokes 40 cigarettes per day, and drinks approximately 4 glasses of alcohol twice per week.

On examination her vital signs are: Temperature 36.4°C, pulse 125/minute and regular, blood pressure 105/60 mmHg, respiratory rate 28/min, oxygen saturation 88% on the right hand.

The most likely diagnosis for her presentation is:

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Please select:
0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 3: Robert

You are on a flight from Brisbane to San Francisco. About 3 hours into the flight you are asked to see Robert, a 29-year-old man, who is feeling unwell after eating lunch. Robert is looking distressed, his face is flushed, his upper lip has swelled and he feels dizzy.

On examination his vital signs are temperature 36.8°C, respiratory rate 24/minute, pulse 100/minute, blood pressure 100/60 mm Hg. There are occasional wheezes bilaterally on chest auscultation.

The plane has a good range of emergency medications in its first aid kit.

What is the most appropriate treatment?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 4: Barbara

Barbara brings her 5-month-old daughter Lily to see you because of a mild rash in her nappy area. Lily is Barbara’s first child. On routine questioning you discover that Lily hasn’t had any immunisations since the Hepatitis B injection at birth.

You spend some time talking with Barbara about immunisation and realise that she is much more concerned about the pain and distress of immunisations than being opposed to vaccination in general. You explain to her that there are things you can do that reduce the pain and distress.

Which strategy has the strongest evidence for reducing pain with childhood immunisations?

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Please select:
0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 5: Chloe

Chloe, a 6-year-old girl, is brought to your general practice by her mother. Chloe is generally well but does suffer from eczema. Her mother is worried about some spots that have appeared on her chest, which are different to her eczema. These lesions don’t appear to trouble Chloe but are increasing in number.

What is the most likely diagnosis?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 6: Simon

Simon is a 52-year-old man with type 2 diabetes and diabetic nephropathy. He has had consistent blood pressure measurements of around 148/92 mmHg. He is started on perindopril. On review 2 weeks later his blood pressure has fallen to 138/82 mmHg.

Blood test results show an increase in his serum creatinine concentration from a baseline of 80 umol/L (prior to starting perindopril) to 96 umol/L.

What is the most appropriate management at this point?

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Please select:
0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 7: Layla

Layla, a 2-week-old baby, is brought to you by her mother because she has developed a “sticky eye”.  This morning her right eyelids were stuck together and her mother cleared it with a saline wash. On examination Layla’s right eyelids are mildly swollen. There is a moderate amount of pus in the inner canthus and the conjunctiva is red.

What is the most appropriate management of this condition?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 8: Belinda

Belinda, a 45-year-old woman, comes to see you at your practice complaining of heavy irregular periods.  Six months ago her menstrual pattern had been a regular 29-day cycles and her menstrual loss only moderate. She reports that she is otherwise well with no other symptoms.

On physical examination today there are no abnormalities and she had a pap smear 12 months ago which was normal.  Her haemoglobin is at the lower limit of normal. 

What is the next most appropriate management step?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 9: Stella

Stella, a 4-year-old child, is brought to the emergency department of the rural hospital where you are working as a general practice registrar.  She has had intermittent abdominal pain for the last 24 hours and has now developed a painful, swollen ankle and a rash “like hives” (present for 4 hours).

On examination, the abdomen is soft; there is localised oedema of the dorsal aspects of her feet and tenderness and swelling of the right ankle.  There are raised red weals present over the buttocks and lower extremities. 

What is the most appropriate investigation for this patient?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 10: Heartprev

The pharmaceutical representative has come to talk to you about a new medication, Heartprev, and has brought with him a published journal article on the findings of a randomised, controlled trial. You look at the results:

  • 2,000 people with several risk factors for heart disease were included in the trial.
  • 1,000 people were in the control group and of these 400 experienced an acute myocardial infarct in the 5 year trial period.
  • 1,000 people were in the treatment group and of these 200 experienced an AMI acute myocardial infarct in the 5-year trial period

What is the Absolute Risk Reduction for Heartprev?

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1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 11: David

David, aged 53 years, has a past history of obesity, hypertension, hyperlipidaemia and gastro-oesophageal reflux disease (GORD).

He presents today because his older brother recently had a massive heart attack. He says to you - “That’s it! I have decided that I must do something to lose weight and I am committed to following it through”.

What would be the most appropriate next step to help him change his behaviour?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 12: Matt

Matt, a 56-year-old man presents with a 2-day history of a red, painful lump under his left eyelid.

What is the most likely diagnosis?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 13: Betty

Betty, a 76-year-old woman, has end stage COPD and a background of chronic hip and knee pain due to osteoarthritis. She is on home oxygen. She lives on her own and her son contacts you today because he is concerned that she is disoriented and drowsy. He has come from the country to stay with Betty for a few weeks. He reports that she has not been eating as well as previously, has offensive smelling urine, seems more breathless, and has vomited once.
She is on more than 10 medications including tramadol, amitriptyline and sertraline.

You visit her at home. On examination she is cachectic and frail, pulse rate 99 beats/min, respiratory rate 22/minute, oxygen saturation 86% on 2L of oxygen via nasal prongs, temperature 38° C, BP 130/75. The Glasgow coma score is E4V4M6 = GCS 14/15. On chest examination there is widespread wheeze and decreased air entry at the bases. Abdominal examination is unremarkable. Urinalysis is negative.

What is the most appropriate next step?

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1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 14: Simone

Simone, a 45-year-old woman presents to her GP for a checkup. She wants to be healthier and avoid developing osteoporosis. She is fit and healthy and asks what exercise would be most beneficial for prevention of osteoporosis.

Which exercise would the GP recommend as the most osteogenic?

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1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 15: James

James, a 55-year-old man, comes to your general practice because he has injured his shoulder a week ago and it is still painful.  He is a labourer and felt a sharp pain in his right shoulder as he was lifting a heavy crate.  On examination he has moderate pain and generalised tenderness in the shoulder.  The shoulder can be moved passively through most of its range of movement, but active abduction can only be achieved if assisted through the initial 90 degrees.

What is the most likely diagnosis?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 16: Mandy

Mandy, aged 37, presents to you for follow up of results.  She saw you 5 days ago with dysuria and urinary frequency. Her mid-stream urine (MSU) test for microscopy, culture and sensitivity (MCS) has shown an E Coli infection which is sensitive to the empiric trimethoprim you gave her. 

Mandy is frustrated as this is her 3rd urinary tract infection this year. Investigations in the past 12 months have confirmed normal renal function and a normal renal tract ultrasound. An MSU microscopy and culture when she was asymptomatic was negative.   

What is the most appropriate next management step?

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0. No idea / guess
1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 17: Terese

Terese, a 20-year-old woman, presents to her general practitioner due to recurrent nose bleeds.  On questioning she also reports heavy periods. 

On examination she has a BP 90/60 mmHg, pulse 80 beats/minute and regular, respiratory rate 12/minute, temperature 37.1°C. She has bruises of different ages on her extremities and there is no palpable organomegaly on examination of the abdomen. 

Investigations show:

  • FBE – Hb 115 g/L (120-160 g/L), WCC 8x109/L 4.3 – 10.8x109 /L), platelets 20x109/L (150-350 x 109/L;
  • Coagulation – prolonged bleeding time; and
  • ANA – negative.

What is the most likely diagnosis?

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1. Very uncertain
2. Uncertain
3. Certain
4. Very certain

Question 18: Simone

During a general examination of Simone, aged 35 years who is a new patient to your general practice, you find one non-tender nodule in the thyroid. It measures about 10 mm.

What is the most likely diagnosis?

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Question 19: Stephen

You see Stephen, a 35-year-old man, as a new patient. He is requesting a sexually transmitted infection (STI) screen.  On sensitive questioning, you establish that he has no regular current partner, but has had 3 male partners in the past year.  On several occasions he has had unprotected oral and anal sex.  He has no STI related symptoms.  During general history taking, he tells you that he has had some vaccinations over the years but can’t recall what they were. He denies any intravenous drug use.

Physical examination is unremarkable.

Which of the following investigations is important to include in the STI screen you order?

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Question 20: Thomas

Thomas, a 23-year-old man, comes for treatment of recurring severe right sided headaches.  These are located over his right eye and have been occurring daily for the past week. They wake him at about 6am every morning and last about two hours.  He has had no associated nausea or neurological symptoms, but has noticed his right eye also gets red and becomes watery. 

What is the most likely diagnosis?

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Question 21: Barry

Barry, aged 55, presents in the middle of a busy morning at your urban surgery after his wife has convinced him to come in.  He is generally well, but reports an episode yesterday morning where he felt quite odd, was slurring his speech and fumbling with his right hand.  The symptoms lasted for about half an hour, then gradually resolved.  He now feels back to normal, and was reluctant to come in as he is supposed to be at work today. 

Physical examination is unremarkable.

What would be the most important part of your initial management of Barry while he is in your surgery?

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2. Uncertain
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Question 22: Isaac

Isaac, aged 45 years, presents for his PSA results. He had seen you a week ago and requested a ‘prostate test’ because a friend had recently had prostate cancer diagnosed and he was concerned. He does not have any lower urinary tract symptoms and there is no relevant family history. You had discussed the benefits and risks of PSA testing but he remained keen to have the PSA test.

His PSA is on the 78th percentile for age.

Given this result, what is the most appropriate next step?

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Question 23: Jasmine

Jasmine, aged 28 years, is an Aboriginal woman from a rural community in North Queensland. She presents to the local hospital with 3 days of worsening of persistent cough, fever, chills and shortness of breath. She has been well in the past.

On examination her temperature is 39.8°C, respiratory rate 30 breaths/minute, pulse 120 beats/minute. Her oxygen saturation is 92%. Her throat is mildly inflamed and on auscultation there are crackles and bronchial breathing in the right lung upper lobe.

What is the most likely diagnosis?

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Question 24: Brian

Brian, aged 62 years, presents to you complaining of increasing fatigue and shortness of breath over the past 6 months. On further questioning he describes being able to walk long distances on the flat, but he gets short of breath walking up hill and avoids it whenever he can. He hasn’t been woken from sleep by breathlessness, and he sleeps on one pillow. He has also had a dry, non-productive cough at night over the last few months. He denies any chest pain.

He has never smoked.  He drinks one standard glass of gin and tonic most evenings. Examination is unremarkable. His only past history is hypertension, and his medications are enalapril and atenolol.

What is the most important investigation, if any, to confirm your provisional diagnosis?

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Question 25: Alicia

Alicia, an 18-month-old child, is brought in to see you by her parents. Alicia had a generalised seizure last night and was seen at the local hospital emergency department. Her parents were reassured that it was a simple febrile convulsion.

Both her parents are present and seem quite anxious and concerned about the fit and seek further information. Alicia seems well today, with a mild fever (38.1°C) and signs of an upper respiratory tract infection (URTI).

In talking with the parents about the prognosis, management and prevention of febrile convulsions which of the following provides the most appropriate advice?

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Question 26: Venita

Venita, a 23-year-old woman, presents to you in general practice to discuss contraception. She is married and has never been pregnant. She has had no sexual partners other than her husband. She has no contraindications to any contraceptive option and her priority is to avoid pregnancy for the next 5 years until she finishes her university course.

Considering the failure rate with typical ('real-life') use, what would be the most appropriate option to recommend for Venita?

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Question 27: Camila

Camila, aged 20 years, attends your practice because of a recall initiated by your colleague. At her last visit a screening endocervical swab had been collected. The result reports the presence of chlamydia. She is generally well with regular periods, and is just finishing her normal menstrual period.

What is the most appropriate management advice to give to Camilla?

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Question 28: Phil

Phil, a 32-year-old man, presents at your general practice with severe left ear pain and decreased hearing. He is a professional police diver, and the symptoms began about an hour after his last dive with no improvement over the past three hours.

Otoscopy reveals vascular injection and a small haemorrhage in the tympanic membrane but no blood in the middle ear.

What is the most appropriate next step?

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Question 29: Zahir

Zahir is a 28-year-old refugee from South Sudan who you are seeing today for discussion of investigation results.  You first saw her a week ago, and ordered a number of investigations including Vitamin B12 levels, which have come back low at 100 pmol/L (120-680 pmol/L).   Her full blood count (FBC) is normal, and she is not pregnant.

What is the most appropriate next step?

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Question 30: Heidi

Heidi, a 23-year-old woman, presents because of breast tenderness ever since she started the oral contraceptive pill Microgynon (30 mcg ethinyl oestradiol and 150 mcg levonorgestrol) 4 months ago. After assessment you believe this to be an adverse effect of the pill. She wishes to continue on a combined pill for contraception.

What is the most appropriate management strategy?

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Summary

Congratulations. You have now completed the activity.

Your score for the MCQs is 0 out of (%)

Your average certainty rating over the whole activity was 0 out of possible (0%).

Below you can review a summary of the question topic, your confidence rating and also review the reference material for any areas where you identified gaps. Click on the print icon if you wish to print or download a copy of this.