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| 2 | Oral montelukast Explanation The immediate bronchodilator for an acute asthma exacerbation is inhaled salbutamol, preferably via a pressurised metered-dose inhaler with spacer when appropriate. The Australian Asthma Handbook recommends repeated inhaled salbutamol during the first hour according to severity AMC sequence: ipratropium. Acute asthma → SABA first → assess severity → O₂ if hypoxaemic + steroids ± | 77 |
| 3 | No treatment is required Explanation: Paroxysmal coughing followed by post-tussive vomiting strongly suggests pertussis. In a clinically stable child without hypoxaemia, oxygen is not the primary treatment. Appropriate antibiotics—typically a macrolide—reduce infectivity and transmission, particularly when given early. AMC Clue Coughing fits → whoop/post-tussive vomiting → think PERTUSSIS. A mother notices a painless abdominal mass while bathing her 3-year-old child. Examination demonstrates a firm, irregular abdominal mass that extends across the midline. What is the most likely diagnosis? A. Neuroblastoma B. Wilms tumour C. Pancreatic pseudocyst D. Intussusception E. Mesenteric cyst Explanation: An abdominal mass is the most common presentation of neuroblastoma, and the disease predominantly occurs in young children Important differentiation Neuroblastoma → irregular abdominal mass → may cross the midline → often adrenal/sympathetic origin Wilms tumour → renal mass → classically painless abdominal/flank mass in a young child. A patient has a suspected Candida infection, but the appearance is atypical and the diagnosis is uncertain. What is the most appropriate investigation to confirm the diagnosis? A. No investigation B. HbA1c only C. Swab/specimen for microscopy and/or culture D. Skin biopsy routinely E. HPV PCR Explanation : A specimen for microscopy/culture can help when candidiasis is atypical, recurrent, refractory, or diagnostically uncertain. Important AMC point: if the original picture showed classic uncomplicated candidiasis, a routine swab may not be required because many Candida presentations are diagnosed clinically. Therefore, I would need the original Q89 clinical picture/stem to confirm that “Swab” is definitely the intended answer. A 58-year-old postmenopausal woman presents with an abnormal whitish vulvovaginal lesion with well-defined margins. She has been using menopausal hormone therapy. Examination confirms a persistent focal lesion. What is the most appropriate next step? A. Vaginal swab B. Biopsy of the lesion C. Reassurance only D. Increase the dose of HRT E. Empirical antifungal therapy Explanation A persistent or suspicious vulval lesion in a postmenopausal woman requires further evaluation, and biopsy is appropriate when malignancy, lichen sclerosus, lichen planus or another significant dermatosis needs to be excluded. A simple swab is more appropriate when the main concern is infection or discharge rather than an abnormal focal lesion. Queensland Health specifically flags abnormal vulval lesions in postmenopausal women for specialist assessment. AMC clue: Postmenopausal + abnormal focal vulval lesion → think biopsy, not reassurance. A 29-year-old woman who is 9 weeks pregnant presents with mild vaginal spotting. She has systemic lupus erythematosus and has previously experienced two miscarriages. She has also recently developed a lupus-type rash. Which underlying condition should be particularly suspected as the cause of her recurrent pregnancy losses? A. Chromosomal abnormality B. Cervical insufficiency C. Antiphospholipid syndrome D. Gestational diabetes E. Placenta praevia Explanation In a woman with SLE and recurrent pregnancy loss, antiphospholipid syndrome (APS) is an important diagnosis to consider. APS is associated with pregnancy morbidity including recurrent miscarriage and fetal loss. The rash suggests underlying SLE activity, but the important clue explaining the recurrent pregnancy loss is possible APS associated with SLE. RANZCOG specifically includes recurrent miscarriage and antiphospholipid syndrome among important pregnancy-related immunological conditions. AMC clue: SLE + recurrent miscarriages → think APS A 25-year-old patient with known asthma presents with acute wheeze, cough, chest tightness and increased work of breathing. An acute asthma exacerbation is diagnosed. What is the most appropriate immediate treatment? A. Oral antibiotics B. IV aminophylline C. Inhaled salbutamol via pMDI and spacer D. Long-acting beta₂ agonist alone E. | 60 |
| 4 | Oral corticosteroids Explanation: The combination of chronic dry cough + postnasal drip + nasal/coryzal symptoms + normal chest X-ray strongly suggests upper airway cough syndrome (UACS), previously called postnasal drip syndrome. An intranasal corticosteroid, such as fluticasone, is appropriate first-line treatment because it reduces inflammation in the nasal and upper airway mucosa. It can be combined, when appropriate, with: Saline nasal irrigation A non-sedating antihistamine, particularly when allergic rhinitis is present. AMC Exam Pearl: Chronic cough + postnasal drip/nasal symptoms + normal CXR → Upper airway cough syndrome → intranasal corticosteroid. A 58-year-old postmenopausal woman reports a persistent burning sensation affecting her tongue and oral cavity for several months. Examination of the mouth shows normal-appearing oral mucosa with no ulcers or visible lesions. She also reports a dry mouth and altered taste. Investigations for nutritional deficiency, diabetes, thyroid disease, candidiasis, and Sjögren syndrome are unremarkable. What is the most likely diagnosis? A. Oral candidiasis B. Geographic tongue C. Burning mouth syndrome D. Oral lichen planus E. Aphthous ulceration Explanation : Burning mouth syndrome is characterized by chronic burning oral pain despite a clinically normal oral mucosa. It is particularly common in postmenopausal women and may be associated with xerostomia and altered taste. It is a diagnosis of exclusion , so secondary causes should first be ruled out, including: Oral candidiasis Iron, vitamin B12 and folate deficiency Diabetes mellitus Hypothyroidism Sjögren syndrome/xerostomia Medication effects, including some ACE inhibitors Denture-related trauma/contact allergy Geographic tongue Management Reassurance + explanation → remove/treat reversible causes → CBT Other options may include topical or low-dose clonazepam and treatment directed at neuropathic pain. AMC Key Burning mouth + normal oral examination + postmenopausal woman = Burning mouth syndrome. A 69-year-old man presents with a slowly enlarging, well-demarcated erythematous scaly plaque on a chronically sun-exposed area of his skin. The lesion has persisted for several months and does not heal. What is the most likely diagnosis? A. Basal cell carcinoma B. Actinic keratosis C. Bowen disease D. Keratoacanthoma E. Malignant melanoma Explanation: Bowen disease is squamous cell carcinoma in situ, meaning malignant keratinocytes are confined to the epidermis and have not invaded the dermis. It classically presents as a persistent erythematous, scaly or crusted plaque. Cancer Council Australia categorises Bowen disease as SCC in situ AMC clue: Persistent red scaly plaque → Bowen disease → SCC in situ. A sexually active young adult presents with multiple soft, painless, papillomatous/cauliflower-like lesions around the genital region. What is the most likely diagnosis? A. Genital herpes B. Molluscum contagiosum C. Primary syphilis D. Anogenital warts E. Lichen sclerosus Explanation: Anogenital warts are caused by human papillomavirus (HPV) and are usually diagnosed clinically from their characteristic appearance. Routine HPV PCR testing is not used to diagnose genital warts. AMC clue: Painless cauliflower/papillomatous genital lesion → HPV wart. A 25-year-old patient develops multiple symmetrical target-shaped lesions over the hands and extensor surfaces following a recent herpes simplex infection. The patient is otherwise well and has no significant mucosal involvement. What is the most appropriate initial management? A. IV immunoglobulin B. Oral prednisolone routinely C. Broad-spectrum antibiotics D. Supportive symptomatic treatment E. Emergency surgical debridement A child is brought to the GP with recurrent paroxysms of severe coughing followed by vomiting. Between coughing episodes, the child appears well. Oxygen saturation and other vital signs are normal. What is the most appropriate management? A. Supplemental oxygen alone B. Commence appropriate antibiotic therapy C. Oral corticosteroids D. Salbutamol inhaler E. | 30 |
| 5 | Exam sequence: Suspected PAD → ABPI first → if ABPI unreliable in diabetes/CKD → TBI/toe pressure → Duplex Doppler for anatomical assessment → CTA/MRA if planning intervention. A 28-year-old Rh-negative pregnant woman has not attended antenatal follow-up since 22 weeks of gestation and therefore missed her routine anti-D prophylaxis. She now presents at 33 weeks and ultrasound demonstrates polyhydramnios. What is the most likely underlying cause? A. Rh alloimmunisation (Rh isoimmunisation) B. Parvovirus B19 infection C. Oesophageal atresia D. Gestational diabetes mellitus E. Fetal renal abnormality Explanation The major clue is that the mother is Rh-negative and missed routine anti-D prophylaxis. Maternal sensitisation to Rh-positive fetal red blood cells can lead to production of anti-D antibodies, which cross the placenta and cause fetal haemolysis. Pathway: Rh alloimmunisation → fetal haemolysis → severe fetal anaemia → high-output cardiac failure → hydrops fetalis → may be associated with polyhydramnios. AMC Key Point Rh-negative mother + missed anti-D + fetal anaemia/hydrops ± polyhydramnios → think Rh alloimmunisation. A 68-year-old man presents with a rapidly enlarging skin lesion on a sun-exposed area. The lesion developed over the past 6 weeks and is a dome-shaped nodule with a central crater filled with keratin. There are no features of systemic illness. What is the most likely diagnosis? A. Basal cell carcinoma B. Squamous cell carcinoma C. Keratoacanthoma D. Melanoma E. Seborrhoeic keratosis Explanation : Keratoacanthoma typically presents as a rapidly growing, dome-shaped lesion with a characteristic central keratin-filled crater. It usually enlarges over several weeks, which is much faster than many other common skin cancers. Rapid growth over 4–8 weeks Dome-shaped nodule Central keratin plug/crater Clinically resembles SCC Management → complete excision / treat as SCC, rather than observation Memory clue: “Rapid growth + central keratin crater = Keratoacanthoma. ” During an antenatal ultrasound, a pregnant woman is found to have a 4.5 cm ovarian/adnexal cyst containing multiple internal echoes with a relatively thick wall. She also reports a maternal history of breast cancer. What is the most appropriate next step? A. Reassess the cyst at the morphology ultrasound B. Measure serum CA-125 C. Immediate surgical removal D. CT abdomen and pelvis Explanation: For a relatively small adnexal cyst detected during pregnancy, the next step is generally ultrasound follow-up to reassess its size and morphology, rather than immediately relying on a tumour marker. Australian referral guidance also uses repeat ultrasound surveillance for smaller ovarian cysts when appropriate AMC pearl: Adnexal cyst in pregnancy + clinically stable → ultrasound surveillance first. Suspicious morphology/persistent or enlarging mass → specialist review. An otherwise healthy patient is found to have an isolated elevation in serum bilirubin on blood tests performed after a period of fasting. The patient is completely asymptomatic, and the remainder of the liver profile is normal. What is the most appropriate next step? A. No further investigation is required B. Abdominal ultrasound C. Hepatitis serology D. MRCP E. CT abdomen Explanation: This presentation is typical of Gilbert syndrome, a common benign condition caused by reduced activity of the bilirubin-conjugating enzyme UGT1A1. It produces a mild, intermittent unconjugated hyperbilirubinaemia, particularly during: Fasting Illness Stress Dehydration Strenuous exercise AMC Exam Pearl: Asymptomatic + isolated unconjugated bilirubin ↑ + fasting/illness trigger + normal other LFTs → Gilbert syndrome → reassurance. A man presents with a persistent dry cough associated with postnasal drip and coryzal/nasal symptoms. His chest X-ray is normal. What is the most appropriate initial treatment? A. Intranasal fluticasone spray B. Oral antibiotics C. Salbutamol inhaler D. Proton-pump inhibitor E. | 24 |
| 6 | Endometriosis commonly presents with chronic or cyclical pelvic pain, dysmenorrhoea, deep dyspareunia, dyschezia, and possible subfertility. Examination may reveal pelvic/adnexal tenderness, uterosacral nodularity, or a fixed retroverted uterus, but it can also be normal. Why not PID? Acute PID usually presents over days to weeks with lower abdominal pain, cervical motion tenderness, fever, abnormal/purulent vaginal discharge, and STI-related features. The long-standing symptoms without acute infective features make endometriosis more likely. A doctor is on holiday at a beach resort with his brother-in-law, who has chronic pain following a motor vehicle accident one year ago. He regularly takes temazepam or oxycodone but has lost his prescription and does not have enough medication to last for the remainder of the trip. He asks the doctor to prescribe the medication for him. What is the most appropriate course of action? A. Recommend meloxicam as an alternative analgesic B. Arrange for him to be assessed by a local GP C. Advise him to contact his usual prescribing doctor D. Prescribe a short supply of his usual medication Explanation: The doctor should not prescribe oxycodone to a family member. Australian Medical Board guidance advises doctors to avoid treating family members except in emergencies and specifically states they must not prescribe Schedule 8 medicines to family members. Oxycodone is a Schedule 8 controlled medicine. AMC Exam Point Family/friend + controlled drug + non-emergency → do NOT prescribe → arrange independent medical assessment. Answer: B — Arrange appointment with a local GP. This situation is not an emergency. The brother-in-law has chronic pain and needs a proper, independent clinical assessment, medication-history review, and appropriate documentation. Therefore, arranging an appointment with a local GP is the safest and most professionally appropriate option. A woman is found to have a 3 cm painless cystic swelling at the posterior vaginal fourchette, consistent with a Bartholin gland cyst. What is the most appropriate management? A. Marsupialisation B. Oral antibiotics C. Incision and drainage alone D. Complete gland excision Explanation: A Bartholin cyst results from obstruction of the Bartholin duct, typically producing a swelling near the posterior vaginal introitus (4 or 8 o’clock position). Marsupialisation creates a permanent drainage opening and is commonly used for symptomatic or recurrent cysts. AMC nuance : If the cyst is genuinely small, painless and completely asymptomatic, observation is generally appropriate rather than intervention. The recall appears to be testing marsupialisation as definitive treatment for a Bartholin cyst. Exam pearl : Painful + fluctuant → think Bartholin abscess. New Bartholin mass in a woman >40 years → biopsy/excision to exclude malignancy. A 62-year-old man with a long history of diabetes mellitus presents with pain in his right toes. On examination, the right foot is cool and the dorsalis pedis pulse is weak. Peripheral arterial disease is suspected. What is the most appropriate next investigation? A. Ankle–brachial pressure index (ABPI) B. Arterial duplex Doppler ultrasound C. CT angiography of the lower limb D. MR angiography E. Digital subtraction angiography Explanation The combination of toe pain + reduced peripheral pulse + diabetes suggests peripheral arterial disease (PAD). In general practice, ABPI is the initial diagnostic test for suspected PAD. Duplex Doppler is mainly used when more anatomical information about the site and severity of arterial stenosis is required Important AMC Exam Point In patients with diabetes or chronic kidney disease, arterial calcification can make ankle arteries poorly compressible and the ABPI may be falsely normal or falsely elevated. In this situation, toe pressure / toe–brachial index (TBI) is particularly useful because toe arteries are less affected by medial calcification. Queensland Health includes both ABI and TBI in lower-limb vascular assessment pathways. | 23 |
| 7 | #aug2026
AUGUST DAY 3 A 73-year-old woman presents with burning pain over the right mandibular region. The pain is not precipitated by chewing, but eating causes significant discomfort. Examination of the right buccal mucosa and palate shows unilateral erythematous erosive plaques. What is the most appropriate management? A. Famciclovir B. Antibiotics C. Fluconazole or clotrimazole D. Mouthwash HERPES ZOSTER (SHINGLES) - AUSTRALIAN GUIDELINES Early diagnosis and treatment within 72 hours reduces acute symptoms and risk of complications (e.g., PHN) OVERVIEW CLINICAL FEATURES TYPICAL RASH • Reactivation of latent Varicella zoster virus (VZV) in sensory ganglia. • Presents with unilateral, painful, vesicular rash in a dermatomal distribution. / Prodrome: burning pain, tingling, or itching in a dermatomal area / Unilateral vesicular rash on erythematous base / Severe neuropathic pain / Possible complications: • Common in older adults and immunocompromised patients. post-herpetic neuralgia (PHN), ophthalmic involvement, encephalitis (rare) Thoracic dermatome Ophthalmic (V1) involvement INVESTIGATIONS (IF UNCERTAIN DIAGNOSIS OR COMPLICATIONS SUSPECTED) TREATMENT 1ST LINE THERAPY 2ND LINE / ALTERNATIVE THERAPY • PCR for VZV DNA - most sensitive test (vesicle fluid, swab, or blood) • Antiviral therapy - start as early as possible (within 72 h • Tzanck smear - multinucleated giant cells of rash onset) & • Use if contraindicated, intolerant, or severe/immunocompromised (consider IV therapy) (less specific) • Acyclovir • Valaciclovir (alternative dosing) 800 mg 5 times daily PO for 7 days 1 g 2 times daily PO for 7 days• Serology - rarely needed (not useful in acute setting) • Valaciclovir • Famciclovir (alternative dosing) 1 750 mg 2 times daily PO for 7 days• Full blood count, U&E - if severe illness 1 g 3 times daily PO for 7 days or immunocompromised • Famciclovir • Ophthalmology review - if eye involvement 500 mg 3 times daily PO for 7 days s u s p e c t e d
Severe disease / unable to take PO Acyclovir IV 10 mg/kg 8 hourly for 7-10 days (adjust for renal function) ADJUNCTIVE MANAGEMENT
All above are first-line options per Australian guidelines (RACGP, Therapeutic Guidelines, eTG) for immunocompetent adults.
Consult infectious diseases or hospital team for immunocompromised or disseminated zoster. Analgesia: Paracetamol or NSAIDs ‡ opioids for severe pain Neuropathic pain (e.g., PHN): Amitriptyline, Pregabalin, or Gabapentin Topical care: Keep lesions clean and dry, calamine lotion for comfort Eye involvement: Urgent ophthalmology referral + antiviral therapy SPECIAL CONSIDERATIONS • • Immunocompromised patients - more severe disease, consider IV acyclovir i • Pregnancy - antivirals can be used if needed (acyclovir preferred) & • Renal impairment - adjust dose of antivirals • Start treatment within 72 hours for best outcome, but may still benefit if started later in severe cases COMPLICATIONS • Post-herpetic neuralgia (most common) • Ophthalmic zoster ￫ keratitis, uveitis, vision loss • Ramsay Hunt syndrome (facial palsy, ear pain) • Disseminated zoster (immunocompromised) • Bacterial superinfection PREVENTION • Recombinant zoster vaccine (Shingrix®) - recommended for:
Adults ≥ 50 years
Immunocompromised adults ≥ 18 years • 2 doses (0 and 2-6 months apart) • Reduces risk of shingles and PHN KEY POINTS • Start antivirals ASAP (within 72 h) • Pain control is essential • Vaccination prevents herpes zoster References: RACGP - Herpes zoster (Shingles) Management, Therapeutic Guidelines (eTG) - Antiviral, Australian Immunisation Handbook A 32-year-old woman presents with a long-standing history of chronic pelvic pain and deep dyspareunia. On pelvic examination, there is bilateral adnexal tenderness, but no adnexal mass is palpable. She has no fever or purulent vaginal discharge. What is the most likely diagnosis? A. Pelvic inflammatory disease B. Endometriosis C. Ovarian torsion D. Ectopic pregnancy E. Ruptured ovarian cyst Explanation The key clue is the chronic nature of the pelvic pain associated with deep dyspareunia. | 24 |
| 8 | #aug2026 as above | 29 |
| 9 | ┌────────────┴────────────┐
▼ ▼
YES NO
│ │
▼ ▼
Suspected cardiac cause Assess cause of syncope
│ │
▼ ▼
Cardiology review ┌─────────────────┐
Echo / monitoring │ Classify type │
└─────────────────┘
│
┌──────────────────────────┼──────────────────────┐
▼ ▼ ▼
Reflex syncope Orthostatic Cardiac syncope
(vasovagal) hypotension (high risk)
│ │ │
▼ ▼ ▼
Reassurance + Review medications Further cardiac
lifestyle advice Fluids + treat cause investigations A newborn baby is delivered with an Apgar score of 8/9. After a short period, the baby
develops respiratory distress with reduced air entry on one side of the chest.
What is the most likely diagnosis and appropriate investigation?
A) Meconium aspiration syndrome — Chest X-ray
B) Pneumothorax — Transillumination test and Chest X-ray
C) Respiratory distress syndrome — Surfactant level testing
D) Congenital diaphragmatic hernia — Abdominal ultrasound NEWBORN WITH RESPIRATORY DISTRESS │
▼
Sudden onset + unilateral ↓ air entry
│
▼
Suspect Pneumothorax
│
▼
┌─────────────────────────────┐
│ Is baby haemodynamically │
│ stable or unstable? │
└─────────────────────────────┘
│
┌──────┴──────┐
▼ ▼
STABLE UNSTABLE
(Tension PTX)
│ │
▼ ▼
CXR Immediate treatment
(confirm) │
▼
Needle decompression
│
▼
Chest tube insertion A 32-year-old woman at 36 weeks gestation presents with sudden-onset abdominal pain
and vaginal bleeding. Examination shows a tender, firm, tense uterus. The fetal heart rate
is 90 beats/min. Her pulse is 110/min and blood pressure is 100/60 mmHg. What is the
most likely diagnosis?
A) Placenta praevia B) Placental abruption
C) Vasa praevia
D) Uterine rupture
E) Cervical polyp
PAINFUL VAGINAL BLEEDING
+
ABDOMINAL PAIN / UTERINE TENDERNESS
|
↓
SUSPECT PLACENTAL ABRUPTION
|
--------------------------------
| |
Assess Mother Assess Fetus | |
ABC approach CTG monitoring
IV access ×2 Fetal heart rate
Bloods:
- FBC
- Group & crossmatch
- Coagulation profile
- Kleihauer test (if indicated)
|
↓
Is mother haemodynamically stable?
|
-----------------------------
| |
Stable Unstable / Shock
| |
↓ ↓
Assess gestation Resuscitation
and fetal status - IV fluids
- Blood products
- Correct coagulopathy
Placental Abruption
|
--------------------------------
| |
Fetus alive Fetal death
| |
↓ ↓
Urgent delivery Vaginal delivery
|
-------------------------------
| |
Term / severe abruption Preterm + stable
| |
Delivery Conservative
(induction or C-section management may be
depending on situation) considered with close monitoring CHILD WITH SPINA BIFIDA
|
↓
Before any surgical procedure
|
↓
Is patient latex sensitised?
|
-----------------------------
| |
YES NO
| |
Latex-free environment Still use latex
| precautions if high risk
|
Avoid:
- Latex gloves
- Latex catheters
- Latex equipment
|
Monitor for allergic reaction | 33 |
| 10 | observe; unstable → intervene. A patient is found to have a splenic artery aneurysm measuring 2.2 cm. What is the most
appropriate management?
A) Reassurance and routine follow-up only
B) Intervention (endovascular or surgical treatment )
C) Immediate splenectomy in all cases
D) Anticoagulation therapy Explanation :
Splenic artery aneurysms require treatment when they are:
>2 cm in size
Symptomatic
Enlarging
Present in pregnancy or women of childbearing age
A 2.2 cm aneurysm crosses the usual treatment threshold, so intervention should be
considered.
AMC High-Yield Point
Splenic artery aneurysm >2 cm → consider intervention. Pregnancy = treat regardless of
size due to rupture risk. SPLENIC ARTERY ANEURYSM
|
Assess symptoms + risk factors
|
---------------------------------
| |
Symptomatic / High risk Asymptomatic
| |
| Size assessment
|
INTERVENTION
|
-----------------------------
| |
Endovascular Surgery
(coil embolisation (if rupture,
or stent graft) unsuitable anatomy) A patient is admitted with acute pancreatitis. He has right upper abdominal pain.
Ultrasound shows multiple gallstones (largest 10 mm) with no common bile duct (CBD)
stones. His symptoms resolve after 2 hours. What is the most appropriate management?
A) Magnetic resonance cholangiopancreatography (MRCP)
B) Endoscopic retrograde cholangiopancreatography (ERCP)
C) Laparoscopic cholecystectomy during the same admission
D) Delay surgery and arrange elective cholecystectomy after 6 weeks Explanation:
This patient has mild gallstone pancreatitis:
Gallstones present on ultrasound
No CBD stone
Symptoms resolved → mild disease
According to guidelines, patients with mild gallstone pancreatitis should undergo laparoscopic
cholecystectomy during the same hospital admission to prevent recurrence of pancreatitis and
other biliary complications.
AMC High-Yield Recall
Gallstone pancreatitis:
Mild + no CBD obstruction
Same admission laparoscopic cholecystectomy
CBD stone/cholangitis
ERCP first → then cholecystectomy
Severe pancreatitis with necrosis
Delay cholecystectomy until recovery |
Gallstone Pancreatitis Assess severity + CBD obstruction
|
----------------------------
| |
Mild disease CBD obstruction/
No CBD stone Cholangitis
| |
| ERCP + stone removal
|
Supportive treatment
|
Symptoms improve
|
Laparoscopic cholecystectomy
during same admission A patient presents with a bulging appearance of the biceps muscle belly (Popeye
deformity) after an injury. What is the most likely diagnosis?
A) Osteosarcoma of biceps brachii
B) Rupture of the long head of biceps brachii tendon
C) Rupture of triceps tendon
D) Distal fracture of the humerus
Explanation:
Popeye deformity occurs due to proximal rupture of the long head of the biceps tendon.
When the tendon ruptures:
The biceps muscle retracts distally
A visible bulge appears in the upper arm
Often associated with sudden pain and weakness in elbow flexion/supination AMC High-Yield Recall
Popeye deformity = Long head of biceps tendon rupture
Proximal biceps rupture → Popeye deformity
Distal biceps rupture → Reverse Popeye deformity
Test:
Weak elbow flexion
Weak forearm supination
Clinical clue:
"Sudden arm pain + bulging biceps muscle → think biceps tendon rupture.
" Long head biceps rupture
|
Assess age + activity level
|
-----------------------------
| |
Older/low demand Young/active
| | Conservative Surgical opinion
| |
Physiotherapy Tenodesis
Analgesia (re-attach tendon) A young woman suddenly loses consciousness and falls while shopping. She has now
recovered and is haemodynamically stable. There is no history of sensory or motor
weakness. Her blood pressure is 90/60 mmHg.
What is the most appropriate next investigation?
A) Echocardiography
B) ECG
C) Chest X-ray
D) CT brain PATIENT WITH
TRANSIENT LOSS OF CONSCIOUSNESS
│
▼
Initial Assessment + History + Examination
│
▼
┌─────────────────────────┐
│ Check: Is patient stable? │
└─────────────────────────┘
│
┌──────────────┴──────────────┐
▼ ▼
UNSTABLE STABLE (shock, arrhythmia, │
severe injury) ▼
│ 12-lead ECG (FIRST TEST)
▼ │
Resuscitation ▼
Abnormal ECG?
│ | 29 |
| 11 | #aug2026
AUGUST DAY 4:
A 32-year-old woman presents with intense vulval itching and thick, white, curd-like
vaginal discharge for 3 days. She recently completed a 10-day course of broad-spectrum
antibiotics for a respiratory infection. On examination, the vulva is erythematous with
excoriation. Vaginal pH is 4.2. A potassium hydroxide (KOH) preparation shows budding
yeast with pseudohyphae.
What is the most appropriate first-line treatment?
A) Oral metronidazole 400 mg twice daily for 5 days
B) Intravaginal azole therapy for 1–7 days
C) Oral azithromycin single dose
D) Oral fluconazole weekly for 6 months
Explanation:
Features suggest vulvovaginal candidiasis:
Thick white "cottage cheese " discharge
Severe vulval itching
Normal vaginal pH (<4.5)
KOH showing pseudohyphae
First-line treatment:
Topical intravaginal azoles (e.g., clotrimazole/miconazole)
High-Yield AMC Points :
Candida = itching + thick white discharge + normal pH
BV = thin grey discharge + fishy smell + pH >4.5
Trichomoniasis = frothy yellow-green discharge + strawberry cervix A pregnant woman presents with mild depression. She has a past history of depression
that was previously treated successfully with fluoxetine. What is the most appropriate
management?
A) Start sertraline as a safer SSRI in pregnancy
B) Restart fluoxetine as she previously responded well
C) Start cognitive behavioural therapy (CBT) only
D) Stop all treatment and observe until after delivery Explanation:
Management of depression during pregnancy depends on severity, patient preference, and
previous response to treatment.
Although psychological therapy (CBT/interpersonal therapy) is preferred for many cases of
mild depression, a patient who has previously responded well to a particular antidepressant can
be restarted on that medication after discussing the benefits and potential risks in pregnancy.
Fluoxetine is an SSRI that can be used in pregnancy when clinically indicated.
High-Yield AMC Point:
Pregnancy + depression + previous good response to antidepressant → restart the
same effective medication after risk–benefit discussion. A patient presents with a stab wound in the posterior thorax (between the scapulae). He
is haemodynamically stable. What is the next best step?
A) Remove the knife immediately
B) CT scan of the chest
C) Emergency thoracotomy
D) Endotracheal intubation
Explanation :
In a haemodynamically stable patient with penetrating posterior thoracic injury, the next step is
CT imaging to assess:
Trajectory of the object
Lung injury
Vascular injury
Mediastinal involvement An impaled object should not be removed outside a controlled surgical environment because
removal may cause severe bleeding.
AMC Key Point Stable penetrating chest trauma → CT first
Unstable patient → Immediate surgical management
A 60-year-old man presents with acute chest pain. ECG shows ST depression in leads
V1–V3 with tall R waves. Posterior leads (V7–V9) show ST elevation.
What is the most likely diagnosis ?
A) Anterior STEMI
B) Inferior STEMI
C) Posterior myocardial infarction
D) Lateral myocardial infarction
Explanation:
Posterior MI produces a reciprocal (mirror image) pattern in anterior chest leads:
V1–V3 → ST depression + tall R waves
Posterior leads V7–V9 → ST elevation
The posterior wall infarction is commonly associated with inferior MI (RCA occlusion). A patient is diagnosed with a Grade III renal injury following trauma. The patient is
haemodynamically stable. What is the most appropriate management?
A) Immediate nephrectomy
B) Surgical exploration and repair
C) Conservative (non-operative) management with observation
D) Angioembolisation in all cases
Explanation:
Management of renal trauma depends mainly on haemodynamic stability.
Stable patient + Grade I–III renal injury → Conservative management
Bed rest/observation
Monitor vital signs
Serial haemoglobin levels
Follow-up imaging if required
Unstable patient or ongoing bleeding → Intervention (angioembolisation or surgery)
AMC High-Yield Point
Renal trauma: Haemodynamic status decides management — stable Grade I–III → | 72 |
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| 13 | Thinking of Nepal today. 🇳🇵❤️
To my Nepalese friends and followers, I hope you and your families are safe. | 428 |
| 14 | https://www.instagram.com/p/DcfzPSNDDf4/?igsi=a2pibG9rM3RuaDFx | 489 |
| 15 | 🚨 NEW PROMO – Limited to the First 10 Subscribers! 🚨
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| 16 | 🚨 NEW PROMO – Limited to the First 10 Subscribers! 🚨
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We've just made your exam prep even better:
✅ NEW: Recall questions are now organised by topic for faster, focused revision.
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| 17 | https://www.instagram.com/reel/DcYRrq0Th-n/?igsi=MTR4YmV6cmt6d29haQ==
Answer in the comment | 538 |
| 18 |  لا يوجد نص... | 504 |
| 19 | The correct answer is B.Gentamicin
Explanation
Mechanism: Aminoglycosides like gentamicin can inhibit the pre-synaptic release of acetylcholine and decrease post-synaptic sensitivity to acetylcholine at the neuromuscular junction.
Risk: This mechanism can severely exacerbate muscle weakness and trigger a life-threatening myasthenic crisis in patients with Myasthenia Gravis.
Other choices:
While macrolides (like Azithromycin) also carry warnings for Myasthenia Gravis, aminoglycosides like Gentamicin are classic, well-documented agents known for directly inducing or worsening a neuromuscular blockade.
Amoxicillin and Doxycycline are generally considered safe alternatives. | 493 |
| 20 |  لا يوجد نص... | 419 |
