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australian guidelines

Practice targeted AMC-style multiple-choice questions on australian guidelines.

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A 55-year-old man, non-smoker, presents for a health check. BP 135/85 mmHg, total cholesterol 5.5 mmol/L, HDL 1.2 mmol/L. No personal history of CVD or diabetes. Family history of premature CVD in father. BMI 28. Based on Australian guidelines, what is the most appropriate initial management step?

A. Order a fasting glucose and HbA1c.
B. Start perindopril 5mg daily.
C. Start atorvastatin 20mg daily.
D. Calculate absolute cardiovascular risk and discuss lifestyle modification.
E. Advise weight loss and recheck BP in 6 months.
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A 62-year-old male presents to his general practitioner with a six-month history of a painless bulge in his right groin. On examination, a soft swelling is palpable in the right inguinal region, which increases in size on coughing or straining. The swelling is located medial to the inferior epigastric vessels. Which of the following is the most appropriate initial management strategy according to current Australian guidelines?

A. Reassurance and watchful waiting, with advice to return if symptoms worsen.
B. Urgent referral to an emergency department for exclusion of strangulation.
C. Prescription of a truss to provide symptomatic relief.
D. Referral to a physiotherapist for core strengthening exercises.
E. Referral to a general surgeon for consideration of elective repair.
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A refugee family from Iraq has registered at your clinic, having settled 6 months ago. What is an important consideration for their health assessment in the Australian context?

A. Order a standard battery of tests, including a full range of tropical disease screening for all family members.
B. Focus only on acute medical issues they present with.
C. Assume the father can translate for the whole family to save time.
D. Ensure they are aware of the Medicare rebate available for refugee health checks.
E. Defer a comprehensive health check until they have been settled for at least 12 months.
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An 18-year-old teenage girl presents with a sudden change in behavior at a music festival, appearing confused and aggressive after consuming 5-6 vodkas, with uncertainty about illicit drug use. What is the most appropriate next step in her management in the Australian context?

A. Administer IV fluids to sober her up.
B. Leave the patient alone to cool off.
C. Calmly de-escalate in a quiet room and assess for underlying causes.
D. Restrain the patient physically until she calms down.
E. Immediately administer IV droperidol 10 mg.
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A 28-year-old man presents to his general practitioner for a routine health check. He reports being in a non-monogamous relationship for the past year. He states he uses condoms inconsistently, particularly within the primary relationship where his partner's HIV status is unknown. He denies any recent febrile illness, rash, or lymphadenopathy. His last HIV test, performed 6 months ago, was negative. He has no other significant medical history. Considering his presentation and reported risk factors, which of the following is the most appropriate next step in his management according to Australian guidelines?

A. Order a comprehensive panel of sexually transmitted infection tests, excluding HIV, and review results.
B. Advise strict and consistent condom use for all sexual encounters.
C. Schedule a repeat HIV test in 6 months as part of routine screening.
D. Prescribe a course of post-exposure prophylaxis (PEP) immediately.
E. Discuss and offer HIV pre-exposure prophylaxis (PrEP) after confirming negative HIV status.
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A 62-year-old male presents to his general practitioner with a six-month history of a painless swelling in his right groin. He reports that the swelling becomes more prominent when he strains or coughs and reduces when he lies down. On examination, a soft, reducible bulge is palpable in the right inguinal region. The bulge is felt to emerge medial to the inferior epigastric vessels. Which of the following is the most appropriate next step in management, according to current Australian guidelines?

A. Referral to a physiotherapist for core strengthening exercises.
B. Referral to a general surgeon for elective open or laparoscopic inguinal hernia repair.
C. Urgent referral to an emergency department for assessment of possible strangulation.
D. Reassurance and watchful waiting, with advice on lifestyle modifications.
E. Prescription of a truss to support the hernia.
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A patient with community-acquired pneumonia has a CURB-65 score of 3. What is the most appropriate management setting?

A. Outpatient management with IV antibiotics
B. Outpatient management with oral antibiotics
C. ICU management
D. Inpatient management
E. Observation unit
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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard CC BY-SA 3.0 · Source

A previously well 3-year-old boy presents to the emergency department with a 12-hour history of sudden onset, intermittent, severe, colicky abdominal pain, associated with non-bilious vomiting. Between episodes, he appears lethargic and pale. His vital signs are stable: HR 110, BP 90/60, RR 24, Temp 37.2. Abdominal examination reveals mild distension and tenderness, but no guarding or rebound. Bowel sounds are present. A point-of-care ultrasound is performed by the emergency physician. Considering the clinical presentation, the patient's current stable vital signs, and the specific findings demonstrated in the provided ultrasound image, which of the following represents the single most appropriate immediate next step in the management of this patient in an Australian tertiary paediatric centre?

A. Proceed directly to surgical exploration.
B. Attempt pneumatic or hydrostatic reduction under fluoroscopic guidance.
C. Obtain a CT scan of the abdomen and pelvis.
D. Administer IV fluids and observe for resolution.
E. Discharge home with pain relief and follow-up.
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A 23-year-old backpacker doing farm work presents with a low-grade fever for 4 days. Q fever is suspected. What is the most appropriate diagnostic method for acute Q fever in Australia?

A. Chest X-ray
B. Serology (IFA for Phase II antibodies)
C. Serum PCR for C. burnetii.
D. Rapid antigen test for C. burnetii.
E. Serial blood cultures
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A 25-year-old gentleman presents with 3 days of rhinorrhea, fever, cough, and abdominal pain. On examination, his temperature is 39.6°C, he has reduced breath sounds, and an enlarged spleen. Which of the following causative pathogens, if identified, would require mandatory notification in Australia?

A. Respiratory Syncytial Virus (RSV)
B. Mycoplasma pneumoniae
C. Adenovirus
D. Chlamydia psittaci
E. Parainfluenzae
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A 62-year-old man presents to his general practitioner with a 6-month history of a bulge in his groin that appears when he strains or coughs. He reports mild discomfort but no severe pain. On examination, the GP identifies a soft, reducible mass in the right groin area that appears to emerge through the superficial inguinal ring when the patient coughs. The mass reduces spontaneously when the patient lies down. Which of the following is the most appropriate next step in management, according to Australian guidelines?

A. Urgent referral to the emergency department for strangulation risk
B. Referral to a general surgeon for elective repair
C. Referral for an abdominal CT scan to rule out other pathology
D. Reassurance and watchful waiting with lifestyle advice
E. Prescription of a truss to support the hernia
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A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It feels smooth, mobile, and non-tender. No family history of breast cancer. On examination, a 2cm, firm, mobile mass is noted. Considering Australian guidelines for a palpable breast lump in this age group, what is the most appropriate initial investigation?

A. MRI breast
B. Core biopsy
C. Mammography
D. Ultrasound scan
E. Fine needle aspiration cytology
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What is the recommended initial antibiotic regimen for severe community-acquired pneumonia in an Australian adult requiring ICU admission?

A. Ceftriaxone plus azithromycin
B. Azithromycin monotherapy
C. Ciprofloxacin monotherapy
D. Doxycycline monotherapy
E. Amoxicillin
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A 60-year-old non-smoker has a calculated 5-year cardiovascular disease risk of 12%. Based on current Australian guidelines, what is the most appropriate initial management focus?

A. Annual risk reassessment without intervention
B. Lifestyle modification and shared decision-making regarding pharmacotherapy
C. Immediate initiation of high-intensity statin therapy
D. Referral for specialist cardiology review
E. Low-dose aspirin therapy for primary prevention
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A 55-year-old non-smoker with no known comorbidities has a consistent office BP of 155/98 mmHg. His 10-year CVD risk is calculated as low. According to Australian guidelines, what is the most appropriate initial management?

A. Recommend lifestyle modifications and review in 3-6 months
B. Investigate for secondary causes of hypertension
C. Initiate single antihypertensive therapy
D. Refer for ambulatory blood pressure monitoring
E. Initiate dual antihypertensive therapy
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A 52-year-old woman presents to her general practitioner with fatigue, increased thirst, and frequent urination over the past three months. She has a history of hypertension and hyperlipidemia, for which she takes lisinopril and atorvastatin. Her BMI is 32 kg/m². On examination, her blood pressure is 140/85 mmHg, and her heart rate is 78 bpm. Laboratory tests reveal a fasting plasma glucose of 8.5 mmol/L and an HbA1c of 7.2%. She is diagnosed with type 2 diabetes mellitus. Which of the following is the most appropriate initial management step for this patient according to Australian guidelines?

A. Lifestyle modification including diet and exercise
B. Commencement of insulin therapy
C. Initiation of metformin therapy
D. Referral to an endocrinologist
E. Addition of a sulfonylurea
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A 35-year-old woman presents to her GP with worsening shortness of breath, cough, and wheeze over 2 days, requiring her salbutamol reliever daily and waking her at night. Her PEF is 60% of her personal best. She is alert, speaking in sentences, RR 22, HR 95. Based on Australian guidelines, what is the most appropriate initial management step?

A. Prescribe a course of oral prednisolone.
B. Order a chest X-ray to rule out pneumonia.
C. Increase the dose of her regular inhaled corticosteroid.
D. Arrange immediate transfer to the nearest emergency department.
E. Administer inhaled salbutamol via spacer and reassess clinical status and PEF.
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A 30-year-old woman attends her first antenatal visit at 28 weeks gestation. She has no significant medical history and received her last tetanus booster 10 years ago. She is otherwise well. According to Australian guidelines, which vaccination is most specifically recommended for administration during this gestational period?

A. Hepatitis B vaccine
B. Influenza vaccine
C. Measles-mumps-rubella (MMR) vaccine
D. Varicella vaccine
E. Diphtheria-tetanus-acellular pertussis (dTpa)
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A 55-year-old male with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 150/95 mmHg despite lifestyle modifications. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A. Prescribe a diuretic
B. Increase lifestyle modifications
C. Refer to a cardiologist
D. Start a beta-blocker
E. Initiate an ACE inhibitor
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A 32-year-old woman presents to her general practitioner complaining of severe anal pain during and after bowel movements, along with bright red blood on the toilet paper. She reports constipation and straining during defecation. Examination reveals a visible longitudinal tear in the anal mucosa at the 6 o'clock position. Which of the following is the MOST appropriate initial management strategy, according to Australian guidelines?

A. Recommend regular sitz baths with antiseptic solution.
B. Prescribe oral antibiotics to treat potential infection.
C. Advise increased fluid and fibre intake, stool softeners, and topical application of a local anaesthetic and a topical nitrate ointment.
D. Refer for surgical lateral internal sphincterotomy.
E. Order a colonoscopy to rule out inflammatory bowel disease.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the appearance of the abnormality demonstrated in the provided image, which is the most appropriate method for obtaining a tissue diagnosis?

A. Surgical excisional biopsy with wire localisation as the initial diagnostic step
B. Ultrasound-guided core biopsy of the area corresponding to the mammographic finding
C. Follow-up mammography in 6 months to assess stability of the finding
D. Stereotactic core biopsy targeting the clustered microcalcifications
E. Fine needle aspiration cytology of the suspicious area
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A 52-year-old woman presents to her general practitioner with fatigue, increased thirst, and frequent urination over the past three months. She has a history of hypertension and hyperlipidemia, managed with lisinopril and atorvastatin. Her BMI is 32 kg/m². On examination, her blood pressure is 140/85 mmHg, and her heart rate is 78 bpm. Laboratory tests reveal a fasting plasma glucose of 8.5 mmol/L and an HbA1c of 7.2%. She is concerned about her risk of complications and asks about the best initial management strategy. Considering Australian guidelines, what is the most appropriate next step in managing her condition?

A. Initiate metformin therapy
B. Advise lifestyle modifications only
C. Prescribe a sulfonylurea
D. Refer to an endocrinologist immediately
E. Start insulin therapy
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Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Based on the clinical presentation and the provided image, if outpatient management is deemed appropriate, which of the following antibiotic regimens is most consistent with current Australian guidelines?

A. Intravenous ceftriaxone and metronidazole for 5 days
B. Oral amoxicillin-clavulanate for 7-10 days
C. Oral metronidazole monotherapy for 14 days
D. Oral doxycycline for 7 days
E. Oral ciprofloxacin monotherapy for 5 days
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A 50-year-old woman presents with a newly discovered, firm, mobile lump in her left breast, approximately 2 cm in size. She has no family history of breast cancer. She is post-menopausal. On examination, the lump is palpable in the upper outer quadrant, appears well-defined, and is non-tender. There are no skin changes or nipple discharge. Axillary nodes are not palpable. Considering the Australian guidelines for breast lump assessment, which of the following is the most appropriate initial investigation?

A. Mammography and ultrasound
B. Clinical breast examination and review in 3 months
C. Ultrasound and core biopsy
D. Fine needle aspiration cytology
E. Mammography alone
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A 5-year-old girl presents with an itchy bottom at night, worse at night, suggestive of threadworm infection. What is the best treatment for her infection in the Australian context?

A. Advise dietary changes, such as reducing sugar intake, as the primary treatment.
B. Recommend applying a topical anti-itch cream to the perianal area.
C. Treat only the affected child with a single dose of pyrantel.
D. Reassure the parents that this is common and has low morbidity, requiring no treatment.
E. Treat the whole family with pyrantel or mebendazole, and repeat in 2 weeks.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the clinical presentation, the patient's history, and the specific finding demonstrated in the provided image from her screening mammogram, what is the most appropriate immediate next step in the management pathway for this patient?

A. Stereotactic vacuum-assisted core biopsy of the suspicious calcifications.
B. Proceed directly to surgical excision of the area under wire localisation.
C. Repeat the mammogram in 3-6 months with spot compression and magnification views.
D. Request a breast MRI with contrast to better delineate the extent of the abnormality.
E. Perform a targeted ultrasound of the area of concern.
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A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He denies abdominal pain or pulsatile mass. His blood pressure is 130/80 mmHg. The provided image is an axial view from this scan. Based on this finding and the patient's clinical status, what is the most appropriate next step in management according to Australian guidelines?

A. Arrange for surveillance ultrasound in 12 months
B. Repeat CT angiography in 6 months
C. Arrange for urgent surgical consultation
D. No further follow-up is required
E. Schedule elective endovascular aneurysm repair (EVAR)
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A 45-year-old woman presents to the emergency department with a 3-day history of fever, productive cough with greenish sputum, and pleuritic chest pain. She has a history of asthma and is currently on salbutamol and fluticasone inhalers. On examination, her temperature is 38.5°C, respiratory rate is 24 breaths per minute, and oxygen saturation is 92% on room air. Auscultation reveals decreased breath sounds and crackles in the right lower lung field. A chest X-ray shows a right lower lobe consolidation. What is the most appropriate initial antibiotic therapy for this patient, considering Australian guidelines?

A. Doxycycline
B. Ceftriaxone
C. Amoxicillin-clavulanate
D. Azithromycin
E. Ciprofloxacin
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A 55-year-old man with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 160/95 mmHg despite lifestyle modifications. He is currently on perindopril 5 mg daily. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A. Switch to losartan
B. Refer for renal artery imaging
C. Add hydrochlorothiazide
D. Add amlodipine
E. Increase perindopril to 10 mg daily
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A 45-year-old woman presents to her GP with recurrent episodes of biliary colic. An ultrasound confirms the presence of multiple gallstones. She is otherwise healthy with no significant past medical history. After discussing management options, she opts for a laparoscopic cholecystectomy. Which of the following is the MOST appropriate next step in her preoperative assessment, according to Australian guidelines?

A. Routine liver function tests (LFTs) and coagulation studies
B. Cardiologic assessment with ECG
C. Upper endoscopy to exclude other causes of abdominal pain
D. Hepatobiliary iminodiacetic acid (HIDA) scan to assess gallbladder function
E. Magnetic resonance cholangiopancreatography (MRCP) to rule out choledocholithiasis
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A 32-year-old male presents to his general practitioner with persistent anal pain and bleeding on defecation for the past 8 months. He reports a cycle of pain, relief after bowel movements, followed by throbbing pain lasting several hours. Examination reveals a visible anal fissure at the 6 o'clock position, along with a skin tag. Which of the following is the MOST appropriate next step in management, according to Australian guidelines?

A. Topical glyceryl trinitrate (GTN) ointment and stool softeners
B. Fibre supplementation and sitz baths
C. Botulinum toxin injection into the internal anal sphincter
D. Excision of the fissure and skin tag with advancement flap
E. Lateral internal sphincterotomy
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