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  • Question 1 - A 50-year-old man presents for a routine check-up and inquires about the benefits...

    Correct

    • A 50-year-old man presents for a routine check-up and inquires about the benefits and drawbacks of taking daily aspirin. He has normal blood pressure and his cholesterol and glucose levels are within normal limits.
      What is the one accurate statement regarding the advantages and disadvantages of aspirin in primary prevention?

      Your Answer: Aspirin use in primary prevention reduces risk of non-fatal myocardial infarction

      Explanation:

      The Pros and Cons of Aspirin in Primary Prevention

      Aspirin has been found to reduce the risk of myocardial infarction in primary prevention studies. However, this benefit is counterbalanced by an increased risk of gastrointestinal bleeding, which is highest in the first 1-2 years of use but decreases with continued use. Despite this, there is a significant body of evidence indicating that aspirin can reduce the risk of cancer, particularly colorectal cancer, and also lower the risk of metastases. Additionally, stopping aspirin use can lead to a temporary increase in the risk of myocardial infarction. Currently, there is no consensus on whether aspirin or other antiplatelets should be recommended for primary prevention in otherwise healthy patients due to insufficient evidence.

    • This question is part of the following fields:

      • Cardiovascular Health
      754.4
      Seconds
  • Question 2 - Samantha is a 32-year-old female who has been dealing with premenstrual syndrome (PMS)...

    Correct

    • Samantha is a 32-year-old female who has been dealing with premenstrual syndrome (PMS) for a few years. She experiences lower abdominal cramping and bloating 1-2 days before her menstrual period. Recently, she found herself becoming more irritable and upset with her coworkers, which is out of character for her. What advice can you offer to help improve her PMS symptoms?

      Your Answer: 2-3 hourly small balanced meals rich in complex carbohydrates

      Explanation:

      To manage premenstrual syndrome, it is recommended to make specific lifestyle changes such as consuming 2-3 hourly small balanced meals that are rich in complex carbohydrates. This is because complex carbohydrates are more nutrient-dense and higher in fiber compared to simple carbohydrates. Consuming complex carbohydrates in smaller, frequent meals helps to stabilize blood sugar levels and provide the body with essential nutrients throughout the day, which can help control PMS symptoms. Other options have not been proven to improve the severity of symptoms.

      Understanding Premenstrual Syndrome (PMS)

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

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

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

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

    • This question is part of the following fields:

      • Gynaecology And Breast
      81
      Seconds
  • Question 3 - A 30-year-old Caucasian woman presents to her General Practitioner (GP) with a painful,...

    Incorrect

    • A 30-year-old Caucasian woman presents to her General Practitioner (GP) with a painful, swollen, left lower leg. She has recently been started on a combined oral contraceptive pill (COCP). She has never smoked. Her mother had a pulmonary embolism in her thirties, while pregnant.
      On examination, her body mass index (BMI) is 23 kg/m2.
      What is the most probable reason for her symptoms? Choose ONE option only.

      Your Answer: Protein C deficiency

      Correct Answer: Factor V Leiden mutation

      Explanation:

      Understanding Thrombophilias: Factor V Leiden Mutation and Other Genetic Risk Factors for DVT

      Deep-vein thrombosis (DVT) is a serious medical condition that can be caused by a variety of risk factors, including heritable thrombophilias. These genetic conditions can be identified in up to 50% of venous thromboemboli cases, and the most common heritable thrombophilia in Caucasians is the Factor V Leiden mutation. This autosomal-dominant condition affects around 5% of the population and increases the risk of thrombosis three to eight times, depending on the individual’s genotype. Other genetic risk factors for DVT include protein C and protein S deficiencies, which are less common than Factor V Leiden mutation. It is important to consider these genetic risk factors when evaluating patients with DVT, especially those with a family history of hormone-associated VTE or without other traditional risk factors for thrombosis. Understanding thrombophilias can help clinicians make informed decisions about treatment and prevention strategies for DVT.

    • This question is part of the following fields:

      • Genomic Medicine
      24.3
      Seconds
  • Question 4 - A 28-year-old man presents with macroscopic haematuria and is found to have a...

    Correct

    • A 28-year-old man presents with macroscopic haematuria and is found to have a serum creatinine level of 160 µmol/l (60-120 µmol/l).
      Select from the list the single feature that would be most suggestive of a diagnosis of nephritic syndrome rather than nephrotic syndrome.

      Your Answer: Oliguria

      Explanation:

      Understanding Nephrotic and Nephritic Syndrome: Symptoms and Causes

      Nephrotic syndrome is characterized by proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia, while nephritic syndrome is defined by acute kidney injury, hypertension, oliguria, and urinary sediment. Both syndromes can be caused by various renal diseases and are a constellation of several symptoms.

      In nephritic syndrome, increased cellularity within the glomeruli and a leucocytic infiltrate cause an inflammatory reaction that injures capillary walls, leading to red cells in urine and decreased glomerular filtration rate. Hypertension is likely due to fluid retention and increased renin release. Examples of conditions causing nephritic syndrome include diffuse proliferative glomerulonephritis, IgA nephropathy, and lupus nephritis.

      Acute nephritic syndrome is the most serious and requires immediate referral to secondary care, while patients with nephrotic syndrome will also be referred but usually do not require acute admission.

    • This question is part of the following fields:

      • Kidney And Urology
      13
      Seconds
  • Question 5 - Hb 105 g/L (130-180)
    RBC 4.5 Ɨ1012/L -
    Hct 0.353 (0.4-0.52)
    MCV 75 fL (80-96)
    MCH 32.5...

    Correct

    • Hb 105 g/L (130-180)
      RBC 4.5 Ɨ1012/L -
      Hct 0.353 (0.4-0.52)
      MCV 75 fL (80-96)
      MCH 32.5 pg (28-32)
      Platelets 325 Ɨ109/L (150-400)
      WBC 7.91 Ɨ109/L (4-11)
      Neutrophils 6.15 Ɨ109/L (1.5-7.0)
      Lymphocytes 1.54 Ɨ109/L (1.5-4.0)
      Monocytes 0.33 Ɨ109/L (0-0.8)
      Eosinophils 0.16 Ɨ109/L (0.04-0.4)
      Basophils 0.08 Ɨ109/L (0-0.1)
      Others 0.14 Ɨ109/L -

      Which of the following investigations would be the most appropriate initial investigation for the above full blood count (FBC) result in a 60-year-old patient?

      Your Answer: Ferritin concentration

      Explanation:

      Interpretation of FBC Results

      When analyzing a full blood count (FBC), it is important to consider all the parameters to determine the underlying cause of any abnormalities. In this case, the FBC shows microcytosis, which is a low mean corpuscular volume (MCV), and anaemia, indicated by low hemoglobin levels. These findings are typical of iron deficiency anaemia.

      To confirm iron deficiency, a ferritin test should be requested. If the test confirms iron deficiency, the next step is to identify the source of blood loss. If the faecal occult blood test is positive, an endoscopy may be necessary.

      It is important to note that folate and B12 deficiencies cause macrocytic anaemia, which is characterized by elevated MCV. Hypothyroidism is also associated with elevated MCV. However, in this case, the low MCV indicates iron deficiency anaemia.

      While a bone marrow biopsy can confirm iron deficiency, it is an invasive procedure and is not necessary at this stage, particularly in a primary care setting.

    • This question is part of the following fields:

      • Haematology
      46.9
      Seconds
  • Question 6 - A 76-year-old female, recently diagnosed with hypertension, presents to the emergency department after...

    Incorrect

    • A 76-year-old female, recently diagnosed with hypertension, presents to the emergency department after collapsing. She reports feeling dizzy just before the incident and had recently begun a new medication prescribed by her GP. Her medical history includes type II diabetes mellitus, glaucoma, and diverticular disease.

      Which medication is most likely responsible for her symptoms?

      Your Answer: Timolol eye drops

      Correct Answer: Ramipril

      Explanation:

      First-dose hypotension is a potential side effect of ACE inhibitors like ramipril, which is commonly used as a first-line treatment for hypertension in diabetic patients. If a patient experiences dizziness or lightheadedness, it may be a warning sign of impending syncope.

      Prochlorperazine is not indicated for any of the patient’s medical conditions and is unlikely to cause syncope. Fludrocortisone, on the other hand, can increase blood pressure and is therefore not a likely cause of syncope.

      Metformin is not known to cause hypoglycemia frequently, so it is unlikely to be the cause of the patient’s collapse. While beta-blockers can cause syncope, it is unlikely to occur after the application of eye drops.

      ACE inhibitors are a type of medication that can have side-effects. One common side-effect is a cough, which can occur in around 15% of patients and may happen up to a year after starting treatment. This is thought to be due to increased levels of bradykinin. Another potential side-effect is angioedema, which may also occur up to a year after starting treatment. Hyperkalaemia and first-dose hypotension are also possible side-effects, especially in patients taking diuretics.

      There are certain cautions and contraindications to be aware of when taking ACE inhibitors. Pregnant or breastfeeding women should avoid these medications. Patients with renovascular disease may experience significant renal impairment if they have undiagnosed bilateral renal artery stenosis. Aortic stenosis may result in hypotension, and patients receiving high-dose diuretic therapy (more than 80 mg of furosemide a day) are at increased risk of hypotension. Individuals with hereditary or idiopathic angioedema should also avoid ACE inhibitors.

      Monitoring is important when taking ACE inhibitors. Urea and electrolytes should be checked before treatment is initiated and after increasing the dose. A rise in creatinine and potassium levels may be expected after starting treatment, but acceptable changes are an increase in serum creatinine up to 30% from baseline and an increase in potassium up to 5.5 mmol/l. It is important to note that different guidelines may have slightly different acceptable ranges for these changes.

    • This question is part of the following fields:

      • Cardiovascular Health
      36.9
      Seconds
  • Question 7 - A new type of blood test is being studied that may accurately detect...

    Incorrect

    • A new type of blood test is being studied that may accurately detect the presence of a certain disease in elderly patients. One hundred and fifty patients who have the disease confirmed via the gold standard, a specific medical test, are recruited, along with one hundred and fifty patients who do not have the disease. They are all subjected to the new blood test and the results are as follows:

      Disease present on medical test Disease absent on medical test
      Blood test positive 90 30
      Blood test negative 60 120

      What is the positive predictive value?

      Your Answer: 0.8

      Correct Answer: 0.75

      Explanation:

      The positive predictive value (PPV) is calculated by dividing the number of true positives by the total number of positive results. In this case, the total number of positive blood tests is 120, with 90 true positives. Therefore, the PPV is 0.75.
      The sensitivity of the test is the proportion of patients with the condition who have a positive test result. In this scenario, out of the 150 people with the disease identified on CTPA, 90 have a positive blood result, resulting in a sensitivity of 0.6.
      The negative predictive value (NPV) is the proportion of true negative results out of all negative results. In this case, there are 180 negative blood results, with 120 being truly negative as per the disease being absent on CTPA. Therefore, the NPV is 0.67.
      The figure of 0.7 is not relevant to this scenario.

      Precision refers to the consistency of a test in producing the same results when repeated multiple times. It is an important aspect of test reliability and can impact the accuracy of the results. In order to assess precision, multiple tests are performed on the same sample and the results are compared. A test with high precision will produce similar results each time it is performed, while a test with low precision will produce inconsistent results. It is important to consider precision when interpreting test results and making clinical decisions.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      52.3
      Seconds
  • Question 8 - A 32-year-old man presents with a football-related injury. He complains of acute pain...

    Incorrect

    • A 32-year-old man presents with a football-related injury. He complains of acute pain in his right calf that began with a popping sound during running. You suspect an Achilles tendon rupture and proceed to perform Simmonds' Triad examination.

      What is involved in Simmonds' Triad examination?

      Your Answer: Calf squeeze test, palpation of the tendon, tiptoe test

      Correct Answer: Calf squeeze test, observation of the angle of declination, palpation of the tendon

      Explanation:

      To assess for an Achilles tendon rupture, Simmonds’ triad can be used. This involves three components: palpating the Achilles tendon to check for a gap, examining the angle of declination at rest to see if the affected foot is more dorsiflexed than the other, and performing the calf squeeze test. A positive result for the calf squeeze test is when squeezing the calf doesn’t cause the foot to plantarflex as expected. It’s important to note that struggling to stand on tiptoes or having an abnormal gait are not part of Simmonds’ triad.

      Understanding Achilles Tendon Disorders

      Achilles tendon disorders are a common cause of posterior heel pain, which can present as tendinopathy, partial tear, or complete rupture of the Achilles tendon. Certain risk factors, such as quinolone use and hypercholesterolaemia, can predispose individuals to these disorders.

      Achilles tendinopathy typically presents with gradual onset of posterior heel pain that worsens following activity, along with morning pain and stiffness. Management usually involves supportive measures, such as simple analgesia, reduction in precipitating activities, and calf muscle eccentric exercises.

      On the other hand, Achilles tendon rupture should be suspected if the person experiences an audible ‘pop’ in the ankle, sudden onset significant pain in the calf or ankle, or the inability to walk or continue the sport. Simmond’s triad can be used to help exclude Achilles tendon rupture, and ultrasound is the initial imaging modality of choice for suspected cases. An acute referral to an orthopaedic specialist is necessary following a suspected rupture.

    • This question is part of the following fields:

      • Musculoskeletal Health
      27.6
      Seconds
  • Question 9 - A 32-year-old female patient visits her GP for a follow-up on her metacarpophalangeal...

    Incorrect

    • A 32-year-old female patient visits her GP for a follow-up on her metacarpophalangeal joint pain. She has been taking ibuprofen which has provided some relief. Upon examination, the doctor observes swelling and tenderness in the metacarpophalangeal joint on one side, indicating synovitis. The patient's vital signs are normal and she doesn't have a fever. Blood tests are ordered and the patient is scheduled for a subsequent review.

      What would be the next best course of action?

      Your Answer: Refer routinely to rheumatology

      Correct Answer: Refer urgently to rheumatology

      Explanation:

      It is crucial to refer any patient who presents with new synovitis to a rheumatologist urgently for evaluation. This is because the patient may have an inflammatory joint disease that requires immediate attention. The rheumatologist can conduct blood tests to check for related auto-immune antibodies, including Antinuclear antibody and rheumatoid factor, while the patient is being referred.

      In case the patient is febrile or has risk factors for septic arthritis, such as intravenous drug use, it would be useful to organise joint aspiration. However, it is best to leave this decision to the rheumatologist.

      It is not advisable to reassure the patient and avoid referring them to a specialist. Early identification and treatment of inflammatory arthropathy can prevent long-term functional impairment.

      Referring the patient to rheumatology is necessary and should be done urgently. Delaying the referral can lead to the loss of hand function and other debilitating effects of untreated inflammatory arthritis.

      Referring the patient to the emergency department is not required unless the patient is febrile and hypotensive.

      Rheumatoid arthritis can be diagnosed clinically, which is considered more important than using specific criteria. However, the American College of Rheumatology has established classification criteria for rheumatoid arthritis. These criteria require the presence of at least one joint with definite clinical synovitis that cannot be explained by another disease. A score of 6 out of 10 is needed for a definite diagnosis of rheumatoid arthritis. The score is based on factors such as the number and type of joints involved, serology (presence of rheumatoid factor or anti-cyclic citrullinated peptide antibody), acute-phase reactants (such as CRP and ESR), and duration of symptoms. These criteria are used to classify patients with rheumatoid arthritis for research and clinical purposes.

    • This question is part of the following fields:

      • Musculoskeletal Health
      66.4
      Seconds
  • Question 10 - A 32 year old woman who is 15 days postpartum visits your clinic...

    Correct

    • A 32 year old woman who is 15 days postpartum visits your clinic complaining of feeling feverish and hot for the past 3 days. She reports having a painful, swollen, and red right breast. During examination, her temperature is 37.8 degrees, and there is firmness and erythema in the upper quadrant of the right breast. Based on the diagnosis of puerperal mastitis, what is the most appropriate advice to provide her?

      Your Answer: Advise her to continue Breastfeeding

      Explanation:

      Mastitis is a common condition that affects breastfeeding women, typically occurring six weeks after giving birth. It can be difficult to distinguish between an engorged breast, blocked duct, non-infectious mastitis, and infected mastitis. Milk accumulation in breast tissue can cause an inflammatory response, leading to bacterial growth and resulting in a painful breast with fever, malaise, and a tender, red, swollen, and hard area of the breast.

      If symptoms do not improve or worsen after 12-24 hours despite effective milk removal, or if a nipple fissure is infected, infectious mastitis should be suspected. Breast milk culture is not routinely required unless mastitis is severe, there has been no response to antibiotics, or this is recurrent mastitis.

      Management of mastitis involves relieving pain with simple analgesia and warm compresses, and ensuring complete emptying of the breast after feeding. Breastfeeding should be continued as it improves milk removal and prevents nipple damage. If pain prevents breastfeeding, expressing breast milk by hand or pump is recommended until breastfeeding can be resumed.

      Antibiotics are only recommended if necessary, and the first line antibiotic is flucloxacillin for 14 days (erythromycin if penicillin allergic). Intravenous antibiotics are rarely needed, but urgent referral to breast surgeons for drainage may be necessary if a breast abscess is suspected.

      Breastfeeding Problems and Management

      Breastfeeding can come with its own set of challenges, but most of them can be managed with proper care and attention. Some common issues include frequent feeding, nipple pain, blocked ducts, and nipple candidiasis. These problems can be addressed by seeking advice on positioning, breast massage, and using appropriate creams and suspensions.

      Mastitis is a more serious condition that affects around 1 in 10 breastfeeding women. It is important to seek treatment if symptoms persist or worsen, including systemic illness, nipple fissures, or infection. The first-line antibiotic is flucloxacillin, and breastfeeding or expressing should continue during treatment. If left untreated, mastitis can lead to a breast abscess, which requires incision and drainage.

      Breast engorgement is another common issue that can cause pain and discomfort. It usually occurs in the first few days after birth and can affect both breasts. Hand expression of milk can help relieve the discomfort of engorgement, and complications can be avoided by addressing the issue promptly.

      Raynaud’s disease of the nipple is a less common but still significant problem that can cause pain and blanching of the nipple. Treatment options include minimizing exposure to cold, using heat packs, avoiding caffeine and smoking, and considering oral nifedipine.

      Concerns about poor infant weight gain can also arise, prompting consideration of the above breastfeeding problems and an expert review of feeding. Monitoring of weight until weight gain is satisfactory is also recommended. With proper management and support, most breastfeeding problems can be overcome, allowing for a successful and rewarding breastfeeding experience.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      25.5
      Seconds
  • Question 11 - A 42-year-old woman reports to her General Practitioner with complaints of lateral left...

    Incorrect

    • A 42-year-old woman reports to her General Practitioner with complaints of lateral left elbow pain while lifting books at work with her forearm pronated. She experiences tenderness at the insertion of the common extensor tendon and pain with resisted wrist extension. What is the most suitable course of action to enhance this patient's long-term prognosis? Choose ONE option only.

      Your Answer: Ibuprofen tablets

      Correct Answer: Reducing lifting

      Explanation:

      Treatment Options for Tennis Elbow: Managing Symptoms and Long-Term Prognosis

      Tennis elbow, or lateral epicondylitis, is a painful condition that can be triggered by certain activities, such as lifting objects. The National Institute for Health and Care Excellence recommends modifying these activities to alleviate symptoms. However, in severe cases, other treatment options may be necessary.

      Botulinum toxin A injections can be effective in paralyzing the affected fingers, but the resulting paralysis can significantly impact daily activities and is only recommended for severe cases. Corticosteroid injections can provide short-term pain relief, but the high relapse rate at three months makes them less suitable for long-term management.

      Glyceryl trinitrate patches have shown short-term benefits in managing pain, but their long-term efficacy is uncertain. Ibuprofen may provide temporary pain relief, but it doesn’t affect the long-term prognosis. Overall, managing symptoms and preventing further injury through activity modification is the most important aspect of treating tennis elbow.

    • This question is part of the following fields:

      • Musculoskeletal Health
      20.3
      Seconds
  • Question 12 - A 35-year-old woman presents to her General Practitioner with a 3-day history of...

    Correct

    • A 35-year-old woman presents to her General Practitioner with a 3-day history of a painful and swollen right knee. She is pyrexial with a temperature of 38.0 °C and has had chills. She mentions that she developed a painful left ear and saw her doctor six days ago who told her she had an ear infection and prescribed antibiotics. Her right knee is swollen, red, tender and slightly flexed. A diagnosis of septic arthritis is made.
      Which of the following is the single most likely causative organism?

      Your Answer: Staphylococcus aureus

      Explanation:

      Septic Arthritis: Common Causal Organisms and Symptoms

      Septic arthritis is a condition resulting from joint infection with pyogenic organisms. The most common causal organism is Staphylococcus aureus, which enters the joint through the bloodstream from known sites of infection. Patients typically experience pain, redness, warmth, and swelling in a single joint, most commonly the knee. Aspiration and fluid culture are diagnostic, and immediate treatment with appropriate antibiotics is crucial to prevent cartilage destruction. Joint immobilization is also recommended. Patients with prior joint damage or prosthetic joints are at higher risk.

      Other causal organisms include Neisseria meningitides, which can cause polyarthropathy, fever, and skin changes; Haemophilus influenza, which is common in children under three years old; and Streptococcus pyogenes, a common organism in ear, nose, and throat infections. Gram-negative rods, such as Escherichia coli, are rare causes of septic arthritis. It is important to differentiate septic arthritis from other similar conditions, such as transient synovitis, especially in children.

    • This question is part of the following fields:

      • Musculoskeletal Health
      19.1
      Seconds
  • Question 13 - A 32-year-old woman who is four months pregnant is planning to travel to...

    Correct

    • A 32-year-old woman who is four months pregnant is planning to travel to Africa with her husband for his business. She visits your clinic as she needs to update her vaccinations.
      Which of the following vaccines is safe to administer during pregnancy?

      Your Answer: Hepatitis A

      Explanation:

      Live, Antigenic, and Toxoid Vaccines

      Live vaccines are those that contain a weakened or attenuated form of the virus or bacteria they protect against. Examples of live vaccines include oral polio vaccines, measles, mumps, rubella, yellow fever, and BCG. These vaccines are effective because they stimulate the immune system to produce a strong and long-lasting response.

      Antigenic vaccines, on the other hand, contain a part of the virus or bacteria that triggers an immune response. Hepatitis A and B vaccines are examples of antigenic vaccines. They are indicated in cases where there is a risk of exposure to Hepatitis A or B.

      Toxoid vaccines contain a toxin produced by the bacteria they protect against that has been inactivated or detoxified. Tetanus vaccination is an example of a toxoid vaccine. These vaccines are effective because they stimulate the immune system to produce antibodies that neutralize the toxin.

      In summary, live, antigenic, and toxoid vaccines are all important tools in preventing the spread of infectious diseases. Each type of vaccine works differently, but all are designed to stimulate the immune system to produce a protective response.

    • This question is part of the following fields:

      • Population Health
      12.5
      Seconds
  • Question 14 - A 30-year-old woman is seeking advice on which coil to use for contraception....

    Correct

    • A 30-year-old woman is seeking advice on which coil to use for contraception. She is concerned about the possibility of experiencing heavier or more painful periods. Additionally, she has a history of adult acne and noticed that her skin worsened while taking the progesterone-only pill. She wants to minimize the risk of this happening again by using a coil with the lowest amount of serum levonorgestrel (LNG). What coil would be the best option for her?

      Your Answer: JaydessĀ® coil

      Explanation:

      Compared to the Mirena IUS, the Jaydess IUS has lower release rates and serum levels of levonorgestrel. In the UK, there are various copper coils available with either banded copper arms or copper in the stem only, licensed for either 5 or 10 years. The insertion tube sizes vary, with the Nova-T 380 being the smallest at 3.6mm and the Mirena and Jaydess at 4.4mm and 3.8mm, respectively. The Jaydess has the lowest levels of levonorgestrel at 13.5mg, while the Kyleena has 19.5mg and the Mirena has 52mg. The Jaydess is licensed for 3 years, while the Mirena and Kyleena are licensed for 5 years.

      New intrauterine contraceptive devices include the JaydessĀ® IUS and KyleenaĀ® IUS. The JaydessĀ® IUS is licensed for 3 years and has a smaller frame, narrower inserter tube, and less levonorgestrel than the MirenaĀ® coil. The KyleenaĀ® IUS has 19.5mg LNG, is smaller than the MirenaĀ®, and is licensed for 5 years. Both result in lower serum levels of LNG, but the rate of amenorrhoea is less with KyleenaĀ® compared to MirenaĀ®.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      21
      Seconds
  • Question 15 - A 65-year-old female presents with a three month history of a dry, pruritic...

    Incorrect

    • A 65-year-old female presents with a three month history of a dry, pruritic rash affecting the lower arms and thighs.

      What is the most appropriate initial management of this patient?

      Your Answer: Emollients

      Correct Answer: Patch testing to ascertain contact allergen

      Explanation:

      Asteatotic Eczema and Xerotic Skin in the Elderly

      Asteatotic eczema is a common problem that often affects the elderly population. This condition can be improved with the use of plain emollients. Xerotic skin is also common in the elderly, particularly during the winter months when central heating can cause dryness. While other treatments may be necessary for patients who do not respond to emollients, these moisturizers should be the first line of defense against asteatotic eczema and xerotic skin. By using emollients regularly, patients can help to keep their skin hydrated and healthy.

      Overall, it is important for healthcare providers to be aware of these common skin conditions in the elderly and to recommend appropriate treatments to help manage symptoms and improve quality of life. By addressing asteatotic eczema and xerotic skin early on, healthcare providers can help to prevent more serious complications from developing.

    • This question is part of the following fields:

      • Dermatology
      24.5
      Seconds
  • Question 16 - You plan to look at the effectiveness of a Chlamydia screening programme on...

    Incorrect

    • You plan to look at the effectiveness of a Chlamydia screening programme on detection rates for the disease among teenagers at the clinic.

      The research is designed to look merely at detection rates, not the effectiveness of treatment.

      Which of the following is true with respect to rules around ethical approval and consent for this project?

      Your Answer: All patients participating in the study should be aware of good medical practice

      Correct Answer: You should have a clear publication plan at the outset of your study

      Explanation:

      Importance of a Clear Publication Plan for Clinical Studies

      A clear publication plan is essential for any clinical study. The study should be worthy of publication in some form, whether it is a local CCG journal or a peer-reviewed international publication. The research should provide learning outcomes that can improve clinical practice, and without publication, wider dissemination is impossible.

      It is crucial to ensure that all staff involved in the study are aware of good medical practice, and patients should be provided with an information leaflet about the study. If the study is conducted in multiple areas, MREC approval means that the study can proceed without a separate full LREC application.

      In summary, having a clear publication plan is crucial for any clinical study to ensure that the research findings are disseminated widely and can contribute to improving clinical practice.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      41.6
      Seconds
  • Question 17 - A 25-year-old patient with complex partial seizures controlled with carbamazepine is 32 weeks...

    Correct

    • A 25-year-old patient with complex partial seizures controlled with carbamazepine is 32 weeks pregnant.

      She has not had a seizure throughout pregnancy. She expresses a wish to breastfeed, but is concerned that the carbamazepine may affect her child.

      What advice should be given to her?

      Your Answer: Serum carbamazepine levels should be monitored whilst Breastfeeding

      Explanation:

      Epilepsy and Pregnancy: Considerations for Medication and Breastfeeding

      Carbamazepine (CBZ) is present in breast milk, but only in small amounts. Breastfeeding mothers should be encouraged to continue breastfeeding as the levels of CBZ in breast milk are too low to cause any harm to the baby.

      Prior to conception, it is recommended that women take folic acid at a dose of 5 mg daily to prevent neural tube defects in the fetus. However, it is not recommended for breastfeeding mothers.

      For patients with well-controlled epilepsy, there is no increased risk of seizures during pregnancy or the postpartum period. While there is no routine need to monitor serum anti-epileptic concentrations, the NICE guidelines suggest monitoring levels in certain circumstances such as adjusting phenytoin dose, poor concordance, and suspected toxicity.

      Overall, it is important for women with epilepsy to work closely with their healthcare provider to ensure the best possible outcomes for both mother and baby during pregnancy and breastfeeding.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      11
      Seconds
  • Question 18 - A father brings his 2-year-old son to your GP clinic. The child has...

    Correct

    • A father brings his 2-year-old son to your GP clinic. The child has been experiencing symptoms of a cold for the past 2 days. Last night, he developed a barking cough and a slight fever of 37.8Āŗ.

      During the examination, you notice mild stridor when the child moves around, but there are no visible recessions. The chest sounds clear, and there is good air entry on both sides. The temperature remains at 37.8Āŗ, but all other vital signs are normal.

      What is the most appropriate course of action for management?

      Your Answer: Give a stat dose of dexamethasone 150 micrograms/kg PO

      Explanation:

      For a child with croup, a single dose of oral dexamethasone (0.15 mg/kg) should be taken immediately regardless of the severity of the illness. Croup typically begins with cold-like symptoms and progresses to a barking cough with a seal-like sound. The severity of croup can be determined by the presence of symptoms such as stridor, recessions, and distress. In this case, the child has mild croup and hospital admission is not necessary. Nebulized adrenaline is only recommended for children with severe symptoms, while a salbutamol inhaler is not effective for croup. Antibiotics are not useful for treating croup as it is a viral illness. Steroids, such as dexamethasone, have been shown to alleviate symptoms and reduce the need for hospitalization.

      Croup is a respiratory infection that affects young children, typically those between 6 months and 3 years old. It is most common in the autumn and is caused by parainfluenza viruses. The main symptom is stridor, which is caused by swelling and secretions in the larynx. Other symptoms include a barking cough, fever, and cold-like symptoms. The severity of croup can be graded based on the child’s symptoms, with mild cases having occasional coughing and no audible stridor at rest, and severe cases having frequent coughing, prominent stridor, and significant distress or lethargy. Children with moderate or severe croup should be admitted to the hospital, especially if they are under 6 months old or have other airway abnormalities. Diagnosis is usually made based on clinical symptoms, but a chest x-ray can show subglottic narrowing. Treatment typically involves a single dose of oral dexamethasone or prednisolone, and emergency treatment may include high-flow oxygen or nebulized adrenaline.

    • This question is part of the following fields:

      • Children And Young People
      12.1
      Seconds
  • Question 19 - You are assessing a 28-year-old woman who has chronic plaque psoriasis. Despite trying...

    Correct

    • You are assessing a 28-year-old woman who has chronic plaque psoriasis. Despite trying various combinations of potent corticosteroids, vitamin D analogues, coal tar and dithranol over the past two years, she has seen limited improvement. Light therapy was attempted last year but the psoriasis returned within a month. The patient is feeling increasingly discouraged, especially after a recent relationship breakdown. As per NICE guidelines, what is a necessary requirement before considering systemic therapy for this patient?

      Your Answer: It has a significant impact on physical, psychological or social wellbeing

      Explanation:

      Referral Criteria for Psoriasis Patients

      Psoriasis is a chronic skin condition that affects a significant number of people. According to NICE guidelines, around 60% of psoriasis patients will require referral to secondary care at some point. The guidance provides some general criteria for referral, including diagnostic uncertainty, severe or extensive psoriasis, inability to control psoriasis with topical therapy, and major functional or cosmetic impact on nail disease. Additionally, any type of psoriasis that has a significant impact on a person’s physical, psychological, or social wellbeing should also be referred to a specialist. Children and young people with any type of psoriasis should be referred to a specialist at presentation.

      For patients with erythroderma or generalised pustular psoriasis, same-day referral is recommended. erythroderma is characterized by a generalised erythematous rash, while generalised pustular psoriasis is marked by extensive exfoliation. These conditions require immediate attention due to their severity. Overall, it is important for healthcare professionals to be aware of the referral criteria for psoriasis patients to ensure that they receive appropriate care and management.

    • This question is part of the following fields:

      • Dermatology
      24.9
      Seconds
  • Question 20 - A 42-year-old man visits his GP with concerns about decreased libido and erectile...

    Incorrect

    • A 42-year-old man visits his GP with concerns about decreased libido and erectile dysfunction. His wife notes that he has a constant tan and lacks energy. He also reports experiencing hand pains. What investigation is most likely to uncover the diagnosis?

      Your Answer: Cortisol

      Correct Answer: Ferritin

      Explanation:

      To screen for haemochromatosis in the general population, a transferrin saturation level higher than ferritin is used. For family members, HFE genetic testing is recommended. It is important to note that while the patient in question is experiencing symptoms associated with haemochromatosis, diabetes mellitus alone would not typically result in decreased libido.

      Understanding Haemochromatosis: Investigation and Management

      Haemochromatosis is a genetic disorder that causes iron accumulation in the body due to mutations in the HFE gene. The best investigation to screen for haemochromatosis is still a topic of debate. For the general population, transferrin saturation is considered the most useful marker, while genetic testing for HFE mutation is recommended for testing family members. Diagnostic tests include molecular genetic testing for the C282Y and H63D mutations and liver biopsy using Perl’s stain.

      A typical iron study profile in patients with haemochromatosis includes high transferrin saturation levels, raised ferritin and iron, and low TIBC. The first-line treatment for haemochromatosis is venesection, which involves removing blood from the body to reduce iron levels. Transferrin saturation should be kept below 50%, and the serum ferritin concentration should be below 50 ug/l to monitor the adequacy of venesection. If venesection is not effective, desferrioxamine may be used as a second-line treatment. Joint x-rays may also show chondrocalcinosis, which is a characteristic feature of haemochromatosis.

      It is important to note that there are rare cases of families with classic features of genetic haemochromatosis but no mutation in the HFE gene. As HFE gene analysis becomes less expensive, guidelines for investigating and managing haemochromatosis may change.

    • This question is part of the following fields:

      • Haematology
      9.2
      Seconds
  • Question 21 - A 6-month-old is brought to your clinic with suspected reflux. The parents report...

    Incorrect

    • A 6-month-old is brought to your clinic with suspected reflux. The parents report that the baby has been experiencing regurgitation after feeds and becomes very distressed. The baby is fully formula-fed and has been difficult to feed. However, the baby is gaining weight well and is otherwise healthy. There is a family history of reflux, with the baby's older sibling having had reflux in infancy. Upon examination, the baby doesn't have tongue-tie, has a normal suck-reflex, and the abdominal examination is reassuring. What steps should be taken to address the suspected reflux?

      Your Answer: Dilute the feeds

      Correct Answer: Trial of alginate added to the formula

      Explanation:

      While positional management of gastro-oesophageal reflux may seem logical, it is important to note that infants should always sleep on their backs to minimize the risk of cot death. Although there are no concerning symptoms, it is advisable to provide treatment for the child’s distress. It is not recommended to increase the volume of feeds as this may exacerbate reflux. Instead, smaller and more frequent feeds could be considered. Diluting the feeds will not improve symptoms and may actually increase the volume in the stomach.

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

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

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

    • This question is part of the following fields:

      • Children And Young People
      30
      Seconds
  • Question 22 - A 42-year-old man presents with painless left testicular enlargement. He reports noticing it...

    Incorrect

    • A 42-year-old man presents with painless left testicular enlargement. He reports noticing it approximately 3 weeks ago and denies any urinary symptoms or penile discharge.
      What is the most suitable plan of action?

      Your Answer: Urgent urological admission

      Correct Answer: Refer to urology on a suspected cancer pathway

      Explanation:

      Urgent Referral Pathway for Suspected Testicular Cancer

      Any painless enlargement of the testis should be referred urgently to urology for investigation of testicular cancer. The patient should be seen within 2 weeks, and an ultrasound should be arranged urgently. While serum alpha-fetoprotein (AFP) is a tumour marker associated with testicular cancer, it should not be used alone to exclude a tumour. AFP can also be used in staging. A mid-stream specimen of urine (MSU) is not necessary unless there are urinary symptoms or signs of infection. Antibiotics are not indicated for painless swelling without signs of infection or epididymo-orchitis. While prompt investigation is necessary, urgent urological admission is not required unless the patient is acutely unwell.

    • This question is part of the following fields:

      • Kidney And Urology
      10.9
      Seconds
  • Question 23 - A 44-year-old woman presented with complaints of constant fatigue and underwent a blood...

    Correct

    • A 44-year-old woman presented with complaints of constant fatigue and underwent a blood test. All results were within normal range except for her thyroid function test (TFT) which revealed:

      TSH 12.5 mU/l
      Free T4 7.5 pmol/l

      What would be the most suitable course of action?

      Your Answer: Levothyroxine 75 mcg daily 30 minutes before breakfast, caffeine and other medication(s)

      Explanation:

      The TFTs indicate a diagnosis of hypothyroidism, which can be treated with levothyroxine. Carbimazole is not suitable for this condition as it is used to treat hyperthyroidism. To ensure proper absorption, levothyroxine should be taken 30 minutes before consuming food, caffeine, or other medications.

      Managing Hypothyroidism: Dosage, Goals, and Side-Effects

      Hypothyroidism is a condition where the thyroid gland doesn’t produce enough thyroid hormone. The management of hypothyroidism involves the use of levothyroxine, a synthetic form of thyroid hormone. The initial starting dose of levothyroxine should be lower in elderly patients and those with ischaemic heart disease. For patients with cardiac disease, severe hypothyroidism, or patients over 50 years, the initial starting dose should be 25mcg od with dose slowly titrated. Other patients should be started on a dose of 50-100 mcg od. After a change in thyroxine dose, thyroid function tests should be checked after 8-12 weeks. The therapeutic goal is to achieve a ‘normalisation’ of the thyroid stimulating hormone (TSH) level, with a TSH value of 0.5-2.5 mU/l being the preferred range.

      Women with established hypothyroidism who become pregnant should have their dose increased ‘by at least 25-50 micrograms levothyroxine’* due to the increased demands of pregnancy. The TSH should be monitored carefully, aiming for a low-normal value. There is no evidence to support combination therapy with levothyroxine and liothyronine.

      Levothyroxine therapy may cause side-effects such as hyperthyroidism due to over-treatment, reduced bone mineral density, worsening of angina, and atrial fibrillation. Interactions with iron and calcium carbonate may reduce the absorption of levothyroxine, so they should be given at least 4 hours apart.

      In summary, the management of hypothyroidism involves careful dosage adjustment, regular monitoring of thyroid function tests, and aiming for a TSH value in the normal range. Women who become pregnant should have their dose increased, and combination therapy with levothyroxine and liothyronine is not recommended. Patients should also be aware of potential side-effects and interactions with other medications.

      *source: NICE Clinical Knowledge Summaries

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      34.2
      Seconds
  • Question 24 - A 64-year-old man visits his primary care physician for a blood pressure check-up....

    Incorrect

    • A 64-year-old man visits his primary care physician for a blood pressure check-up. He has a medical history of hypertension, hypercholesterolemia, and ischemic heart disease.

      The patient is currently taking the following medications:
      - Ramipril 10 mg once daily
      - Amlodipine 10 mg once daily
      - Bendroflumethiazide 2.5mg once daily
      - Atorvastatin 80 mg once daily
      - Aspirin 75 mg once daily

      The most recent change to his blood pressure medication was the addition of bendroflumethiazide 6 months ago, which has reduced his average home systolic readings by approximately 15 mmHg. The average of home blood pressure monitoring over the past two weeks is now 160/82 mmHg.

      A blood test is conducted, and the results show:
      - K+ 4.6 mmol/L (3.5 - 5.0)

      After ruling out secondary causes of hypertension, what is the next course of action in managing his blood pressure?

      Your Answer: Add spironolactone 25 mg orally once daily

      Correct Answer: Add atenolol 25 mg orally once daily

      Explanation:

      The patient has poorly controlled hypertension despite taking an ACE inhibitor, calcium channel blocker, and a standard-dose thiazide diuretic. As their potassium levels are above 4.5mmol/l, it is recommended to add an alpha- or beta-blocker to their medication regimen. According to the 2019 NICE guidelines, this stage is considered treatment resistance hypertension, and the GP should also assess for adherence to medication and postural drop. If blood pressure remains high, referral to a specialist or adding a fourth drug may be necessary. Bendroflumethiazide should not be stopped as it has been effective in lowering blood pressure. Atenolol is a suitable beta-blocker to start with, and a reasonable starting dose is 25 mg, which can be adjusted based on the patient’s response. Spironolactone should only be considered if potassium levels are below 4.5mmol/l.

      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.

    • This question is part of the following fields:

      • Cardiovascular Health
      86
      Seconds
  • Question 25 - What is a true statement about scaphoid fractures? ...

    Incorrect

    • What is a true statement about scaphoid fractures?

      Your Answer: Anterioposterior and lateral radiographs reveal most fractures

      Correct Answer: Should be treated by bone grafting and internal fixation even if undisplaced

      Explanation:

      Scaphoid Fractures and Wrist Injuries

      Scaphoid fractures are frequently seen in young adult males and are caused by falling on an outstretched hand. If complicated by avascular necrosis, the proximal pole is typically affected due to the scaphoid blood supply’s distal to proximal direction. Undisplaced fractures can be treated with a plaster. Wrist fractures are also common. Due to difficulties in visualizing fractures, initial radiographs usually involve four views of the scaphoid.

      In summary, scaphoid fractures and wrist injuries are prevalent among young adult males. Proper diagnosis and treatment are crucial to prevent complications such as avascular necrosis. Radiographs are essential in identifying fractures, and multiple views may be necessary to ensure accurate diagnosis.

    • This question is part of the following fields:

      • Musculoskeletal Health
      20.7
      Seconds
  • Question 26 - You receive a call from the Coroner's officer regarding the sudden death of...

    Correct

    • You receive a call from the Coroner's officer regarding the sudden death of a patient you were treating. Upon reviewing your written report on the patient's care, you are summoned to appear in person at the Coroner's court to provide evidence, along with other healthcare professionals who also treated the patient. What is the purpose of this procedure?

      Your Answer: Inquest

      Explanation:

      Understanding Inquests

      An inquest is a public investigation into the circumstances surrounding a person’s death. It is held at a Coroner’s Court and aims to determine the who, where, when, and how of the death. As a healthcare professional, you may be required to attend an inquest to provide evidence about your involvement in the care of a patient who has died. It is important to note that an inquest is a legal proceeding, but it is not a criminal one. This means that it cannot assign blame or responsibility to a person or organization. Instead, its purpose is to gather information and establish facts. During an inquest, you may be questioned by a lawyer representing the patient, and there may be a jury and members of the press present. It is essential to be prepared and understand the process to ensure that you can provide accurate and helpful information.

    • This question is part of the following fields:

      • End Of Life
      15.9
      Seconds
  • Question 27 - A 12-year-old girl has a sore throat.
    Select from the list the single feature...

    Correct

    • A 12-year-old girl has a sore throat.
      Select from the list the single feature that would make it LESS likely that this is a streptococcal infection.

      Your Answer: Cough

      Explanation:

      Differentiating between Viral Sore Throat and Group A β-haemolytic Streptococcus

      It can be challenging to distinguish between a viral sore throat and one caused by Group A β-haemolytic streptococcus (GABS) through examination alone. However, the Centor criteria can be useful in making this differentiation. These criteria include the presence of tonsillar exudate, tender anterior cervical lymph nodes, absence of cough, and a history of fever. If a patient has three of these signs, there is a 40-60% chance that they have GABS. Conversely, if a patient doesn’t have three of these signs, there is an 80% chance that they have a viral infection. Additionally, the presence of a scarlet fever-like rash, a flushed face, circumoral pallor, and a white or red strawberry tongue may also suggest the possibility of a streptococcal infection.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      30.9
      Seconds
  • Question 28 - Linda is a 32-year-old woman who presents with a 6 month history of...

    Correct

    • Linda is a 32-year-old woman who presents with a 6 month history of chronic pelvic pain and dysmenorrhoea that is beginning to impact her daily life, especially at work. During the consultation, Linda mentions experiencing painful bowel movements that begin just before her period and persist throughout it.

      As her healthcare provider, you suspect endometriosis. Linda asks you about the best way to confirm this diagnosis.

      What is the definitive test that can be done to confirm endometriosis for Linda?

      Your Answer: Laparoscopic visualisation of the pelvis

      Explanation:

      According to NICE guidelines, laparoscopy is the most reliable method of diagnosing endometriosis in patients.

      To confirm the presence of endometriosis, it is necessary to perform a laparoscopic examination of the pelvis, regardless of whether a transvaginal or transabdominal ultrasound appears normal.

      If a thorough laparoscopy is conducted and no signs of endometriosis are found, the patient should be informed that she doesn’t have the condition and offered alternative treatment options.

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

    • This question is part of the following fields:

      • Gynaecology And Breast
      30.8
      Seconds
  • Question 29 - You see a 68-year-old widow in your clinic for a routine blood pressure...

    Incorrect

    • You see a 68-year-old widow in your clinic for a routine blood pressure check. While you chat she mentions that she misses her old role as a volunteer at the local library from which she had to retire when she reached 65. However, she mentions that she has kept in touch with some of the young adults from the library and that they come around to her house to help out with errands and other tasks. How should you respond to this disclosure?

      Your Answer: After the clinic, you make a discreet phone call to the head of the local scout group to ask if they had any concerns about Mr Lawson, and if they know that the boys are going to his house

      Correct Answer: You ask the patient about this arrangement, and as it seems to you that there is nothing to be concerned about, you take no further action

      Explanation:

      Safeguarding Children in Healthcare

      Safeguarding children has undergone significant changes in recent years, following the Children Act 2004 and the Victoria ClimbiƩ Inquiry. As a result, healthcare professionals must navigate a complex landscape of guidance documents, terminology, and organizational changes. The Royal College of General Practitioners offers a useful toolkit for those seeking an introduction to the topic.

      According to the General Medical Council, the safety of children and young people must be a healthcare professional’s first concern. If there is reasonable concern that a child is at risk of abuse or neglect, the appropriate person or authority must be informed promptly. If there is no cause for concern, it is still important to discuss and record the decision, as well as any concerns, discussions, and reasons for not sharing information.

      While confidentiality is important, it can be breached in limited circumstances, such as safeguarding children at risk. Healthcare professionals must avoid making discreet enquiries, as this can lead to unfounded rumors, breaches of confidentiality, and potentially prejudicing further enquiries. Overall, safeguarding children is a critical responsibility for healthcare professionals, and they must stay informed and vigilant in their efforts to protect vulnerable children.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      29.4
      Seconds
  • Question 30 - A 65-year-old lady came in with complaints of heartburn. She has a history...

    Incorrect

    • A 65-year-old lady came in with complaints of heartburn. She has a history of osteoporosis and has been on alendronate for several years.

      What is the probable reason for her symptoms?

      Your Answer: Oesophagitis

      Correct Answer: Ischaemic heart disease

      Explanation:

      Side Effects of Oral Bisphosphonates

      Oral bisphosphonates can cause serious side effects in some patients, including esophagitis, gastritis, and diarrhea. However, when used as directed, these complications are rare. Patients with pre-existing esophageal conditions, such as achalasia, stricture, Barrett’s esophagus, severe reflux, and scleroderma, should avoid taking oral bisphosphonates.

      Interestingly, if patients experience gastrointestinal side effects while taking bisphosphonates, treatment with proton pump inhibitors (PPIs) is often ineffective. The only way to alleviate these symptoms is by discontinuing the use of bisphosphonates. It is important for patients to discuss any concerns or pre-existing conditions with their healthcare provider before starting treatment with oral bisphosphonates.

    • This question is part of the following fields:

      • Gastroenterology
      8.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Health (1/3) 33%
Gynaecology And Breast (2/2) 100%
Genomic Medicine (0/1) 0%
Kidney And Urology (1/2) 50%
Haematology (1/2) 50%
Evidence Based Practice, Research And Sharing Knowledge (0/2) 0%
Musculoskeletal Health (1/5) 20%
Maternity And Reproductive Health (3/3) 100%
Population Health (1/1) 100%
Dermatology (1/2) 50%
Children And Young People (1/2) 50%
Metabolic Problems And Endocrinology (1/1) 100%
End Of Life (1/1) 100%
Infectious Disease And Travel Health (1/1) 100%
Improving Quality, Safety And Prescribing (0/1) 0%
Gastroenterology (0/1) 0%
Passmed