1.
A 53-year old man books a
consultation with a GP. His main
complaint is a pain in the back. He
is worried about is work as he
thinks it would be difficult for him
to work as a carpenter.
Which of the following is the best
way of starting the consultation in
Australian general practice?
a. Tell me about the pain
b. Where is the pain?
c. Is the pain severe?
d. The pain is severe
e. You want to know the cause
of the pain?
Answer detail:
The correct answer is a.
The open-ended question is
essential in initiating the
interview.
A question such as ‘tell me about
the pain’ says to the patient ‘I’m
interested in anything you may
feel is important enough for you
to tell me’.
The open-ended question gives
the patient an opportunity to take
temporary control of the
consultation and to outline
problems and concerns.
Option b) is an example of ‘Direct
Question’. These questions are
useful in later part of the
consultation.
Option c) is an example of closed-
ended question.
Option d) is an example of a
leading question.
Option e) is an example of a
reflective question.
2. Cigarette smoking is associated
with several hazards if mother
smokes during pregnancy. Which
of the following is not a
complication related to smoking?
a. Premature rupture of
membranes
b. Abruption placental
c. Placenta previa
d. High rate of infant
respiratory distress
syndrome
e. Less likely to die of sudden
infant death syndrome
Answer detail:
The correct answer is e.
Cigarette smoking is a big health
hazard during pregnancy.
Maternal complications of smoking
during pregnancy include:
-Premature rupture of membrane.
-Placental abruption.
-Placenta previa.
-High abortion rate.
Fetal complications due to
maternal smoking during
pregnancy include high rate of
infant respiratory distress
syndrome, high rate of sudden
infant death syndrome and small
for gestational age.
3. A 33-year old woman is visiting
you in your primary care office as a
new patient. She is healthy
otherwise. Her mother was
diagnosed with colorectal cancer at
the age of 50.
When should this patient be
screened for colorectal cancer?
a. At the age of 40
b. At the age of 50
c. At the age of 60
d. At the age 30
e. There is no proven benefit
for colorectal cancer
screening
Answer detail:
The correct answer is a
Screening for bowel cancer should
begin approximately 10 years
before the age of diagnosis of
colorectal cancer in a first-degree
relatives like parent or sibling.
Given that this patient’s mother
was diagnosed at the age of 50,
this patient should have screening
at age 40.
The natural history of a colon
polyp to develop into cancer is
thought to be 10 years.
Colorectal cancer screening has
proven mortality benefit and it is
wrong to say that it has no proven
benefit.
4. Which of the following vaccine is
recommended to use during
pregnancy?
a. MMR
b. Varicella vaccine
c. Monovalent rubella vaccine
d. Yellow fever
e. Influenza vaccine
Answer detail:
The correct answer is e.
All of these (MMR, varicella
vaccine, monovalent rubella
vaccine and yellow fever) are live
attenuated vaccines and are
contraindicated in a pregnant
woman.
In general, live vaccine should not
be administered during
pregnancy, and women should be
advised not to become pregnant
within 4 weeks of receiving a live
vaccine.
Influenza vaccination is safe to
use in a pregnant woman.
5. A 45-year old man presented to
your clinic with a history of angina
pectoris. He develops chest pain on
mild exertion and is very compliant
with his medication. He has come
to your clinic for advice regarding
driving advice.
Which of the following is correct
according to medical fitness
requirements for driving license in
Australia?
a. He cannot have commercial
driving license
b. He is eligible for commercial
driving license
c. He is not eligible for private
license
d. He is unfit for driving for 6
months
e. He should be reviewed every
week before he goes out for
driving
Answer detail:
The correct answer is a.
Person with stable angina that is
well managed by medication and
does not cause any symptoms on
mild exertion can drive without
(private) license restriction and
notification to the driver licensing
authority yet subject to periodic
monitoring.
However, he cannot have a
commercial driving license while
he has a diagnosis of angina and
requires medication to help with
his symptoms. This patient
requires regular medication and
thus is not eligible to hold a
driving license for a commercial
vehicle.
6. A 48-year old man comes to your
clinic to discuss about his risk of
getting bowel cancer. He is
asymptomatic otherwise and has
no personal history of bowel
cancer, colorectal adenomas or
ulcerative colitis.
His mother died at the age of 80
with urosepsis and his father died
 of myocardial infraction at the age
of 59.
However his second cousin was
diagnosed of bowel cancer at the
age of 56.
What is most appropriate advice to
this patient?
a. FOBT every year starting at
the age of 50
b. FOBT every two years
starting at the age of 50
c. Urgent colonoscopy referral
d. Sigmoidoscopy
e. Colonoscopy now and then
every five year
Answer detail:
The correct answer is b.
If a patient is:
-asymptomatic
-no personal history of bowel
cancer, colorectal adenoma or
ulcerative colitis
-no confirmed family history of
colorectal cancer in first-degree
relative or second-degree relative
with colorectal cancer
Diagnosed at the age of 55 over.
Such person should have FOBT
every 2 years.
So this patient qualifies this
criteria and should have foecal
occult blood test every 2 years at
the age of 50.
Urgent colonoscopy referral is not
required at this stage.
Sigmoidoscopy is usually
combined with double contrast
barium enema to enhance the
usefulness in bowel cancer
screening. However this is not the
case here.
Colonoscopy every five years is
needed in patients who are at high
risk of getting colorectal cancer.
7. You are working as a GP and doing
Aboriginal and Torres Strait
Islander Adult Health Checks.
Which of the following is true
regarding screening for trachoma
in Australia?
a. In areas where trachoma is
endemic, Aboriginal and
Torres Strait Islander people
aged 40-54 years should be
screened every two years
b. In areas where trachoma is
endemic, Aboriginal and
Torres Strait Islander people
those aged above 55 years
should be screened every
two years
c. In areas where trachoma is
endemic, Aboriginal and
Torres Strait Islander people
aged 30-40 years should be
screened every year
d. No screening for trachoma
needed in aboriginal
population
e. Only ophthalmologist can do
trachoma screening as this is
eye disease
Answer detail:
The correct answer is a.
In areas where trachoma or
trichiasis is endemic, Aboriginal
and Torres Strait Islander people
aged 40 to 54 years should be
screened every 2 years and those
aged above 55 years should be
screened annually for trichiasis as
part of an adult health check.
Then identified patients with
trichiasis should be referred to an
eye specialist.
8. A 45-year old male presented to
your office for his 3-yearly fasting
blood sugar check which is normal.
He has blood pressure 110/80,
heart rate 89/min regular, oxygen
saturation is 98% on room air and
 respiratory rate 14/min. he is non-
smoker and non-alcoholic. What
would your advice him?
a. Fasting blood sugar every 10
years
b. Serum cholesterol
estimation every 5 years
c. Check serum B12 and red
cell folates
d. Check vitamin D level
e. Check blood pressure every
5 years
Answer detail:
The correct answer is b.
This patient is asymptomatic and
generally well.
In Australia, it is recommended to
check fasting blood glucose every
3 years for non-diabetic
individuals over the age of 40. So
this patient would need fasting
blood sugar tested in 3 years, not
10 years, even though his blood
sugar is normal now. Option a is
incorrect.
All adult over the aged of 45 and
over should have 5-yearly
estimation of serum cholesterol.
This is correct for this person
(option b).
Checking vitamin D level and
vitamin B12 and red cell folates is
not recommended as a part of
general health screen in y
Young people before the age of
60. These should only be
requested if patient is at high risk
for these deficiencies.
Blood pressure should be recorded
every 1-2 years on all people 16
years and over. So option e is
incorrect.
9. A 40-year old male truck driver
comes to your office with his wife
for assessment. His wife is worried
about him as he snores every night
so loud that they sleep in the
separate room. He feels sleep all
day and reports falling asleep while
waiting at traffic signals.
On examination, his blood pressure
is 140/90mmHg. His BMI is 46.
You advise him to no to drive the
truck until a sleep physician
completes the further assessment.
He is declining to do that as he
does not want to lose his job.
What will you do next?
a. Explain him about the
danger of driving associated
with his condition
b. Tell him to surrender his
driving license now
c. Prescribe modafinil
d. Inform local driving licensing
authority
e. Advice to lose weight as this
will reduce the risk of
accidents
Answer detail:
The correct answer is d
This patient has developed clinical
features of narcolepsy and
possible obstructive sleep apnea.
He is legally not allowed to drive
until further assessment by sleep
physician is completed and
compliance is recorded.
As this patient is declining to see
the sleep physician and is not
ready to stop driving, it is medical
practitioner’s moral obligation to
notify the local driving licensing
authority.
Narcolepsy is present in 0.05% of
the population and usually starts
in the second or third decade of
life 26 sufferers present with
excessive sleepiness and can have
periods of sleep with little or no
warning of sleep onset. Other
symptoms include cataplexy, sleep
paralysis and vivid hypnagogic
hallucinations.
Diagnosis of narcolepsy is made
on the combination of clinical
features, and multiple sleep
latency test (MSLT) with
diagnostic sleep study on the prior
night to exclude other sleep
disorder and aid interpretation of
MSLT.
They should have a review at least
annually by their specialist.
Those with narcolepsy perform
worse on simulated driving tasks
and are more likely to have
accidents than control subjects.
A conditional commercial license
may be granted by the driving
licensing authority, taking into
account the opinion of a specialist
in sleep disorder, and the nature
of the driving task and subject to
periodic (at least annual) review,
after the following requirement
are met.
Patient should be made aware of
the effect of their condition on
driving and should be advised of
their legal obligation to notify the
driver licensing authority where
driving is likely to be affected. The
practitioner may themselves
advise the driving licensing
authority as the situation
requires.
10.A junior doctor in the hospital had
a needle stick injury while setting
up the line for intravenous fluids.
The patient status for hepatitis B is
unknown. The recipient has no
history of previous hepatitis B
vaccination.
The blood test of the recipient
came back positive for HbsAg.
What will you do next for the
recipient?
a. Give immunoglobulin
b. Give hepatitis B vaccine and
immunoglobulin
c. Counselling and follow up
d. Lamivudine
e. Give hepatitis B vaccine
Answer detail:
The correct answer is c.
This health care worker had the
needle stick injury and blood test
came back positive for hepatitis B
surface antigen.
This health care worker should be
counseled about the result and
should have followed-up testing at
three months and six months. If
the blood test remain positive for
hepatitis surface antigen beyond
six months, refer the patient to a
hepatologist.
Lamivudine is an antiviral drug
that can be used for the treatment
of chronic active hepatitis
however it is not used for the
treatment of acute hepatitis B.
As this recipient has already
developed hepatitis B infection
already from needle stick injury,
the role of vaccine and
immunoglobulins is limited.
11.You are working as a resident in a
hospital. One of your colleagues is
intoxicated with alcohol before
starting morning ward round.
a. Notify medical board
b. Ask him not to drink alcohol
in future
c. Notify nurse unit manager
d. Notify chief executive officer
of the hospital
e. Take hand over from him
and tell him to go home
Answer detail:
The correct answer is a.
Intoxication by alcohol or drugs
while practicing or training in
profession constitutes misconduct.
This essentially notifiable to the
medical board.
12.A 39-year old lady presented with
a second episode of seizure within
one week. An EEG confirmed the
diagnosis of epilepsy. She has been
started on carbamazepine.
She asked you when she can
drive?
a. Within 12 months after
review
b. Within 4 weeks
c. She cannot drive as long as
she is on carbamazepine
d. She can drive as long as she
is on carbamazepine
e. Call the police and notify
them to cancel her license
Answer detail:
The correct answer is a.
If a patient has been diagnosed
with epilepsy for the first time, a
conditional license may be
considered by the driver licensing
authority subject to at least
annual review in 12 months,
taking into account information
provided by the treating doctor as
to whether the following criteria
are met:
1-the person has been treated for
at least 6 months.
2-there have been no seizures in
the preceding six months
3-if any seizures occurred after
the start of treatment, they
happened only in the first 6
months after starting treatment
and not in the last 6 months.
4-the person follows medical
advice, including adherence to
medication.
It is the responsibility of the
driving license holder to notify the
police about the conditions
applied due to medical illness.
13.A 22-year-old university student
presents for HIV checkup as she
had unsafe sex with her new
boyfriend not known to have HIV 2
days ago. You performed the test
and report comes back negative.
What will be the next step?
a. Call the police to arrest the
unknown person
b. Liase on with local council to
trace the unknown person
c. Perform HIV test in 12
weeks
d. Start her on ciprofloxacin for
14 days
e. Reassure her that everything
is fine
Answer detail:
The correct answer is c.
It takes up to 12 weeks before
HIV is detected in the blood. This
is called the window period.
If someone has unsafe sex, it is
required to wait for 12 weeks
before a test can reliably confirm
or rule out HIV infection.
During this time patient need to
practice safe sex and avoid blood
donation.
Contacting police or local council
is not required. Starting her on
ciprofloxacin is not required.
Ceftriaxone and azithromycin may
be needed if Chlamydia
trachomatus and Nesseria
gonorrhea infection is suspected.
Patient should also be tested for
hepatitis B and hepatitis C
infection.
If any of the test comes back
positive, partner should be traced
and tested for sexually
transmitted infections as well.
14. A 55-year old man presented for
evaluation of his oral cavity. He is
heavy smoker and heavy drinker.
He also chews tobacco and lives
alone. Previous advice to change
life style has failed. Examination of
oral cavity is negative for any ulcer
or lesions.
a. Refer him to dentist
b. Follow up in 12 months
c. Follow up in 24 months
d. Discharge from the clinic
e. Inform him to see you if
develops in problem in next
3 months
Answer detail:
The correct answer is b.
A person who is elder than 50
years of age and his heavy smoker
and heavy drinker is at risk for
developing cancer of the oral
cavity.
Even though clinical examination
is normal, it is recommended to
organize examination of the oral
cavity every 12 months. So option
b is correct.
All other options are incorrect.
15. Which of the following is the
ommonest cause of allergy in
children in Australia?
a. Food allergy
b. Seasonal allergy
c. Pollen allergy
d. Insect venom
e. Medication
Answer detail:
The correct answer is a.
In Australia, food allergy is the
commonest cause of allergic
reactions in children is responsible
for about 80 percent of
anaphylactic reactions in which
the cause has been identified.
It should be noted that drugs are
the most common cause of
anaphylaxis overall including
children and adults.
In adults, foods are implicated in
only 20-30% of cases of allergy.
16. A 60-year old male has been
recently diagnosed with type II
diabetes mellitus and his blood
sugar came under control with
change in diet and exercise. He is
a commercial driver and is keen to
know if he can drive his vehicle on
highways.
What is the most appropriate
advice?
a. No restriction for driving
applies
b. Conditional driving license
with annual review
c. Conditional driving license
with 6-monthly review
d. Conditional driving license
with 2-yearly review
e. Unfit for driving until
reviewed by endocrinologist
Answer detail:
The correct answer is a.
Patients diagnosed with type II
diabetes mellitus, controlled on
diet has no restriction on driving
commercial as well as private
vehicles.
Patients diagnosed with diabetes
mellitus managed with insulin
may obtain a conditional driving
license subject to annual or 2-
yearly review
Review by endocrinologist is not
require for fitness to drive in
diabetes.
17. A 44-year-old women returned
from India 3 weeks ago. She has
been feeling nausea, vomiting,
mild abdominal pain and diarrhea.
Stool microscopy and culture
confirmed human roundworm
infestation.
Which ONE of the following is first
line option for treatment?
a. Pyrantel
b. Mebendazole
c. Albendazole
d. Ivermectin
e. Metronidazole
Answer detail:
The correct answer is a.
This patient has clinical features
consistent with Ascaris
lumbricoids infestation. Patient
usually reports the symptoms of
infestation and diagnosis is
confirmed finding eggs in the
feces
Patient may develop respiratory
tract symptoms or gastrointestinal
symptoms and may notice
roundworms when they emerge
from anus.
First line option is Pyrantel at a
single dose or repeat it after 7
days in cases of heavy infestation.
Albendazole and Mebendazole are
first line options to treat
hookworm (ankylostomiasis)
infestation. Ivermectin is used to
treat human threadworm
(strongyloides) infestations.
Metronidazole is used for
treatment of amebiasis.
18. A 14-year-old male attended your
clinic with his mother. The child
has history
of allergy to yeast and asthma.
Mother wanted her son be
vaccinated for human papilloma
virus infections before becoming
sexually active.
What will be the most appropriate
advice?
a. HPV vaccine cannot be given
now due to history of
asthma
b. HPV vaccine cannot be given
due to history of yeast
allergy
c. HPV vaccine can be given as
he is not sexually active yet
d. Consider this issue on next
appointment
e. Refer this case to infectious
disease specialist
Answer detail:
The correct answer is b.
A child should not be given HPV if
he/she has history of yeast
allergy. Also HPV vaccine should
be avoided in pregnancy, in people
with bleeding disorders and in
cases of anaphylaxis to the
vaccine or any of the vaccine
ingredients.
19. An 82-year-old woman visited you
for the first time in your clinic after
the death of her husband. She
never saw a doctor in last 20
years. There is no documented
medical history. She is mildly
depressed however she is coping
well otherwise/ physical
examination is normal.
What will you offer at your clinic on
this visit?
a. Pap smear
b. Mammography
 c. Bone scan
d. Blood pressure
measurement
e. Urine microscopy and
culture
Answer detail:
The correct answer is d.
This patient is an elderly and has
been reluctant to visit a doctor for
20 years. The first step is build
rapport with the patient and doing
a very thorough examination
(especially checking blood
pressure). This is key in building
therapeutic relationship with the
patient.
Once a good rapport is build,
options of mammography and pap
smears should be discussed.
Recommended age for both Pap
smear and mammography is up to
70 years however this patient may
choose to have these on later
appointment.
Also the risk of cardiovascular
disease increases with age and,
risk of cervical and breast cancer
does not increase after the age of
70 years, all screening test for
cervical and breast malignancy are
recommended up to the age of 70
year. All screening test for cervical
and breast malignancy are
recommended up to the age of 70.
Bone scan is not a screening test
is not required u8ntil she is found
to have fracture. Urine
examination is not required as she
is asymptomatic.
20. A 25-year old male has been
admitted to mental health ward
under involuntary treatment order
for psychosis. On physical
examination, he is found to have
5cmx5cm ulcer on the plantar
surface of the left foot.
Debridement and wound wash is
required along with intravenous
antibiotics as initial step to treat
this wound.
How will you proceed regarding
consent?
a. No consent required as
patient is already involuntary
b. Take consent from the
treating psychiatrist
c. take consent from the patient
d. Contact the family of the
patient for informed consent
e. Apply to the mental health
tribunal for consent to debride the
wound
Answer detail:
The correct answer is c.
Patients who are subject to an
involuntary treatment under
mental health act(Australia), may
still have capacity to give consent
or decline consent for a specific
healthcare matter not related to
their mental illness (for example
the use of antibiotics for chest
infection, or surgical procedure on
the limb).
An assessment of the patient’s
capacity to make decisions about
health care for a specific matter is
undertaken in the usual way and
documented appropriately.
If patient lacks capacity to give
consent for health care for a
condition unrelated to mental
illness, the consent of the
substitute decision maker is
required enabling them to be
treated for that condition outside
the mental health act.
Involuntary treatment order only
applies to mental treatment.
For any other medical condition,
consent should be sought from the
patient. Most mental health
patients can give consent for any
medical treatment if they have
capacity.
21. A 40-year old woman comes to
your office for advice. Her mother
had MI a few years ago, and her
father has a history of
hypercholesterolemia and is on
statins.
Her blood pressure is
150/90mmHg, fasting cholesterol
is seven mmol/l, HDL is 1.0mmol/l,
and fasting blood glucose is 5.6.
She is a non-smoker.
What would you do next?
a. Review in 3 months
b. Advice healthy diet
c. Regular exercise
d. Calculate absolute
cardiovascular risk factor for five
years
e. Start with simvastatin and
review in 6months
Answer detail:
The correct answer is d.
This patient’s clinical information
should be used to calculate the
risk of cardiovascular disease in
next five years.
Absolute cardiovascular disease
risk is the statistical probability of
a cardiovascular event occurring
within a five-year period. It
reflects a person’s overall risk of
developing cardiovascular disease
(CVD) replacing the traditional
method that considers various risk
factors, such as high cholesterol
or high blood pressure, in
isolation.
Clinical decisions based on
absolute CVD risk improve health
outcomes by identifying people
most at risk and directing them to
the right treatment.
The Australia absolute risk
calculator combines several risk
factor to calculate a risk score
(expressed as a percentage),
which is a person’s chance of
having a CVD event such as a
heart attack or stroke in the next
five years.
22. A 30-year old woman is concerned
about breast cancer has her
mother was diagnosed with breast
cancer at the age of 48. Clinical
examination of the breast is
normal.
What is the most appropriate
advice for her?
a. Mammography every year
from the age of 40
b. Mammography every 2 years
from age of 50-69
c. Refer to surgeon
d. Refer for genetic studies
e. Reassure her that she is not
at high risk of breast cancer
Answer detail:
The correct answer is a.
If a woman has a first degree
relative less than 50 years of age
diagnosed with breast cancer, she
should have mammography every
year from the age of 40.
All other options are incorrect.
23. A 25-year-old male presented for
review in your office. His father
was diagnosed with colon cancer at
the age of 35 and his uncle was
diagnosed with colon cancer at the
age of 50. His baseline
investigations including fasting
blood glucose, full blood count,
renal function tests, liver function
tests and iron studies are all
normal.
What will you advise him?
 a. Foecal occult blood test every
6 months
b. Colonoscopy now
c. Colonoscopy every year
d. Colonoscopy every 3 years
e. No further action required
Answer detail:
The correct answer is b.
This patient has one first-degree
relative with a history of colon
cancer at the age of 35 and
another second-degree relative
has a history of colon cancer at
the age of 50. His risk of
developing bowel cancer is
moderately high and he should
have a colonoscopy 10 years
before the onset of colorectal
cancer in his father. So he should
have a colonoscopy now.
According to Cancer Council
Australia guidelines, Individuals
can be placed in one of three
categories of relative risk and
based on their family history.
Category 1 — those at or slightly
above average risk:
This covers about 98 percent of
the population. People fit into this
category if there is:
-No personal history of colorectal
cancer, colorectal adenomas or
chronic inflammatory bowel
disease and no confirmed close
family history of colorectal cancer;
or
-One first-degree (parent, sibling,
child) or second-degree (aunt,
uncle, niece, nephew,
grandparent, grandchild) relative
with colorectal cancer diagnosed
at age 55 or older; or
-Two relatives diagnosed with
bowel cancer at age 55 or older
but on different sides of the
family.
Screening guidelines for this
category include:
-FOBT is recommended at least
every two years for all people over
the age of 50. A full examination
of the large bowel, preferably by
colonoscopy, is recommended in
those shown to have a positive
FOBT. If eligible, participation in
the national bowel cancer
screening program should be
recommended. For those not
eligible for the national program,
advice on access to FOBT is
available from The Cancer Council
Helpline.
-Consider sigmoidoscopy
(preferably flexible) every five
years from the age of 50.
Category 2 — those at moderately
increased risk:
This covers one to two percent of
the population.
People fit into this category if
there is:
-One first-degree relative with
colorectal cancer diagnosed
before the age of 55 (without
potentially high-risk features as in
category 3); or
-Two first or one first and one
second-degree relative/s on the
same side of the family with
colorectal cancer diagnosed at any
age (without potentially high-risk
features as in category 3).
Screening guidelines:
-Offer colonoscopy every five
years starting at 50 or at an age
10 years younger than the age of
the first diagnosis of colorectal
cancer in the family, whichever
comes first.
-Flexible sigmoidoscopy plus
double-contrast barium enema or
CT colonography may be offered if
colonoscopy is contraindicated for
some reason.
-Consider offering FOBT in the
intervening years. Patients should
be informed that a positive test
will require further investigation.
Category 3 — those at potentially
high risk:
This covers less than one percent
of the population.
People fit into this category if
there are:
-Three or more first-degree
relatives or a combination of first
and second-degree relatives on
the same side of the family
diagnosed with colorectal cancer,
or
-Two or more first or second-
degree relatives on the same side
of the family diagnosed with
colorectal cancer plus any of the
following high-risk features:
1- Multiple colorectal cancers in a
family member.
2- Colorectal cancer before the
age of 50 years.
3- A hereditary non-polyposis
colorectal cancer (HNPCC} related
cancer (endometnai, ovarian,
stomach, small bowel, renal pelvis
or ureter, biliary tract, brain
cancer): or
- At least one first-degree or
second-degree relative with a
large number of adenomas
throughout the large bowel
[suspected familial adenomatous
polyposis (FAP)]; or
-Member of a family in which a
gene mutation that confers a high
risk of bowel cancer has been
identified.
Screening guidelines:
-Consider referral to a familial
cancer service for further risk
assessment and possibly genetic
testing.
-Refer to a bowel cancer specialist
to plan appropriate surveillance
and management. This may
include:
Familial Adenomatous Polyposis:
Flexible sigmoidoscopy yearly or
second-yearly, starting from age
12-15 years until polyposis
develops, then prophylactic
surgery. If family genetic testing
is inconclusive and no polyposis
develops, sigmoidoscopy reduced
to every 3 years after the age of
35, then change to population
screening if examinations normal
to age 55. Prophylactic surgery,
e.g. restorative proctocolectomy,
is appropriate for those with
proven FAR.
HNPCC:
Colonoscopy every one to two
years from age 25, or five years
earlier than the youngest
diagnosis in the family (whichever
comes first). FOBT may be offered
in alternate years or to subjects
unwilling to accept colonoscopy.
There are options for surveillance
at other sites, usually starting
from age 25-35. Prophylactic
surgery may be appropriate for
some.
24. Which of the following would
increase the risk of breast cancer
in post-menopausal women?
a. Hypertension
b. Hyperlipidemia
c. Obesity
d. Breastfeeding up to six
months
e. Physical activity for 30
minutes daily
Answer detail:
The correct answer is c.
Obesity is a risk factor for the
development of breast cancer in
post-menopausal women.
Hyperlipidemia and Hypertension,
both are not related to the
increased likelihood of breast
cancer.
Exclusive breastfeeding for up to 6
months and active lifestyle
decreases the risk of breast
cancer development.
25. A 15-year-old girl comes to your
office with a history of unwanted
sexual intercourse last night. She
lives with her same age friend at a
shelter accommodation. You have
offered her emergency
contraception and explained her
about STIs (sexually transmitted
infections) in details.
What will you do next?
a. Referral to sexual assault
counsellor
b. Inform child protection
services
c. Inform parents
d. Notify police
e. Reassure
Answer detail:
The correct answer is a.
This patient is a 15-year-old girl
who is living with her same age
friend at a shelter
accommodation. She is at high
risk of being sexually assaulted.
As she lives independently, so
there is no need to involve child
protection services.
However, she should be treated as
a minor with the capacity to make
decisions.
She should have a forensic
examination by an appropriately
qualified trained doctor. She
should be offered emergency
contraception and STI checks. She
should be given prophylaxis for
STIs as well.
She will need to have follow-up at
2, 6, and 12 weeks following STI
checks.
26. You are working in a surgical ward
where a nurse reports to have
needle-stick injury while putting a
new cannula. Patient is HBsAg
negative and is unlikely to be in
window period as noted from
history.
The nurse is not sure of her
hepatitis B immunization status.
What should be next step in this
situation?
a. No further follow up needed
b. Give hepatitis B
immunoglobulins and hepatitis B
vaccine
c. Organize full course of
hepatitis immunization
d. Report the incidence to
infectious disease specialist
e. Do blood test to check HBsAg
status in three months
Answer detail:
The correct answer is c.
If the source is HBsAg-negative,
and unlikely to be in the window
period, no further follow-up
testing is required of source or
health care worker (health care
worker should be sure of her
hepatitis immunization status).
However this nurse should have
full HBV immunization as she is
not sure of her immunization
status. It should be commenced
as soon as possible, preferably
within 24 hours.
Hepatitis B immunoglobulins are
not indicated in this situation.
Reporting the incidence to team
leader or supervisor is encouraged
however involving infectious
disease specialist is not required.
Follow HBsAg testing again within
3 months is needed if source is
hepatitis B positive.
27. A 52-year-old man, otherwise
healthy, comes to your clinic
concerned about his family history
of prostate cancer.
His father was diagnosed with
prostate cancer at the age of 75
and a friend was diagnosed with
the condition recently.
He is worried he might get prostate
cancer.
On digital rectal examination, his
prostate was smooth, soft and no
other abnormality noted.
What would you do next?
a. Prostate specific antigen level
after 2 weeks
b. Ultrasound
c. Annual rectal exam
d. Reassurance
e. Prostate biopsy
Answer detail:
The correct answer is a.
This patient is worried about his
family history of prostate cancer.
Also, his age falls him the
moderate risk category for
prostate cancer.
He should have the digital rectal
exam and then he need to have
prostate specific antigen level
checked. He should be explained
about the outcome of elevated
PSA as well.
If the prostate specific antigen is
checked after rectal examination
for prostate, there is a possibility
of acute elevation in PSA level. So
after the digital rectal exam, PSA
should be checked after 2 weeks.
28. A 49-year-old married male is
brought to the emergency
department with internal bleeding
from injuries sustained in a motor
vehicle crash.
The patient has been stabilized but
requires a blood transfusion to
replace lost blood and to prepare
for surgery.
When approached to consent for
the transfusion, the patient
refuses, stating that it is forbidden
by his religion. The attending
physician calls for a psychiatric
consult. The psychiatry fellow on
call proceeds to the emergency
room.
Which of the following is the most
appropriate first step in evaluating
this patient?
a. Assess the patient's decision-
making capacity to refuse the
transfusion
b. Call the patient's wife to take
consent for transfusion
c. Consult guardianship court
for consent
d. Order the transfusion against
the patient's wishes
 e. Talk to the patient about
blood substitutes and ask him if he
would consider
accepting one
Answer detail:
The correct answer is a.
According to Australian law any
person who is an adult and has
decision-making capacity, the
doctor should respect his /her
beliefs and should not intervene to
impose treatment.
As the here patient is refusing a
life-saving intervention, the first
important thing is to assess his
decision-making capacity that
includes understanding,
appreciation and reasoning.
Once the decision-making capacity
is evaluated, then we will discuss
other blood substitutes like
hemacil and other intravenous
fluids to save his life.
The doctor cannot transfuse
against patient’s wishes as it is
considered as an assault on their
physical, religious and emotional
feelings.
However, this rule does not apply
to children who need an urgent
transfusion, and their parents are
against transfusion even they
belong to Jehovah's witnesses.
The wife cannot give consent here
unless the patient is unconscious
or lack the capacity to make a
decision and she has power of
attorney or advance directives in
favor of transfusion.
Guardianship court is consulted
when the patient is unable to
make his decision like being
unconscious and he is holding no
power of attorney or advance
directive, and there is a conflict
between family members of the
patient and doctor regarding
intervention.
29. A young woman with family history
of Huntington disease is keen to
know the chances of inheritance of
the disease in her children. She
appears normal with no abnormal
movements. What is the likelihood
of genetic transmission of
Huntington's disease in her case?
a. No chance of transmission
b. 25%
c. 50%
d. 75%
e. 100%
Answer detail:
The correct answer is c.
Huntington disease is caused by
expansion of the cytosine-
adenine-guanine (CAG)
trinucleotide repeats in the HTT
gene located on chromosome
4p16.3 called HD gene. Expansion
of the CAG repeat number over
successive generations causes an
earlier and more severe
phenotype, termed anticipation.
Huntington's disease is inherited
in an autosomal dominant fashion.
The probability of each offspring
inheriting an affected gene is
50%. Inheritance is independent
of gender, and the phenotype does
not skip generations. A child born
to a person who carries the
Huntington's disease gene has a
50 per cent chance of inheriting
the gene and developing the
disease.
If a child does not inherit the HD
gene, he or she will not develop
the disease and cannot pass it to
subsequent generations.A person
who inherits the HD gene, and
survives long enough, will sooner
or later develop the disease.
So in this situation, the risk of
transmission of Huntington's
disease would be 50%. She is
young and without symptoms
however she may develop
symptoms latter in her life. So it
would be the duty of care to offer
her genetic testing to confirm her
inheritance of disease.
30. A 13-year-old girl presented to
your clinic for health check-up. She
disclosed she had unwanted sex
last night. She does not live with
her parents and is sexually active.
What will you do next?
a. Report police
b. Report to the parents
c. Visit shelter
d. Report to child protection
agency
e. Review in 2 days
Answer detail:
The correct answer is d.
Child sexual abuse occurs when a
child has been exposed or
subjected to sexual behaviors that
are exploitative and/or
inappropriate to his/her age and
developmental level.
Examples include sexual
penetration, inappropriate
touching, and exposure to sexual
acts or pornographic materials, or
using the internet for soliciting
children for sexual exploitation.
In practice, all reports are made
to the Department for Child
Protection's Mandatory Reporting
Service. They can be contacting
anytime of the day or week.
31. A mother requests you to organize
hysterectomy for her daughter
with developmental disability.
Daughter is 18-year old and she
cannot give the consent herself
due to intellectual disability.
How will you proceed?
a. Refer to a gynaecologist
b. Obtain a court order
c. Try to convince her that she
should not proceed with this
d. You tell her that you cannot
help her
e. Mother's consent is valid as
she is her guardian
Answer detail:
The correct answer is b.
In circumstances where a young
person with an intellectual
disability, is incapable of giving
consent, a procedure such as,
sterilization, cannot be carried out
lawfully without the authority of
Family court or Guardianship
board in Australia.
Parents cannot consent for this
special medical procedure. So
obtain a court order before putting
a referral to gynecologist.
32. Which of the following 'cancer risk'
is not increased in obesity?
a. Hepatocellular cancer
b. Breast cancer in post-
menopausal women
c. Colorectal cancer
d. Esophageal cancer
e. Renal cell cancer
Answer detail:
The correct answer is a.
There is convincing evidence that
overweight and obesity are risk
factors for following cancers:
-Colorectal cancer
-Renal cell carcinoma
-Pancreas cancer
-Cancer of oesophagus
-Endometrium and breast (in post-
menopausal women)
-Gallbladder cancer.

There is no evidence that obesity
increase the risk of liver cancer. It
is worth noting that excess body
fat probably decreases the risk of
pre-menopausal breast cancer.
33. A mother brings her 9-month old
child, generally healthy, for BCG
vaccination. The family belongs to
India and have been living is
Australia for 2 years. There is no
history of active tuberculosis in the
family. You performed the
tuberculin test which showed
induration of 10 mm in 72 hours.
What is the next best step?
a. Give BCG vaccine now u
b. Repeat tuberculin test in
three week time
c. Give BCG vaccine in a week
time
d. Refer to Immunologist u
e. Inform the mother that BCG
should be avoided in this situation
Answer detail:
The correct answer is e.
A tuberculin test should be
performed prior to BCG
vaccination in all individuals over
6 months of age. It takes about
48-72 hour to show the reaction.
It is not a good test to diagnose
TB.
If area of induration is:
A-Less than 5mm-no tuberculosis.
B-5-10mm-typical of past BCG
vaccination.
C-More than 5mm is significant if
patient is immunocompromised.
D-More than 10mm-positive for
either positive or latent
tuberculosis.
E-More than 15mm-highly
significant for normal people and
shows active tuberculosis.
The BCG vaccine should be given if
the induration is less than 5mm.
Do not give BCG if induration is
more than 5 mm. This child will
need a chest X-ray and further
assessment of tuberculosis.
34. A 32-year-old woman comes to
your clinic for advice regarding
screening. She has history of
gestational diabetes during
pregnancy 2 years ago. Her blood
sugar was normal 6 months ago.
Her grandfather died of myocardial
infarction at the age of 80 years.
Her sister has been diagnosed with
diabetes mellitus at the age of 45.
What will you advise her?
a. Serum cholesterol every 5
years
b. Fasting blood glucose every 3
years
c. Colonoscopy every year
d. Exercise tolerance test every
year
e. FOBT every year
Answer detail:
The correct answer is b.
Fasting blood glucose every 3
years, should be considered at any
age in following high risk groups.
1- All people with a history of
previous cardiovascular event
including acute myocardial
infarction and stroke.
2- All the women with a history of
gestational diabetes mellitus.
3- Women with polycystic ovary
syndrome.
4- Those on antipsychotic drugs.
5- Those with impaired glucose
tolerance test.
This woman fall in this high risk
category and so does need fasting
blood glucose test once every 3
years to make early diagnosis of
diabetes mellitus.
A patient without any family
history of colorectal cancer and
personal history of ulcerative
colitis and colon cancer should
have FOBT at least every two
years after the age of 50.
All adults aged 45 and over should
have 5 yearly check of serum
cholesterol for screening of
hypercholesterolemia.
35. You find one of your colleagues,
prescribing antipsychotics for himself.
What is the most appropriate
action that you will consider?
a. Advice your colleague against
self-prescribing
b. Report to the department
head
c. Report to the medical board
d. Do nothing as it is his
personal affair
e. Write an incident report
Answer detail:
The correct answer is c.
Self-prescription of anti-psychotic
medication by a doctor means
your colleague is either treating
psychosis or bipolar disorder by
himself.
This may be assumed that he/she
might have impaired judgement
because of psychosis.
So it is obligation to report the
matter to medical board of
Australia for safety of both the
patients and the doctor.
The board then will initiate an
inquiry.
Even a doctor is not allowed to re-
prescribe to himself an anti-
psychotic medication which might
have been already prescribed by
psychiatrist even.
36. A 45-year-old woman is concerned
about her risk of getting melanoma
as one of her cousin was recently
diagnosed with melanoma. She has
fair complexion and has developed
multiple dysplastic nevi on arms
and legs. She also had history of
multiple episodes of sunburn in her
childhood.
Which ONE of the following would
make her the highest risk for
developing malignant melanoma?
a. Diagnosis of melanoma in
cousin
b. Fair complexion
c. Multiple dysplastic nevus
d. Multiple episodes of sunburn
in childhood
e. All of the above
Answer detail:
The correct answer is c.
The presence of multiple
dysplastic nevi in this patient puts
her at high risk (6 times normal)
of developing malignant
melanoma in future.
All other features (fair
complexion, diagnosis of
melanoma in second degree
relative, multiple episodes of sun
burn in childhood) increase the
risk of developing malignant
melanoma between 2-5 times
normal.
37. Which of the following is not a
symptom of nicotine dependence?
a. Smoking immediately after
waking up
b. Smoking when ill
 c. Difficulty stopping smoking
d. Finding the first cigarette of
the day the most difficult to give up
e. Smoking more in the
afternoon than in the morning
Answer detail:
The correct answer is e.
Characteristics of smokers with
nicotine dependence include:
1. Smoking soon after waking up.
2. Smoking when ill.
3. Difficulty stopping smoking.
4. Finding the first cigarette of the
day the most difficult to give up.
5. Smoking more in the morning
than in the afternoon.
So e is correct response here.
38. Which one of the following helps in
prevention of sleeping sickness?
a. Avoid areas with tsetse files
b. Vaccine
c. Careful with drinking water
d. Antibiotics
e. Pentamidine
Answer detail:
The correct answer is a.
Human African trypanosomiasis
also known as sleeping sickness,
is caused by protozoan parasites
transmitted via the bite of a tsetse
fly.
There are 2 major methods to
prevent transmission of
trypanosomiasis:
-Vector control-avoiding areas
with tsetse flies.
-Surveillance and early treatment
of identified cases.
Pentamidine is used in the
treatment of trypanosomiasis
(sleeping sickness).There is no
vaccine available for human
African trypanosomiasis
39. An 85-year-old female is
admitted to hospital with a history
of pulmonary fibrosis and chronic
respiratory failure on a Saturday
evening.
She was initially assessed in the
emergency department and was
found to be minimally
responsive. However, after an
hour or so she became
combative and was confused
and distressed. She was
sedated.
At about midnight, she was
moved to a respiratory ward.
You are the attending doctor
and considering her irreversible
condition, you plan to sign her
acute resuscitation plan for NFR
(not for resuscitation).
This patient has no advance
health directive signed. Her only
next of kin available in the
hospital is her daughter to
communicate.
Which one of the following is
correct regarding this situation?
a. It is purely a clinical
decision to decide about not for
resuscitation considering
her terminal illness
b. Consent is not needed to
with-hold or withdraw a life-
sustaining measure, when
providing that treatment would
be inconsistent with good
medical practice
c. Consent to health care
cannot be obtained from a substitute
decision maker on behalf
of the patient like her daughter
d. Consider to make a
decision by involving one of the
relatives who could
consent or object to" as further
intervention was
medically futile”
e. A family member
experiencing anticipatory grief is
unlikely to be a good
decision maker about a dying patient
Answer detail:
The correct answer is d.

In this situation decision to
with-hold futile treatment should
be made after discussion with
the daughter.
It is an offence under the
Guardianship and Administration
Act 2000 to carry out
health care (including the
withholding of
health care) without obtaining
consent.
Consent is needed to withhold
or withdraw a life-sustaining
measure, even if providing that
treatment would be
inconsistent with good
medical practice.
If the patient does not have
an advance health directive,
consent to health care must
be obtained from a substitute
decision maker on behalf of
the patient (GAA, s. 66).
In this case, consent from
patient's daughters is required
before not-for-
resuscitation order could be
made.
It is possible that a family
member experiencing
anticipatory grief is likely
not to be good decision maker
about a dying
patient however it is legal
requirement to involve and
consent from family
member before signing off any
not-for-
resuscitation order.
40. A 50-year-old male presents
with family history of abdominal
aortic aneurysm. He is otherwise
fit and health man with no other
symptoms. Cardiovascular
examination is unremarkable.
What will be your next step in
management?
a. Aortic ultrasound
b. CT anglogram
c. MRI scan
d. No action needed until
he is above 65
e. Refer to vascular
surgeon
Answer detail:
The correct answer is a.
Physical examination is less
accurate and has low
sensitivity for the detection of
abdominal aortic aneurysm
(AAA).
It is recommended to perform
a screening aortic ultrasound
for detection of AAA in
asymptomatic patients with
family history of AAA before
age of 55 in men and 60 in
women.
Aortic ultrasound should be
used for screening of AAA
after age of 65 in men and
over 70 in women without
family history of AAA.
Ultrasound is very accurate in
detecting an AAA. There is no
regular screening program for
AM in Australia yet.
41. A 24-year-old male presented to
your office for evaluation. He was
bitten by another person in a cafe
at night. The infectious status of
the victim is unknown. You have
ordered blood tests for HIV, HCV
and HBV. However, the patient
declined to be tested for HCV and
HIV, however, is happy to be
tested for HBV.
You are contacted by the GP
of the other person next
morning. The GP wanted to
 know if you have requested
the blood tests to check for
blood borne diseases. The
victim is unwilling to give
consent for testing his
hepatitis C and HIV.
What will you do next?
a. Get the public health
unit force victim to give her
consent
b. Ask the GP to treat the
biter prophylacticaly
c. Order the laboratory to
perform the test without
patient’s knowledge.
d. Do nothing assuming
victim is not carrying hepatitis
C and HIV virus
e. Ask the biter to contact
the victim and request and
convince him to give
consent for testing.
Answer detail:
The correct answer is b.
This patient was bitten on the
arm by an individual and the
biter was exposed to the
victim's blood.
The GP of the biter contacted
you to add on hepatitis C and
HIV test as well to know the
status of the source (victim).
Ideally, the victim should be
consoled about the possibility
of transmission of blood
borne viral infections (HBV,
HCV, HIV) from the victim to
the biter.
Extensive counselling should
be done and information
should be provided in detail
about the possibility of
positive HIV test and post-
exposure prophylaxis for the
biter.
However, testing for HIV and
HCV is not mandatory in
Australia and this patient
cannot be forced to undergo
blood tests.
In this situation, source
(victim) should be considered
unknown and biter should
receive post-exposure
prophylaxis anti-HIV
medication by his GP along
with blood tests for HIV, HBV,
HCV and regular follow up.
Ideally post-exposure
prophylaxis for HIV in high-
risk patients (where the
source is unknown) without
waiting for the blood test
result as soon as possible
(not later than 72 hours).
42.A 56-year-old man presents
to your clinic for advice about
Quitting smoking. He has a
history of depression.
Which of the following is the
best option you can offer him
to help quitting
a. Varenicline
b. Bupropion
c. Nicotine replacement
therapy
d. Nortriptyline
e. No medication needed
Answer detail:
The correct answer is b.
Varenicline is a nicotine
partial agonist.lt can cause
neuropsychiatric adverse
effects and people taking
varenicline should be
monitored for unusual mood
changes, depression,
behaviour disturbance and
suicidal thoughts.
Bupropion is a non-nicotine
oral therapy with similar
efficacy to nicotine
replacement therapy in aiding
smoking cessation. It is
effective for smokers with
depression, cardiac or
respiratory diseases, and also
to improve short-term
abstinence rates for people
with schizophrenia.
Nicotine replacement therapy
and nortriptyline are second
line options for smoking
cessation.
43. A 60 year-old male visited
your clinic for routine medical
checkup. He smokes 45
cigarettes per day, drinks
alcohol 10 standard drinks
per day and his body mass
index is 32.He wears seat-
belt 60 percent of the times
when he drives. He is
motivated to follow life style
modification advice. Which of
the following is the most
significant advice for
prevention of cardiovascular
disease and premature death
in this patient?
a. Quit smoking
b. Reduce alcohol intake
c. Wear seat-belt every
time
d. Reduce weight
e. Regular exercise
Answer detail:
The correct answer is a.
Smoking is strongly
associated with high risk of
cardiovascular disease.
Quitting smoking is
considered the most effective
lifestyle interventions for
preventing cardiovascular
disease and premature
deaths. ln a patient with
coronary heart disease,
smoking cessation is
associated with a 36 percent
reduction in the risk of all-
cause mortality. Wearing a
properly adjusted seat belt
reduces the risk of mortality
by 50 percent. However this
mortality is related to trauma
and severe injuries and is not
due to cardiovascular disease.
Also advise the patient to
reduce alcohol intake to a
maximum of two standard
drinks per day and have at
least two alcohol-free days
per week. If patient is female,
she should take up to one
standard drink per day with
two alcohol-free days per
week. Blood pressure and
body weight have direct
association with each other.
One percent reduction in
weight lowers systolic blood
pressure by 1mmHg.The
benefits of weight reduction’s
include decrease in insulin
resistance and improvement
in hyperlipidaemia. Regular
exercise increases high-
density lipoprotein
cholesterol and reduces body
weight. This in turn reduce
insulin resistance and
systemic vascular resistance.
Regular exercise has an
independent cardio-protective
activity.
44. A young female intern
accidentally pricked herself
with the needle while taking
blood sample from an HIV
positive patient.
What would be the most
appropriate next step?
a. Give antiretroviral drugs
for 4 weeks
b. Test both patient and
doctor for HIV viral load now
 c. Do not allow doctor to
draw blood for 3 months
d. Give her intravenous
immunoglobulins
e. Educate her that risk of
disease transmission is very
low
Answer detail:
The correct answer is a.
In the situation of needle
stick injury and exposure to
an HIV positive person, post-
exposure HIV prophylaxis is
recommended.
Provision of post exposure
prophylaxis should not be
delayed while establishing
the source status. Early
initiation of post-exposure
prophylaxis (PEP), as soon as
possible after exposure, is
strongly recommended. PEP
should not be offered more
than 72 hours after exposure.
A 28-day course of PEP is
recommended. This health
care worker should have
follow-up HIV antibody
testing at baseline, 6 weeks
and 3 months, and up to 6
months, along with tests for
other blood-borne viruses as
above.
Recommendations for
occupational post-exposure
prophylaxis include a basic
regimen of two
nucleoside/nucleotide reverse
transcriptase inhibitors for
most HIV exposures, and an
expanded regimen with the
addition of a third drug when
the exposure poses an
increased risk for
transmission.
Examples of antiretroviral
drug combinations include
(lamivudine+zidovudine), or
(emtricitabine+tenofovir).
45. A 48-year-old woman comes
to your office to discuss
about breast cancer. Her
friend has been recently
diagnosed with breast cancer.
She has no family history of
breast cancer and she has no
personal risk factors for
breast cancer. She has no
lump found in breasts on
clinical examination.
What is the most appropriate
management?
a. Refer her to breast
screening now
b. Consider a 6 monthly
clinical review
c. Do yearly ultrasound
d. Teach how to do self-
breast examination
e. Commence 2-yearly
mammogram from her age of
50
Answer detail:
The correct answer is e.
This woman is not at high risk
for developing breast cancer
and her examination is
unremarkable. She should
have mammography, every 2
years from age 50 to 69
years.
All other options are
incorrect.
46. A 7-year-old female child is
seen in your office for
unusual behavior. She
displayed sexual behavior
with neighbor kids. This child
is living with her foster
mother as her own mother
has been divorced.
What will you do next?

a. Notify child protection
services
b. Get psychiatric
evaluation
c. Send a blood test for
HIV
d. Chase collateral
information about the family
structure
e. Notify hospital
administration
Answer detail:
The correct answer is a.
If a child is displaying sexual
behavior inappropriate for
her/his age, there is high
suspicion of child sexual
abuse. So immediately notify
the child protection services
and they will follow the case.
All other options are incorrect
as next step however would
be required after notification
to the child protection
services.
47. A medical student sustained
needle stick injury while
getting intravenous access of
a patient. The student is not
immunized for the hepatitis
B. The hepatitis B status of
the patient is unknown.
What is the most appropriate
management?
a. Immunoglobulins
b. Immunoglobulins and
hepatitis B vaccine
c. Hepatitis B vaccine
d. Request serology and
wait for the result before
commencing the vaccine
e. Reassure and consulting
regarding safe occupational
practice
Answer detail:
The correct answer is b.
This medical student had
needle stick injury and needs
post-exposure prophylaxis
according to guidelines. The
exposed person is not immune
to hepatitis B.
So he should be given a single
dose of hepatitis B
immunoglobulin and three
doses of hepatitis B vaccine
over six months.
Also, the status of the source
and exposed person should be
followed up by requesting full
hepatitis B serology.
However, if the exposed
person has previously been
vaccinated for hepatitis B, and
had a blood test documenting
a response to the vaccine,
then no treatment is
necessary.
All other options are incorrect.
48. A 47-year-old woman
arranges a lengthy
consultation with her GP. She
complains of marital discord
with her husband due to her
low sex drive. She has a lot
of things to discuss with the
GP. During the consultation,
the GP uses the sentences
like, "I'm listening', 'I
understand what you are
saying' or 'Go on' at
appropriate times.
Which of the following
interviewing techniques, the
GP is using?
a. Confrontation
b. Open-ended Question
c. Closed-ended Question
d. Facilitation
e. Summarising

Answer detail:
The correct answer is d.
Facilitation encourages
communication by using
manner, gesture or words that
do not specify the kind of
information that is being
sought. It suggests that the
doctor is interested and
encourages the patient to
continue. Silence and
facilitation go hand in hand.
Option a) is incorrect as the
technique of confrontation is
used whereby the interviewer
describes to the patient
something striking about his
or her verbal or non-verbal
behavior when the patient is
not speaking freely or clearly
Examples are: You look sad',
You seem frightened' etc.
Option b) is incorrect.
Option c) is incorrect.
Option e) is incorrect.
Summarizing what the patient
has said can keep the patient
on track and help you to check
the accuracy of the
information by providing the
patient with the opportunity
to revise any
misunderstandings, e.g., 'If
I've understood you correctly
you have told me.
49. A young female presented
with dysuria, vaginal
discharge and post-coital
bleeding. She was diagnosed
with chlamydia. She was
happy to get her own
treatment however she
refused to tell her husband.
What will you do in this
situation?
a. Tell her husband
b. Tell her husband GP
c. Do nothing
d. Notify the department of
health
e. Tell her husband once
she leaves
Answer detail:
The correct answer is d.
Chlamydia is a notifiable
disease and it must be
reported to the department of
health within 5 days of
diagnosis.
It is legal requirement to
protect the public from harm.
The department of health
team will devise a method to
contact possible contacts.
Reassure patient that
confidentiality will be
maintained by using the name
code during contact tracing.
50. A 35-year-old woman
presented to your office for
breast cancer screening as
one of her maternal aunts
was diagnosed with breast
and ovarian cancer at the age
of 40.
What will you advise her?
a. 2 yearly mammography
b. 2 yearly ultrasound
c. Genetic risk screening
d. BRCA gene screening
e. 6 monthly self-breast
examinations
Answer detail:
The correct answer is d.
This patient is at high risk for
both breast and ovarian
cancer due to positive family
history (second degree
relative) of breast and ovarian
cancer.
Two genes, BRCA1 and BRCA2,
are known to dramatically
increase a woman’s risk of
developing breast cancer and
ovarian cancer in her lifetime.
Only 5-10% of those breast
cancers are caused by an
inherited genetic mutation.
The same gene can put women
at a higher risk of ovarian
cancer as well.
Genetic counseling for BRCA1
and BRCA2 mutations can tell
a woman whether she is at
increased risk for these
Cancers.
BRCA gene screening is
indicated in following
situations:
1- High numbers of family
members with cancer
diagnoses (especially breast
and ovarian) throughout
several generations, either
maternal or paternal.
2- Family member diagnosed
with cancer before age 50.
3- Family members who have
been diagnosed with multiple
cancers (for example, breast
and ovarian).
4- Male breast cancers, or
clustering of other cancers
such as colon, prostate,
stomach or pancreatic.
51. A 17-year-old male attended
your clinic with his girlfriend.
His girlfriend wanted him
vaccinated against human
papilloma virus before
becoming sexually active.
What would be the most
appropriate advice?
a. HPV vaccine not
indicated for males
b. Give him vaccine 2
years after he has been
sexually active c. Give
him HPV vaccine now
d. Male of 12-13 year of
age is only eligible for HPV
vaccine
e. Advise condoms as that
is the only way of preventing
HPV infection
Answer detail:
The correct answer is c.
Human papilloma causes
cervical cancer in women and
is transmitted through sexual
activity. A vaccine called
Gardasil has been developed
that protects against the two
high-risk HPV types (types 16
and 18), which cause 70% of
cervical cancers in women and
90% of all HPV-related
cancers in men.
It also protects against two
low-risk HPV types (types 6
and 11), which cause 90% of
genital warts.
All boys and girls aged 12-13
years should have the HPV
vaccine. The vaccine is most
effective at this stage, before
sexual activity has
commenced and when the
body produces more
antibodies.
However if a male presents to
GP for HPV vaccination before
starting sexual activity, a
general practitioner can
prescribe this vaccine in girls
before age of 26 and in boys
before age of 21.
All other options are not
correct
52. You are a GP in a rural area,
and you are actively involved
in bowel cancer screening of
your patients.
What of the following
statement is false about
bowel cancer screening?
a. An asymptomatic 48-
year old man with no family
history of colorectal
cancer does not need a
screening for colorectal
cancer
b. A 55-year old man with
no family should have a
faecal occult blood test
(FOTB) every two years
c. A 55-year old man with
one first-degree relative with
colorectal cancer diagnosed
at 60 years should have a
faecal occult blood test
(FOTB) now and every two
years
d. A 50-year old man with
one first-degree relative with
colorectal cancer diagnosed
at 52 years should have a
colonoscopy now and every
five years
e. A 35-year old man with
one first-degree relative with
colorectal cancer diagnosed
at 52 years should have a
colonoscopy now and every
five years
Answer detail:
The correct answer is e.
He should have a colonoscopy
every five years from 42 years
of age (10 years younger than
the age of the first diagnosis
of colorectal cancer in the
family.
Screening using a faecal
occult blood test (FORT) is
one of the most efficient ways
to reduce the risk of dying
from bowel cancer.
The FOBT can detect blood
from pre-cancerous polyps or
early stage bowel cancer.
When identified early, 90% of
bowel cancer cases can be
successfully treated.
Bowel cancer screening
(FOBT) is recommended every
two years from age 50-75
years and could be continued
beyond 75 years depending on
individual circumstance.
If there is no personal history
of bowel cancer, colorectal
adenomas, inflammatory
bowel disease or family
history of bowel cancer or one
first-degree or second-degree
relative with CRC diagnosed
aged above 55 years, the
patient would be at low
average risk of developing
bowel cancer and two yearly
FOBT should be continued.
If an asymptomatic patient
with has one first-degree
relative with bowel cancer
diagnosed aged below 55
years or two first-degree or
one first-degree and one
second-degree relative(s) on
the same side of the family
with bowel cancer diagnosed
at any age, then the patient
would need colonoscopy from
the age of 50 or at an age 10
years younger than the age of
first diagnosis of CRC in the
family, whichever comes first.
53. A 33-year-old Australian
female presented with her six
month old unvaccinated child.
She has read in the
newspaper that vaccines are
not safe and she planned to
 discuss the matter with you.
After discussion and
understanding the
significance of vaccines, she
decided not to get her child
vaccinated. What is the most
appropriate step you would
consider in this situation?
a. Call the child protection
services
b. Notify the police to
arrest her and present before
the court c. Inform the
local community council
d. Respect her decision
e. Apply for guardianship
for the child
Answer detail:
The correct answer is d.
Vaccination is not compulsory
in Australia a parent decides
not to get a child vaccinated,
it should be respected.in this
situation doctor has informed
her about benefits and risks
associated with vaccines and
she understands everything.
So final decision should be
made by the parents or single
parent to get their childi-
3cciriated or not. Involvement
of child protection services or
police is not required.
54. Which of the following
statement regarding smoking
in Australia is not true?
a. Smoking is responsible
for 20 percent all cancer
deaths
b. Macular degeneration
has no association with
smoking
c. Indigenous Australians
were 2.2 times as likely as
non- Indigenous
Australians to smoke tobacco
d. Successfully quitting
smoking can result in an
increase in life expectancy
of up to 10 years, if it occurs
early enough
e. Smoking soon after
waking is an indicator of
nicotine dependence
Answer detail:
The correct answer is b.
Smoking is responsible for
about 20% of all cancer
deaths in Australia. Macular
degeneration has a strong
association with smoking.
Indigenous Australians are 2.2
times more likely to smoke
tobacco as compared to non-
indigenous Australians.
There is a strong evidence
that quitting smoking in early
life increases life expectancy
of up to 10 years. Nicotine
dependence is present when a
smoker smokes a cigarette
immediately on waking up as
first thing.
55. A woman had recently
undergone a pap smear.
Which of the following types
of preventions she is involved
with?
a. Incidental prevention
b. Secondary prevention
c. Primary prevention
d. Tertiary prevention
e. None of the above
Answer detail:
The correct answer is b.
Secondary prevention includes
actions taken to stop or delay
the progression of the
disease.
The term is usually applied to
measures for the detection of
disease at its earliest stage,
i.e. in the presymptomatic
phase, so that treatment can
be started before irreversible
pathology is present.
The early recognition of
hypertension through routine
testing (screening) of patients
allows treatment during the
presymptomatic phase of the
illness process
Examples include a pap smear,
mammography and endoscopy
for polyps of the large bowel.
Primary prevention includes
action taken to avert the
occurrence of disease.
Tertiary prevention includes
the management of
established disease so as to
minimize disability.
56. In a regular General
Practitioner consultation in
Australia, which of the
following is an example of a
communication barrier with
the patient?
a. Short length of waiting
time
b. Good record system
c. An adequately lit room
d. A receptive demeanor of
the doctor
e. A Long desk in between
the physician and the patient
Answer detail:
The correct answer is e.
Effective communication
depends on four interrelated
factors concerning the
message—the doctor (the
sender), the patient (the
recipient), the message itself
and the environment in which
the message is sent.
There are some barriers in the
communications such as long
length of waiting time, sense
of urgency in the doctor, a
poorly lit room, a long desk in
between the physician and the
patient, a poor record system.
57. In Australia, shared care
model of care is used for care
and management of pregnant
women. Antenatal care is a
major component of care in
General Practice.
Which of the following is true
regarding antenatal
investigations in pregnancy?
a. Syphilis serology should
be performed only on those
at risk b. Hepatitis E
antibody level should be
carried out on all women
c. A glucose tolerance test
should be conducted on all
pregnant women in early
pregnancy
d. Screening for risk of
Down syndrome should be
offered to all pregnant
women
e. Performing a Pap test in
pregnancy is contraindicated
Answer detail:
The correct answer is a.
Syphilis serology is performed
on all pregnant women.
Option b is wrong as Hepatitis
E screening is not routinely
done.
Option c is wrong as glucose
tolerance test is offered
between 24-28 weeks of
pregnancy.
Option e is incorrect as Pap
smear can be done in
pregnancy up to 28 weeks of
gestation. However it is
usually recommended to have
pap smear after delivery if it
is not urgent.
58. Elder Abuse is common in
Australia. Which of the
following is likely to be the
most common cause of elder
abuse?
a. Weakening of the
decision-making capacity of
the elderly person
b. Financial dependence
c. Caregiver degree of
stress
d. Medical condition in the
elderly patient
e. Social isolation
Answer detail:
The correct answer is c.
Although, all of the above are
potential risk factors for elder
abuse but among these, the
most common cause of elder
abuse is the degree of the
stress of the career.
The stress of elder care can
lead to mental and physical
health problems that make
caregivers burned out,
impatient, and more
susceptible to neglecting or
lashing out at the elders in
their care.
Even caregivers in
institutional settings can
experience stress at levels
that lead to elder abuse.
Nursing home staff may be
prone to elder abuse if they
lack training, have too many
responsibilities, are unsuited
to caregiving, or work under
poor conditions.
Among caregivers, significant
risk factors for elder abuse
are:
- Inability to cope with stress
(lack of resilience).
- Depression, which is
common among caregivers.
- Lack of support from other
potential caregivers.
- The caregiver's perception
that taking care of the elder is
burdensome and without
psychological reward.
- Substance abuse.
59. The free National Human
Papillomavirus (HPV)
Vaccination was introduced in
2007 in Australia.
What of the following
statement about HPV
Vaccination in Australia is
false?
a. All eligible girls should
be encouraged to HPV
Vaccination in the first
year of high school
b. All eligible boys should
be encouraged to HPV
Vaccination in the first
year of high school
c. An HPV vaccinated
woman does not need
cervical cytology screening
d. HIV is not a
contraindication for HPV
Vaccination
e. HPV types 16 and 18 are
associated with cervical
cancer
Answer detail:
The correct answer is c.
Participation in the Human
Papilloma Virus (HPV)
Vaccination Program is
encouraged in all eligible boys
and girls in the first year of
high school.

The HPV vaccine is provided
free in schools to all males
and females aged 12-13 years
under the National HPV
Vaccination Program.
Current cervical cytology
screening recommendations
remain unchanged and should
be followed regardless of the
HPV vaccination status.
The presence of
immunosuppression, either
medically or in patients with
HIV infection, is not a
contraindication for Gardasil®
or Cervarix®. However, the
immune response may be
smaller in the
immunocompromised patient
than in immunocompetent
patients.
HPV types 16 and 18 are
associated with cervical
cancer.
60. Domestic violence has shown
an increasing trend in
Australia. Nearly, 17% of
women aged 18 years and
over had experienced
violence by a partner.
Why may an abused woman
remain in an abusive
relationship?
a. She is financially
dependent on her partner
b. She loves her partner
and fears what will happen to
the partner if she leaves
c. Her cultural or religious
beliefs prohibit her from
leaving
d. Because of fear of
reprisals or counter charges
from their partner
e. All of the above
Answer detail:
The correct answer is e.
As per the guidelines, abused
women are usually
constrained from leaving
home by some factors. This
include:
- Fear of reprisals- many
women are subjected to
threats of injury and violence
to themselves or their children
if they leave. Approximately
40-45% of women killed by
their spouse are separated or
in the process of separating.
- Social isolation- several
social factors contribute to
why women feel they cannot
leave; having dependent
children, being deliberately
isolated from friends and
family by the perpetrator, and
shame relating to injuries.
- Financial dependence women
do not have equivalent
earning capacity to men. To
leave their partner condemns
many women, and their
children, to a substantial
decline in their standard of
living.
- Emotional dependence and
fear - many abused women are
committed to their
relationship, love their partner
and are hoping for a change in
the relationship. Some abused
women are fearful that their
partner will not cope with a
separation and the partner
may be threatening to suicide
if she leaves.
- Poor self-esteem- after years
of physical violence and verbal
abuse, many victims lose their
self-confidence and doubt
their ability to cope on their
own.
61. In Australia, which of the
following behaviors does not
constitute domestic/family
violence?
a. Slapping and hitting
b. Sexual intercourse
against the will amongst
married couple c.
constant arguing without an
imbalance of power in the
relationship
d. Stalking
e. Withholding money
finances
Answer detail:
The correct answer is c.
Constant arguing without an
imbalance of power in the
relationship is not considered
a domestic violence in family
relationships.
The forms of domestic
violence include all of the
other given options:
-Sexual intercourse against
the will amongst the married
couple.
-Slapping and hitting.
-Stalking.
-Withholding money/finances.
62. A 30-year-old woman comes
to your clinic for advice
regarding screening. She is
asymptomatic. Her mother
and elder sister both were
diagnosed with colorectal
cancer at the age of 48. Her
father died at the age of 60
due to myocardial infarction.
Her grandfather was
diagnosed with prostate
cancer at the age of 70. What
will you recommend her?
a. 2-yearly colonoscopy
from now
b. Mammography every
year
c. Send her for genetic
studies
d. Check blood sugar now
e. Request fasting lipids
Answer detail:
The correct answer is a.
Currently in Australia, it is
recommended to have 2-
yearly colonoscopy for people
from age of 25-30 years if
there is family history of
colorectal carcinoma:
-Three or more first or second
degree relatives with
colorectal carcinoma at any
age.
-Two or more first or second
degree relatives diagnosed
with colorectal carcinoma
before the age of 50 years.
-A family member where
genetic studies identify a high
risk.
So this patient qualifies for 2-
yearly colonoscopy as her two
family members have
colorectal carcinoma before
the age of 50. So option a is
correct.
All other options are incorrect.
63. A 55-year-old female smoker
was prescribed nicotine patch
by one of your colleagues on
her weeks ago at your GP
clinic. The patient finds it
hard to quit smoking despite
using nicotine patch. She
feels depressed as suicidal
thoughts present. She wants
your advice in this regard.
What is the most appropriate
advice?
 a. Continue to use nicotine
patch only for few more
weeks
b. Start her on bupropion
and cease nicotine patch
c. Start her on bupropion
while she uses nicotine patch
d. Cease nicotine patch
and ask her to come back in
two weeks e. Refer her to
psychiatrist
last appointment 2 well
however no
Answer detail:
The correct answer is c
A study published in
Australian Prescriber showed
that bupropion is an option to
treat depression associated
with quitting smoking.
The study revealed that
bupropion and nicotine when
combined are more effective
in quitting smoking than
either of the medication alone.
While patient is smoking,
bupropion can be started and
nicotine patch is continued.
Cessation of smoking can be
started in second week of
bupropion.
If until seventh week, no
cessation of smoking
achieved, bupropion is less
likely to help then.
Frequent blood pressure
monitoring is necessary with
bupropion therapy.
Referral to psychiatrist is not
required at this stage.
64. A 21-year-old female with
multiple sexual partners for
last 6 months was recently
diagnosed with Chlamydia.
What would you do next?
a. Treat her, trace all her
contacts and treat them
b. Advise to avoid sex with
too many people
c. Use condoms for 7 days
and continue sexual activity
d. Trace only last contact
and treat
e. Giver her antibiotics
Answer detail:
The correct answer is a.
Contact tracing is an
important part of management
of Chlamydia. Patient name
and all identifying information
related to patient are kept
confidential and are not
shared to any of his/her
contact.
Patient is encouraged to give
details of all sexual contacts
in last 6 months (maximum
duration for Chlamydia tracing
in Australia) so that they can
be informed via phone or
letter to visit the sexual
health clinic as soon as
possible.
About 68% of male partners
of infected women are found
to be infected with Chlamydia
infection on contact tracing.
All the sexual partners
exposed by oral, vaginal or
anal sex without condoms are
at high risk of getting
Chlamydia infection. They
should be treated regardless
of symptoms and test results.
A patient who has been
diagnosed with Chlamydia
should not have sex with
anyone even using a condom,
until 7 days after treatment is
completed.

Chlamydia is a notifiable
disease. Doctors and
laboratory staff are legally
required to inform local health
authority in the state.
Treatment of Chlamydia is a
single dose of 1-gram
Azithromycin or doxycyclin for
7 days. Patient should not
have sex until at least a week
has passed after the
treatment.
65. A 30-year-old woman came
for assessment of her
abnormal cervical pathology.
She had low grade squamous
intraepithelial lesion on Pap
smear 12 months ago and her
current Pap smear report also
shows possible low grade
squamous intraepithelial
lesion.
What will you do next?
a. Cease further annual
screening
b. Refer for colposcopy
c. Repeat Pap smear in 6
months
d. Continue 2 yearly Pap
smears
e. Repeat Pap smear in 3
months
Answer detail:
The correct answer is b.
If a woman continues to have
2 consecutive pap smears
showing low grade squamous
intraepithelial lesion (possible
or definitive) at 12 months
intervals, referral for
colposcopy is recommended.
All other options are incorrect.
66. A 52-year old mother brings
her 18-year old mentally
retarded daughter at 8 weeks
of pregnancy. The mother
wants an abortion for her
daughter as she is unable to
look after herself. The patient
does not want an abortion.
How will you proceed?
a. Perform medical
abortion as it is close to 9
weeks otherwise she will
require surgical abortion
b. Do not perform abortion
as patient did not consent
and discharge home
c. Refer the matter to the
family court
d. Get consent from the
local council
e. Discuss the matter with
the father of the girl in a
week
Answer detail:
The correct answer is c.
This patient does not have
capacity to decide due to
mental disability.
Her mother also does not have
capacity to decide and consent
for her daughter in this
particular situation as the
procedure is invasive and
involves risks.
The matter should be referred
to either Supreme Court or
Family Court.
The Supreme Court can
exercise its role as the
supreme parent of children.
The Family Court of Australia
has a similar authority.
An application to the court
should be considered in
situations, and with
procedures, that are so
serious that neither young
person, parent nor can
guardian give valid consent.
This includes situations
where:
1. The procedure is very high
risk (for example, separating
conjoined twins).
2. There may be life changing
effects (for example,
sterilisation of mentally
disabled young persons,
abortions, removal of life
support, the removal of
organs for transplants, gender
re-assignment and bone
marrow harvest).
3. There is a strong objection
from a dissenting parent.
4. A child with capacity to
make decisions is refusing
healthcare and there is
significant risk of harm in
them doing so.
5. The procedure involves
invasive, irreversible or major
surgery (excluding lifesaving
emergency surgery).
If there is any doubt in
relation to consent to provide
healthcare to a child or young
person, it is strongly
recommended that legal
advice is obtained.
67. A 43-year-old lady comes to
your clinic for follow up of her
blood tests you conducted on
last appointment. All of the
reports are normal except
fasting triglycerides level
which is 2.0 mmo1/1.
Which of the following is next
step in her management?
a. High glycemic index
carbohydrate food
b. Poly-unsaturated fats
c. Fish oil
d. Simvastatin
e. Ezetimibe
Answer detail:
The correct answer is b.
Normal value of fasting serum
triglyceride is less than
1.5mmo1/1.
Elevated fasting triglyceride
level greater than 1.9 mmo1/1
increases the risk of coronary
heart disease and stroke by
more than 30%.
So this must be treated by life
style modification and fish oil.
First-line treatment for
hypertriglyceridemia includes
a diet rich in mono- and
polyunsaturated fat (option b)
and low glycaemic index
carbohydrate food.
Best modality to reduce
weight is caloric restriction
and exercise.
The next step is consideration
of marine omega-3 fatty acids
(fish oil) and fibrates.
Simvastatin and ezetimibe are
used to lower LDL cholesterol.
68. A-54-year old male with
history of COPD and
gallstones is undergoing
cholecystectomy. He still
smokes and manages without
oxygen at home. What will be
your advice?
a. Abstain from smoking
for 6 weeks before surgery
b. Abstain from smoking
for one week before surgery
c. Discontinue smoking
after surgery
d. Smoking has no effect
on the surgery
e. None of the above
Answer detail:
The correct answer is a.
COPD is an independent risk
factor for major
cardiopulmonary
complications in major
surgical procedure.
Before surgery, patients with
unstable COPD should receive
oral steroids, which do not
compromise wound healing.
Patients with history of COPD
are recommended to avoid
smoking for 6 weeks prior to
the surgery.
69. A 35-year-old male presented
to your clinic. He has
background history of
depression and has been
taking alcohol regularly. He
wakes in early morning and
feels nothing is interesting in
this world.
What would you ask him
about alcohol intake?
a. Do you drink only in
party
b. Do you drink on
everyday dinner time
c. Do you drink before
sleep
d. Do you drink after wake
up in morning
e. Do you invite your
friends before having a drink
Answer detail:
The correct answer is d.
Any person with history of
alcohol drinking should be
assessed for alcohol related
problems with CAGE
questionnaire:
C-have you ever felt you
should cut down on your
drinking?
A-have people annoyed you by
criticizing your drinking?
G-have you ever felt bad or
Guilty about your drinking?
E- Have you ever had a drink
first thing in the morning to
steady your nerves or to get
rid of a hangover (Eye
opener)?
So only option d is from the
CAGE Questionnaire and is the
correct response.
70. A 27-year-old male known to
be heroin-addict comes to
your clinic for a prescription
of diazepam as he is planning
to kick of his heroin
addiction. He is
asymptomatic at the
movement.
What would be your course of
action?
a. Prescribe him a dose of
diazepam for two weeks
b. Tell him that diazepam
is not used for this purpose
c. Prescribe him diazepam
and he should collect his
tablet on daily basis
from a pharmacy
d. Give him naloxone
e. Refer him to a drug
rehabilitation center
Answer detail:
The correct answer is e.
This patient is motivated to
kick off his heroin addiction,
so this opportunity should be
used to refer him to drug
rehabilitation center.
In Australia, most
detoxification provided to
heroin-dependent persons is
provided in rehabilitation
centers. Detoxification is often
followed by cognitive-
behavioral therapy,
psychotherapy and counselling
for the patient. So this the
best advice.
Benzodiazepines are
associated with fatal and non-
fatal opioid overdose among
heroin users. There is high a
risk of benzodiazepine
dependence especially in drug
abuser and a prescription
longer than 5 days is
discouraged. A patient with
acute withdrawal symptoms
can still have 5 days of
benzodiazepine from a GP if
GP finds withdrawal symptoms
at clinic.
Telling the patient that
diazepam is not used for
management of heroin
withdrawal symptoms is
incorrect as benzodiazepines
such as diazepam may be
recommended for opiate
withdrawal especially if there
is co-morbid alcohol
withdrawal.
Benzodiazepines may
temporarily ease the anxiety,
muscle spasms, and insomnia
associated with opioid
withdrawal. However this is
preferably used in acute
withdrawal while patient is in
drug rehabilitation program.
A severe withdrawal reaction
is sometime precipitated if the
patient has recently used
heroin or another opioid. It is
recommended that naltrexone
should not be commenced
until seven to 10 days after
the last use of heroin.
Methadone maintenance is an
evidence based programmer
which reduces heroin
consumption, death from drug
overdose, HIV infection and
crime activity. lt is very safe
to commence and most
commonly used long-term
programmed for management
of heroin addiction in
Australia.
71. A 49-year-old male,
commercial truck driver by
profession, presented with
left sided chest pain radiating
to the both arms and jaw.
Electrocardiography shows ST
segment elevation consistent
with STEM. Thrombolysis is
done with tenecteplase which
resulted in resolution of
symptoms.
What will you advise him
about driving?
a. He can drive private car
after 4 weeks
b. He can drive his
commercial truck after 4
weeks
c. No driving restriction
d. Notify to the police
e. He should drive carefully
and avoid driving on main
highways
Answer detail:
The correct answer is b.
After acute myocardial
infarction, the driving
restriction applies as follows:
-Private vehicles-2 weeks.
-Commercial vehicles-4
weeks.
After 4 weeks, this person can
start driving if remains well
otherwise.
72. A 42-year-old woman comes
to your clinic discuss the
 report of her recent Pap
smear. The report shows that
she has low grade squamous
intraepithelial lesion. She has
no history of negative pap
smears as she was in
overseas and she did not see
a doctor there.
What is the most appropriate
next step in her
management?
a. Repeat Pap smear in 12
months
b. Repeat Pap smear in 6
months
c. Continue 2 yearly Pap
smears
d. Cease further screening
e. Give human papilloma
vaccine
Answer detail:
The correct answer is b.
If a woman has no history of
negative Pap smears in
preceding 2-3 years, and her
Pap smear shows low grade
squamous intraepithelial
lesion, she should have repeat
Pap smear in 6 month or
referral for colposcopy.
All other options (Pap smear
in 12 months and 2 yearly) is
incorrect. Human papilloma
vaccine is not helpful if the
lesion has already developed.
If a woman has history of
negative Pap smears in
preceding 2-3 years and her
Pap smear shows low grade
squamous intraepithelial
lesion, a 12 month repeat Pap
smear is required.
73. A mother of 18-month child
does not want her child
immunized for MMRV
(measles, mumps, rubella,
and varicella) as he has an
egg allergy. What is the next
step in management?
a. Give MMRV on next visit
b. Do not give the vaccine
c. Give vaccine in hospital
d. Do an allergy tests
e. Explain her that MMRV
does not contain egg protein
Answer detail:
The correct answer is e.
The measles, mumps, rubella,
varicella (MMRV) vaccine is a
combination vaccine that
protects against four
childhood illnesses-measles,
mumps, rubella and varicella
(chickenpox).
MMRV vaccine is as safe as
any other vaccine, and an
allergy to eggs should not
delay measles vaccination.
MMRV vaccine is prepared
from chicken fibroblasts and
not from the eggs. So MIMI/
vaccine can be given to egg
allergic patients.
74. Which of the following would
decrease the risk of breast
cancer in pre-menopausal
women?
a. Smoking
b. Family history of breast
cancer
c. Excess body fat
d. Decreased fruits and
vegetables in the diet
e. Avoiding breastfeeding
Answer detail:
The correct answer is c.
The association of obesity and
excessive body fat is different
in premenopausal and post-
menopausal women.
Excessive body fat in
premenopausal women is
associated with decreased risk
of breast cancer development.
However, obesity and
excessive body fat in post-
menopausal woman is
associated with increased risk
for breast cancer.
Smoking and family history of
breast cancer increases the
risk of breast cancer. Also,
diet containing fewer fruits
and vegetables and avoiding
breastfeeding for six months,
increase the risk of breast
cancer.
75. A 10-year-old child was
diagnosed with
meningococcal meningitis.
His father has severe chronic
liver disease due to hepatitis
C and lives in the same
home.
Which of the following would
be the best chemo-
prophylaxis for his father?
a. Rifampicin
b. Ciprofloxacin
c. Azithromycin
d. Gentamicin
e. Dapsone
Answer detail:
The correct answer is b.
Chemoprophylaxis for
meningococcus meningitis is
offered to close contacts of
the diagnosed case of
meningitis.
It aims to eradicate
asymptomatic carriage in
close contacts so that
susceptible members of the
group do not acquire the
organism and get an invasive
infection.
Suitable regimens for
meningococcus prophylaxis is
ciprofloxacin 500mg orally as
a single dose for adults and
children over 12 years.
Children under 12 years and
pregnant females should avoid
ciprofloxacin. They should use
ceftriaxone as a single dose
injection.
Rifampicin 600 mg orally 12
hourly for 2 days is an
alternate regimen for
prophylaxis for meningococcal
meningitis.
However, it is contraindicated
in severe liver disease,
pregnancy and alcoholism.
76. A 75 year-6d male diagnosed
with terminal lung cancer
came to you requesting an
insertion of intravenous line
to inject lethal drugs to kill
himself lives with his son and
does not want to be a burden
for his family. He has been
independent throughout Ns
life. What would be the most
appropriate step you would
consider?
a. Put intravenous cannula
and prescribe some heavy
doses of midazolam.
b. Refer him to community
nurse for intravenous access
c. Tell him that it is illegal
to do so
d. Refer him to aged care
specialist
e. Prescribe him oral
medication for pain relief
Answer detail:
The correct answer is c.
This patient has been
diagnosed with terminal lung
cancer and he is requesting
physician-assisted suicide. It
means provision of means to
the patient to kill himself. This
may have some moral
justification as being the right
of the individual to self-
determine about his life.
However it is illegal to do so
under criminal law in
Australia.
Referring him to community
nurse or to aged care
specialist is not required. 1 his
patient should be referred to
palliative care center for
comfort measures. Prescribing
him oral pain relief medication
not required as in the question
patient did not come with
pain.
77. A 33-year old woman comes
to your clinic for Pap smear.
During examination, you
noticed some bruises and
injuries on chest and
abdomen. She claims that
these injuries happened
because of slipping on a tiled
floor. She lives with her
partner.
What would be the most
appropriate next step in the
management?
a. Document about injuries
however do not inform her
b. Explore more about
cause of these injuries
c. Notify the police
d. Suggest her that she
may be a victim of domestic
violence e. Do Pap
smear and see her in clinic
once report is available
Answer detail:
The correct answer is b.
In this situation, the best
approach would be to explore
more about the injuries. Ask
patient whether she feels
afraid of her partner.
Emphasize confidentiality so
that patient feels comfortable
in sharing more information.
Accurate documentation is
essential for future record. If
possible, photographs should
be taken of all patients with
visible injuries.
Allow the patient to tell her
story.
Explain that the patient has
legal rights and violence in the
home is as illegal as violence
in the streets. Patient may
choose to inform police.
Encourage and respect the
patient's individual autonomy,
self-determination and self-
esteem.
78. A 34-year-old woman has
been using oral contraceptive
pills for past 3 years. She is
planning to conceive this
year. She drinks regular
alcohol.
What is the most appropriate
advice?
a. Stop alcohol now
b. Stop alcohol after
positive pregnancy test
c. Stop alcohol in 2nd
trimester
d. There is no need to stop
alcohol
e. Avoid pregnancy for 6
months after stopping alcohol
Answer detail:
The correct answer is a.
Alcohol consumption during
pregnancy is a risk factor for
fetal alcohol syndrome, birth
defects, and low birth weight.
Binge drinking is particularly
harmful to fetal
neurodevelopment.
The safest option for pregnant
women is to abstain from
drinking if they are pregnant,
planning a pregnancy or
breastfeeding.
So this patient should stop
drinking alcohol now as she is
planning pregnancy to
minimize the risk of alcohol-
related complications for the
fetus.
79. A mother brings her 13-year-
old daughter to your office to
discuss the prevention of
genital warts and cervical
cancer?
Which of the following is the
right information to be given
to her regarding her
daughter?
a. Human papilloma virus
vaccine can only be given
when she turns 16
b. Human papilloma
vaccine is not available in
Australia yet
c. There is no evidence
that human papilloma vaccine
can be helpful in preventing
cervical cancer
d. This is the right age for
her to be given human
papilloma virus vaccine
e. Regular Pap smears are
not essential because the
HPV vaccine does prevent
all cervical cancers
Answer detail:
The correct answer is d.
This is the right age to start
human papillomavirus vaccine
in this case.
At the age of 12 and 13,
human papilloma vaccine is
given to all school going
children and it is included in
National Immunization
Program (NIP) Schedule and
is funded by Immunize
Australia Program.
HPV infection caused by HPV
types 6, 11, 16 and 18 is
vaccine preventable.
Types 16 and 18 can lead to
cervical cancer. Types 6 and
11 are associated with genital
warts.
Human Papilloma Virus
vaccine is available in
Australia since November
2006 and two types of
vaccines are available,
GARDASIL and CERVARIX.
There is very convincing
evidence that Human
Papilloma vaccine can prevent
cervical cancer.
Regular Pap smears are still
essential because the HPV
vaccine does not prevent all
cervical cancers and should be
conducted as routine.
80. The mother of one of your
patients calls you, inquiring
about the reason for her
daughter's consult. The
daughter is 18 years old.
What do you tell her?
a. Tell her that you cannot
disclose a patient's
information
b. Tell her the reason for
her daughter's consult
 c. Tell her to come in
tomorrow with her daughter
d. Tell her to ask her
daughter
e. Tell her to make another
appointment for her concerns
Answer detail:
The correct answer is a.
The confidentiality and privacy
of the clinical record of a
patient, are very important.
If a girl or boy is elder than 16
years, they are considered as
independent individuals and
their clinical information
should not be told to anyone
including the parents and
spouse.
If the child is a minor (under
16 years of age), the parents
are entitled to act on behalf of
their children.
81. A 24-year-old woman is seen
by you on the first antenatal
visit during her current
pregnancy. She has a history
of asthma and is keen to do
everything which will help to
reduce the risk of asthma in
her child. She and her
husband, both smoke for last
five years.
Which of the following has
evidence to reduce the
likelihood of asthma in her
baby?
a. Quitting smoking
b. Allergen avoidance
c. Maternal dietary changes
d. Fish oil
e. Vitamin A supplements
Answer detail:
The correct answer is a.
Exposure to tobacco smoking
during pregnancy can increase
the risk of health hazards to
the baby antenatal and post-
partum.
Smoking in the environment
increases the risk of
development of asthma in the
child.
Following is the list of things
which are not helpful in
reducing the risk of asthma
after the birth of the baby.
-Maternal dietary changes or
allergen avoidance in
pregnancy, for example,
avoidance of house dust mite
or pet allergens.
-Probiotic dietary
supplements, vitamin A, D or E
supplements, or fish oil.
82. A 35-year-old woman came
for your advice regarding
screening. She is diagnosed
with familial adenomatous
polyposis at the age 32.Her
daughter is 5 year old.
What would you advise for
her daughter?
a. Sigmoidoscopy every
year at the age of 25
b. Colonoscopy every year
at the age of 25
c. Sigmoidoscopy every 2
years after the age of 35
d. Sigmoidoscopy every
year beginning at 10-12
years
e. Refer the case to senior
colleague
Answer detail:
The correct answer is d.
People with familial
adenomatous polyposis are at
high risk of developing bowel
cancer much earlier than the
general population.
If there is family history of
familial adenomatous
polyposis, the person should
begin screening from age 10-
15 years with a sigmoidoscopy
every year until the age of 35.
After age 35, continue
screening with sigmoidoscopy
every 3 years.
83. A 32-year-old female
presented to your office for
advice. She told you that she
has a sexual relationship with
another GP at your practice.
You also noticed your
colleague making sexual
remarks about that patient.
What would you next?
a. Write good notes and
save for future reference
b. Contact medical
indemnity insurance for
advice
c. Tell her that you need to
call the police
d. Inform practice manager
e. Notify Australian health
practitioner regulatory
agency
Answer detail:
The correct answer is e.
It is mandatory to notify
Australian Health Practitioner
Regulatory Agency if you have
reasonable believe that your
colleague is involved in sexual
misconduct with a current or
past patient.
Sexual misconduct also
includes making sexual
remarks, touching patients or
clients in a sexual way, or
engaging in sexual behavior in
front of a patient or client.
Engaging in sexual activity
with a person who is closely
related to a patient or client
under the practitioner's care
may also constitute
misconduct.
84. A 60 year-old male visited
your clinic for routine medical
checkup. He smokes 45
cigarettes per day, drinks
alcohol 10 standard drinks
per day and his body mass
index is 32.He wears seat-
belt 60 percent of the times
when he drives. He is
motivated to follow life style
modification advice. Which of
the following is the most
significant advice for
prevention of cardiovascular
disease and premature death
in this patient?
a. Quit smoking
b. Reduce alcohol intake
c. Wear seat-belt every
time
d. Reduce weight
e. Regular exercise
Answer detail:
The correct answer is a.
Smoking is strongly
associated with high risk of
cardiovascular disease.
Quitting smoking is
considered the most effective
lifestyle interventions for
preventing cardiovascular
disease and premature deaths.
In a patient with coronary
heart disease, smoking
cessation is associated with a
36 percent reduction in the
risk of all-cause mortality.
Wearing a properly adjusted
seat belt reduces the risk of
mortality by 50 percent.
However this mortality is
related to trauma and severe
injuries and is not due to
cardiovascular disease.
Also advise the patient to
reduce alcohol intake to a
maximum of two standard
drinks per day and have at
least two alcohol-free days
per week. If patient is female,
she should take up to one
standard drink per day with
two alcohol-free days per
week.
Blood pressure and body
weight have direct association
with each other. One percent
reduction in weight lowers
systolic blood pressure by 1
mmHg. The benefits of weight
reductions include decrease in
insulin resistance and
improvement in
hyperlipidaemia.
Regular exercise increases
high-density lipoprotein
cholesterol and reduces body
weight. This in turn reduce
insulin resistance and
systemic vascular resistance.
Regular exercise has an
independent cardio-protective
activity.
85. A 45-year-old male patient
with history of depression, is
on amitriptyline for last 2
years. He now presented with
erectly dysfunction. He
smokes 20 packs/day and
drinks 4 standard drinks/day.
What is the most appropriate
management?
a. Change amitriptyline to
sertraline
b. Prescribe sildenafil and
continue amitriptyline
c. Quit smoking
d. Reduce alcohol
e. Encourage exercise
Answer detail:
The correct answer is c.
This patient has erectile
dysfunction secondary to
depression and smoking.
Alcohol use is in moderation
(less than 7 standard drinks
per day) and is unlikely to
cause erectile dysfunction.
Heavy drinking is more than 7
drinks per day and it would be
associated with erectile
dysfunction on long term.
So quitting smoking would be
the best advice. Smoking is
associated with increased
cardiovascular risk and can
lead to organic erectile
dysfunction by causing
atherosclerosis.
Amitriptyline is less likely to
cause erectile dysfunction and
is better than sertraline
regarding sexual side effects.
Known risk factors associated
with erectile dysfunction
include depression, diabetes,
dyslipidaemia, hypertension,
neurovascular disease,
obstructive sleep apnoea,
smoking and medications.
Recommendations of alcohol
consumptions:
1- For healthy men and
women, drinking no more than
two standard drinks on any
day reduces risk of harm from
alcohol-related disease or
injury over a lifetime.
2- Drinking no more than four
standard drinks on a single
occasion reduces the risk of
alcohol-related injury arising
from that occasion
86. A 32-year-old woman visited
you for evaluation. She has
been sexually active for last
12 years and takes combined
oral contraceptive pills since
then. She is non-smoker. She
is slightly obese however she
does exercise daily for 25
minutes.
Which ONE of the following
the strongest risk of
developing cervical cancer?
a. Oral contraceptive pills
for more than 5 years
b. Non-smoking
c. Sexual activity
d. Mild obesity
e. Age
Answer detail:
The correct answer is a.
This patient has been taking
oral contraceptive pills for
longer than 5 years and this
make her high risk for
developing cervical carcinoma.
High risk factors for
developing cervical carcinoma
include:
-Oral contraceptive pills for
more than 5 years
-Smoking
-Immunosuppression
-Persistence infection of high
risk human papilloma virus -
infection.
Sexual activity is an average
risk factor for developing
cervical carcinoma. Mild
obesity with health life style is
unlikely to make high risk for
developing cervical cancer.
87. A 35-year-old Jewish woman
presented to you for breast
cancer screening as one of
her paternal aunts has been
diagnosed with bilateral
breast and ovarian cancer
before the age of 50.
What will you advise her?
a. Two yearly
mammography
b. Two yearly ultrasound
c. Refer to family cancer
clinic for risk assessment and
genetic testing
d. BRCA gene screening
e. Six monthly self-breast
examinations
Answer detail:
The correct answer is c.
A person's first-degree
relative is a parent, sibling, or
child. A first-degree relative
shares about half of their
genes with the person.
A second-degree relative of a
person is an uncle, aunt,
nephew, niece, grandparent,
grandchild or half- sibling A
second-degree relative shares
about one-quarter of their
genes with the person.
This woman has high risk
features for breast cancer due
to strong family history of
possible genetic breast and
ovarian cancer (being Jewish
in origin, bilateral breast
cancer in same person in the
family, breast and ovarian
cancer below the age of 50).
According to RACGP
guidelines, all patients who
are found to be at high-risk
family history of breast and
ovarian cancer, should be
considered for following
things:
-Advise referral to a cancer
specialist or family cancer
clinic for risk assessment,
possible genetic testing and
management plan.
-Ongoing surveillance
strategies may include regular
clinical breast examination,
and annual breast imaging
with mammography, MRI or
ultrasound.
BRCA gene testing would be
required after thorough
assessment at family cancer
clinic in the area.
So option c is correct.
88. 65-year-old male had
abdominal aortic aneurysm.
He was seen by a vascular
surgeon who repaired the
aneurysm and transferred the
patient to intensive care unit
for 24-hours.Patient made
very smooth recovery and is
now ready to be discharged.
He asks if he can drive his
car as before.
What will be the next course
of action?
a. He is unfit to drive for 4
weeks
b. He is unfit to drive
forever as he has been in
intensive care unit
c. He can drive after he
spends a week at home
without any symptoms
d. Refer him to his general
practitioner to look into the
matter e. He is unfit to drive
for 6 months post-repair
Answer detail:
The correct answer is a.
After repair of abdominal
aortic aneurysm, a person is
unfit to drive his private car
for at least 4 weeks according
to Australian legislation.
After that he can have
unconditional permission to
drive. Staying in intensive
care for 24 hours is normal
after repair of the abdominal
aortic aneurysm for strict
monitoring of vitals. It is not
the reason to withhold or
cancel his license.
Referral to general
practitioner is not required as
you can advise the patient
post-operatively before he
goes home. This restriction on
his driving applies
immediately after the
discharge while he may see
his GP in a week. So it is the
treating team's responsibility
to instruct the patient.
89. All of the following situations
are an indication of sexual
misconduct, by health care
provider, except?
a. Ridiculing of a patient's
sexual preferences or
orientation
b. Commenting about
sexual history that are not
relevant to the clinical
issue
c. Requesting details of
sexual history or sexual
preferences not relevant to
the clinical issue
d. Conversations about the
sexual problems or fantasies
of the doctor
e. Talking about sexual
partners with patient who
came for contraceptive
advice
Answer detail:
The correct answer is e.
It is not sexual harassment if
a medical practitioner
discusses with the patient
about sexual behavior and
sexual history if she presents
for contraceptive advice. It is
very relevant to the clinical
issue they are dealing with.
According to guidelines
provided by medical board of
Australia, all of the following
situations account to sexual
misconduct and sexual
harassment:
- Making an unsolicited
demand or request, whether
directly or by implication, for
sexual favors.
- Irrelevant mentioning of a
patient's or doctors sexual
practices, problems or
orientation.
- Ridiculing of a patient's
sexual preferences or
orientation.
- Commenting about sexual
history that are not relevant
to the clinical issue.
- Requesting details of sexual
history or sexual preferences
not relevant to the clinical
issue.
- Conversations about the
sexual problems or fantasies
of the doctor.
- Making suggestive
comments about a patient's
appearance or body.
90. A 25-year-old lady comes to
your clinic for advice
regarding bowel cancer
screening. Her mother had
hereditary nonpolyposis
colorectal cancer and was
treated surgically at 40-year
of age. Her grandmother also
had bowel cancer at the age
of 49. She is not interested
to have genetic testing.
Which of the following is the
most appropriate advice for
her?
a. Refer her for
colonoscopy now
b. Suggest colonoscopy
after every two years starting
at the age of 30
c. Refer her to bowel
surgeon for urgent colectomy
d. Start bowel cancer
screening at the age of 35
e. No follow up needed a
she refused genetic testing
Answer detail:
The correct answer is a.
Hereditary nonpolyposis
colorectal carcinoma (HNPCC)
is an autosomal dominant
disorder responsible for 3 to
5% or cases of bowel cancers.
If a person has a parent
(mother or father) with
HNPCC, he/she has a 50/50
chance of inheriting the
mutated gene.
First degree relatives of
patients with HNPCC should
have colonoscopy every 1-2
year beginning between the
age of 20-25 and yearly faucal
occult blood testing (FOBT)
(according to Cancer Council
of Victoria).
As this patient has family
history of bowel cancer
(HNPCC in mother) in 2 first
degree relatives before the
age of 50, she should be
considered high risk for
hereditary nonpolyposis
colorectal carcinoma and she
should be offered genetic
testing for HNPCC gene.
If she refuses to go for
genetic testing, it should be
assumed that she has HNPCC
gene and should have 2-yearly
colonoscopy starting from now
and yearly FOBT to pick up
bowel cancer at early stage.
91. When should suspected child
sexual abuse be reported?
a. When you are sure that
child is telling the truth
b. Only when you have
confirmed gonorrhea infection
c. After you have contacted
the parents
d. Only when you have
proof of the abuse
e. When you have a belief
based on reasonable grounds
that child sexual abuse
has occurred or is occurring
Answer detail:
The correct answer is e.
A doctor or nurse is legality'
requited to report the
suspected child sexual abuse
to child protection services,
when there is a belief based
on reasonable grounds that
child sexual abuse has
occurred or is occurring.
You do not need to be sure
whether child is telling the
truth or not. You do not need
to contact the parents before
reporting to child protection
services. No proof of sexual
abuse is required for
mandatory reporting of child
sexual abuse.
When you suspect a child
sexw31 abuse, immediately
report to the local child
protection services and they
investigate the matter. There
is no penalty if no child sexual
abuse is confirmed and you
reported it in a good faith.
92. A 32-year-old woman
presented to your clinic at 22
weeks of gestation. She is
quite upset and reports
intimate partner violence for
last few months.
Which of the following is
likely to increase the risk of
intimate partner violence?
a. Non-pregnant women
b. Less frequent
attendance to general
practitioner clinic
c. Treated mental illness
d. Chronic unexplained
physical symptoms
e. Past physical trauma
Answer detail:
The correct answer is d.
The risk of intimate partner
violence should be considered
in following high risk
population:
- Women with symptoms of
mental illness.
- Women with chronic
unexplained physical
symptoms.
- Pregnant women.
- Frequent GP visitors.
-Untreated mental illness.
- Past psychological trauma.
Non-pregnant women are less
likely to be at risk of intimate
partner violence as compared
to pregnant women.
93. A 32-year-old male from
Sydney comes to you clinic
for assessment. He reports 5-
day history of penile
discharge. He denied having
 any fever, rash or any other
symptoms.
He is sexually active with
several female partners, with
inconsistent condom use.
The patient's vital signs are
normal. He has normal male
external genitalia without
inguinal lymphadenopathy or
lesions; purulent material is
expressed from the urethral
meatus.
PCR testing of the swab is
positive for Neisseria
gonorrhoeae and negative for
Chlamydia trachomatis
infection.
Which one of the following
therapies is most appropriate
for this patient?
a. Single doses of
intramuscular ceftriaxone and
oral azithromycin
b. Single dose of
intramuscular ceftriaxone
c. Single dose of
intramuscular benzathine
penicillin G
d. Oral ciprofloxacin for 5
days
e. Single dose of oral
cephalexin
Answer detail:
The correct answer is a.
The most appropriate therapy
for gonococcal urethritis is a
single dose of ceftriaxone 250
mg intramuscularly plus a
single dose of azithromycin 1
gram orally. The most likely
causes of uncomplicated,
purulent urethritis in a
sexually active young man are
Neisseria gonorrhoeae and
Chlamydia trachomatis
infection.
Definitive diagnosis of N.
gonorrhoea infection can be
made with nucleic-acid
amplification testing of a
urethral or urine sample; this
test has largely replaced
culture in clinical practice. If
available, Gram's stain of the
purulent exudate typically
shows gram-negative
diplococci.
Recommended therapy for
gonococcal urethritis consists
of a single dose of ceftriaxone
250 mg intramuscularly plus a
single dose of azithromycin 1
gram by mouth.
Ceftriaxone alone is not
recommended because of high
rates of concomitant infection
with Chlamydia, which is
treated with either
azithromycin or doxycycline.
In addition, there have been
recent reports of ceftriaxone-
resistant gonorrhea, and the
second drug may provide
additional coverage.
Oral fluoroquinolones (such as
ciprofloxacin) and oral
cephalosporins (such as
cephalexin ) are no longer
recommended in this setting
because of concerns about
resistance.
N. gonorrhea may be resistant
to penicillin, which is the drug
of choice for syphilis infection
94. A 32-year-old lady presented
to your office for advice
regarding screening. Her
grandfather was diagnosed
with colon cancer at the age
of 76. Her elder sister had
cholecystectomy at the age of
46. Her brother was
 diagnosed with diabetes
mellitus at 56 year of age.
What would be your advice
for her?
a. Colonoscopy every 12
months
b. Oral glucose tolerance
tests every 12 months
c. Serum cholesterol every
12 months
d. No need for screening
now
e. Request genetic risk
assessment
Answer detail:
The correct answer is d.
This patient is slightly above
the average risk of developing
colon cancer due to positive
family history of colon cancer
with one second degree
relative (grandfather).
She should have FOBT at least
every two years after the age
of 50. Consider sigmoidoscopy
every 5 years from the age of
50.
So this woman does not need
any colonoscopy at this stage.
All adults aged 45 and over
should have 5 yearly check of
serum cholesterol for
screening of
hypercholesterolemia.
Fasting blood glucose should
be done every 3 years in all
patients above 40 years of
age.
Fasting blood glucose every 3
years, should be considered at
any age in following high risk
groups.
1- All people with a history of
previous cardiovascular event
including acute myocardial
infarction and stroke.
2- All the women with a
history of gestational diabetes
mellitus.
3- Women with polycystic
ovary syndrome.
4- Those on antipsychotic
drugs.
5- Those with impaired
glucose tolerance test.
This woman does not fall in
this high risk category and so
does not need oral glucose
tolerance test.
95. A 74-year-old male presented
with inability to speak, facial
weakness and right sided
paralysis. CT scan shows
ischemic stroke involving
more than 65% left
hemisphere. His wife do not
want any active invasive
management. However his
son tells you to do
everything.
What will you do in this
situation?
a. Tell the wife that it is
too soon to decide on
discontinuing the life support
b. Do the treatment as it is
an emergency
c. Call guardianship court
d. Give intravenous
nutritional support
e. Give nasogastric fluids
and noninvasive treatment
Answer detail:
The correct answer is e.
This patient has big ischemic
stroke and need urgent
treatment and intensive
monitoring for possible
hemicraniotomy. This
situation is a contraindication
to thrombolysis due to risk of
hemorrhagic transformation.
The consent should be
obtained from following
people where the patient is
incapable of consenting to
medical treatment and has not
had a guardian appointed.
1- A guardian of the person
needing the treatment.
2- The spouse or de facto
partner of the person needing
the treatment.
3- A person who, on a regular
basis, provides or arranges for
domestic services and support
to the person needing the
treatment but does not
receive remuneration for
doing so.
4- A person who is the nearest
relative (other than the
spouse or de facto partner) of
the person needing.
5- Any other person who
maintains a close personal
relationship with the person
needing treatment.
6- A person prescribed in the
regulations.
So in this situation, the
patient himself cannot consent
to the treatment due to stroke
and his spouse would be the
person who can make decision
about provision of health care.
So option e is correct
response.
96. An 18-year old male escort
comes to your office due to
episodes of dysuria. He also
noted yellowish penile
discharge.
Which of the following is the
next step in management?
a. VDRL reaction
b. Gram stain and culture
of penile discharge
c. Gonococcal complement
fixation test
d. Prostatic massage
e. Dark ground illumination
of the discharge
Answer detail:
The correct answer is b.
The patient's presentation is
suggestive of an acute
gonococcal urethritis.
In men, about 50% acute
infections are
asymptomatic.The symptoms
of gonococcal urethritis
include a penile discharge and
dysuria. The discharge is often
present spontaneously at the
urethral meatus, purulent or
mucopurulent in color, and is
copious in amount.
Risk factors for gonorrhoea
include:
- New sexual partner or
multiple sexual partners.
- Being unmarried.
- Young age.
- Low educational and
socioeconomic levels.
- History of substance abuse.
Previous episode of
gonorrhoea.
The gonococcal organism is
rapidly identified by Gram
stain and culture of penile
discharges.
Due to its high sensitivity and
specificity, a Gram stain of a
male urethral specimen, which
demonstrates
polymorphonuclear leukocytes
with intracellular Gram-
negative diplococci, can be
considered diagnostic for
infection with Neisseria
gonorrhoea in men.
VDRL is used for the diagnosis
of syphilis. Prostatic massage
is an unreliable method of
obtaining a test sample for
acute gonorrhoea.
Dark ground illumination is a
method for demonstrating the
presence of Treponema
pallidurn. Antibiotic
management of acute
gonorrhoea is with ceftriaxone
250 mg IM as a single dose.
Re-culture the organism in 3-
I days after treatment.
Contact tracing is essential.
97. You are working as a GP in a
rural area. You are keen to
do some research in your
area. You decided to do a
research study the clinical
effects of aspirin on
osteoarthritis.
Which study is most effective
study design?
a. Cohort study
b. Cross-sectional study
c. Case study
d. Case-control study
e. Randomized controlled
trials
Answer detail:
The correct answer is e.
Randomized controlled trials
are the most rigorous way of
determining whether a cause-
effect relation exists between
treatment and outcome and
for assessing the cost
effectiveness of a treatment.
An intervention is conducted
on a randomly selected group
of people and compared with a
matched control group not
subject to the specific
intervention. The objective is
to establish a causal
relationship between the
intervention and the
hypothesized outcome.
Cohort (or prospective) study
is also referred to as 'follow-
up'. The study follows a group
(cohort) of individuals with a
specified characteristic or
disease over a period.
Comparisons are made with a
control group.
Cross-sectional or prevalence
study follows a correlation
approach using existing
databases. It is a survey of
the frequency of disease, risk
factors or other
characteristics in a defined
population at one particular
time.
A case study is a research
method involving an up-close,
in-depth, and detailed
examination of a subject of
study (the case), as well as its
related contextual conditions.
Case-control (or
retrospective) study is an
observational study in which
people with a disease (cases)
are compared with those
without it (control group).
98. A 30-year-old woman is
concerned about breast
cancer has her mother was
diagnosed with breast cancer
at the age of 48. Clinical
examination of the breast is
normal.
 What is the most appropriate
advice for her?
a. Mammography every
year from the age of 40
b. Mammography every 2
years from age of 50-69
c. Refer to surgeon
d. Refer for genetic studies
e. Reassure her that she is
not at high risk of breast
cancer
Answer detail:
The correct answer is a.
If a woman has a first degree
relative less than 50 years of
age diagnosed with breast
cancer, she should have
mammography every year
from the age of 40.
All other options are incorrect.
99. You are working in a rural
hospital emergency
department. Your next
patient is a 22-year-old male
who had minor trauma to his
left leg while he fell from his
motorbike this morning. His
wound looks clean and he
had 3 doses of tetanus toxoid
about 3 years ago.
What is the most appropriate
management of this patient?
a. Tetanus toxoid
b. Tetanus
immunoglobulins 250 units
intramuscularly
c. Tetanus toxoid and
tetanus immunoglobulins
d. Give intravenous
antibiotics and tetanus
immunoglobulins
e. Neither passive nor
active immunization is
required at this stage
Answer detail:
The correct answer is e.
All the partially immunized
and un-immunized adults
should receive active
immunization with tetanus
toxoid.
The primary series for adults
consists of three doses. First
and second dose are given 4
weeks apart and third dose is
given by 6 to 12 months.
A clean wound with clear
history of tetanus status more
than 3 doses does not require
both tetanus toxoid and
tetanus immunoglobulins. So e
is correct response.
Intravenous and oral
antibiotics are usually
reserved for dirty wounds and
cellulitis. However clean
wound does not need
antibiotics at all.
100. One of your patients,
meets you on the street mall
and invites you for a coffee
and a chat, and may be lunch
later.
She just had seen you at
your clinic two days ago.
What is true about
socialization between doctors
and patients?
a. You can go out for a
coffee but not more than that
b. You can establish a
contract to finalize her
psychotherapy and
afterwards, you can socialize
c. You can socialize as you
are both consenting adults
d. You should not socialize
with your patients under any
circumstances
 e. Ask patient to give the
phone number so that you
can talk latter
Answer detail:
The correct answer is d.
Doctor patient relationship
has professional limitations on
doctor not to get involved in
any relationship with a
patient.
- Socializing with patients or
with previous patients is
discouraged and considered
unethical.
- Having a coffee together
further increases the risk of
socializing beyond that.
- A physician must not
socialize with patients under
any circumstances.
- Any romantic or sexual
relationship which results
from socializing with the
patients is also unethical.
- Asking for phone number in
a street is also inappropriate.
If you need to contact her
regarding her health, you can
use hospital record to get her
contact details.
101. A 45-year-old male
presented with a self-limiting
episode of seizure in
emergency department. He is
known to have epilepsy which
is well controlled with
carbamazepine for last 12
months. Blood tests do not
show any abnormality and
there is no obvious cause of
the seizure identified.
Patient is keen to know for
how much time he is not
allowed to drive?
a. 4 weeks
b. 3 months
c. 6 months
d. 12 months
e. 3 years
Answer detail:
The correct answer is b.
When a person develops
seizure while being well
controlled on medication
without seizure for 12 months
and no cause of seizure is
identified, patient should not
drive for 3 months.
After 3 months if he remains
seizure-free, he may be
eligible for conditional driving
license after medical review.
Compliance to medication and
good seizure control are key
requirements for driving
license in a patient with
epilepsy.
If a provoking factor (sleep
deprivation, electrolyte
abnormality, alcohol abuse) is
found which lead to seizure
activity and if it can be
avoided, then for 4 weeks,
patient should not drive.
After finishing 4 weeks,
patient should be considered
for conditional driving license
after medical review
The above information is also
available on
www.austroads.com.au.
102. A 42-year-old woman came
to your clinic for advice. She
is a secretary in an office and
she smokes. She does self-
breast examination every
month and clinical
 examination of her breast by
her general practitioner every
2 years. She also does some
physical activity at work and
during leisure time.
Which ONE of the following is
will lower the risk of breast
cancer?
a. Smoking
b. Self-breast examination
c. Physical activity at work
d. Clinical breast
examination
e. All of the above
Answer detail:
The correct answer is c.
There has been a consistent
evidence that physical activity
at work and during leisure
time reduces the risk of breast
cancer by 20-40% in women
of both reproductive and non-
reproductive age.
Self-breast examination and
regular clinical examination of
the breast is no longer is
recommended as evidence
suggest that these tools do
not decrease the number
deaths from breast cancers.
Smoking increases the risk of
developing breast cancer.
103. A 37-year-old woman
comes to your clinic with
concerns about breast
cancer. Her mother was
diagnosed with breast cancer
at the age of 60 years. She is
asymptomatic and her clinical
examination is normal.
What is the most appropriate
next step in her
management?
a. Mammography
b. Ultrasound
c. Weekly self-breast
examination
d. Refer for screening
mammography every year
e. Reassure
Answer detail:
The correct answer is e.
Annual breast cancer
screening is recommended for
women aged 40 years or over
who have one or more of the
following criteria:
-A first-degree relative
(mother/sister/daughter,
father/brother/son) with
breast cancer diagnosed
before the age of 50.
-A first-degree relative with
cancer in both breasts
(diagnosed at any age).
-Two or more first-degree
relatives with breast cancer
(diagnosed at any age).
So this patient does not need
mammogram now and needs
reassurance.
For general population, breast
cancer screening is aimed at
well women without
symptoms, aged between 50
and 69 years (women aged
40-49 and 70 years and older
are also able to attend if they
wish).
Ultrasound is only indicated if
patient develops lump in the
breast and needs further
evaluation before the age of
40. It is not helpful in the
presence of normal clinical
examination.
Mammography is not useful
before the age of 40 due to
dense breast tissue.
104. A female psychologist is
treating a 25-year-old male
patient for complicated grief
related to the death of his
parents in an automobile
crash. The psychologist lost
her own parents when she
was a university student. She
identifies herself strongly
with this patient. The
psychologist often sees him
after regular clinical hours
and usually cancels her other
appointments in order to see
him on a short notice.
Which one of the following
ethical pitfall is this
psychologist in danger of
committing?
a. Breach of confidentiality
b. Divided loyalties as a
dual agent
c. Erosion of professional
boundaries
d. Practicing outside his
scope of clinical competence
e. Abandonment of the
therapeutic alliance
Answer detail:
The correct answer is c.
This clinical scenario involves
a patient who can be
considered difficult because
he resembles the clinician in a
way that threatens her ability
to maintain professional
boundaries.
Potential non-sexual boundary
violations include:
- Excessive self-disclosure.
- Special fee arrangements.
- Extending time beyond what
was initially agreed.
- Allowing telephone calls
between sessions.
- Extra-therapeutic business
relationships.
- Socializing with the patient.
- Calling each other by first
name.
- Treating the patient as a
friend and touching or
frequent hugs.
Abandonment of the
therapeutic alliance describes
a situation in which clinician
may pay less attention to a
patient. This may encourage
the patient to leave treatment.
Confidentiality breaches occur
when clinicians share
information about patients
with others inappropriately.
If a doctor works for any
federal agency, confidentiality
cannot be warranted. This is
an example of divided
loyalties as a dual agent.
105. Which one of the following
malignancies carries the
worst prognosis?
a. Metastatic
choriocarcinoma
b. Metastatic seminoma
c. Hodgkin lymphoma
d. Non-Hodgkin lymphoma
e. Metastatic breast
carcinoma
Answer detail:
The correct answer is e.
Breast cancer is the most
common cancer in women in
Australia and the second most
common cancer to cause death
in women, after lung cancer.
As many as 40% of women
with recurrent or metastatic
breast cancer survive at least
five years. The median
survival for patients with
metastatic (stage IV) breast
cancer is 18 to 24 months.

Amongst the all given options,
metastatic breast cancer
carries the worst prognosis.
Seminoma of the testis is
associated with a good
prognosis, with most tumours
following an indolent course.
In cases without evidence of
lymphatic spread, 5 year
survival approaches 100%.
Even in the presence of early
lymphatic spread, five year
survival is approximately
95%.
Choriocarcinoma is a highly
malignant germ cell tumour
which usually follows an
abnormal pregnancy with a
hydatidiform mole. It may also
occur after a spontaneous
abortion.
The tumour metastasizes
early, by means of vascular
invasion and blood spread.
When combined, surgery and
cytotoxic chemotherapy, lead
to improved survival prognosis
more than 80% survival in 5
years.
Lymphomas are the most
common form of
haematological or blood
cancer in Australia, and the
sixth most common form of
cancer overall. There are two
main types of lymphoma-non-
Hodgkin lymphoma and
Hodgkin lymphoma. More than
90% of lymphomas are non-
Hodgkin.
For people diagnosed with
Hodgkin lymphoma, prognosis
is generally good, with a five
year survival rate of more
than 87% in Australia.
People diagnosed with non-
Hodgkin lymphoma in
Australia have a five year
survival rate of 71%.
106. A 45-year-old woman
presented for assessment.
She is concerned about her
risk of developing ovarian
cancer. She has been using
oral contraceptive pills until 2
years ago when she was
diagnosed with BRCA-1
positive breast cancer. Her
mother was diagnosed with
ovarian cancer at the age of
65.
Which ONE of the following
carries the lowest risk for
developing ovarian cancer?
a. Oral contraceptive pills
b. Age more than 40
c. BRCA-1 positive breast
cancer
d. Family history of ovarian
cancer
e. None of the above
Answer detail:
The correct answer is a.
Previous use of oral
contraceptive pills carry a
very small risk of developing
ovarian cancer. So this is the
correct
Answer.
Age more than 40 is not a risk
factor for developing ovarian
cancer.
Family history of ovarian
cancer and personal history of
SPCA-1 positive breast cancer-
both of these put this woman
at very high risk for
developing ovarian cancer.
107. A 38-year-old male
presented to your office for
evaluation. He has fair skin
color and no history of
 sunburns as a child. He has
tendency to tan rather than
burn when exposed to
sunlight. Past medical history
include excision of a skin
lesion from the right leg
which was squamous cell
carcinoma with clear edges.
Which ONE of the following
the highest risk factor for
developing another squamous
cell carcinoma?
a. Fair skin color
b. Tendency to tan rather
than burn
c. Absence of sunburns as
a child
d. Past history of
squamous cell carcinoma
e. Age
Answer detail:
The correct answer is d.
Following is list of factors
which put a person at the
highest risk of developing
squamous cell carcinoma of
the skin:
-Age over 40
-Past history of non-melanoma
skin cancers
-Tendency to burn rather than
tan when exposed to sun
Fair complexion is a risk factor
for developing squamous cell
carcinoma of the skin however
it is not useful in assessing
the severity of the risk factors
contributing to the disease.
So this patient is younger than
40, has tendency to tan rather
than burn. So these are not
correct options. Past history
of squamous cell carcinoma of
the skin is a big risk factor for
developing another similar
lesion.
108. A-14-year-old girl, who has
left the house and is living in
a shelter, came to you for
certain treatment. While
having consultation, she says
that she is fed up of living in
the shelter. But she left
house because of domestic
violence. You also notice that
she has numerous bruises
and scratches on her face and
hands.
What will be the appropriate
next step?
a. Ask her to go back to
friends/parents' house
b. Ask her to visit your
clinic every day
c. Inform the police
d. Give the number of child
protection agency
e. Visit her shelter
Answer detail:
The correct answer is c.
Both child protection and
domestic violence mandatory
reporting requirements vary
considerably among
Australia's states and
territories.
Under mandatory child
protection reporting
requirements, a range of
professionals, such as health
professionals, teachers and
welfare workers are required
to report to the police or child
protection authorities any
child they suspect is being
abused.
Most Australian jurisdictions
do not have mandatory
reporting requirements for
domestic violence.
Under the Northern Territory's
Domestic and Family Violence
Act, however, any adult must
report domestic violence to
the police if they reasonably
believe that a person has or is
likely to suffer serious
physical harm. On receiving a
report of domestic violence, a
police officer must take
reasonable steps to ensure
that the report is investigated
This girl is likely to suffer
harm or violence and police
must be notified immediately
to help her and ensure her
safety. Police will further
involve child protection
services.
Giving her contact number for
child protection services is not
appropriate as this will not
ensure safety of this domestic
violence victim.
109. A 12-month old male child
is brought to your office by
his mother. He has a history
of anaphylactic reaction to
egg 6 months ago.
Which of the vaccines he
would need medical
supervision in hospital
settings and in split doses?
a. Measles, mumps, rubella
vaccine
b. Influenza vaccine
c. Inactivated polio vaccine
d. Pneumococcal vaccine
e. Hepatitis A vaccine
Answer detail:
The correct answer is b.
All patients who have an
anaphylactic reaction to the
egg should receive following
vaccines in split doses under
medical supervision in
hospital settings.
-Influenza
-Yellow fever
-Q fever
All patients who have an
allergy to egg but not the
anaphylactic reaction can be
given these vaccines as a
single dose.
MMR (measles, mumps, and
rubella) vaccine can be given
safely to children who have an
egg allergy. This vaccine is
made from chicken fibroblasts
and not from egg proteins.
110. A 45-year-old father was
recently diagnosed with
tuberous sclerosis. His wife
does not have the gene for
this disease.
What is expected of his
children in relation to
inheriting the disease?
a. Half normal, half
affected
b. Half of sons affected,
half of daughters carrier
c. None affected, half
carrier
d. All carriers, none
affected
e. Variable inheritance
Answer detail:
The correct answer is a.
Tuberous sclerosis is an
autosomal dominant disorder
therefore half of the offspring
will be affected, and half will
be normal.
It is due to mutation in
chromosomes 9 and 16. The
triad includes facial rash,
intellectual disability and
seizures.
111. A 60-year old male
presented for your opinion.
He is alcohol dependent and
is very keen to get treated.
You plan to administer
naltrexone.
Which one of the following
statement is true regarding
naltrexone?
a. It is given for chronic
marijuana users
b. It is ideal for
intravenous drug user since it
is long acting
c. It is a substitute for
methadone
d. It is a generic name for
naloxone
e. It is short acting
Answer detail:
The correct answer is c.
Naltrexone is essentially a
pure opiate antagonist.
Naltrexone is a long-acting
opioid antagonist which is
well-absorbed orally.
A severe withdrawal reaction
may be precipitated if the
patient has recently taken
heroin or another opioid.
It is recommends that
naltrexone is not commenced
until 7 to 10 days after the
last use of heroin. If heroin or
another opioid is taken by a
patient who has already been
taking naltrexone, all opioid
effects are blocked.
It is not used in management
of marijuana users.
It is mainly used in treatment
of alcohol dependence and
maintenance of opioids
abstinence. Naltrexone is a
substitute of methadone in
maintenance of opioid
abstinence. Both methadone
and naltrexone should not be
prescribed together.
Naltrexone is contraindicated
in:
1. Patients receiving opioid
analgesics.
2. Patients currently
dependent on opioids since an
acute withdrawal syndrome
may ensue.
3. Patients in acute opioid
withdrawal.
4. Any individual with acute
hepatitis or liver failure.
112. A 25-year-old Australian
woman, up to date with her
immunizations, now
presented to your office for
medical advice. She is
planning to travel to India in
next few weeks.
What vaccination you should
consider for her?
a. Pneumococcal
b. Meningococcal
c. Tetanus toxoid and
diphtheria
d. Typhoid
e. Cholera
Answer detail:
The correct answer is c.
In Australia, until the age of
13, she must have received
vaccines against polio,
hepatitis 8, measles, mumps,
rubella, diphtheria, pertussis,
tetanus, H.influenza and
human papilloma virus.
However, the protection
against tetanus requires an
initial course of 3 injections
followed by a booster every
ten years. So she is due to
have tetanus toxoid booster.
This applies to all travelers to
all countries.
Cholera vaccine is not
officially recommended by
WHO because it has only
limited effectiveness. Vaccine
against typhoid is can be
considered while travelling to
India due to poor standards of
sanitation if patient
volunteers.
Pneumococcal vaccine should
only be considered only in
high-risk individuals.
113. A 6-year-old child is
brought for assessment of his
skin problems by his parents.
You suspect atopic dermatitis
as a possible diagnosis and
advise topical corticosteroids.
Parents of the child are not
willing to use steroids for
their child.
What will you do next?
a. Request a court order
b. Notify police
c. Notify child protection
services
d. Cancel the steroid
prescription
e. Refer for second opinion
Answer detail:
The correct answer is c.
The gold standard for
treatment of atopic dermatitis
is topical corticosteroids. So
cancelling the prescription is
not appropriate.
There has been a court case in
Australia where a child was
diagnosed with atopic
dermatitis and parents did not
use the steroids prescribed by
their general practitioner. The
child died due to secondary
sepsis from non-healing
dermatitis.
So now it is advised to protect
a child from abuse by the
beliefs of their parents that
could potentially be harmful to
the child. It is moral and
ethical obligation to make a
formal report to the local child
protection services.
A court order to treat the child
may be granted after
intervention by child
protection services however it
is not the next best step.
114. A 33-year-old woman is
visiting you in your primary
care office as a new patient.
She is healthy otherwise. Her
mother was diagnosed with
colorectal cancer at the age
of 50.
When should this patient be
screened for colorectal
cancer?
a. At the age of 40
b. At the age of 50
c. At the age of 60
d. At the age 30
e. There is no proven
benefit for colorectal cancer
screening
Answer detail:
The correct answer is a.
Screening for bowel cancer
should begin approximately 10
years before the age of
diagnosis of colorectal cancer
in a first-degree relatives like
parent or sibling.
Given that this patient's
mother was diagnosed at the
age of 50, this patient should
have screening at age 40.
The natural history of a colon
polyp to develop into cancer is
thought to be 10 years.
Colorectal cancer screening
has proven mortality benefit
and it is wrong to say that it
has no proven benefit.
115. A 47-year-old male
presented for his regular
health checkup. He is
normotensive and is not over
weight. He plays golf
occasionally on weekends and
drinks alcohol 70 grams per
day.
What would be the most
likely cause of death in next
10 years?
a. Stroke
b. Cirrhosis of liver
c. Ischemic heart disease
d. Accident
e. Suicide
Answer detail:
The correct answer is d.
A standard alcohol drink
contains 10 grams of alcohol.
A male can drink up to 2
standard drinks per day and it
reduces risk of alcohol related
injuries significantly. This
patient is drinking 70 g/day
which makes it 7 standard
drinks daily.
This is heavy alcohol abuse
and can lead to short term as
well as long term problems.
Acute alcohol intoxication is
the most common cause of
alcohol-related problems,
leading to injuries and
premature deaths. It accounts
for two-thirds of the years of
life lost from drinking.
Alcohol is responsible for 30%
of road accidents, 40% of fire
injuries, 34% of falls and
drowning, 16% of child abuse
cases and 12 percent of
suicides.
Alcoholic liver cirrhosis is the
most common cause of death
amongst those who survive
through acute intoxication.
More people die from
accidents related to alcohol
and relatively less number of
people suffer from cirrhosis
and die each year in Australia.
So d is correct response here.
Other causes of death
secondary to alcohol abuse
include stroke, ischemic heart
disease, falls and suicide.
116. You are working as a GP in
a rural area and your next
patient is chronic abuser of
marijuana.
Which of the following is
correct regarding chronic
marijuana abuse?
a. Incidence of COPD
decreases
b. Masks underlying
psychosis
c. Reduces anxiety
d. Impairs the ability to
drive car
e. Increases job
performance
Answer detail:
The correct answer is d.
Chronic marijuana abuse
causes following main issues:
- Laryngitis
- Chronic obstructive
pulmonary disease.
- Unmasks underlying
psychosis and increases
anxiety.
- Impairs the ability to drive a
car.
- Decreases performance at
job.
117. An 82-year-old man
presented with multiple
bruises on various body
parts. He performed serial-7
test very efficiently. He lives
with his daughter and tells
you that his daughter's
boyfriend abused him
physically. He strictly forbids
you from informing the police
as he believes that he could
tackle the situation by
himself at home.
What would be your approach
in this case?
a. After management of
bruises let him go to home
b. Arrange regular follow
up but keep his secret
c. Ask him Li see the social
worker before he leaves
hospital
d. Inform the daughter
about abuse so that she
knows what is going on
e. Notify the police
immediately
Answer detail:
The correct answer is b.
If an elderly man is found to
have been abused physically,
financially, sexually or
neglected intentionally or
unintentionally, it is your
responsibility to help him out.
If he can decide, informed
consent is an essential step to
proceed. The elderly person's
right to decline assistance
should be respected.
If an elderly person has no
capacity, then guardian or
caretaker should be contacted
for consent. After consenting,
a social worker should be
involved to organize a family
meeting to assess the
situation.
So In this situation you should
follow up this patient to
review for complete healing of
bruises and possible
monitoring of the situation.
He has done serial-7 test
which showed he is having
good cognition and capacity to
decide. However, if he
declines to consent for
reporting to the police, it must
be respected.
118. Which ONE of the following
is the most common
preventable cause of non-
melanoma skin cancers?
a. Exposure to arsenic
b. Exposure to ultraviolet
radiation
c. Heart transplant
d. Renal transplant
e. Family history of skin
cancer
Answer detail:
The correct answer is b.
In Australia, the most common
preventable cause of non-
melanoma skin cancer is
ultraviolet radiation exposure.
Other options (exposure to
arsenic, immunosuppression
post-heart and renal
transplant, family history of
skin cancer) increase the risk
of developing non-melanoma
skin cancer however exposure
to ultraviolet radiation is the
most common preventable
cause of these cancers.
119. You are working in a rural
hospital emergency
department. Your next
patient is a 20-year-old male
who had minor trauma to his
left leg while he fell from his
motorbike this morning.
His wound looks clean
however he does not
remember clearly about
status of tetanus vaccination.
What is most appropriate
management for him?
a. Tetanus Toxoid
b. Tetanus
immunoglobulins 250 units
intramuscularly
c. Tetanus toxoid and
tetanus immunoglobulins
d. Give intravenous
antibiotics and tetanus
immunoglobulins
e. Give oral antibiotics and
tetanous toxoid
Answer detail:
The correct answer is a.
All the partially immunised
and un-immunised adults
(also those who cannot
remember their immunisation
status) should receive active
immunisation with tetanus
toxoid.
The primary series for adults
consists of three doses.
First and second dose are
given four weeks apart and
third dose is given by 6 to 12
months.
A clean wound with clear
history of tetanus vaccination
status more than 3 doses does
not require both tetanus
toxoid and tetanus
immunoglobulins.
Intravenous and oral
antibiotics are usually
reserved for dirty wounds and
cellulitis.
However clean wound does
not need antibiotics at all.
120. A 13-year-old girl comes to
your clinic for an advice on
contraception. She informs
you that she is in a
relationship with her
boyfriend and they are
planning to go on a trip out
of the state.
What is the best next step?
a. Immediately call her
father and ask him to consent
for his minor daughter
b. Give the prescription
and educate about prevention
of sexually transmitted
infections
c. Make an appointment
next week to see her and her
boyfriend at your clinic
d. Contact the
guardianship board and get a
consent over phone
e. Advise her not to go out
with her boyfriend
Answer detail:
The correct answer is b.
In Australia, a medical
practitioner is required to get
consent from parents about
treating minor (less than 16
years).
However when writing a
prescription of contraception,
it is required to prevent
unwanted pregnancy and
sexually transmitted
infections by use of condoms.
So the best way of doing this
is to give a prescription of
contraceptives and educate
her how she can prevent
unwanted pregnancy and
sexually transmitted
infections.
All other options are not
correct in Australian health
system.
121. You are working in a GP
clinic. One of your female
patients invites you for a
dinner outside with clearly
romantic intentions. You feel
she is attracted towards you.
How will you proceed?
a. Accept the offer and
plan a meeting outside
b. Decline the request and
continue doctor-patient
relationship c. Decline the
request and discontinue
doctor-patient
relationship
d. Tell her that its
inappropriate meet her
outside but still I will
manage to come
e. Notify the management
for in-appropriate behavior of
the patient but still
continue doctor-patient
relationship
Answer detail:
The correct answer is c.
There are certain situations
when a doctor-patient
relationship can be
terminated.
These include:
- Professional boundary
violations by the patient or
doctor.
- Unacceptable behavior of the
patient like verbal abuse,
threatened or actual violence
and harassment.
This patient has violated the
boundary where it is hard to
continue health care in
professional manners. So
according to guidelines by
Australian Medical
Association, in such situations
doctor-patient relationship
should be terminated however
with due respect for the
patient.
Patient should be notified and
offered to transfer a copy of
her medical record to new
health care provider.
Ending the doctor-patient
relationship should not be
misinterpreted by the patient
as an act of discrimination
based on gender, sexual
preference, race, marital
status, disability, age and HIV
status.
Also you should continue care
if the patient is suffering an
acute illness. In such situation
the patient is entitled to have
appropriate continuity of care
and doctor-patient
relationship should not be
terminated.
122. A 75-year-old male is
brought to the hospital with
reduced level of
consciousness. CT scan of the
head showed epidural
haematoma which requires
non-urgent surgery. You are
unable to discuss the
procedure with the patient
due to decreased level of
consciousness. His spouse
and the eldest son are
present at the scene. His
 spouse says that her husband
never wanted to come to the
hospital and would never
want to be resuscitated or
any surgery on him. His son
requests you to do everything
possible to save his father's
life.
How will you proceed in this
situation?
a. Listen to his son
b. Arrange a family
meeting to reach the
consensus
c. Apply for guardianship
d. Listen to his spouse
e. Request the medical
suprintendent to assess the
patient capacity
Answer detail:
The correct answer is d.
If a person cannot give
consent for their own
treatment and there is no
advance health directive
present, a health practitioner
should obtain consent from
the "person responsible” in
this situation, patient’ spouse
can consent for the patient
future treatment. A spouse
opinion is considered more
valid and appropriate than
sons and daughters.
So in this case listen to the
wife and discuss about the
wishes of the patient. Try to
find out whether patient was
competent or not when he
expressed such wishes.
When no advance health
directive is present and no
spouse or family members or
career is present, a medical
superintendent or authorized
medical officer can decide for
life saving emergency surgery
while considering the patient
incompetent to make a
decision.
Application for Guardianship is
required for all those patients
who lack the capacity to
decide about their treatment
however it usually takes few
days to process.
Under the Guardianship Act
1987, a 'person responsible'
can make decisions about
most medical or dental
treatments.
A 'person responsible' is, in
order of priority:
1. The legally appointed
guardian of the person
(including enduring guardian)
with the function of
consenting to medical/dental
treatment. Or if there is no
guardian
2.Their spouse or de facto
spouse or same sex partner,
or if there is no spouse or de
facto spouse or same sex
partner.
3. Their unpaid career or, if
there is no career.
4. Their relative or friend who
has a close relationship with
the person.
123. All of the following
situations allow
confidentiality and privacy of
the patient to be breached
except?
a. When the patient
consents to allow personal
details to be revealed to a
third party
b. If there are other health
professionals who have a
legitimate therapeutic
interest in the care of the
 patient including medical
students
c. If there are other health
professionals who have a
legitimate therapeutic
interest in the care of the
patient excluding medical
students
d. If there is overriding
public interest
e. Where disclosure of the
information is required or
permitted by operation of
the law
Answer detail:
The correct answer is b.
There are few instances when
the patient's privacy and
confidentiality may be
breached. These include:
1. When the patient consents
to allow, personal details to
be revealed to a third party
such as insurance companies
etc.
2.1f there are other health
professionals who have a
legitimate therapeutic interest
in the care of the patient (this
does not include medical
students).That is, another
doctor may read the case
notes.
So option b is correct choice
here.
3. If there is overriding public
interest.
This is not well defined, but if
the patient was about to
commit, or has committed a
serious crime including
murder, rape, child abuse or
an act of terrorism, or was the
victim of a serious offence,
then an appropriate authority
such as the police should be
informed to reduce likely
associated risks.
4. Where disclosure of the
information is required or
permitted by operation of the
law.
5. Remember, the duty of
confidentiality includes
patients under the age of 18
years who do not want their
parents notified.
A breach of this duty made
lead to civil action for
damages.
124. A 65-year-old male
presented with ischemic
cardiac chest pain.
Electrocardiographic changes
were consistent with inferior
STEW. Emergency angiogram
was performed which showed
triple vessel disease. He
underwent coronary artery
bypass graft next day. He is
commercial driver and is
keen to know if he can
continue driving.
What will be the most
appropriate advice?
a. He is unfit to drive for 2
weeks
b. No commercial driving
for 3 months
c. He can drive as private
car as long as he feels fine
d. No driving restriction
e. Write a letter to road
safety department
Answer detail:
The correct answer is b.
After coronary artery bypass,
a person should not drive a
commercial vehicle for 3
months and private vehicle for
4 weeks.
This is driver's responsibility
to notify the road safety
department about their
condition and health
practitioners are not legally
required to do this in
Australia.
125. What is most common
cause of hepatitis C in
Australia?
a. Blood transfusions
b. Intravenous drug abuse
c. Needle stick injuries at
workplace
d. Vertical transmission
from mother to baby
e. Male to male sexual
transmission
Answer detail:
The correct answer is b.
Most common cause of
hepatitis C in Australia is
intravenous drug abuse in the
community.
Intravenous drug abusers are
at the highest risk of acquiring
hepatitis C and other
infections like HIV, hepatitis B
and syphilis by needle sharing
and using already used
needles.
126. A 14-year-old child
developed acute rheumatic
fever after untreated
streptococcal throat infection
Which of the following is the
best measure to prevent
future attacks of acute
rheumatic fever in this child?
a. Penicillin injection every
month
b. Azithromycin every
month
c. Ciprofloxacin every day
for first 6 months
d. Penicillin injection every
year
e. No further antibiotics
needed
Answer detail:
The correct answer is a.
If a child develops acute
rheumatic fever, he/she is at
high risk of getting another
streptococcal throat infection
and thus develop acute
rheumatic fever.
The most important step to
prevent this from happening
is regularly monthly injection
of penicillin. These injections
should be continued for many
years and should only be
stopped on a specialist doctor
advice.
Azithromycin and
ciprofloxacin are not used for
prevention of acute rheumatic
fever.
127. A 65-year-old male,
commercial driver by
profession, presented with
left hemiparesis and left
homonyms hemianopia. He is
making good recovery.
Which of the following is
most appropriate step
regarding driving?
a. Permanent restriction to
drive
b. Driving assessment
supervised by an
occupational therapist c.
Do not drive for two weeks
d. Refer to neurologist to
decide for fitness to drive
e. Continue driving until
police is notified

Answer detail:
The correct answer is b.
A person is unfit to drive
following a stroke or transient
ischemic attack until the
resolution of neurological
deficit.
Once there is no residual
deficit and there is minimal
risk of recurrence by
commencing secondary
prophylaxis, patient should be
assessed by an occupational
therapist for fitness to drive.
Any patient who has
persistent hemianopia after
stroke, he/she must be
assessed by an occupational
therapist as well as an
ophthalmologist fitness to
drive.
After assessment it will be
decided whether this patient
fulfills the requirements to
continue driving a commercial
vehicle.
128. Which of the following is
the most common type of
lung cancer in people who
never smoke?
a. Adenocarcinoma
b. Squamous cell
carcinoma
c. Small cell carcinoma
d. Non-small cell lung
cancer
e. Benign pulmonary
nodule
Answer detail:
The correct answer is a.
Adenocarcinomas are the most
common type of lung cancer
occurring in never smokers.
Adenocarcinoma is also more
common in women and young
adults (below 60).
Adenocarcinomas often occur
in more peripheral lung
locations and may also be
associated with a history of
smoking.
Squamous cell carcinoma and
small cell cancer are strongly
associated with smoking.
129. You are a local GP in an
Aboriginal Community. You
are seeing more patients with
mental health issues. One of
your patients has committed
suicide 4 weeks after he
visited you. You plan to
screen patients for
depression.
Which ONE of the following
question has the highest
specificity for depression?
a. Do you feel sad?
b. Over the past 2 weeks,
have you felt down,
depressed or hopeless?
c. Do you suffer from any
mental illness?
d. Do you drink alcohol?
e. Do you smoke?
Answer detail:
The correct answer is b.
The depression is quite
common in Aboriginal
communities. A "yes" answer
to following two questions
has, more than 100%
sensitivity and 12.5%
specificity to the diagnosis of
depression.
1-Over the past 2 weeks, have
you felt down, depressed or
hopeless?
2-Over the past 2 weeks, have
you felt little interest or
pleasure in doing things?
So if you plan to do screening
for depression in Aboriginal
Community, these two
questions have the highest
sensitivity and specificity.
130. A 65-year-old male
presented to your office for
blood tests he had last week.
He had high-risk sexual
behavior in the past and anti-
HIV antibodies are detected
in his serum.
What is the most appropriate
management?
a. Give him antibiotics
b. Start zidovudine
c. Repeat the test in 4
weeks
d. Enzyme immunoassay
and western blot
e. Give prophylaxis against
pneumocystis carinii
Answer detail:
The correct answer is d.
The diagnosis of HIV infection
depends on the demonstration
of antibodies to HIV and/or
the direct detection of HIV or
one of its components.
Antibodies to HIV generally
appear in the circulation 3-12
weeks following infection.
Requesting anti-HIV
antibodies on a blood test is
done for screening purpose. If
the antibodies are detected,
further confirmation is
needed.
The standard blood screening
test for HIV infection is the
ELISA, also referred to as an
enzyme immunoassay.
The most commonly used
confirmatory test for HIV is
the Western blot.
131. A 34-year-old male
presented for health check-
up. He is heavy smoker,
alcoholic and non-obese. His
blood pressure is 170/95.
Serum cholesterol is
6.2mmol/L.
His father died at the age of
50 with myocardial infarction.
Which of the following carries
the highest risk of coronary
artery disease?
a. Hypercholesterolemia
b. Hypertension
c. Smoking
d. Alcohol
e. Family history of heart
disease
Answer detail:
The correct answer is a.
Hypercholesterolemia
accounts for between 30 to
40% of all coronary artery
disease related deaths.
Hypertension accounts for
between 20 to 25% of all
coronary artery disease
related deaths.
Smoking accounts for about
17% of all deaths related to
coronary artery disease.
Risk of heart disease
increases in patients with
family history of heart disease
however it is lower than the
risk of coronary artery disease
with hypercholesterolemia,
hypertension and smoking.
Alcohol can result in
hypertension and cause
cardiomyopathy. However it is
not the correct response in
this situation.
So in this patient,
hypercholesterolemia carriers
the highest risk of coronary
artery disease.
132. A health practitioner, who
is your colleague as well, has
been involved in sexual
relationship with one of his
24 year old female patient.
The female has consented to
the relationship.
Which one of the following
statement is correct
regarding this situation?
a. It is not permissible to
have sexual relationship with
a patient even if she has
consented
b. It is permissible to have
sexual relationship with a
patient as she has consented
c. A doctor can only have
sexual relationship with
his/her former patients
d. A doctor can only have
sexual relationship with
his/her exiting patients
e. A sexual relationship
with the career of the patient
is not unethical
Answer detail:
The correct answer is a
Good medical practice relies
on trust between doctors and
patients and their families.
It is always unethical and
unprofessional for a doctor to
breach this trust by entering
into a sexual relationship with
a patient, regardless of
whether the patient has
consented to the relationship.
It may also be unethical and
unprofessional for a doctor to
enter into a sexual
relationship with a former
patient, an existing patient's
career or a close relative of an
existing patient, if this
breaches the trust the patient
placed in the doctor.
133. A 28-weeks pregnant lady
comes to a general practice,
with a presenting complaint
of a gush of clear fluid. On
Speculum examination,
premature rupture of
membranes is confirmed with
closed cervix.
In addition to transferring to
tertiary care, what is the
most appropriate
management?
a. Betamethasone
b. Nifedipine
c. Salbutamol
d. Cardiotocography
e. Urgent ultrasound
Answer detail:
The correct answer is a.
This patient is at 28 weeks of
gestation and presented with
gush of clear fluid. Speculum
examination has confirmed
premature rupture of
membrane (PROM).
Approximately, 50% of PROM
progress to labor within 24
hours and 80% within seven
days. The most important next
step would be to transfer this
patient to tertiary care
hospital as soon as possible.
Also, give corticosteroid
(Betamethasone) therapy if
delivery prior to 34 weeks
likely, for fetal lung maturity.
Cardiotocography (CTG) is
usually not available in
general practice settings, and
it can be done while in the
hospital. Induce labor if CTG is
abnormal or infection present.
There is no role of salbutamol
and nifedipine as she is not in
the labor and does not require
tocolytics.
134. A 25-year-old pregnant
nurse presented for routine
antenatal checkup in her first
trimester. She is concerned
about her Influenza
vaccination as she never got
this vaccination in the past.
She is not allergic to any food
or anything else.
What would be the most
appropriate advice to this
female regarding her
influenza vaccination?
a. Defer the vaccination till
third trimester
b. Defer the vaccination
until after delivery
c. Defer the vaccine, but
ask the nurse to wear mask
regularly d. Defer the
vaccine, but ask the nurse to
wash hands frequently
e. Give vaccine now
Answer detail:
The correct answer is e.
The Western Australian
Department of Health
recommends that all pregnant
women be offered influenza
vaccination as part of routine,
comprehensive, antenatal
care.
Influenza vaccination for
pregnant women is also
recommended by the Royal
Australian and New Zealand
College of Obstetricians and
Gynaecologists, the National
Health and Medical Research
Council and the Australian
Technical Advisory Group on
Immunizations.
Immunization is advised for
all pregnant women during
any stage of pregnancy.
Vaccination early in the
annual flu season, generally
around March, is optimal, but
can occur at any time. So
there is no need to defer the
vaccination till third trimester
or after delivery.
Pregnant females, due to
decreased immunity, are at
increased risk of severe attack
of influenza therefore the only
use of mask is not the most
suitable advice.
Influenza virus is spread via
respiratory droplets so hand
washing has no role in its
prevention. Influenza
vaccination is contraindicated
in people with severe egg
allergy or severe allergic
reaction to previous influenza
vaccine dose.
So all pregnant women should
be vaccinated against
influenza. The
killed/inactivated vaccine that
is usually given by
intramuscular route, is safe
throughout pregnancy while
live attenuated type, given by
intranasal route should be
avoided in pregnancy.
135. A 38-year-old woman
presents to your clinic for
advice. She has glucose
intolerance and BMI 35. All
other blood tests are
reported normal.
What would be the best
approach?
a. Diet and exercise
therapy
b. Gastric bypass surgery
c. Life style modification
and orlistat
d. Review in 2 years e.
Metformin
Answer detail:
The correct answer is c.
This patient has stage 3
obesity and abnormal glucose
tolerance test. The best
approach would be to consider
life style modification (dietary
habits, physical activity, and
behavior modification) and
commence orlistat.
Glucose intolerance is usually
managed with diet and
exercise therapy alone. If
patient is able to lose weight,
glucose intolerance will
improve itself.
General principle of
management of obesity
include:
1-BMI 25-26.9 diet and
exercise therapy alone
2-BMI 27-29.9 without co-
morbidities diet and exercise
therapy alone
3-BMI 27-29.9 co-morbidities
diet and exercise therapy if
failed consider
pharmacotherapy
4-BMI 30-35 with or without
co-morbidities diet and
exercise therapy and
pharmacotherapy
5-BMI more 35-40 with co-
morbidities consider
pharmacotherapy plus gastric
surgery
6-BMI more than 40 gastric
surgery
Co-morbid conditions to
consider in the above
guidelines include established
coronary heart disease,
presence of other
atherosclerotic diseases, such
as peripheral arterial
diseases, abdominal aortic
aneurysm, and symptomatic
carotid artery diseases, type 2
diabetes, and sleep apnea.
Bariatric surgery can be
considered for patients with
severe obesity (BMI 40kg/m2)
or those with moderate
obesity (BMI 35 kg/m2)
associated with a serious
medical condition.
Orlistat (Xenical) is a lipase
inhibitor and a potent, slowly
reversible inhibitor of
pancreatic, gastric, lipases
and phospholipase A2, which
are required for the hydrolysis
of dietary fat into fatty acids
and monoacylglycerols.
The drug acts in the lumen of
the stomach and small
intestine by forming a
covalent bond with the active
site of these lipases.
136. A 16-year old girl is
brought with a deep
laceration on the forearm in
Australian Capital Territory
(ACT) hospital emergency.
You explained her the
complications of not suturing
it, and she seems to
understand. She still refuses
 to have sutures. Her mother
agrees with you to suture it.
What will you do in this
situation?
a. Suture the wound under
general anaesthesia
b. Put stern taps and apply
a bandage
c. Get a psychological and
mental assessment
d. Send to the family court
e. Suture the wound under
nerve block
Answer detail:
The correct answer is e.
The age at which a person
becomes an adult in Australia
is 18 years. Consent for the
medical treatment of patients
less than 18 years old is
provided by parents.
In general, Australian law
recognizes that individuals
aged 18 years and over have
full legal capacity, such that
they are capable of making
decisions relating to their
health care. Before that age,
parents (or legal guardians)
are entitled to consent to their
child's medical and dental
treatment.
If the situation is complicated
or unable to be resolved, then
the jurisdiction for decision-
making lies with the Family
Court of Australia and the
Supreme Court.
In this case, health
practitioner and the mother of
the young girl agree on a
treatment, and it should be
provided. Also, this is in the
best interest of the child in
this emergency situation. So
suture the wound under nerve
block.
The legislation regarding the
age of the child to consent is
different in each state.
In South Australia, the age of
consent for medical treatment
is 16, in New South Wales, it
is 14 and in ACT, it is 18.
137. Which of the following
would increase the risk of
breast cancer in post-
menopausal women?
a. Hypertension
b. Hyperlipidemia
c. Obesity
d. Breastfeeding up to six
months
e. Physical activity for 30
minutes daily
Answer detail:
The correct answer is c.
Obesity is a risk factor for the
development of breast cancer
in post-menopausal women.
Hyperlipidemia and
Hypertension, both are not
related to the increased
likelihood of breast cancer.
Exclusive breastfeeding for up
to 6 months and active
lifestyle decreases the risk of
breast cancer development.
138. A 62-year-old male
presented for absolute
cardiovascular risk
assessment. He has past
medical history include type
II diabetes mellitus and his
albumin creatinine ratio is 5
mg/mmol. He is on metformin
500 mg twice daily and
gliclizide 60 mg daily for
diabetes.
 What will you next?
a. Tell him that he is
already a high risk for
cardiovascular disease
and do not need risk
calculation
b. Do absolute risk
calculation
c. Start him on insulin
d. Reassure
e. Increase medication
dose
Answer detail:
The correct answer is a.
People with any of the
following are at high risk for
cardiovascular disease and do
not need absolute risk
calculation:
- Diabetes and age more than
60 years
- A serum cholesterol more
than 7.5 mmol/L
- Moderate to severe chronic
renal failure
- Systolic blood pressure 180
mmHg or more and diastolic
blood pressure 110 mmHg or
more.
- Familial
hypercholesterolemia.
So this patient is at high risk
for cardiovascular disease and
need management
accordingly. There is no need
to do absolute risk
assessment.
In people with diabetes,
simultaneous treatment with
blood pressure lowering and
lipid modifying therapy is
recommended.
139. A 22-year-old woman
presented to your clinic for
assessment. She is sexually
active and has had 5 sexual
partners in last 3 years. She
has been diagnosed with
chlamydia trachomatis on this
presentation.
What will you do next?
a. Treat her and do contact
tracing for all contacts in last
6 months
b. Treat her and do contact
tracing for all contacts in last
12 months
c. Treat her and her
current partner only
d. Tell her to give you the
names of her boyfriends
e. Ask her to notify the
health department
Answer detail:
The correct answer is a.
The current recommendations
about chlamydia infection of
urogenital tract includes:
- Treat the patient with oral
antibiotics.
- Do contact tracing and treat
patients all sexual contacts in
last 6 months.
- Notify health department
(GP responsibility).
- Repeat testing for chlamydia
in 3-12 months for reinfection.