Sample KFP questions (Complex)

Question 1 of 15

1. Question

6 point(s)

A 19-year-old university student with a known three-year history of Type 1 Diabetes Mellitus is brought to the Bendigo Base Hospital Emergency Department on Wednesday, August 13th, 2025, by his flatmates. He has had a gastrointestinal virus for the past two days with some vomiting. He reports that because he wasn’t eating, he significantly reduced his insulin doses, taking only a small amount of his long-acting insulin and none of his short-acting insulin. Over the past 12 hours, he has become progressively drowsy, developed generalised abdominal pain, and is now breathing in a rapid, deep, sighing pattern (Kussmaul breathing). His breath has a distinct, sweet, “fruity” odour. On arrival, his blood glucose level is 28 mmol/L, and a venous blood gas shows a pH of 7.15 and a bicarbonate of 10 mmol/L. This is a classic presentation of a life-threatening medical emergency: Diabetic Ketoacidosis (DKA).

Which of the following statements accurately describe the pathophysiology and critical management of DKA?

Select 5 correct answers.

The underlying cause of DKA is a state of absolute or near-absolute insulin deficiency, which leads to both hyperglycaemia and uncontrolled ketone production.

Correct Incorrect Correct answer

The first and most important step in management is to give a large bolus of intravenous insulin.

Correct Incorrect Correct answer

The diagnostic biochemical triad of DKA is hyperglycaemia (BGL >11 mmol/L), ketonaemia (or significant ketonuria), and a metabolic acidosis (bicarbonate <18 mmol/L or pH <7.3).

Correct Incorrect Correct answer

The patient’s Kussmaul breathing is a respiratory compensation for his severe metabolic acidosis, as his body tries to “blow off” carbon dioxide to raise the blood pH.

Correct Incorrect Correct answer

The cornerstone of initial management is aggressive intravenous fluid resuscitation to correct the profound dehydration and to help lower the blood glucose.

Correct Incorrect Correct answer

The patient’s total body potassium is expected to be very high, and he will not require any potassium replacement.

Correct Incorrect Correct answer

The patient must be managed in a high-dependency or intensive care setting with a fixed-rate intravenous insulin infusion.

Correct Incorrect Correct answer

The fruity odour on his breath is due to the presence of acetone, a type of ketone body.

Correct Incorrect Correct answer

The patient should be kept nil by mouth, and dextrose should be strictly avoided in his intravenous fluids.

Correct Incorrect Correct answer

A key part of the management is to immediately cease all of his usual subcutaneous insulin.

Correct Incorrect Correct answer

The most important precipitating factor for DKA is a concurrent illness or infection, combined with the incorrect omission of insulin doses.

Correct Incorrect Correct answer

This condition is the most common acute complication of Type 2 diabetes.

Correct Incorrect Correct answer

A CT scan of the brain is the mandatory first-line investigation.

Correct Incorrect Correct answer

The patient’s abdominal pain is a sign of a co-existing surgical emergency like appendicitis.

Correct Incorrect Correct answer

It is crucial to closely monitor and replace potassium during treatment, as the insulin infusion will drive potassium into the cells, causing a rapid and potentially fatal drop in the serum potassium level.

Correct Incorrect Correct answer

Question 2 of 15

2. Question

5 point(s)

A 28-year-old woman presents to your GP clinic in Bendigo on Wednesday, August 13th, 2025. Her primary complaint is a one-year history of her menstrual periods becoming very infrequent and then stopping completely (secondary amenorrhoea). She and her partner have been trying to conceive without success. On further questioning, she also reports a persistent, milky white discharge from both of her breasts (galactorrhoea), which she can express on pressure. She is not pregnant, and she is not taking any medications. On examination, she has some bitemporal pallor of her optic discs, but a formal visual field test is normal. A blood test confirms her serum prolactin level is significantly elevated at 4,000 mU/L (normal <500 mU/L). This clinical picture is classic for a pathological hyperprolactinemia, most likely caused by a prolactin-secreting pituitary adenoma (prolactinoma).

Which of the following statements accurately describe the pathophysiology and initial workup of this condition?

Select 5 correct answers.

The patient’s amenorrhoea and infertility are a direct result of the high prolactin level suppressing the pulsatile release of GnRH from the hypothalamus, leading to a state of hypogonadotropic hypogonadism (low LH, low FSH, and low oestrogen).

Correct Incorrect Correct answer

The first-line treatment is to refer her for an urgent surgical removal of her pituitary gland.

Correct Incorrect Correct answer

The patient’s galactorrhoea is caused by the direct stimulatory effect of the high prolactin level on the epithelial cells of the breast’s lactiferous ducts.

Correct Incorrect Correct answer

The definitive diagnostic investigation to identify a suspected prolactinoma is a contrast-enhanced MRI of the pituitary gland.

Correct Incorrect Correct answer

The pathophysiology of prolactin secretion is unique among pituitary hormones in that it is under tonic inhibitory control from the hypothalamus via the neurotransmitter dopamine.

Correct Incorrect Correct answer

The best way to manage her galactorrhoea is with a course of oral antibiotics.

Correct Incorrect Correct answer

A crucial first step in the investigation of any woman with a high prolactin level is to rule out pregnancy and breastfeeding, which are the most common physiological causes.

Correct Incorrect Correct answer

You should reassure her that her symptoms are a normal part of early menopause.

Correct Incorrect Correct answer

The patient requires a course of radiotherapy to the brain as the first-line treatment.

Correct Incorrect Correct answer

The first-line medical management is a course of oral corticosteroids.

Correct Incorrect Correct answer

A prolactin level of 4,000 mU/L is only mildly elevated and is of no clinical concern.

Correct Incorrect Correct answer

The patient’s symptoms are a classic presentation of polycystic ovary syndrome (PCOS).

Correct Incorrect Correct answer

A CT scan of the brain is more sensitive than an MRI for visualising a pituitary adenoma.

Correct Incorrect Correct answer

You should advise the patient that her condition is untreatable and she will be permanently infertile.

Correct Incorrect Correct answer

All prolactinomas are malignant and require urgent chemotherapy.

Correct Incorrect Correct answer

Question 3 of 15

3. Question

5 point(s)

A 75-year-old man from a property near Junortoun is brought to the Bendigo Base Hospital Emergency Department on Thursday, August 14th, 2025. He has a history of type 2 diabetes, chronic kidney disease (with a baseline eGFR of 35 mL/min), and heart failure. His regular medications include perindopril (an ACE inhibitor) and spironolactone. He has had a gastrointestinal virus for the past three days with poor oral intake and is now feeling extremely weak, with some tingling in his lips. On arrival, he is bradycardic with a heart rate of 45 bpm. An urgent ECG is performed, which shows a loss of P waves, a broadened QRS complex, and tall, peaked T waves. This is a life-threatening medical emergency. A blood gas analysis confirms a serum potassium of 7.8 mmol/L.

What are the critical and immediate steps in the management of this severe, life-threatening hyperkalemia?

Select 5 correct answers.

The first step is to administer a large intravenous fluid bolus of Hartmann’s solution.

Correct Incorrect Correct answer

The patient’s ECG changes are benign and are not a cause for concern.

Correct Incorrect Correct answer

The first and most important, life-saving intervention is the immediate administration of intravenous calcium (either gluconate or chloride) to stabilise the cardiac membrane.

Correct Incorrect Correct answer

The patient’s underlying chronic kidney disease and his use of both an ACE inhibitor and spironolactone are the major contributing factors to his severe hyperkalemia.

Correct Incorrect Correct answer

You should immediately arrange for a repeat blood test from the laboratory to confirm the result before starting any treatment.

Correct Incorrect Correct answer

The purpose of the intravenous calcium is to rapidly lower the serum potassium level.

Correct Incorrect Correct answer

The next step in management is to rapidly shift potassium from the extracellular to the intracellular space. This is most effectively achieved with an infusion of intravenous insulin and dextrose.

Correct Incorrect Correct answer

A key part of the management is to immediately withhold any further doses of his ACE inhibitor and spironolactone.

Correct Incorrect Correct answer

The patient requires an urgent referral to a cardiologist for a permanent pacemaker.

Correct Incorrect Correct answer

The best way to manage this is with a course of oral potassium-binding resins alone.

Correct Incorrect Correct answer

A CT scan of his kidneys is the mandatory next investigation.

Correct Incorrect Correct answer

The definitive management to remove potassium from the body, especially in a patient with severe kidney disease, is urgent haemodialysis.

Correct Incorrect Correct answer

Another agent that can be used to temporarily shift potassium into the cells is a nebulised beta-2 agonist, such as salbutamol.

Correct Incorrect Correct answer

The patient should be given a large dose of an oral potassium supplement to correct his electrolyte balance.

Correct Incorrect Correct answer

All patients with chronic kidney disease will have a potassium level this high.

Correct Incorrect Correct answer

Question 4 of 15

4. Question

6 point(s)

A 70-year-old retired man is brought to your GP clinic in Wodonga, Victoria, on Thursday, August 14, 2025, by his daughter, who is concerned about his health. Over the past six months, he has become progressively more fatigued, constipated, and has been complaining of a persistent, unquenchable thirst (polydipsia) and urinating frequently (polyuria). He also mentions a vague, depressive mood and difficulty concentrating, which he attributes to “old age.” He has no known history of cancer and takes no regular medications. On review of his blood tests, you note a repeatedly elevated corrected serum calcium of 3.1 mmol/L (Reference Range: 2.15-2.55 mmol/L). You now need to establish the underlying cause of his hypercalcemia.

What are the key principles and initial steps in differentiating the cause of his hypercalcemia?

Select 6 correct answers.

The patient’s symptoms of “bones, stones, abdominal groans, and psychic moans” are highly suggestive of hypercalcemia.

Correct Incorrect Correct answer

A low-calcium diet should be implemented immediately as the first-line treatment.

Correct Incorrect Correct answer

The first, most crucial, and differentiating blood test to order is a Parathyroid Hormone (PTH) level.

Correct Incorrect Correct answer

A high or inappropriately normal PTH level in the context of hypercalcemia is diagnostic of primary hyperparathyroidism (PHPT), which is the most common cause in an outpatient setting.

Correct Incorrect Correct answer

An urgent whole-body PET scan is the best initial investigation to look for an underlying cause.

Correct Incorrect Correct answer

A suppressed or low PTH level (<2 pmol/L) effectively rules out PHPT and indicates a non-parathyroid mediated cause of the hypercalcemia.

Correct Incorrect Correct answer

If PTH is suppressed, hypercalcemia of malignancy becomes the most likely diagnosis, even in the absence of a known cancer.

Correct Incorrect Correct answer

This presentation is classic for Vitamin D intoxication.

Correct Incorrect Correct answer

Further investigations for a suspected non-parathyroid cause should include a serum protein electrophoresis (for myeloma), PTH-related peptide (PTHrP), and 25-hydroxyvitamin D levels.

Correct Incorrect Correct answer

The primary treatment for all causes of hypercalcemia is a long-term course of oral bisphosphonates.

Correct Incorrect Correct answer

A radionuclide bone scan is the most important initial test.

Correct Incorrect Correct answer

A referral for urgent parathyroidectomy should be made before any further blood tests.

Correct Incorrect Correct answer

The patient’s symptoms are non-specific and most likely related to age-related depression.

Correct Incorrect Correct answer

The hypercalcemia is benign and doesn’t require further investigation if the patient feels relatively well.

Correct Incorrect Correct answer

The most likely cause is Milk-Alkali syndrome.

Correct Incorrect Correct answer

Question 5 of 15

5. Question

6 point(s)

A 55-year-old male real estate agent from Junortoun, Victoria, presents to your clinic on Wednesday, August 13, 2025. He has come for a “full check-up,” stating he feels “old before his time.” Over the past two years, he has experienced a gradual decline in energy, persistent fatigue, low mood, and poor concentration. He also admits to a significant reduction in his libido and states his erections are not as firm as they used to be. He has a history of type 2 diabetes managed with metformin and is overweight. He recently read an article about “andropause” and is convinced he has “low T,” asking if you can prescribe testosterone to “get his mojo back.” On examination, his BMI is 33 kg/m², and his waist circumference is 112 cm. His testes are of normal volume (approximately 20 mL bilaterally) and consistency. The rest of his examination is unremarkable.

What are the most appropriate principles for the investigation and management of this man’s symptoms and suspected hypogonadism?

Select 6 correct answers.

The patient’s non-specific symptoms are classic for late-onset hypogonadism, and a trial of testosterone replacement therapy (TRT) should be started immediately.

Correct Incorrect Correct answer

A single, random testosterone level taken in the afternoon is sufficient to make a diagnosis.

Correct Incorrect Correct answer

His symptoms are most likely due to depression, and a trial of an SSRI antidepressant is the most appropriate first step.

Correct Incorrect Correct answer

Herbal testosterone boosters available online are a safe and evidence-based alternative to prescription testosterone.

Correct Incorrect Correct answer

Testosterone therapy has been proven to reverse atherosclerosis and is recommended for primary prevention of cardiovascular disease in men like him.

Correct Incorrect Correct answer

The biochemical diagnosis of hypogonadism requires at least two separate, fasting, early morning (8-10 am) measurements of total testosterone that are unequivocally below the laboratory reference range.

Correct Incorrect Correct answer

In a man with obesity and diabetes, it is important to also measure Sex Hormone Binding Globulin (SHBG) to calculate the free or bioavailable testosterone, as total testosterone can be misleadingly low.

Correct Incorrect Correct answer

A crucial first-line management strategy is intensive lifestyle modification, including a structured diet and exercise plan aimed at weight loss, which can significantly improve endogenous testosterone levels.

Correct Incorrect Correct answer

Before considering TRT, a baseline assessment must include a digital rectal examination (DRE) and a Prostate-Specific Antigen (PSA) test to screen for prostate cancer, as testosterone can stimulate its growth.

Correct Incorrect Correct answer

A baseline haematocrit or full blood count is mandatory before starting TRT, as a major side effect is erythrocytosis (an abnormally high red blood cell count), which increases the risk of thrombosis.

Correct Incorrect Correct answer

The patient must be counselled that potential risks of TRT include exacerbation of sleep apnoea, fluid retention, and that it will cause testicular atrophy and render him infertile while on treatment.

Correct Incorrect Correct answer

Once TRT is started, no further blood test monitoring is required.

Correct Incorrect Correct answer

Testosterone therapy is guaranteed to resolve his erectile dysfunction completely.

Correct Incorrect Correct answer

Intramuscular testosterone injections are the only effective form of TRT available in Australia.

Correct Incorrect Correct answer

His type 2 diabetes is unrelated to his potential low testosterone levels.

Correct Incorrect Correct answer

Question 6 of 15

6. Question

5 point(s)

A 34-year-old woman, who is 26 weeks pregnant with her first child, is referred to the obstetric medicine clinic at Bendigo Hospital for new-onset, severe hypertension. Her booking blood pressure at 10 weeks was normal at 115/70 mmHg, but it is now 175/110 mmHg. She has also developed peripheral oedema. Her urine protein-to-creatinine ratio is normal, making pre-eclampsia less likely. Blood tests reveal a significant hypokalemia of 2.9 mmol/L. This combination of severe hypertension and hypokalemia in pregnancy is unusual and raises suspicion for primary aldosteronism. However, investigating and managing this condition during pregnancy presents unique challenges and requires specific considerations for the safety of both mother and fetus.

What are the essential principles for the investigation and management of suspected primary aldosteronism in this pregnant patient?

Select 5 correct answers.

The best diagnostic test is an Aldosterone-to-Renin Ratio (ARR), which is interpreted the same way as in a non-pregnant patient.

Correct Incorrect Correct answer

A CT scan of the adrenals with contrast is the safest and most effective imaging modality to use.

Correct Incorrect Correct answer

The patient should be immediately started on spironolactone, as it is the first-line treatment for primary aldosteronism.

Correct Incorrect Correct answer

The definitive treatment is immediate laparoscopic adrenalectomy to cure the condition during the pregnancy.

Correct Incorrect Correct answer

The development of hypertension and oedema is a normal part of pregnancy and should just be monitored.

Correct Incorrect Correct answer

Diagnosing primary aldosteronism in pregnancy is challenging because the RAAS is physiologically stimulated, and progesterone acts as a natural MRA, making the interpretation of aldosterone and renin levels difficult.

Correct Incorrect Correct answer

While difficult to interpret, a completely suppressed renin level in the face of hypertension would still be highly suggestive of primary aldosteronism.

Correct Incorrect Correct answer

If imaging is required to look for an adrenal adenoma, MRI without gadolinium contrast is the preferred and safest modality during pregnancy.

Correct Incorrect Correct answer

The mineralocorticoid receptor antagonist spironolactone is contraindicated in pregnancy due to its anti-androgenic properties, which pose a risk of feminising a male fetus.

Correct Incorrect Correct answer

Management during pregnancy focuses on safely controlling blood pressure with pregnancy-safe agents (e.g., labetalol, nifedipine) and carefully managing hypokalemia with oral potassium supplements, with a plan for definitive workup and treatment post-partum.

Correct Incorrect Correct answer

The most likely cause of her symptoms is pre-eclampsia.

Correct Incorrect Correct answer

She should be started on an ACE inhibitor like enalapril to control her blood pressure.

Correct Incorrect Correct answer

Adrenal Vein Sampling (AVS) is a safe and routine procedure to perform during pregnancy.

Correct Incorrect Correct answer

The condition is benign and poses no significant risk to the mother or the fetus.

Correct Incorrect Correct answer

The hypokalemia is due to morning sickness and poor dietary intake.

Correct Incorrect Correct answer

Question 7 of 15

7. Question

5 point(s)

A 75-year-old woman is brought to the Bendigo Hospital Emergency Department from her nursing home on Wednesday, August 13, 2025. She is profoundly lethargic, confused, and has been vomiting for the past 24 hours. The nursing staff report she has also been complaining of severe abdominal pain. On examination, she has a GCS of 12, is tachycardic at 120 bpm, and hypotensive with a blood pressure of 85/50 mmHg. She is clinically dehydrated with a prolonged capillary refill time. An ECG shows a shortened QT interval. Her initial blood tests are returned urgently and show a corrected serum calcium of 4.1 mmol/L (Ref: 2.15-2.55 mmol/L), an acute kidney injury, and a subsequent PTH level that is extremely high.

What is the diagnosis, and what are the immediate, life-saving management priorities?

Select 5 correct answers.

The patient’s presentation is most consistent with septic shock.

Correct Incorrect Correct answer

This is a hypercalcemic crisis, a life-threatening medical emergency characterized by severe hypercalcemia causing acute multi-organ dysfunction.

Correct Incorrect Correct answer

The first and most important step in management is to administer a subcutaneous injection of teriparatide.

Correct Incorrect Correct answer

The immediate and most crucial therapy is aggressive intravenous fluid resuscitation with 0.9% sodium chloride (normal saline) to correct dehydration and promote calciuresis.

Correct Incorrect Correct answer

A low-calcium diet should be started immediately.

Correct Incorrect Correct answer

After initial fluid resuscitation, the administration of calcitonin is beneficial as it has a rapid onset of action in lowering serum calcium, although its effect is short-lived.

Correct Incorrect Correct answer

The single most important investigation is a chest X-ray to look for malignancy.

Correct Incorrect Correct answer

A potent intravenous bisphosphonate, such as zoledronic acid, should be administered to provide a more sustained reduction in serum calcium by inhibiting osteoclast-mediated bone resorption.

Correct Incorrect Correct answer

Urgent haemodialysis using a low-calcium dialysate is the definitive first-line treatment.

Correct Incorrect Correct answer

Once the patient is medically stabilized, the definitive treatment is an urgent parathyroidectomy to remove the underlying source of the excessive PTH.

Correct Incorrect Correct answer

The ECG finding of a shortened QT interval is a characteristic feature of severe hypercalcemia.

Correct Incorrect Correct answer

The patient should be given a large dose of Vitamin D to help drive calcium back into the bones.

Correct Incorrect Correct answer

An urgent sestamibi scan should be performed in the emergency department.

Correct Incorrect Correct answer

The abdominal pain is likely due to acute pancreatitis, which is a known complication of severe hypercalcemia.

Correct Incorrect Correct answer

The administration of loop diuretics like furosemide should be the first-line therapy to increase calcium excretion.

Correct Incorrect Correct answer

Question 8 of 15

8. Question

5 point(s)

A 75-year-old retired schoolteacher is brought to your GP clinic in Bendigo on Wednesday, August 13th, 2025, by her concerned daughter. The daughter reports a slow but definite decline in her mother’s memory over the past two years. Initially, it was minor forgetfulness, but it has progressed to her frequently repeating the same questions, misplacing important items like her wallet and keys, and recently getting lost while driving home from the local supermarket, a route she has taken for 40 years. While she remains socially pleasant, her daughter has noticed she is struggling with complex tasks like managing her finances and organising her medication. The patient herself has limited insight into her deficits. This insidious onset and gradual progression of a primary short-term memory deficit is the classic presentation of Alzheimer’s disease.

According to Australian guidelines, what are the most crucial steps in the initial diagnostic workup for this patient?

Select 5 correct answers.

The first and most important step is to obtain a collateral history from a reliable informant, such as her daughter, as the patient may lack insight into the extent of her cognitive decline.

Correct Incorrect Correct answer

The definitive diagnostic test is a blood test for a specific “Alzheimer’s gene.”

Correct Incorrect Correct answer

A key part of the in-clinic assessment is the use of a validated cognitive screening tool, such as the Montreal Cognitive Assessment (MoCA) or the Standardised Mini-Mental State Examination (SMMSE).

Correct Incorrect Correct answer

The patient’s presentation is a normal part of the aging process and requires no investigation.

Correct Incorrect Correct answer

It is essential to perform a panel of screening blood tests to identify and exclude any reversible or contributing causes of cognitive decline, such as thyroid dysfunction (TSH), vitamin B12 and folate deficiencies, and electrolyte imbalances.

Correct Incorrect Correct answer

The first-line management is to start the patient on a high dose of a benzodiazepine to manage her anxiety.

Correct Incorrect Correct answer

A structural brain imaging scan (either a non-contrast CT or an MRI) is a recommended part of the standard dementia workup to exclude other pathologies like a tumour, stroke, or normal pressure hydrocephalus.

Correct Incorrect Correct answer

You should immediately refer the patient to a gynaecologist to discuss starting Menopausal Hormone Therapy.

Correct Incorrect Correct answer

The most important step is to arrange an electroencephalogram (EEG).

Correct Incorrect Correct answer

The patient must have a lumbar puncture to analyse her cerebrospinal fluid before a diagnosis can be made.

Correct Incorrect Correct answer

A key part of the history is to ask about her functional status, including her ability to perform both instrumental activities of daily living (IADLs) like managing finances and medications, and basic ADLs.

Correct Incorrect Correct answer

The best course of action is to tell the daughter to stop worrying and that her mother is fine.

Correct Incorrect Correct answer

A diagnosis of depression should be considered as a key differential.

Correct Incorrect Correct answer

The patient should be referred directly to a nursing home.

Correct Incorrect Correct answer

You should advise the patient and her family that there are no treatments or supports available for dementia.

Correct Incorrect Correct answer

Question 9 of 15

9. Question

5 point(s)

A 68-year-old retired farmer from a property near Junortoun is brought to your GP clinic on Wednesday, August 13th, 2025, by his wife. She is the main historian, as the patient is a man of few words. Her primary concern is a change she has noticed over the past year. She reports that his right arm has become stiff and does not swing when he walks. He has also developed a subtle tremor in his right hand, which is most obvious when he is resting in his armchair but disappears when he reaches for his cup of tea. He reports feeling generally “slower,” and his wife notes his facial expression has become less animated. His handwriting has become very small and cramped. This insidious, asymmetrical onset of motor symptoms is a classic presentation highly suggestive of idiopathic Parkinson’s Disease (PD).

Which of the following statements, clinical features, and management principles are most accurate for this condition?

Select 5 correct answers.

The diagnosis of Parkinson’s Disease is a clinical one, based on the presence of a specific combination of motor signs, and there are no diagnostic blood tests or standard brain scans.

Correct Incorrect Correct answer

The most important first step is to start the patient on a high dose of an antipsychotic medication.

Correct Incorrect Correct answer

The patient’s presentation with a unilateral, asymmetrical onset and a classic rest tremor are key features that strongly support a diagnosis of idiopathic Parkinson’s Disease over other forms of parkinsonism.

Correct Incorrect Correct answer

The single most important motor sign required for the diagnosis of parkinsonism is bradykinesia, which is a slowness of movement and a reduction in the amplitude of repetitive actions.

Correct Incorrect Correct answer

The definitive management for this condition requires a referral to a neurosurgeon for deep brain stimulation.

Correct Incorrect Correct answer

A key part of the management is an early referral to a neurologist to confirm the diagnosis, provide education, and to initiate and manage the specialised medication.

Correct Incorrect Correct answer

The first-line and most effective pharmacological treatment for the motor symptoms of Parkinson’s Disease is levodopa.

Correct Incorrect Correct answer

The patient should be reassured that this is a benign condition that will not progress.

Correct Incorrect Correct answer

A CT scan of the brain is the gold standard for confirming the diagnosis.

Correct Incorrect Correct answer

The patient’s small handwriting is an unrelated finding.

Correct Incorrect Correct answer

The pathophysiology of Parkinson’s Disease involves the loss of dopamine-producing neurons in a part of the brainstem called the substantia nigra.

Correct Incorrect Correct answer

This is a rare neurological condition.

Correct Incorrect Correct answer

A trial of an acetylcholinesterase inhibitor is the recommended first-line treatment.

Correct Incorrect Correct answer

The patient should be advised to reduce his physical activity to conserve his energy.

Correct Incorrect Correct answer

All patients with a tremor have Parkinson’s Disease.

Correct Incorrect Correct answer

Question 10 of 15

10. Question

5 point(s)

A 65-year-old woman presents to your GP clinic in Junortoun on Wednesday, August 13th, 2025, with a six-month history of a debilitating facial pain. She describes the pain as a sudden, severe, and paroxysmal “electric shock” that shoots across the right side of her face, primarily affecting her cheek, upper lip, and gums. Each jolt of pain lasts for only a few seconds, but they occur in rapid, excruciating volleys. She has identified several innocuous triggers for these attacks, including lightly touching her face while washing, brushing her teeth, and even a cool breeze. Between these attacks, she is completely pain-free. She has started to avoid eating and brushing her teeth for fear of triggering the pain. Her neurological examination is entirely normal. This highly characteristic history is pathognomonic for classic trigeminal neuralgia.

Which of the following statements accurately describe the pathophysiology, diagnosis, and first-line management of this condition?

Select 5 correct answers.

The diagnosis of classic trigeminal neuralgia is a clinical one, based on the highly characteristic history of paroxysmal, stereotyped, electric-shock-like pain in a specific nerve distribution.

Correct Incorrect Correct answer

The first-line and most effective medical treatment is a high dose of a non-steroidal anti-inflammatory drug (NSAID).

Correct Incorrect Correct answer

The most common underlying cause of classic trigeminal neuralgia is neurovascular compression, where a pulsating blood vessel (most commonly the superior cerebellar artery) is compressing the trigeminal nerve root at its entry zone into the brainstem.

Correct Incorrect Correct answer

The pain is distributed along one or more branches of the trigeminal nerve (Cranial Nerve V). Pain in the cheek and upper lip, as in this patient, corresponds to the V2 (maxillary) and V3 (mandibular) divisions.

Correct Incorrect Correct answer

The presence of innocuous (non-painful) triggers that provoke the severe pain is a key and pathognomonic feature of the condition.

Correct Incorrect Correct answer

The best course of action is to refer her to a dentist for an urgent extraction of her upper teeth.

Correct Incorrect Correct answer

The first-line, evidence-based pharmacological treatment for trigeminal neuralgia is the anticonvulsant medication carbamazepine, started at a low dose and titrated upwards.

Correct Incorrect Correct answer

This is a classic presentation of a tension-type headache.

Correct Incorrect Correct answer

The patient requires an urgent MRI of her brain before any treatment can be started.

Correct Incorrect Correct answer

You should reassure her that this is a benign condition that will resolve on its own without treatment.

Correct Incorrect Correct answer

A key part of the management is a referral to a pain specialist for a course of opioid analgesia.

Correct Incorrect Correct answer

The pain is a psychosomatic manifestation of an underlying anxiety disorder.

Correct Incorrect Correct answer

A course of a potent oral corticosteroid is the most effective way to manage the pain.

Correct Incorrect Correct answer

The patient should be advised to avoid all triggers by not touching or washing her face.

Correct Incorrect Correct answer

All patients with facial pain have trigeminal neuralgia.

Correct Incorrect Correct answer

Question 11 of 15

11. Question

5 point(s)

A 55-year-old retired farmer presents to your GP clinic in a town near Junortoun on Tuesday, August 12th, 2025. He complains of a “growth” that he first noticed on the inner corner of his right eye about a year ago. Over the last few months, it has become frequently red and irritated, especially when he is outdoors on windy or sunny days. He describes a persistent gritty, foreign body sensation, as if there is sand in his eye. On examination, you observe a triangular, fleshy, wing-shaped growth of fibrovascular tissue arising from the nasal conjunctiva of his right eye. It has grown approximately 2mm onto the edge of the clear part of his eye (the cornea) and has a rich network of fine blood vessels. This is a classic presentation of a pterygium. Your initial management will focus on explaining the nature of the condition and providing conservative treatment for his symptoms.

Which of the following statements accurately describe the pathophysiology, risk factors, and conservative management of a pterygium?

Select 5 correct answers.

The patient should be counselled that the single most important environmental risk factor for the development of a pterygium is chronic exposure to ultraviolet (UV) radiation from the sun.

Correct Incorrect Correct answer

The first-line treatment is to refer him for immediate surgical excision.

Correct Incorrect Correct answer

A pterygium is defined as a benign, degenerative condition of the conjunctiva that leads to an invasion of fibrovascular tissue onto the surface of the cornea.

Correct Incorrect Correct answer

This condition is a highly malignant form of eye cancer.

Correct Incorrect Correct answer

The gritty, foreign body sensation is primarily caused by a disturbance of the tear film, leading to localised dry eye symptoms over the elevated surface of the pterygium.

Correct Incorrect Correct answer

The most appropriate first-line treatment for his symptoms of irritation and redness is the regular use of lubricating eye drops (artificial tears).

Correct Incorrect Correct answer

You should advise him that the most effective way to prevent the pterygium from growing further and to prevent one from forming on his other eye is to wear UV-protective sunglasses consistently when outdoors.

Correct Incorrect Correct answer

This condition is caused by a chronic bacterial infection and requires a long course of oral antibiotics.

Correct Incorrect Correct answer

The patient should be advised to wear an eye patch at all times to protect the growth.

Correct Incorrect Correct answer

The growth is arising from the retina at the back of the eye.

Correct Incorrect Correct answer

A CT scan of the orbits is the mandatory first step in the diagnostic workup.

Correct Incorrect Correct answer

The pterygium is highly contagious and can be spread to his other eye or to family members.

Correct Incorrect Correct answer

He should be advised to try an “herbal eye wash” to dissolve the growth.

Correct Incorrect Correct answer

The growth will resolve on its own without any intervention.

Correct Incorrect Correct answer

This is a rare condition in Australia.

Correct Incorrect Correct answer

Question 12 of 15

12. Question

5 point(s)

A 55-year-old man with a 15-year history of type 2 diabetes attends his routine review at your GP clinic in a town near Junortoun on August 12th, 2025. He is largely asymptomatic but admits his blood sugar control has been poor, with his most recent HbA1c at 9.0%. His vision feels “fine” to him. You receive a letter from his optometrist following his annual diabetic eye screen. The report notes a visual acuity of 6/6 in both eyes, but the dilated fundus examination shows multiple microaneurysms, dot-and-blot haemorrhages, and several clusters of hard exudates in the macular region of both eyes, though the very centre of the macula appears spared. The optometrist has graded this as moderate non-proliferative diabetic retinopathy (NPDR) without clinical macular oedema.

Which of the following statements and management principles are most crucial for this patient?

Select 5 correct answers.

The patient should be reassured that since his vision is 6/6, the findings in his retina are of no clinical concern.

Correct Incorrect Correct answer

Non-proliferative diabetic retinopathy is characterised by microvascular damage that causes the retinal capillaries to become weak and leaky, but without the growth of new blood vessels.

Correct Incorrect Correct answer

The hard exudates seen on his examination are precipitates of lipids and proteins that have leaked from damaged retinal capillaries, indicating a breakdown of the blood-retina barrier.

Correct Incorrect Correct answer

The first-line and most effective treatment for his retinopathy is a course of intravitreal anti-VEGF injections.

Correct Incorrect Correct answer

The cornerstone of management for NPDR is intensive optimisation of his systemic risk factors, including his glycaemic control (targeting a lower HbA1c), blood pressure, and lipid levels.

Correct Incorrect Correct answer

The patient can now be safely discharged from regular eye screening and only needs to return if he notices a change in his vision.

Correct Incorrect Correct answer

The development of retinopathy highlights the importance of annual screening, as significant, potentially sight-threatening damage can occur long before the patient becomes symptomatic.

Correct Incorrect Correct answer

The microaneurysms are a sign of an impending retinal detachment.

Correct Incorrect Correct answer

The patient’s condition is an acute inflammatory process that will resolve with a course of oral steroids.

Correct Incorrect Correct answer

The presence of hard exudates near the macula indicates that he is at high risk of developing diabetic macular oedema, the most common cause of vision loss in diabetes.

Correct Incorrect Correct answer

This is a rare complication of diabetes.

Correct Incorrect Correct answer

The best way to manage his condition is with a course of pan-retinal photocoagulation laser therapy.

Correct Incorrect Correct answer

A blood test for CA-125 is required to stage his retinopathy.

Correct Incorrect Correct answer

The patient should be advised that the only way to save his sight is to immediately stop all his diabetes medications.

Correct Incorrect Correct answer

You should advise him that the findings are irreversible and that intensive glucose control will have no effect on the progression of his eye disease.

Correct Incorrect Correct answer

Question 13 of 15

13. Question

5 point(s)

A 65-year-old woman presents to an urgent care centre in Bendigo on Tuesday, August 12th, 2025. She has a three-day history of a painful, red, and swollen lump at the inner corner of her left eye, located just next to the side of her nose. She reports that her left eye has been constantly watering (epiphora) for the past year, but this acute, painful swelling is new. On examination, she is afebrile. There is a tense, erythematous, and exquisitely tender swelling over the area of the lacrimal sac. When you apply gentle pressure to the swelling, you see a stream of thick, purulent material refluxing from the lower lacrimal punctum. Her eye movements and vision are normal. This is a classic presentation of acute dacryocystitis.

Which of the following statements accurately describe the pathophysiology, microbiology, and initial management of this condition?

Select 5 correct answers.

The underlying cause is an obstruction of the nasolacrimal duct, which leads to stasis of tears in the lacrimal sac, creating a perfect environment for bacterial overgrowth.

Correct Incorrect Correct answer

The first-line treatment is to immediately incise and drain the abscess in the clinic.

Correct Incorrect Correct answer

The clinical triad of pain, redness, and swelling located medially to the inner canthus is the hallmark of acute dacryocystitis.

Correct Incorrect Correct answer

The reflux of purulent material from the punctum upon palpation of the sac is a pathognomonic sign that confirms the diagnosis.

Correct Incorrect Correct answer

This is a viral infection, and the patient should be started on oral valaciclovir.

Correct Incorrect Correct answer

The initial management for a patient who is systemically well is a course of oral broad-spectrum antibiotics that cover common respiratory and skin flora, such as cephalexin or co-amoxiclav.

Correct Incorrect Correct answer

The patient should be advised that this is a rare form of skin cancer.

Correct Incorrect Correct answer

The most common causative organisms are gram-positive bacteria, particularly Staphylococcus aureus and Streptococcus pneumoniae.

Correct Incorrect Correct answer

This condition is a classic presentation of Herpes Zoster Ophthalmicus.

Correct Incorrect Correct answer

The patient must be admitted to the hospital for a course of intravenous antibiotics.

Correct Incorrect Correct answer

A CT scan of the orbits is the mandatory first-line investigation.

Correct Incorrect Correct answer

The patient should be advised to forcefully massage the area every hour to express all the pus.

Correct Incorrect Correct answer

A key part of conservative management is the application of frequent warm compresses to the area to promote comfort and potential drainage.

Correct Incorrect Correct answer

The patient’s epiphora (watery eye) is an unrelated symptom.

Correct Incorrect Correct answer

This condition is caused by a blocked meibomian gland in the eyelid.

Correct Incorrect Correct answer

Question 14 of 15

14. Question

5 point(s)

A 45-year-old woman is brought to the Bendigo Base Hospital Emergency Department on Tuesday, August 12th, 2025. One hour ago, while bushwalking on a trail near Junortoun, she felt a sudden, sharp prick on her left ankle, but she did not see a snake. Her hiking partner immediately implemented first aid, applying a firm crepe bandage from her toes all the way up to her groin and splinting the leg to keep it still. In the ED, the patient is anxious but alert. She complains of a mild headache and some nausea. Her vital signs are stable. On examination, the leg is well-bandaged, and there are no obvious bite marks visible. Your role is to perform the initial assessment, order the correct investigations, and understand the principles of the first aid that has been applied.

According to Australian snake bite management guidelines, which of the following principles and actions are most critical in this initial phase?

Select 5 correct answers.

The first aid that was applied is the Pressure Immobilisation Technique (PIT). Its primary purpose is to compress the lymphatic vessels and prevent the venom from travelling from the bite site into the systemic circulation.

Correct Incorrect Correct answer

The first and most important step in the ED is to immediately remove the bandage and wash the bite site to remove the venom.

Correct Incorrect Correct answer

The non-specific symptoms of headache, nausea, and abdominal pain can be early signs of systemic envenomation.

Correct Incorrect Correct answer

A crucial diagnostic step is to take a swab from the bite site before the bandages are removed, and a urine sample, to be tested with a Snake Venom Detection Kit (VDK).

Correct Incorrect Correct answer

The most important initial blood test is a panel for a coagulopathy, which must include an INR, APTT, and fibrinogen level, as well as a baseline CK for myolysis.

Correct Incorrect Correct answer

The patient should be given a prophylactic dose of brown snake antivenom immediately upon arrival.

Correct Incorrect Correct answer

You should reassure the patient that since she has no major symptoms, she is not envenomed and can be safely discharged home after one hour of observation.

Correct Incorrect Correct answer

The main purpose of the Pressure Immobilisation Technique is to act as a tourniquet to stop arterial blood flow to the limb.

Correct Incorrect Correct answer

All patients with a suspected snake bite, even if completely asymptomatic, must be admitted for a period of observation (typically at least 12 hours) with serial blood tests to rule out a delayed envenomation.

Correct Incorrect Correct answer

The patient should be encouraged to walk around the department to see if it brings on any neurological symptoms.

Correct Incorrect Correct answer

A blood sample, not a bite site swab, is the most reliable sample for the Venom Detection Kit.

Correct Incorrect Correct answer

The most likely diagnosis is an allergic reaction to an insect bite.

Correct Incorrect Correct answer

A course of broad-spectrum antibiotics is a key part of the initial management.

Correct Incorrect Correct answer

The patient’s headache is a sign of an impending stroke and she requires an urgent CT scan of her brain.

Correct Incorrect Correct answer

You should advise her that since she did not see the snake, it is impossible to determine the type and therefore impossible to treat her.

Correct Incorrect Correct answer

Question 15 of 15

15. Question

1 point(s)

A 42-year-old woman undergoes a laparoscopic excision of Stage III endometriosis. The surgeon reports removing multiple peritoneal and ovarian deposits. However, post-operatively, while her deep dyspareunia improves, her severe, cyclical, midline cramping pain and her heavy menstrual bleeding persist. She is frustrated, as she hoped the surgery would solve all her problems. The surgeon organises a pelvic MRI to investigate the persistent symptoms. The MRI report confirms the endometriosis has been excised but describes a thickened junctional zone of 15mm and a bulky, globular uterus. This strongly suggests the patient has co-existent adenomyosis, a condition where the symptoms can significantly overlap with endometriosis, often leading to diagnostic confusion and apparent “treatment failure” if not considered.

Which of the following statements accurately describe the relationship between endometriosis and adenomyosis?

Select 5 correct answers.

Adenomyosis (endometrial tissue within the uterine muscle) and endometriosis (endometrial tissue outside the uterus) are distinct conditions, but they frequently co-exist in the same patient.

Correct Incorrect Correct answer

The classic symptom that is much more specific to adenomyosis than endometriosis is heavy menstrual bleeding (menorrhagia).

Correct Incorrect Correct answer

The patient’s persistent symptoms are a sign that the laparoscopy was a failure.

Correct Incorrect Correct answer

The reason her symptoms have persisted after surgery is that the laparoscopic excision treated the endometriosis outside the uterus, but could not treat the adenomyosis located inside the uterine wall.

Correct Incorrect Correct answer

A hysterectomy is the only effective treatment for both conditions.

Correct Incorrect Correct answer

MRI is the most accurate non-invasive imaging modality for diagnosing co-existent adenomyosis, with a thickened junctional zone (>12mm) being the key diagnostic feature.

Correct Incorrect Correct answer

For a patient with persistent symptoms from adenomyosis after endometriosis surgery, the levonorgestrel-releasing IUD (Mirena) is an excellent next-line treatment option as it directly targets the adenomyosis.

Correct Incorrect Correct answer

The two conditions have the exact same pathophysiology and are considered the same disease.

Correct Incorrect Correct answer

All women with endometriosis also have adenomyosis.

Correct Incorrect Correct answer

The best way to diagnose the persistent pain is with a repeat laparoscopy.

Correct Incorrect Correct answer

A course of broad-spectrum antibiotics is needed to treat the adenomyosis.

Correct Incorrect Correct answer

The patient should be advised that her only option now is to manage with long-term opioid pain relief.

Correct Incorrect Correct answer

A transvaginal ultrasound can never diagnose adenomyosis.

Correct Incorrect Correct answer

The definitive cure for both conditions is a bilateral oophorectomy (removal of the ovaries).

Correct Incorrect Correct answer

The pain from adenomyosis is typically non-cyclical.

Correct Incorrect Correct answer

Pos.	Name	Entered on	Points	Result
Table is loading
No data available

Sample KFP questions (Complex)

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

Average score
Your score