Question 47
An elderly man presents with a pigmented lesion on his face that has been present for several years but recently increased in size and became pruritic. Examination reveals asymmetry, irregular borders, and color variation.
What is the most appropriate next step?
a) Shave biopsy
b) Punch biopsy
c) Excision biopsy
d) Reassurance
e) Cryotherapy
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Question 48
A 58-year-old postmenopausal woman presents with increasing abdominal distension and vague pelvic discomfort. Pelvic ultrasound shows bilateral solid-cystic ovarian masses. She has no prior history of ovarian disease. Further evaluation raises concern for metastatic ovarian involvement rather than a primary ovarian tumor.
What is the most likely primary source of malignancy?
a) Gallbladder carcinoma
b) Colon carcinoma
c) Lung carcinoma
d) Endometrial carcinoma
e) Breast carcinoma
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Question 49
A 25-year-old woman presents with chronic unstable relationships, impulsive behavior, emotional lability, recurrent self-harm, and fear of abandonment. She reports episodes of intense anger and feelings of emptiness.
What is the most appropriate management approach?
a) Long-term benzodiazepines
b) Antipsychotic monotherapy
c) Cognitive behavioral therapy alone
d) Dialectical behavior therapy
e) Electroconvulsive therapy
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81. Aboriginal Catch-Up Vaccination
A 6-year-old Aboriginal child with incomplete immunization history presents for catch-up vaccination. What is the appropriate approach?
a. Restart entire vaccination schedule
b. Provide vaccines according to National Immunisation Program catch-up schedule
c. Delay vaccination until adolescence
d. Give only influenza vaccine
e. No vaccination needed
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82. Psoriasis Management
A 35-year-old man presents with well-demarcated erythematous plaques with silvery scale on elbows and knees. Diagnosis: mild plaque psoriasis. Best initial management?
a. Systemic methotrexate
b. Oral antibiotics
c. Topical corticosteroids
d. Biologic therapy
e. Phototherapy
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83. Atopic Dermatitis Management
A 4-year-old child presents with mild flexural eczema without infection. What is first-line management?
a. Oral steroids
b. Oral antihistamines
c. Topical antifungals
d. Emollients/moisturizers
e. Systemic antibiotics
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84. Acute Eye Pain
A 58-year-old patient presents with sudden severe eye pain, blurred vision, and halos around lights. The eye is red with mid-dilated pupil. What is the most likely diagnosis?
a. Conjunctivitis
b. Acute angle-closure glaucoma
c. Uveitis
d. Corneal abrasion
e. Migraine
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85. Penicillin Allergy – Ethical Response
A patient allergic to penicillin was prescribed cefixime and developed a reaction. In addition to changing the antibiotic, what is the most appropriate step?
a. Blame pharmacy
b. Document and apologize to patient
c. Ignore and discharge
d. Charge for new prescription
e. Report patient for noncompliance
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https://www.soma.org.uk/p/amcmcqfebruary2026

86. Migraine with Aura – Sterilization Request
A 25-year-old woman with three children and migraine with aura currently using IUCD requests permanent sterilization. Best option?
a. Low-dose combined oral contraceptive pill
b. Tubal ligation
c. She is not eligible for sterilization
d. Progestin-only pill
e. Continue IUCD only
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https://www.soma.org.uk/p/amcmcqfebruary2026

112. Antibiotic Choice for Moderate Pediatric Pneumonia
A 4-year-old child presents with fever, cough, tachypnea, and focal crackles on auscultation. Chest X-ray confirms pneumonia. The child appears moderately unwell but hemodynamically stable. What is the most appropriate antibiotic regimen?
a. Gentamicin
b. Clindamycin
c. Amoxicillin alone
d. Ceftriaxone plus azithromycin
e. Flucloxacillin
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113. Pulmonary Embolism Despite Prophylactic Enoxaparin
A 60-year-old postoperative patient receiving prophylactic-dose enoxaparin develops sudden dyspnea. CT pulmonary angiography confirms a small pulmonary embolism. What is the most appropriate next step?
a. Stop enoxaparin
b. Continue enoxaparin and add aspirin
c. Continue prophylactic enoxaparin only
d. Add intravenous unfractionated heparin to enoxaparin
e. Stop prophylactic enoxaparin and commence therapeutic anticoagulation with apixaban
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155. Interstitial Lung Disease (ILD) – Long-Term Management
A 68-year-old man with idiopathic pulmonary fibrosis presents for long-term management planning. He has exertional dyspnea and reduced diffusion capacity on pulmonary function testing. He has no active infection.
Which intervention improves long-term functional status?
a. Long-term prophylactic antibiotics
b. Pulmonary rehabilitation program
c. High-dose corticosteroids indefinitely
d. Routine bronchodilator therapy
e. Bed rest to conserve oxygen
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156. Erectile Dysfunction with Preserved Morning Erections
A 34-year-old man reports difficulty maintaining erections during sexual intercourse over the past 3 months following a recent breakup. He reports normal morning erections, normal libido, and no difficulty with ejaculation. He is experiencing work-related stress and is taking an SSRI for depression.
What is the most likely cause of his erectile dysfunction?
a. Vascular insufficiency
b. Hypogonadism
c. SSRI-induced sexual dysfunction
d. Diabetic neuropathy
e. Peyronie disease
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162. Delusional Disorder
A 45-year-old man believes his neighbor is spying on him through hidden cameras. He has maintained employment and social functioning otherwise. There are no hallucinations, disorganized speech, or negative symptoms. Symptoms have persisted for 8 months.
What is the most likely diagnosis?
a. Schizophrenia
b. Brief psychotic disorder
c. Delusional disorder
d. Bipolar disorder with psychosis
e. Schizoaffective disorder
@Amcmcq @DrShakoree #feb2026@amcmcq
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163. Lung Cancer Screening in a High-Risk Smoker
A 52-year-old man presents for a routine health check. He is asymptomatic and denies cough, hemoptysis, weight loss, or dyspnea. He has a 30-pack-year smoking history and continues to smoke. Physical examination is unremarkable. In addition to counseling on smoking cessation, he asks what else he can do to reduce his risk of dying from lung cancer.
What is the most appropriate additional advice?
a. Annual chest X-ray
b. Sputum cytology screening
c. Low-dose contrast-enhanced CT chest
d. Low-dose non-contrast CT chest annually
e. No screening recommended until symptoms develop
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https://www.soma.org.uk/p/amcmcqfebruary2026

95. A sexually active male with multiple partners has joint pain, rash on palms/soles, and urethral discharge. What test is most appropriate?
a) Anti-CCP
b) Chlamydia urine PCR
c) Gonorrhea culture
@AMCMCQ @DrShakoree

MCQ 66 – Sterilisation in a Mentally Disabled 18-year-old
@AMCMCQ
@DrShakoree
A parent requests sterilisation for her 18-year-old daughter with a
significant intellectual disability. What is the most appropriate course of
action?
a. Inform her that it is illegal to perform sterilisation at her age
b. Refer the case to the local mental health tribunal
c. Report the matter to local social services
d. Advise against the procedure without further evaluation
e. Arrange a multidisciplinary ethics review