AMC MCQ exam Prep by Dr Jayse

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New promo valid for 2 more subscribers Sign up now and get 2 FREE SESSIONS!!! Struggling to find the right study resources? This changes everything. 🔥 ONLY $50 AUD – Get exam-ready faster with: ✔️ High-yield QBank (focus on what actually matters) for 1 month ✔️ Multiple mock exams to sharpen your performance ✔️ Complete notes access for quick revision BONUS: 2 FREE live session classes 💡 Stop wasting time. Start studying smarter. Spots are limited – Sign up NOW: aumedprep.com.au

New promo valid for 2 more subscribers Sign up now and get 2 FREE SESSIONS!!! Struggling to find the right study resources? This changes everything. 🔥 ONLY $50 AUD – Get exam-ready faster with: ✔️ High-yield QBank (focus on what actually matters) for 1 month ✔️ Multiple mock exams to sharpen your performance ✔️ Complete notes access for quick revision BONUS: 2 FREE live session classes 💡 Stop wasting time. Start studying smarter. Spots are limited – Sign up NOW: aumedprep.com.au

New promo valid for 4 more subscribers Sign up now and get 2 FREE SESSIONS!!! Struggling to find the right study resources? This changes everything. 🔥 ONLY $50 AUD – Get exam-ready faster with: ✔️ High-yield QBank (focus on what actually matters) for 1 month ✔️ Multiple mock exams to sharpen your performance ✔️ Complete notes access for quick revision BONUS: 2 FREE live session classes 💡 Stop wasting time. Start studying smarter. Spots are limited – Sign up NOW: aumedprep.com.au

🧠 SPINAL CORD SYNDROMES Can You Localize the Lesion? Mastering spinal cord syndromes is one of the fastest ways to localize neurological lesions in exams, OSCEs, and clinical practice. ⸻ 1️⃣ Anterior Cord Syndrome 🔴 ➊ Bilateral motor weakness below the lesion ➋ Loss of pain & temperature sensation ➌ Vibration and proprioception preserved 💡 Think: “Motor Out, Pain & Temp Out” ⸻ 2️⃣ Brown-Séquard Syndrome 🔵 ➊ Ipsilateral weakness + loss of vibration/proprioception ➋ Contralateral loss of pain & temperature 💡 Think: “Half & Half Syndrome” ⸻ 3️⃣ Central Cord Syndrome 🟡 ➊ Upper limbs affected more than lower limbs ➋ Bilateral pain & temperature loss ➌ Dorsal column functions preserved 💡 Think: “Cape Sign” ⸻ 4️⃣ Posterior Cord Syndrome 🟢 ➊ Loss of vibration, proprioception & fine touch ➋ Motor function preserved ➌ Sensory ataxia and positive Romberg sign 💡 Think: “Position Sense Lost” ⸻ 🎯 Golden Rule ✅ Dorsal columns cross in the medulla ✅ Spinothalamic fibers cross within 1–2 segments of entry ⸻ 📚 Quick Mnemonic 🔴 A = Anterior → Motor + Pain + Temp OUT 🔵 B = Brown-Séquard → Half & Half 🟡 C = Central → Cape Sign 🟢 P = Posterior → Proprioception Lost ⸻ 💬 Which spinal cord syndrome do you find hardest to remember? Aumedprep.com.au

🫀 ECG Emergencies – High-Yield Summary Recognize the Rhythm. Act Immediately ⸻ 1️⃣ Pulseless Ventricular Tachycardia (VT) ⚡ ➊ Wide-complex regular tachycardia ➋ No palpable pulse ➌ Shockable rhythm 💉 Management • Immediate defibrillation • CPR for 2 minutes • Epinephrine 1 mg every 3–5 min • Amiodarone 300 mg IV 💡 Pearl: Treat exactly like VF. ⸻ 2️⃣ Ventricular Fibrillation (VF) ❤️‍🔥 ➊ Chaotic rhythm ➋ No organized QRS complexes ➌ No pulse 💉 Management • Immediate defibrillation • CPR • Epinephrine • Amiodarone 💡 Pearl: Shock first, drugs second. ⸻ 3️⃣ Asystole ⛔ ➊ Flat-line ECG ➋ No pulse ➌ Non-shockable rhythm 💉 Management • High-quality CPR • Epinephrine every 3–5 min • Search for H’s & T’s ⛔ Never defibrillate true asystole. ⸻ 4️⃣ Pulseless Electrical Activity (PEA) 🔍 ➊ Organized ECG activity ➋ No palpable pulse ➌ Non-shockable rhythm 💉 Management • Immediate CPR • Epinephrine • Treat reversible causes 💡 Pearl: PEA = Electrical activity without mechanical contraction. ⸻ 5️⃣ Torsades de Pointes 🌀 ➊ Polymorphic VT ➋ Prolonged QT interval ➌ Twisting QRS complexes 💉 Management • Magnesium sulfate 2 g IV • Correct K⁺ and Mg²⁺ • Stop QT-prolonging drugs • Defibrillate if pulseless 💡 Pearl: Think prolonged QT. ⸻ 6️⃣ STEMI 🚑 ➊ ST elevation in contiguous leads ➋ Acute coronary occlusion ➌ Time = Muscle 💉 Management • Aspirin immediately • Activate cath lab • Primary PCI preferred • DAPT + anticoagulation 💡 Pearl: Door-to-balloon ≤ 90 min. ⸻ 7️⃣ SVT (AVNRT / AVRT) 🔄 ➊ Narrow regular tachycardia ➋ Rate 150–250 bpm ➌ AV node dependent 💉 Management • Modified Valsalva • Adenosine 6 mg IV • Repeat 12 mg if needed ⛔ Avoid adenosine in irregular wide-complex tachycardia. ⸻ 8️⃣ Atrial Fibrillation with RVR ❤️ ➊ Irregularly irregular rhythm ➋ No distinct P waves ➌ Rapid ventricular response 💉 Management • Rate control (β-blocker / diltiazem) • Anticoagulation assessment • Cardioversion if unstable 💡 Pearl: Control rate first. ⸻ 📚aumedprep.com.au

📢 Recommendation for Students Looking for Recent AMC Recalls & Exam-Focused Revision One of the most common questions we receive from students is: “Where can I find reliable recent recalls and exam-focused revision material closer to exam time?” While our program focuses on structured teaching, classes, and comprehensive preparation, we understand that many candidates also value access to recent recall discussions and targeted revision resources. For students looking for this additional support, we are pleased to recommend The AMC Mastery, led by Dr. Bhattaram and his team. AMC Mastery has developed a growing reputation for providing high-yield recall discussions, exam-focused revision sessions. You can learn more here: 🔗 https://t.me/AMCMastery 🔗 amcmastery.learnworlds.com We believe students benefit most when they combine strong foundational learning with focused exam preparation and revision. Wishing all AMC candidates success in their preparation journey. — Dr. Jayse & Team

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New promo valid for 4 more subscribers Sign up now and get 2 FREE SESSIONS!!! Struggling to find the right study resources? This changes everything. 🔥 ONLY $50 AUD – Get exam-ready faster with: ✔️ High-yield QBank (focus on what actually matters) for 1 month ✔️ Multiple mock exams to sharpen your performance ✔️ Complete notes access for quick revision BONUS: 2 FREE live session classes 💡 Stop wasting time. Start studying smarter. Spots are limited – Sign up NOW: aumedprep.com.au

Crash course for JULY AND AUGUST CANDIDATES 10 sessions with doctor working in aussie 2 sets of mock exam 1 month access to qbank with notes access Private group Please message @jayse89 for more details

Explanation: Visceral malignancies (indicated by the abdominal mass) produce a systemic prothrombotic, hypercoagulable state. When paired with a prolonged immobilization catalyst (a long-haul flight), the risk for deep vein thrombosis escalates exponentially. ## Musculoskeletal Medicine & Vascular Surgery Q25. Diagnosis of Iliotibial Band (ITB) Friction Syndrome A 24-year-old amateur athlete presents with sharp, localized lateral knee pain that occurs exclusively during long-distance running or jumping activities. On examination, there is no joint effusion, and the collateral ligaments are intact. However, his characteristic pain is precisely reproduced when the clinician applies direct lateral pressure over the lateral femoral epicondyle while passively flexing the knee from full extension past 30 degrees (Noble's Test). What is the most likely diagnosis? A. Iliotibial Band Friction Syndrome B. Patellofemoral Pain Syndrome C. Lateral Meniscal Tear D. Pes Anserine Bursitis E. Lateral Collateral Ligament Sprain Correct Answer: A. Iliotibial Band Friction Syndrome Explanation: Iliotibial Band (ITB) Syndrome is an overuse injury common in runners and jumpers. The ITB rubs against the lateral femoral epicondyle, with maximal impingement and pain classic at approximately 30 degrees of knee flexion, which forms the basis of Noble's diagnostic compression test. Q26. Diagnosis of Dialysis Access Steal Syndrome A 58-year-old end-stage renal disease patient who underwent the creation of a left radiocephalic arteriovenous (AV) fistula 4 weeks ago presents with a pale, cold, and intensely painful left hand that worsens significantly during hemodialysis sessions. On examination, the digits show delayed capillary refill. Auscultation over the fistula confirms a loud, audible bruit, but palpation demonstrates a significantly diminished thrill compared to baseline. What is the underlying pathology? A. Dialysis Access-Associated Steal Syndrome (DASS) B. Acute bacterial infection of the AV fistula graft C. Complete thrombotic occlusion of the cephalic vein D. Subclavian steal syndrome causing cerebral ischemia E. Standard physiological maturation of a high-flow arteriovenous fistula Correct Answer: A. Dialysis Access-Associated Steal Syndrome (DASS) Explanation: Arteriovenous fistula creation creates a low-resistance path that can divert (or "steal") arterial blood flow away from the distal extremity, directing it into the venous system instead. This causes distal ischemia, characterized by pain, coldness, and pallor in the hand. A drop in the palpable thrill can reflect altered hemodynamics or stenosis within the circuit.

Serial Contrast-enhanced MRI of the Brain and Spine Explanation: While VEP and CSF oligoclonal bands assist in confirming the initial diagnosis of MS, serial brain and spinal MRI tracking is the gold standard for monitoring disease progression, lesion load, plaque accumulation, and therapeutic responses to disease-modifying therapies over time. Q22. Orthostatic Hypotension in Parkinson's Disease A 72-year-old male with long-standing Parkinson's disease managed with Levodopa/Carbidopa presents with recurrent episodes of lightheadedness, dizziness, and unsteadiness upon standing up from a seated position. Bedside assessment confirms a drop in systolic blood pressure of $25\text{ mmHg}$ within 2 minutes of standing. What is the most appropriate initial pharmacological or non-pharmacological management strategy? A. Change Levodopa/Carbidopa to a dopamine agonist like Pramipexole B. Initiate low-dose oral Fludrocortisone therapy alongside physical counter-maneuvers C. Cease all anti-parkinsonian treatments immediately to restore blood pressure D. Prescribe a high-dose loop diuretic to optimize fluid clearance E. Introduce oral Midodrine as a first-line treatment before conservative measures Correct Answer: B. Initiate low-dose oral Fludrocortisone therapy alongside physical counter-maneuvers Explanation: Orthostatic hypotension is a common autonomic complication of Parkinson's disease, often exacerbated by Levodopa. Management begins with conservative measures (hydration, compression stockings, counter-maneuvers). If pharmacological management is required, Fludrocortisone (a mineralocorticoid) is introduced first line to expand intravascular volume. Switching to a dopamine agonist (Pramipexole) would worsen hypotension. Q23. Secondary Complications of Valvular Aortic Stenosis A 76-year-old male presents with progressive, severe shortness of breath on minimal exertion. Transthoracic echocardiography demonstrates a severely calcified aortic valve with an area of $0.7\text{ cm}^2$ (severe aortic stenosis), moderate aortic regurgitation, secondary mitral regurgitation, and a severely reduced left ventricular ejection fraction of 35%. What is the most likely primary driving cause of his heart failure presentation? A. Primary idiopathic Dilated Cardiomyopathy B. Severe chronic Aortic Stenosis causing left ventricular pressure overload and remodeling C. Primary infective endocarditis causing mitral valve destruction D. Ischemic cardiomyopathy from triple-vessel coronary disease E. Age-related physiological decline in cardiac function Correct Answer: B. Severe chronic Aortic Stenosis causing left ventricular pressure overload and remodeling Explanation: Severe aortic stenosis creates immense afterload/pressure overload on the left ventricle. Over time, this leads to concentric hypertrophy followed by ventricular dilation, wall stress, and eventual systolic dysfunction (reduced ejection fraction) accompanied by functional mitral regurgitation. Q24. Secondary Malignancy and Thromboembolic Risk A 68-year-old male returns from a long-haul flight to England to visit his family and presents 3 days later with an acutely swollen, tender, erythematous left lower calf. On examination, a deep vein thrombosis (DVT) is confirmed via venous duplex ultrasound. Additionally, deep palpation reveals an incidental, non-tender palpable mass in his right upper abdominal quadrant. Which underlying factor explains the highest risk link between his presentation and his long-haul travel? A. Travel-induced venous stasis acting as a catalyst for a DVT secondary to an occult visceral malignancy (Trousseau phenomenon) B. Dehydration causing an isolated idiopathic deep vein thrombosis C. An acute arterial thrombosis masquerading as superficial thrombophlebitis D. Trauma sustained from tight airline seating arrangements E. A benign hepatic hemangioma causing localized venous obstruction Correct Answer: A. Travel-induced venous stasis acting as a catalyst for a DVT secondary to an occult visceral malignancy (Trousseau phenomenon)

Which of the following investigations will assist the clinician most in determining whether she meets the criteria for surgical parathyroidectomy versus conservative observation? A. Dual-energy X-ray Absorptiometry (DEXA) bone density scan B. Technetium-99m Sestamibi scan C. High-resolution ultrasound of the neck D. 24-hour urinary calcium clearance ratio E. Serum Vitamin D (25-hydroxyvitamin D) levels Correct Answer: A. Dual-energy X-ray Absorptiometry (DEXA) bone density scan Explanation: International and Australian guidelines state that a DEXA scan showing a T-score of less than $-2.5$ at any site (osteoporosis) is an explicit objective criterion for surgical parathyroidectomy in asymptomatic primary hyperparathyroidism to prevent fracture risk. A Sestamibi scan or ultrasound are purely localization tools used after a decision to operate has already been reached. Q19. Antithyroid Therapy for a Hyperfunctioning ("Hot") Thyroid Nodule A 67-year-old female with severe osteoporosis has been receiving subcutaneous Denosumab injections every 6 months. During a routine review, she notes progressive weight loss, palpitations, and fine tremors. Laboratory results reveal a suppressed TSH ($<0.01\text{ mIU/L}$) and elevated Free T4. A nuclear medicine thyroid uptake scan demonstrates high tracer localization limited to a single "hot" nodule in the right lobe, with suppression of the surrounding thyroid tissue. What is the most appropriate initial medical treatment? A. Carbimazole B. Immediate right hemithyroidectomy C. Switch Denosumab to oral Risedronate safely D. Radioactive Iodine-131 ablation therapy without preparation E. High-dose Propylthiouracil (PTU) Correct Answer: A. Carbimazole Explanation: The patient has a toxic autonomous adenoma ("hot" nodule). The definitive treatment is often surgery or radioactive iodine, but the immediate, mandatory initial step is to stabilize the patient medically and achieve euthyroidism using an antithyroid medication, with Carbimazole being the first-line choice in Australia due to its superior safety profile over PTU. ## Neurology & Cardiovascular Medicine Q20. Classification of Chronic Daily Headaches A 38-year-old female presents with a 4-month history of a constant, unremitting, mild-to-moderate generalized headache that occurs every single day from the moment she wakes up. She has no history of head trauma, no neurological deficits, and no systemic signs of illness. The headache does not worsen with physical activity, is not associated with nausea or photophobia, and does not interfere with her work or home duties. She reports no new lifestyle stressors. What is the most appropriate clinical diagnosis? A. Chronic Tension-Type Headache B. New Daily Persistent Headache (NDPH) C. Chronic Migraine without aura D. Medication Overuse Headache E. Idiopathic Intracranial Hypertension Correct Answer: B. New Daily Persistent Headache (NDPH) Explanation: NDPH is unique because it is continuous and unremitting within 3 days of its onset and persists for greater than 3 months, lacking typical migrainous or prominent tension-type fluctuating characteristics. It is distinct from chronic tension headache because it starts abruptly and stays constant from its onset without an escalating prodromal history. Q21. Monitoring Disease Progression in Multiple Sclerosis A 26-year-old female presents with a central scotoma, painful retro-orbital eye movements, and a relative afferent pupillary defect, leading to a presumptive clinical diagnosis of acute optic neuritis. She is later diagnosed with relapsing-remitting Multiple Sclerosis (MS). Which of the following investigations serves as the most accurate structural biomarker to guide prognosis and track long-term cumulative neurological deficits and plaque burden? A. Serial Visual Evoked Potentials (VEP) latency testing B. Detection of Oligoclonal bands in the CSF C. Serial Contrast-enhanced MRI of the Brain and Spine D. Optical Coherence Tomography (OCT) retinal nerve fiber thickness E. Serum Neurofilament Light Chain assays Correct Answer: C.

Under the ABC emergency medical algorithm, securing a patent airway via urgent endotracheal intubation takes immediate precedence over surgical drainage or diagnostic steps. Q15. Investigation of a Palpable Breast Mass in a Young Female A 21-year-old female presents with a smooth, highly mobile, non-tender 1.5 cm mass in the upper outer quadrant of her left breast. She is highly anxious because her mother was diagnosed with breast cancer at age 48. What is the most appropriate initial diagnostic investigation according to the Australian triple test framework? A. Fine Needle Aspiration Cytology (FNAC) B. Ultrasound-guided Core Biopsy C. Diagnostic Mammogram bilaterally D. High-resolution Breast Ultrasound E. Reassure and review clinically in 3 months Correct Answer: D. High-resolution Breast Ultrasound Explanation: In women under 35 years of age, dense breast tissue reduces the diagnostic utility of mammography. According to Cancer Australia's Triple Test guidelines, the initial imaging modality of choice for any young woman presenting with a palpable breast lump is a Breast Ultrasound. Tissue sampling (Core biopsy or FNAC) is performed subsequently if indicated by the ultrasound findings or persistent clinical suspicion. ## Haematology & Rheumatology Q16. Initial Investigation for Spontaneous Gingival Bleeding A 24-year-old female presents to her general practitioner complaining of spontaneous gingival (gum) bleeding when brushing her teeth and spontaneous bruising on her lower limbs over the past 3 weeks. What is the most appropriate initial screening laboratory investigation? A. Platelet count and morphology (Full Blood Examination) B. Activated Partial Thromboplastin Time (aPTT) C. Specific Factor IX assay activity D. Bleeding Time measurement E. Thrombin Time (TT) Correct Answer: A. Platelet count and morphology (Full Blood Examination) Explanation: Spontaneous mucocutaneous bleeding (petechiae, purpura, gingival bleeding) is classic for primary hemostatic defects, most commonly thrombocytopenia (low platelet count) or platelet dysfunction. Checking a Full Blood Examination (FBE) to assess platelet count and morphology is the mandatory first line of screening. Bleeding time is outdated and rarely performed clinically in Australia. Q17. Pre-Operative Anemia Optimization A 68-year-old male is scheduled to undergo an elective hemicolectomy for stage II colon cancer in exactly 2 weeks. His pre-admission blood tests reveal a hemoglobin of $85\text{ g/L}$ (normal 130–180), low ferritin ($12\,\mu\text{g/L}$), and low transferrin saturation. What is the most appropriate management to optimize his hemoglobin pre-operatively? A. Commencement of high-dose oral iron supplements daily B. Administration of an intravenous iron infusion C. Arrange for a 2-unit Packed Red Blood Cell (PRBC) transfusion one day before surgery D. Postpone the cancer surgery by 3 months to allow marrow recovery E. Administer subcutaneous Erythropoietin (EPO) injections weekly Correct Answer: B. Administration of an intravenous iron infusion Explanation: According to the Australian National Blood Authority (NBA) Patient Blood Management Guidelines, iron deficiency anemia should be corrected before major elective surgery to reduce transfusion rates. With only a 2-week window before surgery, oral iron is too slow to meaningfully raise hemoglobin levels. Intravenous iron is the preferred modality here as it rapidly corrects iron stores and raises hemoglobin within 7–14 days. Pre-operative blood transfusion should be avoided unless the patient is actively hemodynamically unstable. ## Rheumatology & Bone Metabolism Q18. Treatment Thresholds in Primary Hyperparathyroidism A 62-year-old postmenopausal female is diagnosed with asymptomatic primary hyperparathyroidism based on an incidental finding of elevated serum calcium ($2.68\text{ mmol/L}$) and an inappropriately high parathyroid hormone (PTH) level.