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Question 1

Patients suffering from schizophrenia may experience both positive and negative
symptoms. All of the following are negative symptoms EXEP!"
a# Anhedonia
b# $allucinations
c# %ac& of motivation
d# Emotional blunting
e# Alogia
Incorrect. The correct answer is (b).
$allucinations are abnormal perceptions' e.g. hearing voices spea&ing about the
patient' and(or giving instructions to do certain things. !hey represent additional
phenomena and' therefore' are classified as positive symptoms. )elusions *false
ideas# is the other ma+or group of positive symptoms. ,n contrast' each of the other
options represents a loss or diminution of a mental function' e.g. anhedonia is a loss
of capacity for pleasure.
Question -
.artha was born at /0 wee&s gestation. 1he re2uired phototherapy for +aundice
whilst in hospital. .artha is being breast3fed and is beginning to gain weight. 1he is
now two months old. 4egarding routine childhood vaccination which of the following
statements is 544E!6
a# 7accinations due to be given at two months of age should be postponed until
.artha is at least 1/ wee&s old to allow for her prematurity.
b# .artha8s past history of +aundice is not a contraindication to oral polio vaccine.
Correct
c# 7accines for intramuscular in+ection should be given into the buttoc& in a
premature baby.
d# 9reast3feeding is a contraindication to vaccination.
e# ,t is not necessary to immunise .artha against hepatitis 9.
A history of +aundice after birth is not a contraindication to any of the vaccines in the
standard schedule.
7accination should not be postponed because of prematurity. !he fact that a child is
breast3fed is not a contraindication to vaccination. 7accines should never be given
into the buttoc&s. !he anterolateral thigh is the preferred site for vaccination in
infants under 1- months of age. !he deltoid region is the preferred site in older
children *those who have commenced wal&ing# and in adults. .artha would be due to
receive vaccination against hepatitis 9 at the age of two months according to the
current standard vaccination schedule.
: Question /
.aud is a ;< year old who presents with acute peri3umbilical abdominal pain
gradually increasing in intensity. 1he is vomiting profusely and develops watery
diarrhoea with flec&s of blood after an hour of pain. Examination of the abdomen
reveals localised periumbilical tenderness with some rigidity. 4ectal examination is
normal. An irregular pulse is noted and an E= is recorded *shown below#.
!he .51! %,>E%? diagnosis is"
a# Acute appendicitis
b# Acute pancreatis
c# Perforated peptic ulcer
d# 9iliary colic
e# .esenteric artery occlusion
Correct
!he clinical presentation is typical of mesenteric artery occlusion. !his occurs most
commonly in patients with atrial fibrillation leading to embolism. !he E= shows
atrial fibrillation. Arteriography will show the vascular occlusion.
: Question @ A 10 year old male has sudden onset of severe pain in his right lower
abdomen commencing - hours ago. $e has vomited several times in the last hour.
$e is rolling on the bed' stating that the pain is going down into his groin. ! /;.1
degrees elcius' P 11<min' 9P 1/0( A<. Abdomen 3 soft' no rebound. !ender right
testicle. ?our immediate management is"
a# i(v fluids and antibiotics
b# arrange urgent ultrasound examination
c# i(v metoclopramide *maxolon#
d# refer for emergency surgery
Correct
e# arrange for a >B9 Xray
!he sudden onset of severe pain in the lower abdomen' groin or scrotum' in a young
male under -0 years' should be considered to be testicular torsion until proved
otherwise. !his is a surgical emergency' as infarction of the testis can occur 2uic&ly'
and surgical exploration should be underta&en urgently. !his patient has no fever' nor
tenderness of the epididymis to indicate epididymo3orchitis. Antibiotic treatment will
not help. olour doppler ultrasound may show increased blood flow in infection and
the absence of flow in advanced torsion. $owever' these are not reliable findings' and
the investigation would waste valuable time. !he vomiting is related to the pain' and
would be alleviated by appropriate analgesia. .etoclopramide is not an immediate
priority. !he clinical picture is highly suggestive of testicular torsion rather than renal
colic' thus ,7P is not the appropriate immediate management.

: Question 0
,n a / year old child with signs and symptoms suggestive of bacterial meningitis'
which of the following is the 9E1! initial management6
a# Erythromycin ,7
b# =entamicin ,7
c# eftriaxone ,7
Correct
d# Phenoxymethylpenicillin oral
e# Amoxycillin oral
,f bacterial meningitis is suspected clinically it is vital to immediately administer an
appropriate antibiotic prior to urgent transfer to hospital' as meningococcal
meningitis may be rapidly fatal. !he drug of choice would be benzylpenicillin
C<mg(&g up to /g ,7 or ,.' or ceftriaxone 0<mg(&g up to -g ,7 in patients
hypersensitive to penicillin or when further drug treatment may be delayed.

Question C
Atypical antipsychotic drugs *eg. olanzapine# have certain advantages compared to
the typical antipsychotic drugs *eg. chlorpromazine# in the treatment of
schizophrenia. All of the following are advantages of atypical drugs EXEP!"
a# ,mproved therapeutic effect on positive symptoms
b# ,mproved therapeutic effect on negative symptoms
c# 4educed potential for acute extrapyramidal symptoms
d# 4educed potential for longer3term extrapyramidal symptoms
e# ,mproved therapeutic effect in some treatment3resistant patients
Incorrect. The correct answer is (a).
9oth the typical and atypical antipsychotic drugs have a beneficial effect on positive
symptoms in schizophrenia. $owever' they differ with regard to negative symptoms.
Atypical antipsychotics are much better at combating these. !he other options are
true for the atypical drugs.
Question ;
Dhich of the following statements regarding undescended testes is 544E!6
a# !he testes are undescended at birth in @<E of boys.
b# 5nce the testis is palpable in the scrotum it will remain so.
c# )escent is unli&ely to occur after 1 year of age.
Correct
d# 5rchidopexy should be delayed until late childhood.
e# !he undescended testis is at reduced ris& of malignancy.
!estes which are undescended at birth may well descend into the scrotum during the
first two wee&s of life' however descent is unli&ely to ta&e place after the age of one
year. -E of boys born at full3term' and -<E of premature males' have undescended
testes. A testis which was palpable in the scrotum in infancy may ascend and
become impalpable due to failure of the spermatic cord to elongate at the same rate
as body growth. 5rchidopexy is best performed by 1-31A months of age as
spermatogenesis in the undescended testis is impaired after the age of two years.
!he undescended testis is at 031< times greater ris& of developing malignancy
*seminoma#.

Question A
A /@ year old woman presents with an acutely painful swollen &nee. 1ynovial fluid
aspirate shows the following"
D @1<<(u% *F4 G -<<<(u%#' A<E polymorphonuclear lymphocytes
red blood cells HH
no crystals
no organisms cultured
Dhat is your interpretation of these results6
a# ,nflammation is more li&ely
Correct
b# =onococcal arthritis
c# 7iral arthritis
d# !uberculous arthritis
e# !raumatic tap
Formal synovial fluid contains less than -<<< white blood cells per microlitre.
,nflammation causes counts of /<<< or higher. ,nflammation can also cause red
blood cells to migrate into the +oint fluid.
7iral arthritis 3 usually symmetrical polyarthritis' predominantly lymphocytic effusion
!9 arthritis 3 chronic presentation with D I1<'<<<(u%' 0<E P.F%s' culture
positive in 0<E
=onococcal arthritis 3 D I1<3-<'<<<(u%

Question J
oncerning prostate cancer' which 5FE of the following is ,F544E!6
a# !he ma+ority of carcinomas arise in the peripheral zone of the gland
Incorrect. The correct answer is (b).
b# !he prostate specific antigen *P1A# is elevated in all prostate cancers greater
than 1.0 cm
c# ,f metastasis occurs' pelvic lymph nodes are involved early
d# 4adionuclide bone scan is a sensitive but not specific method of detecting bony
metastases
e# Prostate cancers usually appear as hypoechoic nodules on transrectal
ultrasound
A normal P1A occurs in up to -<E of cancers' including tumours greater than 1.0
cm. Prostate cancer is the second most common cause of cancer deaths in men in
Australia. !he ma+ority of prostate cancers3 usually adenocarcinomas3 arise in the
peripheral zone of the gland' and metastasise early to pelvic lymph nodes. 9ony
metastases are also common. 9one scan is unreliable at detecting bony metastases
when the prostate specific antigen *P1A# is G-<ng(ml. !he commonest pattern for
prostate cancer on transrectal ultrasound is of hypoechoic nodules. !his pattern may
also be seen in prostatic hypertrophy or prostatitis.

Question 1<
Dhich 5FE of the following atypical antipsychotic drugs is optimal as first line
therapy in managing the first episode of schizophrenia in a patient6
a# 4isperidone
Incorrect. The correct answer is (b).
b# 5lanzapine
c# Quetiapine
d# Amisulpride
e# lozapine
5lanzapine is the drug of choice for treatment of first episode schizophrenia' since it
does not cause extrapyramidal symptoms at therapeutic doses' and is useful for
combating affective symptoms' including depression. ,ts ma+or disadvantage is
weight gain. !he other drugs listed carry a greater ris& of extrapyramidal symptoms
and other side effects.

Question 11
Ara' 0 years old' presents with a painless limp. ?ou suspect Perthes8 disorder. Dhich
of the following statements is 544E!6
a# $ip mobility is usually reduced' particularly adduction and external rotation
b# Bltrasound is re2uired to ma&e a definitive diagnosis
c# !he white cell count and reactive protein *4P# are usually raised
d# Progress is assessed with serial radiological examination
Correct
e# 5steotomy is the treatment of choice
Perthes8 disorder is most common in @3A year olds. 5n examination hip mobility is
reduced' particularly abduction in flexion. Xray confirms the diagnosis showing
widening of the +oint space' decalcification of the metaphysis and a dense slightly
flattened femoral head. !here is no need for testing white cell count or 4P as these
are normal. ,n most cases the prognosis is excellent and the only re2uirement is to
avoid prolonged wal&ing or exercise. Progress is assessed by clinical examination and
serial radiological examinations. Dhere there are severe changes containment of the
femoral head is the treatment of choice and this usually re2uires a plaster cast or
orthosis. 5steotomy of the pelvis or femur is only rarely re2uired.

Question 1-
1usie is 1C' and has had a lingering cough following an apparent viral bronchitis. $er
doctor referred her for a chest X ray which has shown a mass in the antero3superior
mediastinum. Dhich of the following is F5! a li&ely diagnosis6
a# teratoma
b# thymoma
c# retrosternal thyroid
d# bronchogenic cyst
Correct
e# lymphadenopathy
9ronchogenic cysts are mostly found in the posterior mediastinum' and only rarely in
the anterior mediastinum All of the others are li&ely diagnoses. Approximately half of
all mediastinal masses are asymptomatic and discovered on a 8routine8 X 4ay.
%esions in young people' and lesions which produce symptoms are more li&ely to be
malignant.
*!+andra K' lunie =' !homas 4. *-<<1# 8!extboo& of 1urgery8 9lac&well 1cience Asia'
.elbourne p C-0 #

Question 1/
,n Australia' all of the following are ris& factors for suicide' EXEP!"
a# 1chizophrenia
b# Lamily history of suicide
c# 1ocial disadvantage
d# 9eing female
Correct
e# ?outh
.ales' particularly young men and elderly single men' are at greater ris& of
completed suicide than women however women may be more li&ely to attempt
suicide.
*=uidelines for preventive activities in general practice. *-<<-# Bpdated 0th ed.
Australian Lamily Physician' 1pecial ,ssue' 1,' @0 #
: Question 1@
A 10&g child with a &nown food allergy to peanuts suddenly develops anaphylaxis.
!he 4E5..EF)E) immediate management is"
a# <.1ml of Adrenaline 1"1<<< by deep intramuscular in+ection
b# <.1ml of Adrenaline 1"1<'<<< by deep subcutaneous in+ection
Incorrect. The correct answer is (c).
c# <.10ml of Adrenaline 1"1<<< by deep intramuscular in+ection
d# <.10ml of Adrenaline 1"1<<< by subcutaneous in+ection
e# <.10ml of Adrenaline 1"1<'<<< by deep intramuscular in+ection
Adrenaline 1"1<<<. is recommended as it is readily available' and this concentration
contains 1mg of adrenaline per ml. !he recommended dose of 1"1<<< adrenaline is
<.<1mg(&g body weight by deep intramuscular in+ection' so a 10&g patient would
re2uire <.<1 X 10 M <.10ml i.m.
*4obinson .K' 4obertson ).. *-<</#' Practical Paediatrics' 0th ed' hurchill
%ivingstone' 1ydney' p @103@1C #
Question 10
Dhich 5FE of the following is a mass population screening test which has been
demonstrated to significantly reduce cancer mortality6
a# annual faecal occult blood testing in the over 0< age group
b# annual colposcopy in sexually active women
c# annual plasma A1-0 in post menopausal women
d# annual colonoscopy in siblings of patients with colon cancer
e# - yearly mammography in women in the /03@0 age group
Incorrect. The correct answer is (a).
!here have been at least / randomised control screening trials conducted which show
that faecal occult blood testing every 13- years in the over 0< year population
reduces the mortality from colorectal cancer by around -<E. olposcopy is a
diagnostic' not a screening test. !he appropriate screening test for cancer of the
cervix in sexually active women is the Papanicolaou *Pap# smear. Plasma A1-0
levels may be raised in asymptomatic women with ovarian cancer but there is not' as
yet' any evidence for its benefit as a mass screening measure. olonoscopy for
siblings of patients with colorectal cancer may reduce their mortality' but this is
8selective8 screening' by targeting a high3ris& group.
Dhile mammography in the 0<3;< age group has been shown to reduce mortality
from breast cancer by around /<E' the benefit for women in the @<30< age range is
2uite small' and there is little evidence for benefit in still younger women.
*1emmens' K'Platell'. 89owel ancer8 Australian Lamily Physician vol /< no Cp'0/J #
*Quinn' .. 81creening for 5varian cancer8 Australian Lamily Physician vol /< noC
p0/< #
*$arrison8s 5nline
Available" www.accessmedicine.com(content.aspx6a,)MC<0J< #
Question 1C
All of the following groups are at higher ris& than average of depression' EXEP!"
a# Domen
b# Postpartum women
c# ?oung rural males
Incorrect. The correct answer is (d).
d# Brban males
e# Adolescents
.en living in urban areas are not especially at ris& of depression. $owever' young
men living in rural areas are at greater ris& because of social isolation. Domen'
particularly in the postpartum period' and adolescents are also more vulnerable to
depression.
*=uidelines for preventive activities in general practice. *-<<-# Bpdated 0th ed.
Australian Lamily Physician' 1pecial ,ssue' 1,' @@ #
*$arrison8s 5nline
Available"
www.accessmedicine.com(content.aspx6a,)M1<J/@J #
Question 1;
Lourteen month old .ar& has had a high fever and mild coryza for three days but
has still been 2uite active. .ar&8s temperature has returned to normal today but he
has now developed a red maculopapular rash on his trun&. !he .51! %,>E?
diagnosis is"
a# .easles
b# hic&en pox
c# Erythema infectiosum
d# 4ubella
e# 4oseola infantum
Correct
4oseola infantum is a viral infection usually affecting children between the ages of C3
1A months. !he patient typically develops high fever up to @< degrees elsius' but is
otherwise not particularly unwell. !here may be mild cervical lymphadenopathy and
pharyngitis. After three days the temperature usually returns suddenly to normal and
the patient develops a red macular or maculopapular non3des2uamating rash which
is truncal' usually sparing the face and limbs. !he rash abates within two days.
*.urtagh' K. *-<</#' =eneral Practice' !hird edition' .c=raw3$ill' 1ydney' hap A1' p
J<; #
*4obinson .K' 4obertson ).. *-<</#' Practical Paediatrics' 0th ed' hurchill
%ivingstone' 1ydney' p /C- #
*.erc& .anual
Available" www.merc&.com(mr&shared(mmanual(tables(-C0tbA.+sp #
: Question 1A
A 0< year old woman has had ma+or abdominal surgery yesterday. ?ou are called to
see her urgently as she has symptoms of shoc&. Dhich 5FE of the following
examination findings is of .51! concern6
a# the patient is restless and confused
b# !emperature /J.- degrees elsius
c# pulse 1/<' sinus tachycardia
d# urine output over past @ hours of 1-<ml
e# 9P A<(@0 mm $g
Correct
!he above signs ta&en together describe a picture of shoc&. $ypotension *defined as
systolic 9P GJ<mm $g' or I@<mm $g fall from baseline level# is a sinister
development and re2uires urgent attention. ,t is often a %A!E manifestation of
circulatory failure. !hus it is the most alarming of these findings' and the one most
indicative of the urgency of this situation.
Question 1J
Arthur is a ;@ year old man who presents reluctantly because his wife feels 8he has
not been himself since he came home and is not sleeping properly.8 $is appetite is
poor and he has lost C &g in weight since discharge from hospital eight wee&s ago
following treatment for myocardial infarction. $e has lost interest in his hobbies and
is not ta&ing his medications. $e has been a type - diabetic for 1- years. 5n
examination he shows signs of mild cardiac failure. !he result of an $bA1 test is
1<.0E *target G;E#. Dhich 5FE of the following is the .51! li&ely cause of Arthur8s
condition.
a# 1enile dementia
b# Bncontrolled diabetes
c# )epression
Correct
d# 1ilent reinfarction
e# hronic fatigue syndrome
Arthur is showing several typical features of depression' viz insomnia' loss of interest
in pleasurable activities' loss of appetite and loss of weight. )epression following
myocardial infarction is well recognised and increases the ris& of complications and
death. 1uch patients are less li&ely to observe instructions regarding medications'
ma&ing their situation worse. Arthur8s diabetes is poorly controlled' as shown by the
elevated $bA1 level but this is insufficient to explain his condition. !he other
options could contribute to the clinical picture shown by Arthur but are less li&ely to
be the cause of his condition.

Question -<
Aidan' a / month old boy' presents with paroxysms of coughing associated with
cyanosis' lethargy and poor feeding for several days. 5n examination' between
episodes of coughing' he is afebrile and examination is normal. Dhat is the FEX!
step in management6
a# Admission to hospital
b# Fasopharyngeal aspirate and review in -@ hours
c# ,mmunisation at this visit with )!P and review in -@ hours
d# Erythromycin syrup and review in -@ hours
e# !rial of salbutamol by mas&
Incorrect. The correct answer is (a).
!he clinical picture suggests respiratory infection with 9ordetella pertussis. !he
history of cyanosis associated with the coughing suggests the need for admission to
hospital but' in addition' children under C months of age usually re2uire admission
for pertussis because of the ris& of complications. omplications include respiratory
arrest' bacterial pneumonia and encephalitis.
1albutamol has not been shown to be helpful in a child of this age and is of no
benefit. ,mmunisation at a later date should be encouraged even if the child has had
pertussis. Erythromycin is not curative but may reduce infectivity.

Question -1
1imon aged @ months is diagnosed with pertussis. Dhat is the .51! APP45P4,A!E
management of 1imon8s parents to reduce their ris& of infection6
a# ,mmediate booster immunisations for pertussis
b# A 1< day course of erythromycin
c# ommence a / dose pertussis revaccination schedule
d# Arrange nasopharyngeal swabs
e# ,mmediate immunisation with pertussis immunoglobulin
Incorrect. The correct answer is (b).
Lifty percent of babies with pertussis are infected by their parents. All household
contacts of patients with pertussis should receive erythromycin for 1< days to
prevent further spread of the disease. otrimoxazole is recommended for those
intolerant of erythromycin.
An initial or booster dose of pertussis vaccine should be considered for children aged
up to A years. A booster vaccine is now available for adults and children I Ayrs who
have had the initial course. ,t is recommended for children 1031; yrs of age' parents
planning their first pregnancy' adults wor&ing with young children or at 0< years of
age. 9abies under - months of age who have been exposed are best vaccinated
early.
Passive immunisation with pertussis immunoglobulin is not effective in the prevention
of pertussis. ,solation is not re2uired for household contacts.
*.erc& .anual
Available" www.merc&.com(mr&shared(mmanual(section1J(chapter-C0(-C0a.+sp #
Question --
Dhich of the following conditions is the 5..5FE1! anxiety disorder encountered in
general practice6
a# =eneralised anxiety disorder
b# Phobic disorder
c# 5bsessive compulsive disorder
Incorrect. The correct answer is (a).
d# Panic disorder
e# Post3traumatic stress disorder
=eneralised anxiety disorder is the commonest anxiety disorder seen in general
practice. ,t has an insidious onset' usually having been present 0 to 1< years before
diagnosis. ,t occurs more commonly in women and the fre2uency increases with age.
*=eneralised anxiety disorder *-<<-# )epression Awareness Kournal' 11" 1C31A #
Question -/
Dhich of the following is F5! a diagnostic feature accompanying anxiety in
generalised anxiety disorder *=A)#6
a# 4estlessness
b# Latigue
c# )ifficulty concentrating
d# .uscle tension
e# %oss of appetite
Correct
%oss of appetite is not a feature of =A). !he )1.3,7 criteria include / or more of the
following in addition to anxiety and worry" restlessness' fatigue' difficulty
concentrating' irritability' muscle tension' and sleep disturbance.

Question -@
.artin' aged 0< years' complains of insomnia for two wee&s. $e says this relates to
anxiety about problems at wor& which surround the end of the financial year. Dhile
he is describing his problem' he is excited and agitated. 5n examination' his pulse
rate is ;0(min and 9P 1/0(J0 mm $g. Dhich of the following behavioural therapies
would be .51! helpful to .artin6
a# ognitive therapy
b# 1leep restriction therapy
c# 1timulus control therapy
d# 4elaxation therapy
Correct
e# ,nterpersonal therapy
!he successful treatment of insomnia depends on both behavioural and
pharmacological approaches. 4elaxation therapy would be the most useful
behavioural therapy for .artin' because he displays exaggerated arousal 3 emotional'
cognitive and physiological' shown by his mental approach when describing the
problem and his physiological response in terms of pulse rate and 9P. Progressive
muscle relaxation aims to reduce somatic arousal and attention focussing techni2ues
*e.g. on tran2uil situations# to reduce cognitive and emotional arousal. *1ee
reference for descriptions of other options' except interpersonal therapy which is not
an accepted form of behavioural therapy.#
*=runstein 4 *-<<-# ,nsomnia" diagnosis and management. Australian Lamily
Physician' /1" JJ031<<<
Available"www.racgp.org.au(document.asp6idMJ<-J
Available"www.racgp.org.au(afp(downloads(pdf(november-<<-(-<<-11<1grunstein.
pdf #
Question -0
)oris is a ;@ year old woman whose husband has died suddenly a wee& ago. 1he
see&s your help in dealing with insomnia which has been troubling her since her
husband8s death. 1he has tried an over3the3counter preparation which she obtained
at the local pharmacy but has not found it helpful. Dhich of the following drugs
would you offer to prescribe for )oris6
a# !emazepam
b# Nopiclone
c# Nolpidem
Incorrect. The correct answer is (e).
d# Amitriptyline
e# Any of the above
!here is a well defined role for short3term use of a hypnotic medication in a situation
li&e sudden bereavement. Fone of the drugs listed stands out as the best hypnotic
with few side effects. !emazepam is the most often prescribed hypnotic in Australia.
$owever' benzodiazepines have generally fallen from favour because of their
addictive properties if ta&en for more than several wee&s. Nopiclone and zolpidem
share some of the properties of benzodiazepines but have fewer adverse effects.
Amitriptyline is a tricyclic antidepressant which is a useful hypnotic in lower doses
than are used for depression.
Question -C
,nsomnia is defined as inability to"
a# Lall asleep
Incorrect. The correct answer is (d).
b# .aintain sleep
c# 1leep at normal times
d# 5btain good 2uality sleep
e# 5btain enough sleep
,nsomnia is the commonest sleep disorder and is defined as poor 2uality sleep which
often results in daytime symptoms' including fatigue' irritability' problems with
concentration and memory' and feeling unwell. !he other options describe features of
various insomnia syndromes but do not define the overall problem.

Question -;
.avis is an A/ year old widow who is brought to your consulting room by her
daughter because she 8is not loo&ing after herself properly.8 .avis appears un&empt
and withdrawn and gives monosyllabic answers to your 2uestions. !he daughter says
that she 8has been going downhill for a while'8 ever since 8she began having problems
with her memory.8 Lurther discussion with the daughter reveals that .avis is
suffering from fatigue' anorexia and short3term memory loss' and is afraid to leave
her house. 1he spends much of her day sleeping in front of the television set. Dhich
of the following is the .51! %,>E%? diagnosis6
a# Alzheimer8s dementia
b# 7ascular dementia
Incorrect. The correct answer is (c).
c# .elancholia
d# Psychotic depression
e# 9ipolar disorder
.elancholia *previously called endogenous depression# is a severe form of 8biological8
depression due to a primary abnormality of brain neurotransmitter metabolism'
principally involving serotonin. 1uch severe depression can present as
pseudodementia' mimic&ing Alzheimer8s dementia. Psychotic depression is also a
severe form of biological depression with the additional aspect of psychotic features.
,n bipolar disorder there are alternating episodes of depression and mania. 5ther
possible diagnoses include medical disorders such as hypothyroidism.
*1nowden K *-<<-# 1evere depression in old age. .edicine !oday' /" @13@; #
Question -A
!he prevalence of insomnia in the Australian community is about"
a# 1<E
b# -<E
c# /<E
Correct
d# @<E
e# 0<E
!he prevalence of insomnia in Australia is about /<E. !he situation is similar in other
industrialised nations. .ale sufferers outnumber females by 1./ to 1 in the @<H
years age group. 5ther factors which increase the prevalence of insomnia are old
age' unemployment and lower socio3economic status. !he ma+ority of patients have
a co3existing disorder' such as depression or generalised anxiety' and often present
with fatigue or daytime sleepiness rather than insomnia.
Question -J
Dhich of the following is a cause of primary insomnia6
a# 5bstructive sleep apnoea
b# 4estless legs syndrome
Incorrect. The correct answer is (c).
c# 9ehavioural conditioning
d# 1leep phase disorder
e# 9ereavement
,n primary insomnia there is no pre3existing cause of sleep disorder as there is' for
example' in obstructive sleep apnoea' restless legs syndrome' sleep phase disorder
and bereavement. Dith behavioural conditioning or behaviours impairing sleep the
patient has developed a habit of doing things immediately before bedtime which are
not conducive to sleep' such as sitting in bed watching television. Dith the other
options there is another established condition or situation which disrupts sleep.
$ence insomnia is regarded as secondary in these cases.
Question /<
Patients suffering from generalised anxiety disorder *=A)# often go undiagnosed for
years because they"
a# )eliberately conceal their anxiety
b# ,nadvertently play down their anxiety
c# .ore often present with somatic complaints
d# Are misdiagnosed as having depression
e# !end to &eep away from doctors
Incorrect. The correct answer is (c).
Patients with =A) are fre2uently not diagnosed for years because they tend to
present with associated somatic complaints' such as asthma' bac& pain' migraine'
allergies' and gastrointestinal disorders and often consume a large amount of
medical resources before the diagnosis is made. !hey are not deliberately concealing
things from their doctors 3 they simply do not appreciate the significance of their
feelings. Patients with =A) may also have clinical depression which can further
complicate the issue.
Question /1
All of the following are effective first line topical treatments for severe dandruff
EXEP!"
a# 1elenium sulphide
b# Ninc pyrithione
c# 9etamethasone
d# .iconazole
Incorrect. The correct answer is (c).
e# >etoconazole
)andruff' pityriasis capitis and seborrhoeic dermatitis are related conditions on a
continuum of severity. Pityrosporidium ovale is a fungus which has been implicated in
the development of these conditions. Eradication of the fungus has been shown to
relieve the symptoms of the condition. 1elenium sulphide' zinc pyrithione'
miconazole and &etoconazole are all first line treatments which can be used once
wee&ly to daily depending on severity. !opical application of betamethasone lotion is
effective but only considered if there has been little response to the first line
treatments.

Question /-
Amy' a young girl' is worried about a rash on her face which has been there for a few
wee&s. ,t is mildly itchy and has slowly increased in size. 5n examination it is a
circular lesion which loo&s scaly around the edges with the center appearing
normal*see figure#.
!he .51! %,>E%? diagnosis is"
a# !inea corporis
Correct
b# ,mpetigo
c# Pityriasis versicolor
d# Psoriasis
e# )ermatitis
,n children' tinea commonly involves the hair' face and body. !inea corporis is
recognised by its scaly' erythematous edge with clearing centre. )ermatitis and
psoriasis can mimic tinea and where the clinical picture is uncertain a fungal scraping
may confirm tinea. ,mpetigo may present with blisters that leave a brown crust' or
erosions with yellow crusts but without blistering. Pityriasis versicolor presents as
well demarcated pale or tan3coloured macules usually on the upper trun&.

Question //
After referral to a paediatric oncologist' 9ronwyn is diagnosed as having acute
lymphoblastic leu&aemia *A%%#. 9oth her parents are very distressed and visit you to
find out more about this condition. Dhich of the following statements about acute
lymphoblastic leu&aemia is ,F544E!6
a# ;0E of children with A%% are cured
Incorrect. The correct answer is (c).
b# An initial intense course of treatment lasting approximately @3C wee&s is
re2uired
c# ,ntrathecal therapy is re2uired only if the disease has spread to the spine
d# 4elapse rates are of the order of /<E
e# 4emission rates are of the order of J0E
,ntrathecal therapy is now given to all children with A%%. Prior to blan&et intrathecal
therapy' up to C<E of children had a relapse due to F1 disease. !he use of blan&et
F1 therapy has reduced the F1 relapse rate to less than 1<E.

: Question /@
.ary is an attendant at a local accommodation centre and has an intensely itchy rash
on her wrists and arms that has been present for the past few days *see figure#.
1he has recently bought a new watch and wonders if this is the cause of the
problem. !he .51! %,>E%? diagnosis is"
a# Papular urticaria
Incorrect. The correct answer is (e).
b# !inea
c# ontact dermatitis
d# Eczema
e# 1cabies
1cabies is a s&in infestation by the mite 1arcoptes scabei. ,t is generally spread by
s&in to s&in contact such as in crowded areas' poverty' sexual contact and casual
contact. !he mite can live for - days outside the human body' so infection by contact
with bed linen and other infected material is possible. ,ntense itch is characteristic of
the condition 3 if it is not itchy' it is not scabies. )istinct erythemato3papular itchy
nodules are due to an allergic reaction to the mite' its faeces and its larvae. <.03
1.<cm OburrowsO can often be found on the fingers and wrist. ontact dermatitis to
her watch would produce a local contact dermatitis.

Question /0
Dhich of the following statements about routine immunisation is 544E!6
a# ,f more than / months elapses between triple antigen in+ections the series
should be restarted to obtain ade2uate immunisation
b# !he first triple antigen in+ection should always be half dose *1(- cc# to reduce
allergic reactions
c# A convulsion following acellular pertussis triple antigen vaccine *)!Pa# does not
contraindicate its further use
d# !etanus booster in+ections should be repeated every / years
Incorrect. The correct answer is (c).
e# .easles vaccine should be given at C months of age to protect the child as soon
as possible
A convulsion' in the presence or absence of fever' occurring after )!Pa vaccination'
does not contraindicate completion of the course with )!Pa3containing vaccine. !he
only adverse events which contraindicate further doses of pertussis containing
vaccine are"
encephalopathy within ; days and
an immediate severe allergic reaction.
,t is now recommended that' after a full primary course of childhood vaccination' a
single booster of tetanus toxoid is administered at age 0< years only *unless re2uired
sooner for managing a tetanus3prone wound#. .easles' mumps and rubella
immunisation is recommended at 1- months of age. !riple antigen immunisation is
recommended at -' @' and C months of age with a booster at 1031; years of age
*9oostrix#. !he first dose should not be reduced.

: Question /C
!he .51! appropriate treatment for first degree atrioventricular *A7# heart bloc& is"
a# An artificial pacema&er
b# ,soprenaline hydrochloride *,suprel#
Incorrect. The correct answer is (e).
c# Atropine
d# )igoxin
e# 4e2uires no treatment
Lirst degree A7 bloc& often does not re2uire any treatment. Acute treatment of
extreme bradycardia or second degree A7 bloc& *.obitz type ,,# may re2uire
atropine or isoprenaline' but temporary pacing is the preferred treatment. Permanent
pacing is recommended for distal bloc& *.obitz type -# because of fre2uent early
progression to third3degree atrioventricular bloc&. .ost patients with third degree
*complete# A7 bloc& will re2uire permanent cardiac pacing. )rugs such as digoxin
may be the cause of an A7 bloc& and should be ceased or the dose reduced.
Question /;
.elissa' a @J year old woman' presents with loss of libido which has been worsening
over the past 1- months. 1he ta&es a combined oral contraceptive tablet' and a
selective serotonin reupta&e inhibitor *114,# for depression. 1he is a non smo&er but
drin&s 13- glasses of wine a night. Dhich of the following advice would you offer
.elissa to help her regain her libido6
a# hange to a progestagen only oral contraceptive
b# hange to an oestrogen only oral contraceptive
Incorrect. The correct answer is (d).
c# 4educe her alcohol inta&e
d# hange antidepressant medication
e# Bnderta&e cognitive behavioural therapy
7arious medications may cause loss of libido' including antidepressants li&e the
114,s. !he remedy is to change to a different class of antidepressant. Excess alcohol
consumption can have a deleterious effect on libido' however .elissa8s inta&e is
within recommended limits for adult females. hanging the oral contraceptive would
be unli&ely to help. ognitive behavioural therapy would be the next step if suitable
pharmacotherapy cannot be established.
Question /A
,n assessing a patient for adult3onset asthma' which of the following is LA%1E6
a# !here is usually a history of past or present cigarette smo&ing
b# !here is usually a long history of atopic disease
c# Attac&s can be triggered by chemical and physical agents
Incorrect. The correct answer is (b).
d# !he asthma tends to be more chronic than episodic
e# !he associated cough can be harsh' suffusing and non3productive
Adult onset asthma is non3atopic' although patients can have attac&s precipitated by
aspirin' viruses' cold air and coughing itself. A history of smo&ing is nearly
ubi2uitous' but the connection to the development of adult3onset asthma is not yet
understood. Patients tend not to have long spells of being 8puffer free8' but regular
inhaled steroids are very effective in controlling the condition. !he cough can &eep
the patient awa&e all night' along with the rest of the family.
Question /J
A C1 year old farmer with a history of hypertension presents with an amnesic
episode of sudden onset. Dhen assessed he is perplexed and bewildered' and
repeatedly as&s where he is and how he comes to be there. $e has short term
memory loss but &nows his identity and is fully conscious. $e recovers from his
memory loss after C hours. Feurological examination is normal. $is blood pressure is
1C0(JC sitting. !he .51! %,>E%? diagnosis is"
a# $ypertensive encephalopathy
b# 4ichardson31teele syndrome
c# Alzheimer8s disease
d# !ransient global amnesia
e# omplex partial seizure
Incorrect. The correct answer is (d).
!he most li&ely diagnosis is transient global amnesia. !his is a syndrome in which a
previously well person suddenly becomes confused and amnesic. !he attac&s are
usually spontaneous. !he patient appears bewildered and repeatedly as&s 2uestions
about present and recent events. 5rientation for person and sometimes place is
preserved but recent memory is impaired and the patient cannot recall new
information after a few minutes delay. Attac&s usually last -@ to @A hours. 4ecovery
is complete and recurrence occurs in about -<E of patients. !he cause is a mystery.
omplex partial seizures are brief and the individual loses conscious contact with the
environment. Post3ictal amnesia is common if the seizure becomes generalised.
4ichardson 1teele 1yndrome *or progressive supranuclear palsy# resembles
Par&inson8s disease in that there is a disturbance of balance and gait' with rigidity of
the trun& and nec& muscles. Alzheimer8s disease is a progressive form of dementia
which does not resolve. $ypertensive encephalopathy is an acute syndrome where
severe hypertension is associated with headache' vomiting' convulsions' confusion'
stupor and coma.


Question @<
Dhich of the following factors would F5! be a poor prognostic indicator for +oint
replacement in hip osteoarthritis in a C0 year old man6
a# Age
b# A 9., of //
c# Associated diabetes
Incorrect. The correct answer is (a).
d# Presence of osteoporosis
e# A previous +oint replacement
Poor prognostic indicators for +oint replacement include" age less than 0< years'
diabetes' obesity' high demand' poor bone 2uality' previous +oint surgery and poor
general health. 1ince .ichael is C0 years old his age would not be a poor prognostic
indicator.

hoose the .51! APP45P4,A!E response. =rave8s disease"
a. is a condition affecting bony growth at the metaphysis
b. is a form of hyperthyroidism which involves diffuse thyroid enlargement and
ophthalmopathy
c. is a chronic granulomatous condition of the distal ileum
d. is a form of post3partum hyperthyroidism
e. presents with enophthalmos and ptosis
!he correct answer is *b#.
Alternatively' an extrapolation or further understanding may be re2uired.
Example 2
onsidering exophthalmic =rave8s disease' which of the following is %EA1! %,>E%?6
a. it is present in 0<E of patients when first seen
b. it can develop even after successful treatment
c. it is more common in cigarette smo&ers
d. it is usually painless
e. it may precede the development of thyrotoxicosis by many years
!he correct answer is *d#.
Mastery questions
.astery 2uestions ta&e the &nowledge furtherP they assess your &nowledge in a
critical situation such as"
a Olife or deathO decision
a situation where a patient could be harmed by a wrong decision
a situation where a patient could be exposed to unnecessary anxiety' life3style
disruption' surgery or expense by a wrong decision based on inade2uate
&nowledge
a patient could cause unnecessary expense or consumption of scarce
resources because of inappropriate referral for a harmless condition.
.astery 2uestions are OflaggedO by the presence of an asteris& in front of the
2uestion number.
*Example 3
A patient arrives in the Emergency )epartment and is found to be febrile' agitated
and confused with tachycardia. $e has recently had a Obad dose of the fluOP you
notice he has exophthalmos and is 2uite thin. !he .51! APP45P4,A!E immediate
management would be"
a. ta&e blood for culture and order hest X3ray
b. 1erenace 0mg as a bolus ,7 dose
c. administration of fluids' antibiotics' propanolol and rectal carbimazole
d. obtain urine for illicit drug screening
e. aggressive treatment of malignant hyperthermia with ice and cold ,7 fluids
!he correct answer is *e#
.astery 2uestions are also used to distinguish between the most appropriate
management of what appears to be similar conditions"
*Example 4
A patient presents with a 0mm ulcerated 9asal ell arcinoma on the left chee&. !he
.51! appropriate management would be"
a. elliptical excision clear of the margin and primary closure
b. removal by curettage associated with three freeze(thaw cycles with li2uid
nitrogen
c. removal by laser
d. wide excision with patch s&in graft
e. referral to a Plastic 1urgeon for a .oh8s procedure.
,n this 2uestion' the answer is *a#' because the lesion is ulcerated and not
superficial. $owever' if the 2uestion were re3phrased"
A patient presents with a 0mm ulcerated 9asal ell arcinoma in the left naso3labial
groove. !he .51! APP45P4,A!E management would be"
!he problem is entirely different' and *e# is the only correct answer.
!his is the most straight3forward type of 2uestion' and is generally phrased to
encourage you to search for a true statement.
Questions may contain the words OtrueO' Omost appropriateO' OcorrectO' Omost
commonO' ObestO etc.
Example 5
Lrom the choices below' the 9E1! initial treatment of a burn is"
a. flushing with cold sterile saline solution
b. application of ice pac&s to the s&in
c. provide ade2uate pain relief
d. flooding with cold water
e. clean with warm' soapy water
!he correct answer is *d#. !he examiner will place three or four choices around the
correct answer 3 these are called OdistractorsO because they are there to distract your
attention away from the correct answer by sounding very plausible and sha&ing your
confidence in the answer you originally thought was correct. andidates who &now
their wor& really well can still be led to an incorrect answer by a cleverly worded
distractor.
Negative Questions
Fegative 2uestions wor& by unsettling your way of thin&ing. ,n day3to3day
conversation' we generally use positive terminology' not negative.
i.e" O)o you thin& it will be fine today6O
3 a positive 2uestion 3 compared with"
O)o you thin& it will not rain today6O
which uses a negative term for OfineO ...... Onot rainO.
,n normal use of language' we tend to use positive statements much more fre2uently
than negative' and so when it comes to answering multiple choice 2uestions' we tend
to automatically choose an answer which would be the response to a positive
2uestion' even though the 2uestion may be a negative one.
!ypical words used in a negative 2uestion are Oleast li&elyOP OseldomO" OrarelyOP Onot
oftenOP Ounli&elyOP Onot associatedO OworstO and OneverO.
1o Example 0 would be re3presented as a negative 2uestion as"
Lrom the examples below' the D541! initial treatment of a burn is"
and the same choice of five answers could be given. ,n the hurried' stressful
environment of an exam' with this 2uestion placed between totally unrelated topics'
the automatic preference for a candidate is to nominate *d# as the answer' as that is
the action we routinely carry out for burns. ,t feels almost abnormal to answer *e#'
even though that is what the 2uestion re2uired as an answer.
!he principal difference between a positive 2uestion and a negative 2uestion is that
the P51,!,7E 2uestion as&s you to identify 5FE !4BE statement out of the options
given *where the rest will be false or wrong# and a FE=A!,7E 2uestion as&s you to
identify the 5FE LA%1E or %EA1! applicable statement out of the options where the
rest are !4BE or most applicable.
,t would be well worth your while to loo& through the many examples of multiple
choice 2uestions' simply to be able to identify those that are positive and and those
that are negative' and to familiarize yourself with the varying wording which is used
for each type of 2uestion. !his way' loss of mar&s in an exam will be more li&ely to
be due to lac& of &nowledge of the topic rather than the accidental loss caused by
not understanding the 2uestion properly.
Double negative questions
)ouble negative 2uestions are very difficult' and are recognized as a Odirty tric&O
used by the examiner to confuse a candidate into a wrong answer. !hey are not a
true test of what a candidate &nows' and tend not to be used nowadays. !hey are
extremely difficult to write well' and tend to be very convoluted in their wording. ,n
general' they are typified by a negative statement in the 2uestion' and a negative
statement in one or more of the OdetractorsO.
Example 6
!he %EA1! %,>E%? cause of an itchy erythemopapular rash on the penis is
a. a condition sexually transmitted between homosexual men
b. a condition not li&ely to be highly contagious
c. a condition transmitted by casual contact
d. a condition which occurs in all age groups
e. a condition unassociated with personal hygiene
!he 2uestion is 2uite a straightforward one about scabies' but it has been made
difficult by the negative wording in the main 2uestion and a few negatives *Onot
li&elyO in ObO and OunassociatedO in OeO#.
)ouble negatives are worthwhile loo&ing for if you come across a 2uestion which
seems wordy' out of place or difficult to ma&e sense of. !hey are not li&ely to be
common' so do not waste much time on them. 4ecognizing them will enable you to
&eep a positive OrhythmO going during the exam.
"None of the above" and "All of the above" distractors
Dith Oall of the aboveO as one of the options' all you have to do is recognize if one of
the other distractors is wrong thereby eliminating both and only leaving the rest to
choose from 3 ie you may have reduced your choices from five down to three. ,f'
however' you recognize two other options as being true' then the li&elihood that Oall
of the aboveO is correct is very high.
OFone of the aboveO 2uestions are only applicable if' by reasoning' you can eliminate
all of the other detractors. ,t is a much more Oblac& or whiteO option than Oall of the
aboveO. $owever' they are more common than the positive Oall of the aboveO. ,f you
see it in a 2uestion which as&s for the Omost li&elyO or the Omost correctO 3 in other
words' if a 2uestion implies that the options vary in their degree of correctness' it is
an unli&ely choice 3 unless the 2uestion is factual and a computation yields an
answer which is not listed.
onfusing' isn8t it66
Example 7 may clear the air.
9ridie is an asthmatic child whose best predicted pea& flow is @%(sec. 1he should see
you if her pea& flow falls below
a. @.-0 %(sec
b. /.A0%(sec
c. /.0%sec
d. /./A%(sec
e. none of the above
Present recommendations are that people with asthma should see their doctors if
their pea& flow is below A<E of predicted. Dith this &nowledge' you can calculate
that 9ridie should see you if her pea& flow falls below /.-%(sec' so Onone of the
aboveO would be correct.
!here has been a rumour circulating the studying adult circuit that these types of
detractor *OallO or OnoneO# were always the correct choice when they appeared. !hat
is not true as a rule' and one still should read and interpret these 2uestions with full
attentiveness.
Clarifying the question
Questions can sometimes be 2uite wordy' ma&ing them difficult to understand. ,t is
worthwhile to Ore3writeO the 2uestion in your own mind *and maybe translate it to
your native language# in such a form as to ma&e the intent of the 2uestion clear.
1ome examples from the 9rief !est"
: J. ,n acute asthma in childhood' the %EA1! APP45P4,A!E treatment would be"
a. ,nhaled salbutamol
b. ,nhaled salmeterol
c. ,nhaled budesonide
d. ,ntravenous aminophylline
e. 1ubcutaneous adrenaline
ould be re3written as O!he wrong drug for acute asthma isO
:0. A / year old child is admitted to AQE with a history of rapid onset of sore throat'
pain on swallowing' high fever and a low pitched grunting noise while breathing. !he
child appears toxic' is sitting forward and is drooling excessively. !here is no
significant cough and only mild chest recession. !he most appropriate management
would be"
a. arefully inspect the pharynx for evidence of tonsillitis or foreign body
b. ,nsert an intravenous cannula to obtain blood samples and start ,7 fluids
c. 1end to X34ay for inspiratory and expiratory X4 to exclude an inhaled
foreign body
d. As& the anxious parents to leave the room as they may upset the child
e. =ive oxygen
ould be summarized as" Otoxic child with upper airways obstruction suggestive of
epiglottitis 3 , must...
:-<. oncerning coronary artery bypass grafting *A9=#' which of the following is
!4BE6
a. it is indicated for crescendo *pre3infarct# angina
b. it is indicated for congestive heart failure
c. it is not indicated for chronic disabling angina
d. it is associated with a 1<E operative mortality rate
e. it is only indicated if significant triple vessel disease is demonstrated on
angiography.
!he 2uestion is much clearer if expressed as 8oronary bypass grafting is...8
:-C Dhich of the following screening tools for osteoporosis is currently
recommended for all menopausal women6
a. %ateral !horacic spine X3ray
b. )ual3energy X3ray absorptiometry
c. 9one densitometry
d. 4adio nucleotide bone scan
e. Periodic health maintenance visits
!his is clearer if expressed as 8!he most cost3effective screening tool for osteoporosis
in menopausal women is.....8
@. A -C3year3old patient has had three consecutive spontaneous abortions early in
the second trimester. Dhich would be the %EA1! useful investigation6
a. $ysterosalpingogram
b. hromosomal analysis of the couple
c. Endometrial biopsy in the luteal phase
d. Post3coital test
e. !hyroid function test
ould be rewritten as O!he least useful test for a woman with recurrent -
nd
trimester
abortions is...
Altering the point of the question
As in Q@ above' you can ma&e it a positive 2uestion by as&ing for the most
appropriate test.
Answer is *a# 3 $ysterosalpingogram
?ou now have two facts about -
nd
trimester abortions 3 and it is now well worthwhile
to loo& up the boo& and find out more.
Dith conversion of a positive 2uestion to a negative 2uestion and vice versa' you can
sometimes get a new perspective and understanding of the clinical condition under
consideration 3 it doesn8t wor& all the time' and sometimes you will have to loo& up a
boo& to find the answerP within a previously negative 2uestion' you should find at
least two to four true facts about the topic you can use.
Checking out the distractor
Dhat other good can be made of them6
hec& Q-@
!he .51! 5..5F pathogen causing urinary tract infection in pregnancy is"
a. Pseudomonas aerugenosis
b. Proteus mirabilis
c. $aemophilus influenzae
d. Escherichia coli
e. >lebsiella pneumoniae
1o we select one out as the right answer' but what would the 2uestions be if each of
the other distractors were to be the correct answer6
1imilarly' you may come across a distractor you had not seen before 3 it is a great
opportunity to learn something new' and it may give you a greater insight into
something you already &now.
1ome distractors are nonsense and re2uire no further chec&ing out 3 li&e felodipine
increasing =14R
New question
A six3month old infant has eaten a diet with the following content and inta&e for the
past five months"
Protein @E of alories
Lat 0<E of calories
$5 @CE of calories
alories 1<0(&g wt(day
!he child is .51! %,>E%? suffering from"
a. ric&ets
b. merasmus
c. obesity
d. tetany
e. &washior&or
,s the answer b# or is it e#6
.erasmus is due to calorie lac& with resulting catabolism of muscle 3 hence the
cachectic child. ,n &washior&or' there are sufficient calories' but insufficient protein'
especially albumin' hence the little pot3bellied oedematous child.
9ut ....chec& out the other distractorsR $ow much do you &now about ric&ets6 $ow is
obesity defined in a child this age6 Dhat could cause a child to develop tetany6 =ood
2uestions' all worth finding solutions for.
5ne of the most useful habits you can develop to help your life3long medical career is
to become a chronic 2uestion as&erR
Checking your answer
!here are two basic types of .Q tests 3 those that give an OannotatedO answer' and
those that give a simple Oright or wrongO answer. Annotated types give you the right
answer' D$? it is right and usually' *but not always#' why the distractors are
incorrect. ?our =PEA site gives annotated answers' chec&ed against the best possible
sources.
Lor every 2uestion you do' regardless of source' you should chec& your answer to
see if you got it right for the correct reasonR ,n other words' that it simply wasn8t a
good guess. !his is the only way to ensure that you possess the &nowledge to
answer the same 2uestion again correctly. ,t also provides a further Obuilding bloc&O
to a complete understanding of a topic. ,f you did get it right for the right reason' it
re3enforces your confidence in your &nowledge of the sub+ect. A Oluc&y guessO is a
great indicator of where you are lac&ing &nowledge 3 you don8t &now enough about
the sub+ect to &now if it is either right or wrongR
Annotated answers will allow you to chec& immediately. !ry not to fall into the trap of
not chec&ing 2uestions that are not annotated 3 the effort of chec&ing your answer
out in a textboo& is well worth it. !wenty 2uestions assessed and wor&ed through
thoroughly is much more valuable than wor&ing through fifty 2uic&ly to see if you
can score twenty3five or better. )o your time trials as you get within a month of the
exam.
Enforcing and directing study by scores
?ou may be able to ObatchO some 2uestions into similar groups 3 say OcardiologyO or
OpregnancyO or OdiabetesO etc. 1ome of these 2uestions may deal with pathogenesis'
symptoms' OnormalO or therapeutics. ,f you do a group' then score yourself' it is
most important that you find out your areas of wea&ness. Lor instance' you might do
0< 2uestions on paediatrics and find that you did well in areas of childhood infections
and oncology' but poorly in normal developmental milestones and neonatology. !his
should direct you to spending some time reading the textboo& on the areas you got
wrong' and going OeasyO on the areas you got right.
,f you were to fill out a study timetable for the wee& and mar&ed it OPaediatricsO' it
would be well worthwhile putting aside two hours or so to e2uip yourself with 0<31<<
2uestions at random from various sources to give yourself a Opre3testO. At the end of
your study period for that sub+ect' repeat the test using the same 2uestions. !his will
give you a good indication of the effectiveness of your study' and indicate the areas
that need more wor&.
!he program for this course has OtopicsO set for each wee& except those wee&s
where you allowed time to address your personal study needs. !here are /<
2uestions each wee&' but not all /< 2uestions are strictly related to that topic. Lor
instance' wee& - is based around the haemopoeitic system' but 1< of the 2uestions
are on paediatric aspects. !his is designed to not only test the Oarea of interestO for
the wee&' but to help you factor in review of areas of wea&ness that may be
highlighted by the Oout of typeO 2uestions.
, hope the sections above have helped you to realize that there is much more to
multiple choice 2uestions than +ust answering them' especially if you are sitting for
an exam li&e the A.. =oing through the 2uestions using this approach is time
consuming' especially initially' but it will provide benefits. !his must be balanced with
two important factors"
you still have to do text boo& study and review
you still have to do Otime trialsO 3 use your own watch or do the Otime trialsO
in the B1.%E web site *groups 1 and -# *www.B1.%E.org#.
Before the exa
4elax *if you canR#" try breathing meditation' a solitary wal&' a non3exam chat with
friendsP pat a catP prayP singP say poetry out loud *no3one will come near you#. ,
always found a bit of under3the3breath swearing useful' but each to their own.
Avoid highly anxious people who want to chec& on the molecular weight of amyloid
and who otherwise want to damage your confidence. 1imilarly' avoid confident'
boisterous people who want to as& you ODhat is the most appropriate voltage setting
for Electroconvulsive !herapy in a @< year3old woman with a 9., of /A6O and expect
you to &now the answer. ,gnore themR ,f they are encouraged' they breedR
.entally rehearse" imagine yourself wal&ing into the exam room calmly' filling out
your name and number on the exam sheets in your best handwriting' and confidently
opening the first page when the bell rings and Ogetting on with itO.
!n the exa
over the answers with your hand or a piece of paper.
4ead the 2uestion and ma&e sure it is clear in your mind
4ead the answers deliberately but 2uic&ly
,f the answer is obvious' mar& it down on the answer sheet carefully and
move onto the next 2uestion. )o not chec& until you have completed the
whole paper.
,f you simply have no idea' ta&e a foolhardy' gallant guess' mar& it on the
answer form *you don8t have to be careful#' leave it in the past' and move on
to the next 2uestion. ?our chances of getting it right are still much better than
your winning the lottoR
,f you thin& you may &now the answer' re3read the answers. )o not re3read
the 2uestion as your reading of the answers will colour or distort your re3
reading of the 2uestion.
Adopt a 2uizzical loo&' po&e your tongue out at the right angle' select the
answer you are happy with and congratulate yourself. .ar& it carefully on the
answer sheet' move on and forget it. 4eview when you have finished all other
2uestions.
Dhile you are doing all the above' watch the timeR
After the exa
=o home' relax with the family' and put the exam behind you. ?ou can ring your
friends tomorrow and go through the exam 2uestion by 2uestion' but today' you
have been through enough torture.
All at the RACGP wish you the very best in your exas.
!"ossible questions
Every one of us has had the disheartening experience in a multiple choice exam of
coming across a 2uestion where we had simply no idea what the answer was. De
then tend to waste time trying to ma&e sense of it. ,t is a good idea to loo& on these
2uestions not as a stumbling bloc& but as a OgiftO from the examiner 3 you &now you
will not get it right' so +ump in and have a brave guess *much li&e lancing a 2uinsyR#'
and use the time more advantageously on another 2uestion.
O,t8s not English.......it8s Australian EnglishRO
!he above statement was made by an exam candidate whose English was excellent'
but who had difficulty with understanding some 2uestions in the exam. Apart from
having an O,ntroduction to Australian EnglishO course run by )ame Edna Everidge'
there appears to be no easy solution. $owever' it may be worthwhile reviewing .Qs
from different places' such as the following"
O$E>BPO programs *)45.# 3 4A=P 3 Australian
B1.%E 3 boo&s and ,nternet *www.B1.%E.org# 3 B1A
)avison8s and other texts 3 =reat 9ritain
!his may help to ac2uaint you with the varying forms of English .Qs. ,t is also
worthwhile to review these 2uestions to distinguish their varying content.
!he $E>BP 2uestions are similar in some aspects of content and style to the A.
2uestions' but are heavily clinical in nature' with few simply factual 2uestions.
B1.%E 2uestions tend to be scientific and factual' and there are obvious differences
in content. ,f you loo& critically' you will be able to discern 2uestions which are of no
use to you in your A. preparation' and will be able to leave them and concentrate
on more relevant material.
!he differences in content reflect the differing emphases placed on areas of concern
in each place. Lor instance' you will find 2uite a few 2uestions on Ocrac&O cocaine in
the B1.%E 2uestions' whereas Australian 2uestions tend to be more concerned about
the adverse health effects of alcohol abuse.