澳大利亚MCQ考试真题.doc

By proceeding with this practice examination, you will have read and understood that :This examination has a one hour time limit. There will be 50 questions in this exam. While every attempt has been made to ensure this on line practice examination represents the actual AMC MCQ examination, there may be slight differences in the layout due to differing software platforms. This examination should be treated as a sample only and should be viewed as a) a means of familiarising yourself with answering a multiple choice question type examination using a computer.b) a means of providing performance feedback At the conclusion of this examination, feedback will be provided on your performance. The results of this on line practice examination are purely for your information only. They do not in any way reflect or impact on your result for the actual AMC MCQ examination. It is in your best interests to answer the questions in this examination without external assistance. This will provide you with accurate feedback on your performance. The AMC reserves the right to change the layout and content of this on line practice examination. Please note: The computer based AMC practice MCQ examination consists of Type A questions only. Questions 1 - 50 consist of a stem and five (5) responses labelled A,B,C,D and E of which only ONE (1) is correct. Decide which ONE response is the BEST answer. There will always be five possible responses to a question. If you cannot immediately see them all on the screen, scroll down until you can see them all. To answer a question, place a mark inside the circle corresponding to your answer by clicking the circle. Once you have selected an answer, click the Next button to move onto the next question, or the Previous button to move to the previous question. The computer based AMC practice MCQ examination will conclude once you have answered ALL questions. If you reach the last question and cannot see the Finish button, review all of the questions to ensure there is an answer for each one. The Previous, Next and Finish (when applicable) buttons are all located at the top of the screen. Laboratory test results, where applicable, are expressed in Australian standard abbreviations with the reference range for the particular patient in brackets following. ?2004 by Australian Medical Council Incorporated Copyright for this examination rests with the Australian Medical Council IncorporatedAll rights reserved. No part of this examination may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the Copyright Act 1968, without the prior permission of the copyright owner.Australian Medical Council Incorporated40 Macquarie StreetBARTON ACT 2600Telephone: (02) 6270 9777Facsimile: (02) 6270 9799Email: .au Clicking the proceed button will start the on line practice examination. By doing this, you will also start the 1 hour timed session.Click the Start button below to start the examination.- 1.Cardiac auscultation reveals accentuation of the first heart sound at the apex, accentuation of the second pulmonary sound and a presystolic murmur at the apex. The MOST LIKELY diagnosis is (A) pulmonary stenosis. (B) mitral stenosis. (C) aortic stenosis. (D) mitral incompetence. (E) functional heart murmur. - 2. A previously healthy 3-year-old child has a single generalised convulsion lasting 5 min. She is found to have a reddened throat and rectal temperature of 39.7 degrees C, from which she recovers uneventfully in 5 days. Three months later she again becomes febrile with an upper respiratory tract infection. Which one of the following is CORRECT? (A) She should be started on oral phenobarbitone. (B) She should be put in a bath of cold water. (C) 600 mg aspirin should be administered. (D) An antibiotic should be administered promptly. (E) Most such children will not have a further seizure. - ?Australian Medical Council Inc *3. A 40-year-old school teacher has been receiving treatment for depressive symptoms following his wifes desertion. A week after being involved in a traffic accident in which a child was hospitalised with head injuries, he takes an overdose of fifty 25 mg imipramine tablets and a large amount of alcohol. He has previously refused referral to a psychiatrist or voluntary hospitalisation for assessment. Your INITIAL management, after successful medical treatment of his overdose, SHOULD BE to (A) increase his imipramine to 150 mg daily. (B) change him to a different tricyclic antidepressant. (C) contact his wife and try and persuade her to return home. (D) arrange involuntary psychiatric hospitalisation, if he still refuses voluntary admission. (E) refer him for alcohol counselling. 4.The skin lesions shown in the above photograph were found on the hands of a 73-year-old nursing home patient. She has been noted to be constantly scratching the lesions and appears poorly cared for. The MOST APPROPRIATE treatment would be (A) topical steroids. (B) erythromycin. (C) gamma benzene hexachloride. (D) miconazole cream. (E) prednisone, 60mg daily. 5. A healthy non-smoking 19-year-old man, hospitalised for an appendicectomy, is mistakenly given an overdose of his narcotic premedication. He is found unconscious and on auscultation of his chest, he has reduced breath sounds but no added sounds. Emergency chest X-ray is clear. His arterial blood gases (in mmHg), taken while breathing room air are MOST LIKELY to show (A) pH - 7.22 PaO2 - 70 PaCO2 - 61. (B) pH - 7.23 PaO2 - 90 PaCO2 - 59. (C) pH - 7.23 PaO2 - 86 PaCO2 - 30. (D) pH - 7.39 PaO2 - 65 PaCO2 - 42. (E) pH - 7.39 PaO2 - 75 PaCO2 - 60. 6. A 26-year-old man has been under your care after falling 10 m while rock climbing, sustaining bilateral compound tibial fractures and a fractured pelvis. Three days postoperatively, after open reduction and fixation of his tibial fractures, he becomes acutely breathless. A chest X-ray reveals a diffuse bilateral pulmonary infiltrate. He suddenly becomes confused and fearful, believing his food to be poisoned, and that the hospital staff are plotting against him and plan to murder him. The MOST LIKELY explanation for the change in his mental state is (A) aspiration pneumonia. (B) pulmonary embolism. (C) fat embolism syndrome. (D) subacute pancreatitis. (E) extradural haematoma. 7.A 67-year-old man presents with a history of progressive dysphagia and hoarseness over the preceding 24 h. On examination there is a right Horner syndrome and the right side of the palate does not elevate on phonation. The right gag reflex is absent and the patient cannot produce an explosive cough. These signs and symptoms are MOST LIKELY due to which one of the following? (A) A left capsular haemorrhage. (B) A meningioma at the foramen magnum. (C) Thrombosis of the left posterior inferior cerebellar artery. (D) A left cerebello-pontine angle tumour. (E) A right-sided brain stem infarction. 8. A 32-year-old woman, G5, P4, at 32 weeks gestation is admitted to hospital because of mild, bright red vaginal bleeding amounting to approximately 100 mL. Her last two children were born by lower uterine segment caesarean section. She has no pain or contractions. Vital signs are stable within the normal range. Fetal heart rate is 140 beats/min and regular and the CTG shows no decelerations and good beat to beat variation. Intravenous fluids are started, and blood is drawn for typing, cross-matching, and complete blood count. In addition to bed rest, management at this time SHOULD INCLUDE (A) a rectal examination. (B) a vaginal examination. (C) beta sympathomimetic agents. (D) immediate caesarean section. (E) observation and further investigation. 9.A 65-year-old overweight man complains of recent misty vision on sunny days. His vision, when tested, is 6/18 right and left. Which one of the following is the MOST LIKELY basis of his complaint? (A) Chronic simple glaucoma. (B) Myopia. (C) Cataract. (D) Macular degeneration. (E) Diabetic retinopathy. * 10) In a 25-year-old woman with gluten-sensitive enteropathy, which one of the following statements is CORRECT? (A) The anaemia is most likely due to Vitamin B12 deficiency. (B) The pretreatment biopsy will demonstrate flattened villi and an inflammatory cell infiltrate of periodic acid-Schiff positive macrophages. (C) Corn contains gluten and should be excluded from the diet. (D) When placed on a strict gluten-free diet, the small bowel histology will improve markedly within 2 weeks. (E) There is an association with the development of lymphoma. *11) A previously well boy aged 18 months presents with a 24 h history of cough and wheeze and has a respiratory rate of 35/min. There is a family history of asthma and allergy. Examination shows a boy who is generally well but he has softer breath sounds over the left hemithorax. There are bilateral wheezes, more marked on the left. The APPROPRIATE MANAGEMENT is (A) give nebulised salbutamol 4 hourly. (B) refer for physiotherapy. (C) give amoxycillin. (D) arrange inspiratory and expiratory chest x-rays. (E) admit to hospital and nurse in 30% oxygen. 12) Which one of the following is CORRECT? (A) Meatal ulceration is a complication of circumcision. (B) The prepuce is fully retractable in 90% of uncircumcised boys aged 6 months. (C) Circumcision is the first stage in the repair of hypospadias. (D) Neonatal circumcision is safe in haemophilia, because of transplacental passage of factor VIII. (E) Neonatal circumcision is painless. * 13) Nine days after anterior resection of the rectum in an obese 57-year-old man, his left leg becomes swollen with tenderness of the calf. He has a slight fever and tachycardia. The MOST IMPORTANT aspect of his treatment WOULD be (A) elevation of the foot of the bed. (B) an elastic stocking. (C) anticoagulant therapy with heparin. (D) insertion of an inferior vena caval filter. (E) ligation of the left femoral vein. 14) Which one of the following maternal conditions generally CONTRAINDICATES epidural anaesthesia in labour? (A) Hypertension. (B) Previous caesarean delivery. (C) Platelet count less than 40x10 9/L (150-40x10 9/L) (D) Mitral stenosis. (E) Chronic anaemia. * 15) A discrete mobile mass in the breast of a 25-year-old woman is MOST LIKELY to be (A) carcinoma. (B) fibroadenoma. (C) intraduct papilloma. (D) fibroadenosis. (E) fat necrosis. 16) A patient lacerates the ulnar nerve just above the wrist. Which one of the following physical findings is MOST LIKELY to be present? Inability to (A) extend the wrist. (B) flex the wrist. (C) flex the distal phalanges of the fourth and fifth digits. (D) oppose the thumb and index finger. (E) spread the fingers. 17) A placid 4-week-old formula-fed baby has vomited feeds since the first week of life. Her maternal grandmother is convinced that the baby is ill. The mother is also concerned but says that the baby feeds well. You confirm that she has gained weight normally, and find no clinical abnormality. You SHOULD (A) reassure the mother and tell her to ignore anyone who says the child is ill. (B) explain that the baby probably has gastro-oesophageal reflux. (C) arrange barium swallow and meal. (D) arrange suprapubic aspiration of urine for microscopy and culture. (E) advise that the formula be diluted to make it more digestible. * 18) A 65-year-old man develops sudden excruciating interscapular pain radiating into the right lower limb. On physical examination, the right femoral pulse is not felt and the left femoral pulse is weak. There is an aortic diastolic murmur. The blood pressure is 160/90 mmHg, and the pulse rate is 100/min. The MOST LIKELY diagnosis is (A) myocardial infarction. (B) embolus of the abdominal aorta. (C) dissecting aortic aneurysm. (D) pulmonary embolus. (E) spontaneous pneumothorax. 19) A delusion is an EXAMPLE of (A) formal thought disorder. (B) blunted affect. (C) a false belief. (D) auditory hallucinations. (E) passivity experiences. 20) Papillary carcinoma of the thyroid gland (A) is a slow growing tumour which is influenced by thyroid stimulating hormone secretion. (B) is multifocal and spreads mainly by the blood to bone. (C) is sometimes associated with phaeochromocytoma and skin lesions. (D) produces calcitonin and the syndrome of malignant hypocalcaemia. (E) is extremely radiosensitive and should be treated by irradiation of the thyroid gland. 21) In the preoperative evaluation of a person for a possible bleeding tendency the MOST IMPORTANT of the following is (A) clotting time. (B) bleeding time. (C) clinical history. (D) prothrombin time of Internaional Normalised Ratio (INR). (E) partial thromboplastin time. 22) A young woman who is obviously pregnant is found at the side of the road at the site of an automobile accident. She is unresponsive to verbal stimuli. Assessment of her condition should give FIRST PRIORITY to (A) respiratory status. (B) level of consciousness. (C) fetal viability. (D) presence of bleeding. (E) assessment of possible shock. 23) A 34-year-old married woman has sought your advice on chronic and fluctuating food intolerance, accompanied by nausea, vomiting spells, abdominal pain, bloating and diarrhoea. She tells you that she has been sickly for most of the last 20 years of her life since puberty, and has had a lot of gynaecological investigations for severe dysmenorrhoea, excessive menstrual bleeding and dyspareunia. She has consulted a number of neurologists for trouble with walking, muscle weakness and fainting spells for which she was prescribed anticonvulsants, with little benefit. A cardiologist had prescribed a beta-blocker for episodes of palpitations accompanied by chest pain and breathlessness, and a rheumatologist had given her a trial of various anti-inflammatory drugs for small joint pain and lumbago with only temporary relief. Your physical examination revealed that she is apparently tense and anxious despite diazepam 15 mg daily, and that she has abdominal scars from a previous appendicectomy and separate hysterectomy. The MOST LIKELY psychiatric diagnosis that this woman has is (A) somatisation disorder. (B) hypochondriasis. (C) conversion disorder. (D) Munchausen syndrome. (E) factitious illness. 24) Which one of the following is the MOST LIKELY pathological diagnosis of the lesions in the above photograph which were noted on the back of an elderly woman? (A) Pigmented basal cell carcinomas. (B) Seborrhoeic keratoses. (C) Mycosis fungoides. (D) Solar keratoses. (E) Hutchinson melanotic freckles. 25) Which one of the following USUALLY resolves spontaneously? (A) Small ventricular septal defect in a child aged 12 months. (B) Small atrial septal defect in a child aged 3 years. (C) Patent ductus in a toddler. (D) Aortic coarctation in a premature infant. (E) Congenital heart block. 4444444444444444444444444444444444444444444444444444444444444444444444444426) The MOST COMMON cause of blood-stained stool in an otherwise normal infant is (A) anal fissure. (B) anal fistula. (C) haemorrhoids. (D) Meckel diverticulitis. (E) intussusception. 27) A 19-year-old woman, prescribed a triphasic oral contraceptive for the first time one month ago, complains of frequent spotting. The MOST APPROPRIATE MANAGEMENT is to (A) increase the dose of oestrogen. (B) increase the dose of progestogen. (C) advise alternative contraception. (D) continue the medication and review in two months. (E) change to a biphasic pill. 28) 27-year-old woman is hospitalised at 36 weeks gestation because of jaundice, haematemesis and increased confusion. For 10 days prior to admission she had nausea, vomiting, lack of appetite and fatigue. Results of laboratory studies are: urea 18 mmol/L (3-8); uric acid 0.6 mmol/L (0.15-0.40); bilirubin 60 umol/L (2-20); alanine aminotransferase (ALT) 240 U/L (5-40); aspartate aminotransferase (AST) 210 U/L (10-45); alkaline phosphatase (ALP) 80 U/L (25-100). Serum ammonia concentration is elevated. The MOST LIKELY diagnosis is (A) acute viral hepatitis. (B) alcoholic cirrhosis. (C) pre-eclampsia. (D) acute fatty liver of pregnancy. (E) cholestasis of pregnancy. 29) A 73-year-old woman complains of pain mainly in the limb girdles, associated with marked stiffness. Her symptoms are worse in the early hours of the morning and on waking. There is no abnormality on examination apart from mild generalised stiffness of the shoulder and hip joints. Your provisional diagnosis would MOST LIKELY be CONFIRMED by (A) X-ray of the pelvis and shoulder girdle. (B) serum calcium and phosphorus levels. (C)