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  • Question 1 - A 25-year-old transgender man comes to your clinic for a follow-up on his...

    Incorrect

    • A 25-year-old transgender man comes to your clinic for a follow-up on his testosterone treatment. He discloses that he had unprotected vaginal sex three days ago and doesn't want to conceive.

      What is the best course of action for managing this patient?

      Your Answer: Prescribe emergency contraception and advise that he takes a pregnancy test in 72 hours time

      Correct Answer: Prescribe emergency contraception and advise the patient that testosterone therapy is contraindicated in pregnancy

      Explanation:

      Transgender males who are on testosterone therapy should be aware that this treatment doesn’t prevent pregnancy. In the event that a patient becomes pregnant, testosterone therapy is not recommended as it can have harmful effects on the developing fetus. Instead, emergency contraception should be prescribed and the patient should be advised against continuing testosterone therapy during pregnancy. It is important to note that emergency contraception is still safe for patients on testosterone therapy. While discussing the risk of sexually transmitted infections is important, it is not a substitute for effective contraception. While a future pregnancy test may be necessary, the immediate priority is to provide emergency contraception. It is also important to note that testosterone therapy is not a form of emergency contraception and that other options, such as a copper intrauterine device or specific medications, should be considered.

      Contraceptive and Sexual Health Guidance for Transgender and Non-Binary Individuals

      The Faculty of Sexual & Reproductive Healthcare has released guidance on contraceptive choices and sexual health for transgender and non-binary individuals. The guidance emphasizes the importance of sensitive communication and offering options that consider personal preferences, co-morbidities, and current medications or therapies. For those engaging in vaginal sex, condoms and dental dams are recommended to prevent sexually transmitted infections. Cervical screening and HPV vaccinations should also be offered. Those at risk of HIV transmission should be advised of pre-exposure prophylaxis and post-exposure prophylaxis.

      For individuals assigned female at birth with a uterus, testosterone therapy doesn’t provide protection against pregnancy, and oestrogen-containing regimens are not recommended as they can antagonize the effect of testosterone therapy. Progesterone-only contraceptives are considered safe, and non-hormonal intrauterine devices may also suspend menstruation. Emergency contraception may be required following unprotected vaginal intercourse, and either oral formulation or the non-hormonal intrauterine device may be considered.

      In patients assigned male at birth, hormone therapy may reduce or cease sperm production, but the variability of its effects means it cannot be relied upon as a method of contraception. Condoms are recommended for those engaging in vaginal sex to avoid the risk of pregnancy. The guidance stresses the importance of offering individuals options that take into account their personal circumstances and preferences.

    • This question is part of the following fields:

      • Sexual Health
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      Seconds
  • Question 2 - A 63-year-old male had routine bloods done. He is a known type 2...

    Incorrect

    • A 63-year-old male had routine bloods done. He is a known type 2 diabetic and takes metformin 500mg BD and atorvastatin 20 mg ON. His blood results showed cholesterol at 7.2 mmol/L with raised triglycerides. His Hba1c increased from 72 mmol/L three months ago to 81 mmol/L currently. His urea and electrolytes are stable. He reports no significant changes in his diet and is compliant with his medications.

      What is the most appropriate course of action regarding his medication regimen?

      Your Answer: Continue current medications and re-check bloods in three months

      Correct Answer: Increase metformin to 500mg TDS and repeat bloods in three months

      Explanation:

      To manage hyperlipidaemia, it is important to address any accompanying hyperglycaemia. The patient’s abnormal cholesterol levels could be a result of his deteriorating diabetic condition. Therefore, the best course of action would be to maintain the current statin dosage and adjust the metformin dosage accordingly. By treating the hyperglycaemia, there is a possibility of improving the patient’s cholesterol levels.

      Management of Hyperlipidaemia: NICE Guidelines

      Hyperlipidaemia, or high levels of lipids in the blood, is a major risk factor for cardiovascular disease (CVD). In 2014, the National Institute for Health and Care Excellence (NICE) updated their guidelines on lipid modification, which caused controversy due to the recommendation of statins for a significant proportion of the population over the age of 60. The guidelines suggest a systematic strategy to identify people over 40 years who are at high risk of CVD, using the QRISK2 CVD risk assessment tool. A full lipid profile should be checked before starting a statin, and patients with very high cholesterol levels should be investigated for familial hyperlipidaemia. The new guidelines recommend offering a statin to people with a QRISK2 10-year risk of 10% or greater, with atorvastatin 20 mg offered first-line. Special situations, such as type 1 diabetes mellitus and chronic kidney disease, are also addressed. Lifestyle modifications, including a cardioprotective diet, physical activity, weight management, alcohol intake, and smoking cessation, are important in managing hyperlipidaemia.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
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  • Question 3 - A 40-year-old man presents with painless blood staining of the semen upon ejaculation....

    Correct

    • A 40-year-old man presents with painless blood staining of the semen upon ejaculation. He reports no recent unprotected sexual intercourse and is in good health otherwise.
      What is the most probable diagnosis? Choose ONE answer.

      Your Answer: Idiopathic and self-limiting

      Explanation:

      Understanding Haematospermia: Causes and Symptoms

      Haematospermia, the presence of blood in the ejaculate, is a common and usually benign symptom that can affect men of any age. In about 50% of cases, the cause is unknown and the symptom is self-limiting. However, further investigation may be necessary for men over 40 or those with accompanying symptoms such as perineal pain or abnormal examination findings.

      Other conditions, such as urinary tract infections, epididymitis, hypertension, and prostate cancer, can also cause haematospermia. However, these conditions are usually accompanied by other symptoms such as dysuria, testicular pain, urinary symptoms, penile discharge, headaches, visual disturbance, or are unlikely in a 35-year-old man without any other symptoms.

      It is important to seek medical attention if haematospermia persists or is accompanied by other symptoms.

    • This question is part of the following fields:

      • Kidney And Urology
      104.3
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  • Question 4 - A 7-year-old boy has a problem with bed-wetting. This has been a long-term...

    Correct

    • A 7-year-old boy has a problem with bed-wetting. This has been a long-term problem and he is otherwise fit and well.
      Which of the following features of this condition would necessitate the need for urinalysis?

      Your Answer: Daytime symptoms

      Explanation:

      When to Perform Urinalysis for Bed-Wetting: NICE Guidelines

      The National Institute for Health and Care Excellence (NICE) has provided guidelines on when to perform urinalysis for bed-wetting. According to NICE, urinalysis is only necessary if bed-wetting has started recently, there are daytime symptoms, signs of ill health or urinary tract infection, or a history of diabetes. Daytime symptoms may indicate a bladder disorder and require further investigation or referral.

      Bed-wetting that occurs soon after going to bed and a large volume of urine in the first few hours of the night are typical and do not require urinalysis. However, severe bed-wetting that occurs every night may require active measures to promote resolution.

      NICE advises against routine urinalysis in children with bed-wetting, as up to 5% of 10-year-old children may still wet the bed. Therefore, urinalysis should only be performed when necessary based on the patient’s symptoms and medical history.

    • This question is part of the following fields:

      • Children And Young People
      61.5
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  • Question 5 - Samantha, a 48-year-old woman, visits you for her annual medication review.

    Samantha has a...

    Incorrect

    • Samantha, a 48-year-old woman, visits you for her annual medication review.

      Samantha has a medical history of hypertension and hyperlipidemia. Her current medications include lisinopril 10 mg, hydrochlorothiazide 25 mg, and atorvastatin 40 mg. She has no known drug allergies.

      During the review, Samantha expresses her concern about her persistent headaches and occasional dizziness. Upon further questioning, she reveals that she has been experiencing stress at work and difficulty sleeping due to worrying about her job security.

      You diagnose mild anxiety and discuss starting an anxiolytic. Samantha agrees, and you prescribe lorazepam 0.5mg as needed.

      What other step is important in managing Samantha's condition at this point?

      Your Answer: Prescribe amitriptyline

      Correct Answer: Prescribe lansoprazole

      Explanation:

      When prescribing medication to a patient who is already taking an NSAID, such as aspirin, it is important to assess their risk for gastrointestinal bleeding. According to NICE guidelines, patients with 1-2 risk factors are considered moderate risk and should either be prescribed a COX-2 inhibitor alone or a PPI. One risk factor is taking a selective serotonin reuptake inhibitor (SSRI), so in this case, the patient should be prescribed lansoprazole along with citalopram.

      It is important to note that taking both citalopram and amitriptyline can increase the risk of serotonin syndrome. While co-codamol may be helpful for the patient’s back pain, it would be best to assess the pain before prescribing pain relief.

      Gabapentin is not necessary in this situation, and Z drugs like zopiclone should not be the first choice for managing sleep difficulties associated with depression.

      Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression, with citalopram and fluoxetine being the preferred options. They should be used with caution in children and adolescents, and patients should be monitored for increased anxiety and agitation. Gastrointestinal symptoms are the most common side-effect, and there is an increased risk of gastrointestinal bleeding. Citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in certain patients. SSRIs have a higher propensity for drug interactions, and patients should be reviewed after 2 weeks of treatment. When stopping a SSRI, the dose should be gradually reduced over a 4 week period. Use of SSRIs during pregnancy should be weighed against the risks and benefits.

    • This question is part of the following fields:

      • Mental Health
      66.9
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  • Question 6 - A 29-year-old woman has been diagnosed with familial hypercholesterolaemia due to being heterozygous...

    Incorrect

    • A 29-year-old woman has been diagnosed with familial hypercholesterolaemia due to being heterozygous for the condition. During the consultation, you suggest screening her family members. She mentions that her father has normal cholesterol levels. What is the likelihood that her brother will also be impacted?

      Your Answer: 100%

      Correct Answer: 50%

      Explanation:

      Familial Hypercholesterolaemia: Causes, Diagnosis, and Management

      Familial hypercholesterolaemia (FH) is a genetic condition that affects approximately 1 in 500 people. It is an autosomal dominant disorder that results in high levels of LDL-cholesterol, which can lead to early cardiovascular disease if left untreated. FH is caused by mutations in the gene that encodes the LDL-receptor protein.

      To diagnose FH, NICE recommends suspecting it as a possible diagnosis in adults with a total cholesterol level greater than 7.5 mmol/l and/or a personal or family history of premature coronary heart disease. For children of affected parents, testing should be arranged by age 10 if one parent is affected and by age 5 if both parents are affected.

      The Simon Broome criteria are used for clinical diagnosis, which includes a total cholesterol level greater than 7.5 mmol/l and LDL-C greater than 4.9 mmol/l in adults or a total cholesterol level greater than 6.7 mmol/l and LDL-C greater than 4.0 mmol/l in children. Definite FH is diagnosed if there is tendon xanthoma in patients or first or second-degree relatives or DNA-based evidence of FH. Possible FH is diagnosed if there is a family history of myocardial infarction below age 50 years in second-degree relatives, below age 60 in first-degree relatives, or a family history of raised cholesterol levels.

      Management of FH involves referral to a specialist lipid clinic and the use of high-dose statins as first-line treatment. CVD risk estimation using standard tables is not appropriate in FH as they do not accurately reflect the risk of CVD. First-degree relatives have a 50% chance of having the disorder and should be offered screening, including children who should be screened by the age of 10 years if there is one affected parent. Statins should be discontinued in women 3 months before conception due to the risk of congenital defects.

    • This question is part of the following fields:

      • Cardiovascular Health
      53.2
      Seconds
  • Question 7 - What is a true statement about obsessive compulsive disorder (obsessional neurosis)? ...

    Incorrect

    • What is a true statement about obsessive compulsive disorder (obsessional neurosis)?

      Your Answer: Low intelligence is a common feature

      Correct Answer: The onset is usually after the age of 50 years

      Explanation:

      Understanding Obsessional Neurosis and Obsessional Compulsive Disorder

      Obsessional neurosis is a mental health condition characterized by repetitive rituals, persistent fears, and disturbing thoughts. Patients with this disorder maintain insight and often find the illness distressing, which can lead to depression. On the other hand, obsessional compulsive disorder typically starts in early adulthood and has equal sex incidence. Patients with this disorder have above-average intelligence.

      It is important to note that Sigmund Freud’s theory that obsessive-compulsive symptoms were caused by rigid toilet-training practices is no longer widely accepted. Despite this, understanding these disorders and their symptoms can help individuals seek appropriate treatment and support. By recognizing the signs and symptoms of these disorders, individuals can work towards managing their symptoms and improving their overall quality of life.

    • This question is part of the following fields:

      • Mental Health
      40.9
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  • Question 8 - A 35-year-old mother of a one-year-old baby boy presented to your clinic with...

    Incorrect

    • A 35-year-old mother of a one-year-old baby boy presented to your clinic with a sharp pain and redness in her right eye, following a scratch from her baby. Upon examination, a central oval-shaped fluorescent uptake of the right cornea was observed, indicating a corneal abrasion. What would be the most appropriate next step in managing this patient's condition?

      Your Answer: Refer to an optometrist

      Correct Answer: Start the patient on chloramphenicol eye ointment, QID for 5 days

      Explanation:

      Treatment for Simple Corneal Abrasion

      From the patient’s history and examination, it can be concluded that they have a simple corneal abrasion caused by a scratch. The recommended treatment for this condition is a topical ocular antibiotic. The abrasion should heal quickly, and no follow-up is necessary. It is important to avoid using topical ocular steroids as they can slow down the healing process.

      It is worth noting that GPs can treat simple corneal abrasions, and there is no need for ophthalmology referral. Topical prophylactic antibiotics, such as chloramphenicol 1%, can be used to manage corneal abrasions. By following these guidelines, patients can receive effective treatment for their condition and avoid unnecessary referrals or complications.

    • This question is part of the following fields:

      • Eyes And Vision
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  • Question 9 - A 30-year-old female is worried about the unsightly appearance of her toenails. She...

    Incorrect

    • A 30-year-old female is worried about the unsightly appearance of her toenails. She has noticed a whitish discoloration that extends up the nail bed in several toes on both feet. After confirming a dermatophyte infection, she has been diligently cutting her nails and applying topical amorolifine, but with no improvement. What is the best course of treatment?

      Your Answer: Oral terbinafine

      Correct Answer: Topical terbinafine

      Explanation:

      Treatment for Fungal Nail Infection

      If an adult has a confirmed fungal nail infection and self-care measures or topical treatment are not successful or appropriate, treatment with an oral antifungal agent should be offered. The first-line recommendation is Terbinafine because it is effective against both dermatophytes and Candida species. On the other hand, the ‘-azoles’ such as fluconazole do not have as much efficacy against dermatophytes. Proper diagnosis and treatment can help prevent the spread of infection and improve the appearance of the affected nail.

    • This question is part of the following fields:

      • Dermatology
      63.7
      Seconds
  • Question 10 - A 22-year-old medical student comes to the clinic complaining of bilateral leg weakness...

    Incorrect

    • A 22-year-old medical student comes to the clinic complaining of bilateral leg weakness and paraesthesia. She reports that the symptoms started in her feet and have been gradually moving up over the past few days. She also mentions that she had a bout of diarrhoea while on an elective in Zimbabwe about a week ago. Upon examination, her GCS is 15/15, her lower limb sensation is intact, but her strength is 2/5 throughout with reduced tone and reflexes. Her plantars are downgoing. Based on her symptoms and examination findings, what is the most likely diagnosis?

      Your Answer:

      Correct Answer: Guillain-Barre syndrome

      Explanation:

      Guillain-Barre syndrome is characterized by an ascending peripheral neuropathy, while multiple sclerosis presents with mixed motor and sensory deficits and lesions affecting both upper and lower motor neurons. Transverse myelitis also involves both upper and lower motor neurons, with the specific deficits depending on the location of the spinal cord lesion. Brain abscess, on the other hand, typically results in upper motor neuron lesions.

      Understanding Guillain-Barre Syndrome and Miller Fisher Syndrome

      Guillain-Barre syndrome is a condition that affects the peripheral nervous system and is often triggered by an infection, particularly Campylobacter jejuni. The immune system attacks the myelin sheath that surrounds nerve fibers, leading to demyelination. This results in symptoms such as muscle weakness, tingling sensations, and paralysis.

      The pathogenesis of Guillain-Barre syndrome involves the cross-reaction of antibodies with gangliosides in the peripheral nervous system. Studies have shown a correlation between the presence of anti-ganglioside antibodies, particularly anti-GM1 antibodies, and the clinical features of the syndrome. In fact, anti-GM1 antibodies are present in 25% of patients with Guillain-Barre syndrome.

      Miller Fisher syndrome is a variant of Guillain-Barre syndrome that is characterized by ophthalmoplegia, areflexia, and ataxia. This syndrome typically presents as a descending paralysis, unlike other forms of Guillain-Barre syndrome that present as an ascending paralysis. The eye muscles are usually affected first in Miller Fisher syndrome. Studies have shown that anti-GQ1b antibodies are present in 90% of cases of Miller Fisher syndrome.

      In summary, Guillain-Barre syndrome and Miller Fisher syndrome are conditions that affect the peripheral nervous system and are often triggered by infections. The pathogenesis of these syndromes involves the cross-reaction of antibodies with gangliosides in the peripheral nervous system. While Guillain-Barre syndrome is characterized by muscle weakness and paralysis, Miller Fisher syndrome is characterized by ophthalmoplegia, areflexia, and ataxia.

    • This question is part of the following fields:

      • Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Sexual Health (0/1) 0%
Metabolic Problems And Endocrinology (0/1) 0%
Kidney And Urology (1/1) 100%
Children And Young People (1/1) 100%
Mental Health (0/2) 0%
Eyes And Vision (0/1) 0%
Dermatology (0/1) 0%
Neurology (0/1) 0%
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