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ACRRM MCQ study materials
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ACRRM MCQ practice questions

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Question 1General Practice (Rural and Remote Medicine)

A 24-year-old farm worker in a remote town presents 6 hours after a clean laceration to the forearm from a metal fence. The wound has been irrigated and is suitable for primary closure. His tetanus vaccination history is unknown. What is the most appropriate tetanus prophylaxis?

  1. Give tetanus toxoid vaccine only
  2. Give tetanus immunoglobulin only
  3. Give tetanus toxoid vaccine plus tetanus immunoglobulin Correct answer.
  4. Give no tetanus prophylaxis and review in 48 hours

Explanation

When the vaccination history is unknown, the patient is treated as unimmunised, so both an age-appropriate tetanus-containing vaccine and tetanus immunoglobulin are indicated for a wound that warrants it. Immunoglobulin provides immediate passive antibody cover while the vaccine begins active immunity. Documentation and completion of a catch-up schedule should follow.

Question 2General Practice (Rural and Remote Medicine)

Which single finding best supports a diagnosis of meningococcal septicaemia rather than a simple viral illness in a febrile child in a remote setting?

  1. A generalised blanching maculopapular rash
  2. A temperature above 39 degrees Celsius
  3. A non-blanching petechial rash Correct answer.
  4. Refusal of oral fluids

Explanation

A non-blanching petechial or purpuric rash reflects capillary leakage and microthrombosis and is a red flag for meningococcal disease. Fever, poor feeding and blanching rashes are common and nonspecific in viral illnesses. Any non-blanching rash in a febrile child warrants urgent parenteral antibiotics and retrieval.

Question 3General Practice (Rural and Remote Medicine)

A 58-year-old man in a remote community has an acutely swollen, painful first metatarsophalangeal joint. He takes hydrochlorothiazide and has chronic kidney disease with an eGFR of 35 mL/min/1.73m2. Which acute treatment is most appropriate?

  1. Oral colchicine at standard dose
  2. Oral naproxen
  3. Intra-articular corticosteroid injection Correct answer.
  4. Oral allopurinol at high dose

Explanation

Intra-articular corticosteroid avoids systemic NSAID and colchicine toxicity and is effective for an acute monoarthritis when infection has been reasonably excluded. NSAIDs are relatively contraindicated in significant renal impairment, and colchicine requires dose reduction and carries toxicity risk in renal disease. Allopurinol is not used to treat an acute attack.

Question 4General Practice (Rural and Remote Medicine)

Which feature most strongly suggests that a patient's chronic leg ulcer is venous rather than arterial in origin?

  1. Ulceration in the gaiter area with surrounding haemosiderin staining Correct answer.
  2. Pain relieved by dependency and worse on elevation
  3. Ulceration over the lateral malleolus with a punched-out appearance
  4. Ankle-brachial pressure index of 0.6

Explanation

Venous ulcers typically occur in the gaiter area with surrounding pigmentation from haemosiderin deposition, oedema and lipodermatosclerosis. Arterial ulcers are often punched out, painful on elevation and associated with a low ankle-brachial pressure index. Compression therapy should be withheld until arterial status is assessed.

Question 5General Practice (Rural and Remote Medicine)

A 34-year-old woman in a remote area is 10 weeks pregnant and presents with vaginal bleeding and lower abdominal pain. She is haemodynamically stable. Which investigation is most appropriate first-line to locate the pregnancy?

  1. Serum beta-hCG repeated in 48 hours
  2. Plain abdominal X-ray
  3. Diagnostic laparoscopy
  4. Transvaginal ultrasound Correct answer.

Explanation

Transvaginal ultrasound is the first-line investigation to confirm intrauterine pregnancy and to assess for ectopic pregnancy or miscarriage. Serial beta-hCG is useful when ultrasound is inconclusive but does not localise the pregnancy by itself. Laparoscopy is reserved for diagnostic uncertainty or surgical management.

Question 6General Practice (Rural and Remote Medicine)

An elderly man in a remote town has acute urinary retention with a palpable bladder and severe suprapubic pain. Which initial step is most appropriate?

  1. Perform immediate suprapubic aspiration
  2. Give oral tamsulosin and reassess in 4 hours
  3. Insert an indwelling urethral catheter and leave it in place
  4. Urgent urethral catheterisation with controlled decompression Correct answer.

Explanation

Acute painful retention is a urological emergency requiring prompt bladder decompression, usually by urethral catheterisation. Controlled decompression with clamping and release reduces the risk of decompression haematuria and hypotension. Suprapubic catheterisation is reserved for failed urethral attempts or specific indications.

Question 7General Practice (Rural and Remote Medicine)

Which statement about the use of adrenaline in adult anaphylaxis is correct?

  1. It is given intramuscularly into the anterolateral thigh at 0.5 mg of 1:1000 Correct answer.
  2. It is given intravenously at 0.5 mg of 1:1000 in all patients
  3. It should be withheld until antihistamines have been tried
  4. It is given subcutaneously into the deltoid at 0.1 mg of 1:10,000

Explanation

First-line treatment of adult anaphylaxis is intramuscular adrenaline 0.5 mg of 1:1000 into the anterolateral thigh, repeated after 5 minutes if needed. The thigh gives rapid absorption. Intravenous adrenaline is reserved for specialist use in refractory cases with monitoring.

Question 8General Practice (Rural and Remote Medicine)

A 62-year-old diabetic man in a remote community has a deep foot ulcer with surrounding cellulitis and crepitus. He is systemically unwell. What is the most appropriate immediate management?

  1. Broad-spectrum intravenous antibiotics and urgent surgical referral Correct answer.
  2. Oral antibiotics and outpatient review in 24 hours
  3. Topical antiseptic dressing and offloading
  4. Await wound swab results before starting antibiotics

Explanation

Crepitus with systemic illness suggests a necrotising soft tissue infection, which requires urgent surgical debridement and broad-spectrum intravenous antibiotics. Delay increases mortality and amputation risk. Retrieval to a surgical facility should be arranged concurrently.

Question 9General Practice (Rural and Remote Medicine)

Which finding is most consistent with a diagnosis of acute otitis media in a child?

  1. A retracted tympanic membrane with normal colour
  2. Clear serous effusion without bulging
  3. A bulging, erythematous tympanic membrane with reduced mobility Correct answer.
  4. Itching of the external auditory canal

Explanation

Acute otitis media is characterised by a bulging tympanic membrane, erythema and reduced mobility on pneumatic otoscopy, often with fever and ear pain. A retracted drum or simple effusion suggests other diagnoses such as otitis media with effusion. External canal itching points to otitis externa.

Question 10General Practice (Rural and Remote Medicine)

A 45-year-old woman in a remote area has a blood pressure of 168/104 mmHg on two occasions, no symptoms and no end-organ damage. She has no other cardiovascular risk factors. What is the most appropriate initial management?

  1. Admit for intravenous antihypertensives
  2. Start lifestyle advice and arrange ambulatory blood pressure monitoring to confirm the diagnosis Correct answer.
  3. Commence two antihypertensive agents immediately
  4. Reassure and review in 12 months

Explanation

A new elevated reading without end-organ damage should be confirmed with out-of-office measurement such as ambulatory or home monitoring before a diagnosis of hypertension is made. Lifestyle advice and cardiovascular risk assessment are started meanwhile. Immediate dual therapy or intravenous treatment is reserved for severe or symptomatic hypertension.

Question 11General Practice (Rural and Remote Medicine)

Which feature in a patient with acute low back pain suggests a serious underlying cause requiring urgent imaging?

  1. Pain worsened by movement
  2. Bilateral leg pain relieved by sitting
  3. A history of cancer with new night pain and weight loss Correct answer.
  4. Pain that improves with rest

Explanation

Red flags for serious spinal pathology include a history of malignancy, unexplained weight loss, night pain, fever, neurological deficit and age over 50 at onset. These warrant urgent imaging and specialist assessment. Mechanical features such as pain with movement or relief with rest are common and nonspecific.

Question 12General Practice (Rural and Remote Medicine)

A 70-year-old man in a remote town has a 3-week history of painless visible haematuria. He takes aspirin. What is the most appropriate next step?

  1. Stop aspirin and review in 6 weeks
  2. Urgent referral for urological assessment Correct answer.
  3. Treat empirically for urinary tract infection
  4. Reassure and repeat urinalysis in 3 months

Explanation

Visible haematuria in an older adult, even if painless, requires urgent urological referral to exclude bladder or renal malignancy. Aspirin use does not explain visible haematuria and should not delay investigation. Empirical antibiotics are inappropriate without evidence of infection.

Question 13General Practice (Rural and Remote Medicine)

Which is the most appropriate first-line treatment for a patient with newly diagnosed type 2 diabetes and an HbA1c of 7.5% (58 mmol/mol) who has no contraindications?

  1. No treatment, review in 6 months
  2. Metformin with lifestyle modification Correct answer.
  3. Basal insulin
  4. A sulfonylurea alone

Explanation

Metformin combined with lifestyle modification is the usual first-line therapy for type 2 diabetes in the absence of contraindications. It is effective, weight-neutral and has a good safety profile. Insulin and sulfonylureas are generally reserved for later or specific circumstances.

Question 14General Practice (Rural and Remote Medicine)

A 28-year-old woman in a remote area is 34 weeks pregnant and presents with a blood pressure of 160/110 mmHg, headache and visual disturbance. Which is the most appropriate immediate action?

  1. Send home with analgesia and review in 48 hours
  2. Perform an urgent CT brain scan before any treatment
  3. Give oral labetalol and arrange routine antenatal review
  4. Arrange urgent transfer and commence antihypertensive therapy and magnesium sulfate Correct answer.

Explanation

Severe hypertension with neurological symptoms in pregnancy suggests pre-eclampsia with severe features, requiring urgent blood pressure control, magnesium sulfate for seizure prophylaxis and transfer to a facility with obstetric and neonatal care. Delaying treatment risks eclampsia, stroke and placental abruption. Neuroimaging is considered only if there is diagnostic uncertainty after stabilisation.

Question 15General Practice (Rural and Remote Medicine)

Which single measure is most effective in reducing the spread of influenza in a rural clinic waiting room during an outbreak?

  1. Encouraging hand hygiene alone
  2. Providing surgical masks to symptomatic patients and separating them from others Correct answer.
  3. Routine use of antibiotics for all attendees
  4. Increasing the waiting room temperature

Explanation

Source control through masking symptomatic patients and separating them from others reduces droplet transmission in waiting areas. Hand hygiene helps but is less effective alone for a respiratory virus. Antibiotics have no role in viral influenza and contribute to resistance.

Question 16General Practice (Rural and Remote Medicine)

A 19-year-old in a remote town presents with a 2-day history of sore throat, fever and tender cervical nodes. Examination shows tonsillar exudate and no cough. Which management is most appropriate?

  1. Prescribe amoxicillin and await results
  2. Perform a rapid streptococcal test or throat swab and treat with penicillin if positive Correct answer.
  3. Reassure and advise rest without testing
  4. Perform a throat swab and treat with a macrolide if positive

Explanation

Testing for group A streptococcus with a rapid antigen test or culture helps target antibiotic therapy in suspected bacterial pharyngitis. Penicillin or amoxicillin is first-line when infection is confirmed. Amoxicillin without confirmation and macrolides as first-line are not preferred.

Question 17General Practice (Rural and Remote Medicine)

Which is the most appropriate initial investigation for suspected iron deficiency anaemia in an adult?

  1. Serum ferritin with full blood count Correct answer.
  2. Bone marrow biopsy
  3. Serum vitamin B12 only
  4. Abdominal ultrasound

Explanation

A full blood count with serum ferritin is the standard initial assessment for suspected iron deficiency anaemia. Ferritin is the most specific marker of iron stores, though it rises in inflammation. Further investigation of the underlying cause, such as endoscopy in older adults, follows confirmation.

Question 18General Practice (Rural and Remote Medicine)

A 55-year-old man in a remote community has sudden severe tearing chest pain radiating to the back. He is hypertensive and has a pulse deficit between arms. Which is the most appropriate immediate action?

  1. Arrange urgent transfer for CT angiography and commence blood pressure control Correct answer.
  2. Give aspirin and arrange outpatient review
  3. Reassure and repeat blood pressure in 1 hour
  4. Give a thrombolytic and observe

Explanation

Sudden tearing pain with a pulse deficit suggests aortic dissection, which requires urgent imaging and blood pressure control, often with beta-blockade, before definitive management. Thrombolysis is contraindicated and potentially fatal. Transfer to a centre with vascular and cardiothoracic expertise is essential.

Question 19General Practice (Rural and Remote Medicine)

Which is the most appropriate first-line treatment for a patient with major depressive disorder of moderate severity?

  1. An antipsychotic alone
  2. Electroconvulsive therapy
  3. No treatment and review in 3 months
  4. An antidepressant plus psychological therapy Correct answer.

Explanation

Moderate to severe depression is usually managed with an antidepressant combined with a structured psychological therapy such as cognitive behavioural therapy. This combination is more effective than either alone for moderate depression. Electroconvulsive therapy is reserved for severe or treatment-resistant cases.

Question 20General Practice (Rural and Remote Medicine)

A 3-year-old in a remote community presents with a barking cough, inspiratory stridor at rest and mild chest wall retraction. What is the most appropriate initial management?

  1. Immediate intubation
  2. Oral amoxicillin
  3. Oral dexamethasone with observation Correct answer.
  4. Nebulised salbutamol

Explanation

Croup with stridor at rest is managed with a single dose of oral dexamethasone, which reduces airway oedema and severity. Nebulised adrenaline is added for severe distress. Intubation is reserved for impending airway failure. Antibiotics have no role in viral croup.

Question 21General Practice (Rural and Remote Medicine)

Which is the most reliable clinical indicator of dehydration in a young child in a remote setting?

  1. Capillary refill time above 2 seconds Correct answer.
  2. Sunken eyes
  3. Dry mucous membranes
  4. Reduced skin turgor

Explanation

Prolonged capillary refill time is among the more reliable signs of significant dehydration and poor perfusion in children. Dry mucous membranes and sunken eyes are useful but less specific, and reduced skin turgor is harder to assess in young infants. Combining signs improves accuracy.

Question 22General Practice (Rural and Remote Medicine)

A 40-year-old man in a remote area presents with a hot, swollen, painful knee. He is febrile and there is no history of trauma. Which is the most appropriate next step?

  1. Order an MRI before any intervention
  2. Aspirate the joint for microscopy and culture before antibiotics Correct answer.
  3. Start oral antibiotics and review in 1 week
  4. Apply ice and rest the joint

Explanation

A hot swollen joint with fever suggests septic arthritis, and joint aspiration for Gram stain, culture and cell count is required before antibiotics to identify the organism. Empirical antibiotics should follow promptly. Delay risks permanent joint destruction.

Question 23General Practice (Rural and Remote Medicine)

Which strategy best improves medication adherence in a patient with multiple chronic conditions in a remote community?

  1. Changing all medications to brand names
  2. Increasing the number of daily doses
  3. Withholding information about side effects
  4. Simplifying the regimen and using dose administration aids Correct answer.

Explanation

Regimen simplification, dose administration aids and clear counselling improve adherence in patients with polypharmacy. Fewer daily doses and linking medicines to routine activities help. Providing information about side effects supports informed adherence rather than undermining it.

Question 24General Practice (Rural and Remote Medicine)

A 65-year-old woman in a remote town has a 3-month history of progressive dysphagia to solids and 5 kg weight loss. What is the most appropriate initial investigation?

  1. Upper gastrointestinal endoscopy Correct answer.
  2. Abdominal ultrasound
  3. Trial of proton pump inhibitor for 8 weeks
  4. Barium swallow

Explanation

Progressive dysphagia with weight loss in an older adult is a red flag for oesophageal malignancy, and urgent upper gastrointestinal endoscopy with biopsy is the investigation of choice. Barium swallow may be used if endoscopy is unavailable but does not allow biopsy. Empirical acid suppression delays diagnosis.

Question 25General Practice (Rural and Remote Medicine)

Which is the most appropriate management for a patient with a suspected scaphoid fracture and normal initial X-rays?

  1. Reassure and provide analgesia only
  2. Discharge with advice to return if pain persists
  3. Immobilise in a thumb spica cast and repeat imaging or refer for further assessment Correct answer.
  4. Perform an immediate open reduction

Explanation

Initial radiographs may be normal in scaphoid fracture, so clinical suspicion warrants immobilisation and repeat imaging or advanced imaging. Missed fractures risk non-union and avascular necrosis. Discharge without immobilisation is unsafe.

Question 26General Practice (Rural and Remote Medicine)

A 24-year-old farm worker in a remote area presents with a snake bite on the lower leg. The bite occurred 40 minutes ago and he has a pressure immobilisation bandage in place. Which is the most appropriate next step in management?

  1. Keep the patient still, keep the limb immobilised and arrange urgent retrieval to a hospital with antivenom available Correct answer.
  2. Apply a tourniquet above the bite site and observe for 6 hours in the clinic
  3. Remove the bandage immediately and encourage the patient to walk to assess for systemic symptoms
  4. Give oral antihistamine and discharge with advice to return if symptoms develop

Explanation

For suspected venomous snake bite, pressure immobilisation of the whole limb plus complete rest slows lymphatic spread of venom. The patient should be kept still and transferred urgently to a facility with antivenom and monitoring capability, because systemic envenoming can evolve over hours.

Question 27General Practice (Rural and Remote Medicine)

Which statement about the use of a metered-dose inhaler with a spacer in a child with acute asthma is correct?

  1. It should be used only after a nebuliser has failed
  2. It delivers at least as much bronchodilator to the lungs as a nebuliser in mild to moderate exacerbations Correct answer.
  3. It is contraindicated in children under 6 years of age
  4. It requires the child to hold a single deep breath for 10 seconds

Explanation

A pressurised metered-dose inhaler with a valved spacer is equivalent or superior to nebulisation for delivering beta-agonist in mild to moderate asthma, including in young children. It avoids the need for nebuliser equipment, which matters in remote settings.

Question 28General Practice (Rural and Remote Medicine)

A 30-year-old woman in a remote community has a 2-day history of dysuria, frequency and suprapubic discomfort, with no fever or flank pain. She is not pregnant. Which is the most appropriate management?

  1. A short course of oral trimethoprim or nitrofurantoin with symptom review Correct answer.
  2. Immediate intravenous antibiotics and hospital admission
  3. Urine culture only, with antibiotics withheld until results return
  4. A single dose of oral fluoroquinolone and no follow-up

Explanation

Uncomplicated cystitis in a non-pregnant woman is treated with a short course of an appropriate oral agent such as trimethoprim or nitrofurantoin. Culture is not routinely required for a first episode with typical symptoms, and admission is unnecessary without systemic features.

Question 29General Practice (Rural and Remote Medicine)

Which is the most appropriate initial step in managing a patient with a suspected acute corneal foreign body in a remote clinic?

  1. Instil topical local anaesthetic, examine with magnification and remove the foreign body with a sterile needle or burr Correct answer.
  2. Apply a firm eye pad and refer non-urgently
  3. Prescribe topical antibiotics and review in 48 hours
  4. Irrigate with tap water and send home without further examination

Explanation

Topical anaesthetic allows a proper slit-lamp or magnified examination, and most superficial corneal foreign bodies can be removed with a sterile needle or burr. After removal, antibiotic ointment and review for infection are needed.

Question 30General Practice (Rural and Remote Medicine)

Which is the recommended schedule for routine tetanus booster vaccination in an adult who completed a full childhood course?

  1. A booster every 10 years, or at 5 years after a tetanus-prone wound Correct answer.
  2. A booster every 2 years regardless of wound type
  3. A booster only if a wound becomes infected
  4. A single lifetime booster is sufficient

Explanation

Adults who completed primary immunisation need a tetanus-containing booster every 10 years, brought forward to 5 years if a tetanus-prone wound occurs. This maintains protective antitoxin levels without over-vaccinating.

Question 31General Practice (Rural and Remote Medicine)

A 68-year-old man in a remote town has a blood pressure of 158/92 mmHg confirmed on repeated readings. He has no diabetes, kidney disease or cardiovascular disease. Which is the most appropriate initial antihypertensive approach?

  1. Lifestyle advice alone with no medication at any stage
  2. No treatment, since he is over 65
  3. Lifestyle advice plus a single low-dose antihypertensive, with review in 4 weeks Correct answer.
  4. Immediate combination of three antihypertensives

Explanation

For grade 1 hypertension in a low-risk older adult, lifestyle measures plus a single low-dose agent, with review, is appropriate initial therapy. Combining multiple drugs at once is reserved for higher-risk or more severe hypertension.

Question 32General Practice (Rural and Remote Medicine)

Which is the most appropriate first-aid treatment for a minor burn in a remote setting?

  1. Cool the burn with running water for 20 minutes and cover with a clean non-adherent dressing Correct answer.
  2. Apply butter or oil to the burn
  3. Apply ice directly to the burn surface
  4. Rupture any blisters to promote drainage

Explanation

Cooling a burn with running water for about 20 minutes reduces tissue damage and pain, and a clean non-adherent dressing protects the wound. Ice, oils and deliberate blister rupture all increase harm.

Question 33General Practice (Rural and Remote Medicine)

A 50-year-old man in a remote community has a 3-day history of unilateral facial weakness affecting the forehead, with inability to close the eye. Which is the most appropriate initial management?

  1. Oral corticosteroids started promptly, plus eye protection with lubricants and taping Correct answer.
  2. Oral aciclovir alone with no other treatment
  3. Reassurance and review in 4 weeks
  4. Immediate referral for thrombolysis

Explanation

Bell's palsy is treated with early oral corticosteroids to improve recovery, together with eye protection to prevent corneal damage. Thrombolysis is for stroke, which typically spares the forehead.

Question 34General Practice (Rural and Remote Medicine)

A 5-year-old child in a remote community has a 2-day history of fever, sore throat and a fine red rash with sandpaper texture, with a strawberry tongue. Which is the most appropriate management?

  1. Oral aciclovir for presumed viral infection
  2. Oral penicillin for 10 days to treat streptococcal infection and prevent rheumatic fever Correct answer.
  3. Topical corticosteroid cream and antihistamine
  4. Observation only, with no antibiotics

Explanation

The features suggest scarlet fever from group A streptococcal infection, which is treated with a full course of penicillin to reduce complications including rheumatic fever. Prompt antibiotics also shorten infectivity.

Question 35General Practice (Rural and Remote Medicine)

A 72-year-old woman in a remote town has a 6-week history of fatigue and pallor. Her haemoglobin is 92 g/L with a mean corpuscular volume of 72 fL. Which is the most appropriate next investigation?

  1. Bone marrow biopsy
  2. Serum B12 and folate only
  3. Repeat full blood count in 3 months
  4. Serum ferritin with iron studies Correct answer.

Explanation

Microcytic anaemia in an older adult most often reflects iron deficiency, so ferritin and iron studies are the appropriate next step. Iron deficiency in this age group also warrants investigation for gastrointestinal blood loss.

Question 36General Practice (Rural and Remote Medicine)

A 60-year-old man in a remote area has sudden onset of a painful, red, swollen big toe. He has a history of gout. Which is the most appropriate treatment for the acute attack?

  1. Antibiotics for presumed cellulitis
  2. Allopurinol started at high dose during the attack
  3. Oral colchicine or an NSAID started early, plus rest and ice Correct answer.
  4. Probenecid started during the attack

Explanation

Acute gout is treated with an anti-inflammatory agent such as colchicine or an NSAID, started as early as possible, along with rest and ice. Urate-lowering therapy is not started or escalated during an acute attack.

Question 37General Practice (Rural and Remote Medicine)

Which statement about the use of a jet nebuliser in a remote clinic is correct?

  1. It cannot deliver bronchodilators
  2. It is preferred over a spacer for all patients with asthma
  3. It can aerosolise infectious particles and should be used in a well-ventilated area with appropriate staff protection Correct answer.
  4. It requires no cleaning between patients

Explanation

Nebulisers generate aerosols that can carry infectious organisms, so they should be used in well-ventilated spaces with staff respiratory protection and proper equipment cleaning. Spacers are preferred where feasible for asthma.

Question 38General Practice (Rural and Remote Medicine)

A 40-year-old woman in a remote community has a 2-week history of a painless, enlarging ulcer on the vulva with raised edges and local lymphadenopathy. Which is the most appropriate initial diagnostic step?

  1. Swab or biopsy the ulcer for microbiological and histopathological assessment Correct answer.
  2. Treat empirically with oral fluconazole
  3. Prescribe topical antifungal cream and review in 4 weeks
  4. Reassure that painless ulcers are benign

Explanation

A painless, indurated ulcer with lymphadenopathy may indicate syphilis or malignancy, so microbiological and histopathological assessment is needed. Empirical antifungal therapy would delay diagnosis.

Question 39General Practice (Rural and Remote Medicine)

A 55-year-old man in a remote town has a 4-day history of a painful vesicular rash in a dermatomal distribution on the chest, with no eye involvement. Which is the most appropriate management?

  1. Oral antiviral started promptly, plus analgesia and wound care Correct answer.
  2. Oral corticosteroid alone
  3. Topical antibiotic cream alone
  4. Immediate hospital admission for intravenous antiviral in all cases

Explanation

Herpes zoster is treated with an oral antiviral started early to reduce severity and duration, together with adequate analgesia and skin care. Admission is reserved for severe, complicated or immunosuppressed cases.

Question 40General Practice (Rural and Remote Medicine)

Which is the most appropriate approach to a patient in a remote community who has a long-term condition and reports difficulty affording prescribed medicines?

  1. Stop all medicines without discussion
  2. Increase the dose to improve adherence
  3. Explore cost barriers, simplify the regimen and consider cheaper or subsidised alternatives Correct answer.
  4. Refer to hospital for long-term admission

Explanation

Cost is a common and modifiable barrier to adherence, so exploring financial barriers and simplifying or substituting medicines is effective. Adherence improves when practical obstacles are addressed.

Question 41General Practice (Rural and Remote Medicine)

A 28-year-old man in a remote area has a 3-day history of fever, headache and neck stiffness. Which is the most appropriate immediate action?

  1. Await a CT scan before any antibiotics
  2. Urgent transfer for lumbar puncture and intravenous antibiotics, with antibiotics not delayed by transfer Correct answer.
  3. Oral antibiotics and review in 24 hours
  4. Analgesia and observation at home

Explanation

Suspected bacterial meningitis requires urgent antibiotics and diagnostic lumbar puncture, and antibiotics should not be delayed for transfer or imaging. Early treatment reduces mortality.

Question 42General Practice (Rural and Remote Medicine)

A 35-year-old woman in a remote town has a 1-week history of unilateral throbbing headache with photophobia and nausea, worsening with activity. Which is the most appropriate acute treatment?

  1. Daily opioid analgesia
  2. Prophylactic beta-blocker started during the attack
  3. Antibiotics for sinusitis
  4. An oral triptan or NSAID taken early in the attack Correct answer.

Explanation

Acute migraine is treated with a triptan or an NSAID taken early, which is more effective than delayed dosing. Opioids are avoided because of dependence and medication-overuse headache.

Question 43General Practice (Rural and Remote Medicine)

A 65-year-old man in a remote community has a 2-month history of a non-healing ulcer on the lower lip. Which is the most appropriate next step?

  1. Cryotherapy without histological diagnosis
  2. Topical antibiotic and review in 3 months
  3. Reassurance that lip ulcers are benign
  4. Urgent referral for biopsy of the lesion Correct answer.

Explanation

A non-healing lip ulcer in an older adult may be squamous cell carcinoma and requires biopsy, usually via urgent specialist referral. Delay risks progression and metastasis.

Question 44General Practice (Rural and Remote Medicine)

A 45-year-old man in a remote area has sudden onset of severe vertigo, nausea and unsteadiness, with no focal weakness and no hearing loss. Which is the most appropriate initial step?

  1. Prescribe antibiotics for presumed middle ear infection
  2. Assess for central causes with neurological examination and consider urgent imaging if any red flags are present Correct answer.
  3. Reassure and discharge without examination
  4. Start long-term oral corticosteroids

Explanation

Acute vertigo requires distinguishing peripheral from central causes; focal neurological signs, new headache or vascular risk factors warrant urgent imaging. Peripheral causes such as vestibular neuritis are managed supportively.

Question 45General Practice (Rural and Remote Medicine)

A 70-year-old woman in a remote town has a 3-day history of painless jaundice and dark urine, with no fever. Which is the most appropriate initial investigation?

  1. Iron studies only
  2. Oral antibiotics and review in 2 weeks
  3. Reassurance that jaundice is benign in older adults
  4. Liver function tests and urgent referral for imaging of the biliary tree Correct answer.

Explanation

Painless obstructive jaundice in an older adult may indicate malignancy such as pancreatic or cholangiocarcinoma and requires prompt imaging of the biliary tree. Delay can compromise treatment options.

Question 46General Practice (Rural and Remote Medicine)

A 22-year-old man in a remote community has a 2-day history of fever, myalgia and a dry cough, and has recently returned from a region with an outbreak of a respiratory virus. Which is the most appropriate initial action in the clinic?

  1. Admit to the general ward without isolation
  2. Apply respiratory precautions, test for the suspected pathogen and notify public health as required Correct answer.
  3. Prescribe antibiotics and discharge without precautions
  4. Reassure that returned travellers cannot transmit respiratory viruses

Explanation

A returned traveller with febrile respiratory illness requires appropriate infection-control precautions, testing and public health notification where mandated. This protects staff and other patients and supports outbreak control.

Question 47General Practice (Rural and Remote Medicine)

A 58-year-old man in a remote area has a 3-week history of progressive calf pain and swelling after a long bus journey, with no trauma. Which is the most appropriate immediate investigation?

  1. Reassurance and review in 4 weeks
  2. Plain X-ray of the leg
  3. Urgent compression ultrasound of the leg Correct answer.
  4. Serum electrolytes only

Explanation

Prolonged immobility with progressive unilateral leg swelling suggests deep vein thrombosis, and compression ultrasound is the diagnostic test of choice. Anticoagulation is started while awaiting confirmation if suspicion is high.

Question 48General Practice (Rural and Remote Medicine)

A 12-year-old in a remote community has a 2-day history of fever, abdominal pain and a maculopapular rash that began on the trunk. Which is the most appropriate management?

  1. Supportive care with isolation from vulnerable contacts and review for complications Correct answer.
  2. Immediate antibiotics for presumed bacterial sepsis
  3. Hospital admission for all children with a rash
  4. Oral aciclovir for all cases

Explanation

Many childhood febrile rashes, including viral exanthems, are managed supportively with attention to hydration and isolation from vulnerable contacts. Admission and antivirals are reserved for complicated or specific cases.

Question 49General Practice (Rural and Remote Medicine)

A 60-year-old woman in a remote town has a 4-week history of progressive dyspnoea, fatigue and ankle swelling. Which is the most appropriate initial investigation?

  1. Serum calcium only
  2. Electrocardiogram and echocardiogram referral Correct answer.
  3. Chest X-ray alone with no cardiac assessment
  4. Spirometry only

Explanation

Progressive dyspnoea with oedema suggests heart failure, and an ECG plus echocardiogram are key initial investigations. Other tests such as chest X-ray and blood tests support the assessment but do not replace cardiac evaluation.

Question 50General Practice (Rural and Remote Medicine)

A 30-year-old woman in a remote area has a 2-day history of severe unilateral eye pain with blurred vision and a fixed mid-dilated pupil. Which is the most appropriate immediate action?

  1. Urgent ophthalmology referral for suspected acute angle-closure glaucoma Correct answer.
  2. Oral antihistamine and cold compress
  3. Topical antibiotic drops and review in 24 hours
  4. Reassurance that the symptoms will settle spontaneously

Explanation

Severe eye pain with blurred vision and a fixed mid-dilated pupil suggests acute angle-closure glaucoma, which is an ophthalmic emergency requiring urgent specialist care to prevent permanent vision loss.