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  • Question 1 - A 60-year-old man presents to the General Practitioner with a rubbery 3-cm swelling...

    Correct

    • A 60-year-old man presents to the General Practitioner with a rubbery 3-cm swelling of the left breast disc. He has no past history of breast disease and is currently undergoing hormone therapy for prostatic cancer. His body mass index is 28 kg/m2. What is the most probable cause of his symptoms?

      Your Answer: Gynaecomastia

      Explanation:

      Understanding Gynaecomastia: Causes, Symptoms, and Treatment Options

      Gynaecomastia is a common condition characterized by the benign enlargement of male breast tissue. It affects more than 30% of men and can occur at any age, with prevalence increasing with age. The condition presents as a firm or rubbery mass that extends concentrically from the nipples. While usually bilateral, it can also be unilateral.

      Gynaecomastia can be classified as physiological or pathological. Physiological gynaecomastia is seen in newborns, adolescents during puberty, and elderly men with low testosterone levels. Pathological causes include lack of testosterone, increased estrogen levels, liver disease, and obesity. Drugs, such as finasteride and spironolactone, can also cause gynaecomastia in adults.

      In this scenario, the patient is likely being treated with a gonadorelin analogue for prostate cancer, which can cause side effects similar to orchidectomy. While the patient is overweight, his body mass index doesn’t meet the definition of obesity.

      It is important to note that male breast cancer accounts for only 1% of all breast cancer cases. While unilateral swelling may increase the likelihood of breast cancer, other factors such as rapid growth, a hard irregular swelling, or a size greater than 5cm should also be considered.

      Overall, understanding the causes, symptoms, and treatment options for gynaecomastia can help individuals make informed decisions about their health and seek appropriate medical care.

    • This question is part of the following fields:

      • Gynaecology And Breast
      25.1
      Seconds
  • Question 2 - An 80-year-old woman is admitted to the hospital for symptomatic first-onset atrial fibrillation....

    Incorrect

    • An 80-year-old woman is admitted to the hospital for symptomatic first-onset atrial fibrillation. She has a history of two falls in the past year and the doctors are preparing to discharge her home after rate control treatment. One of the doctors has been requested to assess her bleeding risk using an ORBIT score.

      Considering the patient's risk factors, what is the best course of action regarding her anticoagulation?

      Your Answer: Start aspirin 75 mg once daily

      Correct Answer: Start anticoagulation

      Explanation:

      Anticoagulation should be started despite the risk of falls or old age alone, according to NICE guidelines. Previously, doctors would consider factors such as alcohol abuse when deciding whether to start anticoagulation due to the risk of haemorrhage. However, the ORBIT score is now recommended by NICE to determine the risk of haemorrhage. Delaying or withholding anticoagulation could be dangerous for the patient while they are at risk of stroke. Aspirin is no longer used for thromboembolism prophylaxis in atrial fibrillation, so both answers involving aspirin are incorrect.

      Atrial fibrillation (AF) is a condition that requires careful management, including the use of anticoagulation therapy. The latest guidelines from NICE recommend assessing the need for anticoagulation in all patients with a history of AF, regardless of whether they are currently experiencing symptoms. The CHA2DS2-VASc scoring system is used to determine the most appropriate anticoagulation strategy, with a score of 2 or more indicating the need for anticoagulation. However, it is important to ensure a transthoracic echocardiogram has been done to exclude valvular heart disease, which is an absolute indication for anticoagulation.

      When considering anticoagulation therapy, doctors must also assess the patient’s bleeding risk. NICE recommends using the ORBIT scoring system to formalize this risk assessment, taking into account factors such as haemoglobin levels, age, bleeding history, renal impairment, and treatment with antiplatelet agents. While there are no formal rules on how to act on the ORBIT score, individual patient factors should be considered. The risk of bleeding increases with a higher ORBIT score, with a score of 4-7 indicating a high risk of bleeding.

      For many years, warfarin was the anticoagulant of choice for AF. However, the development of direct oral anticoagulants (DOACs) has changed this. DOACs have the advantage of not requiring regular blood tests to check the INR and are now recommended as the first-line anticoagulant for patients with AF. The recommended DOACs for reducing stroke risk in AF are apixaban, dabigatran, edoxaban, and rivaroxaban. Warfarin is now used second-line, in patients where a DOAC is contraindicated or not tolerated. Aspirin is not recommended for reducing stroke risk in patients with AF.

    • This question is part of the following fields:

      • Cardiovascular Health
      57.6
      Seconds
  • Question 3 - You are contemplating recommending a selective serotonin reuptake inhibitor for a middle-aged patient...

    Incorrect

    • You are contemplating recommending a selective serotonin reuptake inhibitor for a middle-aged patient with depression. What category of medication is most prone to interact with a selective serotonin reuptake inhibitor?

      Your Answer: Beta-blocker

      Correct Answer: Triptan

      Explanation:

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

    • This question is part of the following fields:

      • Mental Health
      27.6
      Seconds
  • Question 4 - A 65-year-old woman has suffered three episodes of transient right monocular blindness.

    Her rate...

    Incorrect

    • A 65-year-old woman has suffered three episodes of transient right monocular blindness.

      Her rate is 88 beats per minute (regular) and she is in sinus rhythm.

      Which is the single most appropriate investigation that would diagnose the condition?

      Your Answer: Carotid duplex ultrasonography

      Correct Answer: CT scan

      Explanation:

      Carotid Duplex Ultrasonography for Atherosclerotic Stenosis

      Whilst carotid duplex ultrasonography may not be arranged directly from primary care, it is important for healthcare professionals to have an understanding of investigations that may be arranged by secondary care and to be able to discuss this in more general terms with their patients, including indications. This is particularly relevant for patients who have experienced amaurosis fugax caused by internal carotid artery atherosclerotic stenosis, which may also present with temporary paresis, aphasia, or sensory deficits. Fundoscopic examination may reveal bright yellow cholesterol emboli in patients with retinal involvement. The investigation to identify the significant stenosis or occlusive lesion usually greater than 70% is carotid duplex ultrasonography.

    • This question is part of the following fields:

      • Cardiovascular Health
      48.1
      Seconds
  • Question 5 - A breastfeeding mother brings in her three-month-old infant who has been experiencing some...

    Incorrect

    • A breastfeeding mother brings in her three-month-old infant who has been experiencing some burning pain in both nipples during feeds and for up to an hour after. She also reports some itching and sensitivity in her nipples. The baby is growing well and there are no other concerns. During examination, the mother's breasts and nipples appear normal, but the infant has white patches on their tongue. What is the recommended initial treatment?

      Your Answer: Oral fluconazole for mother and baby

      Correct Answer: Miconazole cream for the mother and nystatin suspension for the baby

      Explanation:

      When treating nipple candidiasis during breastfeeding, it is recommended to use miconazole cream for the mother and nystatin suspension for the baby. This is likely to be nipple thrush, and it’s important to treat both mother and baby simultaneously to prevent re-infection, even if the baby shows no signs of infection. It’s worth noting that while miconazole gel can also be used for babies over 4 months, it’s not licensed for those under 4 months due to concerns about choking on the gel. Parents should be carefully informed about the risks and how to administer it safely if it’s prescribed.

      Breastfeeding Problems and Management

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

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

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

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

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

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      86.9
      Seconds
  • Question 6 - A 16-year-old female comes to you requesting a termination of pregnancy. She tells...

    Incorrect

    • A 16-year-old female comes to you requesting a termination of pregnancy. She tells you that her boyfriend is 18-years-old.

      Having asked a number of questions about the relationship you do not have reason to suspect that it is abusive. The patient seems to be mature for her age, understands what you are telling her about her options and appears capable of deciding for herself what she wants to do. You cannot persuade her to inform her parents that she is pregnant.

      The girl's mother makes an appointment the following day and tells you that she knows her daughter has been to see you. She says that she is worried about her daughter, and asks you to tell her whether you have given her daughter any family planning advice.

      What is the most appropriate action to take in this situation?

      Your Answer: Reassure her mother that you have provided her daughter with family planning advice but do not tell her that the daughter is pregnant

      Correct Answer: Inform the police because underage sex is against the law, and do not tell the patient or her mother that you are doing so

      Explanation:

      Confidentiality and Capacity of Minors

      At the age of 15, a patient is not yet considered an adult, but if they are deemed capable of making decisions about the disclosure of information, they are entitled to confidentiality. This is known as Gillick (Fraser) competence, which allows minors under the age of 16 to give valid consent without parental knowledge or agreement in certain circumstances.

      While there is no obligation to report a crime, if a doctor suspects that a patient is at risk of serious harm, such as abuse, they should take action. It is recommended to discuss such cases with a child protection lead or medical defence organization to ensure that the decision to disclose or withhold information is justified and documented. Ultimately, the goal is to protect the patient’s well-being while respecting their right to confidentiality.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      105.4
      Seconds
  • Question 7 - A 56-year-old man has undergone some blood tests and X-rays for bilateral hand...

    Incorrect

    • A 56-year-old man has undergone some blood tests and X-rays for bilateral hand pain. He reports he is in good health and takes regular vitamin and mineral supplements. He is taking lisinopril 10 mg for hypertension and his blood pressure is 130/80 mmHg. The only blood test abnormality is a serum calcium concentration of 2.96 mmol/l (2.25–2.5 mmol/l) and hand X-ray demonstrates subperiosteal bone resorption in the majority of his phalanges.
      What is the single most likely cause of the hypercalcaemia?

      Your Answer: Angiotensin-converting enzyme (ACE) inhibitor treatment

      Correct Answer: Primary hyperparathyroidism

      Explanation:

      Differential diagnosis of hypercalcaemia

      Hypercalcaemia, an abnormally high level of calcium in the blood, can have various causes. One of the most common is hyperparathyroidism, which results from overactivity of the parathyroid gland. Primary hyperparathyroidism is usually due to a benign adenoma, while secondary and tertiary hyperparathyroidism can occur in the context of renal failure or transplant. The hallmark radiological feature of hyperparathyroidism is subperiosteal bone resorption, which can be seen in the phalanges.

      High dietary vitamin D intake is unlikely to cause hypercalcaemia, as most vitamin D is synthesized in the skin upon exposure to sunlight. Angiotensin-converting enzyme (ACE) inhibitor treatment may lead to hyperkalaemia, but not hypercalcaemia. High dietary calcium intake is also unlikely to be a significant factor, as the body has mechanisms to regulate calcium absorption and excretion. However, iatrogenic hypercalcaemia can occur from excessive calcium and vitamin D supplementation.

      Malignancy is another important cause of hypercalcaemia, especially in breast, lung, renal, and multiple myeloma. Therefore, occult malignancy should always be considered in the differential diagnosis of hypercalcaemia. However, in the case of subperiosteal bone resorption, hyperparathyroidism is more likely, and further investigation such as parathyroid hormone measurement and imaging studies may be needed to confirm the diagnosis.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      44.5
      Seconds
  • Question 8 - A randomised controlled trial was conducted to test a new treatment for preventing...

    Incorrect

    • A randomised controlled trial was conducted to test a new treatment for preventing recurrence of stroke. The trial involved 1000 patients who were randomly assigned to receive the new treatment and another 1000 patients who received standard therapy. During the trial, 66 patients who received the new treatment suffered a recurrent stroke, while 110 patients in the control group experienced the same outcome. What is the relative risk reduction in the treatment group?

      Your Answer: 0.60%

      Correct Answer: 40%

      Explanation:

      Calculating Relative and Absolute Risk Reduction in a Study on Stroke Prevention

      In a study on stroke prevention, various measures were used to determine the effectiveness of a treatment. These measures include the relative risk reduction (RRR), absolute risk reduction (ARR), absolute risk in the treatment and control groups, and the relative risk of having a recurrent stroke. By understanding how to calculate these measures, researchers and healthcare professionals can better interpret the results of the study and make informed decisions about treatment options.

    • This question is part of the following fields:

      • Population Health
      300.1
      Seconds
  • Question 9 - A week ago you started an elderly patient with urge incontinence on immediate...

    Correct

    • A week ago you started an elderly patient with urge incontinence on immediate release oxybutynin tablets.

      She says she had to stop taking them because of side effects.

      What side effect is commonly found in elderly women taking oxybutynin?

      Your Answer: Dry mouth

      Explanation:

      Understanding the Side Effects of Oxybutynin

      Oxybutynin is a medication that belongs to the antimuscarinic class of drugs. It is commonly used to treat urinary incontinence and overactive bladder. However, it can cause several side effects such as dry mouth, constipation, dry eyes, and decreased sweating. If the immediate release formulation of oxybutynin is not well-tolerated, a sustained release formulation may be considered.

      It is important to note that a recent clinical review published in the BMJ has highlighted the potential cognitive side effects of medications with a high anticholinergic burden, including oxybutynin. This can lead to cognitive impairment, which can worsen the symptoms of dementia or even lead to false positive diagnoses. Therefore, it is crucial to be aware of the potential side effects of oxybutynin and to discuss any concerns with your healthcare provider.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      40.1
      Seconds
  • Question 10 - A 32 year old woman comes to your clinic 3 weeks after giving...

    Incorrect

    • A 32 year old woman comes to your clinic 3 weeks after giving birth to a healthy baby girl. She is worried that her baby is not breastfeeding properly, unlike her previous two children. The baby seems to struggle with latching on and the mother experiences pain during attachment. You suspect that the baby may have tongue-tie. What is true about tongue-tie?

      Your Answer: Always requires surgical correction

      Correct Answer: Division of the tongue-tie is usually performed without anaesthesia

      Explanation:

      Understanding Tongue-Tie

      Tongue-tie, also known as ankyloglossia, is a congenital condition that is characterized by a short, thick lingual frenulum that restricts the movement of the tongue. The severity of the condition varies, with some cases being mild and others more severe. In mild cases, the tongue is only bound by a thin mucous membrane, while in more severe cases, the tongue is tethered to the floor of the mouth.

      While some cases of tongue-tie are asymptomatic and can be managed with simple interventions such as breastfeeding advice and tongue exercises, others can cause significant problems with breastfeeding, speech, and oral hygiene. A tethered tongue can prevent the tongue from contacting the anterior palate, which can lead to open bite deformity and mandibular prognathism.

      To prevent future problems with speech, swallowing, and feeding, many clinicians advocate for early surgical division of the lingual frenulum. This procedure, known as frenotomy, involves using sharp, blunt-ended scissors to divide the frenulum. In infants, the procedure is usually performed without anesthesia, although local anesthesia may be used in some cases. In older infants and children, general anesthesia is typically required.

      Overall, understanding tongue-tie and its potential consequences is important for parents and healthcare providers alike. Early intervention can help prevent future problems and ensure that children are able to breastfeed, speak, and eat properly.

    • This question is part of the following fields:

      • Children And Young People
      39.2
      Seconds
  • Question 11 - A 42-year-old woman visits her General Practitioner (GP) complaining of widespread muscular pain...

    Correct

    • A 42-year-old woman visits her General Practitioner (GP) complaining of widespread muscular pain that has persisted for several months and was previously diagnosed as osteoarthritis by another GP. She also experiences fatigue, sleep disturbance, and constipation. Despite undergoing routine tests, thyroid function tests, and rheumatological investigations, all results have been normal. Her joint examination is also normal. What is the most appropriate treatment to alleviate her symptoms?

      Your Answer: Amitriptyline

      Explanation:

      Treatment Options for Fibromyalgia: Choosing the Right Medication

      Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and sleep disturbances. While there is no cure for fibromyalgia, there are several treatment options available to manage its symptoms.

      One medication commonly prescribed for fibromyalgia is amitriptyline, an antidepressant that can improve pain, mood, and sleep quality. Aerobic exercise and cognitive behavior therapy can also be effective in improving overall wellbeing.

      However, medications such as methotrexate and prednisolone are not recommended for fibromyalgia as they are used for inflammatory conditions and lack evidence of benefit for this condition. Strong opioids like slow-release morphine sulfate are also not recommended due to their potential for addiction and tolerance. Non-steroidal anti-inflammatory drugs like naproxen may provide short-term relief for acute pain, but are not typically used for chronic pain management in fibromyalgia.

      It is important for patients with fibromyalgia to work closely with their healthcare provider to determine the best treatment plan for their individual needs.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 12 - You are assessing a 67-year-old woman with longstanding varicose veins. A couple of...

    Incorrect

    • You are assessing a 67-year-old woman with longstanding varicose veins. A couple of weeks ago, she experienced pain and redness around one of them, which resolved after using ibuprofen gel for a few weeks. Upon examination, her legs appear normal except for the varicose veins, and she has normal distal pulses. Based on current NICE guidelines, what is the most suitable next step in management?

      Your Answer: Arrange an ankle-brachial pressure index (ABPI)

      Correct Answer: Routine referral to vascular services

      Explanation:

      Patients with varicose veins and a history of superficial thrombophlebitis should be referred for routine referral to vascular services according to NICE guidance. This condition is usually self-limiting but has a high likelihood of recurrence without treatment. Dermatology is not involved in this condition, and ABPI is usually used in the context of peripheral arterial disease or compression bandaging. Class 2 compression stockings are used in the treatment of varicose veins without complications in primary care.

      Understanding Varicose Veins

      Varicose veins are enlarged and twisted veins that occur when the valves in the veins become weak or damaged, causing blood to flow backward and pool in the veins. They are most commonly found in the legs and can be caused by various factors such as age, gender, pregnancy, obesity, and genetics. While many people seek treatment for cosmetic reasons, others may experience symptoms such as aching, throbbing, and itching. In severe cases, varicose veins can lead to skin changes, bleeding, superficial thrombophlebitis, and venous ulceration.

      To diagnose varicose veins, a venous duplex ultrasound is typically performed to detect retrograde venous flow. Treatment options vary depending on the severity of the condition. Conservative treatments such as leg elevation, weight loss, regular exercise, and compression stockings may be recommended for mild cases. However, patients with significant or troublesome symptoms, skin changes, or a history of bleeding or ulcers may require referral to a specialist for further evaluation and treatment. Possible treatments include endothermal ablation, foam sclerotherapy, or surgery.

      In summary, varicose veins are a common condition that can cause discomfort and cosmetic concerns. While many cases do not require intervention, it is important to seek medical attention if symptoms or complications arise. With proper diagnosis and treatment, patients can manage their condition and improve their quality of life.

    • This question is part of the following fields:

      • Cardiovascular Health
      620.7
      Seconds
  • Question 13 - You see a 62-year-old man with a recent diagnosis of polymyalgia rheumatica (PMR)....

    Incorrect

    • You see a 62-year-old man with a recent diagnosis of polymyalgia rheumatica (PMR). He was diagnosed 6 weeks ago. He has been on a tapering dose of prednisolone since diagnosis but after reducing his dose from 12.5mg to 10 mg, he reports a significant relapse in symptoms.

      What is the next most appropriate management step?

      Your Answer:

      Correct Answer: Maintain same prednisolone tapering regimen but add simple analgesia

      Explanation:

      Managing Relapsing Symptoms in Rheumatoid Arthritis

      In cases of relapsing symptoms in rheumatoid arthritis, the National Institute for Health and Care Excellence (NICE) recommends increasing prednisolone to the previous dose that controlled symptoms and monitoring response. The British Society of Rheumatologists and British Health Professionals in Rheumatology guidelines also support this approach but suggest considering referral for disease-modifying antirheumatic drug (DMARD) therapy if more than two relapses occur. While erythrocyte sedimentation rate (ESR) measurement may be useful, the decision to change prednisolone dose can be made based on clinical features. By following these guidelines, healthcare professionals can effectively manage relapsing symptoms in patients with rheumatoid arthritis.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      0
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  • Question 14 - You are in a consultation with a 60-year-old man who has just received...

    Incorrect

    • You are in a consultation with a 60-year-old man who has just received a diagnosis of Parkinson's disease. Despite experiencing mild symptoms, his neurologist has presented him with various treatment options. Which therapy is known to provide the most significant enhancement in symptom management and daily activities?

      Your Answer:

      Correct Answer: Levodopa

      Explanation:

      Levodopa is the antiparkinson drug that is linked to the most significant enhancement in symptoms and daily functioning.

      Understanding the Mechanism of Action of Parkinson’s Drugs

      Parkinson’s disease is a complex condition that requires specialized management. The first-line treatment for motor symptoms that affect a patient’s quality of life is levodopa, while dopamine agonists, levodopa, or monoamine oxidase B (MAO-B) inhibitors are recommended for those whose motor symptoms do not affect their quality of life. However, all drugs used to treat Parkinson’s can cause a wide variety of side effects, and it is important to be aware of these when making treatment decisions.

      Levodopa is nearly always combined with a decarboxylase inhibitor to prevent the peripheral metabolism of levodopa to dopamine outside of the brain and reduce side effects. Dopamine receptor agonists, such as bromocriptine, ropinirole, cabergoline, and apomorphine, are more likely than levodopa to cause hallucinations in older patients. MAO-B inhibitors, such as selegiline, inhibit the breakdown of dopamine secreted by the dopaminergic neurons. Amantadine’s mechanism is not fully understood, but it probably increases dopamine release and inhibits its uptake at dopaminergic synapses. COMT inhibitors, such as entacapone and tolcapone, are used in conjunction with levodopa in patients with established PD. Antimuscarinics, such as procyclidine, benzotropine, and trihexyphenidyl (benzhexol), block cholinergic receptors and are now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson’s disease.

      It is important to note that all drugs used to treat Parkinson’s can cause adverse effects, and clinicians must be aware of these when making treatment decisions. Patients should also be warned about the potential for dopamine receptor agonists to cause impulse control disorders and excessive daytime somnolence. Understanding the mechanism of action of Parkinson’s drugs is crucial in managing the condition effectively.

    • This question is part of the following fields:

      • Neurology
      0
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  • Question 15 - You see a 70-year-old patient with diabetes, hypertension, and chronic kidney disease (CKD)....

    Incorrect

    • You see a 70-year-old patient with diabetes, hypertension, and chronic kidney disease (CKD). He had an anterior myocardial infarction (MI) 2 months ago for which he had a stent. He is having his annual review when he mentions that he has suffered from erectile dysfunction for the last 2 years. He says that it came on gradually and that he now never has erections anymore, in any situation. He has been married for 45 years and this is having an effect on his relationship with his wife.

      His blood pressure today is 135/85 mmHg. Recent blood tests reveal that his blood glucose levels are well controlled on oral medications and his CKD is stable. He takes regular exercise.

      What is the recommended first-line treatment for this patient's erectile dysfunction?

      Your Answer:

      Correct Answer: A vacuum erection device along with lifestyle advice

      Explanation:

      The NICE clinical knowledge summary (CKS) guidelines recommend phosphodiesterase (PDE-5) inhibitors, such as sildenafil and tadalafil, as the first-line treatment for erectile dysfunction (ED) unless there are contraindications. However, those who cannot or will not take PDE-5 inhibitors may benefit from vacuum erection devices, which are recommended as the first-line treatment for well-informed older men with infrequent sexual intercourse and comorbidity requiring non-invasive, drug-free management of ED. Lifestyle changes and risk factor modification should also be considered, but this patient already has good control of his risk factors and regularly exercises. Intracavernous injections may be a second-line option for men with pelvic trauma or spinal cord injury. Vasculogenic causes, such as cardiovascular disease, are the most common organic cause of ED, and lifestyle changes and drug treatment can be effective in managing this condition.

      Erectile dysfunction (ED) is a condition where a man is unable to achieve or maintain an erection that is sufficient for sexual performance. It is not a disease but a symptom that can be caused by organic, psychogenic, or mixed factors. It is important to differentiate between the causes of ED, with factors such as a gradual onset of symptoms and lack of tumescence favoring an organic cause, while sudden onset of symptoms and decreased libido favoring a psychogenic cause. Risk factors for ED include cardiovascular disease, alcohol use, and certain medications.

      To assess for ED, it is recommended to measure lipid and fasting glucose serum levels to calculate cardiovascular risk. Free testosterone should also be measured in the morning, and if low or borderline, further assessment may be needed. PDE-5 inhibitors, such as sildenafil, are the first-line treatment for ED and should be prescribed to all patients regardless of the cause. Vacuum erection devices can be used as an alternative for those who cannot or will not take PDE-5 inhibitors. Referral to urology may be appropriate for young men who have always had difficulty achieving an erection, and those who cycle for more than three hours per week should be advised to stop.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 16 - An 83-year-old woman comes to her doctor with a recent weight loss of...

    Incorrect

    • An 83-year-old woman comes to her doctor with a recent weight loss of 6 kg over the past three months, without any significant pain. During the examination, she appears drawn and emaciated, with deep yellow sclera. She has experienced jaundice twice before, once in her teens, and her sister has also had it. She typically enjoys a glass or two of wine on weekends and smokes 10 cigarettes per day. What is the probable reason for her jaundice?

      Your Answer:

      Correct Answer: Infective hepatitis

      Explanation:

      Causes of Jaundice and their Characteristics

      Jaundice can be caused by various conditions, each with their own unique characteristics. Cancer of the pancreas, particularly in the head, can cause painless jaundice. On the other hand, cancer in the body or tail of the pancreas can present with dull, unremitting central abdominal pain or back pain. Smoking is a known risk factor for pancreatic cancer.

      Gilbert’s syndrome, a familial condition, can also cause jaundice. However, the jaundice in this case is pale yellow and the patient typically feels well. While Gilbert’s syndrome is not uncommon, it is important to consider other potential causes of jaundice, especially if the patient has significant weight loss. As a wise surgeon once said, People with IBS get Ca bowel too – never forget that.

      Hepatitis A is more commonly seen in adolescents and young adults. Primary biliary cirrhosis, on the other hand, has its peak incidence in the fifth decade of life and often presents with generalized pruritus or asymptomatic hepatomegaly. Understanding the characteristics of different causes of jaundice can help in making an accurate diagnosis and providing appropriate treatment.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 17 - A 12-year-old boy presents with gastrointestinal symptoms and you suspect Crohn's disease. What...

    Incorrect

    • A 12-year-old boy presents with gastrointestinal symptoms and you suspect Crohn's disease. What is the most common symptom of Crohn's disease?

      Your Answer:

      Correct Answer: Abdominal pain

      Explanation:

      Understanding Crohn’s Disease

      Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the digestive tract, from the mouth to the anus. The exact cause of Crohn’s disease is unknown, but there is a strong genetic component. Inflammation occurs in all layers of the affected area, which can lead to complications such as strictures, fistulas, and adhesions.

      Symptoms of Crohn’s disease typically appear in late adolescence or early adulthood and can include nonspecific symptoms such as weight loss and lethargy, as well as more specific symptoms like diarrhea, abdominal pain, and perianal disease. Extra-intestinal features, such as arthritis, erythema nodosum, and osteoporosis, are also common in patients with Crohn’s disease.

      To diagnose Crohn’s disease, doctors may look for raised inflammatory markers, increased faecal calprotectin, anemia, and low levels of vitamin B12 and vitamin D. It’s important to note that Crohn’s disease shares some features with ulcerative colitis, another type of inflammatory bowel disease, but there are also important differences between the two conditions. Understanding the symptoms and diagnostic criteria for Crohn’s disease can help patients and healthcare providers manage this chronic condition more effectively.

    • This question is part of the following fields:

      • Gastroenterology
      0
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  • Question 18 - A 32-year-old woman with a body mass index of 51 kg/m2 presents to...

    Incorrect

    • A 32-year-old woman with a body mass index of 51 kg/m2 presents to you seeking guidance on weight management, including the use of medication. You recently reviewed a systematic review of RCTs comparing orlistat to placebo for weight management, which included an asymmetrical funnel plot. What type of bias could this indicate?

      Your Answer:

      Correct Answer: Publication bias

      Explanation:

      The failure to publish results from valid studies, particularly if they show a negative or uninteresting result, is known as publication bias. This can result in a skewed representation of the effectiveness of a treatment or intervention. To assess for publication bias, a funnel plot can be used, which plots the effect estimates from individual studies against their size or precision. If publication bias has occurred, smaller studies with no evidence of an effect may not have been published, resulting in an asymmetric appearance of the funnel plot. Other types of bias include attrition bias, performance bias, and selection bias, which refer to systematic differences in withdrawals from a study, care provided or exposure to other factors, and baseline characteristics of the groups being compared, respectively. Effective randomisation and blinding can help prevent these types of bias.

      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.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
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  • Question 19 - A 25-year-old medical student presents to the emergency department accompanied by his friend,...

    Incorrect

    • A 25-year-old medical student presents to the emergency department accompanied by his friend, reporting a 24-hour history of aggressive behaviour, irritability, and hallucinations. The friend suspects that the patient has experienced a mental breakdown due to sleep deprivation from studying for exams. Laboratory tests reveal no evidence of drug use or infection. The patient is admitted to the hospital for observation and returns to his usual behaviour the following day.

      What is the probable diagnosis in this case?

      Your Answer:

      Correct Answer: Brief psychotic disorder

      Explanation:

      The correct answer is brief psychotic disorder, which is a short-term condition characterized by the sudden onset of at least one positive psychotic symptom, such as delusions, hallucinations, disorganized speech, or catatonic behavior. Unlike other disorders, brief psychotic disorder often resolves with a return to baseline functioning. Adjustment disorder, bipolar disorder, and schizoaffective disorder are not the correct answers as they have different symptoms and characteristics.

      Understanding Psychosis: Symptoms and Associated Features

      Psychosis is a term used to describe a person’s experience of perceiving things differently from those around them. This can manifest in a variety of ways, including hallucinations, delusions, thought disorganization, alogia, tangentiality, clanging, and word salad. These symptoms can be associated with agitation, aggression, neurocognitive impairment, depression, and thoughts of self-harm.

      Psychotic symptoms can occur in a number of conditions, including schizophrenia, depression, bipolar disorder, puerperal psychosis, brief psychotic disorder, neurological conditions like Parkinson’s disease and Huntington’s disease, and as a result of prescribed drugs or certain illicit drugs like cannabis and phencyclidine.

      The peak age of first-episode psychosis is around 15-30 years. It is important to understand the symptoms and associated features of psychosis in order to recognize and seek appropriate treatment for those experiencing these symptoms.

    • This question is part of the following fields:

      • Mental Health
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  • Question 20 - Which statement about obstructive sleep apnoea (OSA) is accurate? ...

    Incorrect

    • Which statement about obstructive sleep apnoea (OSA) is accurate?

      Your Answer:

      Correct Answer: Is associated with thyroid dysfunction

      Explanation:

      Treatment Options and Risks for Obstructive Sleep Apnoea

      Obstructive sleep apnoea (OSA) is a condition that affects breathing during sleep, leading to interrupted sleep and daytime fatigue. In the UK, the Uvulopalatopharyngoplasty (UPPP) treatment is used for simple snoring, while in the USA, it is used to treat OSA with a success rate of around 65%. Tonsillectomy can also benefit some cases. However, successful treatment with continuous positive airways pressure (CPAP) is the most effective way to reduce the risk of road traffic accidents (RTA) to normal levels and doesn’t exclude the sufferer from holding any type of driving licence. The risk of RTA, untreated, is estimated to be eight times normal. OSA is also associated with hypothyroidism and acromegaly, according to a study published in the Medicine Journal in May 2008. It is important to consider the various treatment options and risks associated with OSA to manage the condition effectively.

    • This question is part of the following fields:

      • Respiratory Health
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  • Question 21 - A 26-year-old male has been diagnosed with schizophrenia and is currently receiving olanzapine...

    Incorrect

    • A 26-year-old male has been diagnosed with schizophrenia and is currently receiving olanzapine depot injections to manage his psychotic symptoms. Prior to starting the treatment, his psychiatrist conducted a full blood count, urea and electrolytes, and liver function test. If the patient continues to take olanzapine in the long term, how frequently should these parameters be monitored?

      Your Answer:

      Correct Answer: Annually

      Explanation:

      Before starting a patient on antipsychotics and on an annual basis thereafter, it is recommended to conduct a full blood count, urea and electrolytes, and liver function test. Any other options presented in this scenario are incorrect. It is important to note that different antipsychotics may have varying monitoring requirements, and consulting the BNF is advised if unfamiliar with these drugs.

      Patients taking antipsychotic medication require extensive monitoring in addition to clinical follow-up. The British National Formulary (BNF) recommends regular testing of full blood count (FBC), urea and electrolytes (U&E), and liver function tests (LFT) at the start of therapy and annually thereafter. Clozapine requires more frequent monitoring of FBC, initially weekly. Lipids and weight should be tested at the start of therapy, at 3 months, and annually. Fasting blood glucose and prolactin should be tested at the start of therapy, at 6 months, and annually. Blood pressure should be monitored frequently during dose titration, and an electrocardiogram and cardiovascular risk assessment should be done at baseline and annually. The BNF provides specific recommendations for individual drugs, and patients should consult their healthcare provider for more information.

    • This question is part of the following fields:

      • Mental Health
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  • Question 22 - A 55-year-old woman, who is receiving endocrine therapy for advanced breast cancer, presents...

    Incorrect

    • A 55-year-old woman, who is receiving endocrine therapy for advanced breast cancer, presents to her General Practitioner complaining of fatigue. Clinical examination reveals no additional information. Sodium, potassium, calcium, magnesium and glucose levels, renal function, C-reactive protein, albumin levels and liver and thyroid function are all normal. A full blood count is also normal. She denies depression or any problem with sleep.
      Which of the following is the most appropriate prescription?

      Your Answer:

      Correct Answer: Prescribing is not indicated

      Explanation:

      Managing Fatigue in Advanced Chronic Illness: Non-Pharmacological Interventions Recommended

      Fatigue is a common symptom in advanced chronic illness, but it is often under-recognised by healthcare professionals. While potentially reversible factors should be treated, the cause of fatigue may remain poorly understood. Non-pharmacological interventions such as pacing activities, graded exercise, stress/anxiety management, and sleep hygiene advice may help reduce the impact of fatigue on daily life. Vitamin supplements are not recommended unless there is a proven deficiency, and dexamfetamine and fluoxetine are not indicated for treating fatigue in this context. Methylphenidate may be an option under specialist supervision, but non-pharmacological interventions should be tried first. Overall, managing fatigue in advanced chronic illness requires awareness, acknowledgement, and a focus on non-pharmacological interventions.

    • This question is part of the following fields:

      • End Of Life
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  • Question 23 - A 22-year-old student from India requests to enroll at the clinic. Which of...

    Incorrect

    • A 22-year-old student from India requests to enroll at the clinic. Which of the following statements is accurate?

      Your Answer:

      Correct Answer: He cannot register unless he plans to live in the UK for more than 6 months

      Explanation:

      Eligibility for NHS Treatment

      Primary care is available to individuals who are considered ordinarily resident in the UK, regardless of their nationality or National Insurance contributions. This means that they must be residing in the UK for at least six months, but there is no qualifying period. Refugees are also considered ordinarily resident.

      Secondary care is free for everyone who needs it, including contraception, emergency department treatment, compulsory psychiatric treatment, and treatment for certain communicable diseases such as tuberculosis, malaria, and meningitis, including HIV. Visitors can also receive free NHS hospital treatment if they are a national of an EEA country or Switzerland, normally live abroad and receive a UK state pension, have lived in the UK for at least ten years in the past, or are a national or resident of certain non-EEA countries with which the UK has a reciprocal agreement.

      It is important to note that HIV treatment is no longer chargeable, following an amendment to the NHS (Charges to Overseas Visitors) Regulations in 2012.

    • This question is part of the following fields:

      • Equality, Diversity And Inclusion
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  • Question 24 - A 25-year-old woman presents with recurrent syncope following aerobics classes. On examination, a...

    Incorrect

    • A 25-year-old woman presents with recurrent syncope following aerobics classes. On examination, a systolic murmur is heard that worsens with the Valsalva manoeuvre and improves on squatting. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Hypertrophic obstructive cardiomyopathy

      Explanation:

      Hypertrophic obstructive cardiomyopathy (HCM) is a condition where the left ventricle of the heart becomes enlarged, often affecting the interventricular septum and causing a blockage in the left ventricular outflow tract. Patients with HCM typically experience shortness of breath, but may also have angina or fainting spells. Physical examination may reveal a prominent presystolic S4 gallop, a harsh systolic ejection murmur, and a left ventricular apical impulse. The Valsalva manoeuvre and standing up from a squatting position can increase the intensity of the murmur. An echocardiogram is the preferred diagnostic test for HCM. Syncope occurs in 15-25% of HCM patients, and recurrent syncope in young patients may indicate an increased risk of sudden death. Aortic stenosis, on the other hand, typically affects older patients and causes exertional syncope. The ejection systolic murmur associated with aortic stenosis is loudest at the upper right sternal border and radiates to the carotids. It increases with squatting and decreases with standing and isometric muscular contraction. Atrial fibrillation can also cause syncope, but if it is associated with HCM, the underlying cause is still HCM. Vasovagal syncope is usually triggered by prolonged standing or exposure to hot, crowded environments. The term syncope excludes other conditions that cause altered consciousness, such as seizures or shock.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 25 - You are asked by one of your practice nurses to see a new...

    Incorrect

    • You are asked by one of your practice nurses to see a new health care support worker at the practice who has become unwell. She is a young adult and has just put on a pair of latex gloves to assist the nurse with a procedure. Immediately after putting the gloves on she has developed diffuse itch and widespread urticaria is present. She has some mild angioedema and a slight wheeze is audible.

      Which of the following describes this scenario?

      Your Answer:

      Correct Answer: Type II allergic reaction

      Explanation:

      Allergic Reactions to Natural Rubber Latex

      Natural rubber latex (NRL) is commonly found in healthcare products, including gloves. However, NRL proteins can cause a type I immediate hypersensitivity allergic reaction, which can be severe. In addition, some products made with NRL may contain chemical additives that cause an irritant contact dermatitis, resulting in localized skin irritation. This is not an allergic response to NRL.

      Another type of allergic reaction, a type IV allergic contact dermatitis, can occur due to sensitization to the chemical additives used in NRL gloves. This type of reaction may take months or even years to develop, but once sensitized, symptoms usually occur within 10-24 hours of exposure and can worsen over a 72 hour period. It is important for healthcare workers and patients to be aware of the potential for allergic reactions to NRL and to take appropriate precautions.

    • This question is part of the following fields:

      • Dermatology
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  • Question 26 - You come across a 55-year-old man who needs a refill of his prescription....

    Incorrect

    • You come across a 55-year-old man who needs a refill of his prescription. Upon reviewing his medication list, you notice that two of his medications fall under schedule 3 controlled drugs as per The Misuse of Drugs Regulations 2001. What medications are likely to be on his list?

      Your Answer:

      Correct Answer: Buprenorphine, tramadol and levothyroxine

      Explanation:

      The correct answer is buprenorphine, tramadol, and levothyroxine because only buprenorphine and tramadol are classified as schedule 3 drugs according to The Misuse of Drugs Regulations 2001. Zopiclone is classified as schedule 4, morphine as schedule 2, and diazepam as schedule 4, making them all incorrect answers.

      Controlled drugs are medications that have the potential for abuse and are regulated by the 2001 Misuse of Drugs Regulations act. The act divides these drugs into five categories or schedules, each with its own rules on prescribing, supply, possession, and record keeping. When prescribing a controlled drug, certain information must be present on the prescription, including the patient’s name and address, the form and strength of the medication, the total quantity or number of dosage units to be supplied, the dose, and the prescriber’s name, signature, address, and current date.

      Schedule 1 drugs, such as cannabis and lysergide, have no recognized medical use and are strictly prohibited. Schedule 2 drugs, including diamorphine, morphine, pethidine, amphetamine, and cocaine, have recognized medical uses but are highly addictive and subject to strict regulations. Schedule 3 drugs, such as barbiturates, buprenorphine, midazolam, temazepam, tramadol, gabapentin, and pregabalin, have a lower potential for abuse but are still subject to regulation. Schedule 4 drugs are divided into two parts, with part 1 including benzodiazepines (except midazolam and temazepam) and zolpidem, zopiclone, and part 2 including androgenic and anabolic steroids, hCG, and somatropin. Schedule 5 drugs, such as codeine, pholcodine, and Oramorph 10 mg/5ml, have a low potential for abuse and are exempt from most controlled drug requirements.

      Prescriptions for controlled drugs in schedules 2, 3, and 4 are valid for 28 days and must include all required information. Pharmacists are generally not allowed to dispense these medications unless all information is present, but they may amend the prescription if it specifies the total quantity only in words or figures or contains minor typographical errors. Safe custody requirements apply to schedules 2 and 3 drugs, but not to schedule 4 drugs. The BNF marks schedule 2 and 3 drugs with the abbreviation CD.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
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  • Question 27 - A 25-year-old man has become withdrawn and is receiving messages via the television....

    Incorrect

    • A 25-year-old man has become withdrawn and is receiving messages via the television. You suspect he may have schizophrenia.
      Select from the list the single correct statement regarding the treatment of schizophrenia.

      Your Answer:

      Correct Answer: Clozapine is indicated for treatment-resistant schizophrenia

      Explanation:

      Antipsychotic Medication for Schizophrenia: Types, Side-Effects, and Treatment Options

      Antipsychotic medication is commonly used to alleviate the symptoms of schizophrenia, particularly positive symptoms. However, they may not be as effective for negative symptoms. Newer or atypical antipsychotics, such as amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and sertindole, are often preferred as they have a better balance between efficacy and side-effects.

      First-generation antipsychotic drugs, also known as typical antipsychotics, primarily block dopamine D2 receptors in the brain, which can lead to extrapyramidal symptoms and elevated prolactin. Second-generation antipsychotic drugs, or atypical antipsychotics, act on a wider range of receptors and have more distinct clinical profiles. Both types of antipsychotics are effective in treating schizophrenia.

      Early treatment is recommended to prevent further deterioration of brain functioning. In some cases, long-acting antipsychotic injections may be used to improve compliance. Benzodiazepines may also be used as a short-term adjunct therapy for behavior disturbances, insomnia, aggression, and agitation, although the evidence supporting this is limited.

      Clozapine is indicated for patients with schizophrenia who are unresponsive to or intolerant of conventional antipsychotic drugs. It can only be prescribed by a specialist and requires at least two previous trials of antipsychotics, including one newer/atypical antipsychotic, at adequate dosages and treatment periods. However, it carries a risk of life-threatening neutropenia as a potential side-effect.

    • This question is part of the following fields:

      • Mental Health
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  • Question 28 - You are assessing a patient with chronic plaque psoriasis. Previously, a combination of...

    Incorrect

    • You are assessing a patient with chronic plaque psoriasis. Previously, a combination of beclomethasone and calcipotriol was attempted but proved ineffective. Subsequently, calcipotriol monotherapy was prescribed twice daily, but this also failed to alleviate symptoms. The patient, who is in his mid-thirties, presents with plaques measuring approximately 6-7 cm on his elbows and knees. According to NICE guidelines, what are the two most suitable options to discuss with him?

      Your Answer:

      Correct Answer: Beclomethasone twice a day OR a coal tar preparation

      Explanation:

      Psoriasis is a chronic skin condition that can also affect the joints. The National Institute for Health and Care Excellence (NICE) has released guidelines for managing psoriasis and psoriatic arthropathy. For chronic plaque psoriasis, NICE recommends a stepwise approach starting with regular use of emollients to reduce scale loss and itching. First-line treatment involves applying a potent corticosteroid and vitamin D analogue separately, once daily in the morning and evening, for up to 4 weeks. If there is no improvement after 8 weeks, a vitamin D analogue twice daily can be used as second-line treatment. Third-line options include a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily. Phototherapy and systemic therapy are also options for managing psoriasis.

      For scalp psoriasis, NICE recommends using a potent topical corticosteroid once daily for 4 weeks. If there is no improvement, a different formulation of the corticosteroid or a topical agent to remove adherent scale can be used before applying the corticosteroid. For face, flexural, and genital psoriasis, a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks is recommended.

      When using topical steroids, it is important to be aware of potential side effects such as skin atrophy, striae, and rebound symptoms. The scalp, face, and flexures are particularly prone to steroid atrophy, so topical steroids should not be used for more than 1-2 weeks per month. Systemic side effects may occur when potent corticosteroids are used on large areas of the body. NICE recommends a 4-week break before starting another course of topical corticosteroids and using potent corticosteroids for no longer than 8 weeks at a time and very potent corticosteroids for no longer than 4 weeks at a time. Vitamin D analogues, such as calcipotriol, can be used long-term and tend to reduce the scale and thickness of plaques but not the redness. Dithranol and coal tar are other treatment options with their own unique mechanisms of action and potential adverse effects.

    • This question is part of the following fields:

      • Dermatology
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  • Question 29 - Samantha is a 30-year-old woman who visits her doctor complaining of fatigue, night...

    Incorrect

    • Samantha is a 30-year-old woman who visits her doctor complaining of fatigue, night sweats, and muscle pains that have been bothering her for a few months. She believes that these symptoms began after she developed a rash on her leg four months ago. She has not traveled anywhere. Samantha is upset and emotional about her symptoms.

      As part of Samantha's evaluation, which tests should be considered?

      Your Answer:

      Correct Answer: Borrelia burgdorferi antibody test

      Explanation:

      Consider Lyme disease as a possible diagnosis for patients presenting with vague and unexplained symptoms such as fever, night sweats, headache, or paraesthesia. These symptoms may also include inflamed lymph nodes, neck pain, and joint/muscle aches. The causative agent of Lyme disease is Borrelia burgdorferi. Malaria is unlikely in patients with no travel history and symptoms lasting for 4 months. Scabies typically presents with an itchy rash, which is not evident in the scenario. Glandular fever may cause fatigue and muscle aches, but the absence of a sore throat and the need for a blood test for diagnosis make it less likely. Toxoplasma gondii is usually asymptomatic but may cause flu-like symptoms and muscle aches, and it is not associated with a rash.

      Lyme Disease: Symptoms and Progression

      Lyme disease is a bacterial infection that is transmitted through the bite of an infected tick. The disease progresses in two stages, with early and later features. The early features of Lyme disease include erythema migrans, which is a small papule that often appears at the site of the tick bite. This papule develops into a larger annular lesion with central clearing, resembling a bulls-eye. This occurs in 70% of patients and is accompanied by systemic symptoms such as malaise, fever, and arthralgia.

      As the disease progresses, it can lead to more severe symptoms. The later features of Lyme disease include cardiovascular symptoms such as heart block and myocarditis, as well as neurological symptoms such as cranial nerve palsies and meningitis. Patients may also experience polyarthritis, which is inflammation in multiple joints.

    • This question is part of the following fields:

      • Dermatology
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  • Question 30 - A multicentre trial was carried out in General Practice to test the effectiveness...

    Incorrect

    • A multicentre trial was carried out in General Practice to test the effectiveness of a new oral preparation for moderate and severe acne vulgaris (defined as Leeds grade 3 or above) in adolescents. It was a blinded, randomised controlled trial. Matched controls were given oxytetracycline. A total of 200 adolescent patients were recruited into each arm of the trial. After six months, the results for the new drug, as measured by improvement in acne grade, were significantly better than for oxytetracycline. Of adolescent patients taking the new drug, 40% completed the 6-month trial, compared with 56% of adolescent patients taking oxytetracycline.
      Which of the following is the most likely source of bias in this trial?

      Your Answer:

      Correct Answer: Patients dropping out of the trial

      Explanation:

      Potential Sources of Bias in a Clinical Trial Comparing Two Acne Treatments

      Clinical trials are essential in determining the safety and efficacy of new treatments. However, bias can be introduced into the study design, potentially affecting the validity of the results. In a clinical trial comparing two acne treatments, several potential sources of bias should be considered.

      Patients dropping out of the trial can introduce bias, as those who do not complete the study may have different characteristics or outcomes than those who do. This can be especially problematic if there are different dropout rates in the intervention and comparison groups. Measures such as intention-to-treat analysis can help minimize this bias.

      Recall bias, which occurs when participants have different recollections of past events or experiences, is not likely to be an issue in this trial. However, bias due to confounders, such as other acne treatments or lifestyle habits, could be introduced. Matching the two arms of the trial can help minimize this bias.

      Lack of power, or the study’s ability to detect a difference or association, can also be a potential source of bias. The sample size of 200 patients in each arm of the trial is not small, but without information on whether a statistical power calculation was done, this could still be a concern.

      Finally, observer bias can occur if researchers grading the outcome do not make accurate assessments. Using a validated scale and providing training can help minimize this potential source of bias.

      Overall, it is important to consider and address potential sources of bias in clinical trials to ensure the validity of the results.

    • This question is part of the following fields:

      • Population Health
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SESSION STATS - PERFORMANCE PER SPECIALTY

Gynaecology And Breast (1/1) 100%
Cardiovascular Health (0/3) 0%
Mental Health (0/1) 0%
Maternity And Reproductive Health (0/1) 0%
Improving Quality, Safety And Prescribing (1/2) 50%
Metabolic Problems And Endocrinology (0/1) 0%
Population Health (0/1) 0%
Children And Young People (0/1) 0%
Musculoskeletal Health (1/1) 100%
Passmed