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risk factors

Practice targeted AMC-style multiple-choice questions on risk factors.

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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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Facial eosinophilic granuloma. Red-brown nodule on the nose. Clearly visible follicular structures ("peau d'orange").
Image by Sand, Michael, et al. CC BY 2.0 · Source

A 35-year-old man presents to his general practitioner reporting a lesion on his nose that he first noticed approximately three months ago. He describes it as initially resembling a persistent pimple, but notes it has not resolved and appears to be slowly increasing in size. He denies any associated pain, itching, or bleeding from the site. His past medical history is unremarkable, and he is not currently taking any regular medications. He works outdoors in a role involving significant sun exposure but admits to inconsistent use of sun protection measures. On physical examination, his vital signs are within normal limits. The lesion in question is located on his nose and has the appearance shown in the accompanying image. No other suspicious skin lesions are identified elsewhere on his body, and regional lymph nodes are not palpable. Considering the clinical presentation and the appearance of the lesion depicted, what is the most appropriate initial step in the management of this patient?

A. Perform a punch biopsy of the lesion for histological examination.
B. Arrange an urgent ultrasound scan of the nose and regional lymph nodes to assess for depth and spread.
C. Prescribe a course of topical antibiotic cream and review in two weeks.
D. Advise the patient to monitor the lesion for further changes and return in three months if it persists or grows.
E. Initiate treatment with a high-potency topical corticosteroid cream twice daily.
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Facial eosinophilic granuloma. Red-brown nodule on the nose. Clearly visible follicular structures ("peau d'orange").
Image by Sand, Michael, et al. CC BY 2.0 · Source

A 35-year-old male presents to his general practitioner with a lesion on his nose that has been present for approximately 3 months. He initially thought it was a persistent pimple but it has not resolved and seems to be slowly growing. He denies pain, itching, or bleeding from the lesion. He has no significant past medical history and takes no regular medications. He works outdoors but reports using sunscreen inconsistently. On examination, vital signs are stable. The lesion is as shown in the image. There are no other skin lesions noted elsewhere. Regional lymph nodes are not palpable. Based on the appearance of the lesion shown, what is the most appropriate next step in the management of this patient?

A. Reassure the patient and arrange for review in 3 months.
B. Prescribe a course of topical corticosteroid cream.
C. Initiate a course of oral antibiotics.
D. Arrange for cryotherapy to the lesion.
E. Perform a biopsy of the lesion for histological examination.
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A patient has Bowen's disease on their trunk. Which exposure is a significant risk factor for Bowen's disease, especially in non-sun-exposed areas?

A. Smoking
B. Chronic UV radiation
C. HPV infection
D. Arsenic exposure
E. Immunosuppression
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A couple with a 4-year-old daughter who has cystic fibrosis (CF), and both are CFTR gene carriers, want to try for another baby. What is the likelihood of having a second baby with cystic fibrosis?

A. There is a 25% chance of cystic fibrosis (CF) in the child.
B. 0% chance of CF in the child.
C. There is a 50% chance of being a carrier.
D. There is a 75% chance of cystic fibrosis (CF) in the child.
E. There is a 50% chance of cystic fibrosis (CF) in the child.
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A middle-aged man who already has a 20% cardiovascular risk and is on lifestyle modification and statin therapy: Which one of the following helps you assess his cardiovascular risk?

A. Coronary artery angiogram
B. ECG
C. Exercise ECG
D. Echocardiogram
E. Coronary artery calcium score
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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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A middle-aged man with a 20% estimated cardiovascular risk is already on lifestyle modifications and statin therapy. Which of the following investigations can help further assess or reclassify his cardiovascular risk?

A. Coronary artery angiogram
B. Echocardiogram
C. Stress echocardiogram
D. Coronary artery calcium score
E. Exercise ECG
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