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Question 1
Correct
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A 68-year-old man presents to his primary care physician with raised intraocular pressure (IOP) on routine review. The physician notes that there are no visual symptoms or headaches and on examination, there are no visual field defects demonstrated. The optic disc appears normal and specifically, there is no cupping or pallor.
What is the most appropriate management for this patient in primary care?Your Answer: Referral to ophthalmology
Explanation:Management of Raised Intraocular Pressure
Raised intraocular pressure (IOP) is a common finding in adults over 40 years of age, with up to 2% having an IOP > 21 mmHg without signs of glaucoma. While chronic glaucoma is usually asymptomatic, it can cause deterioration in visual fields and peripheral sensitivity, leading to tunnel vision. Patients with raised IOP require lifelong follow-up and should be referred to an ophthalmologist.
In cases of acute angle closure glaucoma, patients may experience pain and nausea due to a rapid increase in IOP. This condition requires urgent ophthalmology review to prevent permanent visual loss. However, if the patient is asymptomatic and there are no signs of acute angle closure glaucoma, reassurance may be provided.
Treatment of glaucoma and intraocular hypertension is typically initiated and monitored by specialists. Topical latanoprost and timolol are commonly prescribed medications for glaucoma management. However, these medications should only be prescribed by specialists in secondary care.
In summary, patients with raised IOP require lifelong follow-up and referral to an ophthalmologist. Acute angle closure glaucoma requires urgent ophthalmology review, while chronic glaucoma is usually asymptomatic and requires specialist management.
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This question is part of the following fields:
- Eyes And Vision
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Question 2
Incorrect
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You are asked to go and review Sarah, an 82-year-old nursing home resident with pains in her legs.
Sarah has a 40-pack-year smoking history and has recently been diagnosed with mild cognitive impairment.
For the last 48 hours, the staff at the nursing home have noticed Sarah is very uncomfortable when getting out of her bed. The nursing staff mention that she has now started to require assistance to transfer into her chair from the bed as she reports the pain makes her legs 'give way'.
Sarah describes severe pains in her legs, mainly located at the back of her thighs but sometimes moving down into her lower legs and feet. She describes the pain as ‘electric shocks’.
What is the most likely diagnosis?Your Answer: Peripheral neuropathy
Correct Answer: Cauda equina syndrome
Explanation:The most probable diagnosis for a patient presenting with bilateral sciatica is cauda equina syndrome. This condition may be caused by malignant spread, which is more likely in patients with a history of smoking and advanced age, increasing the risk of prostate cancer. Bilateral claudication, Guillain-Barré syndrome, osteoarthritis, and peripheral neuropathy are less likely diagnoses as they do not present acutely with bilateral sciatica symptoms.
Understanding Cauda Equina Syndrome
Cauda equina syndrome (CES) is a rare but serious condition that occurs when the nerve roots in the lower back are compressed. This can lead to permanent nerve damage and long-term leg weakness, as well as urinary and bowel incontinence. It is important to consider CES in any patient who presents with new or worsening lower back pain.
The most common cause of CES is a central disc prolapse, typically occurring at L4/5 or L5/S1. Other causes include tumors, infections, trauma, and hematomas. CES may present in a variety of ways, including low back pain, bilateral sciatica, reduced sensation or pins-and-needles in the perianal area, and decreased anal tone. Urinary dysfunction, such as incontinence, reduced awareness of bladder filling, and loss of urge to void, is also a possible symptom.
It is crucial to recognize that there is no one symptom or sign that can diagnose or exclude CES. However, checking anal tone in patients with new-onset back pain is good practice, even though studies show that it has poor sensitivity and specificity for CES. In case of suspected CES, an urgent MRI is necessary. The management of CES involves surgical decompression.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 3
Correct
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Sophie is a 26-year-old woman who has come to you with a rash on her cheeks and bridge of her nose. She has also been experiencing nonspecific muscle and joint aches and extreme fatigue.
You order some blood tests to investigate any potential systemic causes, with a particular concern for systemic lupus erythematosus (SLE).
Which of the following positive blood test results would strongly indicate a diagnosis of SLE?Your Answer: Anti-dsDNA
Explanation:The anti-dsDNA test is highly specific for detecting lupus, making it useful in ruling out systemic lupus erythematosus if the results are negative. On the other hand, anti-CCP is used to diagnose rheumatoid arthritis, while anti-La is primarily found in patients with Sjogren’s syndrome, but can also be present in those with lupus. However, it is not very specific. Interestingly, babies born to mothers with anti-La and anti-Ro antibodies are at a higher risk of developing neonatal lupus. ANCA is an antibody that targets neutrophils and is commonly seen in patients with autoimmune vasculitis.
Systemic lupus erythematosus (SLE) can be investigated through various tests, including antibody tests. ANA testing is highly sensitive and useful for ruling out SLE, but it has low specificity. About 99% of SLE patients are ANA positive. Rheumatoid factor testing is positive in 20% of SLE patients. Anti-dsDNA testing is highly specific (>99%) but less sensitive (70%). Anti-Smith testing is also highly specific (>99%) but has a lower sensitivity (30%). Other antibody tests that can be used include anti-U1 RNP, SS-A (anti-Ro), and SS-B (anti-La).
Monitoring of SLE can be done through various markers, including inflammatory markers such as ESR. During active disease, CRP levels may be normal, and a raised CRP may indicate an underlying infection. Complement levels (C3, C4) are low during active disease due to the formation of complexes that lead to the consumption of complement. Anti-dsDNA titres can also be used for disease monitoring, but it is important to note that they are not present in all SLE patients. Overall, these investigations can help diagnose and monitor SLE, allowing for appropriate management and treatment.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 4
Incorrect
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You are reviewing some pathology results and come across the renal function results of a 75-year-old man. His estimated glomerular filtration rate (eGFR) is 59 mL/min/1.73 m2. The rest of his results are as follows:
Na+ 142 mmol/l
K+ 4.0 mmol/l
Urea 5.5 mmol/l
Creatinine 92 µmol/l
You look back through his notes and see that he had blood taken as part of his annual review two weeks ago when his eGFR was at 58 (mL/min/1.73 m2). These current blood tests are a repeat organised by another doctor.
He takes 10 mg of Lisinopril for hypertension but he has no other past medical history.
You plan to have a telephone conversation with him regarding his renal function.
What is the correct information to give this man?Your Answer: This lady has chronic kidney disease (CKD), she needs no further tests to diagnose it
Correct Answer: If her eGFR remains below 60 mL/min/1.73 m2 on at least 2 occasions separated by at least 90 days you can then diagnose CKD
Explanation:Chronic kidney disease (CKD) is a condition where there is an abnormality in kidney function or structure that lasts for more than three months and has implications for health. Diagnosis of CKD requires an eGFR of less than 60 on at least two occasions, separated by a minimum of 90 days. CKD can range from mild to end-stage renal disease, with associated protein and/or blood leakage into the urine. Common causes of CKD include diabetes, hypertension, nephrotoxic drugs, obstructive kidney disease, and multi-system diseases. Early diagnosis and treatment of CKD aim to reduce the risk of cardiovascular disease and progression to end-stage renal disease. Testing for CKD involves measuring creatinine levels in the blood, sending an early morning urine sample for albumin: creatinine ratio (ACR) measurement, and dipping the urine for haematuria. CKD is diagnosed when tests persistently show a reduction in kidney function or the presence of proteinuria (ACR) for at least three months. This requires an eGFR persistently less than 60 mL/min/1.73 m2 and/or ACR persistently greater than 3 mg/mmol. To confirm the diagnosis of CKD, a repeat blood test is necessary at least 90 days after the first one. For instance, a lady needs to provide an early morning urine sample for haematuria dipping and ACR measurement, and another blood test after 90 days to confirm CKD diagnosis.
Chronic kidney disease is often without symptoms and is typically identified through abnormal urea and electrolyte levels. However, some individuals with advanced, undetected disease may experience symptoms. These symptoms may include swelling in the ankles, weight gain, increased urination, fatigue, itching due to uraemia, loss of appetite leading to weight loss, difficulty sleeping, nausea and vomiting, and high blood pressure.
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This question is part of the following fields:
- Kidney And Urology
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Question 5
Correct
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A 50-year-old man presents having recently noticed a lump in his right groin which disappears when he is recumbent. It is accompanied by some discomfort. He has a chronic cough due to smoking and has had an appendicectomy previously. What is the most likely diagnosis?
Your Answer: Inguinal hernia
Explanation:Inguinal hernia is the most probable reason for a lump in the right groin of a patient in this age group. This type of hernia occurs when a part of the intestine protrudes through the external inguinal ring. It may go unnoticed for a while, cause discomfort or pain, and resolve when lying flat. Femoral hernias are more common in females, while an epigastric hernia or an incisional hernia following appendicectomy would be unlikely in this anatomical site.
This patient’s persistent cough due to smoking puts him at a higher risk of developing hernias.
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This question is part of the following fields:
- Gastroenterology
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Question 6
Incorrect
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You are evaluating a 5-year-old boy with eczema. Which of the following emollients is most likely to cause skin irritation?
Your Answer: Oilatum
Correct Answer: Aqueous cream
Explanation:Aqueous Cream May Cause Skin Irritation, Warns Drug Safety Update
The use of aqueous cream as an emollient has been widely prescribed in the UK. However, a report published in the March 2013 issue of the Drug Safety Update (DSU) warns that it may cause burning and skin irritation in some patients, particularly children with eczema. The report showed that 56% of patients attending a paediatric dermatology clinic who used aqueous cream as a leave-on emollient reported skin irritation, typically within 20 minutes of application. This compared to 18% of children who used an alternative emollient. Skin irritation was not seen in patients using aqueous cream as a soap substitute. It is believed that the high sodium lauryl sulfate content in aqueous cream may be the cause of the irritation. The DSU doesn’t suggest that aqueous cream should not be prescribed, but advises that patients and parents should be warned about possible side-effects. It is recommended to routinely prescribe alternative emollients.
Spacing: 2
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This question is part of the following fields:
- Dermatology
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Question 7
Correct
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You have been seeing a 52-year-old man who has been frequently attending with lower respiratory tract infections. He has lost weight and appears pale and gaunt. During your consultation, you inquire about his travel history and any potential exposure to sexually transmitted infections. The patient confesses to having unprotected sexual intercourse with a sex worker while on a business trip to Thailand a few years ago when his marriage was going through a rough patch. Since then, he has reconciled with his wife and she has been his only sexual partner. With the patient's consent, you conduct a blood test to screen for Human Immunodeficiency Virus (HIV), which comes back positive. You discuss the implications of the result with the patient, but he insists that he cannot disclose this information to his wife, who is also a patient at your practice. What is your course of action?
Your Answer: Give the patient an opportunity to tell his wife and if he doesn't then inform him that it is your duty to inform her
Explanation:The question pertains to patient confidentiality and when it is acceptable to breach it. Specifically, if a patient has been diagnosed with a serious communicable disease, there is a risk of transmission to another patient. According to GMC guidelines, it is permissible to disclose information to a sexual partner of a patient with a sexually transmitted serious communicable disease if the patient has not informed them and cannot be convinced to do so. However, the patient should be informed before the disclosure is made, if possible and safe to do so. Any decision to disclose personal information without consent must be justified. Therefore, in this scenario, if the patient refuses to inform their spouse, it is appropriate to inform the spouse after informing the patient of the decision. It is important to follow professional guidelines in such situations, and other options would not be appropriate.
GMC Guidance on Confidentiality
Confidentiality is a crucial aspect of medical practice that must be upheld at all times. The General Medical Council (GMC) provides extensive guidance on confidentiality, which can be accessed through a link provided. As such, we will not attempt to replicate the detailed information provided by the GMC here. It is important for healthcare professionals to familiarize themselves with the GMC’s guidance on confidentiality to ensure that they are meeting the necessary standards and protecting patient privacy.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 8
Incorrect
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A 33-year-old woman comes to you with concerns about exposure to Chickenpox. Her 4-year-old nephew has the virus and she was in close contact with him yesterday. She is currently 16 weeks pregnant with her first child and is unsure if she had Chickenpox as a child. The midwife advised her to avoid exposure to the virus. You urgently test her blood for varicella antibody.
VZV IgG NOT DETECTED
What is the best course of action in this situation?Your Answer: Varicella vaccination
Correct Answer: Give varicella immunoglobulin
Explanation:If a pregnant woman who is not immune to Chickenpox has been exposed to the virus before 20 weeks of pregnancy, the recommended course of action is to administer VZIG. Ganciclovir is not typically used to treat Chickenpox, but may be used for acute herpetic keratitis or cytomegalovirus. However, it should be avoided during pregnancy unless the benefits outweigh the risks. General advice is not appropriate for pregnant women with symptoms of Chickenpox due to the risk of fetal varicella syndrome. If the pregnant woman had already developed Chickenpox, oral aciclovir may be prescribed within 24 hours of the onset of the rash.
Chickenpox Exposure in Pregnancy: Risks and Management
Chickenpox is caused by the varicella-zoster virus and can pose risks to both the mother and fetus during pregnancy. The mother is at a five times greater risk of pneumonitis, while the fetus is at risk of developing fetal varicella syndrome (FVS) if the mother is exposed to Chickenpox before 20 weeks gestation. FVS can result in skin scarring, eye defects, limb hypoplasia, microcephaly, and learning disabilities. There is also a risk of shingles in infancy and severe neonatal varicella if the mother develops a rash between 5 days before and 2 days after birth.
To manage Chickenpox exposure in pregnancy, post-exposure prophylaxis (PEP) may be necessary. If the pregnant woman is not immune to varicella, VZIG or antivirals may be given within 10 days of exposure. Waiting until days 7-14 is recommended to reduce the risk of developing clinical varicella. However, the decision on choice of PEP for women exposed from 20 weeks of pregnancy should take into account patient and health professional preference as well as the ability to offer and provide PEP in a timely manner.
If a pregnant woman develops Chickenpox, specialist advice should be sought. Oral aciclovir may be given if the pregnant woman is ≥ 20 weeks and presents within 24 hours of onset of the rash. However, caution should be exercised if the woman is < 20 weeks. Overall, managing Chickenpox exposure in pregnancy requires careful consideration of the risks and benefits to both the mother and fetus.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 9
Incorrect
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You are evaluating an elderly gentleman with metastatic prostate cancer. He has bony metastases affecting his pelvis and has been experiencing a persistent pain in his groin that he describes as a combination of burning and shooting. Despite taking paracetamol 1 g QDS and codeine 60mg QDS regularly, he has found that his current medication doesn't effectively alleviate this new pain. He has been struggling with this pain for the past few weeks and has sought advice due to its persistent nature and the failure of his current medication. What is the most appropriate medication to add to his treatment regimen for this symptom?
Your Answer: Amitriptyline 25 mg ON
Correct Answer: Ibuprofen 400 mg TDS
Explanation:Treatment Options for Neuropathic Pain
Neuropathic pain is often described as burning or shooting pain and can be difficult to manage with traditional painkillers. However, there are several treatment options available.
Tricyclic antidepressants like amitriptyline are commonly used and can be started at a low dose of 10-25 mg at night, with the option to increase up to 75 mg under specialist advice. Other nerve painkillers like gabapentin, pregabalin, and carbamazepine may also be effective.
If a tumour is compressing a nerve, dexamethasone may be useful to reduce tumour oedema. Nerve blocks can also be an option for localized pain. However, NSAIDs like ibuprofen are not effective for neuropathic pain.
Opioids like tramadol and oxycodone can be used with some success, but they only have a partial effect on neuropathic symptoms. Immediate release morphine is not preferable to amitriptyline, and regular medication is more appropriate.
Lidocaine plasters can be useful for post-herpetic neuralgia, but they are not a first-line therapy for neuropathic pain. Finally, oxybutinin can be helpful in treating bladder spasm.
In summary, there are several treatment options available for neuropathic pain, and it may take some trial and error to find the most effective one for each individual patient.
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This question is part of the following fields:
- End Of Life
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Question 10
Incorrect
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A 49-year-old accountant presents with severe central chest pain. An ECG shows ST elevation in leads II, III and aVF. The patient undergoes percutaneous coronary intervention and a right coronary artery occlusion is successfully stented. Post-procedure, there are no complications and echocardiography shows an ejection fraction of 50%. The patient inquires about the impact on his driving as he relies on his car for commuting to work. What guidance should you provide regarding his ability to drive?
Your Answer: Stop driving for at least 6 weeks, inform the DVLA
Correct Answer: Stop driving for at least 1 week, no need to inform the DVLA
Explanation:Driving can resume after hospital discharge if the patient has successfully undergone coronary angioplasty and there are no other disqualifying conditions. However, if the patient is a bus, taxi, or lorry driver, they must inform the DVLA and refrain from driving for a minimum of 6 weeks.
DVLA Guidelines for Cardiovascular Disorders and Driving
The DVLA has specific guidelines for individuals with cardiovascular disorders who wish to drive a car or motorcycle. For those with hypertension, driving is permitted unless the treatment causes unacceptable side effects, and there is no need to notify the DVLA. However, if the individual has Group 2 Entitlement, they will be disqualified from driving if their resting blood pressure consistently measures 180 mmHg systolic or more and/or 100 mm Hg diastolic or more.
Individuals who have undergone elective angioplasty must refrain from driving for one week, while those who have undergone CABG or acute coronary syndrome must wait four weeks before driving. If an individual experiences angina symptoms at rest or while driving, they must cease driving altogether. Pacemaker insertion requires a one-week break from driving, while implantable cardioverter-defibrillator (ICD) implantation results in a six-month driving ban if implanted for sustained ventricular arrhythmia. If implanted prophylactically, the individual must cease driving for one month, and Group 2 drivers are permanently barred from driving with an ICD.
Successful catheter ablation for an arrhythmia requires a two-day break from driving, while an aortic aneurysm of 6 cm or more must be reported to the DVLA. Licensing will be permitted subject to annual review, but an aortic diameter of 6.5 cm or more disqualifies patients from driving. Finally, individuals who have undergone a heart transplant must refrain from driving for six weeks, but there is no need to notify the DVLA.
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This question is part of the following fields:
- Cardiovascular Health
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Question 11
Incorrect
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A 21-year-old man is worried about having asthma. What factor in his medical history would decrease the likelihood of this diagnosis?
Your Answer:
Correct Answer: Peripheral tingling during episodes of dyspnoea
Explanation:According to the British Thoracic Society, if a patient experiences peripheral tingling, it is less likely that they have asthma. However, the patient’s smoking history doesn’t rule out asthma as a diagnosis, and given his age, it is highly unlikely that he has COPD.
Asthma diagnosis has been updated by NICE guidelines in 2017, which emphasizes the use of objective tests rather than subjective/clinical judgments. The guidance recommends the use of fractional exhaled nitric oxide (FeNO) test, which measures the level of nitric oxide produced by inflammatory cells, particularly eosinophils. Other established objective tests such as spirometry and peak flow variability are still important. All patients aged five and above should have objective tests to confirm the diagnosis. For patients aged 17 and above, spirometry with a bronchodilator reversibility (BDR) test and FeNO test should be performed. For children aged 5-16, spirometry with a BDR test and FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative BDR test. For patients under five years old, diagnosis should be made based on clinical judgment. The specific points about the tests include a FeNO level of >= 40 ppb for adults and >= 35 ppb for children considered positive, and a FEV1/FVC ratio less than 70% or below the lower limit of normal considered obstructive for spirometry. A positive reversibility test is indicated by an improvement in FEV1 of 12% or more and an increase in volume of 200 ml or more for adults, and an improvement in FEV1 of 12% or more for children.
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This question is part of the following fields:
- Respiratory Health
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Question 12
Incorrect
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A 28-year-old woman comes in for evaluation. She reports having 'IBS' and experiencing occasional episodes of abdominal pain, bloating, and loose stools for the past two years. However, her symptoms have significantly worsened over the past two weeks. She is now having 3-4 watery, grey, 'frothy' stools per day, along with increased abdominal bloating, cramps, and flatulence. She also feels that she has lost weight based on the fit of her clothes. The following blood tests are ordered:
Hb 10.9 g/dl
Platelets 199 * 109/l
WBC 7.2 * 109/l
Ferritin 15 ng/ml
Vitamin B12 225 ng/l
Folate 2.1 nmol/l
What is the most probable diagnosis?Your Answer:
Correct Answer: Coeliac disease
Explanation:The key indicators in this case suggest that the patient may have coeliac disease, as evidenced by her anaemia and low levels of ferritin and folate. While her description of diarrhoea is typical, some patients may have more visibly fatty stools.
It is unlikely that the patient has irritable bowel syndrome, as her blood test results would not be consistent with this diagnosis. While menorrhagia may explain her anaemia and low ferritin levels, it would not account for the low folate.
Coeliac disease is much more common than Crohn’s disease, and exams typically provide more clues to suggest a diagnosis of Crohn’s (such as mouth ulcers).
Understanding Coeliac Disease
Coeliac disease is an autoimmune disorder that affects approximately 1% of the UK population. It is caused by sensitivity to gluten, a protein found in wheat, barley, and rye. Repeated exposure to gluten leads to villous atrophy, which causes malabsorption. Coeliac disease is associated with various conditions, including dermatitis herpetiformis and autoimmune disorders such as type 1 diabetes mellitus and autoimmune hepatitis. It is strongly linked to HLA-DQ2 and HLA-DQ8.
To diagnose coeliac disease, NICE recommends screening patients who exhibit signs and symptoms such as chronic or intermittent diarrhea, failure to thrive or faltering growth in children, persistent or unexplained gastrointestinal symptoms, prolonged fatigue, recurrent abdominal pain, sudden or unexpected weight loss, unexplained anemia, autoimmune thyroid disease, dermatitis herpetiformis, irritable bowel syndrome, type 1 diabetes, and first-degree relatives with coeliac disease.
Complications of coeliac disease include anemia, hyposplenism, osteoporosis, osteomalacia, lactose intolerance, enteropathy-associated T-cell lymphoma of the small intestine, subfertility, and unfavorable pregnancy outcomes. In rare cases, it can lead to esophageal cancer and other malignancies.
The diagnosis of coeliac disease is confirmed through a duodenal biopsy, which shows complete atrophy of the villi with flat mucosa and marked crypt hyperplasia, intraepithelial lymphocytosis, and dense mixed inflammatory infiltrate in the lamina propria. Treatment involves a lifelong gluten-free diet.
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This question is part of the following fields:
- Gastroenterology
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Question 13
Incorrect
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A 32-year-old man is brought by his wife and appears to be experiencing an elevated mood, along with increased activity and energy, and difficulty sleeping. He is extremely talkative and jumps quickly from one topic to another. He has no hallucinations or delusions. His wife believes he requires medication to help calm him down.
What medication would be the most appropriate for the mental health team to prescribe for this patient?Your Answer:
Correct Answer: Olanzapine
Explanation:Treatment for Mania/Hypomania
Mania/hypomania is a condition that requires specialist mental health assessment. The patient may be prescribed atypical antipsychotic drugs such as olanzapine, quetiapine, or risperidone, which have a quicker onset and lower incidence of extrapyramidal side-effects compared to older antipsychotics like chlorpromazine. Alternatively, benzodiazepines like lorazepam may be used to aid sleep.
Lithium, a mood stabilizer, has a slower onset of action and is only used alone if symptoms are mild. It is usually initiated after a specialist assessment. In this case, the treatment with antipsychotics is to calm the patient down in the immediate short-term. Managing mania or hypomania in adults requires careful consideration of the patient’s symptoms and individual needs.
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This question is part of the following fields:
- Mental Health
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Question 14
Incorrect
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A new mother comes to see you with her baby for a routine eight week check. She is anxious about cot death and wants to discuss the subject further.
Which of the following statements about cot death is correct?Your Answer:
Correct Answer: It is more common in the winter months
Explanation:Sudden infant death syndrome (SIDS), also known as cot death, is not fully understood and its exact cause is unknown. It is more common in infants under 5 months of age, especially premature babies who have had apnoeic episodes during resuscitation. However, the risk can be reduced by placing the baby on their back to sleep, using a firm mattress, avoiding loose covers, positioning the baby’s feet to the foot of the cot, maintaining a reasonable room temperature, not sharing a bed with the baby, using a dummy at bedtime, avoiding cigarette smoking, recognizing and treating illnesses, and breastfeeding. Media campaigns have helped reduce the number of cases over the years.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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Question 15
Incorrect
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A 25-year-old male presents with a testicular mass.
On examination the mass is painless, approximately 2 cm in diameter, hard, with an irregular surface and doesn't transilluminate.
What is the most likely cause of the lump?Your Answer:
Correct Answer: Teratoma
Explanation:Tumour Diagnosis Based on Lump Characteristics
The lump’s characteristics suggest that it is a tumour, specifically due to its hard and irregular nature. However, the patient’s age is a crucial factor in determining the type of tumour. Teratomas are more commonly found in patients aged 20-30, while seminomas are prevalent in those aged 30-50. Teratomas are gonadal tumours that originate from multipotent cells present in the ovaries.
In summary, the characteristics of a lump can provide valuable information in diagnosing a tumour. However, age is also a crucial factor in determining the type of tumour, as different types of tumours are more prevalent in certain age groups.
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This question is part of the following fields:
- Kidney And Urology
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Question 16
Incorrect
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A patient with irritable bowel syndrome (IBS) and a tendency towards loose stools has not responded well to loperamide and antispasmodics. According to NICE, what is the recommended second-line medication class for this condition?
Your Answer:
Correct Answer: Tricyclic antidepressant
Explanation:The initial medication prescribed for individuals with irritable bowel syndrome typically includes antispasmodics, as well as loperamide for diarrhea or laxatives for constipation. If these treatments prove ineffective, low-dose tricyclic antidepressants such as amitriptyline (5-10 mg at night) may be considered as a secondary option to alleviate abdominal pain and discomfort, according to NICE guidelines. Linaclotide may also be an option for those experiencing constipation. Selective serotonin reuptake inhibitors may be used as a tertiary treatment.
Managing irritable bowel syndrome (IBS) can be challenging and varies from patient to patient. The National Institute for Health and Care Excellence (NICE) updated its guidelines in 2015 to provide recommendations for the management of IBS. The first-line pharmacological treatment depends on the predominant symptom, with antispasmodic agents recommended for pain, laxatives (excluding lactulose) for constipation, and loperamide for diarrhea. If conventional laxatives are not effective for constipation, linaclotide may be considered. Low-dose tricyclic antidepressants are the second-line pharmacological treatment of choice. For patients who do not respond to pharmacological treatments, psychological interventions such as cognitive behavioral therapy, hypnotherapy, or psychological therapy may be considered. Complementary and alternative medicines such as acupuncture or reflexology are not recommended. General dietary advice includes having regular meals, drinking at least 8 cups of fluid per day, limiting tea and coffee to 3 cups per day, reducing alcohol and fizzy drink intake, limiting high-fiber and resistant starch foods, and increasing intake of oats and linseeds for wind and bloating.
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This question is part of the following fields:
- Gastroenterology
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Question 17
Incorrect
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What is the single correct statement concerning the use of inhaled corticosteroids?
Your Answer:
Correct Answer: Hoarseness is a side-effect
Explanation:Understanding Inhaled Corticosteroids: Uses, Benefits, and Side Effects
Inhaled corticosteroids are commonly used to manage reversible and irreversible airways disease. They can also help distinguish between asthma and chronic obstructive pulmonary disease (COPD) when used for 3-4 weeks. If there is clear improvement over this period, it suggests asthma. In COPD, inhaled corticosteroids can reduce exacerbations when combined with an inhaled long-acting beta2 agonist. However, it’s important to use corticosteroid inhalers regularly for maximum benefit, and improvement of symptoms usually occurs within 3-7 days.
While inhaled corticosteroids are generally safe, high doses used for prolonged periods can induce adrenal suppression. However, in children, growth restriction associated with systemic corticosteroid therapy and high dose inhaled corticosteroids doesn’t seem to occur with recommended doses. Although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. The most common side-effects are hoarseness, throat irritation, and candidiasis of the mouth or throat. Candidiasis can be reduced by using a spacer device and rinsing the mouth with water or cleaning a child’s teeth after taking a dose. Paradoxical bronchospasm is a rare occurrence.
In summary, inhaled corticosteroids are a valuable tool in managing airways disease, but it’s important to use them as directed and be aware of potential side-effects. With proper use, they can provide significant relief and improve quality of life for those with asthma and COPD.
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This question is part of the following fields:
- Respiratory Health
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Question 18
Incorrect
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A 25-year-old man wakes up on a Monday morning unable to extend his wrist. He had consumed a large amount of alcohol the night before. What could be the probable reason for his weakness?
Your Answer:
Correct Answer: Radial nerve palsy
Explanation:The cause of this man’s condition, known as ‘Saturday night palsy’, is the compression of the radial nerve against the humeral shaft. It is likely that this was caused by sleeping on a hard chair with his arm hanging over the back.
The Radial Nerve: Anatomy, Innervation, and Patterns of Damage
The radial nerve is a continuation of the posterior cord of the brachial plexus, with root values ranging from C5 to T1. It travels through the axilla, posterior to the axillary artery, and enters the arm between the brachial artery and the long head of triceps. From there, it spirals around the posterior surface of the humerus in the groove for the radial nerve before piercing the intermuscular septum and descending in front of the lateral epicondyle. At the lateral epicondyle, it divides into a superficial and deep terminal branch, with the deep branch crossing the supinator to become the posterior interosseous nerve.
The radial nerve innervates several muscles, including triceps, anconeus, brachioradialis, and extensor carpi radialis. The posterior interosseous branch innervates supinator, extensor carpi ulnaris, extensor digitorum, and other muscles. Denervation of these muscles can lead to weakness or paralysis, with effects ranging from minor effects on shoulder stability to loss of elbow extension and weakening of supination of prone hand and elbow flexion in mid prone position.
Damage to the radial nerve can result in wrist drop and sensory loss to a small area between the dorsal aspect of the 1st and 2nd metacarpals. Axillary damage can also cause paralysis of triceps. Understanding the anatomy, innervation, and patterns of damage of the radial nerve is important for diagnosing and treating conditions that affect this nerve.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 19
Incorrect
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A 23-year-old woman presents to you with concerns about the possibility of pregnancy after engaging in consensual, unprotected sexual intercourse last night. She is currently on day 10 of her menstrual cycle and had taken the morning-after-pill seven days ago after a similar incident. She had stopped taking her combined oral contraceptive pill four weeks ago and was scheduled to have a levonorgestrel intrauterine system inserted next week. Her medical history is unremarkable, and she has a height of 180cm and a weight of 74kg (BMI 22.8). What is the most appropriate course of action to prevent pregnancy?
Your Answer:
Correct Answer: Levonorgestrel at double dose by mouth
Explanation:The correct answer is to double the dose of levonorgestrel to 3 mg by mouth for this patient, as she has a weight of over 70kg, despite having a healthy BMI. This information is based on the BNF guidelines.
Inserting a copper intrauterine device would not be the best option for this patient, as she already has plans for levonorgestrel device insertion and may be using it for additional hormonal benefits, such as reducing the heaviness of her bleeding.
Inserting the levonorgestrel uterine system would not provide the emergency contraception required for this patient, as it takes about 7 days to become effective. Therefore, it is not appropriate in this situation.
The standard dose of levonorgestrel 1.5mg would be given to females who weigh less than 70 kg or have a BMI less than 26. However, in this case, it would be inappropriate due to the patient’s weight being over 70kg.
It would be risky to suggest to this patient that she doesn’t need to take another form of emergency contraception, as the initial pill may not have prevented ovulation during this cycle.
Emergency contraception is available in the UK through two methods: emergency hormonal contraception and intrauterine device (IUD). Emergency hormonal contraception includes two types of pills: levonorgestrel and ulipristal. Levonorgestrel works by stopping ovulation and inhibiting implantation, and should be taken as soon as possible after unprotected sexual intercourse (UPSI) for maximum efficacy. The single dose of levonorgestrel is 1.5mg, but should be doubled for those with a BMI over 26 or weight over 70kg. It is safe and well-tolerated, but may cause vomiting in around 1% of women. Ulipristal, on the other hand, is a selective progesterone receptor modulator that inhibits ovulation. It should be taken within 120 hours after intercourse, and may reduce the effectiveness of hormonal contraception. The most effective method of emergency contraception is the copper IUD, which may inhibit fertilization or implantation. It must be inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date. Prophylactic antibiotics may be given if the patient is at high-risk of sexually transmitted infection. The IUD is 99% effective regardless of where it is used in the cycle, and may be left in-situ for long-term contraception.
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This question is part of the following fields:
- Gynaecology And Breast
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Question 20
Incorrect
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A national screening programme exists in the UK for abdominal aortic aneurysms.
Select the single correct statement regarding this process.Your Answer:
Correct Answer: Screening all men at 65 is estimated to reduce the rate of premature death from ruptured aortic aneurysm by 50%
Explanation:National Screening Programme for Aortic Aneurysm in Men at 65
The National Screening Programme aims to reduce the rate of premature death from ruptured aortic aneurysm by 50% by screening all men in their 65th year. The prevalence of significant aneurysm in this age group is 4%. Screening will be done through ultrasound, and those without significant aneurysms will be discharged. For those with aneurysms greater than 5.5 cm in diameter, surgery will be offered to 0.5% of men. Those with small aneurysms will enter a follow-up programme. However, the mortality from elective surgery is 5-7%.
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This question is part of the following fields:
- Cardiovascular Health
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Question 21
Incorrect
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Which of the following prescriptions should not be used during pregnancy?
Your Answer:
Correct Answer: Doxycycline for malaria prophylaxis
Explanation:Pregnant women should not take any tetracyclines. It is important to note that the aforementioned medications may not be the preferred initial treatments.
Prescribing Considerations for Pregnant Patients
When it comes to prescribing medication for pregnant patients, it is important to exercise caution as very few drugs are known to be completely safe during pregnancy. Some countries have developed a grading system to help guide healthcare professionals in their decision-making process. It is important to note that the following drugs are known to be harmful and should be avoided: tetracyclines, aminoglycosides, sulphonamides and trimethoprim, quinolones, ACE inhibitors, angiotensin II receptor antagonists, statins, warfarin, sulfonylureas, retinoids (including topical), and cytotoxic agents.
In addition, the majority of antiepileptics, including valproate, carbamazepine, and phenytoin, are potentially harmful. However, the decision to stop such treatments can be difficult as uncontrolled epilepsy poses its own risks. It is important for healthcare professionals to carefully weigh the potential risks and benefits of any medication before prescribing it to a pregnant patient.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 22
Incorrect
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A 16-year-old girl from the travelling community comes to you with a 4-day history of fever, myalgia, malaise, and headache. She reports that her face has been swelling for the past two days and the pain has increased while chewing food. Upon examination, you notice that her parotid glands are tender and bilaterally swollen. Her temperature is 38.5ºC, heart rate 120 beats/minute, and blood pressure 110/70 mmHg. What is the most appropriate course of action?
Your Answer:
Correct Answer: Supportive treatment- advise rest, fluids and simple analgesia
Explanation:The individual in question is suffering from mumps, which may be more prevalent in travelling communities due to lower vaccination rates. Supportive care is the recommended treatment for mumps, as antibiotics are ineffective against viral infections and steroids are not advised. While immediate vaccination is not necessary for this patient, it may be beneficial to assess their immunisation status for other diseases such as rubella and measles and administer appropriate vaccinations. Additionally, those who have been in contact with the patient should be offered the measles, mumps, and rubella vaccine. Hospitalisation is not required. This information is sourced from NICE CKS Mumps.
Understanding Mumps: Causes, Symptoms, Prevention, and Management
Mumps is a viral infection caused by RNA paramyxovirus that typically occurs during the winter and spring seasons. The virus spreads through droplets and affects respiratory tract epithelial cells, parotid glands, and other tissues. The infection is contagious, and a person can be infectious seven days before and nine days after the onset of parotid swelling. The incubation period for mumps is usually 14-21 days.
The clinical features of mumps include fever, malaise, and muscular pain. The most common symptom is parotitis, which causes earache and pain while eating. Initially, the swelling is unilateral, but it becomes bilateral in around 70% of cases.
Prevention of mumps is possible through the MMR vaccine, which has an efficacy rate of around 80%. Management of mumps involves rest and the use of paracetamol to alleviate high fever and discomfort. Mumps is a notifiable disease, and healthcare professionals must report cases to the relevant authorities.
Complications of mumps include orchitis, which is uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. It typically occurs four or five days after the onset of parotitis. Other complications include hearing loss, meningoencephalitis, and pancreatitis.
In conclusion, understanding the causes, symptoms, prevention, and management of mumps is crucial in preventing the spread of the infection and minimizing its complications. Vaccination and early diagnosis are essential in controlling the disease.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 23
Incorrect
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You have a telephone consultation with Sarah, a 49-year-old woman who is worried about experiencing menopausal symptoms. She reports having hot flashes, insomnia, and mood swings. Her last period was 12 months ago, and she is not using any hormonal contraception. Sarah has tried non-hormonal methods, but they have not been effective. She has never had a hysterectomy and has no history of breast cancer. Sarah smokes 10 cigarettes a day.
With a weight of 75 kg and a height of 160 cm, Sarah's BMI is calculated to be 29.3 kg/m2. She is not currently pregnant.
Sarah is seeking advice on the best HRT option as there are many available. Which HRT option would you recommend for her?Your Answer:
Correct Answer: Continuous combined transdermal preparation
Explanation:The appropriate HRT for Annie, who is postmenopausal and at risk of venous thromboembolism due to her smoking and obesity, is a continuous combined transdermal preparation. This is because she requires the progestogen component for endometrial protection and oral preparations should be avoided in her case. Cyclical preparations, both oral and transdermal, are not indicated as she has been amenorrhoeic for over 12 months.
Hormone Replacement Therapy: Uses and Varieties
Hormone replacement therapy (HRT) is a treatment that involves administering a small amount of estrogen, combined with a progestogen (in women with a uterus), to alleviate menopausal symptoms. The indications for HRT have changed significantly over the past decade due to the long-term risks that have become apparent, primarily as a result of the Women’s Health Initiative (WHI) study.
The most common indication for HRT is vasomotor symptoms such as flushing, insomnia, and headaches. Other indications, such as reversal of vaginal atrophy, should be treated with other agents as first-line therapies. HRT is also recommended for women who experience premature menopause, which should be continued until the age of 50 years. The most important reason for giving HRT to younger women is to prevent the development of osteoporosis. Additionally, HRT has been shown to reduce the incidence of colorectal cancer.
HRT generally consists of an oestrogenic compound, which replaces the diminished levels that occur in the perimenopausal period. This is normally combined with a progestogen if a woman has a uterus to reduce the risk of endometrial cancer. The choice of hormone includes natural oestrogens such as estradiol, estrone, and conjugated oestrogen, which are generally used rather than synthetic oestrogens such as ethinylestradiol (which is used in the combined oral contraceptive pill). Synthetic progestogens such as medroxyprogesterone, norethisterone, levonorgestrel, and drospirenone are usually used. A levonorgestrel-releasing intrauterine system (e.g. Mirena) may be used as the progestogen component of HRT, i.e. a woman could take an oral oestrogen and have endometrial protection using a Mirena coil. Tibolone, a synthetic compound with both oestrogenic, progestogenic, and androgenic activity, is another option.
HRT can be taken orally or transdermally (via a patch or gel). Transdermal is preferred if the woman is at risk of venous thromboembolism (VTE), as the rates of VTE do not appear to rise with transdermal preparations.
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This question is part of the following fields:
- Gynaecology And Breast
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Question 24
Incorrect
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A 35-year-old teacher presents to your clinic. She experienced upper respiratory symptoms during the COVID-19 pandemic in March 2020 and subsequently tested positive for the virus. Her dyspnea gradually worsened, and she was hospitalized ten days into her illness. She received oxygen therapy and was discharged one week later. She has been off work for three months since the onset of her symptoms and has interacted with several colleagues during this time. She now comes to you nine months after the onset of her symptoms, complaining of persistent fatigue. On physical examination, everything appears normal. Her chest X-ray, lung function tests, electrocardiogram, full blood count, and thyroid function tests are all normal, and she has been discharged from the care of respiratory physicians. How would you manage this patient?
Your Answer:
Correct Answer: Consider that she could be suffering with psychological effects following her illness
Explanation:Dealing with Uncertainty in Long Covid Management
Dealing with uncertainty can be challenging for both patients and clinicians, especially in a rapidly evolving field like long covid management. It is unlikely that candidates will be tested on precise details that may change between question setting and the exam. Instead, questions may focus on the management of conditions that are poorly understood or the more reliable do not dos.
One important point to note is that there is no reliable evidence to support prescribing steroids or antivirals for suspected long covid, especially by a generalist. At least 10% of people with acute covid-19 may experience symptoms that persist for months, and recovery timescales can vary. There is no set date by which patients should have settled, and there is no evidence that patients are infectious at this stage of the disease.
It is also important to consider psychological illness as a potential factor in long covid management. Clinicians should keep an open mind about this when evaluating patients, while also being alert to alternative diagnoses and investigating where appropriate. By staying informed and adaptable, clinicians can better navigate the uncertainties of long covid management.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 25
Incorrect
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An 82-year-old woman is brought to the General Practitioner by her son because of concerns about worsening confusion over the last two days. Her son has been staying with her as he is worried about her, and throughout the night, the patient was shouting out that she was seeing figures behind the curtains.
Which of the following features most suggests a diagnosis of delirium?
Your Answer:
Correct Answer: Symptoms developing rapidly over a few hours or days
Explanation:Differentiating between Delirium and Dementia: Symptoms and Signs to Look Out For
Delirium and dementia are two conditions that can cause confusion, memory problems, and other cognitive impairments. However, there are some key differences in how these conditions present themselves. Here are some symptoms and signs to look out for when trying to differentiate between delirium and dementia:
Symptoms developing rapidly over a few hours or days: This is more consistent with delirium, which can cause confusion, hallucinations, and delusions to develop rapidly over a short period of time. Dementia, on the other hand, usually develops gradually over several months.
Gradual worsening of symptoms over months: If symptoms such as confusion, poor concentration, and memory problems have been getting worse over a period of months, this is more suggestive of dementia.
Improved mobility: Patients with delirium may suddenly have difficulty with tasks they could previously do easily, such as walking.
Low mood: A low mood is more suggestive of depression, which usually develops over several weeks or months. However, hypoactive delirium can be misdiagnosed as depression, so it’s important to consider this possibility in patients who become suddenly withdrawn, drowsy, and unable to stay focused when awake.
Patient’s ability to concentrate on reading her book club novel: Attention is usually reduced in delirium, but in the early stages of dementia, patients may still be able to concentrate on activities such as reading or watching television.
By paying attention to these symptoms and signs, healthcare professionals can better differentiate between delirium and dementia and provide appropriate treatment.
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This question is part of the following fields:
- Mental Health
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Question 26
Incorrect
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A 32-year-old man with schizophrenia reports that thoughts are leaking out of his head and being read by others around him.
What is the correct term for this symptom?Your Answer:
Correct Answer: Thought broadcast
Explanation:Understanding Different Types of Thought Experiences
There are various types of thought experiences that individuals may encounter. One of these is thought broadcast, where others can seemingly hear or read one’s thoughts as they are being broadcasted from the individual. On the other hand, thought insertion and withdrawal refer to the experience of having thoughts inserted into or taken out of one’s mind by an external force. In thought blocking, individuals may suddenly find themselves unable to continue speaking as their minds go blank. Meanwhile, thought echo involves hearing one’s own thoughts being spoken aloud after thinking them. Finally, auditory hallucinations refer to the perception of hearing sounds or voices without any external stimulus. Understanding these different types of thought experiences can help individuals better recognize and cope with them.
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This question is part of the following fields:
- Mental Health
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Question 27
Incorrect
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In the UK, there are several screening programs for significant health concerns, such as prostate cancer. A new screening test for prostate cancer is being assessed in comparison to the traditional use of PSA testing. There are concerns that this test may lead to overdiagnosis and overtreatment, as it detects many cases of prostate cancer that may never cause harm.
What type of bias is this?Your Answer:
Correct Answer: Lead time bias
Explanation:Lead-time bias occurs when a new test for a disease is compared to an older test, and the new test diagnosis the disease earlier. However, this earlier diagnosis doesn’t necessarily lead to an improvement in the outcome of the disease.
Length time bias is a phenomenon where a disease may progress at different rates, and slower-growing or less aggressive diseases have a higher chance of being detected through screening than faster-growing or more aggressive diseases.
Self-selection or volunteer bias occurs when people who participate in screening programs are not representative of the general population. Typically, those who participate in screening programs tend to have a higher socio-economic status and engage in other healthy lifestyle choices.
Procedure bias is a type of bias that can occur in comparative studies. It happens when patients are treated differently based on their group allocation.
Recall bias is a type of bias that can affect the accuracy of data collected retrospectively. For example, when examining past asbestos exposure, a patient may not be able to accurately recall the exact years they were exposed.
Understanding Bias in Clinical Trials
Bias refers to the systematic favoring of one outcome over another in a clinical trial. There are various types of bias, including selection bias, recall bias, publication bias, work-up bias, expectation bias, Hawthorne effect, late-look bias, procedure bias, and lead-time bias. Selection bias occurs when individuals are assigned to groups in a way that may influence the outcome. Sampling bias, volunteer bias, and non-responder bias are subtypes of selection bias. Recall bias refers to the difference in accuracy of recollections retrieved by study participants, which may be influenced by whether they have a disorder or not. Publication bias occurs when valid studies are not published, often because they showed negative or uninteresting results. Work-up bias is an issue in studies comparing new diagnostic tests with gold standard tests, where clinicians may be reluctant to order the gold standard test unless the new test is positive. Expectation bias occurs when observers subconsciously measure or report data in a way that favors the expected study outcome. The Hawthorne effect describes a group changing its behavior due to the knowledge that it is being studied. Late-look bias occurs when information is gathered at an inappropriate time, and procedure bias occurs when subjects in different groups receive different treatment. Finally, lead-time bias occurs when two tests for a disease are compared, and the new test diagnosis the disease earlier, but there is no effect on the outcome of the disease. Understanding these types of bias is crucial in designing and interpreting clinical trials.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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Question 28
Incorrect
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Which statement about erectile dysfunction (ED) is correct?
Your Answer:
Correct Answer: Prolactin and LH levels should be measured
Explanation:Important Information about Erectile Dysfunction
Erectile dysfunction (ED) is a common condition that affects a significant portion of the population, with prevalence estimates ranging from 32 to 52%. It is important to measure both lipids and glucose in all patients, as early detection of ED may precede cardiovascular disease (CVD) symptoms by up to three years. While the causes of ED are multifactorial, it is recommended to only measure pituitary hormones if testosterone levels are low. Additionally, it is important to note that recreational drugs such as cocaine and heroin can also cause ED. Overall, it is crucial to be aware of the potential risk factors and causes of ED in order to properly diagnose and treat this condition.
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This question is part of the following fields:
- Kidney And Urology
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Question 29
Incorrect
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What is the only accurate statement regarding the management of osteoarthritis according to the 2014 NICE guidance?
Your Answer:
Correct Answer: Patients with mechanical knee locking symptoms should be referred for arthroscopic lavage and debridement
Explanation:NICE Guidance for Managing Osteoarthritis Pain
The National Institute for Health and Care Excellence (NICE) recommends exercise for all patients with osteoarthritis. When analgesia is necessary, paracetamol and topical NSAIDs should be the first line of treatment, followed by oral NSAIDs or COX-2 inhibitors if needed. However, a proton pump inhibitor should be used alongside these medications to reduce the risk of gastrointestinal side effects.
NICE doesn’t recommend the use of acupuncture or glucosamine for managing osteoarthritis pain. Arthroscopic debridement, a surgical procedure to remove damaged tissue from the joint, is only indicated if the patient has a clear history of mechanical locking, rather than morning joint stiffness, giving way, or X-ray evidence of loose bodies.
Overall, NICE’s guidance emphasizes the importance of exercise and non-pharmacological interventions in managing osteoarthritis pain, while also providing recommendations for safe and effective use of analgesic medications.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 30
Incorrect
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A study found that of 100 people over the age of 60 treated with a certain medication, 80 had improvement in their symptoms, whereas of 100 people over the age of 60 not treated, only 50 had improvement. What is the number needed to treat (NNT)?
Your Answer:
Correct Answer: 4
Explanation:Calculating the Number Needed to Treat (NNT) for Vertigo Treatment
To determine the effectiveness of a vertigo treatment, we can calculate the Number Needed to Treat (NNT). This is done by first calculating the Absolute Risk Reduction (ARR), which is the difference between the Control Event Rate (CER) and the Experimental Event Rate (EER). For example, if 55 out of 100 control patients failed to have a resolution of vertigo, and 30 out of 100 treatment patients failed to improve, the ARR would be 0.55 – 0.30 = 0.25. To find the NNT, we simply take the reciprocal of the ARR, which in this case would be 1/0.25 = 4. This means that for every 4 patients treated with the vertigo treatment, one patient will have a resolution of their vertigo.
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This question is part of the following fields:
- Population Health
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