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Set 5 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 you 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: Sophia

Sophia, 3 years old, presents with a generalised rash. Her mother says that Sophia has been unwell for 6 days with a runny nose, mild cough, and mild fevers. The rash started two days ago and has quickly spread to her neck, trunk, arms and legs.

Sophia has been well in the past. She and her siblings have never been immunised.

On examination her vital signs are normal apart from a temperature of 37.8°C. Her ears and throat are normal and she has mildly tender posterior auricular and posterior cervical lymph nodes.

The appearance of the rash is shown in the picture.

What is the most likely diagnosis?

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2. Uncertain
3. Certain
4. Very certain

Question 2: Bob

Bob, aged 60, is a retired builder and a new patient.  He presented yesterday because of chronic cough and gradually worsening breathlessness over the past few years. He is currently smoking about 5 cigarettes per day. 

You arranged for a chest x-ray and spirometry. Bob couldn’t stay for the spirometry yesterday so returned today to complete the test.

The nurse brings in his spirometry results (shown below).

Test

Predicted

Pre bronchodilator

% predicted

Post bronchodilator

% predicted

FVC (L)

4.83

4.75

98

4.73

98

FEV1 (L)

3.76

1.79

48

1.85

49

FEV1/FVC (%)

77

38

 

39

 

PEFR (L/min)

576

403

69

415

72

Key: FVC Forced vital capacity; L litres; FEV1 Forced expiratory volume in one second; PEFR peak expiratory flow rate

What is the most accurate interpretation of these results?

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Question 3: Francine

Francine aged 30 years, presents feeling generally tired for the last two months.  Her past medical history includes asthma in childhood.  She denies any recent symptoms suggesting infection.  A thorough systems review is unremarkable apart from occasional mouth ulcers and troublesome painful finger joints.  She works in a busy accountancy firm.  She is happily married and trying, so far unsuccessfully, to become pregnant.

Her vital signs are: Temperature 37.5°C; BP 135/70; P 84 and regular; BMI 23; RR 12/minute.  Her appearance is as shown in the image below.

Based on this clinical information, what investigation is the most sensitive screening test for the provisional diagnosis?

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Question 4: Clark

Clark, 17 years old, presents because he is embarrassed about his acne and wants something “to clear it up”.

In the past he has used topical benzoyl peroxide and adapalene but states that they didn’t make much difference. Most recently he has been using both topical treatments with oral doxycycline 100 mg. After 6 weeks of this combination treatment his acne hasn’t really improved. He confides that he is getting embarrassed to go out socially with his friends because of the acne and he really wants something that will work.

His facial acne is shown in the image.

What is the most appropriate next treatment option for Clark?

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Question 5: Simon

Simon, aged 56 years, has attended for a ‘mole check’. He is an infrequent attender to the clinic because he is normally well and is on no medications. You take his blood pressure and it is 160/97mmHg. After 15 minutes lying down in the nurse’s station his follow-up BP reading is 150/90 mmHg.

What is the next most appropriate management step regarding his blood pressure?

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Question 6: Matthew

Matthew, aged 17 years, returns with his mother after visiting the psychiatrist. You had arranged a referral because the school had contacted Matthew’s mother with concerns over a four month decline in his cognitive ability and general functioning (daydreaming, poor attention) compared to his former high performance in earlier years. Additionally, Matthew’s mother had noticed that he was more recently restless, moody and less interested in his usual hobbies of sports and meeting up with friends.  She was also worried because Matthew’s father suffers from bipolar disorder (parents are separated).

The letter from the psychiatrist suggests that Matthew is in a possible ‘prodromal’ phase for psychosis i.e. is symptomatic in a high ‘at risk’ mental state.

Matthew’s mother wants to talk about possible prevention options.

In addition to cognitive behavioural therapy, what is the most appropriate preventive treatment at this stage?

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Question 7: Vera

During a general examination of Vera, aged 42 years, a new patient to your general practice you find one non-tender nodule in her thyroid.  It is firm and measures about 13 mm.  She has previously been well, and there are no other significant examination findings.

You organise some blood investigations and all are normal including the TSH.

What is the most appropriate next step in investigating this nodule?

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Question 8: Alan

Alan, aged 61 years, presents with indigestion. He has now had three episodes of treatment with esomeprazole. The first time his symptoms settled after 3months; the second time he required 6 months of treatment and eighteen months ago, he started the medication again for a third time and has been on a low dose ever since. Despite the low dose he is now getting indigestion symptoms again. 

Alan’s past medical history includes mild hypertension (being treated non-pharmacologically) and central obesity. He smokes 15 cigarettes / day.  He drinks 6 stubbies of beer / weekend.

He has no significant family medical history.

Which one of the following risk factors does the evidence suggest will have the greatest impact on Alan’s future risk of Barrett’s oesophagitis?

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Question 9: Sara

Sara, aged 45 years, presents because over the last 12 months her periods have been progressively getting heavier. She previously had regular 28-day cycles with bleeding for 5-7 days.  However, they have now become more irregular (occurring every 24 – 37 days) and prolonged (lasting 8-10 days).

For the first 3-4 days she is changing her pads almost every two hours and in the last 5 months she has had two very embarrassing episodes of “flooding” while at work. She does have cramping pains but only when she passes large clots. There is no intermenstrual bleeding.

She has three children aged 20, 15 and 13 years old. She is divorced and not currently sexually active. Her smear tests have been normal.

On examination Sara looks tired but is otherwise unremarkable.

Results of last week’s full blood count, electrolytes, liver function tests and thyroid stimulating hormone, are normal.

What is the most appropriate initial diagnostic investigation?

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Question 10: Jeanie

Jeanie, aged 62 years, is a retired secretary who has no significant past history.  She presents with a 3-week history of general malaise and stiffness.  In the past month or so she has been tired, achy, and she has lost her appetite.  She has noticed stiffness in her shoulders.  She is finding it an effort to hang out her washing, and she also reports struggling to get out of her chair of an evening. When she wakes in the morning she feels stiff for about 3 hours. She doesn’t recall any recent fever or respiratory tract symptoms. 

What is the most important diagnostic investigation to arrange?

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Question 11: Daisy

Daisy is a 3-year-old Indigenous child brought in by her aunty who is concerned about ongoing discharge from both of her ears.  She says that there has been yellowish fluid coming out of both ears intermittently for at least 2 months.  She thinks that Daisy may have had a cold when the discharge first started.  Upon further questioning, she reports that Daisy has also had a runny nose most of the time since then but is currently well with no fevers, no earache and good energy levels. 

Nobody has noticed any problems with Daisy’s hearing, and there are no concerns about her development.  Her aunty says that she hasn’t taken her to see a doctor before now as she didn’t seem unwell and she thought it would just clear up by itself.

Daisy has no significant past medical history, and no allergies.

On examination, Daisy is afebrile and well looking.  The only clinical finding of note is purulent discharge in both of her auditory canals, and small perforations of both of her tympanic membranes.  The tympanic membranes do not appear inflamed.

What is the most appropriate treatment?

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Question 12: Emergency contraception

You are planning to deliver a session on contraception at the local high school. One of the areas you want to cover is emergency contraception.

Which one of the following statements is correct for the Levonorgestrel –Emergency Contraception (LNG-EC) method?

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Question 13: Dylan

Dylan, a 3-month-old baby, is brought to you by his mother with a history of excessive tearing of the right eye since birth, as well as some yellow discharge from the same eye.  His mother has tried antibiotic eye drops and massage at the corner of his eyes. She has also been washing his eye regularly with saline.  On examination both Dylan’s eyes appear normal other than pooling of tears along the right lower eyelid. 

What is the next most appropriate management of Dylan’s condition?

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Question 14: Oliver

Oliver, a fit and active 62-year-old, has presented to discuss his treatment options following a diagnosis of prostate cancer by the urologist. He initially had a prostatic-specific antigen (PSA) test because his brother (aged 70 years) had been diagnosed with prostate cancer. His brother had significant side effects after his radical prostatectomy to treat the cancer. Oliver has heard that most treatments for prostate cancer commonly cause side effects.

The letter from the urologist indicates that he has localised cancer with one of four cores positive, clinical stage T2, a Gleason score of 6 and a PSA of 6.5 ng/ml.

While you plan to discuss a range of options, what is the most appropriate management to suggest to Oliver?

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Question 15: Zahir

Zahir is a 28-year-old refugee from South Sudan who you are seeing today for discussion of results.  You first saw her a week ago and ordered a number of investigations.

Zahir’s iron studies results are:

  • Serum iron 10 ug/L (10-30/L)
  • Total iron binding capacity 73 umol/L (45-70 umol/L)
  • Transferrin saturation 11% (16-50%)
  • Ferritin 20 ug/L (15-290 ug/L))

Relating to the commencement of iron therapy, what is the most appropriate management advice for Zahir?

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Question 16: CPR

You are planning to take your practice team and the visiting medical student through basic cardiopulmonary resuscitation (CPR).

Which of the following is correct regarding the Australian and New Zealand Committee on Resuscitation (ANZCOR) guidelines for basic CPR?

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Question 17: Rod

Rod, aged 53, presents for renewal of his prescriptions.  On general questioning, he says he has been feeling a bit tired and lacking in energy lately.  He describes poor sleep and waking feeling unrefreshed.  He laughs that his wife now sleeps in the other room because of his snoring.

What additional clinical information would most suggest the need for a sleep study?

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Question 18: Ash

Ash, aged 11 years, presents with his mother because of fatigue, persistent fevers and generalised muscle and joint aches and pains. His symptoms began about a month ago and his mother (a nurse) thought they would settle. He has however now missed several days of school.

She says that Ash has been spiking a fever late afternoon on most days, which settles completely by the evening.   She adds that during the fever he often develops a pink rash on his torso and limbs which settles within an hour or two.

On examination Ash looks unwell but he is afebrile and his other vital signs are normal. He has generalised muscle tenderness on palpation and evidence of swelling and pain in the left knee and left wrist. He has a mild hepatomegaly but no splenomegaly. Examination is otherwise unremarkable.

What is the most likely diagnosis?

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Question 19: Brian

Brian is a 58-year-old fisherman. You have just excised a small lesion (possible BCC) from the dorsum of his hand and sutured the site.

When would be the most appropriate time for him to return for suture removal?

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Question 20: Sally

Sally aged 67 years has a history of hypertension, hypercholesterolaemia, gastro-oesophageal reflux disease (GORD), ischaemic heart disease and chronic heart failure. Her medications include: perindopril, metoprolol controlled release, frusemide, and esomeprazole.

She come to see you because she has had a few episodes of being light headed in the last few days and has fainted once. On further questioning these seem to occur with posture changes. On examination her pulse is 85 and regular, and her BP is 110/80 sitting and on standing for 2 minutes is 90/ 60. Her cardio-respiratory examination is otherwise unremarkable and her electrocardiogram (ECG) is unchanged from previously.

The most appropriate next management step is to:

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Question 21: Anne

You are asked to review the pathology results of a patient, Anne, aged 32 years.  Anne saw one of your colleagues last week complaining of general malaise.  She works as a waitress in a restaurant, and 2 weeks ago was given a course of roxithromycin for a respiratory tract infection.  Her general health is usually good although she is significantly overweight (body mass index 29).  She is on the combined oral contraceptive pill (COCP).

Her full blood count is normal, as are her electrolytes.  Her liver function test (LFT) results show:

Albumin

40 g/L (34–48)

Protein

72 g/L (65–85)

Total bilirubin

34 μmol/L (2–24)

Gamma-glutamyl transferase (GGT)

30 U/L (<60)

Alkaline phosphatase (ALP)

80 U/L (30–110)

Alanine transaminase (ALT)

34 U/L (<55)

Aspartate transaminase (AST)

24 U/L (<45)

What is the most likely explanation for Anne’s LFT results?

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Question 22: Gayle

Gayle, aged 36 years, has come to see you to discuss a diagnosis of relapsing-remitting multiple sclerosis (RRMS) after a recent visit to a neurologist.   She had optic neuritis diagnosed 2 months ago, and investigations following this included an MRI which showed 4 brain lesions suggestive of MS.   On review of her history you also note that she had an episode of trigeminal neuralgia 5 years ago.

The specialist indicated that he wanted to start Gayle on a highly effective treatment early. Gayle and her family are shocked and upset by the diagnosis, and Gayle wants to discuss treatment and side effects with you as she felt a little overwhelmed with the specialist.

What is the most appropriate initial treatment for Gayle’s MS to reduce the frequency of attacks and the rate of disease progression?

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Question 23: Margie

Margie, aged 33 years, is one of your regular patients. She is very excited to be pregnant. She is also very keen to breast feed her baby after delivery, and you discuss this in detail at her 36-week visit. An examination of her breasts is unremarkable.

When considering Margie’s suitability for breastfeeding, what further clinical information or examination would indicate that breastfeeding is contraindicated?

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Question 24: Sarah

Sarah, aged 29 years, is 15 weeks into her first pregnancy. You see from her notes that she is being managed by your local hospital maternity clinic and has presented today as she has a bad head cold. She tells you that she has been taking paracetamol but it hasn’t been helping much, and she wants to know what else she can take. Prior to pregnancy she used to use fluticasone furoate (Avamys®) nasal spray with good effect whenever she got a bad head cold, and she is wondering if it is safe to use this.

After looking up your pregnancy database, you explain to Sarah that fluticasone furoate is a Category B3 drug – it has been taken by a limited number of pregnant women without any observed increase in frequency of adverse foetal effects, although studies in animals have shown an increased occurrence of foetal damage.

What is the most appropriate response you could give to Sarah?

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Question 25: Jack

Jack, aged 7 years, is brought in to see you by his mother Natalie and his grandmother Shirley.  Natalie is concerned because a child in Jack’s class at school has been recently diagnosed with whooping cough.  On questioning, Natalie says that Jack has been well with no cough or fevers.

Natalie is also worried as she is 25 weeks pregnant.  She tells you that she had a pertussis vaccination during her pregnancy with Jack, and has been recently well with no cough.  Shirley also asks you about her risk of whooping cough as she will be helping out with caring for the baby after its arrival, and recalls being vaccinated about 12 years ago. Jack is up to date with his vaccinations.

What is the most appropriate management advice at this consultation?

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Question 26: Trina

Trina, aged 49 years, presents with a skin lesion on her left upper arm that she is concerned may be a melanoma. Her mother has had two melanomas removed over the past 15 years. Trina thinks that her mole has changed in shape and has darker spots in it.

Trina is otherwise well and on no medications.

On examination the appearance of the lesion is shown below. There are no palpable axillary lymph nodes.

What is the most appropriate initial management?

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Question 27: Maria

You are a rural GP working in a local, regional hospital and are reviewing Maria, aged 82 years, on the ward. She had presented to the hospital following a large gastrointestinal bleed for which she required 3 units of packed cells.

Maria’s past history includes longstanding persistent atrial fibrillation, a right sided stroke 3 years ago and hypertension. Her medication on admission to hospital was warfarin (which was promptly ceased), metoprolol and enalapril.

Maria is worried about her risks of another stroke now she is not taking warfarin, but doesn’t want another bleeding episode.

What is the most appropriate management option for Maria?

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Question 28: Louise

Louise, an 8-year-old girl, presents with her mother. Louise has a white vaginal discharge and vulval redness and mild itch for the last two days. It has not settled with a dilute vinegar bath. Her mother is concerned that it is getting worse. Louise is now complaining of burning when she passes urine. Louise has no past history of any skin rashes, and has no allergies.

On examination there is moderate vulval redness, some linear scratches, an intact hymen and some white discharge. You take an introital swab.

What is the most appropriate treatment of Louise’s symptoms, if an infective cause is suspected?

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Question 29: Brenda

Brenda attends with her 4-year-old daughter Sophie. She has come for a cervical cancer screening test but also asks you for a repeat prescription of salbutamol for Sophie. You ask about Sophie’s asthma and Brenda tells you that Sophie has flare ups of her asthma about once a month, but that these are managed with salbutamol aerosol, 2 puffs every 4 hours as necessary. She is not on any other medications.  In between the flare-ups Sophie has no symptoms. Brenda confirms that she is using a spacer to administer the salbutamol, and her demonstration of the technique is appropriate. 

Sophie’s physical examination is normal.

What is the most appropriate management option for Sophie?

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Question 30: Rowan

You are a general practitioner and have gone to watch your 15-year-old son, Rowan, play AFL football. During the game Rowan takes a high mark but comes down hard onto the ground and hits his head. He is slow to get up but takes the kick. Afterwards he seems a bit unsteady and his coach takes him off the ground. You go over to check on Rowan.

What clinical symptom or sign would suggest that Rowan needs urgent medical assessment?

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Summary

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