preventative medicine

Practice targeted AMC-style multiple-choice questions on preventative medicine.

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 28-year-old woman, 18 weeks pregnant, presents to her GP two days after her 5-year-old son developed varicella. She is unsure of her immunity status and is asymptomatic. Which of the following is the most appropriate initial management step?

A. Observe closely for symptoms and treat with acyclovir if rash develops.

B. Reassure her that the risk is low given she is asymptomatic.

C. Administer varicella vaccine.

D. Obtain urgent varicella serology and administer VZIG if non-immune.

E. Administer varicella-zoster immunoglobulin (VZIG) as soon as possible.

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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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Following a positive genetic test for a hereditary cancer syndrome, what is the most important next step for the patient's family?

A. Advise increased cancer screening for all family members.

B. Offer genetic counselling and cascade testing to at-risk relatives.

C. Recommend prophylactic surgery for all first-degree relatives.

D. Focus solely on lifestyle changes for risk reduction.

E. Inform family the risk is only for future children.

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Which genetic variant classification most strongly mandates clinical action?

A. Pathogenic

B. Benign

C. Variant of uncertain significance (VUS)

D. Likely benign

E. Likely pathogenic

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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 22-year-old lady was wrongly given a B12 prescription for another patient. The error was noticed later at the pharmacy. What is the next step?

A. Notify the practice manager.

B. Report to AHPRA.

C. Apologize to the patient for the error.

D. Review practice procedures.

E. Document in patient notes.

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An Aboriginal woman, 48 years old, attends your general practice for a routine health check. She has a history of gestational diabetes and lives in a rural community. When discussing preventative health screening, which of the following is the MOST culturally appropriate and evidence-based approach?

A. Refer her to a specialist diabetes clinic in a major city for comprehensive assessment and management, ensuring she understands the importance of specialist care.

B. Recommend genetic testing for diabetes risk, as Aboriginal Australians have a higher prevalence of certain genetic predispositions.

C. Offer a comprehensive assessment including HbA1c, urine albumin creatinine ratio, blood pressure, BMI, smoking and alcohol use, and discuss cardiovascular risk, while acknowledging the impact of social determinants of health and incorporating her preferences for health management.

D. Focus primarily on diabetes screening with HbA1c testing, as she has a history of gestational diabetes, and provide written information about diabetes management.

E. Advise her to follow a standard Western diet and exercise plan to manage her diabetes risk, as these are proven effective strategies.

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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 35-year-old healthcare worker has a positive tuberculin skin test (12mm induration) following a known occupational exposure. Her chest X-ray is clear, and she reports no symptoms. Which is the most appropriate next step in management?

A. Initiate treatment for latent tuberculosis infection.

B. Order an Interferon-Gamma Release Assay (IGRA).

C. Reassure the patient and advise annual screening.

D. Repeat the tuberculin skin test in three months.

E. Start a four-drug regimen for active tuberculosis.

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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 with a history of smoking presents for a routine check-up. The image is taken. What is the recommended surveillance interval?

A. No further imaging required

B. Initiate statin therapy and monitor annually

C. Repeat imaging in 6-12 months

D. Immediate surgical consultation

E. Repeat imaging in 3 years

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A 66-year-old man, active with a good diet, whose mother had osteoporosis at age 91, wants to check his osteoporosis risk. What risk factors prompt a bone mineral density (BMD) test?

A. Asthma

B. Rheumatoid arthritis

C. Generalized anxiety disorder

D. Type 2 Diabetes Mellitus

E. Hypertension

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preventative medicine

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