AMC MCQ - Australian Medical Council Multiple Choice Questions Neurology and Mental Health Questions and Answers 1 — Questions and Answers
Question 1: A 68-year-old man is brought to the emergency department with a sudden onset of left-sided facial droop, arm weakness, and slurred speech. The symptoms started 90 minutes ago. He has a history of hypertension. His blood pressure is 170/95 mmHg and his blood glucose is 7.2 mmol/L. According to Australian stroke guidelines, what is the most crucial next step in management?
- Administer 300mg of aspirin immediately.
- Perform an urgent non-contrast CT scan of the brain. (Correct answer)
- Arrange for an urgent MRI of the brain with diffusion-weighted imaging.
- Commence an intravenous infusion of labetalol to lower his blood pressure.
Correct answer: Perform an urgent non-contrast CT scan of the brain.
The most critical initial step in managing a patient with suspected acute ischaemic stroke is to perform an urgent non-contrast CT scan of the brain. This is essential to exclude intracranial haemorrhage, which is a contraindication to thrombolytic therapy. Thrombolysis is a time-critical intervention, and imaging should not be delayed. While aspirin is indicated, it is only given after a haemorrhagic stroke has been excluded. An MRI provides more detail but is less readily available and takes longer, potentially delaying treatment. Blood pressure management is important but is secondary to the initial diagnostic imaging.
Question 2: A 34-year-old woman is diagnosed with her first episode of moderate Major Depressive Disorder. She has no other medical or psychiatric comorbidities and is not pregnant. According to the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines, which of the following is considered an appropriate first-line treatment option?
- Electroconvulsive therapy (ECT).
- A selective serotonin reuptake inhibitor (SSRI) such as sertraline. (Correct answer)
- A benzodiazepine such as diazepam.
- Lithium carbonate.
Correct answer: A selective serotonin reuptake inhibitor (SSRI) such as sertraline.
For moderate Major Depressive Disorder, RANZCP guidelines recommend either an evidence-based psychotherapy (like CBT or IPT) or a recognised antidepressant as first-line treatment. Selective serotonin reuptake inhibitors (SSRIs) are a common and appropriate first-line pharmacological choice due to their efficacy and tolerability profile. ECT is reserved for severe, treatment-resistant, or psychotic depression. Benzodiazepines are not a first-line treatment for depression and are used for short-term management of anxiety. Lithium is primarily a mood stabiliser used for bipolar disorder.
Question 3: A 72-year-old man presents with a 2-year history of progressive difficulty with his mobility. His wife reports he has a persistent tremor in his right hand which is most noticeable when he is watching television but improves when he reaches for his cup. On examination, you note a lack of facial expression, a slow, shuffling gait, and 'cogwheel' rigidity in his right arm. Which of the following is the most likely diagnosis?
- Essential tremor
- Drug-induced parkinsonism
- Parkinson's disease (Correct answer)
- Multiple system atrophy
Correct answer: Parkinson's disease
This patient presents with the classic triad of Parkinson's disease: a resting tremor, bradykinesia (slowness of movement, evidenced by shuffling gait and lack of facial expression), and rigidity. The asymmetric onset and the nature of the tremor (present at rest, improving with action) are highly characteristic of Parkinson's disease. Essential tremor is an action tremor. While drug-induced parkinsonism can present similarly, the progressive history without a clear offending medication makes it less likely. Multiple system atrophy often has more prominent autonomic features early on.
Question 4: According to the DSM-5 criteria, which of the following is a core diagnostic feature of Borderline Personality Disorder (BPD)?
- A grandiose sense of self-importance and a need for excessive admiration.
- A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
- A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour.
- Frantic efforts to avoid real or imagined abandonment and a pattern of unstable interpersonal relationships. (Correct answer)
Correct answer: Frantic efforts to avoid real or imagined abandonment and a pattern of unstable interpersonal relationships.
A core feature of Borderline Personality Disorder (BPD) as defined by the DSM-5 is a pervasive pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity. Specifically, this includes frantic efforts to avoid abandonment and a pattern of unstable and intense relationships that alternate between idealisation and devaluation. The other options describe features of Narcissistic Personality Disorder (A), Avoidant Personality Disorder (B), and Dependent Personality Disorder (C).
Question 5: A 29-year-old woman presents with a history of recurrent headaches. She describes them as a severe, unilateral, pulsating pain that lasts for about 8-10 hours. During the headaches, she feels nauseous and prefers to lie down in a dark, quiet room. She denies any preceding visual disturbances. Based on the International Classification of Headache Disorders (ICHD-3) criteria, what is the most likely diagnosis?
- Tension-type headache
- Cluster headache
- Migraine without aura (Correct answer)
- Migraine with typical aura
Correct answer: Migraine without aura
The patient's symptoms align perfectly with the ICHD-3 diagnostic criteria for Migraine without aura. These criteria include a duration of 4-72 hours, unilateral location, pulsating quality, moderate or severe intensity, and associated symptoms like nausea and/or photophobia/phonophobia. She specifically denies aura (like visual disturbances), making 'Migraine with aura' incorrect. Tension-type headaches are typically bilateral and non-pulsating, while cluster headaches are extremely severe, shorter in duration, and associated with autonomic symptoms.
Question 6: A patient with severe schizophrenia is being considered for involuntary treatment under an Australian Mental Health Act because they are deemed to be a serious risk to their own safety. In making this decision, which guiding principle is of primary importance?
- The patient's absolute right to refuse treatment.
- The opinion of the patient's family members.
- Ensuring treatment is provided in the least restrictive environment possible. (Correct answer)
- The availability of a private hospital room for the admission.
Correct answer: Ensuring treatment is provided in the least restrictive environment possible.
Australian Mental Health Acts are underpinned by several principles, a key one being the 'least restrictive principle'. This means that any infringement on the person's rights and liberties should be the minimum necessary to provide safe and effective treatment. While a person's wishes and family input are considered, the legal framework prioritises providing necessary care in a way that is least restrictive to the person's freedom. The availability of specific rooms is a logistical, not a legal, principle.
AMC MCQ - Australian Medical Council Multiple Choice Questions Neurology and Mental Health Questions and Answers 1
A 68-year-old man is brought to the emergency department with a sudden onset of left-sided facial droop, arm weakness, and slurred speech.
The symptoms started 90 minutes ago.
He has a history of hypertension.
His blood pressure is 170/95 mmHg and his blood glucose is 7.2 mmol/L.
According to Australian stroke guidelines, what is the most crucial next step in management?