AMC MCQ Mock Exam: 20 Timed Questions

Answer: B. Admit for urgent echocardiography, intravenous immunoglobulin (IVIG), and high-dose aspirin

Why: Kawasaki disease is an acute systemic medium-vessel vasculitis. The diagnosis is clinical, requiring fever for >= 5 days plus at least 4 of: conjunctival injection, oral mucous membrane changes (strawberry tongue), polymorphous rash, extremity changes (erythema/edema), and cervical lymphadenopathy. Prompt treatment with IVIG and high-dose aspirin reduces the risk of coronary artery aneurysms from 25% to <5%.

• A. The presentation meets the diagnostic criteria for Kawasaki Disease; antibiotic therapy is inappropriate and delays critical therapy.
• C. Delayed treatment of Kawasaki disease significantly increases the risk of coronary artery aneurysms; immediate admission is required.
• D. High-dose aspirin and IVIG are the primary treatments; corticosteroids are reserved for refractory cases and are not first-line monotherapy.

Sources: RCH Melbourne Clinical Practice Guideline: Kawasaki Disease

Answer: C. Arrange urgent diagnostic and therapeutic laparoscopy

Why: Ovarian torsion is an acute gynecological emergency caused by the partial or complete rotation of the ovary on its pedicle, compromising vascular supply. Urgent laparoscopy is required for surgical detorsion (unwinding the ovary) and cystectomy of the predisposing cyst to prevent permanent ovarian ischemia and necrosis.

• A. Ovarian torsion is a gynaecological emergency; delaying surgical intervention leads to ovarian necrosis and irreversible loss of function.
• B. Elective surgery is inappropriate for an acute ischemic event that compromises organ viability.
• D. Methotrexate has no role in the management of ovarian torsion and is reserved for stable ectopic pregnancies.

Sources: RANZCOG: Gynaecological Emergencies Guideline

Answer: D. Continue observation and discharge during daylight hours if he remains well

Why: Serial blood tests and clinical examination after suspected snakebite take a minimum of 12 hours from the time of the bite, and this boy has now completed them with normal results and no symptoms. Even so, children with suspected snakebite should only be discharged in daylight hours, because neurological envenomation can be subtle and is most reliably detected while the child is awake. Removing the pressure immobilisation bandage is also restricted to a centre with full treatment facilities and, if envenomation were present, would wait until antivenom had been given. Intensive care admission, antivenom and observation beyond daylight are therefore not justified here.

• A. Neurological signs after Australian snakebite can be subtle and may only become apparent when the child is awake and observed, so discharge in the early hours is unsafe.
• B. Critical care admission is not required once examination and serial blood tests remain normal, and he is better managed with short stay observation.
• C. Antivenom is indicated only where there is evidence of envenomation, and exposing a non-envenomed child to it creates risks of anaphylaxis and serum sickness for no benefit.
• E. The bandage is left in place until the child is in a centre with full treatment facilities, and removing it does not remove the need for observation.

Sources: The Royal Children's Hospital Melbourne. Clinical Practice Guidelines: Snakebite. January 2018.

Answer: A. Scaphoid fracture

Why: Scaphoid fractures account for the vast majority of carpal fractures following a FOOSH injury. Classic physical findings include focal tenderness in the anatomical snuffbox, scaphoid tubercle tenderness, and pain on axial thumb compression. Due to the retrograde arterial supply to the proximal pole, unrecognized or undisplaced scaphoid fractures carry a high risk of non-union and avascular necrosis (AVN). Initial plain radiographs can be negative, requiring scaphoid-cast immobilization and re-imaging or MRI.

• B. Incorrect. A Colles fracture involves the extra-articular distal radius with dorsal displacement, causing a 'dinner fork' deformity rather than isolated snuffbox tenderness.
• C. Incorrect. Lunate dislocation presents with volar wrist pain, swelling, and potential median nerve compression symptoms.
• D. Incorrect. A Boxer's fracture is a fracture of the 5th metacarpal neck resulting from a direct axial punch impact.

Sources: Australian Orthopaedic Association (AOA) Clinical Guidelines; Therapeutic Guidelines: Emergency

Answer: C. Cognitive Behavioral Therapy (CBT) incorporating Exposure and Response Prevention (ERP)

Why: CBT with Exposure and Response Prevention (ERP) is the first-line therapy for OCD. If pharmacotherapy is required, high-dose SSRIs (e.g., Fluoxetine up to 80mg, Sertraline up to 200mg) or Clomipramine (a TCA with serotonergic activity) are used.

• A. IPT is not indicated or effective for OCD.
• B. Psychoeducation is important but insufficient as a primary active therapy for GAD or OCD.
• D. While ACT can be adjunctive, ERP remains the gold-standard exposure-based therapy for OCD.

Sources: RANZCP Anxiety and OCD Guidelines; eTG Complete - Obsessive Compulsive Disorder

Answer: A. Oral Alendronate 70mg once weekly

Why: First-line pharmacotherapy for postmenopausal osteoporosis in Australia includes antiresorptive agents, primarily oral bisphosphonates (Alendronate or Risedronate) or subcutaneous Denosumab. Patients must be counseled on correct administration of oral bisphosphonates (take on an empty stomach with a full glass of water, remaining upright for 30 minutes) to prevent esophageal ulceration.

• B. HRT is not recommended as first-line treatment for osteoporosis in women over 60 due to increased risks of stroke, DVT, and breast cancer.
• C. Teriparatide is an anabolic agent reserved for severe osteoporosis with multiple fractures who have failed antiresorptive therapy.
• D. Calcium and Vitamin D are necessary adjuncts, but they are insufficient as monotherapy to treat established osteoporosis with a T-score of -2.8.

Sources: Healthy Bones Australia / RACGP Osteoporosis Clinical Guidelines; eTG complete, Rheumatology, Osteoporosis

Answer: C. ARNI (Sacubitril/Valsartan)

Why: Angiotensin Receptor-Neprilysin Inhibitors (ARNI, Sacubitril/Valsartan) are recommended to replace ACE inhibitors or ARBs in patients with symptomatic HFrEF despite optimal background medical therapy. Sacubitril inhibits neprilysin, increasing natriuretic peptides, while Valsartan blocks the AT1 receptor.

• A. Incorrect. Digoxin provides symptom control in atrial fibrillation or advanced heart failure but does not confer a primary mortality benefit in HFrEF.
• B. Incorrect. Non-dihydropyridine calcium channel blockers (Verapamil/Diltiazem) have negative inotropic effects and are contraindicated in HFrEF.
• D. Incorrect. Aspirin is indicated for secondary prevention of ischaemic heart disease but does not replace ACE inhibitors in heart failure management.

Sources: Heart Foundation Guidelines

Answer: D. Annual screening

Why: RACGP recommends annual screening for people with impaired glucose tolerance or impaired fasting glucose. Choose a screening approach that matches the patient's age, risk group, previous results and ability to complete testing.

• A. Every 3 years regardless of impaired glucose tolerance is not the screening recommendation for this age and risk group.
• B. Every 10 years is not the screening recommendation for this age and risk group.
• C. Only if symptoms begin is not the screening recommendation for this age and risk group.

Sources: RACGP Management of type 2 diabetes: A handbook for general practice, 2024

Answer: A. Infectious mononucleosis (Glandular fever)

Why: Infectious mononucleosis (glandular fever) is most commonly caused by the Epstein-Barr virus (EBV). The clinical presentation of fever, pharyngitis, exudative tonsillitis, splenomegaly, and symmetric posterior cervical adenopathy in a young adult is classic. Diagnostic tests include the monospot test (heterophile antibodies) and atypical lymphocytosis on FBC.

• B. While streptococcal infection causes sore throat and exudates, splenomegaly and posterior cervical lymphadenopathy are highly characteristic of glandular fever.
• C. Acute HIV can present with a mononucleosis-like syndrome, but is less common and usually features a maculopapular rash and painful mucocutaneous ulcers.
• D. Diphtheria is rare in immunized populations and presents with a thick, gray pseudomembrane that bleeds on scraping.

Sources: eTG complete, Infectious Diseases; RACGP Glandular Fever Management

Answer: C. Recent discharge from a psychiatric hospital

Why: Case finding for suicide risk means being alert to defined higher-risk situations rather than screening everyone. Recognised factors include mental illness, especially mood disorders and substance misuse, previous attempts or self-harm, access to harmful means, recent bereavement or other loss, legal or disciplinary problems, relationship conflict, bullying, family history of suicide, chronic or terminal illness, living alone, imprisonment, and discharge from a psychiatric hospital within the previous 12 months, along with women experiencing intimate partner violence. His recent discharge is the pertinent factor here.

• A. Being male raises population risk, but the specific high-risk factor here is his recent psychiatric hospital discharge.
• B. Weight gain is not among the recognised risk factors for suicide in this context.
• D. Living alone is the recognised risk factor; living with family is not a specific alerting feature.

Sources: RACGP Guidelines for preventive activities in general practice (Red Book), Suicide

Answer: D. Provide smoking cessation counseling, offer influenza and pneumococcal vaccination, and initiate dual LAMA/LABA inhaler therapy

Why: The Australian COPD-X guidelines recommend a stepwise approach. Non-pharmacological management (smoking cessation, vaccination, pulmonary rehabilitation) is fundamental. For pharmacotherapy, symptomatic patients are escalated from SABA/SAMA as-needed to dual long-acting bronchodilators (LAMA/LABA). ICS is reserved for patients with features of asthma or frequent exacerbations despite dual bronchodilation.

• A. Oxygen therapy is only indicated for patients with chronic hypoxemia (PaO2 < 55 mmHg or < 59 mmHg with cor pulmonale).
• B. ICS monotherapy is not recommended in COPD due to lack of efficacy and increased risk of pneumonia; it is only used in combination for frequent exacerbators.
• C. Oral corticosteroids are reserved for acute exacerbations and should not be used as maintenance therapy in stable COPD.

Sources: The COPD-X Plan: Australian and New Zealand Guidelines for the Management of COPD

Answer: C. Reassess capacity and support him to participate in the decision

Why: The code of conduct section on patients who may have additional needs states that a doctor should ensure a patient decision-making capacity is reassessed when indicated, and should encourage supported decision-making so that patients with impaired capacity can participate as far as possible. It also notes that capacity and needs may fluctuate over time. Equating a cognitive diagnosis with incapacity, handing the whole decision to the family, or freezing all care pending a formal assessment all depart from that guidance.

• A. A diagnosis does not determine capacity, and the code requires capacity to be reassessed when indicated, noting that capacity and needs may fluctuate.
• B. The code encourages supported decision-making so the patient can participate as far as possible, rather than excluding him from the process.
• D. Reassessment should occur when indicated, but the code does not require all care to stop pending a formal assessment.

Sources: Medical Board of Australia, Good medical practice: a code of conduct for doctors in Australia (2020)

Answer: B. Interview the patient alone to assess for elder abuse and determine her safety.

Why: Suspected elder abuse should be evaluated by interviewing the patient privately. This allows the doctor to assess safety, capacity, and patient preferences without influence from family members.

• A. Police involvement should respect patient autonomy unless there is immediate danger.
• C. This fails to address safety concerns and suspected abuse.
• D. Advising the son directly is inappropriate and unsafe for the patient.

Sources: RACGP Elder Abuse Guidelines

Answer: C. Extend cardiotocography to 24 hours

Why: At 22 weeks gestation or more, continuous cardiotocography is commenced as soon as feasible and continued for a minimum of four hours after any maternal trauma, because the fetal heart rate is a sensitive surrogate for maternal perfusion and can change before maternal deterioration is apparent. Monitoring is extended to 24 hours when there is more than one contraction every ten minutes, uterine tenderness, significant abdominal pain, ruptured membranes, vaginal bleeding, a positive Kleihauer-Betke test or an abnormal trace, and this woman has two of those features. Mild trauma does not exempt her from monitoring, symptoms are an unreliable guide, and a normal ultrasound does not exclude abruption.

• A. Even minor injuries are associated with placental abruption, preterm labour and fetal loss, and around half of fetal losses follow minor trauma.
• B. Four hours is only the minimum after trauma, and her uterine tenderness and frequent contractions are indications to extend monitoring.
• D. Relying on symptoms under-estimates risk, because abruption can occur with few symptoms and initially normal observations.
• E. Ultrasound is not sensitive enough to exclude abruption, for which false negative rates are high, so it cannot end monitoring.

Sources: Queensland Clinical Guidelines. Traumatic injury in pregnancy. Guideline No. MN26.31-V3-R31. Queensland Health. 2026.

Answer: C. Prescribe a short course of a short-acting benzodiazepine (e.g., Diazepam 2-5 mg) to be taken 1 hour before the flight.

Why: For simple phobias where exposure is infrequent (e.g., flying), a low dose of a short-acting benzodiazepine (like Diazepam or Alprazolam) can be used as needed. Long-term management should focus on CBT and exposure therapy.

• A. SSRIs require several weeks to work and are not indicated for isolated situational anxiety.
• B. While beta-blockers help with performance anxiety (tremor/tachycardia), they are less effective for severe situational phobias compared to short-term benzodiazepines.
• D. Atypical antipsychotics are not indicated for simple phobias and carry metabolic/cardiac risks.

Sources: RANZCP Anxiety Guidelines; eTG Complete - Situational Anxiety

Answer: A. Administer a single dose of dTpa (tetanus-diphtheria-pertussis) vaccine.

Why: For tetanus-prone wounds (dirty, contaminated, deep), a booster dose of dTpa or dT is recommended if the last dose was more than 5 years ago. Tetanus Immunoglobulin (TIG) is only required if the patient has a history of incomplete or uncertain primary immunisation (<3 doses).

• B. TIG is only required for tetanus-prone wounds in individuals who are unvaccinated.
• C. Primary course does not provide lifelong immunity; a booster is required after 5 years.
• D. Antibiotics do not replace immunisation for tetanus prevention.

Sources: Australian Immunisation Handbook

Answer: D. Torsion of the testicular appendage

Why: Torsion of the appendix testis is a common cause of acute scrotal pain in prepubertal boys and produces a tender nodule at the upper pole with a blue dot sign seen through the skin. The cremasteric reflex is preserved and the testis remains normally positioned, which helps distinguish it from testicular torsion. Epididymo-orchitis is very rarely seen between the ages of 7 and 16 years and is usually febrile, while an irreducible hernia is an infantile problem that produces a firm inguinoscrotal swelling extending from the groin.

• A. A high-riding, transversely lying testis with an absent cremasteric reflex is expected in torsion, whereas this boy has a normally positioned testis and an intact reflex.
• B. This infection is very rarely seen between 7 and 16 years of age and typically produces fever with tenderness of the postero-lateral testis.
• C. An irreducible hernia produces a firm, tender inguinoscrotal swelling that extends to the scrotum and is seen in infants rather than this age group.

Sources: RCH Melbourne Clinical Practice Guideline: Acute scrotal pain or swelling (2026)

Answer: A. Influenza vaccination is strongly recommended at any trimester in each pregnancy

Why: Vaccination of pregnant women is strongly recommended to protect them against respiratory illness including influenza. RANZCOG advises influenza vaccination for all pregnant women at any trimester in each pregnancy, especially if the pregnancy falls during the influenza season, and it is also safe to receive while breastfeeding. Deferring to the postpartum period would leave her unprotected, and the recommendation is not restricted to women with chronic respiratory disease. Inactivated vaccine is used in pregnancy rather than a live attenuated product.

• B. Waiting until after birth leaves both mother and infant unprotected through the period of highest risk for severe influenza.
• C. The recommendation applies to all pregnant women and is not limited to those with pre-existing respiratory disease.
• D. A live attenuated influenza vaccine is not the preferred product in pregnancy, where the inactivated vaccine is used.

Sources: RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023

Answer: B. Advise the patient to undertake a gluten challenge (eating gluten daily for at least 4-6 weeks) followed by serology and gastroscopy with duodenal biopsy

Why: For diagnostic tests to be accurate, patients must be consuming gluten. Coeliac Australia recommends that patients who have started a gluten-free diet undergo a gluten challenge (e.g., eating at least 4 slices of wheat bread or equivalent daily for 4-6 weeks) before receiving serological screening (tTG IgA) and a gastroscopy with duodenal biopsies (the gold standard for diagnosis showing villous atrophy).

• A. Serological markers can become false-negative if the patient has been gluten-free; a gluten challenge is required first.
• C. HLA typing has a high negative predictive value but cannot confirm active disease, as many healthy individuals carry these genes.
• D. Empirical dietary changes without histological confirmation are not recommended, as a lifelong gluten-free diet requires definitive diagnosis.

Sources: Coeliac Australia Medical Advisory Committee Guidelines; RACGP Coeliac Disease Screening Guidelines

Answer: A. Within 5 minutes of the onset of the cardiac arrest, by a trained team.

Why: Cardiopulmonary arrest after cardiac surgery is usually caused by a small number of reversible problems such as tamponade, bleeding, tension pneumothorax, pacing failure or graft problems, and emergency re-sternotomy addresses most of them. The trained team should complete re-sternotomy within 5 minutes of the onset of the arrest, and chest compressions should not be withheld while this is prepared. Waiting for drugs to work, for compressions to fail, or for transfer to an operating theatre all waste that critical window.

• B. This delay is far too long; reversible causes after cardiac surgery are addressed by re-sternotomy rather than by prolonged drug therapy.
• C. Waiting for compressions to fail before opening the chest wastes the time in which re-sternotomy is most likely to succeed.
• D. Re-sternotomy is performed where the patient arrests rather than after transfer, which would add harmful delay.

Sources: ANZCOR Guideline 11.10 Resuscitation in Special Circumstances (2026)