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Question 1
Incorrect
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A 50-year-old man is to have a prostate specific antigen (PSA) test performed.
Select from the list the option that would allow you to do the test immediately rather than defer it to a later date.Your Answer: Chronic prostatitis was suspected and he has completed 4 weeks of antibiotics
Correct Answer: He says his last ejaculation was 4 days ago
Explanation:PSA levels can be affected by various factors such as digital rectal examination, urinary or prostatic infections, prostate biopsies, urinary catheterization, prostate or bladder surgery, prolonged exercise, and ejaculation. It is advisable to defer DRE for a week, but if necessary, a gentle examination is unlikely to significantly increase PSA levels. PSA levels may remain elevated for several months after infections, and testing should be delayed for at least three months after biopsies or surgeries. Prolonged exercise and ejaculation may raise PSA levels for up to 48 hours.
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This question is part of the following fields:
- Kidney And Urology
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Question 2
Incorrect
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What is the ethnic group with the highest incidence of prostate cancer?
Your Answer: Hispanic
Correct Answer: Asian
Explanation:Factors to Consider in Prostate Cancer
Ethnicity is a significant factor to consider when discussing prostate cancer. The incidence of prostate cancer varies geographically, with the highest rates found in men of black ethnic group and the lowest rates in Chinese men. Age is another important factor, as prostate cancer is rare in men under 50 years old, with the majority of diagnoses made in patients over 65. Family history is also a risk factor, particularly in younger men. Prostate cancer can cluster within families, and having a first-degree relative under 70 with prostate cancer can double a patient’s relative risk of developing the disease. Finally, diet is another factor to consider, as a diet rich in red meat and dairy products has been linked to an increased risk of prostate cancer. By taking these factors into account, healthcare professionals can better assess a patient’s risk of developing prostate cancer and provide appropriate screening and treatment.
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This question is part of the following fields:
- Kidney And Urology
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Question 3
Incorrect
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When investigating the impact of patients' attitudes, beliefs, and knowledge of health literature on the management of chronic mechanical low back pain, researchers typically establish inclusion and exclusion criteria for their patient sample. Which of the following options is most likely to be an exclusion criterion?
Your Answer: Ability to communicate in English
Correct Answer: Leg pain and back pain
Explanation:Criteria for Selecting Participants in a Study on Mechanical Low Back Pain
The study aims to investigate attitudes and beliefs related to mechanical low back pain. To ensure the validity of the results, the researchers have established specific criteria for selecting participants. These criteria include a diagnosis of mechanical low back pain, the ability to communicate in English, age between 20 and 50 years, and being off work for three months or more due to low back pain.
Mechanical low back pain is defined as pain that cannot be attributed to any particular pathology. However, patients with significant leg pain are more likely to have nerve root compression, which is commonly caused by intervertebral disc protrusion. Therefore, patients with leg pain are excluded from the study.
The ability to communicate in English is important as the study involves interviewing participants. Excluding participants based on their language proficiency would be illogical.
Restricting the age range to between 20 and 50 years avoids ages where other pathologies are more likely to occur. Patients who are younger than 20 or older than 50 are more likely to have alternative causes of back pain.
Finally, the researchers require participants to have been off work for three months or more due to low back pain. This ensures that the participants are disabled by their back pain and satisfies the definition of chronic back pain.
Overall, these criteria aim to select participants who are most likely to provide valuable insights into attitudes and beliefs related to mechanical low back pain.
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This question is part of the following fields:
- Population Health
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Question 4
Incorrect
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You have a scheduled telephone consultation with Mrs. O'Brien, a 55-year-old woman who has been undergoing BP monitoring with the health-care assistant. The health care assistant has arranged the appointment as her readings have been consistently around 150/90 mmHg. Upon reviewing her records, you see that she was prescribed amlodipine due to her Irish ethnicity, and she is taking 10 mg once a day. Her only other medication is atorvastatin 20 mg. The health care assistant has noted in the record that the patient confirms she takes her medications as directed.
As per NICE guidelines, what is the next step in managing hypertension in Mrs. O'Brien, taking into account her ethnic background?Your Answer: Angiotensin-converting enzyme inhibitor
Correct Answer: Angiotensin II receptor blocker
Explanation:For patients of black African or African–Caribbean origin who are taking a calcium channel blocker for hypertension and require a second medication, it is recommended to consider an angiotensin receptor blocker instead of an ACE inhibitor. An alpha-blocker is typically not a first-line option, while spironolactone may be considered as a fourth-line option. However, the 2019 update to the NICE guidelines on hypertension recommends an ARB as the preferred choice for this patient population.
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 5
Correct
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A 27-year-old African American woman who is 28 weeks pregnant undergoes an oral glucose tolerance test (OGTT) due to her ethnicity and a history of being overweight. An ultrasound reveals that the fetus is measuring larger than expected for its gestational age. The results of the OGTT are as follows:
Time (hours) Blood glucose (mmol/l)
0 9.5
2 15.1
What would be the most suitable course of action?Your Answer: Start insulin
Explanation:Immediate initiation of insulin is recommended due to the high blood glucose levels and presence of macrosomia. Additionally, it is advisable to consider administering aspirin as there is an elevated risk of pre-eclampsia.
Gestational diabetes is a common medical disorder that affects around 4% of pregnancies. It can develop during pregnancy or be a pre-existing condition. According to NICE, 87.5% of cases are gestational diabetes, 7.5% are type 1 diabetes, and 5% are type 2 diabetes. Risk factors for gestational diabetes include a BMI of > 30 kg/m², previous gestational diabetes, a family history of diabetes, and family origin with a high prevalence of diabetes. Screening for gestational diabetes involves an oral glucose tolerance test (OGTT), which should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
To diagnose gestational diabetes, NICE recommends using the following thresholds: fasting glucose is >= 5.6 mmol/L or 2-hour glucose is >= 7.8 mmol/L. Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week and taught about self-monitoring of blood glucose. Advice about diet and exercise should be given, and if glucose targets are not met within 1-2 weeks of altering diet/exercise, metformin should be started. If glucose targets are still not met, insulin should be added to the treatment plan.
For women with pre-existing diabetes, weight loss is recommended for those with a BMI of > 27 kg/m^2. Oral hypoglycaemic agents, apart from metformin, should be stopped, and insulin should be commenced. Folic acid 5 mg/day should be taken from preconception to 12 weeks gestation, and a detailed anomaly scan at 20 weeks, including four-chamber view of the heart and outflow tracts, should be performed. Tight glycaemic control reduces complication rates, and retinopathy should be treated as it can worsen during pregnancy.
Targets for self-monitoring of pregnant women with diabetes include a fasting glucose level of 5.3 mmol/l and a 1-hour or 2-hour glucose level after meals of 7.8 mmol/l or 6.4 mmol/l, respectively. It is important to manage gestational diabetes and pre-existing diabetes during pregnancy to reduce the risk of complications for both the mother and baby.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 6
Correct
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You are discussing the results of a fasting blood sugar with a 50-year-old patient. It was done after the patient was found to be hypertensive:
Glucose (fasting) 6.5 mmol/l
This patient therefore has impaired fasting glycaemia. Following recent Diabetes UK guidelines, what is the most appropriate way to communicate this result with the patient?Your Answer: 'Prediabetes'
Explanation:Understanding Prediabetes and Impaired Glucose Regulation
Prediabetes is a term used to describe impaired glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes mellitus. This includes individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Diabetes UK estimates that around 1 in 7 adults in the UK have prediabetes, and many of them will eventually develop type 2 diabetes mellitus (T2DM), putting them at risk of microvascular and macrovascular complications.
To identify patients with prediabetes, NICE recommends using a validated computer-based risk assessment tool for adults aged 40 and over, people of South Asian and Chinese descent aged 25-39, and adults with conditions that increase the risk of T2DM. Patients identified as high risk should have a blood sample taken, and a fasting plasma glucose of 6.1-6.9 mmol/l or an HbA1c level of 42-47 mmol/mol (6.0-6.4%) indicates high risk.
Lifestyle modifications such as weight loss, increased exercise, and changes in diet are recommended for managing prediabetes. Patients should have at least yearly follow-up with blood tests. NICE recommends metformin for adults at high risk who are still progressing towards T2DM despite participating in an intensive lifestyle-change program.
There are two main types of impaired glucose regulation: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). IFG is due to hepatic insulin resistance, while IGT is due to muscle insulin resistance. Patients with IGT are more likely to develop T2DM and cardiovascular disease than those with IFG.
To diagnose IFG, a fasting glucose level of 6.1-6.9 mmol/l is required. IGT is defined as a fasting plasma glucose level less than 7.0 mmol/l and an OGTT 2-hour value of 7.8-11.1 mmol/l. People with IFG should be offered an oral glucose tolerance test to rule out a diagnosis of diabetes. A result below 11.1 mmol/l but above 7.8 mmol/l indicates that the person has IGT but not diabetes.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 7
Correct
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A 54-year-old businessman has just registered with your practice and has asked the receptionists for an appointment to discuss prevention of cardiovascular disease.
He was generally well but had suffered a myocardial infarction six months ago whilst on business in South Africa. He was diagnosed with diabetes three years ago and is on diet control alone.
He had an eight year history of hypertension with a blood pressure of 150/90 mmHg. He was obese with a BMI of 34 kg/m2.
Investigations reveal:
Total cholesterol 5.0 mmol/L (<5.2)
Which would be the most appropriate management?Your Answer: Add a statin (HMG coA reductase inhibitor)
Explanation:Secondary Prevention Scenario: Managing a Type 2 Diabetic with Cardiovascular Disease
Firstly, it is important to recognize that this scenario involves secondary prevention. Evidence from trials such as the MRC/BHF Heart Protection Study has shown the benefits of lowering cholesterol in Type 2 diabetics with cardiovascular disease, regardless of their initial total cholesterol levels. Similarly, studies like CARE have demonstrated the advantages of maintaining cholesterol levels below 6 mmol/L in secondary prevention.
As this patient is likely to be hypertensive, it would be appropriate to initiate antihypertensive therapy if their blood pressure remains elevated. The decision regarding insulin therapy would depend on their HbA1c levels, with metformin being the initial treatment of choice to improve insulin resistance.
It is important to note that there is no significant benefit from using 300 mg over 75 mg of aspirin in these patients, and the higher dose may lead to more side effects. Additionally, there is no evidence to support improved life expectancy with Xenical.
In summary, managing a Type 2 diabetic with cardiovascular disease in a secondary prevention scenario involves lowering cholesterol levels, initiating antihypertensive therapy if necessary, and considering insulin therapy based on HbA1c levels. It is important to carefully consider the risks and benefits of medications such as aspirin and Xenical.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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Question 8
Incorrect
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A 20-year-old male presents at your clinic with symptoms resembling the flu. He has recently been diagnosed with type 1 diabetes and seeks guidance on managing his diabetes during illness. What is one of the 'sick-day rules' that insulin-dependent diabetics should follow when they are sick?
Your Answer: Check blood sugars as normal
Correct Answer: Aim to drink at least 3L of fluid
Explanation:It is recommended that patients consume a minimum of 3 liters of fluids within a 24-hour period. Patients should maintain their regular insulin routine but monitor their blood glucose levels more frequently, making options 1 and 2 incorrect. It is not advisable to replace main meals with sugary foods, but if a patient is having difficulty eating, they may consume sugary beverages. Additionally, ketone levels should be checked more frequently, every 3-4 hours or more frequently based on the results.
Managing Diabetes Mellitus during Illness: Sick Day Rules
When a patient with diabetes mellitus becomes unwell, it is important to provide them with key messages to manage their condition. Increasing the frequency of blood glucose monitoring to at least four hourly is crucial, as well as encouraging fluid intake of at least 3 litres in 24 hours. If the patient is struggling to eat, sugary drinks may be necessary to maintain carbohydrate intake. Educating patients to have a box of sick day supplies can also be helpful. Access to a mobile phone has been shown to reduce the progression of ketosis to diabetic ketoacidosis.
Patients taking oral hypoglycemic medication should continue taking their medication even if they are not eating much. However, metformin should be stopped if the patient is becoming dehydrated due to its potential impact on renal function. Patients on insulin must not stop taking it, as this can lead to diabetic ketoacidosis. They should continue their normal insulin regime and check their blood sugars frequently. If ketone levels are raised and blood sugars are also raised, corrective doses of insulin may be necessary. The corrective dose varies by patient, but a rule of thumb is the total daily insulin dose divided by 6 (maximum 15 units).
Possible indications for hospital admission include suspicion of underlying illness requiring hospital treatment, inability to keep fluids down for more than a few hours, persistent diarrhea, significant ketosis in an insulin-dependent diabetic despite additional insulin, blood glucose persistently >20 mmol/l despite additional insulin, patient unable to manage adjustments to usual diabetes management, and lack of support at home (e.g., a patient who lives alone and is at risk of becoming unconscious). By following these sick day rules, patients with diabetes mellitus can better manage their condition during illness.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 9
Correct
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A 50-year-old female comes to her doctor with a complaint of feeling tired for the past two months. Upon conducting blood tests, the following results were obtained:
Na+ 128 mmol/l
K+ 5.6 mmol/l
Urea 5.3 mmol/l
Creatinine 99 µmol/l
Total T4 66 nmol/l (70 - 140 nmol/l)
Which diagnostic test is most likely to reveal the underlying condition?Your Answer: Short synacthen test
Explanation:The most effective way to diagnose Addison’s disease is through the short synacthen test. If a patient presents with lethargy, hyponatraemia, and hyperkalaemia, it is highly indicative of Addison’s disease. While the patient’s thyroxine level is slightly low, it is unlikely to be the cause of the hyperkalaemia. It is possible that the patient also has hypothyroidism, but this would not fully explain their symptoms.
Investigating Addison’s Disease: ACTH Stimulation Test and Serum Cortisol Levels
When investigating a patient suspected of having Addison’s disease, the most definitive test is the ACTH stimulation test, also known as the short Synacthen test. This involves measuring plasma cortisol levels before and 30 minutes after administering Synacthen 250ug IM. Adrenal autoantibodies, such as anti-21-hydroxylase, may also be detected.
However, if an ACTH stimulation test is not readily available, a 9 am serum cortisol level can be useful. A level of over 500 nmol/l makes Addison’s disease very unlikely, while a level below 100 nmol/l is definitely abnormal. If the level falls between 100-500 nmol/l, an ACTH stimulation test should be performed.
It is important to note that around one-third of undiagnosed patients with Addison’s disease may also have associated electrolyte abnormalities, such as hyperkalaemia, hyponatraemia, hypoglycaemia, and metabolic acidosis. Therefore, it is crucial to investigate these levels as well to ensure a proper diagnosis and treatment plan.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 10
Correct
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A 45-year-old bus driver has a past medical history of an isolated seizure. He has notified the DVLA and has stopped driving his bus. He holds a full driving licence and has never taken medication. He has undergone a recent assessment by a neurologist and, following initial investigations, is thought to have no continuing increased risk of seizures.
Assuming he remains free of epileptic attacks, when, if at all, can he resume driving a group 2 bus or lorry?Your Answer: 5 years
Explanation:DVLA Guidance on Medical Conditions for Group 2 Bus and Lorry Drivers
According to the DVLA’s guidance on medical conditions, drivers of group 2 buses or lorries who have experienced an isolated seizure must meet certain conditions in order to continue driving. Unlike drivers with epilepsy and a history of recurrent seizures, who must be seizure-free for 10 years, drivers with an isolated seizure must meet the following criteria:
– Hold a full ordinary driving licence
– Have been free of epileptic attacks for the last 5 years
– Have not taken any medication to treat epilepsy during these 5 years or had a seizure during these 5 years
– Have undergone a recent assessment by a neurologist
– Have no continuing increased risk of seizuresIt is important for drivers to follow these guidelines in order to ensure their safety and the safety of others on the road. By meeting these criteria, drivers can continue to operate group 2 buses and lorries without posing a risk to themselves or others.
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This question is part of the following fields:
- Consulting In General Practice
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Question 11
Incorrect
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An 80-year-old man comes to the clinic complaining of occasional palpitations without any accompanying chest pain, shortness of breath, or lightheadedness. He has no notable medical history and is not taking any medications at present. Physical examination and vital signs are normal except for an irregular heartbeat, which is later diagnosed as atrial fibrillation. What is the suggested preventive therapy for a stroke?
Your Answer: Consider a beta-blocker
Correct Answer: Consider an anticoagulant
Explanation:Anticoagulation must be taken into account for individuals with a CHA2DS2-VASC score of 1 or higher if they are male, and a score of 2 or higher if they are female. In this case, the gentleman’s CHA2DS2-VASC score is 1, indicating that he should be considered for anticoagulation after assessing his HAS-BLED score. It is important to note that if his HAS-BLED score is 3 or higher, alternative options to anticoagulation should be considered. Beta-blockers, aspirin, and clopidogrel are not recommended for primary prevention against cerebrovascular accidents. It is incorrect to assume that no treatment is necessary, as the CHA2DS2-VASC score indicates a need for consideration of anticoagulation.
Atrial fibrillation (AF) is a condition that requires careful management, including the use of anticoagulation therapy. The latest guidelines from NICE recommend assessing the need for anticoagulation in all patients with a history of AF, regardless of whether they are currently experiencing symptoms. The CHA2DS2-VASc scoring system is used to determine the most appropriate anticoagulation strategy, with a score of 2 or more indicating the need for anticoagulation. However, it is important to ensure a transthoracic echocardiogram has been done to exclude valvular heart disease, which is an absolute indication for anticoagulation.
When considering anticoagulation therapy, doctors must also assess the patient’s bleeding risk. NICE recommends using the ORBIT scoring system to formalize this risk assessment, taking into account factors such as haemoglobin levels, age, bleeding history, renal impairment, and treatment with antiplatelet agents. While there are no formal rules on how to act on the ORBIT score, individual patient factors should be considered. The risk of bleeding increases with a higher ORBIT score, with a score of 4-7 indicating a high risk of bleeding.
For many years, warfarin was the anticoagulant of choice for AF. However, the development of direct oral anticoagulants (DOACs) has changed this. DOACs have the advantage of not requiring regular blood tests to check the INR and are now recommended as the first-line anticoagulant for patients with AF. The recommended DOACs for reducing stroke risk in AF are apixaban, dabigatran, edoxaban, and rivaroxaban. Warfarin is now used second-line, in patients where a DOAC is contraindicated or not tolerated. Aspirin is not recommended for reducing stroke risk in patients with AF.
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This question is part of the following fields:
- Cardiovascular Health
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Question 12
Correct
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A 25-year-old woman requests reduction mammoplasty because she is convinced her breasts are grossly large and misshapen. She dresses in elaborate clothing to hide her shape and, although she swims well, has stopped going to the pool. Physical examination reveals breasts well within the normal range of size and shape.
What is the single most likely diagnosis?
Your Answer: Body dysmorphic disorder
Explanation:Understanding Body Dysmorphic Disorder: Differentiating it from Other Mental Health Conditions
Body dysmorphic disorder (BDD) is a mental health condition characterized by a preoccupation with an imagined defect in appearance or excessive concern with a slight physical anomaly. To diagnose BDD, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria should be followed. It is important to differentiate BDD from other mental health conditions such as agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and schizoaffective disorder. By understanding the unique features of BDD, proper diagnosis and treatment can be provided to those who are affected by this condition.
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This question is part of the following fields:
- Mental Health
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Question 13
Correct
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A 36-year-old woman comes to the clinic with difficult to manage hypertension. She is taking three medications and her current blood pressure is 160/100 mmHg. She has noticed that her face has become rounder over time and she is experiencing more acne and hirsutism. Fasting blood glucose testing has shown impaired glucose tolerance. Additionally, she has been struggling with abdominal obesity and has noticed the appearance of purple stretch marks around her abdomen.
What is the most probable diagnosis?Your Answer: Cushing syndrome
Explanation:Cushing syndrome is a rare disease that causes weight gain, hypertension, and other symptoms. It is often caused by a pituitary adenoma producing ACTH. Diagnosis is made through urinary free-cortisol assay and differentiation of the cause is done through the dexamethasone-suppression test. Drug-resistant hypertension may be caused by chronic kidney disease, obstructive sleep apnoea, or hyperaldosteronism. Phaeochromocytoma is a rare tumour that causes severe hypertension and other symptoms. Multiple endocrine neoplasia is a group of syndromes featuring tumours of endocrine glands. Simple obesity can be differentiated from Cushing syndrome by specific signs such as easy bruising, facial plethora, proximal myopathy, and purple striae.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 14
Correct
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A 76-year-old woman presents for review. She underwent ambulatory blood pressure monitoring which revealed an average reading of 142/90 mmHg. Apart from hypothyroidism, there is no significant medical history. Her 10-year cardiovascular risk score is 23%. What is the best course of action for management?
Your Answer: Start amlodipine
Explanation:For patients under 80 years old, the target blood pressure during clinic readings is 140/90 mmHg. However, the average reading is currently above this threshold, indicating the need for treatment with a calcium channel blocker.
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 15
Incorrect
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A 64-year-old patient has scheduled a phone consultation to discuss cervical screening. She has seen recent Public Health adverts raising awareness of cervical cancer and encouraging women to get screened. Although she is aware that she is now past the age for routine screening, she would like to self-refer for cervical screening, just as her friend did for breast screening. Upon checking her records, you find that her last smear was 3 years ago, and she has never had an abnormal result. She confirms that she has no symptoms. What advice should you give her?
Your Answer: She can self-refer for cervical screening 3-yearly by calling the number on the NHS website
Correct Answer: She is no longer eligible for cervical screening
Explanation:Cervical screening is only available to women between the ages of 25 and 64, and cannot be offered to those outside of this age range. However, if a patient has never had a screening test or has not had one since age 50, they can have a one-off test. Unlike breast and bowel screening, patients cannot self-refer for cervical screening outside of the routine age range. This is because cervical cancer is unlikely to develop after this age if previous tests have been normal. Patients with symptoms of cervical cancer should be referred for colposcopy, while asymptomatic patients should not be referred as screening is designed to detect asymptomatic cases.
Understanding Cervical Cancer Screening in the UK
Cervical cancer screening is a well-established program in the UK that aims to detect Premalignant changes in the cervix. This program is estimated to prevent 1,000-4,000 deaths per year. However, it should be noted that cervical adenocarcinomas, which account for around 15% of cases, are frequently undetected by screening.
The screening program has evolved significantly in recent years. Initially, smears were examined for signs of dyskaryosis, which may indicate cervical intraepithelial neoplasia. However, the introduction of HPV testing allowed for further risk stratification. Patients with mild dyskaryosis who were HPV negative could be treated as having normal results. The NHS has now moved to an HPV first system, where a sample is tested for high-risk strains of human papillomavirus (hrHPV) first, and cytological examination is only performed if this is positive.
All women between the ages of 25-64 years are offered a smear test. Women aged 25-49 years are screened every three years, while those aged 50-64 years are screened every five years. Cervical screening cannot be offered to women over 64, unlike breast screening, where patients can self-refer once past screening age. In Scotland, screening is offered from 25-64 every five years.
In special situations, cervical screening in pregnancy is usually delayed until three months postpartum, unless there has been missed screening or previous abnormal smears. Women who have never been sexually active have a very low risk of developing cervical cancer and may wish to opt-out of screening.
While there is limited evidence to support it, the current advice given out by the NHS is that the best time to take a cervical smear is around mid-cycle. Understanding the cervical cancer screening program in the UK is crucial for women to take control of their health and prevent cervical cancer.
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This question is part of the following fields:
- Gynaecology And Breast
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Question 16
Incorrect
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A 48-year-old female has an IUS. This was fitted 3 years previously. She has not had a period for 2 years. She asks her GP if the IUS can be removed as for the past 4 months she is getting monthly headaches and acne, which she attributes to the IUS. She is in a long term sexual relationship.
How should the GP counsel her regarding this?Your Answer: The device should be removed and she should be changed over to an alternative contraception until menopause can be assumed aged 55 yrs.
Correct Answer: She should have FSH levels checked at least 4 weeks apart to confirm a diagnosis of menopause. If both levels ≥30IU/L then contraception can be stopped after 24 months
Explanation:IUS and Menopause: Understanding the Connection
Her symptoms are unlikely to be caused by the IUS and may be related to ovulation, which is common in up to 75% of patients with an IUS. This doesn’t affect the effectiveness of the contraceptive. It’s important to note that amenorrhea is not a reliable indicator of menopause in patients on oestrogen and/or progesterone-containing contraception. Therefore, ongoing contraception is necessary.
For patients aged 45 years or older with an IUS fitted, the device can be maintained until aged 55 years if they are amenorrheic. At this point, menopause can be assumed to have occurred. If a patient wishes to confirm menopause, FSH levels can be checked. If both levels are >30IU/L 6 weeks apart, contraception can be stopped after 12 months.
Understanding the connection between IUS and menopause is crucial for patients and healthcare providers. By following the guidelines and recommendations, patients can make informed decisions about their contraceptive options and overall health.
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This question is part of the following fields:
- Sexual Health
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Question 17
Correct
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You are asked to assess an elderly 83-year-old man who has advanced prostate cancer and is experiencing poor appetite and anorexia. Upon further inquiry, he reports that his nausea is well-managed with cyclizine as needed, and he doesn't have any difficulty swallowing. His pain is adequately controlled, and he has regular bowel movements. What would be the most beneficial approach in this situation?
Your Answer: Nutritional supplements alongside any tolerated diet
Explanation:Addressing Lack of Appetite in Palliative Care Patients
A thorough history and clinical examination are crucial in identifying the underlying cause of anorexia and lack of appetite in palliative care patients. Pain, constipation, nausea, vomiting, and dysphagia are some of the potential causes that need to be treated accordingly. However, if the primary cause is a lack of appetite, specific measures should be taken to address it.
Home care input may not be effective in improving appetite, and changing antiemetics is unnecessary if the current medication is working well. Nutritional supplements may aid in caloric intake, but addressing the lack of appetite is still the priority. Referral for PEG feeding is not appropriate if there are no physical problems preventing oral intake.
The best option to stimulate appetite and improve oral intake is a course of prednisolone or dexamethasone. These corticosteroids have been proven to increase appetite and enjoyment of food in many patients. Progestogens are also effective but are more expensive.
In conclusion, addressing the lack of appetite in palliative care patients is crucial in improving their quality of life. A thorough assessment of the underlying cause is necessary, and appropriate measures should be taken to address it. Corticosteroids such as prednisolone and dexamethasone are effective in stimulating appetite and improving oral intake.
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This question is part of the following fields:
- End Of Life
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Question 18
Correct
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A 50-year-old man on your patient roster has been experiencing recurrent angina episodes for the past few weeks despite being prescribed bisoprolol at the highest dose. You are contemplating adding another medication to address his angina. His blood pressure is 140/80 mmHg, and his heart rate is 84 beats/min, which is regular. There is no other significant medical history.
What would be the most suitable supplementary treatment?Your Answer: Amlodipine
Explanation:If beta-blocker therapy is not effective in controlling angina, a longer-acting dihydropyridine calcium channel blocker like amlodipine should be added. However, it is important to note that rate-limiting calcium-channel blockers such as diltiazem and verapamil should not be combined with beta-blockers as they can lead to severe bradycardia and heart failure. In cases where a calcium-channel blocker is contraindicated or not tolerated, potassium-channel activators like nicorandil or inward sodium current inhibitors like ranolazine may be considered. It is recommended to seek specialist advice before initiating ranolazine.
Angina pectoris can be managed through lifestyle changes, medication, percutaneous coronary intervention, and surgery. In 2011, NICE released guidelines for the management of stable angina. Medication is an important aspect of treatment, and all patients should receive aspirin and a statin unless there are contraindications. Sublingual glyceryl trinitrate can be used to abort angina attacks. NICE recommends using either a beta-blocker or a calcium channel blocker as first-line treatment, depending on the patient’s comorbidities, contraindications, and preferences. If a calcium channel blocker is used as monotherapy, a rate-limiting one such as verapamil or diltiazem should be used. If used in combination with a beta-blocker, a longer-acting dihydropyridine calcium channel blocker like amlodipine or modified-release nifedipine should be used. Beta-blockers should not be prescribed concurrently with verapamil due to the risk of complete heart block. If initial treatment is ineffective, medication should be increased to the maximum tolerated dose. If a patient is still symptomatic after monotherapy with a beta-blocker, a calcium channel blocker can be added, and vice versa. If a patient cannot tolerate the addition of a calcium channel blocker or a beta-blocker, long-acting nitrate, ivabradine, nicorandil, or ranolazine can be considered. If a patient is taking both a beta-blocker and a calcium-channel blocker, a third drug should only be added while awaiting assessment for PCI or CABG.
Nitrate tolerance is a common issue for patients who take nitrates, leading to reduced efficacy. NICE advises patients who take standard-release isosorbide mononitrate to use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimize the development of nitrate tolerance. However, this effect is not seen in patients who take once-daily modified-release isosorbide mononitrate.
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This question is part of the following fields:
- Cardiovascular Health
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Question 19
Correct
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A 29-year-old man with a history of moderate ulcerative colitis and mesalazine use presents with a fever and sore throat lasting for a week. What is the primary investigation that should be conducted initially?
Your Answer: Full blood count
Explanation:If a patient is taking aminosalicylates, they may experience various haematological adverse effects, including agranulocytosis. Therefore, it is crucial to conduct a full blood count promptly if the patient presents with symptoms such as fever, sore throat, fatigue, or bleeding gums.
While C-reactive protein may be a part of the overall management plan, it is not the most critical initial investigation and is unlikely to alter the management plan.
Although the monospot test for glandular fever may be useful if glandular fever is suspected, it is not the primary investigation that needs to be conducted urgently.
Similarly, while a throat swab may be necessary as part of the overall management plan, it is not the most crucial initial investigation that needs to be performed urgently.
Aminosalicylate Drugs for Inflammatory Bowel Disease
Aminosalicylate drugs are commonly used to treat inflammatory bowel disease (IBD). These drugs work by releasing 5-aminosalicyclic acid (5-ASA) in the colon, which acts as an anti-inflammatory agent. The exact mechanism of action is not fully understood, but it is believed that 5-ASA may inhibit prostaglandin synthesis.
Sulphasalazine is a combination of sulphapyridine and 5-ASA. However, many of the side effects associated with this drug are due to the sulphapyridine component, such as rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, and lung fibrosis. Mesalazine is a delayed release form of 5-ASA that avoids the sulphapyridine side effects seen in patients taking sulphasalazine. However, it is still associated with side effects such as gastrointestinal upset, headache, agranulocytosis, pancreatitis, and interstitial nephritis.
Olsalazine is another aminosalicylate drug that consists of two molecules of 5-ASA linked by a diazo bond, which is broken down by colonic bacteria. It is important to note that aminosalicylates are associated with a variety of haematological adverse effects, including agranulocytosis. Therefore, a full blood count is a key investigation in an unwell patient taking these drugs. Pancreatitis is also more common in patients taking mesalazine compared to sulfasalazine.
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This question is part of the following fields:
- Haematology
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Question 20
Correct
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A 75-year-old obese woman had a deep venous thrombosis several years ago. She has an ulcer over the left medial malleolus with fibrosis and purpura of the surrounding skin.
What is the most probable diagnosis?Your Answer: A venous ulcer
Explanation:Understanding Venous Leg Ulcers: Causes, Symptoms, and Treatment Options
Venous leg ulcers are a common condition in the UK, accounting for approximately 3% of new cases seen in dermatological clinics. These ulcers are more prevalent in patients who are obese, have a history of varicose veins, or have experienced deep vein thrombosis. The underlying cause of venous leg ulcers is venous stasis, which leads to an increase in capillary pressure, fibrin deposits, and poor oxygenation of the skin. This, in turn, can result in poorly nourished skin and minor trauma, leading to ulceration.
Treatment for venous leg ulcers focuses on reducing exudates and promoting healing using dressings such as Granuflex® or Sorbisan®. Compression bandaging is the primary treatment option, and preventive therapy may include weight loss, wearing support stockings, or surgical treatment of varicose veins.
It is important to note that other conditions may present with similar symptoms, such as absent pulses, widespread purpura on the legs, injury, or diabetes. Therefore, a proper diagnosis is crucial to ensure appropriate treatment.
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This question is part of the following fields:
- Dermatology
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Question 21
Incorrect
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A 32-year-old man is brought by his wife and appears to be experiencing an elevated mood, along with increased activity and energy, and difficulty sleeping. He is extremely talkative and jumps quickly from one topic to another. He has no hallucinations or delusions. His wife believes he requires medication to help calm him down.
What medication would be the most appropriate for the mental health team to prescribe for this patient?Your Answer: Lithium
Correct Answer: Olanzapine
Explanation:Treatment for Mania/Hypomania
Mania/hypomania is a condition that requires specialist mental health assessment. The patient may be prescribed atypical antipsychotic drugs such as olanzapine, quetiapine, or risperidone, which have a quicker onset and lower incidence of extrapyramidal side-effects compared to older antipsychotics like chlorpromazine. Alternatively, benzodiazepines like lorazepam may be used to aid sleep.
Lithium, a mood stabilizer, has a slower onset of action and is only used alone if symptoms are mild. It is usually initiated after a specialist assessment. In this case, the treatment with antipsychotics is to calm the patient down in the immediate short-term. Managing mania or hypomania in adults requires careful consideration of the patient’s symptoms and individual needs.
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This question is part of the following fields:
- Mental Health
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Question 22
Correct
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A 25-year-old woman has recurrent oral candidiasis. She has well-controlled asthma on regular inhalers and is otherwise well. She also takes a combined oral contraceptive pill.
What is the most likely underlying cause?
Your Answer: Inhaled corticosteroid
Explanation:Understanding the Relationship Between Medications and Oral Candidiasis
Oral candidiasis, also known as thrush, is a common fungal infection that can affect the mouth and throat. While it can occur in anyone, certain medications can increase the risk of developing this condition. Here is a breakdown of how different medications may impact the likelihood of oral candidiasis:
Inhaled Corticosteroid: Patients with well-controlled asthma may use inhaled corticosteroids, which can increase the risk of oral candidiasis. Using a spacer device and rinsing the mouth with water after inhalation can help reduce this risk. Antifungal medication can be used to treat oral candidiasis without discontinuing therapy.
Inhaled β2 Agonist: This type of inhaler is used as a reliever for poorly controlled asthma and doesn’t increase the risk of oral candidiasis. Common side effects include palpitations, tremors, and hypokalaemia.
Combined Oral Contraceptive: While the combined oral contraceptive pill doesn’t increase the risk of oral candidiasis, it may be associated with vulvovaginal candidiasis.
Montelukast: This oral medication used to treat asthma doesn’t increase the risk of oral candidiasis. Dry mouth is a possible side effect, along with gastrointestinal problems, headaches, and sleep disturbance.
Type II Diabetes Mellitus: Patients with poorly controlled diabetes may be more susceptible to recurrent infections, including oral candidiasis. If a patient presents with symptoms or risk factors for diabetes, blood glucose and/or haemoglobin A1c should be checked.
Understanding the relationship between medications and oral candidiasis can help healthcare providers make informed decisions about treatment and management.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 23
Incorrect
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A 35-year-old teacher presents to you with concerns about her Depo-Provera injectable contraceptive. She has been experiencing irregular bleeding since starting the contraceptive 4 months ago. This is causing her personal inconvenience and putting a strain on her relationship. She denies any vaginal discharge and is in a stable relationship. She has had regular cervical smears and her last one was normal 2 years ago. What advice would you give her?
Your Answer: Referral to a gynaecologist
Correct Answer: Trial of a short-term combined oral contraceptive pill
Explanation:Management of Unscheduled Bleeding in a Young Lady on Depo-Provera Injection
This patient is a young lady who has been experiencing unscheduled bleeding after being put on the Depo-Provera injection. However, she has no red flag symptoms and is up-to-date with her cervical smears, which provides reassurance to her history. At this stage, blood tests and a pelvic ultrasound scan are not necessary, but may be considered later on. Referral to a gynaecologist is not indicated as there are no alarming symptoms present.
It is important to follow advice from the cervical screening hub regarding cervical smears and not order one sooner than indicated. If any alarming symptoms arise, referral to a gynaecologist is recommended. For women experiencing unscheduled bleeding while on a progesterone-only injectable and who are medically eligible, a combined oral contraceptive can be offered for three months in the usual cyclic manner. The longer-term use of the combined contraceptive pill with the injectable progesterone is a matter of clinical judgement.
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This question is part of the following fields:
- Gynaecology And Breast
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Question 24
Correct
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You are consulted for a 50-year-old patient with type 2 diabetes who presents with a 24-hour history of polyuria, polydipsia, and vomiting. The patient is currently taking metformin, gliclazide, and empagliflozin. On examination, the patient has a temperature of 37.4°C, blood pressure of 130/80 mmHg, pulse of 100, blood glucose of 13 mmol/L, and blood ketones of 3.3 mmol/L. Urinalysis shows +++ ketones, but is otherwise normal.
What is the most likely diagnosis?Your Answer: Diabetic ketoacidosis
Explanation:Patients with type 2 diabetes can experience diabetic ketoacidosis, as seen in this case where the patient has a blood glucose level of ≥11mmol/L and blood ketones of ≥3mmol/L. Immediate hospital admission is necessary for treatment with intravenous fluids and insulin. It is important to note that individuals taking SGLT2 inhibitors, such as empagliflozin, are at risk of DKA even with moderate blood glucose levels. DKA is more prevalent in Afro-Caribbean patients with type 2 diabetes. Hyperosmolar non-ketotic state (HONK) is characterized by elevated blood glucose levels but less than 2+ ketones in urine or 3mmol/L blood ketones.
Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus, accounting for around 6% of cases. It can also occur in rare cases of extreme stress in patients with type 2 diabetes mellitus. DKA is caused by uncontrolled lipolysis, resulting in an excess of free fatty acids that are converted to ketone bodies. The most common precipitating factors of DKA are infection, missed insulin doses, and myocardial infarction. Symptoms include abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and breath that smells like acetone. Diagnostic criteria include glucose levels above 11 mmol/l or known diabetes mellitus, pH below 7.3, bicarbonate below 15 mmol/l, and ketones above 3 mmol/l or urine ketones ++ on dipstick.
Management of DKA involves fluid replacement, insulin, and correction of electrolyte disturbance. Fluid replacement is necessary as most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially, even if the patient is severely acidotic. Insulin is administered through an intravenous infusion, and correction of electrolyte disturbance is necessary. Long-acting insulin should be continued, while short-acting insulin should be stopped. Complications may occur from DKA itself or the treatment, such as gastric stasis, thromboembolism, arrhythmias, acute respiratory distress syndrome, acute kidney injury, and cerebral edema. Children and young adults are particularly vulnerable to cerebral edema following fluid resuscitation in DKA and often need 1:1 nursing to monitor neuro-observations, headache, irritability, visual disturbance, focal neurology, etc.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 25
Correct
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A 30-year-old football player comes in for evaluation the day after a game. He has noticeable swelling and redness in his left ear. Upon examination, it appears to be an auricular hematoma. What is the best course of action for treatment?
Your Answer: Refer to secondary care
Explanation:The RCGP curriculum includes a specific mention of auricular haematomas.
Auricular haematomas are frequently observed in individuals who participate in rugby or wrestling. It is crucial to seek immediate medical attention to prevent the development of ‘cauliflower ear’. The management of auricular haematomas necessitates an evaluation by an ENT specialist on the same day. Incision and drainage have been demonstrated to be more effective than needle aspiration.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 26
Incorrect
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As per the guidelines of NICE and National Patient Safety Agency (NPSA), how frequently should lithium levels be monitored once a stable dose has been attained?
Your Answer: Every month
Correct Answer: Every 3 months
Explanation:Once a stable dose has been achieved, lithium levels need to be monitored every 3 months.
Lithium is a medication used to stabilize mood in individuals with bipolar disorder and as an adjunct in refractory depression. It has a narrow therapeutic range of 0.4-1.0 mmol/L and is primarily excreted by the kidneys. The mechanism of action is not fully understood, but it is believed to interfere with inositol triphosphate or cAMP formation.
Common adverse effects of lithium include nausea, vomiting, diarrhea, fine tremors, and nephrotoxicity. It may also cause thyroid enlargement, ECG changes, weight gain, idiopathic intracranial hypertension, leucocytosis, and hyperparathyroidism.
Monitoring of patients on lithium therapy is crucial to prevent toxicity. It is recommended to check lithium levels 12 hours after the last dose and weekly after starting or changing the dose until concentrations are stable. Once established, lithium levels should be checked every 3 months. Thyroid and renal function should be checked every 6 months. Patients should be provided with an information booklet, alert card, and record book. Inadequate monitoring of patients taking lithium is common, and guidelines have been issued to address this issue.
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This question is part of the following fields:
- Mental Health
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Question 27
Correct
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Samantha, a 10-year-old girl, visits your clinic with her mother. She reports having a constant headache for several weeks. Her mother is extremely worried. However, Samantha is always anxious during medical appointments and refuses to cooperate with a thorough examination.
As a healthcare provider, you are concerned about Samantha's condition and decide to request an immediate referral. What is the maximum time frame within which she should receive an appointment with a specialist?Your Answer: 3 days
Explanation:Referral Guidelines for Children with Suspected Cancer
When a child presents with symptoms and signs of cancer, it is important to refer them to a paediatrician or a specialist children’s cancer service, if appropriate. If the child experiences headaches and vomiting that cause early morning waking or occur on waking, this could be a sign of raised intracranial pressure, and an immediate referral should be made.
It is important to note that patients have a legal right to be seen by a specialist within two weeks of being urgently referred for suspected cancer by their GP. If this is not possible, the NHS must do everything it reasonably can to offer them clinically appropriate alternatives. By following these referral guidelines, healthcare professionals can ensure that children with suspected cancer receive timely and appropriate care.
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This question is part of the following fields:
- Neurology
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Question 28
Incorrect
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A 65-year-old man with a history of lumbar spondylosis and chronic back pain complains of progressive bilateral upper limb tingling and stiffness in his legs. Which of the following tests is confirmatory for his probable diagnosis?
Your Answer: MRI Lumbar Spine
Correct Answer: MRI Cervical spine
Explanation:Upper limb neurological symptoms suggest that there is a problem in the cervical spinal cord or brain, with brain disease more likely to cause unilateral issues. Therefore, an MRI of the lumbar spine would not provide a conclusive diagnosis in this case. When degenerative cervical myelopathy is suspected, an MRI of the cervical spine is the preferred test, as it can reveal disc degeneration, ligament hypertrophy, and cord signal change. CT imaging is only used when MRI is not possible, and radiographs are not useful in this context. Additional investigations, such as nerve conduction studies and EMG, may be performed if the diagnosis is unclear, but an MRI of the cervical spine should be the primary investigation when cervical myelopathy is suspected.
Degenerative cervical myelopathy (DCM) is a condition that has several risk factors, including smoking, genetics, and certain occupations that expose individuals to high axial loading. The symptoms of DCM can vary in severity and may include pain, loss of motor function, loss of sensory function, and loss of autonomic function. Early symptoms may be subtle and difficult to detect, but as the condition progresses, symptoms may worsen or new symptoms may appear. An MRI of the cervical spine is the gold standard test for diagnosing cervical myelopathy. All patients with DCM should be urgently referred to specialist spinal services for assessment and treatment. Decompressive surgery is currently the only effective treatment for DCM, and early treatment offers the best chance of a full recovery. Physiotherapy should only be initiated by specialist services to prevent further spinal cord damage.
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This question is part of the following fields:
- Neurology
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Question 29
Correct
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Which one of the following is not a risk factor for sudden toddler death syndrome?
Your Answer: Female sex
Explanation:Sudden infant death syndrome (SIDS) is more likely to occur in infants who sleep on their stomachs, have parents who smoke, share a bed with their parents, experience overheating or have their heads covered, and are born prematurely. Additionally, male infants are at a higher risk for SIDS than female infants.
Sudden infant death syndrome (SIDS) is the leading cause of death in infants during their first year of life, with the highest incidence occurring at three months of age. There are several major risk factors associated with SIDS, including placing the baby to sleep on their stomach, parental smoking, prematurity, bed sharing, and hyperthermia or head covering. These risk factors are additive, meaning that the more risk factors present, the higher the likelihood of SIDS. Other risk factors include male sex, multiple births, lower social classes, and maternal drug use. SIDS incidence also tends to increase during the winter months. However, there are protective factors that can reduce the risk of SIDS, such as breastfeeding, room sharing (but not bed sharing), and the use of pacifiers. In the event of a SIDS case, it is important to screen siblings for potential sepsis and inborn errors of metabolism.
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This question is part of the following fields:
- Children And Young People
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Question 30
Correct
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A 72-year-old man seeks advice regarding his upcoming trip to Australia to visit his daughter who has emigrated. He is concerned about the risk of deep vein thrombosis as he was diagnosed with this condition approximately 40 years ago during his wife's second pregnancy. However, there are no other significant risk factors for venous thromboembolism. What is the best advice to provide?
Your Answer: Wear compression stockings
Explanation:Considering her age, previous DVT, and long haul destination, this woman is at a higher risk of travel related thrombosis. Therefore, the most suitable recommendation for her would be to wear compression stockings.
Travel-Related Thrombosis and Guidelines for Prevention
Long-haul air travel has been associated with an increased risk of venous thromboembolism (VTE), commonly known as economy class syndrome. However, there is no universal agreement on how to advise patients regarding VTE prevention during travel. The British Committee for Standards in Haematology, SIGN, and Clinical Knowledge Summaries have all produced guidelines, but they differ in their recommendations.
The most recent CKS guidelines suggest a risk-based approach. Patients with no major risk factors for VTE do not require special measures. However, those with major risk factors should consider wearing anti-embolism stockings, which can be bought or prescribed. In cases of very high risk, such as a long-haul flight following recent major surgery, delaying the flight or seeking specialist advice regarding the use of low-molecular weight heparin may be necessary.
It is important to note that all guidelines agree that there is no role for aspirin in VTE prevention for low, medium, or high-risk patients. A 2001 study in the New England Journal of Medicine showed that the risk of pulmonary embolism increases with travel distance, with 4.8 cases per million for travel over 10,000 km. While the Civil Aviation Authority doesn’t provide specific guidance on VTE prevention, healthcare providers can use these guidelines to help patients make informed decisions about their travel plans.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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