AMC MCQ confusing question collection for discussion

Discussion in 'Australian Medical Council (AMC) EXAM' started by Guest, Oct 1, 2007.

  1. Guest

    Guest Guest

    AMC MCQ confusing question collection for discussion
    PART 1
    Hi, I will post here some old AMC MCQ questions which I had trouble with. Maybe you have some answers and further questions for discussion!!!


    1.) Which is least likely to cause HIV?

    a. blood transfusion in 1988
    b. hemophilia
    c. homosexual lees contact in ten years (couldn't figure out what lees was)
    d. I/V drug user in 1990
    e. Hetrosexual more with prostitute

    I have no idea, would guess b if you not thinkl of recurrent blood transfusions as treatment or e ??? Any ipout?


    2.) You can breach confidentiality except
    a. harm to patient
    b. harm to others
    c. emergency to hospital
    d. court order
    e. maybe beneficial to patient

    My answer would be e, as the maybe sounds a weak reason. But if there is harm to other peopla with concrete plans or sonsequences you can breach…


    3.) Cyclic vulvovaginitis caused by
    a. bacterial vaginosis
    b. group B streptococcus
    c. E coli
    d. trichomonas

    Think a, maybe b. Thought usually candida. And is with cyclic meant a woman having still or already menstruation or is it a specific term? Strep is most common cause in prepupertal girls as per therapeutic guidelines.


    4.) Lung abscesses can be caused by all except
    a. Staph
    b. Klebsiella
    c. Mycoplasma
    d. bacteroides fragilis
    e. Pneumocystis carinii

    Well, definate causes a and b. My guess is c, but read bacteroides species can cause abscess OTHER than b. fragilis! And Pneumoc. Carinii is oftne not even noticed on CXR! What do you think guys?


    5.) Losing of association is associated with
    a. schizophrenia
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia

    My guess is d, but what is association here exactly? Other people thought it is a.


    6.) Arterial ischemia and absent femoral and popliteal pulses, initally you will do
    a. ankle brachial index pressure
    b. femoral arteriogram
    c. MRarteriogram
    d. arterigram

    My answer is a, although if acute wouldn’t it be arteriogram? What about ultrasound, what to we usually do first if acute or if non-acute as investigation? Any ideas?


    7.) Menopausal lady with progesterone containing OCP, no bleed for 3 months what would you do initially?
    a. USG to determine endometrial thickness
    b. endometrial biopsy
    c. increase the dosage of progesterone

    My guess a but not clear why determinethickness. Should she as being menopausal still have menstruation on OCP???


    8.) Toxic shcok syndrome is most commonly associated with (if this was an actual question then I think I will pass the exam)
    a. super absorbent pad
    b. endotoxin
    c. desquamated rash

    Struggle as obvious is a but what about c? C is typical with TSS. And nowadays cause often not menstruation related!


    9.) Common cause of rupture of EPL
    a. RA and SLE
    b. avascular necrosis in neonate
    c. tenosynovitis

    Struggeling between a and c. My guess is a as RA can cause rupture but I read: most common cause of extensor pollicis longus rupture is infiltration, abrasion, synovitis, as well as periodic steroid injection and ischcaemic necrosis. But I don’t tink happens often in n eonates, or?


    10.) Which of the following is a least likely finding in sexual abuse
    a. finding gonococci
    b. finding condylomata virus
    c. labial hematoma
    d. lacerations in the vagina

    My answer is b. As it should be HPV. Or anyone thinks it is c?


    11.) 2 year old child with fever, irritability, MSU shows WBC 20, protein ++, which of the following is correct?
    a. amoxycillin 150mg daily
    b.suprapubic aspiration
    c. repeat urine examination
    d. send culture and wait for result

    I think it is b. But it is an MSU which would be sufficient if child 3-4 years but SPA is prefered. Amoxycillin used to be given but now often resistance and not appropiate anymore. Just wondered, when do we start treatment? As soon as we have WCC or as soon as pathology/lab finds WCC and/or organism?


    12.) Child with UTI, which is least appropriate
    a. send culture after antibiotic treatment
    b. continue medication until urinary tract abnormality excluded
    c. do USG of urinary tract
    d. immediate micturation urethrogram

    My guess after lots of thinking is d. As it should not be performed within 4 weeks. Can have false result and concerning radiation for child…. Other possible answer would be a I guess.


    13.) 10 year old girl with simple patial seizure and 4 year history of intake of carbemazepine but convulsion 4 times in the last 2 weeks, which is the most appropriate Rx
    a. stop CBZ and start phenytoin
    b. increase dose of CBZ
    c. continue CBZ and start sodium valproate
    d. arrange CT scan and EEG

    My answer is d. But actually I would have done EUCs and level, maybe EEG. Then imaging if all normal. I think we don’t like polypharmacy in epilepsy.


    14.) A neonate developed jaundice after discharge on the 2nd day, he is lethargic and has poor feeding, whats the best management?
    a. MSU
    b LFT
    c. phototherapy
    d. Rx as sepsis

    Well. Not sure. My answer now d, as unwell and so could be sepsis. But would take bili level first and probably start phototherapy straight away as well until all results… or what do you think?



    that's it for now
    I will keep posting questions if I get some answers and ideas from you guys... cheers
  2. Guest

    Guest Guest

    1.) Which is least likely to cause HIV?

    a. blood transfusion in 1988
    b. hemophilia
    c. homosexual lees contact in ten years (couldn't figure out what lees was)
    d. I/V drug user in 1990
    e. Hetrosexual more with prostitute

    I have no idea, would guess b if you not thinkl of recurrent blood transfusions as treatment or e ??? Any ipout?


    2.) You can breach confidentiality except
    a. harm to patient
    b. harm to others
    c. emergency to hospital
    d. court order
    e. maybe beneficial to patient

    My answer would be e, as the maybe sounds a weak reason. But if there is harm to other peopla with concrete plans or sonsequences you can breach…


    3.) Cyclic vulvovaginitis caused by
    a. bacterial vaginosis
    b. group B streptococcus
    c. E coli
    d. trichomonas

    Think a, maybe b. Thought usually candida. And is with cyclic meant a woman having still or already menstruation or is it a specific term? Strep is most common cause in prepupertal girls as per therapeutic guidelines.


    4.) Lung abscesses can be caused by all except
    a. Staph
    b. Klebsiella
    c. Mycoplasma
    d. bacteroides fragilis
    e. Pneumocystis carinii

    Well, definate causes a and b. My guess is c, but read bacteroides species can cause abscess OTHER than b. fragilis! And Pneumoc. Carinii is oftne not even noticed on CXR! What do you think guys?


    5.) Losing of association is associated with
    a. schizophrenia
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia

    My guess is d, but what is association here exactly? Other people thought it is a.


    6.) Arterial ischemia and absent femoral and popliteal pulses, initally you will do
    a. ankle brachial index pressure
    b. femoral arteriogram
    c. MRarteriogram
    d. arterigram

    My answer is a, although if acute wouldn’t it be arteriogram? What about ultrasound, what to we usually do first if acute or if non-acute as investigation? Any ideas?


    7.) Menopausal lady with progesterone containing OCP, no bleed for 3 months what would you do initially?
    a. USG to determine endometrial thickness
    b. endometrial biopsy
    c. increase the dosage of progesterone

    My guess a but not clear why determinethickness. Should she as being menopausal still have menstruation on OCP???


    8.) Toxic shcok syndrome is most commonly associated with (if this was an actual question then I think I will pass the exam)
    a. super absorbent pad
    b. endotoxin
    c. desquamated rash

    Struggle as obvious is a but what about c? C is typical with TSS. And nowadays cause often not menstruation related!


    9.) Common cause of rupture of EPL
    a. RA and SLE
    b. avascular necrosis in neonate
    c. tenosynovitis

    Struggeling between a and c. My guess is a as RA can cause rupture but I read: most common cause of extensor pollicis longus rupture is infiltration, abrasion, synovitis, as well as periodic steroid injection and ischcaemic necrosis. But I don’t tink happens often in n eonates, or?


    10.) Which of the following is a least likely finding in sexual abuse
    a. finding gonococci
    b. finding condylomata virus
    c. labial hematoma
    d. lacerations in the vagina

    My answer is b. As it should be HPV. Or anyone thinks it is c?


    11.) 2 year old child with fever, irritability, MSU shows WBC 20, protein ++, which of the following is correct?
    a. amoxycillin 150mg daily
    b.suprapubic aspiration
    c. repeat urine examination
    d. send culture and wait for result

    I think it is b. But it is an MSU which would be sufficient if child 3-4 years but SPA is prefered. Amoxycillin used to be given but now often resistance and not appropiate anymore. Just wondered, when do we start treatment? As soon as we have WCC or as soon as pathology/lab finds WCC and/or organism?


    12.) Child with UTI, which is least appropriate
    a. send culture after antibiotic treatment
    b. continue medication until urinary tract abnormality excluded
    c. do USG of urinary tract
    d. immediate micturation urethrogram

    My guess after lots of thinking is d. As it should not be performed within 4 weeks. Can have false result and concerning radiation for child…. Other possible answer would be a I guess.


    13.) 10 year old girl with simple patial seizure and 4 year history of intake of carbemazepine but convulsion 4 times in the last 2 weeks, which is the most appropriate Rx
    a. stop CBZ and start phenytoin
    b. increase dose of CBZ
    c. continue CBZ and start sodium valproate
    d. arrange CT scan and EEG

    My answer is d. But actually I would have done EUCs and level, maybe EEG. Then imaging if all normal. I think we don’t like polypharmacy in epilepsy.


    14.) A neonate developed jaundice after discharge on the 2nd day, he is lethargic and has poor feeding, whats the best management?
    a. MSU
    b LFT
    c. phototherapy
    d. Rx as sepsis

    Well. Not sure. My answer now d, as unwell and so could be sepsis. But would take bili level first and probably start phototherapy straight away as well until all results… or what do you think?
  3. guess

    guess Guest

    corect me. Thanks



    1.) Which is least likely to cause HIV?

    a. blood transfusion in 1988
    b. hemophilia////
    c. homosexual lees contact in ten years (couldn't figure out what lees was)
    d. I/V drug user in 1990
    e. Hetrosexual more with prostitute

    I have no idea, would guess b if you not thinkl of recurrent blood transfusions as treatment or e ??? Any ipout?


    2.) You can breach confidentiality except
    a. harm to patient
    b. harm to others
    c. emergency to hospital
    d. court order
    e. maybe beneficial to patient

    My answer would be e, as the maybe sounds a weak reason. But if there is harm to other peopla with concrete plans or sonsequences you can breach…

    don't know. Help please

    3.) Cyclic vulvovaginitis caused by
    a. bacterial vaginosis
    b. group B streptococcus
    c. E coli
    d. trichomonas

    Think a, maybe b. Thought usually candida. And is with cyclic meant a woman having still or already menstruation or is it a specific term? Strep is most common cause in prepupertal girls as per therapeutic guidelines.


    4.) Lung abscesses can be caused by all except
    a. Staph
    b. Klebsiella
    c. Mycoplasma
    d. bacteroides fragilis
    e. Pneumocystis carinii/////

    Well, definate causes a and b. My guess is c, but read bacteroides species can cause abscess OTHER than b. fragilis! And Pneumoc. Carinii is oftne not even noticed on CXR! What do you think guys?


    5.) Losing of association is associated with
    a. schizophrenia////
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia

    My guess is d, but what is association here exactly? Other people thought it is a.


    6.) Arterial ischemia and absent femoral and popliteal pulses, initally you will do
    a. ankle brachial index pressure////
    b. femoral arteriogram
    c. MRarteriogram
    d. arterigram

    My answer is a, although if acute wouldn’t it be arteriogram? What about ultrasound, what to we usually do first if acute or if non-acute as investigation? Any ideas?


    7.) Menopausal lady with progesterone containing OCP, no bleed for 3 months what would you do initially?
    a. USG to determine endometrial thickness///
    b. endometrial biopsy
    c. increase the dosage of progesterone

    My guess a but not clear why determinethickness. Should she as being menopausal still have menstruation on OCP???


    8.) Toxic shcok syndrome is most commonly associated with (if this was an actual question then I think I will pass the exam)
    a. super absorbent pad
    b. endotoxin////
    c. desquamated rash////

    Struggle as obvious is a but what about c? C is typical with TSS. And nowadays cause often not menstruation related!


    9.) Common cause of rupture of EPL
    a. RA and SLE
    b. avascular necrosis in neonate
    c. tenosynovitis

    Struggeling between a and c. My guess is a as RA can cause rupture but I read: most common cause of extensor pollicis longus rupture is infiltration, abrasion, synovitis, as well as periodic steroid injection and ischcaemic necrosis. But I don’t tink happens often in n eonates, or?


    10.) Which of the following is a least likely finding in sexual abuse
    a. finding gonococci
    b. finding condylomata virus///
    c. labial hematoma
    d. lacerations in the vagina

    My answer is b. As it should be HPV. Or anyone thinks it is c?


    11.) 2 year old child with fever, irritability, MSU shows WBC 20, protein ++, which of the following is correct?
    a. amoxycillin 150mg daily
    b.suprapubic aspiration/////
    c. repeat urine examination
    d. send culture and wait for result

    I think it is b. But it is an MSU which would be sufficient if child 3-4 years but SPA is prefered. Amoxycillin used to be given but now often resistance and not appropiate anymore. Just wondered, when do we start treatment? As soon as we have WCC or as soon as pathology/lab finds WCC and/or organism?


    12.) Child with UTI, which is least appropriate
    a. send culture after antibiotic treatment///
    b. continue medication until urinary tract abnormality excluded
    c. do USG of urinary tract
    d. immediate micturation urethrogram

    My guess after lots of thinking is d. As it should not be performed within 4 weeks. Can have false result and concerning radiation for child…. Other possible answer would be a I guess.


    13.) 10 year old girl with simple patial seizure and 4 year history of intake of carbemazepine but convulsion 4 times in the last 2 weeks, which is the most appropriate Rx
    a. stop CBZ and start phenytoin/// (second line Tx)
    b. increase dose of CBZ
    c. continue CBZ and start sodium valproate
    d. arrange CT scan and EEG

    My answer is d. But actually I would have done EUCs and level, maybe EEG. Then imaging if all normal. I think we don’t like polypharmacy in epilepsy.


    14.) A neonate developed jaundice after discharge on the 2nd day, he is lethargic and has poor feeding, whats the best management?
    a. MSU/////( I think best initial Invest)
    b LFT
    c. phototherapy
    d. Rx as sepsis

    Well. Not sure. My answer now d, as unwell and so could be sepsis. But would take bili level first and probably start phototherapy straight away as well until all results… or what do you think?
  4. samu

    samu Guest

    1.) Which is least likely to cause HIV?

    a. blood transfusion in 1988
    b. hemophilia
    c. homosexual lees contact in ten years (couldn't figure out what lees was)
    d. I/V drug user in 1990
    e. Hetrosexual more with prostitute

    I think D. a,b are possible, but d has the highest rate.

    2.) You can breach confidentiality except
    a. harm to patient
    b. harm to others
    c. emergency to hospital
    d. court order
    e. maybe beneficial to patient

    I choose d.


    3.) Cyclic vulvovaginitis caused by
    a. bacterial vaginosis
    b. group B streptococcus
    c. E coli
    d. trichomonas

    a is correct.


    Sorry, it is halfway, but sleepy.

    see ya.
  5. guess

    guess Guest

    1.) Which is least likely to cause HIV?

    a. blood transfusion in 1988
    b. hemophilia
    c. homosexual lees contact in ten years (couldn't figure out what lees was)
    d. I/V drug user in 1990
    e. Hetrosexual more with prostitute

    I think D. a,b are possible, but d has the highest rate.

    but the Q ask about least likely?
  6. guess

    guess Guest

    Cyclic vulvovaginitis caused by
    a. bacterial vaginosis
    b. group B streptococcus
    c. E coli
    d. trichomonas

    a is correct.
    Other also choose a, but I can't find ref. For sure due to candida. Look for your reply.Thanks
  7. Guest

    Guest Guest

    Thanks for your answers, here a few more questions

    Thanks for your answers, here a few more questions:

    AMC MCQ confusing question collection for discussion
    PART 2

    15. What is the role of anti-d?

    a. coating maternal RBC to prevent reaction
    b. stimulate material immune system to secrete anti body
    c. eliminate foetal sensitized anti body from maternal blood

    Not sure if a or c. Role is to provide passively anti-Rh(D) ab and supress anti-Rh (D) production, possibly due to binding antigen. So my guess is c.


    16. G2 P1 previous C/S because of breech; longitudinal lie vertex presentation position plus one, cervix 5 cm dilated suddenly Hx; which of the following is the most likely cause?

    a. placenta praevia
    b. uterine rupture
    c. amniotic emboli
    d. coagulation defect

    Don’t really understand question, least likely cause of what? I would have thought maybe diagnhosis incompetemt cervix. What does position plus one mean???
    As it doesn’t make too much sense to me and b would be associated with labour and shock, c would be respiratory problems I would say answer is a.


    17. Old man with 3rd nerve lesion with normal pupillary reflex; most likely
    a. retrobulbar tumor
    b. aneursym of (incomplete)
    c. carotid artery occlusion
    d. neosyphilis (as opposed to palaeosyphillis) possibly neurosyphillis

    Pupil sparing 3rd nerve palsy. Most common due to ischcaemia. Also common in general with 3rd nerve palsy aneurysm but mainly with affected pupil.
    So answer ischaemia would be c, but there would be symptoms as partial or complete blindness in one eye and an absent pupillary light response. And so my answer is b.


    18. A teacher with chest pain which she thinks reduces the enjoyment of her life which of the following is least likely
    a. depression
    b. hypochondriasis
    c. somatization

    My answer is b. As this would be more preoccupation with fear of havng serious disease but she is not enjoying life…

    19. Sebaceous cyst in the neck of a 14 year old boy, mother wants it removed but boy refuses, WOF is correct?

    a. comply with the mother
    b. refer to a surgeon
    c. simple aspiration of the cyst
    d. refer to a child protection organisation
    e. comply with the boy

    I would say e. As Old enough and not life saving procedure.
  8. Samu

    Samu Guest

    17 3nerve palsy...
    Basically partial third nerve pasly is cause from microvasculoocculusion,
    such as diabetes, hypertension. It means not compressive.
    So, the most possible answer is syphilis.

    I know that it is not the best answer.
    But I choose D.
  9. Samu

    Samu Guest

    No.15
    Anti-D, do you mean, anti-D immunoglubulin?
    We use it to prevent mother blood from sensitizing foetal antigen(RH-D).

    Answer may be C.
  10. Samu

    Samu Guest

    NO.16
    Are there any extra information?
    What is the problem?
  11. Samu

    Samu Guest

    No 18
    I thinkm it is masked depression.
    I choose A.
  12. Guest

    Guest Guest

    hi samu
    why do you think depression is LEAST likely?
  13. samu

    samu Guest

    Hi,
    The reasons I choose depression are
    1. Hypochondriasis is often associated with a certain medical history.
    In this case, she or he may have a family history or past history.

    2. Patients with hypochondriasis are worried about their life. I think, in this case, the patient doenn`t mention what they may have a serious disease, just pain.

    3. The symptpm results in decrease their hapiness is reasonable to diagnose depression.

    Actually, I am not familiar with psychiatry, so please let me know your opinion.

    Thanks,

    samu
  14. doctor666

    doctor666 Guest

    Which of the following are not used in treatment of osteoperosis

    a) Ca salts
    b)Vitamin D
    c) raloxifene
    d) exercise

    Accorging to me all are possible then is the question wrong?
  15. doctor666

    doctor666 Guest

    MY answers to Qs posted by "angelitainca"

    1.) Which is least likely to cause HIV?

    a. blood transfusion in 1988
    b. hemophilia
    c. homosexual lees contact in ten years (couldn't figure out what lees was)
    d. I/V drug user in 1990
    e. Hetrosexual more with prostitute

    Ans is “A” and not hemophelia because will need more frequent transfusions so increased risk!

    2.) You can breach confidentiality except
    a. harm to patient
    b. harm to others
    c. emergency to hospital
    d. court order
    e. maybe beneficial to patient

    Ans “D”

    3.) Cyclic vulvovaginitis caused by
    a. bacterial vaginosis
    b. group B streptococcus
    c. E coli
    d. trichomonas

    Ans A can also be caused by candida infections

    4.) Lung abscesses can be caused by all except
    a. Staph
    b. Klebsiella
    c. Mycoplasma
    d. bacteroides fragilis
    e. Pneumocystis carinii

    Ans C commonly presents with no chest findings

    5.) Losing of association is associated with
    a. schizophrenia
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia

    Ans A it is a sudden change topic or not sticking to the train of thought


    6.) Arterial ischemia and absent femoral and popliteal pulses, initally you will do
    a. ankle brachial index pressure
    b. femoral arteriogram
    c. MRarteriogram
    d. arterigram

    ANS A The Ankle Brachial Pressure Index (ABPI) is a measure of the fall in blood pressure in the arteries supplying the legs and as such is used to detect evidence of blockages (PVD). It is calculated by dividing the systolic BP in the ankle by the higher of the two systolic blood pressures in the arms.

    7.) Menopausal lady with progesterone containing OCP, no bleed for 3 months what would you do initially?
    a. USG to determine endometrial thickness
    b. endometrial biopsy
    c. increase the dosage of progesterone

    Ans A (Progesterone should be given in the smallest dose possible to prevent endometrial hyperplasia so better to be sure)

    8.) Toxic shcok syndrome is most commonly associated with (if this was an actual question then I think I will pass the exam)
    a. super absorbent pad
    b. endotoxin
    c. desquamated rash

    Ans C The characteristic rash, often seen early in the course of illness, resembles a sunburn, and can involve any region of the body, including the lips, mouth, eyes, palms and soles. In patients who survive the initial onslaught of the infection, the rash desquamates, or peels off, after 10–14 days.

    9.) Common cause of rupture of EPL
    a. RA and SLE
    b. avascular necrosis in neonate
    c. tenosynovitis

    Ans A- this tendon is prone to rupture from synovitis and increases friction at Lister's tubercle second to diseases such as RA and Lupus

    10.) Which of the following is a least likely finding in sexual abuse
    a. finding gonococci
    b. finding condylomata virus
    c. labial hematoma
    d. lacerations in the vagina

    A ??? not sure ?Most STD prevalence rates in prepubertal children tend to be below 4%; in adolescents, the prevalence rate is approximately 14%.
  16. Guest

    Guest Guest

    Does a patient with haemophilia need blood transfusion?
    If you are not sure, please review your textbook regarding the management of haemophilia.
    Please note Factor VIII is now available as recombinant products. So the patients with haemophilia have the least chance to be infected with HIV.
  17. Guest

    Guest Guest

    Toxic shcok syndrome is caused by EXOTOXIN but not endotoxin (which is usually released by E. Coli.)
  18. Insiders

    Insiders Guest

    The AMC Exam will be scrapped in 2008

    The AMC exam most likely will be scrapped from the next year.


    Cheers

    Insider
  19. Guest

    Guest Guest

    13.) 10 year old girl with simple patial seizure and 4 year history of intake of carbemazepine but convulsion 4 times in the last 2 weeks, which is the most appropriate Rx
    a. stop CBZ and start phenytoin/// (second line Tx)
    b. increase dose of CBZ
    c. continue CBZ and start sodium valproate
    d. arrange CT scan and EEG

    If you look at the options carefully, you should notice a, b and c are all about how to change medications in epilepsy. I don't think it's necessary to repeat EEG and CT scan, which should have been done before carbamezapine was considered.
    My answer is c as cross over is necessary if you want to change to another medication, it's nothing to do with polypharmacy). An important question should be asked: why patient had 4 seizures in 2 weeks lately.
  20. Guest

    Guest Guest

    13.) 10 year old girl with simple patial seizure and 4 year history of intake of carbemazepine but convulsion 4 times in the last 2 weeks, which is the most appropriate Rx
    a. stop CBZ and start phenytoin/// (second line Tx)
    b. increase dose of CBZ
    c. continue CBZ and start sodium valproate
    d. arrange CT scan and EEG

    If you look at the options carefully, you should notice a, b and c are all about how to change medications in epilepsy. I don't think it's necessary to repeat EEG and CT scan, which should have been done before carbamezapine was considered.
    My answer is c as cross over is necessary if you want to change to another medication, it's nothing to do with polypharmacy). An important question should be asked: why patient had 4 seizures in 2 weeks lately.
  21. Guest

    Guest Guest

    15. What is the role of anti-d?
    a. coating maternal RBC to prevent reaction
    b. stimulate material immune system to secrete anti body
    c. eliminate foetal sensitized anti body from maternal blood

    This is basically a immunology question. After a woman with Rh -ve type receives an anti-D shot, the anti-D antibodies circulate in the body and attach to D +ve fetal red cells. The attached RBCs will then be destroyed by the immune system before they cause sensitization.
  22. Guest

    Guest Guest

    "17. Old man with 3rd nerve lesion with normal pupillary reflex"

    Is it possible? the 3rd nerve controls both eye movement and pupil contraction, i.e, 3rd nerve palsy causes large pupil and pupil reflex will be affected as the result.
  23. guess

    guess Guest

    Toxic shcok syndrome is caused by EXOTOXIN but not endotoxin (which is usually released by E. Coli.)

    Would u let me know which organism can cause toxic shock syndrome?.
  24. Guest

    Guest Guest

    Q5) answer is defibnately schizophrenia as I found the question in the AMC book

    Q11) discussed with ppaediatric reg. MSU should mean a clean catch! If WCC 20 means only 20 cells that is not a strong hint for UTI. And as the child is already 2 yr, so a suprapubic aspiration is actually more difficult and they don't do them often in this age anymore! So their answer is D.

    Q14) discussed with paediatric registrar. The answer would be d as you really gotta think of sepsis here and react and treat quickly.
  25. Guest

    Guest Guest

    Some from the latest questions from Sep 2007 to discuss:

    20.) 8yr old giral doing well in school everything normal teachers are concerned becoz she mimics intercourse in the p-layground wen children around.cause?

    a)normal behaviour
    b)sexual abuse

    ANSWER B


    21.) a 3 yr child presented wid severe central abdominal pain.on palpation u find a hard mass just to the left of the umbilicus.wht is ur diagnosis

    a)neuroblastoma
    b)wilms tumor
    c)polycystic kidney

    difficult. would guess B but not sure, could also be a. Anyone knows how to clinically decide which one?


    22.) A researcher took 1000 neonates who had jaundice to study the demographics which he compared with 1000 neonates born on the same hospital who did not have jaundice and followed them to the prenatal period, this type of study is called:
    E) Case control study
    F) Cross sectional study
    G) Cohort study
    H) Prospective study.

    Not sure, my answer is E as I think I would see the study as an retrospective one.


    23.) Primi at 26 weeks gestation comes with abdominal pain: which is the best indicator that she will have a preterm delivery:
    A) Fetal Fibronectin level in cervix
    B) External os open, internal os closed on USG
    C) Cervix 3.8cm
    D) Effaced cervix

    My answer is A. But what does cervix 3.8cm stand for? is it the length than it is normal, is it dilation than the lady is in labour... what do you guys think?


    24.) 4 year old child with past 2 history of suppurative middle ear infection, now comes with another one, what is the most important step in the investigation
    A) PUS culture and gram staining
    B) CT head
    C) Antibiotics including fluclox, penicillin, gentamicin ?

    I think recurrent counts only if more than 3 episodes in 6 months. so my answer is A. but have not seen it done on the ward.


    25.) The least useful investigation to evaluate rhesus Isoimmunisation in a child is:
    A) Cord blood group
    B) Cord DCT
    C) Maternal blood indirect coomb’s test
    D) Paternal blood grop
    E) Kleihaur test

    If I think here about the child my answer is E. As this is for determination of how much Rh Ig necessary. And so protective for future children... or what do you think?


    26.) 8 year old boy who is academically and otherwise well at school, noticed to be interested in wearing the clothes of his single mother .. of lately he was also starting to buy the clothes of ladies to satisfy his desire. His mother is aware about it, but is not bothered, the character is typical of:

    A) Transvestism
    B) Voyeurism
    C) Transexuality
    D)

    My answer A. If there would have been transvestic fetishism I would have said that.



    Well, keep writing answers so we can discuss the questions guys! We are all able to look answers up but can you ever be sure about the right one? So I find it helpful to see what other people would have said!
  26. Guest

    Guest Guest

    My bad not tranfusions, i meant Replacement therapy of factor viii.... U are correct.
  27. Guest

    Guest Guest

    23.) Primi at 26 weeks gestation comes with abdominal pain: which is the best indicator that she will have a preterm delivery:

    The criteria for diagnosis are:
    (1) gestation < 36/40
    (2) uterine contractions every 5-10 mins, last for > 30 sec, persists for >60 mins
    (3) cervix > 2.5cm and more than 75% effaced

    fibrinectin has 100% negative predictive value and 35-50% positive predictive value. This means that if it's negative then patient is NOT in pre-term labour, and if it's positive then patient may / may not be in labour.

    As a result, I think the best and most reliable answer to this question is "vervical dilatation"
  28. Guest

    Guest Guest

    "Would u let me know which organism can cause toxic shock syndrome?."
    Staph, the problem is associated with tampon use (not pad).
  29. Guest

    Guest Guest

    14.) A neonate developed jaundice after discharge on the 2nd day, he is lethargic and has poor feeding, whats the best management?
    a. MSU
    b LFT
    c. phototherapy
    d. Rx as sepsis

    It's about neonatal jaundice. and it's also a common station in AMC's clinical examination.
    If jaundice starts at <24 hr of age: consider blood group incompatibility (Rhesus, ABO), G6PD, congenital infection (conjugated jaundice)
    If starts at 24 hr to 2 weeks: consider physiological jaundice, breast milk, jaundice, infection (UTI - unconjugated), haemolysis (G6PD, ABO incompatability)
    If > 2 weeks: physiological, breast milk, biliary atresia, UTI, hypothyroidism, G6PD
  30. Guest

    Guest Guest

    21.) a 3 yr child presented wid severe central abdominal pain.on palpation u find a hard mass just to the left of the umbilicus.wht is ur diagnosis

    a)neuroblastoma
    b)wilms tumor
    c)polycystic kidney

    A and B usually presented with painless abdo mass, but occasionally wilms can cause pain and haematuria. It seems this question is incomplete (something important missing here)
  31. Guest

    Guest Guest

    "25.) The least useful investigation to evaluate rhesus Isoimmunisation in a CHILD is: "

    This question is confusing - a common problem with the recall papers.
    Rhesus isoimmunisation occurs in mother with Rh -ve. If mother has developed anti-D in her body, then the next FETUS with Rh +ve is likely to develop anaemia, hydrops, growth restriction, pre-term labour or intrauterine death. So investigation and management should focus on the preganancy and fetus but not the child who has been born (after birth, the tests for the child mainly include direct coomb, grouping Hb and bililubin, and management is simple and straightforward)
  32. Guest

    Guest Guest

    Hi Samu, here the question you asked me:

    27.) HLA is done for transplantation in Australia. For which of the following is HLA assessment most commonly and widely used?
    a) Kidney transplant
    b) Liver transplant
    c) Brain transplant
    d) Heart transplant
    e) Lung transplant

    My guess is a), as it is a common transplant organ and HLA is used there. And as evidence that antigens of the HLA system provide the major barrier to acceptance of renal transplants...
    or does anyone know it better?
  33. Guest

    Guest Guest

    angelitainca, a close match of HLA improves outcome of renal transplant.
  34. Guest

    Guest Guest

    "5.) Losing of association is associated with
    a. schizophrenia
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia "

    Lossing of association = dissociation
    "Dissociation is the compartmentalisation of one's identity to avoid emotional distress", Dissociative disorders are "generally regarded as being among the post-traumatic syndromes, borderline personality disorder and some of the somatoform disorders"

    four core dissociative symptoms:
    (1) amnesia - people with dissociative disorders may have gaps in memory or a sense of having "lost time".
    (2) depersonalisation
    (3) derealisation (feels detached from the outside world)
    (4) identity confusion/alteration (the person lacks a coherent sense of who he/she is)
  35. Guest

    Guest Guest

    "4.) Lung abscesses can be caused by all except
    a. Staph
    b. Klebsiella
    c. Mycoplasma
    d. bacteroides fragilis
    e. Pneumocystis carinii "

    Pneumocystis carinii infection occurs in AIDS, and often has normal CXR.
  36. Guest

    Guest Guest

    "7.) Menopausal lady with progesterone containing OCP, no bleed for 3 months what would you do initially?
    a. USG to determine endometrial thickness
    b. endometrial biopsy
    c. increase the dosage of progesterone "

    I think something wrong with the recall.
    (1) A menopausal lady shouldn't take OCP but HRT if she has hot flushes and dryness

    (2) If the lady is young, then pregnancy test must be done to exclude pregnancy due to pill failure

    (3) If the lady is menopausal and she's on HRT, and she develops irregular PV bleeding, then she needs USG to measure endometrial thickness

    (4) If she just started HRT, then management depends on the type of HRT (continuous or cyclic)

    (5) If she's perimenosausal and just started OCP, then the dosage needs to be adjusted after a negative pregnancy test (of course, OCP may cause amenorrhoea).
  37. Guest

    Guest Guest

    “"5.) Losing of association is associated with
    a. schizophrenia
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia "

    Lossing of association = dissociation
    "Dissociation is the compartmentalisation of one's identity to avoid emotional distress", Dissociative disorders are "generally regarded as being among the post-traumatic syndromes, borderline personality disorder and some of the somatoform disorders"

    four core dissociative symptoms:
    (1) amnesia - people with dissociative disorders may have gaps in memory or a sense of having "lost time".
    (2) depersonalisation
    (3) derealisation (feels detached from the outside world)
    (4) identity confusion/alteration (the person lacks a coherent sense of who he/she is)”

    **Ok first of all I yhink the question is wrong. Its supposed to be “LOOSENING of association NOT LOSING”

    association is NOT = dissociation

    It is a disorder of thought
    A lack of logical connection between a the parts of a train of thought referred to as (knights move thinking – in chess).

    Refer…. Oxford Core Text - Psychiatry (second edition) page no. 9
  38. Guest

    Guest Guest

    28) A girl is rescued from a house fire, she was not burnt, but had respiratory distress and was coughing. O/E there is soot (carbon particles on her pharynx), the next immediate management involve:
    A) Endotracheal intubation
    B) Facial oxygen
    C) IVFluid
    D) Antibiotics

    My answer is A.
    BUT am a bit confused as I would say you need oxygen mask until intubation is ready - answer b).
    Indication for immediate intubation is as per up to date:
    stridor, coma, resp. distress, hypoxia, hypercap., deep burns on face and neck, blisters or oedema oropharynx. Other than immediate oxygen we need ABG and COHb and CXR as stat investigations.


    29) 3 year old boy from Greece, complains of abdominal distension, diarhoea and poor weight gain and anemia, O/E there is severe anaemia, vague abdominal distension, which of the following is diagnostic (The original History is more close to an celiac disease)
    A) Antigliadin antibody
    B) Small bowel biopsy
    C) Stool culture for rota virus

    Was confused as it is recommended if high chance of celiac disease (or child with failure to thrive and anaemia probably iron deficiency anaemia) to to serology AND biopsy. Antigliadin is no longer recommended as low sens. aand specif. and eg. many false positives. Now tests for IgEMA (endomysial) and IgAETG (transglutaminase).
    If low risk do serology of those markers and biopsy if positive.
    But i think in children diagnostic is biopsy AND responding to gluten free diet.
    So my answer is B.


    30) The commonest psychiatric problem in those living close to the air port is:

    A) Bipolar disorder
    B) Violent behaviour
    C) Schizophrenia
    D) Agarophobia
    E) Insomnia

    I can only think of answer E, but did not find any literature.


    31) Your patient recently revealed to you about her child hood sex abuse, and request you to give her your contact number so that she can contact you incase of emergency, You should.
    A) Give your personal mobile number
    B) Your clinic’s after hours number
    C) Give the contact number of the counsellors of the local area
    D) Refer her to psychiatry specialist
    E) Do not give any contact number

    Well, those ones always get me. But I would think that you have a resposibility of care and I would give her B.


    32) Your colleague asks for a prescription for Nitrazepam because he has some difficulty getting sleep related to anxiety of examns, You should
    A) Refer him to a specialist
    B) Give diazepam instead
    C) Give one week of Nitrazepam and review
    D) Inform the Department about his behaviour and ask them to review him

    Well, I don't think nitrazepam is a good choice as it is long acting. Usually we give the short acting ones like temazepam for sleeping. In this case i would do A). Or what would you do.


    33) Who is at highest risk of suicide (Male)
    A) Single male
    B) Married
    C) Divorced
    D) Homeless
    E) Widowed

    My answer is 1st D), as there is a reason with no support and
    second highest risk I think has the single man, than widowed, then seperated, then divorced, then married without children.


    34) A 70 year old lady comes for check up and you find that she has metastatic cancer and the son who is looking after this lady request you not to tell her about the cancer, You should:
    A) Information can not be hidden based on son’s request
    B) Ask him to discuss with other relative
    C) you have to act according to your judgement ????


    What do you think? my answer is A. But I am never sure with those ones... Or what is the appropiate thing to do in general?
  39. Guest

    Guest Guest

    32) Your colleague asks for a prescription for Nitrazepam because he has some difficulty getting sleep related to anxiety of examns, You should
    A) Refer him to a specialist
    B) Give diazepam instead
    C) Give one week of Nitrazepam and review
    D) Inform the Department about his behaviour and ask them to review him

    The answer should be E (get detailed history from your colleague and make an assessment, don't jump into any conclusion or prescribe)
  40. Guest

    Guest Guest

    33) Who is at highest risk of suicide (Male)
    A) Single male
    B) Married
    C) Divorced /// = single
    D) Homeless /// = no support
    E) Widowed /// = single

    I think this should be an EXCEPT question.
  41. Guest

    Guest Guest

    32) Your colleague asks for a prescription for Nitrazepam because he has some difficulty getting sleep related to anxiety of examns, You should
    D) Inform the Department about his behaviour and ask them to review him
    "The answer should be E (get detailed history from your colleague and make an assessment, don't jump into any conclusion or prescribe)"

    Do you really think you inform the department is the right answer? isn't there some breach of confidentiality too, as he came to you as a doctor?
    I don't know!


    One more question:
    35)Commonest cause for post operative bleeding, who received 13 units of blood during the surgery:
    A) Hypocalcemia
    B) DIC ?
    C) Thrombocytopenia
    D) Vitamin K def.

    I think it is B) DIC, Here is what I found in textbooks:
    As first of all acute DIC is a common and potentially serious complication of extensive surgery and trauma (which would be indicated here by the 13 units of blood); it is due to a release of tissue enzymes and or phospholipids from damaged tissue into the systemic circulation triggers activation of cytokine networks and the hemostatic system. And secondly massive transfusion also cause of DIC.
    ALTHOUGH there is also some dilution of platelets – 10-12 units can cause a 50% fall in platetlet count.
    Coagulopathy accompanying massive transfusion is multifactorial, including contributions from direct loss, consumption, and dilution of clotting factors and platelets; hypothermia as cool fluids are infused; and shock-related hepatic dysfunction leading to impaired clearance of activated coagulation factors and their breakdown products. Early studies implicated thrombocytopenia as being the predominant early consequence of massive transfusion, but more recent studies show that a coagulation factor deficit is the earlier derangement. Hypocalcemia can contribute to coagulopathy during truly massive transfusion (greater than 100 mL/min), but this is not often seen because citrate can be rapidly metabolized by the liver.
    Other source: Recalcitrant coagulopathy accounts for the majority of trauma deaths occurring within the first 24 h of hospitalization. Although the causes of coagulopathy are multifactorial, including coagulation abnormalities resembling disseminated intravascular coagulation, excessive fibrinolysis, hypothermia, and acidosis, dilutional coagulopathy as a result of massive transfusion is a significant contributor. Thrombocytopenia is the most common contributor to clotting abnormalities in the setting of massive transfusion (1980).
  42. samu

    samu Guest

    Liver HLAmtching not required
    Kidney at least compatibility of HLA
    cardiac blood type

    Probably, kidney.

    Thanks, guys.
  43. samu

    samu Guest

    One more question:
    35)Commonest cause for post operative bleeding, who received 13 units of blood during the surgery:
    A) Hypocalcemia
    B) DIC ?
    C) Thrombocytopenia
    D) Vitamin K def.

    Yes, B. I agree.

    A,C,D are also possbilly result in massive transufusion, but DIC is caused from mediatior so main cause(e.g. shock, luekemia, sepsis...)should be treated, so massive blood is needed.
  44. samu

    samu Guest

    32) Your colleague asks for a prescription for Nitrazepam because he has some difficulty getting sleep related to anxiety of examns, You should
    A) Refer him to a specialist
    B) Give diazepam instead
    C) Give one week of Nitrazepam and review
    D) Inform the Department about his behaviour and ask them to review him

    The answer should be E (get detailed history from your colleague and make an assessment, don't jump into any conclusion or prescribe)


    I don`t think E is the most realistic, I would choose A.
    but, it`s a ambiguous question.
  45. samu

    samu Guest

    Hi, a hard worker.


    Cool A girl is rescued from a house fire, she was not burnt, but had respiratory distress and was coughing. O/E there is soot (carbon particles on her pharynx), the next immediate management involve:


    A) Endotracheal intubation
    B) Facial oxygen
    C) IVFluid
    D) Antibiotics

    My answer is A.
    Possibly. I completely agree. In terms of medical test, we must choose A.
    In clinical situation, as you knew, we have to check many things before intubation, but patients with severe chemical injury don`t have enough time.

    29) 3 year old boy from Greece, complains of abdominal distension, diarhoea and poor weight gain and anemia, O/E there is severe anaemia, vague abdominal distension, which of the following is diagnostic (The original History is more close to an celiac disease)
    A) Antigliadin antibody
    B) Small bowel biopsy
    C) Stool culture for rota virus

    Was confused as it is recommended if high chance of celiac disease (or child with failure to thrive and anaemia probably iron deficiency anaemia) to to serology AND biopsy. Antigliadin is no longer recommended as low sens. aand specif. and eg. many false positives. Now tests for IgEMA (endomysial) and IgAETG (transglutaminase).
    If low risk do serology of those markers and biopsy if positive.
    But i think in children diagnostic is biopsy AND responding to gluten free diet.
    So my answer is B.

    I wanna ask you why you think it is celiac disease. In my country, there is little patient with celiac disease, so I have a little knowledge.
    There are other differential diagnosis, celiac sprue, lactose intolerance, disaccharide intolerance.



    31) Your patient recently revealed to you about her child hood sex abuse, and request you to give her your contact number so that she can contact you incase of emergency, You should.
    A) Give your personal mobile number
    B) Your clinic’s after hours number
    C) Give the contact number of the counsellors of the local area
    D) Refer her to psychiatry specialist
    E) Do not give any contact number

    Well, those ones always get me. But I would think that you have a resposibility of care and I would give her B.

    Really difficult one! I choose C. but what is emergency case for her?


    33) Who is at highest risk of suicide (Male)
    A) Single male
    B) Married
    C) Divorced
    D) Homeless
    E) Widowed

    My answer is 1st D), as there is a reason with no support and
    second highest risk I think has the single man, than widowed, then seperated, then divorced, then married without children.

    I choose E, but I`m not sure. D is incorrect, it seems to me, `cause they are usually tough. They are usually living without help support, at least, in
    my country. I cannot imgine D will suicide.
  46. samu

    samu Guest

    4.) Lung abscesses can be caused by all except
    a. Staph
    b. Klebsiella
    c. Mycoplasma
    d. bacteroides fragilis
    e. Pneumocystis carinii

    The answer is C. Sometimes pnemocystis carinii create a abcess.
    Please see Hariison.

    5.) Losing of association is associated with
    a. schizophrenia
    b. dissociative identity disorder
    c. bipolar disorder
    d.dementia

    I choose a?
    What do u think?
  47. Guest

    Guest Guest

    36) A patient with history of weakness of the right interrosseous muscle and small muscles of the right hand associated with paralysis and loss of reflex of brachioradialis; the biceps and triceps reflex are preserved the site of lesion:

    A) Radial nerve
    B) Anterior interrosei nerve
    C) Posterior interossei
    D) Ulnar
    E) Median nerve

    Don’t really get it. My answer would be D. :?:
    But am confused as interosseus and small muscles would be ulnar nerve. But brachioradialis reflex is radial nerve, or am I wrong??? Or then is answe C as this is a branch of the radial nerve?


    37) The nerve injured if the patient has inability to extend the foot with some sensory loss at the dorsum of foot on the lateral side: ankle and knee jerk normal
    A) Sciatic
    B) L5
    C) L4
    D) Sural
    E) Common peroneal nerve.

    Please correct me if I am wrong, aswer is E)?


    38.) A young man presented with severe head ache in the occipital region, visual disturbance on right side of short duration, and O/E there is neck stiffness. The diagnosis is:

    A) Atlanto-axial rotational dislocation
    B) Basilar artery infarction
    C) Meningioma

    My answer is A, can cause occipital headache and probably more likely than infarction and meningeoma in a young man. Although meningeoma age mean is 40-70yr and common visual field defects. I thought basilaris would have also common effects as changed level of conciousness and bulbar symptoms.
  48. Guest

    Guest Guest

    39) Cause for greenish discharge from one nipple:
    A) Duct ectasia
    B) Ductal Papilloma
    C) Fat necrosis
    D) Breast abscess

    My answer is B).
    Usually straw like –transparent dischareg but common cause for discharge. Abscess I would think has other sign descriped as erythema and…


    40) The most important step in the management of severely compound (open wound) fracture of tibia:
    A) Debridement
    B) Antibiotics
    C) Hyperbaric oxygen
    D) Rigid internal fixation
    E) External fixation

    I really don’t know. Importan is clean and keep sterile and immediate antibiotics, if not very severy debridement and closure in first 8hours. If not possible or severe open fracture keep it open with external fixation.
    So definitely antibiotics, but as always I think in the anmswers for wound debridement is very important. So my answer is A.
    What do you think? Anyone with surgical/orthopaedic experience?
  49. guess

    guess Guest

    39) Cause for greenish discharge from one nipple:
    A) Duct ectasia////
    B) Ductal Papilloma
    C) Fat necrosis
    D) Breast abscess

    My answer is B).
    Usually straw like –transparent dischareg but common cause for discharge. Abscess I would think has other sign descriped as erythema and…
  50. guess

    guess Guest

    40) The most important step in the management of severely compound (open wound) fracture of tibia:
    A) Debridement/////
    B) Antibiotics
    C) Hyperbaric oxygen
    D) Rigid internal fixation
    E) External fixation

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