A 70-year-old male patient has recently registered with your practice, having moved from another area. He had a radical prostatectomy three years ago for early prostate cancer. He remains clinically well and has been undergoing follow-up in primary care.
You have no previous PSA (prostate specific antigen) readings for comparison but have checked his PSA at his first visit with you. Which of the following would be a reason for an urgent re-referral to the local urology department, bearing in mind that the normal age related range is <4.5 ng/ml?
AKT-5558
According to NICE guidelines, if a patient with diabetes has a 5 year coronary event risk of >10% but no microalbuminuria, at what threshold level of BP (stage 2 hypertension) should you offer treatment?
AKT-5562
A 65-year-old woman seeks your advice on reducing her risk of pancreatic cancer after her sister was recently diagnosed with the disease. She smokes 10 cigarettes a day, doesn’t drink alcohol, and has lost weight through dieting. She consumes a lot of low calorie sweetened drinks and drinks four to five cups of strong coffee daily. She has been taking hormone replacement therapy for the past four years and regularly takes over-the-counter omega 3 capsules. What factor is linked to an increased risk of pancreatic cancer?
AKT-5566
Abuse of which of the following substances is implicated most frequently as the cause of occupational accidents and injuries among workers aged 18 to 25?
AKT-5572
A 31-year-old construction worker visits your clinic with concerns about his anxiety. As you talk with him, he reveals that he drinks two bottles of beer every evening. These bottles are 500 ml each and have an alcohol by volume (ABV) of 5%.
How many units of alcohol does he consume per week?
AKT-5568
A 35-year-old male comes to you seeking advice. He had a splenectomy ten years ago after a cycling accident and has been in good health since. However, a friend recently informed him that he should be receiving treatment after having a splenectomy. He is currently not taking any medication. What would you recommend?
AKT-5559
You are investigating an elderly patient with suspected heart failure. The NT-proBNP result arrived today as 1300 ng/litre.
Which of the following would be the most appropriate management step?
AKT-5561
A 65-year-old man has a six week history of dry cough, weight loss of 1 stone and generalised fatigue. He has smoked 15 cigarettes per day for 45 years. He had a chest x ray done a week ago which reports a suspicious mass in the left lung with hilar enlargement ? lung cancer. The radiologist recommends urgent referral.
You explain the findings to the patient and his wife and discuss the need for referral. The patient states that he has private medical insurance to cover out-patient appointments and he also has a close friend who is a general physician. He requests private referral to him as he knows he will be seen within a few days.
There are other options for referral in your area. You have a district general hospital nearby where a respiratory physician does a clinic once a month, however the last clinic has only just been held. You have a community hospital nearby with a general physician visiting every two weeks. The tertiary referral hospital is some distance away but this is where the specialist lung cancer multi-disciplinary team are based and the patient will be seen within two weeks.
The patient would rather be seen as near to home as possible.
What is the most appropriate course of action?
AKT-5567
Researchers wanted to investigate the effectiveness of a smoking cessation programme. They recruited women aged between 20 and 40 years who were smokers and attending an optional Planned Parenthood Clinic organised by midwives at a teaching hospital. Of the 200 women approached, 75% agreed to participate in the study. There were no differences between participants and non-participants with respect to personal demographics and smoking rates. Volunteers were divided into a group that entered the programme and a matched group that received ‘usual care’. The results of the study showed the programme to be significantly more effective than ‘usual care’. Which of the following issues is most problematic about this study?
AKT-5569
What other screening method has strong evidence for its effectiveness in detecting bowel cancer besides faecal occult blood testing for those aged 60-74?