Trial MCQ Paper 1

A 7-month-old infant is brought to your clinic with paroxysmal cough and occasional vomiting, but is otherwise well between episodes. Pertussis (whooping cough) is suspected, and the infant is started on azithromycin. He lives at home with his mother, father, and two older brothers aged 3 and 5 years, neither of whom has received any pertussis immunizations. Which one of the following is the most appropriate next action?

A 35-year-old single father presents to your clinic requesting sleeping tablets. On further questioning, he reports feeling overwhelmed and exhausted. He admits to drinking heavily every night to “calm down” and has been unable to maintain steady employment. He lives with his 6-year-old son, who has not been attending school regularly. He confesses that sometimes he is too hungover in the morning to prepare meals or take his son to school. Which one of the following would be the most appropriate next step in management?

A 62-year-old man presents to the Emergency Department with sudden-onset colicky abdominal pain, abdominal distension, nausea, and vomiting for the past 6 hours. On examination, his abdomen is distended, tympanic, and mildly tender without peritoneal signs. Bowel sounds are hyperactive. An abdominal X-ray is performed and shown below. Which one of the following is the most appropriate next step in management?

You are a junior doctor in the Emergency Department. A 3-year-old girl is brought in by her mother with a fractured arm. The mother says the child “fell off the couch.” On examination, you notice multiple bruises of varying ages on the child’s back and thighs, which are not consistent with the history provided. This is the second visit in the past two months for traumatic injuries. When you gently question the mother further, she becomes defensive and says, “She’s just a clumsy child, stop accusing me!” Which one of the following would be the most appropriate next step in management?

A 32-year-old woman is admitted involuntarily to the psychiatric ward for treatment of acute mania. During her stay, she develops acute appendicitis and requires urgent surgical intervention. Which one of the following is the most appropriate approach regarding consent for surgery?

A 29-year-old woman presents with her first manic episode 3 weeks postpartum. She is breastfeeding her newborn. She exhibits elevated mood, decreased need for sleep, pressured speech, and grandiose ideas. There are no psychotic features. Which one of the following is the treatment of choice for her?

A 74-year-old man is brought to the clinic by his wife because of recent forgetfulness and poor concentration over the past 3 months. He reports feeling very low in mood, has lost interest in gardening (his usual hobby), and complains of early morning awakening. During the Mini-Mental Status Examination (MMSE), when asked the date and to recall 3 words, he repeatedly replies, “I don’t know.” His MMSE score is 27/30. Which of the following is the most likely diagnosis?

A 9-year-old boy is swimming at a beach in Northern Queensland when he suddenly screams in pain and is helped ashore. On examination, he has multiple linear, whip-like erythematous lesions across his right thigh and calf. He is crying due to severe burning pain. The surrounding skin is red and swollen. Which one of the following is the most appropriate immediate step in management?

During your night shift in a rural hospital in Northern Territory, you receive a 27-year-old man 30 minutes after being bitten by a brown snake on the left ankle. Upon arrival, he has no symptoms. On examination, you notice scratches over the left ankle, but no fang marks are present. The nearest tertiary hospital is 150 km away. Which one of the following is the most appropriate next step in management?

A 42-year-old construction worker presents to the Emergency Department after accidentally stepping on a rusty nail at the worksite. On examination, there is a single puncture wound on the plantar surface of the right foot, contaminated with dust and debris. The patient reports completing his primary childhood immunization and receiving a tetanus booster 9 years ago. The wound has been irrigated and dressed appropriately. Which one of the following is the best step regarding tetanus prophylaxis in this patient?

A 25-year-old woman with a history of primary pulmonary hypertension presents to your clinic. She is currently well and wishes to conceive in the next few months. Which one of the following is the most appropriate advice?

A 54-year-old man presents to your clinic with a 2-month history of painless intermittent rectal bleeding. He has no significant past medical history. Physical examination is unremarkable. Colonoscopy is performed after adequate bowel preparation and reveals three pedunculated polyps: one in the transverse colon, one in the descending colon, and one in the rectum. All polyps are removed endoscopically. Histopathology shows that the polyp from the transverse colon has high-grade dysplasia, while the others are low-grade adenomas. Which one of the following is the most appropriate next step in his management?

A 71-year-old man is admitted to the surgical ward after undergoing hemicolectomy 3 days ago. The nurse calls you because the patient has become restless, pulling out his IV line, and trying to get out of bed. On examination, he is disoriented, agitated, and not cooperative with the staff. His temperature is 37.9°C, pulse rate 102/min, and blood pressure 140/85 mmHg. His respiratory rate is 20/min, and oxygen saturation is 96% on room air. Which one of the following is the most appropriate immediate next step in management?

A 68-year-old man presents to the Emergency Department with sudden-onset severe headache, vomiting, and left-sided weakness. On examination, he is drowsy, blood pressure is 200/110 mmHg, and there is left hemiplegia with facial droop. A non-contrast CT scan of the brain is taken and shown below. Which one of the following is the most appropriate next step in management?

A 70-year-old man is being evaluated after recovering from a transient ischemic attack (TIA). On examination, his blood pressure is 180/110 mmHg, and a bruit is heard over the right carotid artery. Duplex Doppler ultrasonography shows 50% stenosis of the right carotid artery and 60% stenosis of the left carotid artery. Which one of the following is the most appropriate next step to prevent further thromboembolic events?

Emma, a 22-year-old woman, presents with a 2-week history of a rash on her trunk. She reports that the rash started with a single large oval pink patch on her chest, followed by the appearance of multiple smaller scaly oval lesions on her back and abdomen. The lesions are slightly itchy. She is otherwise well with no systemic symptoms. An image of the rash is shown below. Which one of the following is the most appropriate management?

A 78-year-old man is brought to your clinic by his daughter due to recent memory problems and episodes of confusion. Over the past 6 months, he has become increasingly disoriented, sometimes talking to people who are not there, and complains of seeing animals in the living room. His family also reports he shuffles when walking, has difficulty initiating movement, and sometimes freezes in place. On examination, he is disoriented to time and place, has fine resting tremors in both hands (more pronounced on the left), and exhibits rigidity on passive movement. Which of the following is the most likely diagnosis?

A 27-year-old woman at 32 weeks gestation is found to have a fetus in breech presentation. She has gestational diabetes, and fetal assessment reveals macrosomia. The fetus is otherwise normal. Which one of the following would be the most appropriate advice regarding the mode of delivery?

James, a 27-year-old man, presents to the emergency department with sudden onset of palpitations, dizziness, and mild shortness of breath. His pulse is 180 beats per minute and regular, blood pressure is 110/70 mmHg, and oxygen saturation is 98% on room air. An ECG is taken and shown in the below image. He is otherwise healthy with no past medical history. What is the most appropriate next step in the management of this patient?

A 63-year-old woman undergoes an elective colectomy. In the first 24 hours after surgery, her total urine output is 250 ml. During the procedure, she received 2 liters of crystalloids and 1 unit of packed red cells. Postoperatively, her vitals are: BP 125/80 mmHg, HR 96/min, RR 18/min, SpO₂ 98% on room air. She is afebrile, and her abdomen is soft and non-tender with a Foley catheter in situ draining minimal concentrated urine. Which of the following is the most appropriate next step in management?

A doctor wants to test whether smoking causes dementia. He collects a group of patients who already have dementia and another group who do not have dementia, and then looks back at their history of smoking. Which one of the following study designs is he using?

Amelia, a 56-year-old woman with a history of poorly controlled type 1 diabetes, is brought to the emergency department with nausea, vomiting, abdominal pain, and rapid breathing. On examination, she is drowsy, blood pressure is 85/60 mmHg, pulse is 120 beats per minute, and respiratory rate is 30 breaths per minute with deep labored breathing (Kussmaul respirations). Arterial blood gas results are as follows: pH: 7.10 PaCO₂: 40 mmHg HCO₃⁻: 12 mmol/L Which of the following best describes her acid–base status?

A 63-year-old woman with acute myeloid leukemia underwent an allogeneic bone marrow transplant. On day 6 after transplant, she develops a fever of 38.5 °C and complains of chills and malaise. On examination, she looks ill but hemodynamically stable. Laboratory investigations show: White cell count: 0.2 × 10⁹/L (4–11 × 10⁹/L) Platelet count: 25 × 10⁹/L (150–400 × 10⁹/L) Hemoglobin: 85 g/L (120–160 g/L) Which one of the following is the most appropriate next step in management?

A 28-year-old motorcyclist is brought to the Emergency Department after colliding with a truck. On arrival, his airway is patent but he is restless and speaking incoherently. His blood pressure is 85/60 mmHg, pulse 128/min, and respiratory rate 24/min. Pulse oximetry shows oxygen saturation of 90% on room air. He has multiple abrasions over the chest and abdomen. Which of the following is the most appropriate next step in management?

A 52-year-old man presents with a dark pigmented lesion on his upper lip, which he first noticed three months ago. The lesion is shown below. Which one of the following would be the most appropriate management?