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MAFP/icFRACGP Part 1 study materials
MAFP/icFRACGP Part 1 study resources

MAFP/icFRACGP Part 1 practice questions

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Question 1Communication and the patient-doctor relationship

A 58-year-old man with newly diagnosed type 2 diabetes tells you he does not want to discuss diet today and asks only for a repeat prescription. Which response best demonstrates patient-centred communication?

  1. Hand him a printed diet sheet and end the consultation without further discussion.
  2. Explain that diet is essential and insist on covering it before issuing any prescription.
  3. Acknowledge his agenda, provide the prescription, and offer to discuss diet at a time he chooses. Correct answer.
  4. Refer him to a dietitian immediately so the responsibility shifts away from you.

Explanation

Patient-centred care respects the patient's agenda while maintaining a safety net; exploring and negotiating rather than imposing maintains the therapeutic relationship. Acknowledging his request and offering a future discussion preserves autonomy and keeps the door open for later health behaviour change.

Question 2Communication and the patient-doctor relationship

Which communication technique is most likely to encourage a patient to disclose sensitive information during a consultation?

  1. Reassuring the patient that there is nothing to worry about before they speak.
  2. Using open-ended questions followed by silence to allow the patient to continue. Correct answer.
  3. Asking a series of closed questions to keep the consultation efficient.
  4. Completing the history on the computer screen before making eye contact.

Explanation

Open-ended questions invite narrative and silence gives the patient space to elaborate, which facilitates disclosure of sensitive material. Closed questioning and premature reassurance tend to close down the conversation and can signal that the clinician is not ready to hear difficult content.

Question 3Communication and the patient-doctor relationship

During a consultation about a new diagnosis, a patient becomes tearful and says, 'I just can't take any more.' What is the most appropriate immediate response?

  1. Continue delivering the remaining information quickly so the consultation finishes on time.
  2. Acknowledge the emotion, pause, and explore what the patient means before continuing. Correct answer.
  3. Change the subject to a neutral topic to help the patient regain composure.
  4. Reassure the patient that everyone feels this way after a new diagnosis.

Explanation

Responding to strong emotion with acknowledgement and exploration, sometimes called picking up the cue, allows the patient to feel heard and clarifies whether there is risk. Rushing, deflecting, or normalising prematurely can miss important information and damage the relationship.

Question 4Communication and the patient-doctor relationship

A patient with limited English proficiency attends with her adult son, who offers to interpret. Which approach best supports effective communication?

  1. Use written instructions only, as interpreting is unnecessary in this situation.
  2. Speak to the son and ask him to relay the key points to his mother.
  3. Use a professional interpreter and address the patient directly rather than the son. Correct answer.
  4. Accept the son as interpreter because it is quicker and more convenient.

Explanation

Professional interpreting preserves accuracy and confidentiality and avoids role conflicts for family members, who may filter or alter information. Speaking directly to the patient maintains respect and supports the therapeutic alliance.

Question 5Communication and the patient-doctor relationship

Which statement best describes the purpose of summarising during a consultation?

  1. It replaces the need for a safety-netting plan at the end of the consultation.
  2. It demonstrates the clinician's expertise to reassure the patient.
  3. It checks shared understanding and provides an opportunity for the patient to correct the clinician. Correct answer.
  4. It shortens the consultation by allowing the clinician to omit the patient's concerns.

Explanation

Summarising confirms that the clinician has understood the patient's account and invites correction, which supports shared understanding. It is not a time-saving device for omitting concerns and does not substitute for safety netting.

Question 6Communication and the patient-doctor relationship

A patient repeatedly asks for antibiotics for an upper respiratory tract infection. Which response best reflects shared decision-making?

  1. End the consultation and ask the patient to return if symptoms worsen.
  2. Explore the patient's concerns, explain the likely viral cause, and agree a plan together. Correct answer.
  3. Prescribe antibiotics to preserve the relationship and avoid conflict.
  4. Refuse the request firmly and state that antibiotics are never appropriate.

Explanation

Shared decision-making involves eliciting the patient's ideas and concerns, sharing evidence, and agreeing a plan. This approach addresses expectations while maintaining appropriate prescribing and preserving the relationship.

Question 7Communication and the patient-doctor relationship

Which behaviour best demonstrates active listening during a consultation?

  1. Writing notes continuously without looking up.
  2. Reflecting back the patient's words and checking their meaning. Correct answer.
  3. Repeating the patient's exact words without comment.
  4. Interrupting to correct factual errors as soon as they arise.

Explanation

Active listening involves reflecting and checking meaning to confirm understanding and show engagement. Interrupting, avoiding eye contact, and mechanical repetition without checking understanding do not achieve this.

Question 8Communication and the patient-doctor relationship

A 16-year-old attends alone requesting contraception and asks that her parents not be told. She is assessed as competent to consent. What is the most appropriate response?

  1. Refuse to discuss contraception until a parent is present.
  2. Inform her parents immediately because she is under 18.
  3. Respect confidentiality within the limits you explain, and discuss what would need to be shared. Correct answer.
  4. Tell her that everything will be kept secret without any exceptions.

Explanation

Where a young person is assessed as competent, confidentiality should be respected within clearly explained limits, such as serious risk of harm. Promising absolute secrecy is unsafe, and automatic parental disclosure undermines trust and autonomy.

Question 9Communication and the patient-doctor relationship

Which question is most likely to elicit a patient's ideas, concerns, and expectations near the start of a consultation?

  1. 'What were you hoping we might do about this today?' Correct answer.
  2. 'Is there any family history of heart disease?'
  3. 'You have been taking your tablets, haven't you?'
  4. 'Have you had this before, yes or no?'

Explanation

Asking what the patient hoped to achieve invites them to express ideas, concerns, and expectations in their own words. Closed questions and leading questions constrain the response and do not explore the patient's perspective.

Question 10Communication and the patient-doctor relationship

A patient becomes angry and raises his voice because he feels his previous concerns were ignored. What is the most appropriate initial approach?

  1. Ask him to leave and rebook when he is calmer.
  2. Match his tone to show that you will not be intimidated.
  3. Explain that his records show he was seen appropriately.
  4. Stay calm, acknowledge his frustration, and invite him to explain what happened. Correct answer.

Explanation

De-escalation begins with calm acknowledgement and an invitation for the patient to explain, which validates the concern and reduces tension. Confrontation, dismissal, or defensive justification tends to escalate conflict.

Question 11Communication and the patient-doctor relationship

Which statement about breaking bad news using a structured approach is most accurate?

  1. Warning the patient that important information is coming allows them to prepare. Correct answer.
  2. Family members should always be told before the patient.
  3. Delivering all information in one uninterrupted block is preferred.
  4. Avoiding the word 'cancer' prevents distress and is always advisable.

Explanation

A warning shot, such as signalling that results are serious, gives the patient time to prepare and supports processing. Information should be paced and checked, and the patient is normally the first to know.

Question 12Communication and the patient-doctor relationship

A patient with a long list of problems presents at the end of a ten-minute appointment. What is the most appropriate communication strategy?

  1. Acknowledge the list, prioritise concerns with the patient, and arrange follow-up for the rest. Correct answer.
  2. Tell the patient to book a longer appointment in future and end the consultation.
  3. Address only the first item and ignore the remainder.
  4. Attempt to address every item fully regardless of time.

Explanation

Negotiating priorities with the patient ensures the most important concerns are addressed safely and the remainder are planned. Attempting everything risks incomplete care, while ignoring or dismissing items damages trust.

Question 13Communication and the patient-doctor relationship

Which element is essential when providing safety-netting advice at the end of a consultation?

  1. Providing a prescription to cover any eventuality.
  2. Specifying which symptoms should prompt the patient to seek further help and how to do so. Correct answer.
  3. Advising the patient to return only if they feel it is necessary.
  4. Telling the patient that the condition will definitely resolve without treatment.

Explanation

Safety netting requires clear, specific information about warning symptoms, when and how to seek help, and what to expect. Vague advice or false reassurance does not support safe follow-up.

Question 14Communication and the patient-doctor relationship

A patient says, 'My father died of the same thing last year.' Which response best demonstrates empathy?

  1. 'Try not to worry, treatments have improved since then.'
  2. 'Let's focus on your results rather than your father's case.'
  3. 'How old was your father when he died?'
  4. 'That sounds really frightening, especially after what happened to your father.' Correct answer.

Explanation

Empathy involves recognising and naming the patient's emotion and its context. Offering premature reassurance, redirecting to results, or moving straight to factual questioning may miss the emotional cue.

Question 15Communication and the patient-doctor relationship

Which statement best describes the concept of transference in the doctor-patient relationship?

  1. The clinician unconsciously redirects feelings onto the patient.
  2. The patient deliberately manipulates the clinician to obtain treatment.
  3. The patient unconsciously redirects feelings from past relationships onto the clinician. Correct answer.
  4. The clinician and patient agree on a treatment plan together.

Explanation

Transference describes the patient's unconscious displacement of feelings from earlier relationships onto the clinician. Countertransference is the clinician's equivalent response, while shared planning is a separate collaborative process.

Question 16Communication and the patient-doctor relationship

During a consultation, a clinician notices strong irritation towards a patient who reminds him of a difficult relative. What is the most appropriate response?

  1. Act on the irritation to set firm boundaries with the patient.
  2. Refer the patient to another clinician without explanation.
  3. Ignore the feeling entirely as it is irrelevant to clinical care.
  4. Recognise this as countertransference and use it to reflect on the interaction. Correct answer.

Explanation

Recognising countertransference allows the clinician to reflect on the interaction and avoid acting it out. Ignoring it or acting on it can distort communication and harm the relationship.

Question 17Communication and the patient-doctor relationship

Which approach best supports a patient with suspected mild cognitive impairment during a consultation?

  1. Speak rapidly to cover all information before the patient forgets.
  2. Direct all questions to the accompanying relative.
  3. Avoid discussing the diagnosis to prevent distress.
  4. Use short sentences, check understanding, and involve a companion if the patient agrees. Correct answer.

Explanation

Clear, paced communication with comprehension checks and agreed involvement of a companion supports understanding and autonomy. Speaking rapidly, excluding the patient, or withholding information undermines these aims.

Question 18Communication and the patient-doctor relationship

Which statement about the use of jargon in medical consultations is most accurate?

  1. Jargon is acceptable if spoken quickly and confidently.
  2. Jargon should be avoided or explained because it can create misunderstanding and distance. Correct answer.
  3. Jargon is useful because it demonstrates clinical competence.
  4. Jargon should be used to keep discussions brief.

Explanation

Unexplained jargon impairs comprehension and can make patients feel excluded. Clear language, or explanation of necessary terms, supports shared understanding.

Question 19Communication and the patient-doctor relationship

A patient discloses that she has been experiencing domestic abuse. What is the most appropriate communication approach?

  1. Change the subject to avoid causing further distress.
  2. Advise her to leave immediately and insist she act on this today.
  3. Listen without judgement, validate her experience, and discuss options and safety at her pace. Correct answer.
  4. Tell her that you must inform the police regardless of her wishes.

Explanation

A non-judgemental response that validates the disclosure and explores options at the patient's pace supports safety and autonomy. Directing action, automatic police involvement, or avoidance can endanger and alienate the patient.

Question 20Communication and the patient-doctor relationship

Which technique is most likely to improve adherence when prescribing a new medicine?

  1. Giving the prescription without discussion to save time.
  2. Providing written information only, without verbal explanation.
  3. Explaining the purpose of the medicine and checking the patient's understanding. Correct answer.
  4. Emphasising the risks of non-adherence in a stern tone.

Explanation

Explaining the rationale and checking understanding supports informed concordance and adherence. Omitting explanation or using a stern tone reduces engagement, and written information alone may be insufficient.

Question 21Communication and the patient-doctor relationship

Which statement best describes the clinician's role in supporting a patient's informed choice about treatment?

  1. Withhold information about side effects to avoid alarming the patient.
  2. Recommend the option the clinician prefers and discourage alternatives.
  3. Leave the patient to research options alone without guidance.
  4. Present options, discuss benefits and harms, and support the patient's decision. Correct answer.

Explanation

Informed choice requires balanced information about options, benefits, and harms, with support for the patient's decision. Directing, withholding, or abandoning the patient undermines informed consent.

Question 22Communication and the patient-doctor relationship

A patient with terminal illness says he wants to discuss his prognosis but his wife asks you not to tell him. What is the most appropriate response?

  1. Agree to withhold information to protect the patient from distress.
  2. Tell the wife that her request is unreasonable and ignore her concerns.
  3. Explore the wife's concerns and explain that information belongs to the patient. Correct answer.
  4. Ask the wife to leave the room and disclose information without discussion.

Explanation

Information belongs to the patient, but the family's concerns should be explored sensitively and addressed. Agreeing to withhold or dismissing the family abruptly both fail to balance autonomy with compassion.

Question 23Communication and the patient-doctor relationship

Which behaviour best supports a collaborative relationship with a patient who has a chronic illness?

  1. Set goals for the patient without discussion.
  2. Agree shared goals and review them together at follow-up. Correct answer.
  3. Change the plan at each visit without explanation.
  4. Focus only on clinical measurements and ignore the patient's priorities.

Explanation

Collaborative care involves agreeing shared goals and reviewing them together, which supports engagement and self-management. Imposing goals, ignoring priorities, or changing plans without explanation undermines partnership.

Question 24Communication and the patient-doctor relationship

Which statement best describes the role of non-verbal communication in the consultation?

  1. Non-verbal cues should be ignored to remain objective.
  2. Posture, eye contact, and facial expression convey attention and can influence disclosure. Correct answer.
  3. Crossing the arms always indicates that the patient is being dishonest.
  4. Non-verbal behaviour is irrelevant if the clinician's words are accurate.

Explanation

Non-verbal behaviour communicates attention and emotion and can facilitate or inhibit disclosure. It is not irrelevant, and single gestures cannot reliably indicate dishonesty.

Question 25Applied professional knowledge and skills

A 54-year-old man with type 2 diabetes attends for review. His blood pressure is persistently 152/94 mmHg on three separate visits despite lifestyle measures. Which antihypertensive class is recommended as first-line therapy in an Australian general practice setting for a patient with diabetes and no albuminuria?

  1. An ACE inhibitor or angiotensin II receptor blocker Correct answer.
  2. A beta-blocker
  3. A thiazide-like diuretic
  4. A calcium channel blocker

Explanation

Guidelines recommend an ACE inhibitor or ARB as first-line antihypertensive therapy in people with diabetes because of their renoprotective benefit, particularly when albuminuria is present. They remain a reasonable first choice even without albuminuria, and are preferred over beta-blockers, which are not first-line for uncomplicated hypertension.

Question 26Applied professional knowledge and skills

A 28-year-old woman presents with a 3-day history of dysuria, urinary frequency and suprapubic discomfort. She is otherwise well, afebrile, and not pregnant. What is the most appropriate initial management?

  1. A 3-5 day course of oral trimethoprim or nitrofurantoin after urine testing Correct answer.
  2. Await urine culture results before starting any antibiotic
  3. Immediate referral to an emergency department for intravenous antibiotics
  4. A single dose of oral trimethoprim without further assessment

Explanation

Uncomplicated cystitis in a non-pregnant woman is managed with a short course of an appropriate oral antibiotic such as trimethoprim or nitrofurantoin, guided by local resistance data and urine dipstick. Culture is not routinely required in straightforward cases but should be considered if symptoms are recurrent or atypical.

Question 27Applied professional knowledge and skills

A 62-year-old man with a 30 pack-year smoking history reports a persistent cough and one episode of haemoptysis. He has no weight loss and examination is unremarkable. What is the most appropriate next step in the general practice setting?

  1. Reassure and review in three months
  2. Arrange an urgent chest X-ray and consider referral for suspected lung cancer Correct answer.
  3. Order a sputum culture and await the result before imaging
  4. Prescribe a course of antibiotics and reassess only if symptoms persist

Explanation

Haemoptysis in a person over 40 with a significant smoking history is a red-flag symptom that warrants urgent chest imaging and consideration of referral under suspected cancer pathways. Delaying investigation risks missing an operable lung cancer.

Question 28Applied professional knowledge and skills

A 34-year-old woman with no significant past history presents with a 6-week history of low mood, anhedonia, poor sleep and reduced concentration. She denies suicidal ideation. Which initial approach is most consistent with a stepped-care model for depression?

  1. Immediate referral to a psychiatrist for medication review
  2. Offer guided self-help or brief psychological therapy with active monitoring Correct answer.
  3. Commence an SSRI without any psychological intervention
  4. Arrange admission to a mental health unit

Explanation

For mild to moderate depression, stepped care recommends low-intensity interventions such as guided self-help, brief psychological therapy, or structured exercise, with active monitoring and review. Escalation to medication or specialist referral occurs if symptoms are severe or do not respond.

Question 29Applied professional knowledge and skills

A 7-year-old boy is brought in with a 2-day history of sore throat, fever of 38.6°C and tonsillar exudate. He has a maculopapular rash on his trunk and a strawberry tongue. What is the most likely diagnosis?

  1. Scarlet fever Correct answer.
  2. Infectious mononucleosis
  3. Measles
  4. Kawasaki disease

Explanation

Fever, exudative pharyngitis, a sandpaper-like or maculopapular rash and a strawberry tongue are characteristic of scarlet fever, caused by group A streptococcal toxin. Prompt antibiotic treatment reduces the risk of rheumatic fever and transmission.

Question 30Applied professional knowledge and skills

A 68-year-old woman with atrial fibrillation is being assessed for stroke risk. She has hypertension and diabetes but no prior stroke, heart failure or vascular disease. Using the CHA2DS2-VASc score, what is her score and recommended anticoagulation decision?

  1. Score 0; no anticoagulation required
  2. Score 2; anticoagulation should be considered Correct answer.
  3. Score 1; anticoagulation generally not indicated
  4. Score 3; anticoagulation is contraindicated

Explanation

Hypertension and diabetes each contribute one point, giving a CHA2DS2-VASc score of 2, at which anticoagulation is recommended or considered depending on bleeding risk. A score of 1 in women may warrant consideration, but 2 clearly supports anticoagulation.

Question 31Applied professional knowledge and skills

A 45-year-old man presents with acute low back pain after lifting a heavy box. He has no red flags, no neurological deficit and no history of malignancy. What is the most appropriate initial management?

  1. Reassurance, simple analgesia and early return to activity Correct answer.
  2. Immediate MRI of the lumbar spine
  3. Referral for spinal surgery assessment
  4. Strict bed rest for two weeks

Explanation

Uncomplicated acute mechanical low back pain is managed with reassurance, simple analgesia and encouragement to stay active, as prolonged bed rest worsens outcomes. Imaging and surgical referral are reserved for red flags or persistent neurological deficits.

Question 32Applied professional knowledge and skills

A 30-year-old woman is diagnosed with iron deficiency anaemia. She reports heavy menstrual bleeding. Which investigation is most appropriate to identify the cause of her menorrhagia in the general practice setting?

  1. Endometrial biopsy
  2. Hysteroscopy under general anaesthetic
  3. Serum CA-125
  4. Pelvic ultrasound Correct answer.

Explanation

Pelvic ultrasound is the first-line imaging test for heavy menstrual bleeding to identify structural causes such as fibroids, polyps or adenomyosis. It is non-invasive and guides further referral if a structural abnormality is found.

Question 33Applied professional knowledge and skills

A 55-year-old man with type 2 diabetes has an eGFR of 42 mL/min/1.73 m² and a urine albumin-to-creatinine ratio of 45 mg/mmol. He is on metformin. What is the most appropriate action regarding his metformin?

  1. Increase the metformin dose to improve glycaemic control
  2. Continue metformin at the current dose with regular monitoring Correct answer.
  3. Switch to a sulfonylurea without further assessment
  4. Stop metformin immediately

Explanation

Metformin can generally be continued with dose review and monitoring when eGFR is between 30 and 45 mL/min/1.73 m², provided renal function is stable. It should be ceased if eGFR falls below 30 or during acute illness with dehydration.

Question 34Applied professional knowledge and skills

A 24-year-old woman presents with a 2-day history of unilateral throbbing headache, nausea and photophobia. She has had similar episodes previously and is otherwise well. What is the most appropriate acute treatment?

  1. Prophylactic propranolol at the time of the attack
  2. Oral sumatriptan plus an antiemetic Correct answer.
  3. Oral antibiotic therapy
  4. Urgent CT head before any analgesia

Explanation

Acute migraine is treated with a triptan such as sumatriptan plus an antiemetic, ideally taken early in the attack. Simple analgesics may be used in milder attacks, but triptans are more effective for moderate to severe migraine.

Question 35Applied professional knowledge and skills

A 3-month-old infant is brought in with a 2-day history of poor feeding, irritability and a temperature of 38.2°C. What is the most appropriate course of action?

  1. Prescribe oral amoxicillin and review in 48 hours
  2. Reassure and review in 24 hours
  3. Arrange urgent assessment in a paediatric facility Correct answer.
  4. Advise tepid sponging and paracetamol at home

Explanation

Any infant under 3 months with a temperature of 38°C or higher requires urgent assessment in a paediatric facility for sepsis evaluation, including blood, urine and cerebrospinal fluid testing. The threshold for investigation is low because serious bacterial infection can present non-specifically.

Question 36Applied professional knowledge and skills

A 40-year-old woman reports a 3-month history of fatigue, weight gain and cold intolerance. On examination she has a diffuse goitre. Which initial investigation is most appropriate?

  1. Thyroid ultrasound
  2. Serum thyroglobulin
  3. Serum TSH and free T4 Correct answer.
  4. Radioactive iodine uptake scan

Explanation

Thyroid function tests with TSH and free T4 are the first-line investigation for suspected hypothyroidism and will confirm the diagnosis and guide treatment. Ultrasound and uptake scans are reserved for structural assessment or specific diagnostic questions.

Question 37Applied professional knowledge and skills

A 58-year-old man with known ischaemic heart disease presents with sudden onset of severe central chest pain radiating to the back. He is haemodynamically stable. What is the most important initial investigation?

  1. Chest X-ray
  2. CT angiography of the aorta Correct answer.
  3. Troponin and ECG
  4. Transthoracic echocardiography

Explanation

Sudden severe chest pain radiating to the back in a patient with vascular risk factors raises suspicion of acute aortic dissection, for which CT angiography is the definitive investigation once the patient is stabilised. ECG and troponin should also be performed but do not exclude dissection.

Question 38Applied professional knowledge and skills

A 19-year-old university student presents with a 1-week history of fever, sore throat and marked fatigue. Examination reveals palatal petechiae and posterior cervical lymphadenopathy. A heterophile antibody test is negative. Which test is most appropriate to confirm the diagnosis?

  1. Epstein-Barr virus serology Correct answer.
  2. Throat swab for group A streptococcus
  3. Full blood count only
  4. Rapid HIV test

Explanation

The clinical picture suggests infectious mononucleosis, and heterophile antibody testing can be falsely negative in the first week of illness. Epstein-Barr virus-specific serology confirms the diagnosis when the heterophile test is negative.

Question 39Applied professional knowledge and skills

A 6-year-old child is brought in with a 4-day history of cough, coryza and fever, followed by a rash that started on the face and spread downwards. Examination reveals Koplik spots. What is the diagnosis?

  1. Measles Correct answer.
  2. Scarlet fever
  3. Rubella
  4. Roseola infantum

Explanation

Koplik spots are pathognomonic of measles and appear before the characteristic rash, which spreads from the face downwards. The child should be isolated and public health notified.

Question 40Applied professional knowledge and skills

A 72-year-old man with osteoarthritis is being reviewed. He has a history of peptic ulcer disease. Which analgesic strategy is most appropriate for chronic pain management?

  1. High-dose aspirin regularly
  2. Long-term oral corticosteroids
  3. Long-term regular NSAIDs alone
  4. Paracetamol plus topical NSAID, with caution regarding oral NSAIDs Correct answer.

Explanation

In a patient with a history of peptic ulcer disease, oral NSAIDs should be used cautiously or avoided, and paracetamol with topical NSAIDs is a safer first-line strategy. If an oral NSAID is required, gastroprotection with a proton pump inhibitor is indicated.

Question 41Applied professional knowledge and skills

A 26-year-old woman presents with a 3-day history of right lower abdominal pain, fever and vaginal discharge. On examination she has cervical motion tenderness. What is the most appropriate initial management?

  1. Immediate laparoscopy
  2. Empirical broad-spectrum antibiotics covering chlamydia and gonorrhoea Correct answer.
  3. Await swab results before treating
  4. Reassure and review in one week

Explanation

Pelvic inflammatory disease is diagnosed clinically and treated empirically with broad-spectrum antibiotics covering chlamydia and gonorrhoea, without waiting for swab results. Prompt treatment reduces the risk of tubal infertility and ectopic pregnancy.

Question 42Applied professional knowledge and skills

A 60-year-old woman with type 2 diabetes has an HbA1c of 8.9% on metformin monotherapy. She has an eGFR of 55 mL/min/1.73 m² and a BMI of 32. Which add-on therapy is most appropriate?

  1. Insulin as first choice
  2. A sulfonylurea as first choice
  3. No change; continue metformin alone
  4. A GLP-1 receptor agonist or SGLT2 inhibitor Correct answer.

Explanation

In a patient with type 2 diabetes, obesity and reduced renal function, a GLP-1 receptor agonist or SGLT2 inhibitor offers glycaemic and weight benefits with renal protection. These agents are preferred over sulfonylureas, which cause weight gain and hypoglycaemia.

Question 43Applied professional knowledge and skills

A 35-year-old man presents with a 2-week history of palpitations, weight loss and heat intolerance. On examination he has a diffuse goitre and tremor. Which initial investigation is most appropriate?

  1. Thyroid ultrasound
  2. Radioactive iodine uptake scan
  3. Serum thyroglobulin
  4. Serum TSH and free T4 Correct answer.

Explanation

Thyroid function tests with TSH and free T4 are the first-line investigation for suspected thyrotoxicosis and will confirm the diagnosis. Further tests such as uptake scanning or antibody testing are used to determine the underlying cause.

Question 44Applied professional knowledge and skills

A 4-year-old child is brought in with a 2-day history of fever, sore throat and a sandpaper-like rash on the trunk. Examination reveals a strawberry tongue and exudative tonsillitis. What is the most appropriate treatment?

  1. Oral penicillin V for 10 days Correct answer.
  2. No treatment; self-limiting
  3. Antihistamine for the rash
  4. Topical corticosteroid cream

Explanation

Scarlet fever is caused by group A streptococcus and should be treated with a full course of penicillin V (or an appropriate alternative in penicillin allergy) to reduce the risk of rheumatic fever and transmission. Symptomatic treatment alone is insufficient.

Question 45Applied professional knowledge and skills

A 50-year-old woman presents with a 3-month history of fatigue and is found to have a haemoglobin of 105 g/L with a mean corpuscular volume of 72 fL. Which is the most appropriate next step?

  1. Iron studies and investigation for a source of blood loss Correct answer.
  2. Reassurance and repeat full blood count in 12 months
  3. Vitamin B12 and folate levels only
  4. Bone marrow biopsy

Explanation

Microcytic anaemia in an adult suggests iron deficiency, and iron studies help confirm it while investigation for blood loss, particularly gastrointestinal, is required. In a woman over 50, gastrointestinal causes must be excluded even if menstrual loss is present.

Question 46Applied professional knowledge and skills

A 30-year-old man presents with a 2-day history of severe unilateral scrotal pain and swelling, with nausea and vomiting. The testis is high-riding and the cremasteric reflex is absent. What is the most appropriate immediate action?

  1. Reassure and advise scrotal support
  2. Urgent urological referral for exploration Correct answer.
  3. Arrange ultrasound in one week
  4. Prescribe antibiotics for epididymitis and review in 48 hours

Explanation

Acute scrotal pain with an absent cremasteric reflex and a high-riding testis suggests testicular torsion, which is a surgical emergency requiring urgent exploration to preserve the testis. Ultrasound should not delay surgery if torsion is suspected.

Question 47Applied professional knowledge and skills

A 65-year-old woman with a history of hypertension presents with a sudden severe headache described as the worst of her life. She has neck stiffness and photophobia. What is the most appropriate initial investigation?

  1. MRI brain
  2. CT head without contrast Correct answer.
  3. Lumbar puncture immediately
  4. Carotid Doppler ultrasound

Explanation

A sudden severe headache with meningism suggests subarachnoid haemorrhage, for which an urgent non-contrast CT head is the first-line investigation. If the CT is negative and suspicion remains high, lumbar puncture for xanthochromia is performed after 12 hours.

Question 48Applied professional knowledge and skills

A 28-year-old woman with asthma is using a salbutamol inhaler more than three times a week and wakes at night with symptoms twice a month. She is not currently on preventer therapy. What is the most appropriate management?

  1. Add a long-acting beta-agonist alone
  2. Commence a low-dose inhaled corticosteroid preventer Correct answer.
  3. Start oral corticosteroids
  4. Continue salbutamol alone

Explanation

Frequent reliever use and nocturnal symptoms indicate suboptimal asthma control, and guidelines recommend commencing a low-dose inhaled corticosteroid preventer. Reliever-only therapy is no longer appropriate when symptoms occur more than twice a month.

Question 49Applied professional knowledge and skills

A 70-year-old man presents with a 3-month history of progressive dysphagia to solids and weight loss. He has a 40 pack-year smoking history. What is the most appropriate next step?

  1. Urgent referral for endoscopy Correct answer.
  2. Reassurance and dietary advice
  3. Barium swallow in 3 months
  4. Trial of proton pump inhibitor and review in 6 weeks

Explanation

Progressive dysphagia with weight loss in an older smoker is a red flag for oesophageal cancer and warrants urgent endoscopy. Empirical acid suppression may mask symptoms and delay diagnosis.

Question 50Applied professional knowledge and skills

A 52-year-old man with no prior cardiovascular disease attends for a routine review. His 10-year cardiovascular risk has been calculated using a validated risk tool. According to Australian absolute cardiovascular risk guidelines, which risk category is most appropriately managed with lipid-lowering therapy after lifestyle advice?

  1. Any risk with a family history of stroke
  2. 10-year risk above 5%
  3. 10-year risk above 15% Correct answer.
  4. 10-year risk above 25%

Explanation

Australian absolute cardiovascular risk guidelines classify a 10-year risk above 15% as high risk, which warrants lipid-lowering therapy in addition to lifestyle modification. The 5% to 15% band is moderate risk and is generally managed with lifestyle measures first, with treatment individualised. Risk stratification uses the absolute figure rather than a single risk factor such as family history.