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  • Question 1 - You encounter a 28-year-old man who has asthma. He informs you that he...

    Incorrect

    • You encounter a 28-year-old man who has asthma. He informs you that he has visited you today because one of the partners is unwilling to modify his inhaler treatment until he quits smoking. He is presently using a salbutamol inhaler as needed, but he is experiencing frequent wheezing episodes and has developed a cough at night. What is the best course of action?

      Your Answer: Alter his inhaler treatment and advise the patient to see you next time

      Correct Answer: Alter his inhaler treatment and speak to the doctor concerned

      Explanation:

      It is important to note that a patient’s decision to continue smoking should not be a reason to deny them treatment for their asthma. As a healthcare professional, it is your responsibility to bring this to the attention of the doctor involved and discuss the situation with them. This will also give the doctor an opportunity to explain their perspective on the matter. It is not recommended to bring this up during a practice meeting as it may come across as confrontational.

      Simply changing the patient’s inhaler treatment will not address the issue of treatment being withheld. It is not acceptable to refuse to adjust their inhalers until they agree to seek smoking cessation treatment, as this can be seen as blackmail. Additionally, removing the patient from the practice list for not quitting smoking is not an appropriate course of action.

    • This question is part of the following fields:

      • Respiratory Health
      218
      Seconds
  • Question 2 - A 50-year-old male with type 2 diabetes is seen at annual review.

    His glycaemic...

    Incorrect

    • A 50-year-old male with type 2 diabetes is seen at annual review.

      His glycaemic control is suboptimal on diet alone and his most recent HbA1c is 63 mmol/mol (20-46).

      You elect to treat him with metformin 500 mg bd.

      As per NICE NG28 guidance on the management of diabetes, what would be the most suitable interval to re-evaluate his HbA1c after each treatment intensification?

      Your Answer: Three to six months

      Correct Answer: Annually

      Explanation:

      Understanding HbA1c as a Tool for Glycaemic Control

      The glycated haemoglobin (HbA1c) is a measure of the glycosylation of the haemoglobin molecule by glucose. This measurement is widely used in clinical practice to assess glycaemic control, as there is a strong correlation between the glycosylation of HbA1c and average plasma glucose concentrations. Additionally, studies have shown that HbA1c has prognostic significance in both microvascular and macrovascular risk.

      The lifespan of a red blood cell is approximately 120 days, and HbA1c reflects average blood glucose levels during the half-life of the red cell, which is about 60 days. According to NICE guidelines, HbA1c should be re-checked at 3/6 monthly intervals with each treatment intensification. Understanding HbA1c as a tool for glycaemic control is crucial for managing diabetes effectively.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      70.1
      Seconds
  • Question 3 - A woman with chronic lymphocytic leukaemia underwent splenectomy because she did not respond...

    Correct

    • A woman with chronic lymphocytic leukaemia underwent splenectomy because she did not respond to immunosuppression and chemotherapy.
      What is the most likely long-term risk factor after splenectomy?

      Your Answer: Infections

      Explanation:

      The Risks and Benefits of Splenectomy

      Splenectomy, or the surgical removal of the spleen, is a common procedure for various medical conditions. However, it is not without risks. One of the most significant risks is overwhelming post-splenectomy infection (OPSI), which can be fatal. Patients who have had a splenectomy are at a lifetime risk of 5% for OPSI, with the most common causative organism being the pneumococcus. Therefore, it is crucial for these patients to receive vaccinations and prophylactic antibiotics.

      While splenectomy is not typically performed for cancer or liver fibrosis, it may be beneficial for certain haematological disorders such as autoimmune haemolytic anaemia and hereditary spherocytosis. In rare cases, splenectomy may also be indicated for patients with Hodgkin’s disease who are refractory to medical therapy.

      Overall, the decision to undergo splenectomy should be carefully considered, weighing the potential benefits against the risks. Close monitoring and appropriate preventative measures should be taken to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Haematology
      14.1
      Seconds
  • Question 4 - A 28-year-old female patient presents to her GP with cyclical pelvic pain and...

    Correct

    • A 28-year-old female patient presents to her GP with cyclical pelvic pain and painful bowel movements. She has previously sought treatment from gynaecology and found relief with paracetamol and mefenamic acid, but the pain has returned and she is seeking alternative options. She is not pregnant but plans to start a family within the next few years.

      What is the most appropriate next step in managing this patient's condition from the options provided below?

      Your Answer: Combined oral contraceptive pill

      Explanation:

      If simple analgesia with paracetamol and NSAIDs is not effective in treating endometriosis symptoms, hormonal treatment with the combined oral contraceptive pill or a progestogen should be considered.

      Although a referral to gynaecology may be necessary due to the recurrence of symptoms and potential pelvic/bowel involvement, primary care can offer further treatment options in the meantime. Hormonal treatment is recommended for this patient, and the combined oral contraceptive pill or any progestogen options can be considered. As the patient plans to start a family soon, a hormonal option that can be quickly reversed is preferred.

      Buscopan is not an appropriate treatment for endometriosis. While it may provide some relief for pelvic symptoms during menstruation, it is not a treatment for the condition. It may be used to alleviate cramps associated with irritable bowel syndrome.

      Injectable depo-provera is not the best option for this patient as it may delay the return of fertility, which conflicts with her desire to start a family soon.

      Opioid analgesia is not recommended for endometriosis treatment as it carries the risk of side effects and dependence. It is not a suitable long-term solution for managing symptoms.

      Endometriosis is a condition where endometrial tissue grows outside of the uterus, affecting around 10% of women of reproductive age. Symptoms include chronic pelvic pain, painful periods, pain during sex, and subfertility. Diagnosis is made through laparoscopy, and treatment depends on the severity of symptoms. First-line treatments include NSAIDs and hormonal treatments such as the combined oral contraceptive pill or progestogens. If these do not improve symptoms or fertility is a priority, referral to secondary care may be necessary. Treatment options in secondary care include GnRH analogues and surgery, with laparoscopic excision or ablation of endometriosis plus adhesiolysis recommended for women trying to conceive. Ovarian cystectomy may also be necessary for endometriomas.

    • This question is part of the following fields:

      • Gynaecology And Breast
      33.2
      Seconds
  • Question 5 - A 32-year-old woman presents with heavy menstrual bleeding and a haemoglobin level of...

    Correct

    • A 32-year-old woman presents with heavy menstrual bleeding and a haemoglobin level of 102 g/L. Iron studies are ordered. What result would indicate a diagnosis of iron-deficiency anaemia?

      Your Answer: ↓ Ferritin, ↑ total iron-binding capacity, ↓ serum iron, ↓ transferrin saturation

      Explanation:

      In cases of iron-deficiency anemia, it is common for both the total iron-binding capacity (TIBC) and transferrin levels to be elevated. However, it should be noted that the transferrin saturation level is typically decreased.

      Iron deficiency anaemia is a prevalent condition worldwide, with preschool-age children being the most affected. The lack of iron in the body leads to a decrease in red blood cells and haemoglobin, resulting in anaemia. The primary causes of iron deficiency anaemia are excessive blood loss, inadequate dietary intake, poor intestinal absorption, and increased iron requirements. Menorrhagia is the most common cause of blood loss in pre-menopausal women, while gastrointestinal bleeding is the most common cause in men and postmenopausal women. Vegans and vegetarians are more likely to develop iron deficiency anaemia due to the lack of meat in their diet. Coeliac disease and other conditions affecting the small intestine can prevent sufficient iron absorption. Children and pregnant women have increased iron demands, and the latter may experience dilution due to an increase in plasma volume.

      The symptoms of iron deficiency anaemia include fatigue, shortness of breath on exertion, palpitations, pallor, nail changes, hair loss, atrophic glossitis, post-cricoid webs, and angular stomatitis. To diagnose iron deficiency anaemia, a full blood count, serum ferritin, total iron-binding capacity, transferrin, and blood film tests are performed. Endoscopy may be necessary to rule out malignancy, especially in males and postmenopausal females with unexplained iron-deficiency anaemia.

      The management of iron deficiency anaemia involves identifying and treating the underlying cause. Oral ferrous sulfate is commonly prescribed, and patients should continue taking iron supplements for three months after the iron deficiency has been corrected to replenish iron stores. Iron-rich foods such as dark-green leafy vegetables, meat, and iron-fortified bread can also help. It is crucial to exclude malignancy by taking an adequate history and appropriate investigations if warranted.

    • This question is part of the following fields:

      • Haematology
      68.6
      Seconds
  • Question 6 - Sophie is a 4-year-old girl who has been brought in by her father...

    Incorrect

    • Sophie is a 4-year-old girl who has been brought in by her father with a 2 day history of cough and fever. Her father describes the cough sounds like a bark and today Sophie has appeared more breathless.

      On examination, Sophie appears alert with moist mucous membranes. You observe nasal flaring and moderate intercostal recession. You check Sophie's temperature which is 38.2°C and oxygen saturation is 97% in air. Her respiratory rate is 52 breaths per minute and heart rate is 138 beats per minute.

      What red flag symptoms have you observed in Sophie?

      Your Answer: Respiratory rate of 52 breaths per minute

      Correct Answer: Moderate intercostal recession

      Explanation:

      When a child has a fever, moderate or severe intercostal recession is a concerning symptom. This is considered a red flag according to NICE guidelines, which indicate a high risk of serious illness. Other red flag symptoms include those in the amber risk category, such as nasal flaring and a respiratory rate over 40 breaths per minute for children over 12 months old. A heart rate of 138 beats per minute is not a red flag symptom, but a heart rate over 140 beats per minute for children aged 2-5 years is considered an amber symptom. A temperature of 38°C or higher is only a red flag symptom for infants aged 0-3 months.

      The NICE Feverish illness in children guidelines were introduced in 2007 and updated in 2013 to provide a ‘traffic light’ system for assessing the risk of febrile illness in children under 5 years old. The guidelines recommend recording the child’s temperature, heart rate, respiratory rate, and capillary refill time, as well as looking for signs of dehydration. Measuring temperature should be done with an electronic thermometer in the axilla for children under 4 weeks or with an electronic/chemical dot thermometer in the axilla or an infra-red tympanic thermometer. The risk stratification table categorizes children as green (low risk), amber (intermediate risk), or red (high risk) based on their symptoms. Management recommendations vary depending on the risk level, with green children managed at home, amber children provided with a safety net or referred to a specialist, and red children urgently referred to a specialist. The guidelines also advise against prescribing oral antibiotics without an apparent source of fever and note that a chest x-ray is not necessary if a child with suspected pneumonia is not being referred to the hospital.

    • This question is part of the following fields:

      • Children And Young People
      30.3
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  • Question 7 - A 2-year-old girl is brought to the clinic by her mother. She has...

    Correct

    • A 2-year-old girl is brought to the clinic by her mother. She has a history of recurrent otitis media and has been touching her right ear frequently for the past 3 days. She was restless and had a fever overnight, and now has a red, boggy swelling behind her right ear that is more prominent than on the left. During the examination, the child appears unhappy, with a temperature of 39.2ºC, a heart rate of 170 beats/minute, and a respiratory rate of 28 breaths/minute. Due to her distress, it is difficult to examine her ears, but the left ear canal and tympanic membrane appear normal, while the right ear canal and tympanic membrane appear red. What is the most probable diagnosis?

      Your Answer: Mastoiditis

      Explanation:

      Mastoiditis is a bacterial infection that is particularly serious and commonly affects children. It often occurs as a result of prolonged otitis media. The infection can cause the porous bone to deteriorate, and severe cases may require surgery and intravenous antibiotics. Acute otitis media is an infection of the inner ear and typically doesn’t cause swelling. However, mastoiditis can develop as a complication of otitis media. The patient in question has no history of trauma that could explain the described swelling, which is also not in the correct location to be a parotid swelling. While lymphadenitis can cause an erythematous swelling, it is usually described as soft, fluctuant, and tender and is typically found post auricularly rather than over the mastoid process.

      In 2008, NICE released guidelines for the management of respiratory tract infections in primary care, specifically focusing on the prescribing of antibiotics for self-limiting infections in both adults and children. The guidelines recommend a no antibiotic or delayed antibiotic prescribing approach for acute otitis media, acute sore throat/acute pharyngitis/acute tonsillitis, common cold, acute rhinosinusitis, and acute cough/acute bronchitis. However, an immediate antibiotic prescribing approach may be considered for certain patients, such as children under 2 years with bilateral acute otitis media or patients with acute sore throat/acute pharyngitis/acute tonsillitis who have 3 or more Centor criteria present. The guidelines also suggest advising patients on the expected duration of their respiratory tract infection. If a patient is deemed at risk of developing complications, an immediate antibiotic prescribing policy is recommended. This includes patients who are systemically unwell, have symptoms and signs suggestive of serious illness and/or complications, or are at high risk of serious complications due to pre-existing comorbidity.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      104.4
      Seconds
  • Question 8 - A parent mentions she has received a letter about her child taking part...

    Incorrect

    • A parent mentions she has received a letter about her child taking part in the National Child Measurement Program, where all Year 4 & Year 8 children have their Body Mass Index measured. Data is collated nationally, and used to analyse trends and inform the planning of health services. In some areas the children and parents are not routinely informed of their individual results. How might the main purpose of this initiative be described?

      Your Answer: Confidential enquiry

      Correct Answer: Health surveillance

      Explanation:

      Public health is a crucial aspect of the RCGP curriculum, with a focus on promoting health and preventing disease. GPs are required to understand the surveillance systems involved in public health. An example of a health surveillance program in the UK is the National Child Measurement Program, which involves the continuous collection, analysis, and interpretation of health-related data for public health practice. Health protection involves safeguarding the public against health threats, such as air pollution or infectious diseases. Health promotion aims to empower individuals to improve their health, such as through education on healthy eating or access to smoking cessation services. Screening involves testing a population or subgroup for a disease in its early stages to provide early treatment and improve outcomes. Examples of screening programs in the UK include breast, cervical, and bowel cancer screening. Confidential enquiries are investigations into morbidity and mortality to identify areas for improvement, such as the annual Confidential Enquiry into Maternal and Child Health (CEMACH).

      Understanding Health Promotion and Surveillance

      Health promotion refers to the process of empowering individuals to take control of their health and improve it. This is achieved through various means such as education, awareness campaigns, and access to healthcare services. The World Health Organisation defines health promotion as a continuous process that enables people to increase their control over their health.

      On the other hand, health surveillance is the systematic collection, analysis, and interpretation of health-related data. This data is used to plan, implement, and evaluate public health practices. Health surveillance is crucial in identifying health trends and patterns, which can help in the prevention and control of diseases. An example of health surveillance is the National Child Measurement Program, which collects data on childhood obesity.

      In summary, health promotion and surveillance are essential components of public health. Health promotion empowers individuals to take control of their health, while health surveillance provides valuable data that can be used to plan and implement effective public health interventions.

    • This question is part of the following fields:

      • Population Health
      26.6
      Seconds
  • Question 9 - A 21-year-old female contacts the clinic seeking advice. She has been prescribed a...

    Correct

    • A 21-year-old female contacts the clinic seeking advice. She has been prescribed a monophasic combined oral contraceptive pill and takes 21 active pills followed by a pill-free week each cycle. However, she has missed taking some of her pills while away from home and is now concerned as she has been sexually active during this time. Her periods are regular, occurring every 28 days, and she usually bleeds for four days during her pill-free interval. She reports no unscheduled bleeding and has always remembered to take her pill every morning until this cycle. Upon further questioning, she reveals that she missed her pill on two consecutive days (days 15 and 16) of her current cycle, which started 19 days ago. She has taken the pills on days 17, 18, and 19 correctly and was sexually active on day 16 (72 hours ago). She has not missed any previous pills in this packet prior to day 15 and also took her last packet correctly. She has not been sexually active since day 16. What advice should she be given?

      Your Answer: Emergency contraception is not required and she should continue to take her pill as per usual

      Explanation:

      Missed Pills and Emergency Contraception

      A missed pill is when 24 hours have passed since it should have been taken. If only one pill is missed, contraceptive cover is still intact as long as further pills are taken regularly and reliably as directed. However, missing two or more pills or starting the pill pack two or more days late may impact contraceptive cover, and emergency contraception should be considered.

      If two pills have been missed, the most recent missed pill should be taken as soon as possible, and the remaining pills in the pill packet should be taken as prescribed. Condoms or abstinence should be advised until seven pills have been taken consecutively.

      If the pills are missed in week one of the packet (pills 1-7), emergency contraception should be considered if unprotected intercourse has occurred in the pill-free interval or in week one of pill taking. If two or more pills are missed in week two (pills 8-14), emergency contraception is not required if the pills in the preceding seven days have been taken consistently and correctly (assuming the pills thereafter are taken correctly and additional contraceptive precautions are used).

      If two or more pills are missed in the third week (pills 15-21), emergency contraception is not required if the pill-free interval is omitted. Therefore, if a woman has missed two pills on consecutive days in the third week, emergency contraception is not required if the pill-free interval is omitted. She should also be advised to use condoms or abstain from sexual intercourse until she has taken seven pills consecutively and reliably.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      86.7
      Seconds
  • Question 10 - A 6-year-old child comes to the clinic with his father, he has severe...

    Correct

    • A 6-year-old child comes to the clinic with his father, he has severe eczema affecting his hands, flexural surfaces of his arms and legs and his neck.
      He is very upset by it and his father wants something to be done.
      What is the recommended course of action for this child?

      Your Answer: Localised dressings can be used on top of emollients during initial treatment of the eczema flare

      Explanation:

      Treatment Recommendations for Childhood Eczema

      Topical tacrolimus and pimecrolimus should only be used in children with eczema who have not responded to other treatments. antihistamines are not typically recommended for childhood eczema unless there is a specific issue with itching. However, emollients should be applied generously and can even be covered with a local bandage during the initial stages of treatment. It is important to follow these guidelines to effectively manage childhood eczema and provide relief for the child.

    • This question is part of the following fields:

      • Children And Young People
      30.7
      Seconds
  • Question 11 - Which of the following does NHS offer routine screening for? ...

    Incorrect

    • Which of the following does NHS offer routine screening for?

      Your Answer: Prostate cancer

      Correct Answer: Abdominal aortic aneurysm

      Explanation:

      The NHS operates various screening programs, with all men being offered an ultrasound scan to screen for abdominal aortic aneurysm (AAA) in the year they turn 65. The UK National Screening Committee evaluates evidence to determine which conditions should be screened for. Some conditions, such as prostate cancer, glaucoma, and congenital adrenal hyperplasia, are currently under review but are not yet part of routine screening. It is important to note that the NHS recommends a Prostate cancer ‘risk management’ program rather than a screening program. Men can request screening with a PSA test after receiving counseling, but they are not routinely invited for screening.

      Understanding Abdominal Aortic Aneurysms

      Abdominal aortic aneurysms occur when the elastic proteins in the extracellular matrix fail, causing the arterial wall to dilate. This is typically caused by degenerative disease and can be identified by a diameter of 3 cm or greater. The development of aneurysms is complex and involves the loss of the intima and elastic fibers from the media, which is associated with increased proteolytic activity and lymphocytic infiltration.

      Smoking and hypertension are major risk factors for the development of aneurysms, while rare causes include syphilis and connective tissue diseases such as Ehlers Danlos type 1 and Marfan’s syndrome. It is important to understand the underlying causes and risk factors for abdominal aortic aneurysms in order to prevent and treat this potentially life-threatening condition.

    • This question is part of the following fields:

      • Population Health
      13.9
      Seconds
  • Question 12 - A 32-year-old man presents to you with his test results. He has experienced...

    Incorrect

    • A 32-year-old man presents to you with his test results. He has experienced three instances of a swollen left big toe in the past year. As a delivery driver, each episode prevents him from working for at least 5 days. He typically takes paracetamol and ibuprofen, but was given colchicine during his last attack which greatly improved his symptoms. He is not currently taking any other medications. A colleague ordered a blood test 4 weeks after his most recent episode, which revealed a serum urate level of 450µmol/L. He is curious if there are any preventative measures he can take to avoid future attacks. What would be your recommended course of action?

      Your Answer: Start allopurinol when he gets the next attack

      Correct Answer: Start allopurinol now

      Explanation:

      Gout Treatment Guidelines

      Gout is a condition that requires proper management to prevent acute attacks and complications. When initiating prophylactic medication for gout, it is important to be aware of the criteria for starting allopurinol. This medication can be started after two or more attacks of gout within a year or after the first attack in people at higher risk. However, allopurinol should not be initiated during an acute attack and should be started 1-2 weeks after inflammation has settled. The dose should be titrated every few weeks until the serum uric acid level is below 300µmol/L.

      When starting allopurinol, a non-steroidal anti-inflammatory tablet or colchicine should be co-prescribed and advised if an acute attack is precipitated. It is important to note that colchicine is only used for acute attacks and should not be used lifelong or for prophylaxis. Fenbuxostat is second-line therapy if allopurinol is not tolerated or is contraindicated.

      A rheumatology referral is not indicated at present and should only be instigated if the diagnosis is uncertain or the patient is having acute attacks despite maximum doses of prophylactic medication or if complications are present. For more information on gout treatment guidelines, please refer to the CKS website.

    • This question is part of the following fields:

      • Musculoskeletal Health
      83.6
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  • Question 13 - A 72-year-old man who rarely visits the clinic is brought in by his...

    Correct

    • A 72-year-old man who rarely visits the clinic is brought in by his daughter with complaints of orthopnoea, paroxysmal nocturnal dyspnoea and swollen ankles that have been present for a few weeks. On examination, he has bilateral basal crepitations and a resting heart rate of 110 beats per minute. An ECG shows sinus rhythm and an echocardiogram reveals a reduced ejection fraction. He responds well to treatment with optimal doses of an ACE inhibitor and furosemide. What is the most accurate statement regarding his future management?

      Your Answer: He should be started on a ß-blocker

      Explanation:

      Treatment Options for Chronic Heart Failure

      Chronic heart failure is a serious condition that requires proper management to improve patient outcomes. One of the recommended treatment options is the prescription of a cardioselective β-blocker such as carvedilol. However, it should not be taken at the same time as an ACE inhibitor. While diuretics can help control oedema, the mainstay of treatment for chronic heart failure is ACE inhibitors and β-blockade. Although digoxin and spironolactone may have a place in treatment, they are not first or second line options. For severe cases of heart failure, biventricular pacing with an implantable defibrillator can be useful. Overall, a combination of these treatment options can help manage chronic heart failure and improve patient outcomes.

    • This question is part of the following fields:

      • Cardiovascular Health
      39.5
      Seconds
  • Question 14 - Which statement about childhood vaccination is accurate? ...

    Incorrect

    • Which statement about childhood vaccination is accurate?

      Your Answer: Freezing vaccines has no impact on their efficacy

      Correct Answer: Children with stable neurological disorders should be immunised as per schedule

      Explanation:

      Important Information about Vaccinations

      Vaccinations are an essential part of maintaining good health and preventing the spread of diseases. The MMR vaccine, for example, should be given twice – once at around 1 year and then repeated as a Preschool booster – to improve immune response. On the other hand, live polio vaccination has been replaced by an injectable inactive polio vaccine.

      It is crucial to maintain the cold chain for vaccines, as they can be damaged by freezing. Additionally, while vaccinations can be given to pregnant women on occasion, live vaccines are contraindicated. It is also important to note that children with stable neurological conditions like spina bifida should be vaccinated as per schedule.

      Overall, vaccinations are a vital tool in protecting ourselves and our communities from the spread of diseases. By following the recommended vaccination schedule and guidelines, we can ensure that we are doing our part in promoting good health and preventing the spread of illnesses.

    • This question is part of the following fields:

      • Children And Young People
      28.3
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  • Question 15 - A father visits you in general practice with concerns about his 2-year-old daughter...

    Correct

    • A father visits you in general practice with concerns about his 2-year-old daughter who has biliary atresia. He has been informed by the paediatric gastroenterologist that her condition has deteriorated and she requires a liver transplant. The father is feeling anxious and upset and is seeking further information about the procedure. As his GP, what is the best advice you can provide him regarding liver transplantation?

      Your Answer: The donor must be tested for hepatitis B and C

      Explanation:

      Myth-busting Facts about Pediatric Liver Transplantation

      Pediatric liver transplantation is a complex medical procedure that involves replacing a diseased liver with a healthy one from a donor. However, there are several misconceptions surrounding this life-saving surgery. Here are some myth-busting facts about pediatric liver transplantation:

      – The donor must be tested for hepatitis B and C: A potential living donor with antibodies to hepatitis B and C would usually be ruled out as a donor.
      – HLA matching is necessary for kidney, heart, and lung transplants, but not for liver transplants: Blood-group compatibility is necessary, and a relative is more likely to be a match.
      – Immunosuppression is usually required for life, not just 12 months after transplant: While the regimen can be reduced with time, complete withdrawal is only successful in a small number of individuals.
      – Prednisolone is not the only immunosuppressant needed after transplant: A combination of drugs, including prednisolone, ciclosporin, tacrolimus, mycophenolate mofetil, azathioprine, and sirolimus, are commonly used.
      – Survival at one year after liver transplantation is higher than 50% in children: One-year survival is 80% for all children transplanted and may reach 90% for children with biliary atresia.

      It is important to dispel these myths and provide accurate information about pediatric liver transplantation to help families make informed decisions about their child’s health.

    • This question is part of the following fields:

      • Allergy And Immunology
      43.2
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  • Question 16 - A 55-year-old carpenter comes to see you in surgery following an MI three...

    Incorrect

    • A 55-year-old carpenter comes to see you in surgery following an MI three months previously.

      He has made a full recovery but wants to ask about his diet.

      Which one of the following foods should he avoid?

      Your Answer: Margarine containing sitostanol esters

      Correct Answer: Pork

      Explanation:

      Tips for a Heart-Healthy Diet after a Heart Attack

      Following a heart attack, it is important to adopt a healthier overall diet to reduce the risk of future heart problems. Unhealthy diets have been attributed to up to 30% of all deaths from coronary heart disease (CHD). While reducing fat intake is important, exercise also plays a crucial role in maintaining heart health.

      Including canned and frozen fruits and vegetables in your diet is just as beneficial as fresh produce. A Mediterranean diet, which includes many protective elements for CHD, is recommended. Replacing butter with olive oil and mono-unsaturated margarine, such as those made from rape-seed or olive oil, is a healthier option. Organic butter is not any better for heart health than non-organic butter.

      To reduce cholesterol intake, it is recommended to eat less red meat and replace it with poultry. Margarine containing sitostanol ester may also help reduce cholesterol intake. Adding plant sterol to margarine has been shown to reduce serum low-density lipoprotein cholesterol. Eating more fish, including oily fish, at least once a week is also recommended.

      Switching to whole-grain bread instead of white bread and eating more root vegetables and green vegetables is also beneficial. Lastly, it is important to eat fruit every day. By following these tips, you can maintain a heart-healthy diet and reduce the risk of future heart problems.

    • This question is part of the following fields:

      • Cardiovascular Health
      87.5
      Seconds
  • Question 17 - A 45-year-old man comes to the surgery complaining of a productive cough. Upon...

    Incorrect

    • A 45-year-old man comes to the surgery complaining of a productive cough. Upon examination, he has a fever and bronchial breathing in the right lower zone. The working diagnosis is pneumonia and amoxicillin is prescribed with a chest x-ray scheduled for the following day. The patient has a medical history of Addison's disease and takes hydrocortisone (20 mg in the morning and 10 mg in the afternoon). What is the best course of action regarding his steroid dosage?

      Your Answer: Continue to take the same dose

      Correct Answer: Double hydrocortisone to 40 mg mornings and 20 mg afternoon

      Explanation:

      Corticosteroids are commonly prescribed medications that can be taken orally or intravenously, or applied topically. They mimic the effects of natural steroids in the body and can be used to replace or supplement them. However, the use of corticosteroids is limited by their numerous side effects, which are more common with prolonged and systemic use. These side effects can affect various systems in the body, including the endocrine, musculoskeletal, gastrointestinal, ophthalmic, and psychiatric systems. Some of the most common side effects include impaired glucose regulation, weight gain, osteoporosis, and increased susceptibility to infections. Patients on long-term corticosteroids should have their doses adjusted during intercurrent illness, and the medication should not be abruptly withdrawn to avoid an Addisonian crisis. Gradual withdrawal is recommended for patients who have received high doses or prolonged treatment.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      45.1
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  • Question 18 - A 62-year-old Chinese man who is a smoker visits his doctor with complaints...

    Incorrect

    • A 62-year-old Chinese man who is a smoker visits his doctor with complaints of a constantly congested nose and bloody discharge from the nose. What type of cancer is he most susceptible to?

      Your Answer: Laryngeal

      Correct Answer: Nasopharyngeal

      Explanation:

      Differentiating Head and Neck Cancers: Understanding Risk Factors and Symptoms

      Head and neck cancers can present with a variety of symptoms, making it important to understand the risk factors associated with each type of cancer. Nasopharyngeal carcinoma, for example, is more commonly found in Southeast Asia and is thought to be caused by both genetic susceptibility and environmental factors such as heavy alcohol intake and infection with Epstein-Barr virus. Symptoms include nasal obstruction, bloodstained sputum or nasal discharge, tinnitus, headache, ear fullness, and unilateral conductive hearing loss.

      Oral cancers, on the other hand, tend to present with a persistent lump in the mouth or with the patient possibly complaining of ear pain or pain on chewing. Smoking, chewing tobacco, and drinking alcohol are risk factors. Laryngeal cancers are also associated with smoking, but are more common in patients of black and white ethnicities.

      Malignant parotid tumors are rare, and there is no higher prevalence in patients of South Asian descent. Thyroid cancers, which are relatively common, tend to present with an unexplained lump or swelling in the front of the neck and a hoarse voice. Risk factors include exposure to ionizing radiation, thyroiditis and other thyroid diseases, as well as genetic predisposition.

      Understanding the different risk factors and symptoms associated with each type of head and neck cancer can help healthcare professionals make an accurate diagnosis and provide appropriate treatment.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      41.4
      Seconds
  • Question 19 - Galactorrhoea is a potential feature of which of the following conditions? ...

    Correct

    • Galactorrhoea is a potential feature of which of the following conditions?

      Your Answer: Hypothyroidism

      Explanation:

      Causes of Galactorrhoea: Understanding the Link to Hypothyroidism

      Galactorrhoea, the spontaneous flow of milk from the breast, can be caused by a variety of factors. Physiological causes include postpartum changes, hormonal fluctuations during puberty or menopause, and elevated prolactin levels due to conditions such as prolactinoma. Other medical conditions, such as chronic renal failure, bronchogenic carcinoma, and sarcoidosis, can also lead to galactorrhoea.

      One lesser-known cause of galactorrhoea is primary hypothyroidism. This occurs when the thyroid gland fails to produce enough thyroid hormone, leading to increased levels of thyroid-releasing hormone and subsequent secretion of prolactin. The longer the hypothyroidism goes untreated, the more likely it is to cause hyperprolactinaemia and galactorrhoea.

      It’s important to note that breast cancer and schizophrenia are not causes of galactorrhoea. While breast cancer may present with unilateral breast discharge, it is typically not milky. Schizophrenia itself doesn’t cause hyperprolactinaemia, but antipsychotic drugs used to treat the condition can. Other medications, such as antidepressants and spironolactone, can also produce galactorrhoea.

      In summary, galactorrhoea can have a variety of causes, including physiological changes, medical conditions, and certain medications. Primary hypothyroidism is one potential cause that should not be overlooked, as it can lead to hyperprolactinaemia and galactorrhoea if left untreated.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      10
      Seconds
  • Question 20 - A 27-year-old woman calls for guidance. She is 10 weeks pregnant and works...

    Correct

    • A 27-year-old woman calls for guidance. She is 10 weeks pregnant and works in a daycare with young children. She is seeking advice on which infections to avoid during early pregnancy. What viral illness is most likely to cause birth defects in the baby if the mother contracts it during the first trimester?

      Your Answer: Rubella

      Explanation:

      Maternal Rubella and Fetal Damage

      Maternal rubella infection during the first 8-10 weeks of pregnancy can result in fetal damage in as many as 90% of infants, with multiple defects being common. However, the risk of fetal damage decreases to 10-20% by 16 weeks gestation. After 16 weeks, fetal damage due to maternal rubella infection is rare. It is important for pregnant women to ensure they are vaccinated against rubella to prevent potential harm to their developing fetus.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      52.3
      Seconds
  • Question 21 - A 19-year-old long-distance runner who is currently preparing for a regional marathon approaches...

    Incorrect

    • A 19-year-old long-distance runner who is currently preparing for a regional marathon approaches the team doctor with an unusual sensation in her legs. She reports feeling numbness below her knee. Upon examination, the doctor notes sensory loss below the left knee in a non-dermatomal distribution. The doctor suspects a non-organic cause of her symptoms. What type of disorder is this an example of?

      Conversion disorder - typically involves loss of motor or sensory function. May be caused by stress.

      Your Answer: Malingering

      Correct Answer: Conversion disorder

      Explanation:

      Conversion disorder is a condition that often results in the loss of motor or sensory function and is believed to be triggered by stress.

      Unexplained Symptoms in Psychiatry

      In psychiatry, there are several terms used to describe patients who present with physical or psychological symptoms for which no organic cause can be found. Somatisation disorder is characterized by the presence of multiple physical symptoms that persist for at least two years, and the patient refuses to accept reassurance or negative test results. Illness anxiety disorder, also known as hypochondriasis, involves a persistent belief in the presence of an underlying serious disease, such as cancer, despite negative test results. Conversion disorder typically involves the loss of motor or sensory function, and the patient doesn’t consciously feign the symptoms or seek material gain. Dissociative disorder involves the process of separating off certain memories from normal consciousness, and may present with psychiatric symptoms such as amnesia, fugue, or stupor. Factitious disorder, also known as Munchausen’s syndrome, involves the intentional production of physical or psychological symptoms, while malingering refers to the fraudulent simulation or exaggeration of symptoms for financial or other gain. These terms help clinicians to better understand and diagnose patients with unexplained symptoms.

    • This question is part of the following fields:

      • Mental Health
      102.7
      Seconds
  • Question 22 - A 65-year-old man visits his GP urgently due to a recent increase in...

    Incorrect

    • A 65-year-old man visits his GP urgently due to a recent increase in his INR levels. He has been on Warfarin for a decade and has consistently maintained an INR reading between 2 and 3. However, his most recent blood test showed an INR of 6.2. He reports receiving a topical medication for a facial rash at a walk-in centre two weeks ago.
      What is the most probable treatment that led to the elevation in his INR?

      Your Answer: Miconazole

      Correct Answer: Mupirocin

      Explanation:

      Miconazole Oral Gel and Warfarin Interaction

      Miconazole oral gel, commonly known as Daktarin, is often used to treat candidal infections of the mouth and face. However, it can interact with the anticoagulant drug warfarin, which is metabolized by the CYP2C9 enzyme. Miconazole inhibits this enzyme, leading to increased levels of warfarin in the bloodstream and potentially causing bleeding. Other antimicrobial agents like Aciclovir, Clotrimazole, Fucidin, and Mupirocin can be used to treat infected rashes on the face, but they do not have significant interactions with warfarin. As a core competence of clinical management, safe prescribing and medicines management approaches should include awareness of common drug interactions, especially those that can affect patient safety when taking warfarin.

    • This question is part of the following fields:

      • Dermatology
      49.4
      Seconds
  • Question 23 - A 52-year-old man goes for a routine medical check-up before starting a new...

    Correct

    • A 52-year-old man goes for a routine medical check-up before starting a new job. He has no complaints, and his physical examination is unremarkable. Blood tests are ordered, and all the results are normal except for:

      Uric acid 0.66 mmol/l (0.18-0.48 mmol/l)

      After reading about gout online, the patient is concerned about his risk. What treatment should be started based on this finding?

      Your Answer: No treatment

      Explanation:

      NICE doesn’t recommend treating asymptomatic hyperuricaemia to prevent gout. While high levels of serum uric acid are associated with gout, it is possible to have hyperuricaemia without experiencing any symptoms. Primary prevention of gout in such cases has been found to be neither cost-effective nor beneficial to patients. Instead, lifestyle changes such as reducing consumption of red meat, alcohol, and sugar can help lower uric acid levels without the need for medication. The other options listed are only indicated for the treatment of gout when symptoms are present.

      Understanding Hyperuricaemia

      Hyperuricaemia is a condition characterized by elevated levels of uric acid in the blood. This can be caused by an increase in cell turnover or a decrease in the excretion of uric acid by the kidneys. While some individuals with hyperuricaemia may not experience any symptoms, it can be associated with other health conditions such as hyperlipidaemia, hypertension, and the metabolic syndrome.

      There are several factors that can contribute to the development of hyperuricaemia. Increased synthesis of uric acid can occur in conditions such as Lesch-Nyhan disease, myeloproliferative disorders, and with a diet rich in purines. On the other hand, decreased excretion of uric acid can be caused by drugs like low-dose aspirin, diuretics, and pyrazinamide, as well as pre-eclampsia, alcohol consumption, renal failure, and lead exposure.

      It is important to understand the underlying causes of hyperuricaemia in order to properly manage and treat the condition. Regular monitoring of uric acid levels and addressing any contributing factors can help prevent complications such as gout and kidney stones.

    • This question is part of the following fields:

      • Kidney And Urology
      25.9
      Seconds
  • Question 24 - A 26-year-old female patient visits her doctor complaining of an increase in the...

    Correct

    • A 26-year-old female patient visits her doctor complaining of an increase in the frequency of her migraine attacks. She is currently experiencing approximately four migraines per month. What medication would be the most suitable to prescribe in order to decrease the frequency of her migraine attacks?

      Your Answer: Beta-blocker

      Explanation:

      When it comes to treating migraines, the recommended acute treatment options are a combination of triptan with either NSAID or paracetamol. For prophylaxis, the first-line options are topiramate or propranolol. While topiramate is recommended by NICE, it’s important to consider that the patient is a woman of childbearing age, making a beta-blocker like propranolol a safer choice.

      Managing Migraines: Guidelines and Treatment Options

      Migraines can be debilitating and affect a significant portion of the population. To manage migraines, it is important to understand the different treatment options available. The National Institute for Health and Care Excellence (NICE) has provided guidelines for the management of migraines.

      For acute treatment, a combination of an oral triptan and an NSAID or paracetamol is recommended as first-line therapy. For young people aged 12-17 years, a nasal triptan may be preferred. If these measures are not effective or not tolerated, a non-oral preparation of metoclopramide or prochlorperazine may be offered, along with a non-oral NSAID or triptan.

      Prophylaxis should be considered if patients are experiencing two or more attacks per month. NICE recommends either topiramate or propranolol, depending on the patient’s preference, comorbidities, and risk of adverse events. Propranolol is preferred in women of childbearing age as topiramate may be teratogenic and reduce the effectiveness of hormonal contraceptives. Acupuncture and riboflavin may also be effective in reducing migraine frequency and intensity.

      For women with predictable menstrual migraines, frovatriptan or zolmitriptan may be used as a type of mini-prophylaxis. Specialists may also consider candesartan or monoclonal antibodies directed against the calcitonin gene-related peptide (CGRP) receptor, such as erenumab. However, pizotifen is no longer recommended due to common adverse effects such as weight gain and drowsiness.

      It is important to exercise caution with young patients as acute dystonic reactions may develop. By following these guidelines and considering the various treatment options available, migraines can be effectively managed and their impact on daily life reduced.

    • This question is part of the following fields:

      • Neurology
      35.9
      Seconds
  • Question 25 - A 71-year-old man presents with progressive gait disturbance and fluctuating confusion. His symptoms...

    Incorrect

    • A 71-year-old man presents with progressive gait disturbance and fluctuating confusion. His symptoms began about six months ago when he noticed a heaviness in his legs on walking to work. Since then, his handwriting has become more untidy. His wife reports that he has become increasingly forgetful at home, although he denies this. Over the last two months, he has become restless at night and has reported seeing unidentified objects moving on the walls and in the room. On examination, his Mini-Mental State Examination score is 24/30. He is symmetrically rigid and slow, with a mild, jerky tremor in the upper limbs. Cranial nerve examination is unremarkable. His gait is shuffling, with mildly impaired postural reflexes.
      The accumulation of which protein causes the underlying diagnosis?

      Your Answer: Beta-amyloid

      Correct Answer: Alpha-synuclein

      Explanation:

      Neurodegenerative Disorders and Associated Proteins

      Dementia with Lewy bodies (DLB) is a neurodegenerative disorder characterized by cognitive decline, visual hallucinations, and sleep disturbances. It is caused by the accumulation of alpha-synuclein into Lewy bodies in vulnerable neurons.

      Beta-amyloid plaques are insoluble and associated with Alzheimer’s disease. They can be detected in the brain before diagnosis and have subtle effects on cognition.

      Prions are abnormal proteins that induce abnormal folding of other proteins. They are difficult to inactivate and can cause Creutzfeldt-Jakob disease, a rapidly progressive neurodegenerative disorder.

      Tau proteins are microtubule-binding proteins associated with local neurodegeneration and cognitive impairment. They are seen in Alzheimer’s disease as flame-shaped neurofibrillary tangles.

      Overall, DLB is a good differential diagnosis for vascular dementia, but the clinical picture is more suggestive of DLB.

    • This question is part of the following fields:

      • Mental Health
      41.5
      Seconds
  • Question 26 - What is a Roger Neighbour 'checkpoint'? ...

    Correct

    • What is a Roger Neighbour 'checkpoint'?

      Your Answer: Safety Netting

      Explanation:

      Neighbour’s Consultation Model for Telehealth

      Roger Neighbour’s consultation model for doctors has been adapted for telehealth consultations. The model breaks down the consultation into five checkpoints that doctors should consider during the consultation.

      The first checkpoint is connecting, which involves building rapport with the patient. This is especially important in telehealth consultations where the doctor and patient may not have met before. The second checkpoint is summarising, which involves listening and eliciting information from the patient. This is important in all consultations, but particularly in telehealth where non-verbal cues may be missed.

      The third checkpoint is handing over, which involves explaining and negotiating with the patient. This is important in telehealth consultations where the doctor may need to explain complex medical information to the patient. The fourth checkpoint is safety netting, which involves anticipating potential issues and dealing with uncertainty. This is particularly important in telehealth consultations where the doctor may not have access to all the patient’s medical information.

      The final checkpoint is housekeeping, which involves addressing the doctor’s own needs. This is important in telehealth consultations where the doctor may be working from home and need to ensure they have a suitable environment for the consultation. By following these checkpoints, doctors can ensure that their telehealth consultations are effective and provide the best possible care for their patients.

    • This question is part of the following fields:

      • Consulting In General Practice
      14.4
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  • Question 27 - A 68-year-old man presents for follow-up of his atrial fibrillation. He recently underwent...

    Incorrect

    • A 68-year-old man presents for follow-up of his atrial fibrillation. He recently underwent catheter ablation for atrial fibrillation and it was successful.

      The patient has a medical history of hypertension and type 2 diabetes. His most recent blood pressure reading was 150/92 mmHg.

      What is the optimal approach for managing his anticoagulation?

      Your Answer: Repeat an ECG in 3 months, and if the patient remains in sinus rhythm stop anticoagulation

      Correct Answer: Continue anticoagulation long-term

      Explanation:

      Patients who have undergone catheter ablation for atrial fibrillation must continue with long-term anticoagulation based on their CHA2DS2-VASc score. According to the guidelines of the American College of Cardiology, the decision to discontinue anticoagulation after two months of catheter ablation should be based on the patient’s stroke risk profile, not on the outcome of the procedure. There is no published evidence that it is safe to stop anticoagulation after ablation if the CHA2DS2-Vasc score is equal to or greater than 1. Therefore, in the given scenario, since the CHA2DS2-VASc score indicates moderate to high risk (3 points), anticoagulation should be continued.

      Although monitoring heart rhythm is crucial due to the risk of recurrence, anticoagulation should still be continued even if the patient remains in sinus rhythm. Blood pressure readings do not provide any indication to stop anticoagulation.

      Atrial fibrillation (AF) is a heart condition that requires prompt management. The management of AF depends on the patient’s haemodynamic stability and the duration of the AF. For haemodynamically unstable patients, electrical cardioversion is recommended. For haemodynamically stable patients, rate control is the first-line treatment strategy, except in certain cases. Medications such as beta-blockers, calcium channel blockers, and digoxin are commonly used to control the heart rate. Rhythm control is another treatment option that involves the use of medications such as beta-blockers, dronedarone, and amiodarone. Catheter ablation is recommended for patients who have not responded to or wish to avoid antiarrhythmic medication. The procedure involves the use of radiofrequency or cryotherapy to ablate the faulty electrical pathways that cause AF. Anticoagulation is necessary before and during the procedure to reduce the risk of stroke. The success rate of catheter ablation varies, with around 50% of patients experiencing an early recurrence of AF within three months. However, after three years, around 55% of patients who have undergone a single procedure remain in sinus rhythm.

    • This question is part of the following fields:

      • Cardiovascular Health
      55.9
      Seconds
  • Question 28 - A 15-year-old boy with Down's Syndrome and his guardian visit their General Practitioner...

    Correct

    • A 15-year-old boy with Down's Syndrome and his guardian visit their General Practitioner for a check-up as the boy has been struggling with his schoolwork. What are the National Institute for Health and Care Excellence's recommendations for annual health checks for individuals with a learning disability by General Practitioners?

      Your Answer: Current health interventions should be reviewed

      Explanation:

      Importance of Annual Physical Health Checks for People with Learning Disabilities

      The National Institute for Health and Care Excellence recommends that people with learning disabilities should receive an annual physical health check in all settings. This check should be carried out using a standardised template, such as the Welsh health check template, and should include a review of any known or emerging challenging behaviour and how it may be linked to any physical health problems.

      The physical health review should also include a review of current health interventions, including medication and related side effects, drug interactions, and adherence. An agreed and shared care plan for managing any physical health problems, including pain, should also be developed.

      It is important to note that the annual physical health check should be carried out together with a family member, carer, healthcare professional, or social care practitioner who knows the person. This is to ensure that the patient receives the best possible care and that any physical health problems are identified and managed appropriately.

      In conclusion, annual physical health checks are crucial for people with learning disabilities to ensure that any physical health problems are identified and managed appropriately. It is important that healthcare professionals follow the recommended guidelines and carry out these checks in all settings.

    • This question is part of the following fields:

      • Neurodevelopmental Disorders, Intellectual And Social Disability
      67.9
      Seconds
  • Question 29 - Which of the following conditions is NOT inherited in an X-linked recessive fashion?...

    Incorrect

    • Which of the following conditions is NOT inherited in an X-linked recessive fashion?

      Your Answer: Haemophilia B

      Correct Answer: Myotonic dystrophy

      Explanation:

      The following are X-linked conditions: Duchenne/Becker, haemophilia, and G6PD.

      X-Linked Recessive Conditions: Inherited Disorders with Varying Patterns

      X-linked recessive conditions are genetic disorders that are inherited in a specific manner. These conditions are caused by mutations in genes located on the X chromosome, which is one of the two sex chromosomes. As a result, these conditions are more common in males than in females, as males only have one X chromosome while females have two.

      Some of the most well-known X-linked recessive conditions include Duchenne muscular dystrophy, haemophilia A and B, and colour blindness. Other conditions such as Fabry’s disease, Lesch-Nyhan syndrome, and Wiskott-Aldrich syndrome are also inherited in this manner.

      It is important to note that some diseases have varying patterns of inheritance, with the majority being in an X-linked recessive fashion. For example, chronic granulomatous disease is inherited in over 70% of cases in an X-linked recessive manner. Understanding the inheritance patterns of these conditions is crucial for genetic counseling and management of affected individuals.

    • This question is part of the following fields:

      • Children And Young People
      24.6
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  • Question 30 - A 25-year-old crystal healer who lives alone says she doesn't have a best...

    Correct

    • A 25-year-old crystal healer who lives alone says she doesn't have a best friend and thinks that people judge her unfairly. She says that the power of crystals will cure leukaemia and sometimes feels that her life story appears in magazine stories.
      Select from the list the single best description of her personality type.

      Your Answer: Schizotypal

      Explanation:

      Understanding Personality Disorders: Clusters and Characteristics

      Personality disorders are not easy to diagnose, but they can be seen as extreme versions of normal behavior that affect an individual’s social functioning. Psychotherapy and cognitive behavior therapy can be helpful, and medication may be used in some cases. These disorders can be grouped into three clusters: odd, dramatic, and anxious. The odd PDs include paranoid, schizotypal, and schizoid. The dramatic PDs include histrionic, borderline, narcissistic, and antisocial. The anxious PDs include dependent, obsessive-compulsive, and avoidant. Borderline personality disorder is characterized by fear of abandonment, unstable relationships, and dangerous behavior. Histrionic personality disorder is characterized by excessive attention-seeking behavior and a need for approval.

    • This question is part of the following fields:

      • Mental Health
      137.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory Health (0/1) 0%
Metabolic Problems And Endocrinology (1/3) 33%
Haematology (2/2) 100%
Gynaecology And Breast (1/1) 100%
Children And Young People (1/4) 25%
Ear, Nose And Throat, Speech And Hearing (1/2) 50%
Population Health (0/2) 0%
Improving Quality, Safety And Prescribing (1/1) 100%
Musculoskeletal Health (0/1) 0%
Cardiovascular Health (1/3) 33%
Allergy And Immunology (1/1) 100%
Infectious Disease And Travel Health (1/1) 100%
Mental Health (1/3) 33%
Dermatology (0/1) 0%
Kidney And Urology (1/1) 100%
Neurology (1/1) 100%
Consulting In General Practice (1/1) 100%
Neurodevelopmental Disorders, Intellectual And Social Disability (1/1) 100%
Passmed