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  • Question 1 - A 68-year-old teacher suddenly lost her memory after walking her dog. Her husband...

    Correct

    • A 68-year-old teacher suddenly lost her memory after walking her dog. Her husband noticed that she still knew the names of close friends, but she was disorientated in time and place, and seemed perplexed. She could follow complex commands, but was unable to recall something she had been told 5 minutes before. The episode resolved after 10 hours, although she did not remember the event. She has a history of migraine, but the episode of memory loss was not associated with headache.
      What is the most probable clinical diagnosis for this patient?

      Your Answer: Transient global amnesia

      Explanation:

      Transient Global Amnesia: Symptoms, Causes, and Differential Diagnosis

      Transient Global Amnesia (TGA) is a sudden onset condition that profoundly impairs anterograde memory. Patients are disoriented in time and place, but not in person. Retrograde memory is variably disturbed, lasting for hours to years. Patients recognize their memory deficits and repeatedly ask questions to orient themselves. Immediate and procedural memory are preserved, and patients can perform complex tasks. The attack resolves gradually, with subjective recovery occurring in two-thirds of patients within 2-12 hours. Precipitating events include strenuous exercise, intense emotion, and medical procedures. Differential diagnosis includes migraine, transient epileptic amnesia, and transient ischemic attack (TIA).

    • This question is part of the following fields:

      • Neurology
      61.9
      Seconds
  • Question 2 - You see a 35-year-old lady who you are reviewing for subfertility. During the...

    Correct

    • You see a 35-year-old lady who you are reviewing for subfertility. During the history, you discover that she has had chronic pelvic discomfort, pain during intercourse and pain passing urine around the time of menstruation. Examination of the abdomen and pelvis was unremarkable. A recent transvaginal pelvic ultrasound scan was normal.

      Which of the following is the most likely diagnosis?

      Your Answer: Endometriosis

      Explanation:

      Endometriosis: A Possible Cause of Chronic Pelvic Pain

      Endometriosis is a condition that can cause chronic pelvic pain, period-related pains, gastrointestinal symptoms, urinary symptoms, deep dyspareunia, and subfertility in female patients. Although a normal ultrasound scan is possible in endometriosis, a diagnostic laparoscopy may be required to make the diagnosis. It is important to consider endometriosis in a patient presenting with these symptoms, even in the absence of period-related symptoms. Other possible causes may not explain the period-related urinary symptoms, making endometriosis a likely culprit. Proper diagnosis and treatment can help alleviate the symptoms and improve the patient’s quality of life.

    • This question is part of the following fields:

      • Gynaecology And Breast
      38.7
      Seconds
  • Question 3 - A 28-year-old woman complains of multiple occurrences of vaginal candidiasis that have not...

    Incorrect

    • A 28-year-old woman complains of multiple occurrences of vaginal candidiasis that have not responded to OTC or prescribed treatments. As per the guidelines of the British Association of Sexual Health and HIV (BASHH), what is the minimum frequency of yearly episodes required to diagnose recurrent vaginal candidiasis?

      Your Answer: Six or more episodes per year

      Correct Answer: Four or more episodes per year

      Explanation:

      According to BASHH, recurrent vaginal candidiasis is characterized by experiencing four or more episodes per year. This criterion is significant as it helps determine the need for prophylactic treatment to prevent future recurrences.

      Vaginal candidiasis, commonly known as ‘thrush’, is a prevalent condition that many women self-diagnose and treat. Candida albicans is responsible for 80% of cases, while other candida species cause the remaining 20%. Although most women have no predisposing factors, certain conditions such as diabetes mellitus, drug use (antibiotics, steroids), pregnancy, and immunosuppression (HIV) may increase the likelihood of developing vaginal candidiasis. Symptoms include non-offensive discharge resembling cottage cheese, vulvitis, dyspareunia, dysuria, itching, vulval erythema, fissuring, and satellite lesions.

      Routine high vaginal swabs are not necessary if the clinical features are consistent with candidiasis. Treatment options include local or oral therapy. The NICE Clinical Knowledge Summaries recommends oral fluconazole 150 mg as a single dose as the first-line treatment. If oral therapy is contraindicated, a single dose of clotrimazole 500 mg intravaginal pessary may be used. If vulval symptoms are present, a topical imidazole may be added to an oral or intravaginal antifungal. Pregnant women should only use local treatments such as cream or pessaries, as oral treatments are not recommended.

      Recurrent vaginal candidiasis is defined as four or more episodes per year by BASHH. Compliance with previous treatment should be checked, and the diagnosis of candidiasis should be confirmed. A high vaginal swab for microscopy and culture may be necessary, and a blood glucose test should be performed to exclude diabetes. Differential diagnoses such as lichen sclerosus should also be ruled out. An induction-maintenance regime may be used, consisting of oral fluconazole every three days for three doses as induction, followed by oral fluconazole weekly for six months as maintenance.

    • This question is part of the following fields:

      • Gynaecology And Breast
      41.6
      Seconds
  • Question 4 - What food has the highest glycaemic index rating among the options provided? ...

    Incorrect

    • What food has the highest glycaemic index rating among the options provided?

      Your Answer: Sweetcorn

      Correct Answer: Chick peas

      Explanation:

      Understanding Diabetic Diets: The Glycaemic Index

      Feedback from previous MRCGP examinations has highlighted a lack of knowledge regarding diabetic diets. One important factor to consider is the glycaemic index (GI), which refers to the rate at which carbohydrates are absorbed. Foods with a low GI, such as oranges, natural muesli, chickpeas, and sweetcorn, are recommended for people with diabetes. Combining carbohydrates with fat can also lower the GI, as seen in chocolate, which has a medium GI.

      Contrary to popular belief, people with diabetes can consume any type of fruit, regardless of its sugar content. However, it is recommended that no more than one glass of fruit juice is consumed per day. Spreading fruit intake throughout the day can help prevent sudden spikes in blood glucose levels. It is important to note that while low GI foods may help regulate glucose levels, they may not necessarily be healthy in other ways. Understanding the glycaemic index is an important aspect of managing a diabetic diet.

    • This question is part of the following fields:

      • Population Health
      15.3
      Seconds
  • Question 5 - You see a 10-week-old baby boy with his father. He was born at...

    Correct

    • You see a 10-week-old baby boy with his father. He was born at 40+5 without complication. He is breastfeeding well but his father is concerned as he vomits small amounts of milk after most feeds, approximately a tablespoon full. He doesn't seem distressed by the vomiting and is growing along the 75th centile. He has wet and full nappies. He would like some treatment for the regurgitation.

      What would be your initial recommendation for managing this infant's regurgitation?

      Your Answer: This infant requires observation but no treatment initially, and review if worsening or weight loss

      Explanation:

      Gastro-oesophageal reflux (GOR) is a common condition in infants that usually resolves by the age of one. If the infant is not bothered by the GOR and doesn’t experience any complications, observation is sufficient. However, parents should monitor for worsening symptoms, weight loss, or complications. If the infant is distressed or has complications, they may have gastro-oesophageal reflux disease (GORD) and require treatment. Alginate therapy, such as Gaviscon® Infant, is the first-line treatment for breastfed infants with GORD.

      Gastro-oesophageal reflux is a common cause of vomiting in infants, with around 40% of babies experiencing some degree of regurgitation. However, certain risk factors such as preterm delivery and neurological disorders can increase the likelihood of developing this condition. Symptoms typically appear before 8 weeks of age and include vomiting or regurgitation, milky vomits after feeds, and excessive crying during feeding. Diagnosis is usually made based on clinical observation.

      Management of gastro-oesophageal reflux in infants involves advising parents on proper feeding positions, ensuring the infant is not overfed, and considering a trial of thickened formula or alginate therapy. However, proton pump inhibitors (PPIs) are not recommended as a first-line treatment for isolated symptoms of regurgitation. PPIs may be considered if the infant experiences unexplained feeding difficulties, distressed behavior, or faltering growth. Metoclopramide, a prokinetic agent, should only be used with specialist advice.

      Complications of gastro-oesophageal reflux can include distress, failure to thrive, aspiration, frequent otitis media, and dental erosion in older children. If medical treatment is ineffective and severe complications arise, fundoplication may be considered. It is important for healthcare professionals to be aware of the risk factors, symptoms, and management options for gastro-oesophageal reflux in infants.

    • This question is part of the following fields:

      • Children And Young People
      79.7
      Seconds
  • Question 6 - A man attends the surgery for an 'MOT' having just had his 55th...

    Incorrect

    • A man attends the surgery for an 'MOT' having just had his 55th birthday. He is keen to reduce his risk of cardiovascular disease and asks about being started on a 'statin'.

      He has no significant past medical history and takes no medication. His father had a 'heart attack' aged seventy, but his father was obese and a heavy smoker. There is no other family history of note. There is no suggestion of a familial lipid condition.

      What is the most appropriate management approach at this point?

      Your Answer: Use QRISK2 risk assessment tool to assess his cardiovascular risk

      Correct Answer: Optimise adherence to diet and lifestyle measures

      Explanation:

      Primary Prevention of Cardiovascular Disease

      This patient has no history of cardiovascular disease (CVD), and therefore, the primary prevention approach is necessary. The first step is to use a CVD risk assessment tool such as QRISK2 to evaluate the patient’s cardiovascular risk. If the patient has a 10% or greater 10-year risk of developing CVD, measuring their lipid profile and offering atorvastatin 20 mg daily would be appropriate. Additionally, providing advice to optimize diet and lifestyle measures is necessary. However, if the patient’s risk is less than 10%, then diet and lifestyle advice/optimization in isolation would be appropriate. At this point, there is no specific indication for lipid clinic input. The use of QRISK2 in this scenario is the best approach as it guides the management, including whether pharmacological treatment with a statin is necessary.

    • This question is part of the following fields:

      • Cardiovascular Health
      45.7
      Seconds
  • Question 7 - A 28-year-old woman seeks your advice regarding her risk of passing on Duchenne...

    Incorrect

    • A 28-year-old woman seeks your advice regarding her risk of passing on Duchenne muscular dystrophy to her future children. Her brother has the condition and genetic testing has confirmed that she is a carrier. She is aware that the disorder is inherited as an X linked recessive trait. Her partner, who is 31 years old, has no significant medical or family history of genetic disease. What guidance do you provide her?

      Your Answer: Sons of a female carrier have a 50% chance of being a carrier

      Correct Answer: Daughters of a female carrier have a 50% chance of being a carrier

      Explanation:

      Understanding X Linked Recessive Inheritance

      X linked recessive conditions are caused by a mutation in a gene on the X chromosome. This type of inheritance affects males more than females because men only have one gene copy. Females, on the other hand, are typically unaffected but carry the condition.

      One of the key characteristics of X linked recessive inheritance is that there is no male-to-male disease transmission. This means that a father must pass his Y chromosome to all his sons, which makes it impossible for a father to pass on the condition to his son. However, daughters of an affected male must all be carriers because the father must pass his X chromosome to all daughters.

      If a female is a carrier of an X linked recessive condition, her male offspring have a 50% chance of being affected. Female offspring of a female carrier also have a 50% chance of being carriers. Understanding X linked recessive inheritance is important for genetic counseling and family planning.

    • This question is part of the following fields:

      • Genomic Medicine
      112.8
      Seconds
  • Question 8 - A 26-year-old woman visits her GP complaining of severe lower abdomen pain, headache,...

    Correct

    • A 26-year-old woman visits her GP complaining of severe lower abdomen pain, headache, flushing, anxiety, and restlessness during her menstrual cycle. Her symptoms improve as she approaches the end of her period. Blood tests reveal no apparent cause, and a symptom diary suggests a possible diagnosis of premenstrual syndrome.

      According to NICE, which of the following is a potential treatment option for premenstrual syndrome?

      Your Answer: Selective serotonin reuptake inhibitors

      Explanation:

      According to NICE, the treatment of premenstrual syndrome should be approached from various angles, taking into account the severity of symptoms and the patient’s preferences. Effective treatment options include non-steroidal anti-inflammatory drugs taken orally, combined oral contraceptive, cognitive behavioural therapy and selective serotonin reuptake inhibitors. However, the copper intrauterine device, tricyclic antidepressants, diazepam and progestogen only pill are not recommended as treatment options.

      Understanding Premenstrual Syndrome (PMS)

      Premenstrual syndrome (PMS) is a condition that affects women during the luteal phase of their menstrual cycle. It is characterized by emotional and physical symptoms that can range from mild to severe. PMS only occurs in women who have ovulatory menstrual cycles and doesn’t occur before puberty, during pregnancy, or after menopause.

      Emotional symptoms of PMS include anxiety, stress, fatigue, and mood swings. Physical symptoms may include bloating and breast pain. The severity of symptoms varies from woman to woman, and management options depend on the severity of symptoms.

      Mild symptoms can be managed with lifestyle advice, such as getting enough sleep, exercising regularly, and avoiding smoking and alcohol. Specific advice includes eating regular, frequent, small, balanced meals that are rich in complex carbohydrates.

      Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP), such as Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg). Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI), which can be taken continuously or just during the luteal phase of the menstrual cycle (for example, days 15-28, depending on the length of the cycle). Understanding PMS and its management options can help women better cope with this condition.

    • This question is part of the following fields:

      • Gynaecology And Breast
      48.6
      Seconds
  • Question 9 - A 72-year-old woman is discovered to have the subsequent blood tests:

    TSH 0.05 mu/l
    Free...

    Incorrect

    • A 72-year-old woman is discovered to have the subsequent blood tests:

      TSH 0.05 mu/l
      Free T4 19 pmol/l (range 9-25 pmol/l)
      Free T3 7 pmol/l (range 3-9 pmol/l)

      What are the potential outcomes if no treatment is given?

      Your Answer: Supraventricular arrhythmias and hyperlipidaemia

      Correct Answer: Supraventricular arrhythmias and osteoporosis

      Explanation:

      Understanding Subclinical Hyperthyroidism

      Subclinical hyperthyroidism is a condition that is becoming more recognized in the medical field. It is characterized by normal levels of free thyroxine and triiodothyronine, but with a thyroid stimulating hormone (TSH) that falls below the normal range, usually less than 0.1 mu/l. The condition is often caused by a multinodular goitre, particularly in elderly females, or excessive thyroxine intake.

      It is important to recognize subclinical hyperthyroidism because it can have negative effects on the cardiovascular system, such as atrial fibrillation, and on bone metabolism, leading to osteoporosis. It can also impact quality of life and increase the likelihood of dementia.

      Management of subclinical hyperthyroidism involves monitoring TSH levels, as they may revert to normal on their own. If levels remain persistently low, a therapeutic trial of low-dose antithyroid agents for approximately six months may be recommended to induce remission. It is important to address subclinical hyperthyroidism to prevent potential complications and improve overall health.

      Overall, understanding subclinical hyperthyroidism and its potential effects is crucial for proper management and prevention of complications.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      109.6
      Seconds
  • Question 10 - A 72-year-old woman comes to her General Practitioner complaining of intense pain radiating...

    Correct

    • A 72-year-old woman comes to her General Practitioner complaining of intense pain radiating through her left sciatic nerve, which is not being managed by her current pain medication. The pain is so severe that it is disrupting her sleep. She has recently been diagnosed with spinal metastases from a primary breast cancer. She has been prescribed 20 mg oral morphine sulphate twice daily for her back pain. What is the best course of action for managing this patient's condition?

      Your Answer: Add 10 mg amitriptyline at night and increase the dose if tolerated after three to seven days

      Explanation:

      Managing Pain in Palliative Care: Medication Recommendations

      When it comes to managing pain in palliative care, there are several medication options available. For neuropathic pain, amitriptyline is recommended as a starting dose of 10-25 mg at night, with the option to increase after three to seven days. Tricyclic antidepressants can also be used alongside standard analgesics for mixed pain.

      Liquid oral morphine can be added as needed, with a starting dose of 5 ml and no more than a dose every two hours. If the patient requires further morphine, titrating the dose with liquid morphine is recommended.

      While non-steroidal anti-inflammatory agents like naproxen can be used for pain management, they are not first-line for neuropathic pain. Sedating benzodiazepines like diazepam are not recommended for neuropathic pain, but may be used for sleeping problems or anxiety.

      Overall, a combination of medication options may be necessary to effectively manage pain in palliative care.

    • This question is part of the following fields:

      • End Of Life
      52.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (1/1) 100%
Gynaecology And Breast (2/3) 67%
Population Health (0/1) 0%
Children And Young People (1/1) 100%
Cardiovascular Health (0/1) 0%
Genomic Medicine (0/1) 0%
Metabolic Problems And Endocrinology (0/1) 0%
End Of Life (1/1) 100%
Passmed