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Question 1
Incorrect
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A 35-year-old HIV positive man comes to your travel clinic seeking advice on vaccinations for his upcoming trip. He is currently on antiretroviral therapy and his most recent CD4 count is 180 cells/mm³. He has no other medical conditions and is feeling well.
Which vaccines should be avoided in this individual?Your Answer: Meningitis ACWY
Correct Answer: Tuberculosis (BCG)
Explanation:Patients who are HIV positive should not receive live attenuated vaccines like BCG. Additionally, immunocompromised individuals should avoid other live attenuated vaccines such as yellow fever, oral polio, intranasal influenza, varicella, and measles, mumps, and rubella (MMR). This information is sourced from uptodate.
Types of Vaccines and Their Characteristics
Vaccines are essential in preventing the spread of infectious diseases. However, it is crucial to understand the different types of vaccines and their characteristics to ensure their safety and effectiveness. Live attenuated vaccines, such as BCG, MMR, and oral polio, may pose a risk to immunocompromised patients. In contrast, inactivated preparations, including rabies and hepatitis A, are safe for everyone. Toxoid vaccines, such as tetanus, diphtheria, and pertussis, use inactivated toxins to generate an immune response. Subunit and conjugate vaccines, such as pneumococcus, haemophilus, meningococcus, hepatitis B, and human papillomavirus, use only part of the pathogen or link bacterial polysaccharide outer coats to proteins to make them more immunogenic. Influenza vaccines come in different types, including whole inactivated virus, split virion, and sub-unit. Cholera vaccine contains inactivated strains of Vibrio cholerae and recombinant B-subunit of the cholera toxin. Hepatitis B vaccine contains HBsAg adsorbed onto aluminium hydroxide adjuvant and is prepared from yeast cells using recombinant DNA technology. Understanding the different types of vaccines and their characteristics is crucial in making informed decisions about vaccination.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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A 45-year-old woman returns to her General Practitioner for the results of a human immunodeficiency virus (HIV) test; the result is positive. Which of the following investigations will be most useful in estimating her risk of developing an opportunistic infection (OI)?
Your Answer: CD4 count
Explanation:The CD4 count is a reliable way to measure the immune system’s response to HIV infection. In HIV-negative individuals, the CD4 count is usually maintained above 600-800 cells/µl. However, without antiretroviral therapy, HIV-positive individuals will experience a gradual decline in CD4 count over time. A CD4 count of less than 350 cells/µl increases the risk of opportunistic infections, while a count of less than 200 cells/µl indicates an 80% risk of developing an OI within three years. Some patients may remain well despite having a low CD4 count, depending on viral load and host immunity factors. Different OIs are more likely at different CD4 counts. The World Health Organization now recommends starting ART in every HIV-positive individual, regardless of CD4 count.
A CXR is usually normal in HIV-positive individuals without chronic respiratory disorders. Blood cultures may help diagnose an OI, but do not estimate the risk of developing OIs. HIV-positive individuals often have an abnormal FBC, but this does not help with risk assessment for OIs. TST is used to check for immunity to TB and diagnose LTBI. HIV-positive individuals are at higher risk of TB disease, but may have a muted response to TST due to their compromised immunity. TST can be useful in assessing eligibility for isoniazid preventive therapy, but not in assessing disease stage and risk of OIs in general.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Incorrect
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Samantha is a 55-year-old Hispanic woman who visits her primary care physician for a routine check-up of her hypertension. Despite being treated with amlodipine 10 mg once daily, her blood pressure has been poorly controlled during her last two appointments. During her examination today, her blood pressure is 160/100 mmHg, pulse 70/minute, respiratory rate 15/min, and she has no fever. What would be the next appropriate step to attempt to control Samantha's hypertension?
Your Answer: Add metoprolol
Correct Answer: Add candesartan
Explanation:To manage poorly controlled hypertension in patients already taking a calcium channel blocker, the recommended next step is to add an ACE inhibitor, an angiotensin receptor blocker (ARB), or a thiazide-like diuretic. In this particular case, since the patient is black, an ARB is the preferred choice. Beta-blockers like metoprolol are not commonly used for hypertension management. Increasing the dose of amlodipine may lead to more side effects, so it is generally better to add multiple drugs at lower doses instead of increasing the dose of one drug to its maximum.
NICE Guidelines for Managing Hypertension
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 a calcium channel blocker or thiazide-like diuretic in addition to an ACE inhibitor or angiotensin receptor blocker.
The guidelines also provide a flow chart for the diagnosis and management of hypertension. Lifestyle advice, such as reducing salt intake, caffeine intake, and alcohol consumption, as well as exercising more and losing weight, should not be forgotten and is frequently tested in exams. Treatment options depend on the patient’s age, ethnicity, and other factors, and may involve a combination of drugs.
NICE recommends treating stage 1 hypertension in patients under 80 years old if they have target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For patients with stage 2 hypertension, drug treatment should be offered regardless of age. The guidelines also provide step-by-step treatment options, including adding a third or fourth drug if necessary.
New drugs, such as direct renin inhibitors like Aliskiren, may have a role in patients who are intolerant of more established antihypertensive drugs. However, trials have only investigated the fall in blood pressure and no mortality data is available yet. Patients who fail to respond to step 4 measures should be referred to a specialist. The guidelines also provide blood pressure targets for different age groups.
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This question is part of the following fields:
- Cardiovascular
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Question 4
Incorrect
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You have requested a B-type natriuretic peptide (BNP) test for a patient with suspected heart failure who is in their 60s. The results have shown a slightly elevated BNP level. What could be a possible factor that may cause a falsely elevated BNP result?
Your Answer: Furosemide therapy
Correct Answer: COPD
Explanation:Chronic heart failure is a condition that requires proper diagnosis and management. In 2018, NICE updated their guidelines on the diagnosis and management of this condition. Previously, the first-line investigation was determined by whether the patient had previously had a myocardial infarction or not. However, this is no longer the case. All patients should now have an N-terminal pro-B-type natriuretic peptide (NT‑proBNP) blood test as the first-line investigation.
Interpreting the NT-proBNP blood test is crucial in determining the severity of the condition. If the levels are high, specialist assessment, including transthoracic echocardiography, should be arranged within two weeks. If the levels are raised, specialist assessment, including echocardiogram, should be arranged within six weeks. B-type natriuretic peptide (BNP) is a hormone produced mainly by the left ventricular myocardium in response to strain. Very high levels of BNP are associated with a poor prognosis.
There are different levels of BNP, and each level indicates a different severity of the condition. High levels of BNP are greater than 400 pg/ml (116 pmol/litre) for BNP and greater than 2000 pg/ml (236 pmol/litre) for NTproBNP. Raised levels of BNP are between 100-400 pg/ml (29-116 pmol/litre) for BNP and between 400-2000 pg/ml (47-236 pmol/litre) for NTproBNP. Normal levels of BNP are less than 100 pg/ml (29 pmol/litre) for BNP and less than 400 pg/ml (47 pmol/litre) for NTproBNP.
It is important to note that several factors can alter the BNP level. Factors that increase BNP levels include left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia (including pulmonary embolism), GFR < 60 ml/min, sepsis, COPD, diabetes, and age > 70. On the other hand, factors that decrease BNP levels include diuretics, ACE inhibitors, beta-blockers, angiotensin 2 receptor blockers, and aldosterone antagonists.
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This question is part of the following fields:
- Cardiovascular
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Question 5
Incorrect
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A 52-year-old man has been diagnosed with type two diabetes and prescribed medication by his GP. The medication functions by binding to its receptor and closing the potassium ion channels, which reduces potassium efflux from the cell and causes depolarization. This, in turn, leads to calcium ion influx and insulin release. What medication has the patient been prescribed?
Your Answer: Metformin
Correct Answer: Gliclazide
Explanation:Sulfonylureas attach to a KATP channel on the cell membrane of pancreatic beta cells that is dependent on ATP.
Sulfonylureas are a type of medication used to treat type 2 diabetes mellitus. They work by increasing the amount of insulin produced by the pancreas, but they are only effective if the pancreas is functioning properly. Sulfonylureas bind to a specific channel on the cell membrane of pancreatic beta cells, which helps to increase insulin secretion. However, there are some potential side effects associated with these drugs.
One of the most common side effects of sulfonylureas is hypoglycaemia, which can be more likely to occur with long-acting preparations like chlorpropamide. Weight gain is another possible side effect. In rare cases, sulfonylureas can cause hyponatraemia, which is a condition where the body retains too much water and sodium levels become too low. Other rare side effects include bone marrow suppression, hepatotoxicity (liver damage), and peripheral neuropathy. It is important to note that sulfonylureas should not be used during pregnancy or while breastfeeding.
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This question is part of the following fields:
- Endocrinology/Metabolic Disease
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Question 6
Correct
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A 55-year-old man is seen in the clinic for a follow-up appointment. He was prescribed ramipril two months ago for stage 2 hypertension, which was diagnosed after ambulatory blood pressure monitoring. His clinic readings have improved from 164/96 mmHg to 142/84 mmHg. However, he has been experiencing a persistent, dry cough for the past four weeks. What would be the best course of action to take in this situation?
Your Answer: Stop ramipril and start losartan
Explanation:When ACE inhibitors are not well-tolerated, angiotensin-receptor blockers are recommended.
NICE Guidelines for Managing Hypertension
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 a calcium channel blocker or thiazide-like diuretic in addition to an ACE inhibitor or angiotensin receptor blocker.
The guidelines also provide a flow chart for the diagnosis and management of hypertension. Lifestyle advice, such as reducing salt intake, caffeine intake, and alcohol consumption, as well as exercising more and losing weight, should not be forgotten and is frequently tested in exams. Treatment options depend on the patient’s age, ethnicity, and other factors, and may involve a combination of drugs.
NICE recommends treating stage 1 hypertension in patients under 80 years old if they have target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For patients with stage 2 hypertension, drug treatment should be offered regardless of age. The guidelines also provide step-by-step treatment options, including adding a third or fourth drug if necessary.
New drugs, such as direct renin inhibitors like Aliskiren, may have a role in patients who are intolerant of more established antihypertensive drugs. However, trials have only investigated the fall in blood pressure and no mortality data is available yet. Patients who fail to respond to step 4 measures should be referred to a specialist. The guidelines also provide blood pressure targets for different age groups.
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This question is part of the following fields:
- Respiratory Medicine
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Question 7
Incorrect
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A 9-week-old girl is seen by a surgeon for a general evaluation. During the assessment, her head circumference is observed to be between the 0.4th and 2nd percentile. Which of the following options would NOT account for this observation?
Your Answer: Congenital infection
Correct Answer: Fragile X syndrome
Explanation:Although not a typical reason for macrocephaly, children diagnosed with Fragile X syndrome often exhibit an enlarged head size.
Understanding Microcephaly: Causes and Definitions
Microcephaly is a condition characterized by a smaller than average head circumference, with measurements falling below the 2nd percentile. While some cases may be attributed to normal variation or familial traits, other causes include congenital infections, perinatal brain injury, fetal alcohol syndrome, and syndromes such as Patau and craniosynostosis.
In some cases, microcephaly may simply be a variation of normal development, with no underlying medical concerns. However, when it is caused by other factors, it can lead to developmental delays, intellectual disability, and other neurological issues.
It is important to note that microcephaly is not a disease in and of itself, but rather a symptom of an underlying condition. As such, it is crucial to identify and address the root cause of microcephaly in order to provide appropriate treatment and support for affected individuals.
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This question is part of the following fields:
- Paediatrics
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Question 8
Incorrect
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A 55-year-old woman has been prescribed simvastatin for primary prevention of cardiovascular disease (CVD).
Which of the following should be the NEXT step?Your Answer:
Correct Answer: Check LFTs and lipid profiles at 3 months
Explanation:Monitoring Statin Therapy: Recommended Blood Tests and Timing
Statin therapy is a common treatment for patients with high cholesterol levels, both for primary and secondary prevention of cardiovascular disease. However, regular monitoring is necessary to ensure the treatment is effective and safe. Here are some recommended blood tests and their timing for monitoring statin therapy:
Recommended Blood Tests and Timing for Monitoring Statin Therapy
Check LFTs and lipid profiles at 3 months
Within three months of starting high-intensity statin treatment, it is recommended to measure total cholesterol, HDL-cholesterol, and non-HDL cholesterol. The aim is to achieve a >40% reduction in non-HDL-cholesterol. LFTs should also be checked at this time and again at 12 months, unless clinically indicated.
Check LFTs and lipid profiles at 12 months
Both LFTs and the lipid profile should be checked at 12 months, but it is important to assess whether a suitable cholesterol level reduction has been achieved earlier in the process. This allows for discussion of adherence to medication, diet, and lifestyle measures, and consideration of increasing the dose.
Check LFTs at 1 week
Checking LFTs within a week of starting treatment is not necessary, as any liver abnormalities would be unlikely to develop so soon without the patient experiencing symptoms of acute liver disease.
Check the lipid profiles at 1 month
It takes approximately 6-8 weeks for a stable result in lipid reduction to be seen after starting a statin, so checking the lipid profile at 1 month is not appropriate.
Check TFTs at 3 months
There is no need to check thyroid function tests during statin therapy for monitoring purposes. However, patients with other conditions that justify TFTs should have them done as clinically appropriate.
Regular monitoring of statin therapy through blood tests is crucial for ensuring the treatment is effective and safe for patients with high cholesterol levels.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 9
Incorrect
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A 61-year-old man presents to his GP with increasing mild confusion over the past 2 weeks. His husband has also noticed a decline in his mental state. The patient's medical history includes a road traffic accident 8 weeks ago, where he sustained a head injury but was discharged from the emergency department with no significant injuries. He denies any current symptoms of headache, nausea, or changes in vision. On examination, there are no focal neurological deficits, and both ocular and mental state exams are unremarkable. What is the most likely cause of this man's presentation?
Your Answer:
Correct Answer: Subdural haematoma
Explanation:Understanding Subdural Haemorrhage
A subdural haemorrhage is a condition where blood collects deep to the dural layer of the meninges. This collection of blood is not within the brain substance and is referred to as an ‘extra-axial’ or ‘extrinsic’ lesion. Subdural haematomas can be classified based on their age, which includes acute, subacute, and chronic. Although they occur within the same anatomical compartment, acute and chronic subdurals have significant differences in terms of their mechanisms, associated clinical features, and management.
An acute subdural haematoma is a collection of fresh blood within the subdural space and is commonly caused by high-impact trauma. This type of haematoma is associated with high-impact injuries, and there is often other underlying brain injuries. Symptoms and presentation vary depending on the size of the compressive acute subdural haematoma and the associated injuries. CT imaging is the first-line investigation, and surgical options include monitoring of intracranial pressure and decompressive craniectomy.
On the other hand, a chronic subdural haematoma is a collection of blood within the subdural space that has been present for weeks to months. Elderly and alcoholic patients are particularly at risk of subdural haematomas since they have brain atrophy and therefore fragile or taut bridging veins. Infants also have fragile bridging veins and can rupture in shaken baby syndrome. If the chronic subdural is an incidental finding or if it is small in size with no associated neurological deficit, it can be managed conservatively. However, if the patient is confused, has an associated neurological deficit, or has severe imaging findings, surgical decompression with burr holes is required.
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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A 7-year-old girl is brought in for evaluation. Her medical records indicate that she has previously received treatment for constipation, but is generally healthy. The mother reports that the child is currently passing only one hard stool every 3-4 days, which resembles 'rabbit droppings'. There is no history of overflow soiling or diarrhea. The abdominal examination is normal. What is the most suitable initial intervention?
Your Answer:
Correct Answer: Advice on diet/fluid intake + Movicol Paediatric Plain
Explanation:Understanding and Managing Constipation in Children
Constipation is a common problem in children, with the frequency of bowel movements decreasing as they age. The National Institute for Health and Care Excellence (NICE) has provided guidelines for the diagnosis and management of constipation in children. A diagnosis of constipation is suggested by two or more symptoms, including infrequent bowel movements, hard stools, and associated distress or pain. Most cases of constipation in children are idiopathic, but other causes such as dehydration, low-fiber diet, and medication use should be considered and excluded.
If a diagnosis of constipation is made, NICE recommends assessing for faecal impaction before starting treatment. Treatment for faecal impaction involves using polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) as the first-line treatment, with the addition of a stimulant laxative if necessary. Maintenance therapy involves a similar regime, with adjustments to the starting dose and the addition of other laxatives if necessary.
It is important to note that dietary interventions alone are not recommended as first-line treatment, although ensuring adequate fluid and fiber intake is important. Regular toileting and non-punitive behavioral interventions should also be considered. For infants, extra water, gentle abdominal massage, and bicycling the legs can be helpful for constipation. If these measures are not effective, lactulose can be added.
In summary, constipation in children can be managed effectively with a combination of medication, dietary adjustments, and behavioral interventions. It is important to follow NICE guidelines and consider the individual needs of each child.
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This question is part of the following fields:
- Paediatrics
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Question 11
Incorrect
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A 29-year-old male patient informs you that he has Long QT syndrome and you are contemplating prescribing an antibiotic. Which antibiotic should you avoid prescribing to him?
Your Answer:
Correct Answer: Erythromycin
Explanation:A prolonged QT interval may be caused by Erythromycin.
Understanding Long QT Syndrome
Long QT syndrome (LQTS) is a genetic condition that causes delayed repolarization of the ventricles, which can lead to ventricular tachycardia and sudden death. The most common types of LQTS are caused by defects in the alpha subunit of the slow delayed rectifier potassium channel. A normal corrected QT interval is less than 430 ms in males and 450 ms in females.
There are various causes of a prolonged QT interval, including congenital factors, drugs, and other medical conditions. Some drugs that can prolong the QT interval include amiodarone, tricyclic antidepressants, and selective serotonin reuptake inhibitors. Electrolyte imbalances, acute myocardial infarction, and subarachnoid hemorrhage can also cause a prolonged QT interval.
LQTS may be picked up on routine ECG or following family screening. The symptoms and events associated with LQTS can vary depending on the type of LQTS. Long QT1 is usually associated with exertional syncope, while Long QT2 is often associated with syncope following emotional stress or exercise. Long QT3 events often occur at night or at rest.
Management of LQTS involves avoiding drugs that prolong the QT interval and other precipitants if appropriate. Beta-blockers may be used, and in high-risk cases, implantable cardioverter defibrillators may be necessary. It is important to recognize and manage LQTS to prevent sudden cardiac death.
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This question is part of the following fields:
- Cardiovascular
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Question 12
Incorrect
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A 68-year-old male patient presents to the emergency department with rapidly worsening testicular pain, redness, and swelling. Upon initial assessment, his vital signs are as follows: temperature of 38.1ºC, heart rate of 104 bpm, respiratory rate of 16/min, oxygen saturations of 97% on room air, and a blood pressure of 106/91 mmHg. The patient has a medical history of type 2 diabetes, heart failure, osteoarthritis, and benign prostatic hyperplasia. Which medication is most likely responsible for his current presentation?
Your Answer:
Correct Answer: Dapagliflozin
Explanation:SGLT-2 inhibitors, such as dapaglifozin, have been linked to a severe and rapidly progressing infection called necrotising fasciitis of the genitalia or perineum, also known as Fournier’s gangrene. This condition is caused by bacterial flora and is more common in diabetic and immunocompromised patients. It can lead to multiple organ failure and sepsis, making early surgical debridement and antibiotics crucial for management. It is important to note that Fournier’s gangrene is a serious adverse effect of SGLT-2 inhibitors, while the other options presented in the question are not associated with this condition.
Understanding SGLT-2 Inhibitors
SGLT-2 inhibitors are medications that work by blocking the action of a protein called sodium-glucose co-transporter 2 (SGLT-2) in the kidneys. This results in a decrease in the amount of glucose that is reabsorbed by the body and an increase in the amount of glucose that is excreted in the urine. Examples of SGLT-2 inhibitors include canagliflozin, dapagliflozin, and empagliflozin.
While SGLT-2 inhibitors can be effective in treating type 2 diabetes mellitus, they can also have some important adverse effects. One of the most common side effects is an increased risk of urinary and genital infections, which can occur due to the increased amount of glucose in the urine. Fournier’s gangrene, a rare but serious bacterial infection of the genital area, has also been reported in some cases.
Another potential complication of SGLT-2 inhibitors is normoglycemic ketoacidosis, a condition in which the body produces high levels of ketones even when blood sugar levels are normal. This can be a serious and potentially life-threatening condition if left untreated. Additionally, there is an increased risk of lower-limb amputation in patients taking SGLT-2 inhibitors, so it is important to closely monitor the feet for any signs of injury or infection.
Despite these potential risks, SGLT-2 inhibitors can also have some positive effects on overall health. Many patients taking these medications experience weight loss, which can be beneficial in managing type 2 diabetes mellitus. As with any medication, it is important to discuss the potential benefits and risks of SGLT-2 inhibitors with a healthcare provider before starting treatment.
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This question is part of the following fields:
- Renal Medicine/Urology
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Question 13
Incorrect
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A 25-year-old woman visits her doctor complaining of diarrhoea and vomiting after spending Christmas with her family. Her sister has just informed her that she too is experiencing the same symptoms. The doctor suspects norovirus. What is the best way to prevent the spread of this virus?
Your Answer:
Correct Answer: Wash hands with soap and water
Explanation:Handwashing is more effective than alcohol gels in preventing the spread of norovirus.
Norovirus, also known as the winter vomiting bug, is a common cause of gastroenteritis in the UK. It is a type of RNA virus that can cause symptoms such as nausea, vomiting, and diarrhea, as well as headaches, low-grade fevers, and myalgia. The virus is highly contagious and can be transmitted through the fecal-oral route, as well as through aerosolized particles from vomit or contaminated bodily fluids. Good hand hygiene and isolation of infected individuals are important measures to limit transmission. Diagnosis is typically made through clinical history and stool culture viral PCR. While the infection is self-limiting in most cases, dehydration and electrolyte imbalances can occur and require supportive management.
Norovirus is a genus of non-encapsulated RNA virus species that can cause gastroenteritis. The CDC estimates that 1 in 5 cases of infectious gastroenteritis are caused by norovirus, with 685 million cases per year worldwide. Symptoms typically develop within 15-50 hours of infection and can include vomiting, diarrhea, headaches, low-grade fevers, and myalgia. The virus is highly contagious and can be transmitted through direct physical contact, contact with contaminated food, or through aerosolized particles from vomit or contaminated bodily fluids. Good hand hygiene and isolation of infected individuals are important measures to limit transmission. Diagnosis is typically made through clinical history and stool culture viral PCR. While the infection is self-limiting in most cases, dehydration and electrolyte imbalances can occur and require supportive management.
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Incorrect
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A man of 45 years presents following the death of his wife.
Which one of the following is going to heighten your suspicion of an abnormal grief reaction?
Your Answer:
Correct Answer: Delayed or absent grief
Explanation:Understanding Abnormal and Normal Grief Reactions
Grief is a highly individualized experience that can be influenced by personal, social, and cultural factors. There are three recognized types of abnormal grief reactions: delayed, inhibited, and prolonged. Delayed grief is characterized by a delay of more than two weeks before grieving begins, or sometimes not occurring at all until triggered by another subsequent bereavement. Inhibited grief occurs when the bereaved person appears minimally affected by the death, and prolonged grief lasts significantly longer than average.
On the other hand, normal grief reactions are characterized by features such as sadness, weeping, poor sleep, reduced appetite, motor restlessness, searching for the deceased, poor concentration and memory, low mood (but not frank depression), and the impression of seeing or hearing the deceased. Poor memory, brief episodes of seeing the dead person, poor concentration, and searching for the deceased are all common manifestations of a normal grief reaction.
It is important to note that there is a great degree of flexibility when assessing whether a grief reaction is normal or abnormal, as it is a highly personal experience. Understanding the different types of grief reactions can help individuals and their loved ones navigate the grieving process and seek appropriate support.
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This question is part of the following fields:
- Psychiatry
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Question 15
Incorrect
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A 20-year-old male patient visits his GP clinic with a complaint of painful blisters and ulcers on his glans, accompanied by pain during urination. He is sexually active and does not use protection during intercourse. His last unprotected sexual encounter was a week ago. What medication would be beneficial for this patient?
Your Answer:
Correct Answer: Oral aciclovir
Explanation:Male patients with gonorrhea typically experience urethral discharge and dysuria as symptoms, rather than painful ulcers.
Understanding Genital Herpes
Genital herpes is a viral infection caused by the herpes simplex virus (HSV). There are two strains of the virus, HSV-1 and HSV-2, which were previously thought to cause oral and genital lesions respectively. However, there is now considerable overlap between the two strains. The infection is characterized by painful genital ulceration, which may be accompanied by dysuria and pruritus. Primary infections are usually more severe than recurrent episodes and may present with systemic symptoms such as headache, fever, and malaise. Tender inguinal lymphadenopathy and urinary retention may also occur.
To diagnose genital herpes, nucleic acid amplification tests (NAAT) are the preferred investigation method as they are considered superior to viral culture. HSV serology may be useful in certain situations, such as recurrent genital ulceration of unknown cause. Management of the infection involves general measures such as saline bathing, analgesia, and topical anaesthetic agents like lidocaine. Oral aciclovir is also prescribed, and some patients with frequent exacerbations may benefit from longer-term aciclovir.
In pregnant women, a primary attack of herpes occurring after 28 weeks gestation may require an elective caesarean section at term. Women with recurrent herpes who are pregnant should be treated with suppressive therapy and advised that the risk of transmission to their baby is low. Understanding genital herpes and its management is crucial in preventing transmission and managing symptoms.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Incorrect
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A 68-year-old woman is referred with fatigue. Her primary care physician observes that she has jaundice and suspects liver disease. She also presents with angular cheilitis. She has a history of taking steroid inhalers for asthma, but no other significant medical history. A blood smear shows signs of megaloblastic anemia, and her serum bilirubin level is elevated, but her other laboratory results are normal. There are no indications of gastrointestinal (GI) issues.
What is the most appropriate diagnosis for this clinical presentation?Your Answer:
Correct Answer: Pernicious anaemia
Explanation:Differential Diagnosis of Anaemia: Understanding the Causes
Anaemia is a common condition that can be caused by a variety of factors. Here, we will discuss some of the possible causes of anaemia and their corresponding laboratory findings.
Pernicious Anaemia: This type of anaemia is caused by a deficiency in vitamin B12 due to impaired intrinsic factor (IF) production. It is usually seen in adults aged 40-70 years and is characterized by megaloblastic changes in rapidly dividing cells. Anti-parietal cell antibodies are present in 90% of patients with pernicious anaemia. The Schilling test is useful in confirming the absence of IF. Treatment involves parenteral administration of cyanocobalamin or hydroxycobalamin.
Chronic Myeloid Leukaemia: CML is a myeloproliferative disorder that results in increased proliferation of granulocytic cells. Symptoms include fatigue, anorexia, weight loss, and hepatosplenomegaly. Mild to moderate anaemia is usually normochromic and normocytic. Diagnosis is based on histopathological findings in the peripheral blood and Philadelphia chromosome in bone marrow cells.
Iron Deficiency Anaemia: This type of anaemia is primarily a laboratory diagnosis and is characterized by microcytic and hypochromic erythropoiesis. It is caused by chronic iron deficiency and can be due to multiple causes, including chronic inflammation, iron malabsorption, chronic blood loss, and malabsorption of vitamin B12 or folate.
Crohn’s Disease: This chronic inflammatory process can affect any part of the GI tract and can cause anaemia due to chronic inflammation, iron malabsorption, chronic blood loss, and malabsorption of vitamin B12 or folate. However, the lack of GI symptoms in the clinical scenario provided is not consistent with a history of inflammatory bowel disease.
Autoimmune Hepatitis: This chronic disease is characterized by continuing hepatocellular inflammation and necrosis, with a tendency to progress to cirrhosis. Elevated serum aminotransferase levels are present in 100% of patients at initial presentation. Anaemia, if present, is usually normochromic. However, this clinical picture and laboratory findings are not consistent with the scenario given.
In conclusion, understanding the different causes of anaemia and their corresponding laboratory findings is crucial in making an accurate diagnosis and providing appropriate treatment.
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This question is part of the following fields:
- Haematology/Oncology
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Question 17
Incorrect
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A 28-year-old woman is being seen in the asthma clinic. She is currently on salbutamol inhaler 100mcg prn and beclometasone dipropionate inhaler 400 mcg bd, but is experiencing frequent asthma exacerbations and has recently undergone a course of prednisolone. In accordance with NICE guidelines, what would be the most suitable course of action for her management?
Your Answer:
Correct Answer: Add a leukotriene receptor antagonist
Explanation:According to NICE 2017 guidelines, if a patient with asthma is not effectively managed with a SABA + ICS, the first step should be to add a LTRA rather than a LABA.
The management of asthma in adults has been updated by NICE in 2017, following the 2016 BTS guidelines. One of the significant changes is in ‘step 3’, where patients on a SABA + ICS whose asthma is not well controlled should be offered a leukotriene receptor antagonist instead of a LABA. NICE does not follow the stepwise approach of the previous BTS guidelines, but to make the guidelines easier to follow, we have added our own steps. The steps range from newly-diagnosed asthma to SABA +/- LTRA + one of the following options, including increasing ICS to high-dose, a trial of an additional drug, or seeking advice from a healthcare professional with expertise in asthma. Maintenance and reliever therapy (MART) is a form of combined ICS and LABA treatment that is only available for ICS and LABA combinations in which the LABA has a fast-acting component. It should be noted that NICE does not recommend changing treatment in patients who have well-controlled asthma simply to adhere to the latest guidance. The definitions of what constitutes a low, moderate, or high-dose ICS have also changed, with <= 400 micrograms budesonide or equivalent being a low dose, 400 micrograms - 800 micrograms budesonide or equivalent being a moderate dose, and > 800 micrograms budesonide or equivalent being a high dose for adults.
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This question is part of the following fields:
- Respiratory Medicine
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Question 18
Incorrect
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A 35-year-old man presents to his General Practitioner. He has noticed a few patches of pale skin on his arms over the past few weeks. He is not particularly worried about these but wants to know what it could be and what he needs to do about it.
On examination, a few depigmented patches on the arms are noted. His medical history includes asthma, for which he takes inhalers.
Given the likely diagnosis, which of the following treatments should he be started on?Your Answer:
Correct Answer: Daily sunscreen to the affected areas
Explanation:Managing Vitiligo: Recommended Treatments and Precautions
Vitiligo is a skin condition that requires careful management to prevent further damage and reduce the risk of skin cancer. Daily application of sunscreen to affected areas is crucial due to increased susceptibility to UV-light-induced damage. Camouflaging makeup can also help alleviate psychological distress. Topical steroids are recommended for up to two months, and if there is no response, a referral to a dermatologist is necessary. Emollients and oral antihistamines are not useful in vitiligo management. Oral steroids are rarely used, and topical clotrimazole and dapsone are not first-line treatments. Topical tacrolimus and phototherapy may have a role, but caution is needed for light-skinned patients. Overall, early intervention and precautionary measures are key to managing vitiligo effectively.
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This question is part of the following fields:
- Dermatology
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Question 19
Incorrect
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A 55-year-old woman comes to see her general practitioner complaining of a progressively worsening erythematous rash on her nose, forehead, and cheeks accompanied by telangiectasia and papules for the past year. The rash is exacerbated by exposure to sunlight and consumption of hot and spicy foods. She has previously sought medical attention for this condition and has been treated with topical metronidazole, but her symptoms persist. She has no allergies and is otherwise healthy.
What is the most suitable course of action for managing this patient's condition?Your Answer:
Correct Answer: Oral doxycycline
Explanation:The patient has an erythematous rash on the nose, forehead, and cheeks with telangiectasia and papules, worsened by sun exposure and spicy food, suggesting a diagnosis of rosacea. The first-line treatment for mild to moderate cases is topical metronidazole, while severe or resistant cases require oral tetracycline. However, in this case, oral doxycycline should be given instead of metronidazole as it has been ineffective. Oral clarithromycin, erythromycin, and flucloxacillin are not appropriate treatments for rosacea.
Understanding Rosacea: Symptoms and Management
Rosacea, also known as acne rosacea, is a chronic skin condition that has no known cause. It typically affects the nose, cheeks, and forehead, and the first symptom is often flushing. Over time, telangiectasia (visible blood vessels) may appear, followed by persistent redness with papules and pustules. In some cases, rhinophyma (enlarged nose) may develop, and there may be ocular involvement, such as blepharitis. Sunlight can exacerbate symptoms.
Mild cases of rosacea may be treated with topical metronidazole, while topical brimonidine gel may be used for patients with predominant flushing but limited telangiectasia. More severe cases may require systemic antibiotics like oxytetracycline. Patients are advised to apply high-factor sunscreen daily and use camouflage creams to conceal redness. Laser therapy may be appropriate for those with prominent telangiectasia, and patients with rhinophyma should be referred to a dermatologist.
Overall, understanding the symptoms and management of rosacea can help individuals manage their condition and improve their quality of life.
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This question is part of the following fields:
- Dermatology
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Question 20
Incorrect
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A 56-year-old man visits his doctor complaining of bilateral ringing in his ears. He noticed the symptoms shortly after beginning a new medication.
Which of the following drugs is the most probable cause of his condition?Your Answer:
Correct Answer: Furosemide
Explanation:Common Medications and Their Side Effects
Furosemide: A loop diuretic that carries the risk of ototoxicity, especially in patients with renal impairment or given a rapid intravenous infusion. Hearing loss and tinnitus are potential side effects.
Ciprofloxacin: A broad-spectrum quinolone antibiotic that is not commonly associated with ototoxicity, but has an increased risk of Clostridium difficile infection. Rupture of the Achilles tendon is a known side effect.
Amlodipine: A calcium channel blocker used to treat hypertension. Common side effects include flushing, headaches, and ankle swelling due to vasodilation.
Indapamide: A thiazide-like diuretic that is not associated with ototoxicity. Possible side effects include electrolyte imbalances, dry mouth, and gastrointestinal disturbance.
Paracetamol: Not associated with ototoxicity and has few side effects listed in the British National Formulary. Non-steroidal anti-inflammatory drugs, which have similar indications for use, can cause ototoxicity.
Understanding the Side Effects of Common Medications
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This question is part of the following fields:
- ENT
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Question 21
Incorrect
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A 29-year-old woman visits the genitourinary medicine clinic with four fleshy, pigmented lesions on her vulva after starting a new relationship. What is the best initial course of action?
Your Answer:
Correct Answer: Topical podophyllum
Explanation:For the treatment of genital warts, topical podophyllum is recommended for multiple, non-keratinised warts, while cryotherapy is recommended for solitary, keratinised warts. Cryotherapy can also be used as an initial treatment for genital warts.
Understanding Genital Warts
Genital warts, also known as condylomata accuminata, are a common reason for visits to genitourinary clinics. These warts are caused by various types of the human papillomavirus (HPV), with types 6 and 11 being the most common culprits. It is important to note that HPV, particularly types 16, 18, and 33, can increase the risk of cervical cancer.
The warts themselves are small, fleshy protrusions that are typically 2-5mm in size and may be slightly pigmented. They can cause discomfort, itching, and even bleeding. Treatment options for genital warts include topical podophyllum or cryotherapy, depending on the location and type of lesion. Topical agents are generally used for multiple, non-keratinised warts, while solitary, keratinised warts respond better to cryotherapy. Imiquimod, a topical cream, is often used as a second-line treatment. It is important to note that genital warts can be resistant to treatment, and recurrence is common. However, most anogenital HPV infections clear up on their own within 1-2 years without intervention.
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This question is part of the following fields:
- Reproductive Medicine
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Question 22
Incorrect
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A 27-year-old female patient visits the genitourinary medicine clinic seeking treatment for recurring genital warts. Which virus is the most probable cause of this condition?
Your Answer:
Correct Answer: Human papilloma virus 6 & 11
Explanation:Understanding Genital Warts
Genital warts, also known as condylomata accuminata, are a common reason for visits to genitourinary clinics. These warts are caused by various types of the human papillomavirus (HPV), with types 6 and 11 being the most common culprits. It is important to note that HPV, particularly types 16, 18, and 33, can increase the risk of cervical cancer.
The warts themselves are small, fleshy protrusions that are typically 2-5mm in size and may be slightly pigmented. They can cause discomfort, itching, and even bleeding. Treatment options for genital warts include topical podophyllum or cryotherapy, depending on the location and type of lesion. Topical agents are generally used for multiple, non-keratinised warts, while solitary, keratinised warts respond better to cryotherapy. Imiquimod, a topical cream, is often used as a second-line treatment. It is important to note that genital warts can be resistant to treatment, and recurrence is common. However, most anogenital HPV infections clear up on their own within 1-2 years without intervention.
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This question is part of the following fields:
- Reproductive Medicine
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Question 23
Incorrect
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A 25-year-old woman who is 14 weeks pregnant complains of worsening acne that is causing her distress. Despite using topical benzyl peroxide, she has noticed limited improvement. During examination, non-inflammatory lesions and pustules are observed on her face. What would be the most suitable next course of action?
Your Answer:
Correct Answer: Oral erythromycin
Explanation:If treatment for acne is required during pregnancy, oral erythromycin is a suitable option, as the other medications are not recommended.
Acne vulgaris is a common skin condition that typically affects adolescents, with the face, neck, and upper trunk being the most commonly affected areas. It is characterized by the obstruction of hair follicles with keratin plugs, leading to the formation of comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the presence and extent of inflammatory lesions, papules, and pustules.
The management of acne vulgaris typically involves a step-up approach, starting with single topical therapy such as topical retinoids or benzoyl peroxide. If this is not effective, topical combination therapy may be used, which includes a topical antibiotic, benzoyl peroxide, and topical retinoid. Oral antibiotics such as tetracyclines may also be prescribed, but they should be avoided in pregnant or breastfeeding women and children under 12 years of age. Erythromycin may be used in pregnancy, while minocycline is now considered less appropriate due to the possibility of irreversible pigmentation. Oral antibiotics should be used for a maximum of three months and always co-prescribed with a topical retinoid or benzoyl peroxide to reduce the risk of antibiotic resistance.
Combined oral contraceptives (COCP) are an alternative to oral antibiotics in women, and Dianette (co-cyrindiol) may be used as it has anti-androgen properties. However, it has an increased risk of venous thromboembolism compared to other COCPs, so it should generally be used second-line and for only three months. Oral isotretinoin is a potent medication that should only be used under specialist supervision, and it is contraindicated in pregnancy. Finally, there is no evidence to support dietary modification in the management of acne vulgaris.
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This question is part of the following fields:
- Dermatology
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Question 24
Incorrect
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A 47-year-old heavy smoker presents with a persistent cough and occasional wheezing. The chest radiograph reveals hyperinflation but clear lung fields.
What is the next step to assist in making a diagnosis?Your Answer:
Correct Answer: Spirometry
Explanation:Spirometry: The Best Diagnostic Tool for COPD
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that can significantly impact a patient’s quality of life. To diagnose COPD, spirometry is the best diagnostic tool. According to NICE guidelines, a diagnosis of COPD should be made based on symptoms and signs, but supported by spirometry results. Post-bronchodilator spirometry should be performed to confirm the diagnosis. Airflow obstruction is confirmed by a forced expiratory volume in 1 s (FEV1):forced vital capacity (FVC) ratio of <0.7 and FEV1 <80% predicted. Other diagnostic tools, such as CT of the chest, serial peak flow readings, and trials of beclomethasone or salbutamol, may have a role in the management of COPD, but they are not used in the diagnosis of the condition. CT of the chest may be used to investigate symptoms that seem disproportionate to the spirometric impairment, to investigate abnormalities seen on a chest radiograph, or to assess suitability for surgery. Serial peak flow readings may be appropriate if there is some doubt about the diagnosis, in order to exclude asthma. Inhaled corticosteroids and short-acting beta agonists may be used in the management of COPD for breathlessness/exercise limitation, but they are not used in the diagnosis of COPD. In summary, spirometry is the best diagnostic tool for COPD, and other diagnostic tools may have a role in the management of the condition.
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This question is part of the following fields:
- Respiratory Medicine
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Question 25
Incorrect
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A 45-year-old woman presents to the Emergency Department with a 2-day history of pleuritic chest pain. She states that this started in the evening and has gotten worse since then. The pain is central and seems to improve when she leans forward. She has a past medical history of hypertension.
An electrocardiogram (ECG) is performed which shows widespread concave ST-segment elevation and PR interval depression. Extensive investigations reveal no underlying cause.
Given the likely diagnosis, which of the following is the best treatment option?
Select the SINGLE best treatment option from the list below.
Your Answer:
Correct Answer: NSAIDs until symptomatic resolution along with colchicine for three months
Explanation:Treatment Options for Acute Pericarditis
Acute pericarditis requires prompt treatment to prevent complications such as recurrent pericarditis, pericardial effusions, cardiac tamponade, and chronic constrictive pericarditis. The initial treatment for idiopathic or viral pericarditis involves high-dose non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin in combination with colchicine. The duration of NSAID or aspirin treatment depends on symptom resolution and normalization of C-reactive protein (CRP), while colchicine treatment is continued for three months using a low, weight-adjusted dose. Strenuous physical activity should be restricted until symptom resolution and normalization of inflammatory markers, and gastroprotection with a proton-pump inhibitor is recommended.
If NSAIDs and colchicine are contraindicated, low-dose corticosteroids are the next step in the treatment algorithm, after exclusion of infectious causes. However, when the cause of the pericarditis is known, it must be treated first before starting anti-inflammatory treatment.
Managing Acute Pericarditis: Treatment Options and Considerations
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This question is part of the following fields:
- Cardiovascular
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Question 26
Incorrect
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A 28-year-old man comes to your clinic seeking advice on how to improve his health after his uncle passed away from a heart attack at the age of 50. He mentions that he has already begun going to the gym three times a week and has increased his consumption of fruits and vegetables. However, he works in finance and is finding it difficult to reduce his alcohol consumption. What is the highest recommended weekly alcohol limit for men in the UK?
Your Answer:
Correct Answer: 14 units
Explanation:The latest recommendations state that individuals should limit their alcohol consumption to no more than 14 units per week, regardless of gender. Additionally, it is suggested that individuals should spread out their drinking over a minimum of three days if they regularly consume 14 units per week.
Alcohol consumption guidelines were revised in 2016 by the Chief Medical Officer, based on recommendations from an expert group report. The most significant change was a reduction in the recommended maximum number of units of alcohol for men from 21 to 14, aligning with the guidelines for women. The government now advises that both men and women should not exceed 14 units of alcohol per week, and if they do, it is best to spread it evenly over three or more days. Pregnant women are advised not to drink alcohol at all, as it can cause long-term harm to the baby. One unit of alcohol is equivalent to 10 mL of pure ethanol, and the strength of a drink is determined by its alcohol by volume (ABV). Examples of one unit of alcohol include a 25ml single measure of spirits with an ABV of 40%, a third of a pint of beer with an ABV of 5-6%, and half a 175ml standard glass of red wine with an ABV of 12%. To calculate the number of units in a drink, multiply the number of millilitres by the ABV and divide by 1,000.
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This question is part of the following fields:
- Gastroenterology/Nutrition
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Question 27
Incorrect
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An 80-year-old woman is brought to the Emergency Department by her family. She has been experiencing increasing shortness of breath and low energy levels for the past 6 weeks. Upon arrival, an ECG reveals atrial fibrillation with a heart rate of 114 / min. Her blood pressure is 128/80 mmHg and a chest x-ray shows no abnormalities. What medication is recommended for controlling her heart rate?
Your Answer:
Correct Answer: Bisoprolol
Explanation:When it comes to rate control in atrial fibrillation, beta blockers are now the preferred option over digoxin. This is an important point to remember, especially for exams. The patient’s shortness of breath may be related to her heart rate and not necessarily a sign of heart failure, as her chest x-ray was normal. For more information, refer to the NICE guidelines.
Atrial fibrillation (AF) is a condition that requires careful management to prevent complications. The latest guidelines from NICE recommend that patients presenting with AF should be assessed for haemodynamic instability, and if present, electrically cardioverted. For haemodynamically stable patients, the management depends on how acute the AF is. If the AF has been present for less than 48 hours, rate or rhythm control may be considered. However, if it has been present for 48 hours or more, or the onset is uncertain, rate control is recommended. If long-term rhythm control is being considered, cardioversion should be delayed until the patient has been maintained on therapeutic anticoagulation for at least 3 weeks.
Rate control is the first-line treatment strategy for AF, except in certain cases. Medications such as beta-blockers, calcium channel blockers, and digoxin can be used to control the heart rate. However, digoxin is no longer considered first-line as it is less effective at controlling the heart rate during exercise. Rhythm control agents such as beta-blockers, dronedarone, and amiodarone can be used to maintain sinus rhythm in patients with a history of AF. Catheter ablation is recommended for those who have not responded to or wish to avoid antiarrhythmic medication.
The aim of catheter ablation is to ablate the faulty electrical pathways that are causing AF. The procedure is performed percutaneously, typically via the groin, and can use radiofrequency or cryotherapy to ablate the tissue. Anticoagulation should be used 4 weeks before and during the procedure. It is important to note that catheter ablation controls the rhythm but does not reduce the stroke risk, so patients still require anticoagulation as per their CHA2DS2-VASc score. Complications of catheter ablation can include cardiac tamponade, stroke, and pulmonary vein stenosis. The success rate of the procedure is around 50% for early recurrence within 3 months, and around 55% of patients who’ve had a single procedure remain in sinus rhythm after 3 years. Of patients who’ve undergone multiple procedures, around 80% are in sinus rhythm.
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This question is part of the following fields:
- Cardiovascular
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Question 28
Incorrect
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A woman with a history of asthma who is 25 weeks pregnant is found to have consistent blood pressure readings >170/95 mmHg. She is admitted under Gynaecology.
Which of the following antihypertensives would you initiate for this patient?Your Answer:
Correct Answer: Nifedipine
Explanation:Safe and Effective Treatment Options for Gestational Hypertension
Gestational hypertension is a serious condition that requires prompt medical attention. According to NICE guidelines, labetalol is the first-line treatment for gestational hypertension. However, if the patient has asthma, labetalol is contraindicated. In such cases, nifedipine is listed as the second-line treatment, followed by methyldopa if necessary.
Diltiazem is not usually used in gestational hypertension, and the role of this medication in pregnancy is unclear. Bendroflumethiazide is relatively contraindicated in pregnancy, while ACE inhibitors and ARBs are absolutely contraindicated due to their potential adverse effects on fetal blood pressure and renal function.
In cases of gestational hypertension, it is crucial to rule out pre-eclampsia. If the patient’s blood pressure is above 160/110, NICE guidelines recommend admission until the blood pressure is below this level.
Calcium channel blockers, such as nifedipine, are safe and effective in pregnancy, while the role of diltiazem is uncertain. Bendroflumethiazide is relatively contraindicated, while ACE inhibitors and ARBs are absolutely contraindicated. It is essential to choose the appropriate medication based on the patient’s medical history and individual circumstances.
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This question is part of the following fields:
- Cardiovascular
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Question 29
Incorrect
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Sarah, 35, has come to her doctor complaining of weakness on the left side of her face, which is confirmed upon examination. Sarah also reports experiencing ear pain and an otoscopy reveals vesicles on her tympanic membrane. What is the probable diagnosis?
Your Answer:
Correct Answer: Ramsay Hunt syndrome
Explanation:The correct diagnosis for this case is Ramsay Hunt syndrome. This syndrome occurs when the Varicella Zoster virus reactivates in the geniculate ganglion, leading to the appearance of vesicles on the tympanic membrane, as well as other symptoms such as facial paralysis, taste loss, dry eyes, tinnitus, vertigo, and hearing loss. While Bell’s palsy could explain the facial weakness, the presence of tympanic vesicles and ear pain make this diagnosis less likely. Trigeminal neuralgia is unlikely to cause facial weakness, although it could explain the pain. An acoustic neuroma could explain both the facial weakness and ear pain, but the absence of tympanic vesicles makes this diagnosis less probable.
Understanding Ramsay Hunt Syndrome
Ramsay Hunt syndrome, also known as herpes zoster oticus, is a condition that occurs when the varicella zoster virus reactivates in the geniculate ganglion of the seventh cranial nerve. The first symptom of this condition is often auricular pain, followed by facial nerve palsy and a vesicular rash around the ear. Other symptoms may include vertigo and tinnitus.
To manage Ramsay Hunt syndrome, doctors typically prescribe oral aciclovir and corticosteroids. These medications can help reduce the severity of symptoms and prevent complications.
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This question is part of the following fields:
- ENT
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Question 30
Incorrect
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You assess a 79-year-old woman who is on digoxin for atrial fibrillation. What factor is most likely to increase her risk of developing digoxin toxicity?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Patients with hypokalaemia are more likely to experience digoxin toxicity.
Understanding Digoxin and Its Toxicity
Digoxin is a medication used for rate control in atrial fibrillation and for improving symptoms in heart failure patients. It works by decreasing conduction through the atrioventricular node and increasing the force of cardiac muscle contraction. However, it has a narrow therapeutic index and requires monitoring for toxicity.
Toxicity may occur even when the digoxin concentration is within the therapeutic range. Symptoms of toxicity include lethargy, nausea, vomiting, anorexia, confusion, yellow-green vision, arrhythmias, and gynaecomastia. Hypokalaemia is a classic precipitating factor, as it allows digoxin to more easily bind to the ATPase pump and increase its inhibitory effects. Other factors that may contribute to toxicity include increasing age, renal failure, myocardial ischaemia, electrolyte imbalances, hypoalbuminaemia, hypothermia, hypothyroidism, and certain medications such as amiodarone, quinidine, and verapamil.
Management of digoxin toxicity involves the use of Digibind, correction of arrhythmias, and monitoring of potassium levels. It is important to recognize the potential for toxicity and monitor patients accordingly to prevent adverse outcomes.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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