au aE es the SeAustralian Medical Counc. Handbook of Multiple Choice Questions - TABLE OF CONTENTS Foreword SOC BSCS B ERR TCT ES SSCS SSE C HRP HHERHEC SEES SOCCER PERETCHETC ERS [PRR RRR RRR RRR RRR RRR RRR RRR RE ES ote tee o & iii Gordon G Page Preface ........... Bo aaa eae itd Rey taal apurdraaid. aves agald oait PART re eee iv Richard R Doherty and Richard Smallwood Contributors ......... Sgullesuieubounaiureal Wate ceduiseiueeseeiva sets iid hele Bole BF Editorial Committee Additional Contributors and Reviewers AMC Secretariat Acknowledgements SCPC EPEC SSS SHSESHESHESBFETCTHERECEES SPCC SCHESFPTSSTHPTEB ETRE Ss 2G G88 88 o Se eee tee e eft e xii Introduction SSSR FHF CSCC e SSeS TECHS REPHTEF BRB eee Ste eease eee tte eeeeeeesrerees eeeeee Set tttiatethetboatoan Xiv Vernon C Marshall. Section 1 - The AMC MCQ Examination process — Example MCQ 1.1 to 1.22 GN COMMENHMATIES ...........ceeseceseceeerseees ebesuewenieusvescianere gaxieseesaseotesemmvasnaseeds petsaaeey Lal Assessment Methodologies in Medicine — Peter G Devitt and Neil A Spike .......eseseeeeeeeererereeenenes 1.2 Structure and Standard of the AMC Examination: Examination Blueprint and Mix of Questions — Vernon C Marshall, Peter G Devitt, and Neil S Paget 0.0... ceecceceeseeseeeeneeeeeeeeeeeeeene 6 3 Analysis, Revision and Review of Questions — Vernon C Marshall and Neil S Paget: eae fe Audie Bree @ arsecan dhadiea menketecmacnonteecasbtes Jevmevensutaesee) 1.4 Patnweiys ‘0 Meclea Reuse in ‘Australia - lan B BRK. saninalhigiis biti GRE aa BO Section 2 - Trial Examination .................. iy eo siphes peer ptt tacts 45 Self-test Multidisciplinary MCQ Examination MCQ 2.001 -— 2.150 .. Seat Halal ges acteteaudeaad dias lexaiaelpriceuvacuunastuiasoemse oo tesmadoaveaens se OL MCQ Trial Egimniation ‘Commentanes 2. 001 - 2. 150. sednacchhastnnetenntnatiansttiihaainin air EE POn ae Section 3 SERPS REO S PFS STS HOSTS ETTORE Tee ee eee S PSSST STC PCPS TSS SCTE SEES SEEGER EES oo8 203 Annotated MCGQ in five patient group (PG) categories Questions MCQ 3.001 — 3.411 ................006 er tral Allasio ca LS seseceesseeee 204-375 Adult Health and Aged Care (PGI-AH) MCQ 3.001-3.228 Medicine and oe 200 Medicine/Surgery/Gynaecology Gynaecology 28 .. cat icoipiet bcrsceusccuss anol | Child and Adolescent Health (PG2-CH) MCQ 3.229-3.298 POeCiOtriCs 70 oe ce seteteeeeeteeeserees DI Z-3I6 Maternal Health (PG3-MAH} MCQ@ 3:299-3.326 Obstetrics 28 .........csecseterseseresrseranserterens BOF OAF Mental Health (PG4—-MEH) MCQ 3.327-3.378 Psychidtry 52.0000... ccsceeseneeenseeteseeeeeees 048-365 Population and Community Health and MCQ 3.379-3.411 Population and Community Ethics (PGS-PCH) BOTH 3S. cs eencnneccenenitnnendttanasi lid elas as OOOmOre Commentaries MCG 3.001 — SiAV 0 avcsisccccscccdicccvencsscccsccssesscsasececcveravevessescessacosndanes 376-637 Adult Health and Aged Care (PG1—AH) MCQ 3.001-3.228 Medicine and Surgery 200 Medicine/Surgery/Gynaecology GYNOeCOlGY 28s Giiicawnsne cl P84 Child and Adolescent Health (PG2-CH) MCQ@ 3.229-3.298 POeCIATICS 70.........:cccesseeeererssereeesrerere DOO-O/ | Maternal Health (PG3-MAH) MCG 3.299-3.326 Obstetrics 28.00... ccseseeeueenersteereeee 7 2-983 Mental Health (PG4—-MEH) MCQ 3527-8378 Psychiatry 52..... 2c janie cnn 84-619 Population and Community Health and MCQ 3.379-3.411 Population and Community Ethics (PG5-PCH) HOGA SS secre nansinnnanninnOZO OarWE UEUFELe utes cL Section 4—Alleword.. atm idle aie haa 638s 4.] Glossary and Abbreviations:2™ |e. Weement Weneke Oren ee 639 4.2 NONMTIGL VONWES o.csssssescctasasisge hale REM MEMOS AS T 4.3 EDONVINS seistcesia wiseets O49 F 4.4 Guidelines fok Further Multidiseipiinary Reading: “Peter Devitt, Richard ‘Doneny, Frank Homes \ Barry McGrath, Vernon Marshall, Kichu Nair, Neil Paget, Roger Pepperell, Jeffery Prebble, C Graeme Smith, Neil Spike, Ross Sweet, Peter Vine and Bryan Yeo .. iiisenia Seas a NEG i! 4.5 Goals and oe of Medical Education — Mission Statement, Due aicha BRS A EI -ssspansased ccesnncesvaraveimnrcsvavacessiuenitesusies oe MAUR tata a ot clesertireecidl ueliccsccccssrchccen cc, BS r 4.6 Reference Units -— SI Units .. der nunceslnnnnanes Son seasseraunenisuaied-eni tei euiphesennsvus nsnnuunvuarzemec vetted acetone ae? | 47 Question Interpretation .......0... di das) anenlesenanannsca:tindessieps Oto 4.8 ltem Classifications — FuNetiCN aia preeaae Systems/Regions/Subspecialities .. socndedaseslveartnasaaeiauas OPO 4.9 Anthology Clinical Presentation List AMC Anthology of Medical Conditions .. ve eaeuekOD 4.10 Annotated MCQ Scenario Topics, Classifications, Anthology References ane Fswar coe. coments a Tie: Section 5 — Epilogue ............ccccssseeseees WéduiesSieakbaan sawapates camexadibnkguliaciasrotes Siiesiehs 739 Introduction to the AMC's online trial examination MSS Pe i sl CN oe se ofa oe fark Rote oess donee ete ee cee NSS et Aeon Sea I ae a aAustralian Medical Council Handbook of Multiple Choice Questions FOREWORD This Handbook of Multiple Choice Questions is the fourth in a series of publications that has been produced by the Australian Medical Council (AMC) to assist International Medical Graduates (IMGs) prepare for the AMC examinations. The AMC and the authors of this and earlier documents deserve considerable recognition for their insight, Commitment and expertise in supporting IMGs’ entry into the Australian medical system, and for doing so in a manner which assures the Australian public about their competence. The introduction to this book lists The many clinicians who have contributed to its develooment. They are among the most respected doctors in Australia. These same clinicians devote many days each year to the develooment and review of materials for the AMC examinations and most have been doing so for many years. Their commitment to the AMC and its examinations underscores the respect they have and priority they assign to the AMC and its role and, more importantly, the quality of the assessment materials comprising the AMC examinations. The examinations of the AMC are developed to assess competence at the level of a graduate from an Australian medical school, and assess competence relative to the requirements of safe, effective medical practice and health care in Australia. Effective this year, IMGs seeking general registration through the Standard Pathway must pass the AMC's multiple choice question (MCQ) examination as a precondition to working in Australia. This latest publication serves IMGs well as an introduction and orientation to this examination. It has been over a decade since the AMC produced its first publication in this series. The first publication, like this current publication, addressed the needs of IMGs in their preparation for the AMC MCQ@ examination. A comparison of the first and fourth booklets identifies a remarkable evolution of the MCQ examination; from an emphasis on the assessment of an IMG's knowledge base to one of testing their ability to make key clinical decisions underlying safe and effective clinical practice. This evolution is based on the recognition that, while possessing knowledge remains a cornerstone of clinical competence, the ability to apply that knowledge in the context of clinical problems is the real test of clinical competence, and that knowing alone is Q necessary but not sufficient condition to being clinically competent. The skill of applying knowledge to clinical problems, like all skills, is developed through a process of deliberate practice accompanied by feedback. This Handbook of Multiple Choice Questions provides the IMG with an opportunity to practice this skill in the context of the types of questions they will encounter on the AMC MC@ examination and, as needed, to obtain up-to-date and detailed feedback (and knowledge acquisition) to guide its development. The commentaries accompanying each question provide excellent discussions of the rationale for the best response to the question, and for why the other responses are not the best response (e.g. not as likely, not the first step to be taken, not as important). In essence, this publication can be a key resource to IMGs preparing for the AMC MCQ examination and, in addition, is an excellent self-assessment and learning resource for Australian senior medical students and prevocational trainees. Gordon G. Page, PhD Consultant to the Australian Medical Council Emeritus Professor of Medical Education University of British Columbia Vancouver Canadaa Py e Me el ralian Medical Council Medical Council . lbook of Multiple Choice Questions REFACE 1e Board of Examiners of the Australian Medical Council (AMC) is primarily concerned ith ensuring that International Medical Graduates awarded the AMC certificate ill have the right balance of knowledge, skills, judgement and other professional tributes to allow them to work effectively in Australia. The MCQ examination is the st step in the process by which doctors trained outside the Australasian system an demonstrate knowledge and skills comparable to those of a new Australasian ‘aduate. In setting this examination, the AMC's Board of Examiners maintains an 2m bank and develops new test items which focus on important steps in delivery F medical care in an Australian setting. Items selected for examinations cover a ide range of topics and clinical tasks, which take into account factors such as the atterns of illness in the Australian community and health priorities, which largely etermine how health care is delivered. pursuing the objectives of the MCQ examination, we have been particularly mindful f the need to move away from traditional testing strategies in MCQ examinations. s a result, items used in the MCQ examination are increasingly focused on the pplication of medical knowledge to a clinical problem rather than simply the recall f technical information. It has become apparent that this presents a considerable hallenge to many candidates who may not have had to confront such examinations | the past. Ye AMC's Handbook of Multiple Choice Questions should assist candidates prepare 9 the AMC's MCQ examination with more confidence. The book offers a series f carefully chosen insights into the content and style of current AMC MCQ items: 1ey are arranged in the same patient groups and clinical tasks which make up the lueprint of the MCQ examination, and reflect the strong move towards application of Nowledge. Each of the items has been chosen to emphasise a learning point and the em commentaries provide additional guidance to candidates. Candidates should >cognise, however, that the book’s content is not an exhaustive collection and that 1e items in the book are only examples and are not part of the item bank from which \eir examination questions will be drawn; but the book MCQ items exemplify themes nd principles of diagnosis, investigation and management common to current AMC ank questions. 1e book's authors include members of the Board, other senior examiners and a range f contributing clinicians who have been part of the AMC’s item development team. part from drafting the items and their commentaries, the authors have scrutinised ioth content and construction of items in a multidisciplinary editorial panel. We are onfident that this process has produced a volume that candidates will find helpful in 1eir preparation for the AMC examination. ichard R Doherty ~hair, Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners, \ustralian Medical Council ichard Smallwood resident, Australian Medical Council CO EDITC Vernc Edito Emer Cons Senic Past Exar Pete ASSO: Senic Senic Mery of th Clink Rich Profe Con Cen Seni Cha Exar Clini Frar Clin Seni Mer of Tt Clin Ban Pro} Che sen Me of Tt Clir ——Australian Medical Council Handbook of Multiple Choice Questions CONTRIBUTORS EDITORIAL COMMITTEE Vernon C Marshall MBBS, FRACS, FACS Editor-in-Chief, Australian Medical Council Emeritus Professor of Surgery, Monash University Consultant Surgeon, Monash Medical Centre Senior Examiner in Surgery for the Australian Medical Council Past Chairman — Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Peter G Devitt MBBS, MS, FRACS Associate Professor of Surgery, University of Adelaide Senior Visiting Surgeon, Royal Adelaide Hospital Senior Examiner in Surgery for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Clinical Discipline head — Adult Health and Aged Care (Surgery) Richard R Doherty MBBS, DObstRCOG, FRACP Professor of Paediatrics, Monash University Consultant Paediatrician and Head, Paediatric Infectious Diseases, Monash Medical Centre Senior Examiner in Paediatrics for the Australian Medical Council Chairman — Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Clinical Discipline head — Child and Adolescent Health Frank P Hume MBBS, FRACP, MRC Psych Clinical Lecturer, School of Psychiatry, University of New South Wales Senior Examiner in Psychiatry for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Clinical Discipline head — Mental Health Barry P McGrath MBBS, MD, FRACP Professor of Medicine, Monash University Chair — Confederation of Postgraduate Medical Education Councils of Australia Senior Examiner in Medicine for the Australian Medical Council Member—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Clinical Discipline head — Adult Health and Aged Care (Medicine)Ausiralian Medical Council Handbook of Multiple Choice Questions Balakrishnan R Nair AM, MBBS, FRACP, FRCP Clinical Professor of Medicine and Associate Dean of Continuing Professional Development, School of Medical Practice and Population Health, University of Newcastle Director, Continuing Medical Education and Professional Development, Hunter New England Health, Newcastle Senior Examiner in Medicine for the Australian Medical Council Member — Board of Examiners and Clinical Panel of Examiners of the Australian Medical Council Neil S Paget MA, MAdmin, DipEd, MACE Honorary Professor of Medicine, Monash University Technical Advisor on Assessment for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Roger J Pepperell MBBS, MD, MGO, FRACP, FRCOG, FRANZCOG, FACOG (Hon) Emeritus Professor of Obstetrics and Gynaecology, University of Melbourne Consultant Obstetrician and Gynaecologist, Royal Women’s Hospital, Melbourne Senior Examiner in Obstetrics and Gynaecology for the Australian Medical Council Past Chairman — Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners Chairman — Clinical Panel of Examiners of the Australian Medical Council Clinical Discipline head — Maternal Health and Gynaecology Jeffrey Prebble OAM, MBBS, FRACP Associate Professor of Paediatrics, University of Queensland Consultant Paediatrician in Toowoomba, Queensland Examiner in Paediatrics for the Australian Medical Council Member — MCQ Panel of Examiners of the Australian Medical Council Graeme C Smith MBBS, MD, DPM, FRANZCP Emeritus Professor, School of Psychology, Psychiatry and Psychological Medicine, Monash University Honorary Psychiatrist, Southern Health, Victoria Senior Examiner in Psychiatry for the Australian Medical Council Member — Clinical Panel of Examiners of the Australian Medical Council Neil A Spike MBBS, FRACGP Associate Professor and Head, Department of General Practice, Monash University Director of Education, School of Primary Health Care, Monash University Senior Examiner in General Practice for the Australian Medical Council Member -— Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Clinical Discipline head — Population and Community Health and EthicsAustralian Medical Council Handbook of Multiple Choice Questions Ross Sweet AM, MBBS, FRCOG, FRANZCOG, FACLM Former Senior Clinical Lecturer in Obstetrics and Gynaecology, University of Adelaide Former Medical Chief, Women’s and Babies’ Division, Women's and Children’s Hospital, Adelaide Senior Examiner in Obstetrics and Gynaecology for the Australian Medical Council Member — MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Peter J Vine MBBS, FRACP Adjunct Associate Professor, School of Community Health, Charles Sturt University, Albury NSW Senior Lecturer and Head of Campus, University of New South Wales Rural Clinical School, Albury Wodonga Campus Formerly Senior Lecturer (Part-time) Monash University Department of Paediatrics Senior Examiner in Paediatrics for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Bryan W Yeo MBBS, FRACS, FRCS Associate Professor of Surgery, University of New South Wales Senior Visiting Surgeon, Prince of Wales Hospital, Sydney Senior Examiner in Surgery for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council ADDITIONAL CONTRIBUTORS AND REVIEWERS E. Jonn Anstee MBBS, FRACS Consultant Plastic and Reconstructive Surgeon Former Head, Department of Plastic Surgery, Alfred Hospital, Melbourne Senior Lecturer, Monash University Department of Surgery John Barnard DEd, PhD, EdD Adjunct Professor, Department of Medical Education, University of sydney Executive Director, EPEC Pty Ltd Psychometrician for the Australian Medical Council Christen Barras MBBS Stroke Imaging Fellow, Department of Neuroscience, Royal Melbourne Hospital, Parkville Melissa Barrett MBBS, FRANZCP Site Coordinator of Training, Prince of Wales Hospital, SydneyAustralian Medical Council Handbook of Multiple Choice Questions Kerry Breen AM, MBBS, MD, FRACP Associate Professor of Medicine, University of Melbourne Past President, Medical Practitioners Board of Victoria Past President, Australian Medical Council Past Chairman, Australian Health Ethics Committee (NHMRC) Wendy Brown MBBS, PhD, FRACS Clinical Associate Professor, Department of Surgery, Monash University, Alfred Hospital Anthony J Buzzard MBBS, FRACS, FRCS, FACS Associate Professor, Department of Surgery, Monash University, Alfred Hospital Senior Examiner in Surgery for the Australian Medical Council Member - Board of Examiners and MCQ Panel of Examiners of the Australian Medical Council Arthur Lindesay Clark AM, MBBS, MD, FRACP Professor Emeritus of Paediatrics, Monash University Honorary Consultant Paediatrician, Southern Area, Victoria Past Chairman — Board of Examiners and MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Richard N de Steiger MBBS, FRACS, FAOrthA Consultant Orthopaedic Surgeon, Director, Department of Orthopaedic Training and Research, The Eoworth Centre, Richmond, Victoria JEK Galbraith OBE, MBBS, MD, FRACS, FRCS, FRACO, FACS, FACTM Honorary Consultant Ophthalmologist, Royal Melbourne Hospital Examiner in Surgery for the Australian Medical Council Reuben D Glass MBBS, FRACP, DipEd Former Senior Lecturer in Paediatrics, Monash University Consultant Women’s and Children’s Program, Southern Health Senior Examiner in Paediatrics for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Richard W Harper MBBS, FRACP, FACC Consultant and Interventional cardiologist Emeritus Professor/Director of Cardiology, Monash Medical Centre and Monash UniversityAustralian Medical Council Handbook of Multiple Choice Questions Phillioa J Hay MBChB, MD, DPhil, FRANZCP Foundation Professor of Mental Health, School of Medicine, University of Western Sydney Senior Examiner in Psychiatry for the Australian Medical Council Member — Board of Examiners and Clinical Panel of Examiners of the Australian Medical Council Catherine Hickie MBBS, FRANZCP Director of Clinical Training, Bloomfield Hospital, Orange Conjoint Senior Lecturer, School of Psychiatry, University of NSW Manish Jain MBBS, MD, FRANZCR Consultant Radiologist, Monash Radiology Michael R Kidd AM, MBBS, MD, FRACGP, DipRACOG, DCCH Past President, Royal Australian College of General Practitioners Professor of General Practice, The University of Sydney Senior Examiner in General Practice for the Australian Medical Council Member-—Board of Examiners, MCQ Panel of Examiners and Clinical Panel of Examiners of the Australian Medical Council Christian A Lampel MBBS (Lond.), DA, D Obs.RCOG, FACGP General Practitioner, Moe Medical Centre, Moe, Victoria Honorary Lecturer, Monash University Reginald SA Lord AM, MBBS, MD, FRACS, FRCS Emeritus Professor of Surgery, University of New South Wales Professor of Surgery, University of Western Sydney Senior Examiner in Surgery for the Australian Medical Council Member — Clinical Panel of Examiners of the Australian Medical Council Guy Ludbrook MBBS, PhD, FANZCA Professor of Anaesthesia, The University of Adelaide and Royal Adelaide Hospital Prashanth Mayur MBBS, FRANZCP Director, Mood Disorders Unit, Cumberland Hospital, Sydney Ronald McCoy MBBS General Practitioner, Senior Medical Educator, gplearning, Royal Australian College of General Practitioners Adjunct Lecturer, Central Clinical School, University of Sydney lan McCrossin MBBS, FACNSM Consultant Dermatologist, Department of Dermatology, Liverpool Hospital, SyaneyAusiralian Medical Council Handbook of Multiple Choice Questions lan Munt MBBS, FRANZCP Staff Specialist, Townsville Child & Youth Mental Health Service, Townsville Health Service Disirict, Townsville Hospital, Townsville Member — Clinical Panel of Examiners of the Australian Medical Council Michael Oldmeadow MBBS, FRACP senior Lecturer, Monash University Department of Medicine Consultant Physician, Professorial General Medical Unit, The Alfred Hospital, Melbourne senior Examiner in Medicine for the Australian Medical Council Member — MCQ Panel of Examiners and Clinical Panel] of Examiners of the Australian Medical Council Andrew Perry MBBS Emergency Medicine Registrar, Royal Adelaide Hospital Clinical Associate Lecturer, University of Adelaide Laurence Simpson MBBS, MD, FRACS, FCCP Consultant Thoracic Surgeon Deputy President, Committee of Convocation, University of Melbourne Member, Faculty Board, and Lecturer, Faculty of Medicine, Dentistry and Health sciences, University of Melbourne Medical Educator, Royal Australian College of General Practitioners senior Examiner in Surgery, Australian Medical Council Neil Vallance MBBS, FRACS Consultant Otolaryngologist senior Otolaryngologist, Monash Medical Centre and Southern Health, Melbourne Jane Vernon-Roberts MBBS, MPH, GradDipPsychotherapy, FACPPsychMed Head of Clinical Studies, The University of Adelaide Clinical Studies Advisor, The Royal Adelaide Hospital senior Visiting Medical Practitioner, Department of Endocrinology, Royal Adelaide Hospital senior Examiner in General Practice for the Australian Medical Council Member — Clinical Panel of Examiners of the Australian Medical Council Belinda Yeo BA, MBBS Medical Registrar, St. Vincent's Hospital, Sydney David Yeo BMedSc, MBBS, MS, FRACS Surgical Registrar, Royal Prince Alfred Hospital, sydneyarte ae Pe gen Bea en = erik ete lise Res ite __ Handbook of Multiple Choice Questions _ AMC SECRETARIAT ‘Dr. Heather G Alexander BSc , DipNutrDiet , MAppSc (Research), PhD Director, AMC Assessment Services, Australian Medical Council Susan A Buick Project Manager, AMC Examination Development Assistant to the Editor-in-Chief Editorial Committee, Australian Medical Council lan B Frank Chief Executive Officer, Australian Medical Council Martin J Jagodzki Publications Co-ordinator, Australian Medical Council Matthew W Haggan Publications Clerk, Australian Medical CouncilAusiralian Medical Council Handbook of Multiple Choice Questions ACKNOWLEDGEMENTS This selection of MCQ with annotated commentaries extends the Australian Medical Council publication series, which now comprises: a first volume of annotated MCQ: the | AMC Anthology of Medical Conditions (outlining broad aspects of a curriculum based on clinical presentations); the AMC Handbook of Clinical Assessment (containing over 150 annotated clinical case scenarios used in the AMC Part 2 Clinical Examination, outlining standards expected from candidates); and this volume of AMC Annotated | Multiple Choice Questions (Australian Medical Council Handbook of Multiple Choice. Questions), containing a selection of almost 600 MCQ@Q and commentaries from the AMC Part 1 MCQ assessment. The aims of this selection of MCQ remain as before - to acquaint candidates presenting for assessment with details and standards of the AMC Part 1 MCQ assessment and to provide self-testing and educative material across the spectrum of clinical medicine. To meet these aims the AMC has again drawn upon the expertise of a multidisciplinary group of senior examiners and clinical teachers fo provide clinical MCQ and commentaries. The Editorial Committee comprises multi skilled coninbutors to ensure that: continuing trends in medical education and MCQ design and construction are observed and followed; questions testing recall of core Knowledge include clinical application of such knowledge to solve relevant and important clinical problems: the mix of questions supplied gives an appropriately comprehensive overview of the medical syllabus; clinical questions have evidence-based backing wherever possible: both principles and practice of clinical medicine and applied basic clinical sciences are included; and fond prejudices and outworn shibboleths have been largely replaced © by updated consensus reviews of clinical practice. Content and standards have been given additional perspectives by valuable contributions and reviews from additional AMC general and specialist examiners and consultants, and from trainees in major clinical disciplines. As coordinating editor | am most grateful to all contributors and to the core discipline heads for their dedicated efforts. The AMC secretariat continues to evolve and to provide an expert and comprehensive service. Susan Buick has taken on formidable additional responsibilities as overall AMC MCQ@ assessment coordinator and editorial advisor, but her vigour and enthusiasm remain pivotal to the editorial enterprises. The helpful advice of Heather Alexander has been appreciated. Martin Jagodzki has brought invaluable expert professional skills to his role as Publications Coordinator for the AMC; and Matthew Haggan, as Publications Clerk, has also been innovative in formatting and exemplary in attention to detail. Both have coped cheerfully with continuing revisions, reordering and rewriting, and have skillfully co-ordinated publishing activities and examination activities in liaison with Megan Lovett. lan Frank, Chief Executive Officer AMC, has advised and liaised with the Editorial Committee on changes in government regulations; and has provided a chapter on current pathways to medical registration in Australia. As in previous publications, many questions and commentaries contain visual material comprising clinical illustrations, ECGs and imaging results. Peter Devitt, Bryan Yeo and other specialist contributors have generously provided examples from their clinical files. Consent has been obtained for alll illustrations of patients. Additional privacy has