According to the Australian Cardiovascular Disease Risk Calculator (AusCVDRisk / Heart Foundation Australia), what are the 5-year CVD risk categories and when is lipid/BP pharmacotherapy initiated?

Uses the 5-year Australian CVD risk equation (ages 45–79 without known CVD, or ≥30 for Aboriginal and Torres Strait Islander peoples, or ≥35 with diabetes): Low Risk ( 99, family history, CKD, or South Asian/Māori/Pacific Islander ethnicity are present), and High Risk (≥10%—initiate BP-lowering and lipid-modifying statin therapy alongside lifestyle changes).

In Australian Surgery/Gastroenterology, how do you distinguish Diverticulosis, Uncomplicated Acute Diverticulitis, and Complicated Diverticulitis (eTG)?

Acute Diverticulitis presents as 'left-sided appendicitis' (constant LLQ abdominal pain, fever, leukocytosis/raised CRP). Investigate with CT Abdomen/Pelvis with IV contrast (avoid colonoscopy during acute diverticulitis for 6–8 weeks due to perforation risk). Per updated Australian eTG guidelines, immunocompetent patients with mild UNCOMPLICATED acute diverticulitis (no abscess, perforation, fistula, or sepsis) can be managed conservatively WITHOUT routine antibiotics (clear fluids, analgesia, outpatient review in 48h); Complicated diverticulitis or systemic toxicity requires IV Amoxicillin-Clavulanate (or Ceftriaxone + Metronidazole), percutaneous drainage if abscess >4 cm, or Hartmann's procedure for generalized purulent/faecal peritonitis.

In Australian Rural & Remote Medicine (AMC CAT MCQ), how is STEMI managed depending on whether Primary PCI can be achieved within 90 minutes vs. >90–120 minutes?

Give immediate chewed Aspirin 300 mg + P2Y12 inhibitor (Ticagrelor 180 mg or Clopidogrel 300–600 mg) + Anticoagulation. If Primary PCI can be performed within 90 minutes of first medical contact (or within 120 minutes if transferring to a PCI centre), perform Primary PCI. In rural/remote Australia where PCI cannot be achieved within 90–120 minutes, administer immediate IV Fibrinolysis (Tenecteplase weight-based bolus) within 30 minutes (unless contraindicated), then transfer urgently to a PCI-capable centre (rescue PCI if <50% ST resolution at 60–90 min, or routine angiography at 2–24h).

What is the standard Australian '4 × 4 × 4' Asthma First Aid protocol taught by the National Asthma Council Australia?

1) Sit the person upright and stay calm; 2) Shake the blue/grey Salbutamol (100 mcg) puffer and give 4 separate puffs via a Spacer (1 puff at a time, taking 4 breaths from the spacer after each puff); 3) Wait 4 minutes—if there is little or no improvement, give another 4 puffs of salbutamol; 4) If still no improvement, call Triple Zero (000) immediately for an ambulance and continue giving 4 puffs every 4 minutes until paramedics arrive.

According to Australian ADS / ANZSSD guidelines, how is Euglycaemic Diabetic Ketoacidosis (euDKA) caused by SGLT2 inhibitors prevented peroperatively ('ALERT' / 'STOP DKA' rule)?

Cease SGLT2 inhibitors (empagliflozin, dapagliflozin, ertugliflozin) at least 3 days BEFORE elective surgery or colonoscopy (4 days if on ertugliflozin) and withhold immediately during any acute illness, dehydration, fasting, or hospital emergency admission; always check blood KETONES (not just blood glucose, as BGL may be 1.5–3.0 mmol/L with acidosis).

In Australian Hepatology, what are the common causes of Acute and Chronic Liver Disease, and how do you interpret Hepatitis B serology?

HBsAg positive = active infection (chronic if >6 months). Anti-HBs positive ONLY = immunity from vaccination. Anti-HBs positive + Anti-HBc (IgG) positive = immunity from resolved past natural infection. Anti-HBc IgM positive = acute Hepatitis B infection. HBeAg positive = high viral replication/infectivity.

According to the Australian Lung Foundation 'COPD-X Plan' (Confirm, Optimise, Prevent, Develop, eXacerbations), what is the spirometric diagnostic criterion and stepwise bronchodilator ladder for COPD?

Confirm diagnosis with post-bronchodilator FEV1/FVC ratio <0.70. Stepwise pharmacotherapy: 1) Short-acting bronchodilator (SABA or SAMA) PRN → 2) Long-acting bronchodilator monotherapy (LAMA like tiotropium/umeclidinium OR LABA) → 3) Dual bronchodilator therapy (LAMA + LABA) → 4) Triple therapy (LAMA + LABA + ICS) reserved ONLY for patients with moderate-to-severe COPD (FEV1 <50% predicted) and frequent exacerbations (≥2/year or ≥1 hospitalization) or coexisting asthma/eosinophilia.

According to the Australian RHD Guidelines (RHDAustralia), how is Acute Rheumatic Fever (ARF) diagnosed in high-risk Aboriginal and Torres Strait Islander populations, and what is the secondary prophylaxis regimen?

Diagnosed using the Revised Jones Criteria (preceding Group A Strep infection evidence PLUS 2 Major OR 1 Major + 2 Minor criteria; in High-Risk Indigenous Australians, monoarthritis, polyarthralgia, and fever ≥38°C count as sufficient criteria to prevent missed diagnoses). Major criteria ('JONES'): Joints (migratory polyarthritis/aseptic monoarthritis), ♥ Carditis (clinical or subclinical echo valvulitis), Nodules (subcutaneous), Erythema marginatum, Sydenham chorea. Secondary Prophylaxis: Intramuscular Benzathine Benzylpenicillin G (BPG) every 21 to 28 days for a minimum of 5–10 years (or until age 21–40 depending on RHD carditis severity).

In Australian Gastroenterology, how is Hereditary Haemochromatosis (HFE C282Y homozygosity) screened, diagnosed, and treated?

The most common autosomal recessive disorder in Australians of Northern European/Celtic descent (HFE gene C282Y homozygosity on chromosome 6, causing low hepcidin and excessive intestinal iron absorption → bronze skin pigmentation, diabetes, cirrhosis/HCC, cardiomyopathy, chondrocalcinosis/2nd–3rd MCP arthropathy). Screen with fasting Transferrin Saturation (>45%) and Serum Ferritin (>300 µg/L in men, >200 µg/L in women), then confirm with HFE genetic testing. Treat with regular therapeutic Venesection (phlebotomy of 450–500 mL weekly/fortnightly until ferritin is 50–100 µg/L, then maintenance every 3–4 months).

In Australian Rheumatology (Osteoporosis Australia / Healthy Bones Australia), which T-score on DXA defines Osteopenia vs. Osteoporosis, and when does PBS subsidize Denosumab or Bisphosphonates?

Bone Mineral Density (BMD) T-score (compared to young healthy adult mean): Normal ≥ -1.0; Osteopenia -1.0 to -2.5; Osteoporosis ≤ -2.5 (or presence of a minimal-trauma fragility fracture of hip/vertebra regardless of T-score). First-line therapy: Oral Bisphosphonates (Alendronate, Risedronate), annual IV Zoledronic Acid, or 6-monthly SC Denosumab (never stop Denosumab abruptly without transitioning to a bisphosphonate due to rebound multiple vertebral fractures), plus adequate Calcium (1,000–1,300 mg/day) and Vitamin D (≥50 nmol/L).

In Endocrinology, how is Phaeochromocytoma screened, localized, and medically prepared prior to surgical adrenalectomy?

Classic triad: episodic headache, sweating (diaphoresis), and tachycardia/palpitations with labile/paroxysmal hypertension. Screen with Plasma Free Metanephrines and Normetanephrines (or 24h urinary fractionated metanephrines), then localize with Adrenal CT/MRI (and 68Ga-DOTATATE PET/MIBG). Pre-operative golden rule: ALWAYS start Alpha-adrenergic blockade FIRST (Phenoxybenzamine or Doxazosin for 10–14 days with high salt/fluid intake) BEFORE starting a Beta-blocker—giving a beta-blocker first causes unopposed alpha-mediated vasoconstriction and a fatal hypertensive crisis.

According to the RACGP / ADS Australian Type 2 Diabetes Glycaemic Management Algorithm, what is the diagnostic HbA1c/glucose cut-off, target HbA1c, and second-line drug choice after Metformin?

Diagnosis: HbA1c ≥6.5% (48 mmol/mol), Fasting BGL ≥7.0 mmol/L, or 2h OGTT ≥11.1 mmol/L (confirmed on repeat test if asymptomatic). Target HbA1c for most adults is ≤7.0% (53 mmol/mol). First-line is Metformin; if the patient has Cardiovascular Disease, multiple CV risk factors, Heart Failure, or Chronic Kidney Disease, add an SGLT2 inhibitor (empagliflozin/dapagliflozin) or GLP-1 receptor agonist (semaglutide/dulaglutide) as second-line therapy.

According to Australian Therapeutic Guidelines (eTG) and Heart Foundation, what is the diagnostic threshold and first-line drug therapy for uncomplicated Hypertension in Australia?

Diagnostic threshold: Clinic BP ≥140/90 mmHg (confirmed on ABPM daytime ≥135/85 mmHg or HBPM ≥135/85 mmHg), or ≥130/80 mmHg in high-risk patients/diabetes/proteinuric CKD. Unlike UK NICE age/race splitting, in Australia ANY of the 3 first-line classes may be started as low-dose monotherapy or dual combination: 1) ACE inhibitor (e.g., perindopril, ramipril) or ARB (candesartan, irbesartan, telmisartan), 2) Dihydropyridine Calcium Channel Blocker (amlodipine, lercanidipine), or 3) Thiazide/thiazide-like diuretic (indapamide, hydrochlorothiazide). Beta-blockers are NOT first-line for uncomplicated hypertension.

According to Australian COPD-X and eTG guidelines, how is an Acute Exacerbation of COPD (AECOPD) managed?

1) Controlled oxygen therapy titrated strictly to SpO2 88–92%, 2) Inhaled bronchodilators (high-dose Salbutamol + Ipratropium via spacer or air-driven nebulizer), 3) Systemic Corticosteroids: Oral Prednisolone 30–50 mg daily for 5 days, 4) Oral Antibiotics (Amoxicillin or Doxycycline for 5 days) ONLY if clinical signs of bacterial infection are present (increased sputum purulence PLUS increased sputum volume or dyspnoea), 5) Non-Invasive Ventilation (BiPAP) if hypercapnic respiratory acidosis (pH 45 mmHg).

According to the National Asthma Council Australia (Australian Asthma Handbook), what are the two Step 1–2 tracks for adolescents and adults with Asthma?

Track 1 (Preferred anti-inflammatory reliever): Low-dose Budesonide/Formoterol dry powder inhaler taken as needed for symptom relief (Step 1–2), stepping up to maintenance-and-reliever therapy (SMART) at Step 3–4. Track 2 (Alternative): Daily low-dose regular Inhaled Corticosteroid (ICS) preventer + as-needed Short-Acting Beta-2 Agonist (Salbutamol) reliever. SABA-only treatment is restricted strictly to patients with symptoms less than twice a month and zero risk factors for flare-ups.

According to the National Heart Foundation of Australia / CSANZ Atrial Fibrillation guidelines, what is the 'CHA2DS2-VA' sexless score used in Australia?

Australia uses the sexless CHA2DS2-VA score (removing the female sex point 'Sc' from CHA2DS2-VASc): Congestive heart failure (1), Hypertension (1), Age ≥75 (2), Diabetes (1), Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65–74 (1). Score = 0: no anticoagulation. Score = 1: consider oral anticoagulation. Score ≥2: strongly recommend oral anticoagulation (DOAC—apixaban, rivaroxaban, or dabigatran preferred over warfarin unless mechanical heart valve or moderate-to-severe mitral stenosis).

In Endocrinology, what are the screening and confirmatory tests for Cushing's Syndrome vs. Primary Hyperaldosteronism (Conn's Syndrome)?

Cushing's Syndrome: Screen with any 2 of: 1) Overnight 1 mg Dexamethasone Suppression Test (8 am cortisol fails to suppress <50 nmol/L), 2) 24-hour Urinary Free Cortisol, 3) Late-night Salivary Cortisol; then measure plasma ACTH (suppressed = adrenal tumour; elevated = check high-dose dexamethasone/CRH test & pituitary MRI for Cushing's disease vs. ectopic ACTH from small-cell lung cancer). Conn's Syndrome (resistant hypertension ± hypokalaemia): Screen with morning upright Plasma Aldosterone-to-Renin Ratio (ARR—high aldosterone, suppressed renin), confirm with Saline Infusion Suppression Test, and localize with Adrenal CT + Adrenal Venous Sampling (unilateral adenoma = laparoscopic adrenalectomy; bilateral hyperplasia = spironolactone/eplerenone).

In Urology on AMC CAT MCQ, how is acute Ureteric Colic (Renal Calculi) investigated and managed?

Gold-standard investigation: Non-contrast helical CT KUB (low-dose), or renal ultrasound in pregnant women/children. First-line acute analgesia: IM/PR/oral NSAID (Indomethacin, Ketorolac, or Ibuprofen—reduces ureteric spasm and glomerular filtration pressure; avoid in AKI/peptic ulcer) ± IV opioid (morphine/fentanyl). Stones <5 mm usually pass spontaneously (medical expulsive therapy with Tamsulosin for distal ureteric stones 5–10 mm). Urgent surgical decompression (JJ ureteric stent or percutaneous nephrostomy) is MANDATORY if there is an obstructed infected kidney (fever/sepsis), solitary kidney, or worsening AKI.

According to the Australian National Bowel Cancer Screening Program (NBCSP) and Cancer Council guidelines, what is the screening schedule and age range in Australia?

Free home Immunochemical Faecal Occult Blood Test (iFOBT) mailed every 2 years to eligible Australians aged 45 to 74 years (lowered in 2024 so people aged 45–49 can opt in to receive a free kit, with automatic mail-outs from 50 to 74). Any positive iFOBT requires diagnostic colonoscopy.

According to Australian Therapeutic Guidelines (eTG: Antibiotic), how is Community-Acquired Pneumonia (CAP) severity stratified in Australia (SMART-COP / CORB), and what are the empirical antibiotic regimens?

Australia uses SMART-COP or CORB (Confusion, Oxygenation SpO2 ≤90%, RR ≥30, BP <90/60) to assess need for ICU/high-dependency support. Mild CAP (outpatient): Oral Amoxicillin 1 g TDS (add Doxycycline if atypical pathogen like Mycoplasma suspected, or Doxycycline monotherapy). Moderate CAP (inpatient non-severe): IV Benzylpenicillin + Oral Doxycycline (or IV Ceftriaxone + Azithromycin/Doxycycline). Severe CAP (ICU): IV Ceftriaxone (or Cefotaxime) + IV Azithromycin.

According to Australian Therapeutic Guidelines (eTG: Gastrointestinal), what is the first-line eradication regimen for Helicobacter pylori infection in Australia?

7-day Standard Triple Therapy ('EAC'): Esomeprazole (or other PPI) BD + Amoxicillin 1 g BD + Clarithromycin 500 mg BD for 7 days (if penicillin-allergic, substitute Metronidazole 400 mg BD for amoxicillin). Confirm eradication at least 4 weeks after completing antibiotics (and ≥2 weeks after stopping PPI) using a C-13 or C-14 Urea Breath Test (UBT) or faecal antigen test (NEVER serology, as IgG antibodies remain positive for years).

What is the most common cause of Nephrotic Syndrome in children vs. adults, and how does Minimal Change Disease respond to therapy?

Children (ages 2–8): Minimal Change Disease (>80% of paediatric cases), showing normal glomeruli on light microscopy and diffuse effacement (fusion) of podocyte foot processes on electron microscopy; responds dramatically to oral Prednisolone within 4 weeks (excellent prognosis). Adults: Membranous Nephropathy (anti-PLA2R antibodies, 'spike and dome' subepithelial deposits) and Focal Segmental Glomerulosclerosis (FSGS), with Diabetic Nephropathy being the commonest secondary cause overall.

In Australian Infectious Diseases (eTG), what is Melioidosis (Burkholderia pseudomallei), where is it endemic in Australia, who is at highest risk, and how is it treated?

Caused by the environmental saprophytic Gram-negative bacillus Burkholderia pseudomallei found in soil and surface water in Tropical Northern Australia (Top End of Northern Territory, Darwin, Far North Queensland) during the wet/monsoon season. Highest risk: Diabetes mellitus, hazardous alcohol use, chronic kidney disease, chronic lung disease, Indigenous Australians in endemic regions. Presents with severe cavitating pneumonia, septicaemia, or prostatic/splenic abscesses. Treated with intensive-phase IV Ceftazidime or IV Meropenem for ≥2 weeks, followed by 3–6 months of eradication-phase oral Trimethoprim-Sulfamethoxazole (Co-trimoxazole).

In Endocrinology on the AMC CAT MCQ, how do you investigate a Solitary Thyroid Nodule?

Step 1: Measure serum TSH + perform Thyroid Ultrasound. If TSH is suppressed (low/subnormal) → perform a Radionuclide Thyroid Scintigraphy Scan (Tc-99m or I-123): a 'Hot' (hyperfunctioning) nodule is almost always a benign toxic adenoma (no FNA needed); a 'Cold' (non-functioning) nodule or any suspicious nodule with normal/elevated TSH → proceed to Ultrasound-Guided Fine-Needle Aspiration Cytology (FNAC, graded by Bethesda classification).

In Australian Gastroenterology, compare Coeliac Disease serology screening under a gluten-containing diet vs. gluten-free diet and confirmatory biopsy.

Screen with IgA Tissue Transglutaminase (tTG-IgA) PLUS Total Serum IgA (or Deamidated Gliadin Peptide DGP-IgG if IgA-deficient) while the patient is consuming a regular gluten-containing diet (at least 4 slices of wheat bread daily for ≥6 weeks). Confirm diagnosis in adults with gastroscopy and Duodenal Biopsy showing villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis (Marsh classification). If the patient has already started a gluten-free diet and refuses a gluten challenge, perform HLA-DQ2 / HLA-DQ8 genotyping: a NEGATIVE HLA-DQ2/DQ8 test (>99% NPV) virtually excludes Coeliac disease.

How do you differentiate Primary Hyperparathyroidism, Familial Hypocalciuric Hypercalcaemia (FHH), and Malignancy-Associated Hypercalcaemia biochemically?

Primary Hyperparathyroidism (most common outpatient cause, 85% single parathyroid adenoma; 'bones, stones, abdominal groans, psychic moans'): HIGH serum Calcium, LOW phosphate, HIGH or inappropriately normal PTH, and normal/high 24h urinary calcium. FHH (inactivating CaSR mutation—benign, NO surgery): mild hypercalcaemia, mildly elevated PTH, and very LOW 24h urinary calcium excretion (Ca/Cr clearance ratio 3.0–3.5 mmol/L) with SUPPRESSED (low) intact PTH.

According to the Prostate Cancer Foundation of Australia (PCFA) and RACGP guidelines, how is Prostate Cancer screening handled in Australia?

For men at average risk who have been informed of the benefits and harms and decide to undergo regular testing, offer PSA blood testing every 2 years from age 50 to 69 (start at age 40–45 for men with a strong family history of prostate cancer). Do NOT perform routine Digital Rectal Examination (DRE) as a primary screening test in asymptomatic men in primary care. If total PSA is >3.0 ng/mL, repeat PSA in 1–3 months with a free-to-total PSA ratio before multiparametric MRI / urology referral.

In Nephrology, match the classic Glomerulonephritis syndromes tested on AMC CAT MCQ to their presentation and biopsy findings: IgA Nephropathy vs. Post-Streptococcal GN.

IgA Nephropathy (Berger's disease—most common primary glomerulonephritis worldwide): macroscopic haematuria occurring 1–3 DAYS ('synpharyngitic') after a viral URTI or GI infection in a young adult, with mesangial IgA immune complex deposits. Post-Streptococcal Glomerulonephritis (PSGN): nephritic syndrome (tea/cola-coloured haematuria, periorbital oedema, hypertension, oliguria) occurring 1–3 WEEKS after Group A Strep pharyngitis or 3–6 weeks after impetigo/skin sores (especially in remote Indigenous children), with LOW C3 complement (normalizes in 6–8 weeks), positive ASOT/anti-DNase B, and subepithelial 'humps' on EM.

In Australian Vascular Medicine, how is Peripheral Arterial Disease (PAD) vs. Chronic Venous Insufficiency evaluated using the Ankle-Brachial Index (ABI)?

ABI = Highest Ankle Systolic BP (dorsalis pedis or posterior tibial) / Highest Brachial Systolic BP. Normal: 0.90–1.30 (>1.30 indicates non-compressible calcified vessels in diabetes/CKD). Intermittent Claudication: ABI 0.50–0.89 (manage with supervised exercise therapy, smoking cessation, high-intensity statin, and clopidogrel or aspirin). Critical Limb Ischaemia (rest pain in foot relieved by hanging leg over bed, punched-out painful arterial ulcers on toes/lateral malleolus): ABI <0.40 (urgent vascular surgery revascularization). Venous ulcers occur on the medial gaiter area with haemosiderin staining/lipodermatosclerosis—treat with graduated compression bandaging ONLY after confirming ABI ≥0.80.

According to the Australian National Cervical Screening Program (NCSP) and BreastScreen Australia, what are the current national screening schedules?

Cervical Screening (NCSP): 5-yearly Cervical Screening Test (primary HPV DNA test with partial genotyping for HPV 16/18 and reflex LBC, available via clinician-collected or self-collected vaginal swab) for women and people with a cervix aged 25 to 74 years. BreastScreen Australia: Free screening mammogram every 2 years for women aged 50 to 74 years (women aged 40–49 and 75+ are also eligible to attend free of charge on request).

According to Kidney Health Australia (KHA-CARI) guidelines, what constitutes a 'Kidney Health Check' and who should be screened every 1–2 years?

A Kidney Health Check consists of 3 tests: 1) Blood Pressure, 2) eGFR (serum creatinine), and 3) Urine Albumin-to-Creatinine Ratio (uACR, preferably on a first-morning void). Screen annually in patients with Diabetes, Hypertension, or Aboriginal and Torres Strait Islander peoples aged ≥18 years (and every 1–2 years in smokers, obesity, established CVD, or family history of kidney failure).

In Australian Haematology/Cardiology, how do you manage a patient on Warfarin or a DOAC (Apixaban, Rivaroxaban, Dabigatran) requiring Minor Dental Extraction vs. Major Elective Surgery?

Minor dental extraction (1–3 teeth), cataract surgery, or minor skin excision: DO NOT cease Warfarin (ensure INR <3.5) or DOACs; use local haemostatic measures (suturing, tranexamic acid 4.8% mouthwash QDS for 2–5 days). Major surgery: Cease Warfarin 5 days pre-op (bridge with therapeutic Enoxaparin ONLY if very high thrombotic risk such as mechanical mitral valve or recent VTE <3 months); cease Apixaban/Rivaroxaban 48 hours pre-op (72h for high-bleed surgery); cease Dabigatran 48–96 hours pre-op depending on eGFR/CrCl.

AMC CAT MCQ Clinical Medicine I (Australian Therapeutic Guidelines eTG): Cardiology, Respiratory, Gastroenterology, Endocrinology & Renal

High-yield Australian Medical Council (AMC CAT MCQ) clinical vignettes anchored to Australian Therapeutic Guidelines (eTG), Heart Foundation Australia, National Asthma Council Australia, COPD-X, and RACGP Red Book.

Level: advanced
Languages: en → en
Cards: 32
Markdown: AMC CAT MCQ Clinical Medicine I (Australian Therapeutic Guidelines eTG): Cardiology, Respiratory, Gastroenterology, Endocrinology & Renal (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	According to the Australian Cardiovascular Disease Risk Calculator (AusCVDRisk / Heart Foundation Australia), what are the 5-year CVD risk categories and when is lipid/BP pharmacotherapy initiated?	Uses the 5-year Australian CVD risk equation (ages 45–79 without known CVD, or ≥30 for Aboriginal and Torres Strait Islander peoples, or ≥35 with diabetes): Low Risk (<5%), Intermediate Risk (5% to <10%—consider pharmacotherapy if reclassification factors like CAC score >99, family history, CKD, or South Asian/Māori/Pacific Islander ethnicity are present), and High Risk (≥10%—initiate BP-lowering and lipid-modifying statin therapy alongside lifestyle changes).
2	In Australian Surgery/Gastroenterology, how do you distinguish Diverticulosis, Uncomplicated Acute Diverticulitis, and Complicated Diverticulitis (eTG)?	Acute Diverticulitis presents as 'left-sided appendicitis' (constant LLQ abdominal pain, fever, leukocytosis/raised CRP). Investigate with CT Abdomen/Pelvis with IV contrast (avoid colonoscopy during acute diverticulitis for 6–8 weeks due to perforation risk). Per updated Australian eTG guidelines, immunocompetent patients with mild UNCOMPLICATED acute diverticulitis (no abscess, perforation, fistula, or sepsis) can be managed conservatively WITHOUT routine antibiotics (clear fluids, analgesia, outpatient review in 48h); Complicated diverticulitis or systemic toxicity requires IV Amoxicillin-Clavulanate (or Ceftriaxone + Metronidazole), percutaneous drainage if abscess >4 cm, or Hartmann's procedure for generalized purulent/faecal peritonitis.
3	In Australian Rural & Remote Medicine (AMC CAT MCQ), how is STEMI managed depending on whether Primary PCI can be achieved within 90 minutes vs. >90–120 minutes?	Give immediate chewed Aspirin 300 mg + P2Y12 inhibitor (Ticagrelor 180 mg or Clopidogrel 300–600 mg) + Anticoagulation. If Primary PCI can be performed within 90 minutes of first medical contact (or within 120 minutes if transferring to a PCI centre), perform Primary PCI. In rural/remote Australia where PCI cannot be achieved within 90–120 minutes, administer immediate IV Fibrinolysis (Tenecteplase weight-based bolus) within 30 minutes (unless contraindicated), then transfer urgently to a PCI-capable centre (rescue PCI if <50% ST resolution at 60–90 min, or routine angiography at 2–24h).
4	What is the standard Australian '4 × 4 × 4' Asthma First Aid protocol taught by the National Asthma Council Australia?	1) Sit the person upright and stay calm; 2) Shake the blue/grey Salbutamol (100 mcg) puffer and give 4 separate puffs via a Spacer (1 puff at a time, taking 4 breaths from the spacer after each puff); 3) Wait 4 minutes—if there is little or no improvement, give another 4 puffs of salbutamol; 4) If still no improvement, call Triple Zero (000) immediately for an ambulance and continue giving 4 puffs every 4 minutes until paramedics arrive.
5	According to Australian ADS / ANZSSD guidelines, how is Euglycaemic Diabetic Ketoacidosis (euDKA) caused by SGLT2 inhibitors prevented peroperatively ('ALERT' / 'STOP DKA' rule)?	Cease SGLT2 inhibitors (empagliflozin, dapagliflozin, ertugliflozin) at least 3 days BEFORE elective surgery or colonoscopy (4 days if on ertugliflozin) and withhold immediately during any acute illness, dehydration, fasting, or hospital emergency admission; always check blood KETONES (not just blood glucose, as BGL may be <11 mmol/L in euDKA—ketones >1.5–3.0 mmol/L with acidosis).
6	In Australian Hepatology, what are the common causes of Acute and Chronic Liver Disease, and how do you interpret Hepatitis B serology?	HBsAg positive = active infection (chronic if >6 months). Anti-HBs positive ONLY = immunity from vaccination. Anti-HBs positive + Anti-HBc (IgG) positive = immunity from resolved past natural infection. Anti-HBc IgM positive = acute Hepatitis B infection. HBeAg positive = high viral replication/infectivity.
7	According to the Australian Lung Foundation 'COPD-X Plan' (Confirm, Optimise, Prevent, Develop, eXacerbations), what is the spirometric diagnostic criterion and stepwise bronchodilator ladder for COPD?	Confirm diagnosis with post-bronchodilator FEV1/FVC ratio <0.70. Stepwise pharmacotherapy: 1) Short-acting bronchodilator (SABA or SAMA) PRN → 2) Long-acting bronchodilator monotherapy (LAMA like tiotropium/umeclidinium OR LABA) → 3) Dual bronchodilator therapy (LAMA + LABA) → 4) Triple therapy (LAMA + LABA + ICS) reserved ONLY for patients with moderate-to-severe COPD (FEV1 <50% predicted) and frequent exacerbations (≥2/year or ≥1 hospitalization) or coexisting asthma/eosinophilia.
8	According to the Australian RHD Guidelines (RHDAustralia), how is Acute Rheumatic Fever (ARF) diagnosed in high-risk Aboriginal and Torres Strait Islander populations, and what is the secondary prophylaxis regimen?	Diagnosed using the Revised Jones Criteria (preceding Group A Strep infection evidence PLUS 2 Major OR 1 Major + 2 Minor criteria; in High-Risk Indigenous Australians, monoarthritis, polyarthralgia, and fever ≥38°C count as sufficient criteria to prevent missed diagnoses). Major criteria ('JONES'): Joints (migratory polyarthritis/aseptic monoarthritis), ♥ Carditis (clinical or subclinical echo valvulitis), Nodules (subcutaneous), Erythema marginatum, Sydenham chorea. Secondary Prophylaxis: Intramuscular Benzathine Benzylpenicillin G (BPG) every 21 to 28 days for a minimum of 5–10 years (or until age 21–40 depending on RHD carditis severity).
9	In Australian Gastroenterology, how is Hereditary Haemochromatosis (HFE C282Y homozygosity) screened, diagnosed, and treated?	The most common autosomal recessive disorder in Australians of Northern European/Celtic descent (HFE gene C282Y homozygosity on chromosome 6, causing low hepcidin and excessive intestinal iron absorption → bronze skin pigmentation, diabetes, cirrhosis/HCC, cardiomyopathy, chondrocalcinosis/2nd–3rd MCP arthropathy). Screen with fasting Transferrin Saturation (>45%) and Serum Ferritin (>300 µg/L in men, >200 µg/L in women), then confirm with HFE genetic testing. Treat with regular therapeutic Venesection (phlebotomy of 450–500 mL weekly/fortnightly until ferritin is 50–100 µg/L, then maintenance every 3–4 months).
10	In Australian Rheumatology (Osteoporosis Australia / Healthy Bones Australia), which T-score on DXA defines Osteopenia vs. Osteoporosis, and when does PBS subsidize Denosumab or Bisphosphonates?	Bone Mineral Density (BMD) T-score (compared to young healthy adult mean): Normal ≥ -1.0; Osteopenia -1.0 to -2.5; Osteoporosis ≤ -2.5 (or presence of a minimal-trauma fragility fracture of hip/vertebra regardless of T-score). First-line therapy: Oral Bisphosphonates (Alendronate, Risedronate), annual IV Zoledronic Acid, or 6-monthly SC Denosumab (never stop Denosumab abruptly without transitioning to a bisphosphonate due to rebound multiple vertebral fractures), plus adequate Calcium (1,000–1,300 mg/day) and Vitamin D (≥50 nmol/L).
11	In Endocrinology, how is Phaeochromocytoma screened, localized, and medically prepared prior to surgical adrenalectomy?	Classic triad: episodic headache, sweating (diaphoresis), and tachycardia/palpitations with labile/paroxysmal hypertension. Screen with Plasma Free Metanephrines and Normetanephrines (or 24h urinary fractionated metanephrines), then localize with Adrenal CT/MRI (and 68Ga-DOTATATE PET/MIBG). Pre-operative golden rule: ALWAYS start Alpha-adrenergic blockade FIRST (Phenoxybenzamine or Doxazosin for 10–14 days with high salt/fluid intake) BEFORE starting a Beta-blocker—giving a beta-blocker first causes unopposed alpha-mediated vasoconstriction and a fatal hypertensive crisis.
12	According to the RACGP / ADS Australian Type 2 Diabetes Glycaemic Management Algorithm, what is the diagnostic HbA1c/glucose cut-off, target HbA1c, and second-line drug choice after Metformin?	Diagnosis: HbA1c ≥6.5% (48 mmol/mol), Fasting BGL ≥7.0 mmol/L, or 2h OGTT ≥11.1 mmol/L (confirmed on repeat test if asymptomatic). Target HbA1c for most adults is ≤7.0% (53 mmol/mol). First-line is Metformin; if the patient has Cardiovascular Disease, multiple CV risk factors, Heart Failure, or Chronic Kidney Disease, add an SGLT2 inhibitor (empagliflozin/dapagliflozin) or GLP-1 receptor agonist (semaglutide/dulaglutide) as second-line therapy.
13	According to Australian Therapeutic Guidelines (eTG) and Heart Foundation, what is the diagnostic threshold and first-line drug therapy for uncomplicated Hypertension in Australia?	Diagnostic threshold: Clinic BP ≥140/90 mmHg (confirmed on ABPM daytime ≥135/85 mmHg or HBPM ≥135/85 mmHg), or ≥130/80 mmHg in high-risk patients/diabetes/proteinuric CKD. Unlike UK NICE age/race splitting, in Australia ANY of the 3 first-line classes may be started as low-dose monotherapy or dual combination: 1) ACE inhibitor (e.g., perindopril, ramipril) or ARB (candesartan, irbesartan, telmisartan), 2) Dihydropyridine Calcium Channel Blocker (amlodipine, lercanidipine), or 3) Thiazide/thiazide-like diuretic (indapamide, hydrochlorothiazide). Beta-blockers are NOT first-line for uncomplicated hypertension.
14	According to Australian COPD-X and eTG guidelines, how is an Acute Exacerbation of COPD (AECOPD) managed?	1) Controlled oxygen therapy titrated strictly to SpO2 88–92%, 2) Inhaled bronchodilators (high-dose Salbutamol + Ipratropium via spacer or air-driven nebulizer), 3) Systemic Corticosteroids: Oral Prednisolone 30–50 mg daily for 5 days, 4) Oral Antibiotics (Amoxicillin or Doxycycline for 5 days) ONLY if clinical signs of bacterial infection are present (increased sputum purulence PLUS increased sputum volume or dyspnoea), 5) Non-Invasive Ventilation (BiPAP) if hypercapnic respiratory acidosis (pH <7.35, PaCO2 >45 mmHg).
15	According to the National Asthma Council Australia (Australian Asthma Handbook), what are the two Step 1–2 tracks for adolescents and adults with Asthma?	Track 1 (Preferred anti-inflammatory reliever): Low-dose Budesonide/Formoterol dry powder inhaler taken as needed for symptom relief (Step 1–2), stepping up to maintenance-and-reliever therapy (SMART) at Step 3–4. Track 2 (Alternative): Daily low-dose regular Inhaled Corticosteroid (ICS) preventer + as-needed Short-Acting Beta-2 Agonist (Salbutamol) reliever. SABA-only treatment is restricted strictly to patients with symptoms less than twice a month and zero risk factors for flare-ups.
16	According to the National Heart Foundation of Australia / CSANZ Atrial Fibrillation guidelines, what is the 'CHA2DS2-VA' sexless score used in Australia?	Australia uses the sexless CHA2DS2-VA score (removing the female sex point 'Sc' from CHA2DS2-VASc): Congestive heart failure (1), Hypertension (1), Age ≥75 (2), Diabetes (1), Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65–74 (1). Score = 0: no anticoagulation. Score = 1: consider oral anticoagulation. Score ≥2: strongly recommend oral anticoagulation (DOAC—apixaban, rivaroxaban, or dabigatran preferred over warfarin unless mechanical heart valve or moderate-to-severe mitral stenosis).
17	In Endocrinology, what are the screening and confirmatory tests for Cushing's Syndrome vs. Primary Hyperaldosteronism (Conn's Syndrome)?	Cushing's Syndrome: Screen with any 2 of: 1) Overnight 1 mg Dexamethasone Suppression Test (8 am cortisol fails to suppress <50 nmol/L), 2) 24-hour Urinary Free Cortisol, 3) Late-night Salivary Cortisol; then measure plasma ACTH (suppressed = adrenal tumour; elevated = check high-dose dexamethasone/CRH test & pituitary MRI for Cushing's disease vs. ectopic ACTH from small-cell lung cancer). Conn's Syndrome (resistant hypertension ± hypokalaemia): Screen with morning upright Plasma Aldosterone-to-Renin Ratio (ARR—high aldosterone, suppressed renin), confirm with Saline Infusion Suppression Test, and localize with Adrenal CT + Adrenal Venous Sampling (unilateral adenoma = laparoscopic adrenalectomy; bilateral hyperplasia = spironolactone/eplerenone).
18	In Urology on AMC CAT MCQ, how is acute Ureteric Colic (Renal Calculi) investigated and managed?	Gold-standard investigation: Non-contrast helical CT KUB (low-dose), or renal ultrasound in pregnant women/children. First-line acute analgesia: IM/PR/oral NSAID (Indomethacin, Ketorolac, or Ibuprofen—reduces ureteric spasm and glomerular filtration pressure; avoid in AKI/peptic ulcer) ± IV opioid (morphine/fentanyl). Stones <5 mm usually pass spontaneously (medical expulsive therapy with Tamsulosin for distal ureteric stones 5–10 mm). Urgent surgical decompression (JJ ureteric stent or percutaneous nephrostomy) is MANDATORY if there is an obstructed infected kidney (fever/sepsis), solitary kidney, or worsening AKI.
19	According to the Australian National Bowel Cancer Screening Program (NBCSP) and Cancer Council guidelines, what is the screening schedule and age range in Australia?	Free home Immunochemical Faecal Occult Blood Test (iFOBT) mailed every 2 years to eligible Australians aged 45 to 74 years (lowered in 2024 so people aged 45–49 can opt in to receive a free kit, with automatic mail-outs from 50 to 74). Any positive iFOBT requires diagnostic colonoscopy.
20	According to Australian Therapeutic Guidelines (eTG: Antibiotic), how is Community-Acquired Pneumonia (CAP) severity stratified in Australia (SMART-COP / CORB), and what are the empirical antibiotic regimens?	Australia uses SMART-COP or CORB (Confusion, Oxygenation SpO2 ≤90%, RR ≥30, BP <90/60) to assess need for ICU/high-dependency support. Mild CAP (outpatient): Oral Amoxicillin 1 g TDS (add Doxycycline if atypical pathogen like Mycoplasma suspected, or Doxycycline monotherapy). Moderate CAP (inpatient non-severe): IV Benzylpenicillin + Oral Doxycycline (or IV Ceftriaxone + Azithromycin/Doxycycline). Severe CAP (ICU): IV Ceftriaxone (or Cefotaxime) + IV Azithromycin.
21	According to Australian Therapeutic Guidelines (eTG: Gastrointestinal), what is the first-line eradication regimen for Helicobacter pylori infection in Australia?	7-day Standard Triple Therapy ('EAC'): Esomeprazole (or other PPI) BD + Amoxicillin 1 g BD + Clarithromycin 500 mg BD for 7 days (if penicillin-allergic, substitute Metronidazole 400 mg BD for amoxicillin). Confirm eradication at least 4 weeks after completing antibiotics (and ≥2 weeks after stopping PPI) using a C-13 or C-14 Urea Breath Test (UBT) or faecal antigen test (NEVER serology, as IgG antibodies remain positive for years).
22	What is the most common cause of Nephrotic Syndrome in children vs. adults, and how does Minimal Change Disease respond to therapy?	Children (ages 2–8): Minimal Change Disease (>80% of paediatric cases), showing normal glomeruli on light microscopy and diffuse effacement (fusion) of podocyte foot processes on electron microscopy; responds dramatically to oral Prednisolone within 4 weeks (excellent prognosis). Adults: Membranous Nephropathy (anti-PLA2R antibodies, 'spike and dome' subepithelial deposits) and Focal Segmental Glomerulosclerosis (FSGS), with Diabetic Nephropathy being the commonest secondary cause overall.
23	In Australian Infectious Diseases (eTG), what is Melioidosis (Burkholderia pseudomallei), where is it endemic in Australia, who is at highest risk, and how is it treated?	Caused by the environmental saprophytic Gram-negative bacillus Burkholderia pseudomallei found in soil and surface water in Tropical Northern Australia (Top End of Northern Territory, Darwin, Far North Queensland) during the wet/monsoon season. Highest risk: Diabetes mellitus, hazardous alcohol use, chronic kidney disease, chronic lung disease, Indigenous Australians in endemic regions. Presents with severe cavitating pneumonia, septicaemia, or prostatic/splenic abscesses. Treated with intensive-phase IV Ceftazidime or IV Meropenem for ≥2 weeks, followed by 3–6 months of eradication-phase oral Trimethoprim-Sulfamethoxazole (Co-trimoxazole).
24	In Endocrinology on the AMC CAT MCQ, how do you investigate a Solitary Thyroid Nodule?	Step 1: Measure serum TSH + perform Thyroid Ultrasound. If TSH is suppressed (low/subnormal) → perform a Radionuclide Thyroid Scintigraphy Scan (Tc-99m or I-123): a 'Hot' (hyperfunctioning) nodule is almost always a benign toxic adenoma (no FNA needed); a 'Cold' (non-functioning) nodule or any suspicious nodule with normal/elevated TSH → proceed to Ultrasound-Guided Fine-Needle Aspiration Cytology (FNAC, graded by Bethesda classification).
25	In Australian Gastroenterology, compare Coeliac Disease serology screening under a gluten-containing diet vs. gluten-free diet and confirmatory biopsy.	Screen with IgA Tissue Transglutaminase (tTG-IgA) PLUS Total Serum IgA (or Deamidated Gliadin Peptide DGP-IgG if IgA-deficient) while the patient is consuming a regular gluten-containing diet (at least 4 slices of wheat bread daily for ≥6 weeks). Confirm diagnosis in adults with gastroscopy and Duodenal Biopsy showing villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis (Marsh classification). If the patient has already started a gluten-free diet and refuses a gluten challenge, perform HLA-DQ2 / HLA-DQ8 genotyping: a NEGATIVE HLA-DQ2/DQ8 test (>99% NPV) virtually excludes Coeliac disease.
26	How do you differentiate Primary Hyperparathyroidism, Familial Hypocalciuric Hypercalcaemia (FHH), and Malignancy-Associated Hypercalcaemia biochemically?	Primary Hyperparathyroidism (most common outpatient cause, 85% single parathyroid adenoma; 'bones, stones, abdominal groans, psychic moans'): HIGH serum Calcium, LOW phosphate, HIGH or inappropriately normal PTH, and normal/high 24h urinary calcium. FHH (inactivating CaSR mutation—benign, NO surgery): mild hypercalcaemia, mildly elevated PTH, and very LOW 24h urinary calcium excretion (Ca/Cr clearance ratio <0.01). Malignancy (most common inpatient cause—PTHrP from squamous cell lung cancer or osteolytic bone metastases): very HIGH Calcium (>3.0–3.5 mmol/L) with SUPPRESSED (low) intact PTH.
27	According to the Prostate Cancer Foundation of Australia (PCFA) and RACGP guidelines, how is Prostate Cancer screening handled in Australia?	For men at average risk who have been informed of the benefits and harms and decide to undergo regular testing, offer PSA blood testing every 2 years from age 50 to 69 (start at age 40–45 for men with a strong family history of prostate cancer). Do NOT perform routine Digital Rectal Examination (DRE) as a primary screening test in asymptomatic men in primary care. If total PSA is >3.0 ng/mL, repeat PSA in 1–3 months with a free-to-total PSA ratio before multiparametric MRI / urology referral.
28	In Nephrology, match the classic Glomerulonephritis syndromes tested on AMC CAT MCQ to their presentation and biopsy findings: IgA Nephropathy vs. Post-Streptococcal GN.	IgA Nephropathy (Berger's disease—most common primary glomerulonephritis worldwide): macroscopic haematuria occurring 1–3 DAYS ('synpharyngitic') after a viral URTI or GI infection in a young adult, with mesangial IgA immune complex deposits. Post-Streptococcal Glomerulonephritis (PSGN): nephritic syndrome (tea/cola-coloured haematuria, periorbital oedema, hypertension, oliguria) occurring 1–3 WEEKS after Group A Strep pharyngitis or 3–6 weeks after impetigo/skin sores (especially in remote Indigenous children), with LOW C3 complement (normalizes in 6–8 weeks), positive ASOT/anti-DNase B, and subepithelial 'humps' on EM.
29	In Australian Vascular Medicine, how is Peripheral Arterial Disease (PAD) vs. Chronic Venous Insufficiency evaluated using the Ankle-Brachial Index (ABI)?	ABI = Highest Ankle Systolic BP (dorsalis pedis or posterior tibial) / Highest Brachial Systolic BP. Normal: 0.90–1.30 (>1.30 indicates non-compressible calcified vessels in diabetes/CKD). Intermittent Claudication: ABI 0.50–0.89 (manage with supervised exercise therapy, smoking cessation, high-intensity statin, and clopidogrel or aspirin). Critical Limb Ischaemia (rest pain in foot relieved by hanging leg over bed, punched-out painful arterial ulcers on toes/lateral malleolus): ABI <0.40 (urgent vascular surgery revascularization). Venous ulcers occur on the medial gaiter area with haemosiderin staining/lipodermatosclerosis—treat with graduated compression bandaging ONLY after confirming ABI ≥0.80.
30	According to the Australian National Cervical Screening Program (NCSP) and BreastScreen Australia, what are the current national screening schedules?	Cervical Screening (NCSP): 5-yearly Cervical Screening Test (primary HPV DNA test with partial genotyping for HPV 16/18 and reflex LBC, available via clinician-collected or self-collected vaginal swab) for women and people with a cervix aged 25 to 74 years. BreastScreen Australia: Free screening mammogram every 2 years for women aged 50 to 74 years (women aged 40–49 and 75+ are also eligible to attend free of charge on request).
31	According to Kidney Health Australia (KHA-CARI) guidelines, what constitutes a 'Kidney Health Check' and who should be screened every 1–2 years?	A Kidney Health Check consists of 3 tests: 1) Blood Pressure, 2) eGFR (serum creatinine), and 3) Urine Albumin-to-Creatinine Ratio (uACR, preferably on a first-morning void). Screen annually in patients with Diabetes, Hypertension, or Aboriginal and Torres Strait Islander peoples aged ≥18 years (and every 1–2 years in smokers, obesity, established CVD, or family history of kidney failure).
32	In Australian Haematology/Cardiology, how do you manage a patient on Warfarin or a DOAC (Apixaban, Rivaroxaban, Dabigatran) requiring Minor Dental Extraction vs. Major Elective Surgery?	Minor dental extraction (1–3 teeth), cataract surgery, or minor skin excision: DO NOT cease Warfarin (ensure INR <3.5) or DOACs; use local haemostatic measures (suturing, tranexamic acid 4.8% mouthwash QDS for 2–5 days). Major surgery: Cease Warfarin 5 days pre-op (bridge with therapeutic Enoxaparin ONLY if very high thrombotic risk such as mechanical mitral valve or recent VTE <3 months); cease Apixaban/Rivaroxaban 48 hours pre-op (72h for high-bleed surgery); cease Dabigatran 48–96 hours pre-op depending on eGFR/CrCl.