AMC MCQ March 2006A QUESTIONS

Discussion in 'Australian Medical Council (AMC) EXAM' started by Guest, Jun 12, 2006.

  1. Guest

    Guest Guest

    Sorry for got to type the questions up. Here it is -

    1. Woman occasional finding on abdo CT, 1.5 cm adrenal tumor, no physical symptoms. What is the best management?

    a. Surgical removal
    b. Repeat CT in 6 months

    2. A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

    a. Biopsy of the muscle
    b. aerobic culture
    c. anaerobic culture
    d. x-ray of the site and looking for subcutaneous emphysema
    e. blood culture

    3. A young man comes back from Thailand with purulent urethral discharge and dysuria. After treating him for chlamydia what else should u give him.

    a. IM ceftriaxone
    b. Oral ampicillin
    c. Oral roxythromycin

    4. A middle aged lady with acute onset of jaundice and fever. O/E you can feel a mass in RUQ which moves up and down with breathing. Whats the most probable cause?

    a. gall bladder malignancy
    b. CBD stone
    c. liver abscess
    d. gallstone in gallbladder

    5. A young guy comes with mild jaundice and unspecific symptoms. On imaging evaluations you find liver granulomas. They are most likely associated with -

    a. sarcoidosis
    b. candidiasis
    c. liver amyloidosis
    d. crohn's dis.

    6. A patient with unilateral miosis and ptosis. Which one is the most likely cause?

    a. lung Ca
    b. fracture of base of the skull

    7. A lady who has been admitted for pneumonia has been found to have AF. In the lab data, TSH is normal, T4 is marginally raised but T3 is normal. Whats the best management?

    a. carbimazole
    b. radioimaging
    c. recheck TFT one month later

    8. A young man is presented with short stature and increased skin elasticity. Which of the following is the most likely to be associated with this condition?

    a. lens dislocation
    b. aortic regurgitation
    c. mental retardation

    9. A man with HT, Hx of smoking and alcohol abuse complains of the onset of palpitations since 4 hrs. PR 250. After carotid massage his pulse rate decreases. His most like ECG -

    a. Atrial flutter
    b. Mobitz1
    c. Torsades de Pointes
    d. AF

    10. An 80 yr.old lady with normal kidney function (lab data given) has AF and is 45 kg. You put her on digoxin 0.25mg bd. After 14 days she has nausea and vomiting. Like cause -

    a. gastric ca
    b. gastric ulcer
    c. brain infarct
    d. previous unknown renal impairment

    Comments with reference will be much appreciated

    Cheers
  2. faran

    faran Guest

    hi

    A 50 year old woman who had a CT scan abdomen. CT shows 1.5cm mass on the R) adrenal gland. Non symptomatic, no electrolyte imbalance. No hormonal imbalance. What do you do next?

    a) do MRI
    a) PET scan
    a) Biopsy
    a) Repeat CT in 6 months
    a) Ultrasound
    well i guess the answer is repeat ct in 6 months Small adrenal adenomas ( < 2 cm) usually are nonfunctional, produce no symptoms, and require no special treatment but should be kept under observation for growth or development of secretory function. http://www.merck.com/mrkshared/CVMH...word=disorders&domain=www.merck.com#hl_anchor

    Nonfunctional Adrenal Masses
    Space-occupying lesions of the adrenal glands that have no hormonal activity.

    Adrenal adenomas, detected by abdominal CT or MRI, are the most common of these masses. In newborns, spontaneous adrenal hemorrhage may produce large adrenal masses, simulating neuroblastoma or Wilms' tumor. In adults, bilateral massive adrenal hemorrhage may result from thromboembolic disease or coagulopathy. Benign adrenal cysts are observed in the elderly and may be due to cystic degeneration, vascular accidents, bacterial infections, or parasitic infestations (Echinococcus). The adrenals may become infected with tuberculosis organisms via the bloodstream, causing adrenal masses. Rare nonfunctional adrenal carcinoma produces a diffuse and infiltrating retroperitoneal process. The most common nonfunctioning adrenal mass in adults is an adenoma (55%), followed by metastatic tumors (30%). Cysts and lipomas make up most of the remainder.

    Symptoms, Signs, and Treatment
    Nonfunctional adrenal masses are usually found incidentally during tests conducted for other reasons. With any adrenal mass, adrenal insufficiency is rarely observed unless both glands are involved. Small adrenal adenomas ( < 2 cm) usually are nonfunctional, produce no symptoms, and require no special treatment but should be kept under observation for growth or development of secretory function. If metastatic disease is a possibility, fine-needle biopsy can be diagnostic. If the tumor is solid, of adrenal origin, and > 6 cm, it should be excised, because biopsy cannot always distinguish benign from malignant tumors. The major signs of bilateral massive adrenal hemorrhage are abdominal pain, falling Hct, signs of acute adrenal failure, and presence of suprarenal masses on CT or MRI. Tuberculosis of the adrenals may cause calcification and adrenal insufficiency (Addison's disease). Nonfunctional adrenal carcinoma usually manifests as metastatic disease and is not amenable to surgery, though mitotane may afford chemotherapeutic control when used in association with supportive exogenous corticosteroids.
  3. Guest

    Guest Guest

    Thanks FAran. I guess u r right. See my reference below from Harrisons -

    Evaluation of Asymptomatic Adrenal Masses

    With abdominal CT scanning, many incidental adrenal masses (so-called incidentalomas) are discovered. This is not surprising, since 10 to 20% of subjects at autopsy have adrenocortical adenomas. The first step in evaluating such patients is to determine whether the tumor is functioning by means of appropriate screening tests, e.g., measurement of 24-h urine catecholamines and metabolites and serum potassium and assessment of adrenal cortical function by dexamethasone-suppression testing. However, 90% of incidentalomas are nonfunctioning. If an extraadrenal malignancy is present, there is a 30 to 50% chance that the adrenal tumor is a metastasis. If the primary tumor is being treated and there are no other metastases, it is prudent to obtain a fine-needle aspirate of the adrenal mass to establish the diagnosis. In the absence of a known malignancy the next step is unclear. The probability of adrenal carcinoma is <0.01%, the vast majority of adrenal masses being benign adenomas. Features suggestive of malignancy include large size (a size > 4 to 6 cm suggests carcinoma); irregular margins; and inhomogeneity, soft tissue calcifications visible on CT (Fig. 321-8), and findings characteristic of malignancy on a chemical-shift MRI image. If surgery is not performed, a repeat CT scan should be obtained in 3 to 6 months. Fine-needle aspiration is not useful to distinguish between benign and malignant primary adrenal tumors (http://www.accessmedicine.com/content.aspx?aID=98598&searchStr=adrenal mass#98598)
  4. Guest

    Guest Guest

    1. Woman occasional finding on abdo CT, 1.5 cm adrenal tumor, no physical symptoms. What is the best management?

    a. Surgical removal
    b. Repeat CT in 6 months

    2. A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

    a. Biopsy of the muscle
    b. aerobic culture
    c. anaerobic culture
    d. x-ray of the site and looking for subcutaneous emphysema
    e. blood culture

    3. A young man comes back from Thailand with purulent urethral discharge and dysuria. After treating him for chlamydia what else should u give him.

    a. IM ceftriaxone
    b. Oral ampicillin
    c. Oral roxythromycin

    4. A middle aged lady with acute onset of jaundice and fever. O/E you can feel a mass in RUQ which moves up and down with breathing. Whats the most probable cause?

    a. gall bladder malignancy
    b. CBD stone
    c. liver abscess
    d. gallstone in gallbladder

    5. A young guy comes with mild jaundice and unspecific symptoms. On imaging evaluations you find liver granulomas. They are most likely associated with -

    a. sarcoidosis
    b. candidiasis
    c. liver amyloidosis
    d. crohn's dis.

    6. A patient with unilateral miosis and ptosis. Which one is the most likely cause?

    a. lung Ca (ONLY IF IT IS APICAL LOBE)
    b. fracture of base of the skull

    7. A lady who has been admitted for pneumonia has been found to have AF. In the lab data, TSH is normal, T4 is marginally raised but T3 is normal. Whats the best management?

    a. carbimazole
    b. radioimaging
    c. recheck TFT one month later

    8. A young man is presented with short stature and increased skin elasticity. Which of the following is the most likely to be associated with this condition?

    a. lens dislocation
    b. aortic regurgitation
    c. mental retardation

    9. A man with HT, Hx of smoking and alcohol abuse complains of the onset of palpitations since 4 hrs. PR 250. After carotid massage his pulse rate decreases. His most like ECG
    a. Atrial flutter
    b. Mobitz1
    c. Torsades de Pointes
    d. AF ( alcohol - the most common cause in men less than 60 years)

    10. An 80 yr.old lady with normal kidney function (lab data given) has AF and is 45 kg. You put her on digoxin 0.25mg bd. After 14 days she has nausea and vomiting. Like cause -

    a. gastric ca
    b. gastric ulcer
    c. brain infarct
    d. previous unknown renal impairment ( DIGITALIS TOXICITY)
  5. Guest

    Guest Guest

    Thanks Marounissa for your reply. Could you possibly tell give some explanation for Q.8?

    Cheers
  6. Guest

    Guest Guest

    question 8 is ehlers danlos syndrome and is associated with aortic regurgitation with dissection.


    Ehlers-Danos syndrome is a group of inherited disorders characterized by excessive looseness (laxity) of the joints, hyperelastic skin that is fragile and bruises easily, and/or easily damaged blood vessels. The syndrome sometimes involves rupture of internal organs. There are six major types that are characterized by distinctive features.

    Causes, incidence, and risk factors

    Ehlers-Danlos syndrome (EDS) can occur in different forms -- involving blood vessels, skin, and/or joints -- with a variety of different genetic defects as their cause. A variety of genetic mutations cause abnormality in collagen. Collagen provides structure and strength to connective tissue in skin, bone, blood vessels, and internal organs.

    Different forms of EDS have different modes of inheritance. Family history is a risk factor in some cases.

    Incidence is 1 in 400,000 in the USA.

    Symptoms

    Joint dislocation or subluxation
    Joint pain
    Increased joint mobility, joints popping, early arthritis
    Double-jointedness, flat feet
    Easily damaged, bruised, and stretchy skin
    Very soft and velvety skin
    Easy scarring and poor wound healing
    Premature rupture of membranes at birth
    Visual difficulties
    Signs and tests

    Examination by the health care provider may show:

    Excess joint laxity and joint hypermobility
    Soft, thin, or hyperextensible skin
    Mitral valve prolapse
    Periodontitis
    Signs of platelet aggregation failure (platelets do not clump together properly)
    Rupture of intestines, uterus, or eyeball (seen only in vascular EDS, which is rare)
    Deformed cornea
    Tests:

    Collagen typing (performed on a skin biopsy sample)
    Collagen gene mutation testing
    Lysyl hydroxylase or oxidase activity
    Echocardiogram (heart ultrasound)
    Treatment

    There is no specific cure for Ehlers-Danlos syndrome, so individual problems and symptoms must be evaluated and cared for appropriately. Frequently, physical therapy or evaluation by a physician specializing in rehabilitation medicine is needed
  7. Guest

    Guest Guest

    you are a legend Marounissa. Thanks heaps !!!
  8. Guest

    Guest Guest

    you are welcome.
    wish me luck for my exam.
  9. Guest

    Guest Guest

    when's ur exam?
  10. Guest

    Guest Guest

    my exam is on 14 of july, sydney.
  11. Guest

    Guest Guest

    alcohol induced arrythmia

    i think the correct answer is PSVT and it has perhaps been left out of the choices.
    Since the patient has palpitations it is a tachyarrhythmia (so bradyarrythnia like Mobitz 1 is not the cause). Since it responded to carotid massage it is most likely PSVT (in atrial flutter vagal maneuvers can help to unmask the flutter waves by enhancing the degree of AV block but are not therapeutic. Similarly carotid massage is not used in Atrial fibrillation)

    a heart rate of 250 is also against atrial fibrillation. (here the rate usually does not go beyond 170-180)
    Ectopic SVT may be seen in patients with acute MI, chronic lung disease, pneumonia, alcohol intoxication, and digoxin toxicity (where it is often associated with AV block and termed paroxysmal atrial tachycardia with block). Ectopic SVT usually originates in the atria, with an atrial rate of 100 to 250 beats/min (most commonly 140 to 200 beats/min;).
  12. Guest

    Guest Guest

    2. A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

    a. Biopsy of the muscle
    b. aerobic culture
    c. anaerobic culture
    d. x-ray of the site and looking for subcutaneous emphysema
    e. blood culture

    I think the ans is E. b/c exclusion.
  13. Guest

    Guest Guest

    I think the correct answer is PSVT and it has perhaps been left out of the choices.

    I agree with this as narrow complex tachcardia can only be relieved with the valsavul manouuvre, carotid massage.SO it is supraventricular tachycardia.
  14. guest-911

    guest-911 Guest

    are you in MM right now or whereabout ?

    what year U finished ?

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