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Question 1
Incorrect
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A 32-year-old pregnant woman presents to your clinic with concerns about her rubella status. Her sister's child has recently been diagnosed with rubella, and she is currently 10 weeks pregnant.
What would be the initial course of action in this situation?Your Answer: Reassure her that while she may have contracted rubella there is no risk to her baby
Correct Answer: Discuss immediately with the local Health Protection Unit
Explanation:In case of suspected rubella during pregnancy, it is important to consult with the local Health Protection Unit for guidance on appropriate investigations. If the mother is found to be non-immune to rubella, the MMR vaccine should be administered after delivery. However, the risk of transmission to the fetus in this scenario is uncertain. If transmission does occur, particularly later in the pregnancy, it can cause significant harm to the developing fetus. Hospitalization is not necessary at this point.
Rubella and Pregnancy: Risks, Features, Diagnosis, and Management
Rubella, also known as German measles, is a viral infection caused by the togavirus. Thanks to the introduction of the MMR vaccine, rubella is now rare. However, if contracted during pregnancy, there is a risk of congenital rubella syndrome. It is important to note that the incubation period is 14-21 days, and individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash.
The risk of damage to the fetus is as high as 90% in the first 8-10 weeks of pregnancy, but damage is rare after 16 weeks. Congenital rubella syndrome can cause a range of features, including sensorineural deafness, congenital cataracts, congenital heart disease, growth retardation, hepatosplenomegaly, purpuric skin lesions, ‘salt and pepper’ chorioretinitis, microphthalmia, and cerebral palsy.
If a suspected case of rubella in pregnancy arises, it should be discussed immediately with the local Health Protection Unit (HPU) as type/timing of investigations may vary. IgM antibodies are raised in women recently exposed to the virus. It is important to note that it is very difficult to distinguish rubella from parvovirus B19 clinically. Therefore, it is crucial to check parvovirus B19 serology as there is a 30% risk of transplacental infection, with a 5-10% risk of fetal loss.
If a woman is tested at any point and no immunity is demonstrated, they should be advised to keep away from people who might have rubella. Non-immune mothers should be offered the MMR vaccination in the postnatal period. However, MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 2
Incorrect
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A 68-year-old man has been diagnosed with age-related macular degeneration. He wants to know if he can do anything to prevent it from worsening.
What is the most crucial preventive measure? Choose ONE option only.Your Answer:
Correct Answer: Smoking cessation
Explanation:Preventing Age-Related Macular Degeneration: Strategies and Misconceptions
Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults. While some risk factors, such as age and genetics, cannot be modified, there are strategies that can help prevent or slow the progression of the disease. However, there are also misconceptions about certain interventions.
Smoking cessation is the most important modifiable factor in preventing AMD. Current smokers have a two to three times higher risk of developing the disease compared to non-smokers. Quitting smoking can also reduce the risk of progression in those who already have AMD.
Antioxidant supplements, specifically the AREDS2 formula containing vitamin C and E, lutein, zeaxanthin, zinc, and copper, may reduce the risk of progression by 25% in patients with intermediate AMD. However, there is no evidence to support their use in lesser disease or primary prevention.
While some studies have suggested a benefit of eating oily fish, the Royal College of Ophthalmologists recommends a diet rich in leafy green vegetables and fresh fruit to improve concentrations of macular pigment.
There is no conclusive evidence that statins, medications used to lower cholesterol, have an effect on AMD progression. Similarly, treating hypertension, while a risk factor for AMD, doesn’t reduce the risk of developing the disease.
In summary, smoking cessation and antioxidant supplements may be effective strategies for preventing or slowing the progression of AMD, while eating a healthy diet and managing other health conditions can also be beneficial. However, it is important to be aware of misconceptions about certain interventions and to consult with a healthcare professional for personalized recommendations.
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This question is part of the following fields:
- Eyes And Vision
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Question 3
Incorrect
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A 27-year-old woman on antiepileptic medication presents with nausea, diarrhoea, drowsiness, weight gain and thinning of hair.
Select the medication that is most likely to cause these symptoms.Your Answer:
Correct Answer: Sodium valproate
Explanation:Common Side Effects of Antiepileptic Drugs
Antiepileptic drugs are commonly used to treat epilepsy, but they can also cause a range of side effects. The British National Formulary lists the most common side effects of these drugs, which include ataxia, tremor, nystagmus, blood dyscrasias, liver damage, pancreatitis, and weight gain.
Sodium valproate, for example, is associated with ataxia, tremor, nystagmus, blood dyscrasias, liver damage, and pancreatitis. Long-term use of this drug may also lead to weight gain. Phenytoin can cause gum hypertrophy, hirsutism, folate deficiency, osteomalacia, and neuropathy. Phenobarbital and carbamazepine can also cause folate deficiency, megaloblastic anemia, osteomalacia, and neuropathy.
Vigabatrin usage may cause aggression, alopecia, retinal atrophy, and reduced peripheral vision. Carbamazepine can also cause ataxia, nystagmus, diplopia, thrombocytopenia, and other blood dyscrasias. It is important to be aware of these potential side effects when taking antiepileptic drugs and to discuss any concerns with a healthcare provider.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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A 72-year-old woman is being seen for a routine medical check-up at her new GP practice. During the examination, her blood pressure is found to be 146/94 mmHg, which is confirmed on a second reading. According to the latest NICE recommendations, what would be the most suitable course of action?
Your Answer:
Correct Answer: Arrange ambulatory blood pressure monitoring
Explanation:NICE guidelines from 2011 acknowledge the issue of overtreatment of ‘white coat’ hypertension and recommend the use of ambulatory blood pressure monitoring (ABPM) to address this problem. ABPM is also considered a more reliable predictor of cardiovascular risk compared to clinic blood pressure readings, based on strong evidence.
NICE released updated guidelines in 2019 for the management of hypertension, building on previous guidelines from 2011. These guidelines recommend classifying hypertension into stages and using ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension. This is because some patients experience white coat hypertension, where their blood pressure rises in a clinical setting, leading to potential overdiagnosis of hypertension. ABPM and HBPM provide a more accurate assessment of a patient’s overall blood pressure and can help prevent overdiagnosis.
To diagnose hypertension, NICE recommends measuring blood pressure in both arms and repeating the measurements if there is a difference of more than 20 mmHg. If the difference remains, subsequent blood pressures should be recorded from the arm with the higher reading. NICE also recommends taking a second reading during the consultation if the first reading is above 140/90 mmHg. ABPM or HBPM should be offered to any patient with a blood pressure above this level.
If the blood pressure is above 180/120 mmHg, NICE recommends admitting the patient for specialist assessment if there are signs of retinal haemorrhage or papilloedema or life-threatening symptoms such as new-onset confusion, chest pain, signs of heart failure, or acute kidney injury. Referral is also recommended if a phaeochromocytoma is suspected. If none of these apply, urgent investigations for end-organ damage should be arranged. If target organ damage is identified, antihypertensive drug treatment may be started immediately. If no target organ damage is identified, clinic blood pressure measurement should be repeated within 7 days.
ABPM should involve at least 2 measurements per hour during the person’s usual waking hours, with the average value of at least 14 measurements used. If ABPM is not tolerated or declined, HBPM should be offered. For HBPM, two consecutive measurements need to be taken for each blood pressure recording, at least 1 minute apart and with the person seated. Blood pressure should be recorded twice daily, ideally in the morning and evening, for at least 4 days, ideally for 7 days. The measurements taken on the first day should be discarded, and the average value of all the remaining measurements used.
Interpreting the results, ABPM/HBPM above 135/85 mmHg (stage 1 hypertension) should be
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This question is part of the following fields:
- Cardiovascular Health
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Question 5
Incorrect
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You assess a 79-year-old male patient's hypertensive treatment and find that his current medication regimen of losartan and amlodipine is not effectively controlling his blood pressure. What would be the most suitable course of action, assuming there are no relevant contraindications?
Your Answer:
Correct Answer: Add indapamide MR 1.5mg od
Explanation:For poorly controlled hypertension in a patient already taking an ACE inhibitor and a calcium channel blocker, it is recommended to add a thiazide-like diuretic. However, NICE advises against using bendroflumethiazide and suggests alternative options. It is important to note that patients who are already taking bendroflumethiazide should not be switched to another thiazide-type diuretic. In this case, the patient is currently taking losartan, which is an angiotensin 2 receptor blocker. This may be due to previous issues with ACE inhibitor therapy, such as a dry cough. It is generally not recommended for patients to take both an ACE inhibitor and an A2RB simultaneously.
Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers.
Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight.
Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age.
The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added.
If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.
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This question is part of the following fields:
- Cardiovascular Health
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Question 6
Incorrect
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In the UK, there are several screening programs for significant health concerns, such as prostate cancer. A new screening test for prostate cancer is being assessed in comparison to the traditional use of PSA testing. There are concerns that this test may lead to overdiagnosis and overtreatment, as it detects many cases of prostate cancer that may never cause harm.
What type of bias is this?Your Answer:
Correct Answer: Lead time bias
Explanation:Lead-time bias occurs when a new test for a disease is compared to an older test, and the new test diagnosis the disease earlier. However, this earlier diagnosis doesn’t necessarily lead to an improvement in the outcome of the disease.
Length time bias is a phenomenon where a disease may progress at different rates, and slower-growing or less aggressive diseases have a higher chance of being detected through screening than faster-growing or more aggressive diseases.
Self-selection or volunteer bias occurs when people who participate in screening programs are not representative of the general population. Typically, those who participate in screening programs tend to have a higher socio-economic status and engage in other healthy lifestyle choices.
Procedure bias is a type of bias that can occur in comparative studies. It happens when patients are treated differently based on their group allocation.
Recall bias is a type of bias that can affect the accuracy of data collected retrospectively. For example, when examining past asbestos exposure, a patient may not be able to accurately recall the exact years they were exposed.
Understanding Bias in Clinical Trials
Bias refers to the systematic favoring of one outcome over another in a clinical trial. There are various types of bias, including selection bias, recall bias, publication bias, work-up bias, expectation bias, Hawthorne effect, late-look bias, procedure bias, and lead-time bias. Selection bias occurs when individuals are assigned to groups in a way that may influence the outcome. Sampling bias, volunteer bias, and non-responder bias are subtypes of selection bias. Recall bias refers to the difference in accuracy of recollections retrieved by study participants, which may be influenced by whether they have a disorder or not. Publication bias occurs when valid studies are not published, often because they showed negative or uninteresting results. Work-up bias is an issue in studies comparing new diagnostic tests with gold standard tests, where clinicians may be reluctant to order the gold standard test unless the new test is positive. Expectation bias occurs when observers subconsciously measure or report data in a way that favors the expected study outcome. The Hawthorne effect describes a group changing its behavior due to the knowledge that it is being studied. Late-look bias occurs when information is gathered at an inappropriate time, and procedure bias occurs when subjects in different groups receive different treatment. Finally, lead-time bias occurs when two tests for a disease are compared, and the new test diagnosis the disease earlier, but there is no effect on the outcome of the disease. Understanding these types of bias is crucial in designing and interpreting clinical trials.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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Question 7
Incorrect
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You assess a 65-year-old heavy smoker who has just been diagnosed with cancer and is hesitant to undergo surgery. He is interested in exploring the option of radiotherapy. Which tumour from the following list is most suitable for potentially curative treatment with RADIOTHERAPY ALONE? Choose only ONE option.
Your Answer:
Correct Answer: Laryngeal carcinoma
Explanation:Curative Treatment Options for Various Types of Cancer
Laryngeal Carcinoma:
The management of laryngeal cancer involves preserving the larynx whenever possible. For early-stage disease, transoral laser microsurgery or radiotherapy is used. For more advanced disease, radiotherapy with concomitant chemotherapy is the treatment of choice. Total laryngectomy may still be required for some cases.Breast Cancer:
Radiotherapy is used as an adjuvant to primary surgery in breast cancer. It significantly reduces breast-cancer-related deaths and local recurrence rates.Colonic Carcinoma:
Surgical resection of the tumor is the main curative treatment for colonic carcinoma in patients with localized disease. Radiotherapy is limited by the risk of damage to surrounding structures.Gastric Carcinoma:
Partial or total gastrectomy is the only curative treatment for gastric carcinoma. Radiotherapy is ineffective.Lung Cancer:
Surgical excision is the curative treatment for localised non-small cell carcinoma. Radiotherapy with curative intent may be offered to patients unsuitable for surgery with stage I, II or III non-small cell carcinoma and good performance status if there is no undue risk of normal tissue damage.Curative Treatment Options for Different Types of Cancer
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 8
Incorrect
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A 32-year-old man comes to the clinic complaining of a red eye on the left side that has been bothering him for three days. He reports experiencing photophobia, pain, blurred vision, and tearing. There is no visible discharge, and he has never had a similar episode before.
What would be the best course of action for managing this patient's symptoms?Your Answer:
Correct Answer: Refer to local eye casualty
Explanation:Urgent Referral for Potential Anterior Uveitis
The patient’s history suggests potential anterior uveitis (iritis), which requires urgent referral to an ophthalmologist for further management. Anterior uveitis is typically treated with a combination of therapies by an ophthalmologist. Cyclopentolate 1% eye drops may be used to dilate the pupil, reducing pain and the risk of glaucoma. Dexamethasone 0.1% eye drops are commonly used to reduce inflammation, but should only be prescribed after a slit lamp examination confirms the diagnosis. Ibuprofen can be used as an adjunct to reduce inflammation, but it is not the primary management option. Prednisolone is typically reserved for cases of treatment failure with eye drops or in treating posterior uveitis.
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This question is part of the following fields:
- Eyes And Vision
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Question 9
Incorrect
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During your weekly ward round at the local neurological rehabilitation care centre you see a 34-year-old man who has a background of depression, asthma and a traumatic spinal cord injury. The nurses report him being more distressed and agitated over the last two days.
On examination he is profusely sweating in the upper body and face, his blood pressure is 180/110mmHg, heart rate 60/min, oxygen saturations 99%, chest clear to auscultation and Glasgow coma scale 15, calves soft and non-tender, pupils equal and reactive. He admits to drinking 15 units/week and smokes 10 cigarettes/day. Regular medications include salbutamol, oxycodone, co-codamol 30/500 as required and prophylactic dose low molecular weight heparin.
What is the most likely underlying cause of the patient's symptoms?Your Answer:
Correct Answer: Autonomic dysreflexia
Explanation:The most common cause of autonomic dysreflexia is faecal impaction or urinary retention. Treatment involves addressing the underlying cause, which in this case is likely faecal impaction. Risk factors for impaction include immobility, certain medications, anatomic conditions, and neuropsychiatric conditions. The patient may have developed impaction due to the use of oxycodone and Co-codamol without laxatives. This is the only answer that would result in localised flushing above the level of the spinal cord injury.
Alcohol withdrawal is an incorrect answer as the patient’s alcohol consumption is not high enough to cause physical withdrawal symptoms.
Pulmonary embolism is also an incorrect answer as it would present with different symptoms such as tachycardia and signs of a DVT.
Serotonin syndrome is an incorrect answer as it would not cause localised sweating and may present with other symptoms such as tachycardia and dilated pupils.
Autonomic dysreflexia is a condition that occurs in patients who have suffered a spinal cord injury at or above the T6 spinal level. It is caused by a reflex response triggered by various stimuli, such as faecal impaction or urinary retention, which sends signals through the thoracolumbar outflow. However, due to the spinal cord lesion, the usual parasympathetic response is prevented, leading to an unbalanced physiological response. This response is characterized by extreme hypertension, flushing, and sweating above the level of the cord lesion, as well as agitation. If left untreated, severe consequences such as haemorrhagic stroke can occur. The management of autonomic dysreflexia involves removing or controlling the stimulus and treating any life-threatening hypertension and/or bradycardia.
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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A patient with irritable bowel syndrome (IBS) and a tendency towards loose stools has not responded well to loperamide and antispasmodics. According to NICE, what is the recommended second-line medication class for this condition?
Your Answer:
Correct Answer: Tricyclic antidepressant
Explanation:The initial medication prescribed for individuals with irritable bowel syndrome typically includes antispasmodics, as well as loperamide for diarrhea or laxatives for constipation. If these treatments prove ineffective, low-dose tricyclic antidepressants such as amitriptyline (5-10 mg at night) may be considered as a secondary option to alleviate abdominal pain and discomfort, according to NICE guidelines. Linaclotide may also be an option for those experiencing constipation. Selective serotonin reuptake inhibitors may be used as a tertiary treatment.
Managing irritable bowel syndrome (IBS) can be challenging and varies from patient to patient. The National Institute for Health and Care Excellence (NICE) updated its guidelines in 2015 to provide recommendations for the management of IBS. The first-line pharmacological treatment depends on the predominant symptom, with antispasmodic agents recommended for pain, laxatives (excluding lactulose) for constipation, and loperamide for diarrhea. If conventional laxatives are not effective for constipation, linaclotide may be considered. Low-dose tricyclic antidepressants are the second-line pharmacological treatment of choice. For patients who do not respond to pharmacological treatments, psychological interventions such as cognitive behavioral therapy, hypnotherapy, or psychological therapy may be considered. Complementary and alternative medicines such as acupuncture or reflexology are not recommended. General dietary advice includes having regular meals, drinking at least 8 cups of fluid per day, limiting tea and coffee to 3 cups per day, reducing alcohol and fizzy drink intake, limiting high-fiber and resistant starch foods, and increasing intake of oats and linseeds for wind and bloating.
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This question is part of the following fields:
- Gastroenterology
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Question 11
Incorrect
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A 14-year-old female comes to the clinic with her mother. She reports left knee pain for the past 4 weeks without any history of injury. She feels more tired than usual but is not otherwise unwell. Upon examination, her BMI is normal, and her vital signs are unremarkable. The left knee appears normal, and there is a full range of motion. All other joints are also normal. What is the best next step in management?
Your Answer:
Correct Answer: Direct access X ray (within 48 hours)
Explanation:Types of Bone Tumours
Benign and malignant bone tumours are two types of bone tumours. Benign bone tumours are non-cancerous and do not spread to other parts of the body. Osteoma is a benign overgrowth of bone that usually occurs on the skull and is associated with Gardner’s syndrome. Osteochondroma, the most common benign bone tumour, is a cartilage-capped bony projection on the external surface of a bone. Giant cell tumour is a tumour of multinucleated giant cells within a fibrous stroma that occurs most frequently in the epiphyses of long bones.
Malignant bone tumours are cancerous and can spread to other parts of the body. Osteosarcoma is the most common primary malignant bone tumour that mainly affects children and adolescents. It occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure. Ewing’s sarcoma is a small round blue cell tumour that mainly affects children and adolescents. It occurs most frequently in the pelvis and long bones and is associated with t(11;22) translocation. Chondrosarcoma is a malignant tumour of cartilage that most commonly affects the axial skeleton and is more common in middle-age.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 12
Incorrect
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A 35-year-old woman visits her doctor for a check-up. She is worried about her risk of developing cardiovascular disease after hearing about a family member's recent diagnosis.
Which of the following factors would most significantly increase her risk of cardiovascular disease?
Your Answer:
Correct Answer: Rheumatoid arthritis
Explanation:Patients with rheumatoid arthritis may have an increased risk of developing accelerated atherosclerosis, which is believed to be linked to the inflammatory process. The QRisk2 calculator, used to predict the 10-year risk of developing cardiovascular disease, includes rheumatoid arthritis as a risk factor. However, a blood pressure reading of 130/80 mmHg and a BMI of 24 kg/m2 are within the normal range and not a cause for concern. Additionally, the HbA1c level of 41 mmol/mol is normal and doesn’t indicate an increased risk of diabetes. While a family history of myocardial infarction is significant, it is only considered a risk factor if the relative was diagnosed before the age of 60, not at 65.
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This question is part of the following fields:
- Cardiovascular Health
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Question 13
Incorrect
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A 55-year-old man visits his doctor with worries that his spouse is cheating on him. Despite lacking any concrete evidence, he seems extremely agitated and convinced of his suspicions. What could this symptom indicate?
Your Answer:
Correct Answer: Othello's syndrome
Explanation:Erotomania, also known as De Clérambault’s syndrome, is a type of delusion where the patient firmly believes that another person is deeply in love with them.
Understanding Othello’s Syndrome
Othello’s syndrome is a condition characterized by extreme jealousy and suspicion that one’s partner is being unfaithful, even in the absence of any concrete evidence. This type of pathological jealousy can lead to socially unacceptable behavior, such as stalking, accusations, and even violence. People with Othello’s syndrome may become obsessed with their partner’s every move, constantly checking their phone, email, and social media accounts for signs of infidelity. They may also isolate themselves from friends and family, becoming increasingly paranoid and controlling.
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This question is part of the following fields:
- Mental Health
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Question 14
Incorrect
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What is the highest ranked source of evidence in the hierarchy of evidence based medicine?
Your Answer:
Correct Answer: Meta-analysis
Explanation:Hierarchy of Evidence Grades
The strength of evidence provided by different study types is ranked in a hierarchy. This hierarchy is important to understand when making clinical decisions based on research. The National Institute for Health and Care Excellence (NICE) documents these evidence grades in Chapter 6 of their Guidelines manual (PMG6).
The strongest level of evidence is provided by meta-analyses, followed by randomized controlled trials (RCTs), controlled studies without randomization, quasi-experimental studies, non-experimental descriptive studies, and finally expert committee reports, opinions, and clinical experience.
It is crucial to consider the strength of evidence when interpreting research findings and applying them to clinical practice. By understanding the hierarchy of evidence grades, healthcare professionals can make informed decisions that are based on the most reliable and robust evidence available.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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Question 15
Incorrect
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A 25-year-old man recently returned from India, presents with a 10-day history of intermittent diarrhoea, fever (39 oC), headache and a non-productive cough. His pulse is 70 and regular, and his spleen is palpable.
Select from the list the single most likely diagnosis.Your Answer:
Correct Answer: Typhoid
Explanation:Typhoid Fever: Symptoms, Causes, and Complications
Typhoid fever is a bacterial infection caused by Salmonella enterica, specifically S typhi and S paratyphi. It is primarily spread through contaminated food and drink, and is most commonly reported in the UK among individuals who have traveled to the Indian sub-continent. Symptoms typically appear 10-20 days after exposure and may include diarrhea, fever, headaches, cough, and constipation. Other signs may include Rose spots, a relative bradycardia, and eye complications.
As the infection progresses, patients may experience sustained pyrexia, abdominal distension, and splenomegaly. By the third week, weight loss and delirium may occur, along with a liquid, green-yellow pea soup diarrhea. In severe cases, death can result from toxaemia, myocarditis, intestinal hemorrhage, or gut perforation.
It is important to consider other mosquito-borne illnesses, such as dengue fever and malaria, in the differential diagnosis of febrile patients returning from endemic areas. Early diagnosis and treatment are crucial in managing typhoid fever and preventing complications.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 16
Incorrect
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A 20-year-old, previously healthy, female presents with a nine day history of fever, sore throat and fatigue.
On examination of her throat, there are palatal petechiae and white tonsillar exudates. Two days ago, another doctor prescribed amoxicillin, and she has since developed a widespread maculopapular rash.
What is the diagnosis?Your Answer:
Correct Answer: Infectious mononucleosis
Explanation:Understanding Infectious Mononucleosis
Infectious mononucleosis, also known as glandular fever, is a common disease that affects young adults. It is caused by the Epstein-Barr virus, which is excreted through nasopharyngeal secretions, primarily saliva, and can be transmitted through person-to-person contact, earning it the nickname kissing disease. While some carriers may not exhibit symptoms, others may experience acute illness characterized by sore throat, fever, lethargy, lymphadenopathy, palatal petechiae, splenomegaly, hepatitis, and haemolytic anaemia. Rashes may also occur, particularly if the patient is given amoxicillin or ampicillin, which should not be confused with the disease.
When diagnosing infectious mononucleosis, it is important to consider other differential diagnoses such as streptococcal sore throat, HIV seroconversion illness, diphtheria, and leukaemia. These conditions share many common symptoms, but the appearance of a rash after the patient has been given amoxicillin can help confirm the diagnosis. Understanding the signs and symptoms of infectious mononucleosis and its differential diagnoses can aid in proper diagnosis and treatment.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 17
Incorrect
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A 67-year-old woman complains of a sensation of a shadow obstructing a portion of her left eye. She has been experiencing occasional headaches on the same side and reports discomfort in her jaw while eating.
During the assessment, the fundoscopy and eye examination reveal no abnormalities. However, there is slight tenderness on the left side of her head.
What condition is the most probable diagnosis?Your Answer:
Correct Answer: Giant cell arteritis
Explanation:If an elderly patient complains of a headache on one side accompanied by jaw claudication, it is important to consider the possibility of giant cell arteritis and conduct appropriate investigations. Symptoms of acute glaucoma include eye pain, halos in vision, nausea, and general discomfort. Amaurosis fugax is characterized by temporary vision loss without any pain. Episcleritis typically causes mild eye pain, redness, and watering.
Temporal arteritis is a type of large vessel vasculitis that often occurs in patients over the age of 60 and is commonly associated with polymyalgia rheumatica. This condition is characterized by changes in the affected artery that skip certain sections while damaging others. Symptoms of temporal arteritis include headache, jaw claudication, and visual disturbances, with anterior ischemic optic neuropathy being the most common ocular complication. A tender, palpable temporal artery is also often present, and around 50% of patients may experience symptoms of PMR, such as muscle aches and morning stiffness.
To diagnose temporal arteritis, doctors will typically look for elevated inflammatory markers, such as an ESR greater than 50 mm/hr or elevated CRP levels. A temporal artery biopsy may also be performed to confirm the diagnosis, with skip lesions often being present. Treatment for temporal arteritis involves urgent high-dose glucocorticoids, which should be given as soon as the diagnosis is suspected and before the temporal artery biopsy. If there is no visual loss, high-dose prednisolone is typically used, while IV methylprednisolone is usually given if there is evolving visual loss. Patients with visual symptoms should be seen by an ophthalmologist on the same day, as visual damage is often irreversible. Other treatments may include bone protection with bisphosphonates and low-dose aspirin, although the evidence supporting the latter is weak.
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This question is part of the following fields:
- Neurology
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Question 18
Incorrect
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A 42-year-old woman comes back from her cardiology appointment where she was diagnosed with congenital long QT syndrome after an ECG was done for palpitations.
What medication should she avoid in the future?Your Answer:
Correct Answer: Clarithromycin
Explanation:The use of macrolide antibiotics like clarithromycin, erythromycin, and azithromycin may lead to the prolongation of the QTc interval. This can be particularly dangerous for patients with congenital long QT syndrome as it may trigger torsades de pointes. However, medications such as bisoprolol and digoxin can actually shorten the QTc interval and are therefore safe to use. Amoxicillin and cyclizine, on the other hand, do not have any known effects on the QTc interval.
Macrolides are a class of antibiotics that include erythromycin, clarithromycin, and azithromycin. They work by blocking translocation during bacterial protein synthesis, ultimately inhibiting bacterial growth. While they are generally considered bacteriostatic, their effectiveness can vary depending on the dose and type of organism being treated. Resistance to macrolides can occur through post-transcriptional methylation of the 23S bacterial ribosomal RNA.
However, macrolides can also have adverse effects. They may cause prolongation of the QT interval and gastrointestinal side-effects, such as nausea. Cholestatic jaundice is a potential risk, but using erythromycin stearate may reduce this risk. Additionally, macrolides are known to inhibit the cytochrome P450 isoenzyme CYP3A4, which metabolizes statins. Therefore, it is important to stop taking statins while on a course of macrolides to avoid the risk of myopathy and rhabdomyolysis. Azithromycin is also associated with hearing loss and tinnitus.
Overall, while macrolides can be effective antibiotics, they do come with potential risks and side-effects. It is important to weigh the benefits and risks before starting a course of treatment with these antibiotics.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 19
Incorrect
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An 85-year-old frail woman has been diagnosed with osteoporosis. What is the appropriate daily supplemental dose of vitamin D for her vitamin D insufficiency?
Your Answer:
Correct Answer: 20 micrograms (800 units)
Explanation:Vitamin D Supplementation: Recommendations and Dosages
The National Institute of Health and Care Excellence advises that all adults living in the UK should take a daily supplement containing 400 international units (IU) of vitamin D throughout the year, including in the winter months. This is especially important for those at increased risk of vitamin D deficiency. A recent survey in the United Kingdom showed that more than 50% of the adult population have insufficient levels of vitamin D.
For pregnant and breastfeeding mothers, Healthy Start vitamin tablets containing 400 IU of vitamin D, 400 micrograms of folic acid, and 70 mg of vitamin C are suitable. Other people can purchase multivitamin preparations containing 400 IU of vitamin D from pharmacies.
Elderly people who are housebound or living in a nursing home are likely to have vitamin D insufficiency. NICE recommends that people with vitamin D insufficiency should receive maintenance treatment of about 800 IU a day. This is especially important for those with osteoporosis who are likely to be on an antiresorptive drug.
For the treatment of nutritional vitamin D deficiency rickets in children 12-18 years, the dosage is 10,000 units. Vitamin D deficiency caused by intestinal malabsorption or chronic liver disease usually requires vitamin D in doses up to 1 mg (40,000 units) daily. The hypocalcaemia of hypoparathyroidism often requires doses of up to 2.5mg (100,000 units) daily in order to achieve normal levels of calcium.
A variety of vitamin D preparations of different strengths are available, many of them combined with calcium. It is important to consult with a healthcare professional to determine the appropriate dosage and type of vitamin D supplementation for individual needs.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 20
Incorrect
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A 16-year-old student presents with a three week history of a flu-like illness, which progressed after a week to paroxysms of coughing.
He was previously healthy and believes he received all the recommended childhood vaccinations.
Upon examination, he has no fever and his chest sounds clear. You suspect he may have pertussis.
What is the most suitable test to confirm the diagnosis?Your Answer:
Correct Answer: Serology for anti-pertussis IgG antibodies
Explanation:Diagnostic Tests for Pertussis
In diagnosing pertussis, the appropriate test depends on the age of the patient and the timing of their symptoms. For children under 12 months old who are hospitalized, PCR testing is recommended. For those who are not hospitalized, a culture of a pernasal swab is preferred.
For patients over 12 months old and adults, a culture of a pernasal swab is recommended within two weeks of symptom onset or 48 hours of antibiotic therapy. However, if the patient presents more than two weeks after symptom onset or has been on antibiotics for more than 48 hours, serology testing for anti-pertussis IgG antibodies is the most appropriate diagnostic test.
It is important to note that culture testing for Bordetella pertussis is unlikely to be positive beyond two weeks from symptom onset, and a negative result doesn’t exclude pertussis infection. CXR and FBC testing are not specific or diagnostic for pertussis. PCR testing is useful for young infants or late in the disease after antibiotics have been administered, but it is not the recommended test in this scenario.
Overall, understanding and implementing national guidelines for respiratory problems is crucial for accurate diagnosis and treatment of pertussis.
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This question is part of the following fields:
- Children And Young People
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Question 21
Incorrect
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A 65-year-old woman presents with gradual onset proximal shoulder and pelvic girdle muscular pains and stiffness. She is experiencing difficulty getting dressed in the morning and cannot raise her arms above the horizontal. She is currently taking atorvastatin 20 mg for primary prevention and recently completed a course of clarithromycin for a lower respiratory tract infection (penicillin-allergic). Blood tests reveal the following results:
Hb 128 g/L Male: (135-180) Female: (115 - 160)
WBC 12.8 * 109/L (4.0 - 11.0)
Platelets 380 * 109/L (150 - 400)
Na+ 142 mmol/L (135 - 145)
K+ 4.2 mmol/L (3.5 - 5.0)
Urea 6.1 mmol/L (2.0 - 7.0)
Creatinine 66 µmol/L (55 - 120)
Bilirubin 10 µmol/L (3 - 17)
ALP 64 u/L (30 - 100)
ALT 32 u/L (3 - 40)
γGT 55 u/L (8 - 60)
Albumin 37 g/L (35 - 50)
CRP 72 mg/L (< 5)
ESR 68 mg/L (< 30)
Creatine kinase 58 U/L (35 - 250)
What is the most likely underlying diagnosis?Your Answer:
Correct Answer: Polymyalgia rheumatica
Explanation:Polymyalgia rheumatica is not associated with an increase in creatine kinase levels. Instead, blood tests typically reveal signs of inflammation, such as elevated white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. These findings, combined with the patient’s medical history and demographics, strongly suggest polymyalgia rheumatica as the diagnosis.
In contrast, polymyositis and dermatomyositis are characterized by a significant rise in creatine kinase levels, and dermatomyositis also presents with a distinctive rash. Fibromyalgia doesn’t typically show any signs of inflammation on blood tests. While statin-induced myopathy is a possibility given the patient’s history, the high levels of inflammatory markers and normal creatine kinase levels make this diagnosis less likely.
Understanding Polymyalgia Rheumatica
Polymyalgia rheumatica (PMR) is a condition commonly seen in older individuals that is characterized by muscle stiffness and elevated inflammatory markers. Although it is closely related to temporal arteritis, the underlying cause is not fully understood, and it doesn’t appear to be a vasculitic process. PMR typically affects individuals over the age of 60 and has a rapid onset, with symptoms appearing in less than a month. Patients experience aching and morning stiffness in proximal limb muscles, along with mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, and night sweats. Weakness is not considered a symptom of PMR.
To diagnose PMR, doctors look for elevated inflammatory markers, such as an ESR greater than 40 mm/hr. Creatine kinase and EMG are typically normal. Treatment for PMR involves the use of prednisolone, with a typical dose of 15mg/od. Patients usually respond dramatically to steroids, and failure to do so should prompt consideration of an alternative diagnosis. Understanding the symptoms and treatment options for PMR can help individuals manage their condition and improve their quality of life.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 22
Incorrect
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A 17-year-old girl comes in with a magazine clipping and requests a prescription for Cerazette (desogestrel) progesterone-only contraceptive.
With regard to Cerazette, which one of these statements is true?Your Answer:
Correct Answer: With Cerazette, blood pressure should be checked every six months
Explanation:Cerazette: A Controversial Contraceptive Option
Cerazette is a popular contraceptive pill that has been marketed as having a Pearl Index similar to the combined pill. It is known for its ability to suppress ovulation and is suitable for a range of women. However, whether Cerazette is superior to traditional POPs is a topic of debate. Despite its effectiveness, Cerazette is not recommended as a first-line option due to its cost. It is only available on prescription and has a missed pill window of 12 hours.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 23
Incorrect
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Under what conditions is MMR (measles, mumps and rubella) vaccination not recommended?
Your Answer:
Correct Answer: HIV positive individual who is not immunosuppressed
Explanation:MMR Vaccination Contraindications
There are only a few individuals who cannot receive the MMR vaccination. The vaccine should not be given to those who are immunosuppressed, have had a confirmed anaphylactic reaction to a previous dose of a measles, mumps, or rubella-containing vaccination, or have a previous confirmed anaphylactic reaction to neomycin or gelatin. Pregnant women should also avoid the vaccine due to a theoretical risk of fetal infection. However, true anaphylaxis following the MMR vaccination is rare, occurring at a rate of 3.5 to 14.4 per million doses. If a minor allergic reaction occurs, it is not a contraindication to future vaccination. Inactivated vaccines are safe for pregnant women, but should only be used if protection is needed without delay. It is recommended to consult with a specialist or local immunisation coordinator for further advice if there is any doubt.
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This question is part of the following fields:
- Children And Young People
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Question 24
Incorrect
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A 55-year-old is being initiated on insulin therapy to control his diabetes as his HbA1c levels have been consistently high. He had experienced hypoglycemia four years ago. Additionally, he is taking fluoxetine and atorvastatin. He asks if he can drive to visit his parents.
What would be the appropriate guidance to provide?Your Answer:
Correct Answer: He must take breaks every 2 hours to check his blood glucose
Explanation:Insulin-dependent diabetics are required to take breaks every 2 hours to check their blood glucose while driving. They must also have hypoglycemia awareness, no severe hypos in the past year, and no visual impairment. It is important to inform the DVLA of their condition. They can still drive a car, but with additional precautions.
DVLA Regulations for Drivers with Diabetes Mellitus
The DVLA has recently changed its regulations for drivers with diabetes who use insulin. Previously, these individuals were not allowed to hold an HGV license. However, as of October 2011, the following standards must be met for all drivers using hypoglycemic inducing drugs, including sulfonylureas: no severe hypoglycemic events in the past 12 months, full hypoglycemic awareness, regular blood glucose monitoring at least twice daily and at times relevant to driving, an understanding of the risks of hypoglycemia, and no other complications of diabetes.
For those on insulin who wish to apply for an HGV license, they must complete a VDIAB1I form. Group 1 drivers on insulin can still drive a car as long as they have hypoglycemic awareness, no more than one episode of hypoglycemia requiring assistance within the past 12 months, and no relevant visual impairment. Drivers on tablets or exenatide do not need to notify the DVLA, but if the tablets may induce hypoglycemia, there must not have been more than one episode requiring assistance within the past 12 months. Those who are diet-controlled alone do not need to inform the DVLA.
To demonstrate adequate control, the Honorary Medical Advisory Panel on Diabetes Mellitus recommends that applicants use blood glucose meters with a memory function to measure and record blood glucose levels for at least three months prior to submitting their application. These regulations aim to ensure the safety of all drivers on the road.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 25
Incorrect
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A 55-year-old man presents to his General Practitioner reporting ongoing distress following the sudden death of his wife 12 months ago following a cardiac arrest. He took three months off work to ‘deal with’ his wife’s death and then returned to his full-time role. He lives alone and reports that he has been unable to ‘bounce back’. He thinks of his wife’s death often and it distresses and distracts him. He has been sleeping poorly, has missed several shifts and was finally dismissed from his job. He feels isolated and a sense of responsibility that he did not ‘look after his wife’.
What is the most likely underlying diagnosis?Your Answer:
Correct Answer: Complicated grief
Explanation:Understanding Different Types of Grief and Trauma Reactions
Grief and trauma can manifest in various ways, and it is essential to differentiate between different types of reactions to provide appropriate support and treatment. Complicated grief is a type of grief that persists in its intensity, hindering a person’s ability to engage in normal activities and causing feelings of shame or guilt. This type of grief can last for an extended period, and the person may struggle to accept the death, leading to isolation and loneliness. On the other hand, post-traumatic stress disorder (PTSD) can result from a distressing event, causing intrusive symptoms such as vivid and distressing memories or flashbacks. Normal grief reactions follow the Kubler Ross model, with stages of denial, anger, bargaining, depression, and acceptance. However, if the intense feelings of grief persist, it may indicate complicated grief. Major depressive disorder (MDD) shares some symptoms with complicated grief, but the context of the loss is crucial in distinguishing between the two. Acute stress reaction is a transient disorder that develops in response to exceptional physical and mental stress, subsiding within hours or days, and is not indicated in this case. Understanding these different types of grief and trauma reactions can help in providing appropriate support and treatment to those who need it.
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This question is part of the following fields:
- End Of Life
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Question 26
Incorrect
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A 26-year-old man comes to you with complaints of a persistent sore throat and occasional hoarseness that has been bothering him for a few months. He expresses concern that there may be something lodged in his throat, but he is able to swallow without difficulty. He denies any significant weight loss and has no notable medical or family history.
During your examination, you observe mild redness in the oropharynx, but the neck appears normal and there are no palpable masses.
What would be the best course of action in this case?Your Answer:
Correct Answer: Prescribe a trial of a proton pump inhibitor
Explanation:Understanding Laryngopharyngeal Reflux
Laryngopharyngeal reflux (LPR) is a condition that occurs when stomach acid flows back into the throat, causing inflammation in the larynx and hypopharynx mucosa. It is a common diagnosis, accounting for approximately 10% of ear, nose, and throat referrals. Symptoms of LPR include a sensation of a lump in the throat, hoarseness, chronic cough, dysphagia, heartburn, and sore throat. The external examination of the neck should be normal, with no masses, and the posterior pharynx may appear erythematous.
Diagnosis of LPR can be made without further investigations in the absence of red flags. However, the NICE cancer referral guidelines should be reviewed for red flags such as persistent, unilateral throat discomfort, dysphagia, and persistent hoarseness. Lifestyle measures such as avoiding fatty foods, caffeine, chocolate, and alcohol can help manage LPR. Additionally, proton pump inhibitors and sodium alginate liquids like Gaviscon can also be used to manage symptoms.
In summary, Laryngopharyngeal reflux is a common condition that can cause discomfort and inflammation in the throat. It is important to be aware of the symptoms and seek medical attention if red flags are present. Lifestyle measures and medication can help manage symptoms and improve quality of life.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 27
Incorrect
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A 23-year-old female presents with a painful left calf. She has been on the combined oral contraceptive pill for the past two years and her mother had a pulmonary embolus during the postpartum period. Upon clinical examination, a DVT is suspected and confirmed. A thrombophilia screen reveals a factor V Leiden mutation. What recommendations would you make regarding future contraception and pregnancy?
Your Answer:
Correct Answer: Barrier contraception is the only potential option
Explanation:Contraceptive Options for Patients with Medical Conditions
The use of a LNG-IUS is considered safe for patients with medical conditions, falling under UKMEC category 2. While the use of a copper-IUD is a UKMEC category 1, it may not be an option for some patients. Patients with the factor V Leiden mutation may experience a four-fold increase in the risk of venous thromboembolism when using the combined oral contraceptive pill. Homozygosity for the mutation may increase the risk of clots in pregnancy by 50-100 fold, while heterozygosity may increase the risk by 5-10 fold. Warfarin, which can cause fetal bleeding and teratogenicity, is not recommended for pregnant patients. Instead, low molecular weight heparin is used when necessary. Other contraceptive options for patients with medical conditions include the levonorgestrel intrauterine system and progesterone-only pill.
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This question is part of the following fields:
- Sexual Health
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Question 28
Incorrect
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A 25-year-old woman is interested in beginning the combined oral contraceptive pill (COCP) but is concerned about the potential risk of breast cancer due to her maternal grandmother's diagnosis in her 60s. What UK Medical Eligibility Criteria (UKMEC) should be considered for her?
Your Answer:
Correct Answer: UKMEC 1
Explanation:A family history doesn’t pose any contraindications for COCP use and is classified as UKMEC 1. However, being a known BRCA1/2 gene carrier is classified as UKMEC 3 for COCP use. If a person has a current breast cancer diagnosis, it is classified as UKMEC 4. If the breast cancer diagnosis was more than 5 years ago, it is classified as UKMEC 3.
Contraindications for Combined Oral Contraceptive Pill
The decision to prescribe the combined oral contraceptive pill is based on the UK Medical Eligibility Criteria (UKMEC), which categorizes potential cautions and contraindications on a four-point scale. UKMEC 1 represents a condition for which there is no restriction for the use of the contraceptive method, while UKMEC 4 represents an unacceptable health risk. Examples of UKMEC 3 conditions include controlled hypertension, immobility, and a family history of thromboembolic disease in first-degree relatives under 45 years old. Examples of UKMEC 4 conditions include a history of thromboembolic disease or thrombogenic mutation, breast cancer, and uncontrolled hypertension.
In 2016, the UKMEC was updated to reflect that breastfeeding between 6 weeks and 6 months postpartum is now classified as UKMEC 2 instead of UKMEC 3. Diabetes mellitus diagnosed over 20 years ago is classified as UKMEC 3 or 4 depending on severity. It is important for healthcare providers to consider these contraindications when deciding whether to prescribe the combined oral contraceptive pill to their patients.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 29
Incorrect
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A 16-month-old boy, a recent immigrant of Portuguese ethnicity, was noted to be pale and found to have haemoglobin of 91 g/l with a mean corpuscular volume (MCV) of 58 fl. He is otherwise healthy. After a four-week course of an iron supplement, his blood indices remained unchanged.
What is the most appropriate management option?Your Answer:
Correct Answer: Haemoglobin electrophoresis
Explanation:Haemoglobin Electrophoresis for Diagnosis of Thalassaemia
Thalassaemia is a genetic blood disorder that results in microcytic hypochromic anaemia. There are two types of thalassaemia: alpha and beta. The mode of inheritance is usually autosomal recessive. A child who has failed to respond to oral iron may have thalassaemia and should undergo haemoglobin electrophoresis for diagnosis.
Beta-thalassaemia minor is a heterozygous carrier type of thalassaemia that results in a 50% decrease in the synthesis of the beta-globin protein. Such patients have raised haemoglobin A2 (HbA2 > 3.5%) and are slightly anaemic with a low MCV and MCH but clinically asymptomatic. This causes lifelong anaemia that typically requires no treatment, other than recognition for the purposes of patient education, to avoid supplemental iron, and for genetic counselling.
If both gene alleles have thalassemia mutations, there may be a complete absence of the beta-globin protein (ie βo-thalassemia) or a severely reduced synthesis of the beta-globin protein (ie beta+ thalassemia) and such patients are symptomatic.
It is important to note that iron supplements do not correct anaemia due to thalassemia and can lead to iron overload. Faecal occult bloods and paediatric gastroenterology referral are not necessary before knowing the results of haemoglobin electrophoresis. Reassuring the parents that the indices are within the normal range is also incorrect as the normal range for a child of this age is 115–135 g/l for haemoglobin and 73.5–84.7 fl for MCV.
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This question is part of the following fields:
- Haematology
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Question 30
Incorrect
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A father brings his 3-month-old daughter into the clinic for her first round of vaccinations. He expresses concerns about the safety of the rotavirus vaccine. Can you provide him with information about this vaccine?
Your Answer:
Correct Answer: It is an oral, live attenuated vaccine
Explanation:The vaccine for rotavirus is administered orally and is live attenuated. It is given to infants at two and three months of age, along with other oral vaccines like polio and typhoid. Two doses are necessary, and it is not typically given to children at three years of age. This vaccine is not injected and is not an inactivated toxin vaccine, which includes vaccines for tetanus, diphtheria, and pertussis.
The Rotavirus Vaccine: A Vital Tool in Preventing Childhood Mortality
Rotavirus is a significant public health concern, causing high rates of morbidity and hospitalization in developed countries and childhood mortality in developing nations. To combat this, a vaccine was introduced into the NHS immunization program in 2013. The vaccine is an oral, live attenuated vaccine that requires two doses, the first at two months and the second at three months. It is important to note that the first dose should not be given after 14 weeks and six days, and the second dose cannot be given after 23 weeks and six days due to the theoretical risk of intussusception.
The vaccine is highly effective, with an estimated efficacy rate of 85-90%, and is predicted to reduce hospitalization rates by 70%. Additionally, the vaccine provides long-term protection against rotavirus. The introduction of the rotavirus vaccine is a vital tool in preventing childhood mortality and reducing the burden of rotavirus-related illness.
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This question is part of the following fields:
- Children And Young People
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