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  • Question 1 - Which blood tests are included in the standard antenatal screening program for women...

    Incorrect

    • Which blood tests are included in the standard antenatal screening program for women in the UK?

      Your Answer: Hep C

      Correct Answer: Listeriosis

      Explanation:

      Antenatal Screening in the UK: HIV, Listeriosis, Strep B, Hepatitis B and Haemoglobinopathies

      Antenatal screening is an important part of prenatal care in the UK. HIV testing is routinely offered to pregnant women, as appropriate interventions can reduce transmission rates to less than 1%. Listeriosis, although not routinely tested for, is a concern for pregnant women as it can cause pregnancy and birth complications, and even result in miscarriage or the death of the baby. Strep B is also not routinely tested for, but pregnant women with risk factors should be screened as the infection can be life-threatening for newborns. Hepatitis B is part of routine screening, but Hepatitis C is only tested for in women with risk factors. Finally, screening for haemoglobinopathies varies across the UK, with all women in England and Scotland offered screening for sickle cell and thalassaemia, while in Wales only those at increased risk are screened and in Northern Ireland no policy decision has been made. It is important for pregnant women to be aware of these screening options and to discuss them with their healthcare provider.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      4.4
      Seconds
  • Question 2 - A 28-year-old man presents to his GP with complaints of joint pain and...

    Correct

    • A 28-year-old man presents to his GP with complaints of joint pain and swelling, feeling generally unwell. He recently returned from a hiking trip in Thailand, and one day after his return, he experienced severe watery diarrhoea and abdominal cramps that lasted for a week.

      During the examination, the patient appears unwell and fatigued. He has large effusions of the left knee and right ankle, along with tender plantar fascia bilaterally. Additionally, he has tender metatarsophalangeal joints on both feet, and a papular rash on the soles of his feet.

      Despite taking regular paracetamol and ibuprofen for the past week, the patient's symptoms have only minimally improved. What is the most appropriate next step in managing this patient, given the most likely diagnosis?

      Your Answer: Oral prednisolone

      Explanation:

      Reactive arthritis doesn’t usually have an acute onset and can develop up to four weeks after the initial infection. It may have a relapsing-remitting course over several months.

      The correct treatment for this patient’s severe polyarthritis would be oral prednisolone, a systemic corticosteroid. The dosing should be based on the severity of the arthritis, with tapering to the lowest effective dose. Typical starting doses are 20-40 mg/day.

      TNF inhibitor therapy would not be appropriate in this case. However, it may be effective and safe for patients with reactive arthritis who are unresponsive to NSAID or non-biologic DMARD therapy.

      Celecoxib is not the correct choice for this patient. Since regular ibuprofen did not provide relief for a week, the next step would be oral corticosteroids. Although patients may require high doses of NSAIDs with a long half-life, such as Naproxen 500mg BD, systemic corticosteroids are more appropriate for this patient with multiple joints involved and systemic illness.

      Intra-articular injections are useful for large joint effusions, but in this case, systemic corticosteroids are more appropriate due to the patient’s multiple joint involvement and systemic illness.

      Understanding Reactive Arthritis: Symptoms and Features

      Reactive arthritis is a type of seronegative spondyloarthropathy that is associated with HLA-B27. It was previously known as Reiter’s syndrome, which was characterized by a triad of urethritis, conjunctivitis, and arthritis following a dysenteric illness during World War II. However, later studies revealed that patients could develop symptoms after a sexually transmitted infection, now referred to as sexually acquired reactive arthritis (SARA).

      This condition is defined as an arthritis that develops after an infection where the organism cannot be recovered from the joint. The symptoms typically develop within four weeks of the initial infection and last for around 4-6 months. Approximately 25% of patients experience recurrent episodes, while 10% develop chronic disease.

      The arthritis associated with reactive arthritis is usually an asymmetrical oligoarthritis of the lower limbs, and patients may also experience dactylitis. Other symptoms include urethritis, conjunctivitis (seen in 10-30% of patients), and anterior uveitis. Skin symptoms may also occur, such as circinate balanitis (painless vesicles on the coronal margin of the prepuce) and keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles).

      To remember the symptoms associated with reactive arthritis, the phrase can’t see, pee, or climb a tree is often used. It is important to note that the term Reiter’s syndrome is no longer used due to the fact that the eponym was named after a member of the Nazi party. Understanding the symptoms and features of reactive arthritis can aid in prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      23.4
      Seconds
  • Question 3 - A 35-year-old woman presents to her General Practitioner, having developed sudden-onset weakness and...

    Incorrect

    • A 35-year-old woman presents to her General Practitioner, having developed sudden-onset weakness and numbness in her left arm and leg while exercising. She takes the combined oral contraceptive pill. No other risk factors for stroke are identified.
      On examination, she exhibits mild pyramidal weakness on the left side of her face, arm and leg. Left-sided hemisensory loss is also present, as well as left homonymous hemianopia and left-sided inattention.
      She is admitted to hospital for further testing. A brain computed tomography (CT) scan and diffusion-weighted magnetic resonance imaging (MRI) show a recent, single infarction in the territory of the right middle cerebral artery.
      What is the most likely cause for this patient's symptoms?

      Your Answer: Thromboembolic disorder secondary to carotid atherosclerosis

      Correct Answer: Dissection of the right carotid artery

      Explanation:

      Differential diagnosis for a patient with total anterior cerebral syndrome

      Explanation:

      A patient presenting with total anterior cerebral syndrome, which includes left-sided weakness, hemisensory loss, and homonymous hemianopia, may have various underlying causes. One possibility is a spontaneous or minimally provoked cervical vascular dissection, which can affect the internal carotid and its middle cerebral branch. Although two-thirds of patients with this condition experience head or neck pain at onset, some do not, as in this case. Horner syndrome may also occur. Anticoagulation may be necessary, and specialist investigation and management are required.

      Another potential cause is an inherited thromboembolic disorder, which is more likely to manifest as venous thrombosis, such as deep vein thrombosis and pulmonary embolism, rather than arterial ischaemic stroke. Women of childbearing age with this condition may also have recurrent miscarriages.

      Cardioembolism from an atrial septal defect is possible, especially if the ischaemic event occurs during exercise and is precipitated by a Valsalva manoeuvre. However, if exercise provokes the event, arterial dissection is more likely.

      Dissection of the vertebral artery is less common than that of the right carotid artery but can also cause a posterior circulation infarct.

      Finally, a thromboembolic disorder secondary to carotid atherosclerosis, which is more prevalent in older patients with other cardiovascular risk factors, can also lead to ischaemic stroke in a similar distribution.

    • This question is part of the following fields:

      • Neurology
      20.2
      Seconds
  • Question 4 - A child of 6 years is suspected to have Giardiasis.

    Which one of the...

    Correct

    • A child of 6 years is suspected to have Giardiasis.

      Which one of the following drugs is the most appropriate treatment?

      Your Answer: Metronidazole

      Explanation:

      Giardia Lamblia: Causes, Symptoms, and Treatment

      Giardia lamblia is a parasite that can cause malabsorption and non-bloody diarrhea. The condition can be acquired locally, and stool microscopy may not always detect it. However, the good news is that it can be treated with metronidazole. Once treated, malabsorption typically resolves. If you experience symptoms of giardia lamblia, it is important to seek medical attention promptly to receive an accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Children And Young People
      9.5
      Seconds
  • Question 5 - A 56-year-old man with a medical history of COPD, ulcerative colitis, hypertension, and...

    Correct

    • A 56-year-old man with a medical history of COPD, ulcerative colitis, hypertension, and hypothyroidism presented to your clinic for follow-up. He was recently released from the hospital after being diagnosed with pneumonia. According to his discharge summary, he had an allergic reaction to co-trimoxazole during his hospital stay, resulting in the discontinuation of one of his regular medications. He has been instructed to consult with his GP about this medication. Which medication is most likely to have been stopped due to the drug allergy?

      Your Answer: Sulfasalazine

      Explanation:

      If a patient has a known allergy to a sulfa drug like co-trimoxazole, they should avoid taking sulfasalazine.

      Sulfasalazine: A DMARD for Inflammatory Arthritis and Bowel Disease

      Sulfasalazine is a type of disease modifying anti-rheumatic drug (DMARD) that is commonly used to manage inflammatory arthritis, particularly rheumatoid arthritis, as well as inflammatory bowel disease. This medication is a prodrug for 5-ASA, which works by reducing neutrophil chemotaxis and suppressing the proliferation of lymphocytes and pro-inflammatory cytokines.

      However, caution should be taken when using sulfasalazine in patients with G6PD deficiency or those who are allergic to aspirin or sulphonamides due to the risk of cross-sensitivity. Adverse effects of sulfasalazine may include oligospermia, Stevens-Johnson syndrome, pneumonitis/lung fibrosis, myelosuppression, Heinz body anaemia, megaloblastic anaemia, and the potential to color tears and stain contact lenses.

      Despite these potential side effects, sulfasalazine is considered safe to use during pregnancy and breastfeeding, making it a viable option for women who require treatment for inflammatory arthritis or bowel disease.

    • This question is part of the following fields:

      • Respiratory Health
      25.2
      Seconds
  • Question 6 - What is the definition of the statistical term that measures the spread of...

    Incorrect

    • What is the definition of the statistical term that measures the spread of a dataset from its average?

      Your Answer: Standard deviation

      Correct Answer: Mode

      Explanation:

      Understanding Statistical Terms in Evidence-Based Medicine

      A basic understanding of statistical terms is essential in comprehending trial data and utilizing evidence-based medicine effectively. One of the most crucial statistical terms is the standard deviation, which measures the dispersion of a data set from its mean. It summarizes how widely dispersed the values are around the center of a group.

      Another important term is the mode, which refers to the most frequently occurring value in a data set. The range describes the spread of data in terms of its highest and lowest values. On the other hand, the 95% confidence interval (or 95% confidence limits) presents the range of likely effects and includes 95% of results from studies of the same size and design in the same population.

      Lastly, the weighted mean difference examines the difference in means between different sets of values, weighted for differences in the way they were recorded. Understanding these statistical terms is crucial in interpreting and analyzing trial data and making informed decisions in evidence-based medicine.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      14.2
      Seconds
  • Question 7 - A 10-year-old girl presents with her father to the General Practitioner, as her...

    Correct

    • A 10-year-old girl presents with her father to the General Practitioner, as her father is concerned that she may have attention-deficit/hyperactivity disorder (ADHD). He reports that she achieves well in school academically but has difficulty taking turns in games at break times and often interrupts the teacher by blurting out the answer to a question before she has finished it. She can get cross with her father at home when he asks her to carry out chores and sometimes gets in physical fights with her sister.
      Which of the following is one of the diagnostic criteria for ADHD and is displayed by this child?

      Your Answer: Impulsivity

      Explanation:

      Understanding ADHD: Symptoms and Diagnostic Criteria

      Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. One of the diagnostic criteria for ADHD is impulsivity, which can manifest as difficulty waiting turns, interrupting others, or blurting out answers prematurely. However, restricted, repetitive behaviors are not a symptom of ADHD but rather a diagnostic criterion for autism spectrum disorder. Similarly, aggression towards people and animals is not a symptom of ADHD but is included in the diagnostic criteria for conduct disorder. Argumentative or defiant behavior is also not a symptom of ADHD but is a diagnostic criterion for oppositional defiant disorder. It is important to note that high educational attainment is not a diagnostic criterion for ADHD, as individuals with ADHD may struggle in school due to inattention and difficulty concentrating. Understanding the symptoms and diagnostic criteria for ADHD can aid in early identification and appropriate treatment.

    • This question is part of the following fields:

      • Children And Young People
      7.7
      Seconds
  • Question 8 - A 45-year-old woman with stage 3a chronic kidney disease visits her primary care...

    Correct

    • A 45-year-old woman with stage 3a chronic kidney disease visits her primary care physician to receive the results of her yearly eGFR test. The following are her eGFR results from the past three years:

      Date 10/31/17 10/31/18 10/31/19
      eGFR (ml/min/1.73m²) 59 51 35

      What would be the most suitable course of action for her treatment?

      Your Answer: Referral to nephrologist

      Explanation:

      CKD is diagnosed when there is evidence of kidney damage or a decrease in kidney function for at least three months. This can be determined by a persistent eGFR of less than 60 mL/min/1.73 m2 or a change in GFR category or sustained decrease in eGFR of 15 mL/min/1.73 m2 or more within 12 months. Additionally, a urinary albumin:creatinine ratio (ACR) of 70 mg/mmol or more, unless proteinuria is known to be associated with diabetes mellitus and is managed appropriately, or a urinary ACR of 30 mg/mmol or more together with persistent haematuria, after exclusion of a urinary tract infection (UTI), can also indicate CKD. Other indications include hypertension that remains uncontrolled despite the use of at least four antihypertensive drugs at therapeutic doses, a suspected or confirmed rare or genetic cause of CKD, such as polycystic kidney disease, suspected renal artery stenosis, or a suspected complication of CKD.

      Chronic kidney disease (CKD) is a condition where the kidneys are not functioning properly. To estimate renal function, serum creatinine levels are often used, but this may not be accurate due to differences in muscle. Therefore, formulas such as the Modification of Diet in Renal Disease (MDRD) equation are used to estimate the glomerular filtration rate (eGFR). The MDRD equation takes into account serum creatinine, age, gender, and ethnicity. However, factors such as pregnancy, muscle mass, and recent red meat consumption may affect the accuracy of the result.

      CKD can be classified based on the eGFR. Stage 1 CKD is when the eGFR is greater than 90 ml/min, but there are signs of kidney damage on other tests. If all kidney tests are normal, there is no CKD. Stage 2 CKD is when the eGFR is between 60-90 ml/min with some sign of kidney damage. Stage 3a and 3b CKD are when the eGFR is between 45-59 ml/min and 30-44 ml/min, respectively, indicating a moderate reduction in kidney function. Stage 4 CKD is when the eGFR is between 15-29 ml/min, indicating a severe reduction in kidney function. Stage 5 CKD is when the eGFR is less than 15 ml/min, indicating established kidney failure, and dialysis or a kidney transplant may be necessary. It is important to note that normal U&Es and no proteinuria are required for a diagnosis of CKD.

    • This question is part of the following fields:

      • Kidney And Urology
      13.8
      Seconds
  • Question 9 - A General Practitioner receives a call from a patient's relative who is worried...

    Correct

    • A General Practitioner receives a call from a patient's relative who is worried about the patient's possible manic episode due to bipolar disorder. What symptoms would be commonly observed in this situation?

      Your Answer: Lack of normal social inhibitions

      Explanation:

      Symptoms of Mania in Bipolar Disorder

      Mania is a common symptom of bipolar disorder, characterized by a period of elevated or irritable mood, increased energy, and other changes in behavior. Here are some common symptoms of mania:

      Lack of normal social inhibitions: Manic episodes can lead to sexual indiscretions and loss of other normal social inhibitions, putting patients at risk of unplanned pregnancy and sexually transmitted infections.

      Avoidance of pleasurable activities: Manic patients may engage in excessive spending and other pleasurable activities without considering the consequences.

      Increased sleep: While reduced sleep is a common feature of mania, increased sleep can be a symptom of depression in bipolar disorder.

      Power of concentration increased: Manic patients may experience distractibility and reduced concentration, rather than increased levels of concentration.

      Reduced energy levels: While manic patients may feel elated and full of energy, this often shifts into depression, where they feel sad and hopeless with low energy levels.

      It is important to recognize these symptoms and seek appropriate treatment for bipolar disorder.

    • This question is part of the following fields:

      • Mental Health
      7.7
      Seconds
  • Question 10 - A 28-year-old woman presents to you seeking contraception. She is eager to begin...

    Incorrect

    • A 28-year-old woman presents to you seeking contraception. She is eager to begin immediately as she has no desire to conceive. Her last instance of unprotected sexual intercourse was five days ago. She has a history of migraines with aura. After assessment, you determine that the progesterone-only pill would be the most suitable option. What guidance should you provide regarding the commencement of her pill?

      Your Answer: She should perform a pregnancy test two weeks after her last episode of unprotected sexual intercourse

      Correct Answer: She can start contraception straight away, as long as she is aware that there is a possibility of pregnancy

      Explanation:

      Starting Contraception: Important Considerations

      When starting contraception, it is important for the clinician to ensure that the woman is likely to continue to be at risk of pregnancy or has expressed a preference to begin contraception immediately. Additionally, the woman should be aware that she may be pregnant and that there are theoretical risks from contraceptive exposure to the fetus, although evidence indicates no harm. It is also important to note that pregnancy can only be excluded once a pregnancy test is negative at least three weeks after the last episode of unprotected sexual intercourse. Therefore, the woman should be advised to carry out a pregnancy test at least three weeks after the last episode of unprotected sexual intercourse and advised on additional contraception. While a negative pregnancy test is not required before starting contraception, the clinician should be reasonably sure that the woman is not pregnant or at risk of pregnancy. It is important to keep in mind that this practice may be outside the product licence.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      22.5
      Seconds
  • Question 11 - A 36-year-old woman presents to the clinic for a routine cervical smear. Her...

    Correct

    • A 36-year-old woman presents to the clinic for a routine cervical smear. Her previous three smears have all been negative.

      However, this latest smear has revealed mild dyskaryosis. The local cervical screening programme has also included HPV (human papillomavirus) testing as part of the screening process. Her sample has tested 'positive' for high-risk HPV.

      What would be the most appropriate next step in her management?

      Your Answer: Colposcopy

      Explanation:

      HPV Triage in NHS Cervical Cancer Screening Programme

      HPV triage is a new addition to the NHS cervical cancer screening programme. It involves testing cytology samples of women with borderline changes or mild dyskaryosis for high-risk HPV types that are linked to cervical cancer development. The aim is to refer women with abnormalities for colposcopy and further investigation, and if necessary, treatment. However, only a small percentage of women referred for colposcopy actually require treatment as low-grade abnormalities often resolve on their own. HPV testing provides additional information to help determine who needs onward referral for colposcopy and who doesn’t. Women who test negative for high-risk HPV are simply returned to routine screening recall, while those who test positive are referred for colposcopy. HPV testing is also used as a ‘test of cure’ for women who have been treated for cervical intraepithelial neoplasia and have returned for follow-up cytology. Those with ‘normal’, ‘borderline’, or ‘mild dyskaryosis’ smear results who are HPV negative are returned to 3 yearly recall.

    • This question is part of the following fields:

      • Gynaecology And Breast
      19.1
      Seconds
  • Question 12 - A 6-year-old boy is brought to the General Practitioner by his mother. She...

    Correct

    • A 6-year-old boy is brought to the General Practitioner by his mother. She reports that 1-2 hours after he has gone to sleep, she frequently finds him sat up in bed screaming and with his eyes open. He doesn't seem to recognise her, is confused and unable to communicate. After about five minutes he settles down to sleep. He is unable to remember anything about this the next day. On the day after it has happened he is more tired than usual.
      Which of the following is the most likely diagnosis?

      Your Answer: Night terror

      Explanation:

      Understanding Sleep Disorders in Children

      Sleep disorders in children can be distressing for both the child and their parents. It is important to identify the specific type of sleep disorder in order to provide appropriate treatment. Here are some common sleep disorders in children:

      Night Terrors: These are different from nightmares and can affect children between the ages of 4 and 12 years. Symptoms include sudden arousal from non-REM sleep, fear-related behavior, confusion upon waking, and amnesia regarding the event.

      Sleepwalking: Similar to night terrors, sleepwalking involves getting up and moving around while asleep. It is important to ensure the child’s safety during these episodes.

      Nocturnal Epilepsy: Seizures occur only during sleep in this type of epilepsy. It may be difficult to diagnose, but symptoms include involuntary movements during sleep and changes upon awakening.

      Nightmares: These are vivid and frightening dreams that most children experience occasionally. Comforting the child can help them get back to sleep.

      Panic Attacks: Unlike other sleep disorders, panic attacks occur while the child is awake and can be very distressing.

      Post-Traumatic Stress Disorder: Bad dreams about a traumatic event and sleep disturbance are features of PTSD and can be similar to nightmares.

      Understanding these sleep disorders can help parents and healthcare providers provide appropriate care and support for children experiencing sleep disturbances.

    • This question is part of the following fields:

      • Children And Young People
      13.7
      Seconds
  • Question 13 - A 35 year-old woman schedules a consultation to address her suspected food intolerance....

    Correct

    • A 35 year-old woman schedules a consultation to address her suspected food intolerance. She suspects she may have a wheat allergy and has noticed that her symptoms of bloating and diarrhea have improved in recent months by following a gluten-free diet. What guidance should the GP provide?

      Your Answer: Resume eating gluten, bloods for coeliac screen

      Explanation:

      To accurately test for coeliac disease, patients must consume gluten for a minimum of 6 weeks before undergoing the first-line test, which involves measuring serum total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) levels. Failure to consume gluten prior to the test may result in a false negative result. If a patient refuses to consume gluten, they should be referred to a Gastroenterologist, but it should be noted that even an endoscopy and biopsy may yield a negative result if gluten has been excluded from the diet.

      Investigating Coeliac Disease

      Coeliac disease is a condition caused by sensitivity to gluten, which leads to villous atrophy and malabsorption. It is often associated with other conditions such as dermatitis herpetiformis and autoimmune disorders. Diagnosis is made through a combination of serology and endoscopic intestinal biopsy, with villous atrophy and immunology typically reversing on a gluten-free diet.

      To investigate coeliac disease, NICE guidelines recommend using tissue transglutaminase (TTG) antibodies (IgA) as the first-choice serology test, along with endomyseal antibody (IgA) and testing for selective IgA deficiency. Anti-gliadin antibody (IgA or IgG) tests are not recommended. The ‘gold standard’ for diagnosis is an endoscopic intestinal biopsy, which should be performed in all suspected cases to confirm or exclude the diagnosis. Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, increase in intraepithelial lymphocytes, and lamina propria infiltration with lymphocytes. Rectal gluten challenge is a less commonly used method.

      In summary, investigating coeliac disease involves a combination of serology and endoscopic intestinal biopsy, with NICE guidelines recommending specific tests and the ‘gold standard’ being an intestinal biopsy. Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, and lymphocyte infiltration.

    • This question is part of the following fields:

      • Gastroenterology
      11
      Seconds
  • Question 14 - Which of the following is an absolute contraindication to the use of the...

    Incorrect

    • Which of the following is an absolute contraindication to the use of the progesterone only pill for women?

      Your Answer: Concurrent use of rifampicin

      Correct Answer: Breast cancer 3 years ago

      Explanation:

      Contraindications for Progestogen Only Pill

      The UK Medical Eligibility Criteria (UKMEC) is used to determine whether a woman is suitable for a particular type of contraceptive. The criteria categorize potential cautions and contraindications into four levels. UKMEC 1 indicates no restriction for the use of the contraceptive method, while UKMEC 2 suggests that the advantages outweigh the disadvantages. UKMEC 3 indicates that the disadvantages generally outweigh the advantages, and UKMEC 4 represents an unacceptable health risk.

      Examples of UKMEC 3 conditions that may prevent a woman from taking the progestogen only pill include active liver disease or past tumour, liver enzyme inducers, breast cancer more than 5 years ago, undiagnosed vaginal bleeding, and ischaemic heart disease and stroke (initiation = UKMEC2). On the other hand, UKMEC 4 conditions such as pregnancy and breast cancer within the last 5 years are considered unacceptable health risks and would prevent a woman from taking the progestogen only pill. It is important to consult with a healthcare provider to determine if the progestogen only pill is a suitable contraceptive option.

    • This question is part of the following fields:

      • Gynaecology And Breast
      11.3
      Seconds
  • Question 15 - A 42-year-old woman is prescribed amiodarone for her newly diagnosed arrhythmia and expresses...

    Incorrect

    • A 42-year-old woman is prescribed amiodarone for her newly diagnosed arrhythmia and expresses concern to her General Practitioner about its impact on her thyroid function due to her past medical history of autoantibody-positive hypothyroidism. What is the most appropriate management for this patient?

      Your Answer: Monitor the patient’s thyroid function and discontinue amiodarone if it becomes deranged

      Correct Answer: Monitor thyroid function three months after starting amiodarone

      Explanation:

      Thyroid Monitoring and Amiodarone Use: What Patients Need to Know

      Amiodarone is a medication used to treat heart rhythm disorders, but it can also cause thyroid dysfunction. Patients on this drug should have their thyroid function regularly monitored, with a baseline check and another three months after starting the medication. Patients with a history of hypothyroidism can still use amiodarone, but with more stringent monitoring. Those with thyroid autoantibodies are at increased risk of drug-induced hyperthyroidism. If thyroid function becomes deranged, amiodarone may need to be discontinued or thyroxine supplements dose-adjusted. Regular thyroid monitoring is crucial for patients on amiodarone.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      12.1
      Seconds
  • Question 16 - A 50-year-old woman with a history of hypothyroidism presents with fatigue and a...

    Correct

    • A 50-year-old woman with a history of hypothyroidism presents with fatigue and a painful tongue. Her blood tests reveal the following results:

      - Hemoglobin (Hb): 10.7 g/dl
      - Mean corpuscular volume (MCV): 121 fl
      - Platelet count (Plt): 177 * 109/l
      - White blood cell count (WBC): 5.4 * 109/l

      Further investigations reveal that her vitamin B12 levels are 64 ng/l (normal range: 200-900 ng/l) and her folic acid levels are 7.2 nmol/l (normal range: > 3.0 nmol/l). Antibodies to intrinsic factor are also detected. What is the most appropriate course of action?

      Your Answer: 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

      Explanation:

      Vitamin B12 is essential for the development of red blood cells and the maintenance of the nervous system. It is absorbed through the binding of intrinsic factor, which is secreted by parietal cells in the stomach, and actively absorbed in the terminal ileum. A deficiency in vitamin B12 can be caused by pernicious anaemia, post gastrectomy, a vegan or poor diet, disorders or surgery of the terminal ileum, Crohn’s disease, or metformin use.

      Symptoms of vitamin B12 deficiency include macrocytic anaemia, a sore tongue and mouth, neurological symptoms, and neuropsychiatric symptoms such as mood disturbances. The dorsal column is usually affected first, leading to joint position and vibration issues before distal paraesthesia.

      Management of vitamin B12 deficiency involves administering 1 mg of IM hydroxocobalamin three times a week for two weeks, followed by once every three months if there is no neurological involvement. If a patient is also deficient in folic acid, it is important to treat the B12 deficiency first to avoid subacute combined degeneration of the cord.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      18.8
      Seconds
  • Question 17 - A 42-year-old female presents to rheumatology with complaints of fatigue and joint pain...

    Correct

    • A 42-year-old female presents to rheumatology with complaints of fatigue and joint pain in her fingers. She has a history of mild asthma, which is managed with a salbutamol inhaler, and a known allergy to co-trimoxazole. Her blood tests reveal a positive rheumatoid factor and an anti-CCP antibody level of 150u/ml (normal range < 20u/ml). Which medication could potentially trigger an allergic reaction in this patient?

      Your Answer: Sulfasalazine

      Explanation:

      If a patient has a known allergy to a sulfa drug like co-trimoxazole, they should avoid taking sulfasalazine. However, hydroxychloroquine, leflunomide, and methotrexate are all viable options for first-line disease-modifying anti-rheumatic drugs for rheumatoid arthritis in this patient. Sarilumab may also be considered, but only if the patient has not responded well to other medications and has a disease activity score of over 5.1.

      Sulfasalazine: A DMARD for Inflammatory Arthritis and Bowel Disease

      Sulfasalazine is a type of disease modifying anti-rheumatic drug (DMARD) that is commonly used to manage inflammatory arthritis, particularly rheumatoid arthritis, as well as inflammatory bowel disease. This medication is a prodrug for 5-ASA, which works by reducing neutrophil chemotaxis and suppressing the proliferation of lymphocytes and pro-inflammatory cytokines.

      However, caution should be taken when using sulfasalazine in patients with G6PD deficiency or those who are allergic to aspirin or sulphonamides due to the risk of cross-sensitivity. Adverse effects of sulfasalazine may include oligospermia, Stevens-Johnson syndrome, pneumonitis/lung fibrosis, myelosuppression, Heinz body anaemia, megaloblastic anaemia, and the potential to color tears and stain contact lenses.

      Despite these potential side effects, sulfasalazine is considered safe to use during pregnancy and breastfeeding, making it a viable option for women who require treatment for inflammatory arthritis or bowel disease.

    • This question is part of the following fields:

      • Allergy And Immunology
      8.1
      Seconds
  • Question 18 - A 28 year old woman with no pre-existing medical conditions comes to you...

    Correct

    • A 28 year old woman with no pre-existing medical conditions comes to you after discovering she is expecting. During your discussion about pregnancy supplements, she inquires if she can simply continue taking her regular over-the-counter multivitamin tablet. Can you inform her which vitamin, when consumed in excessive amounts, can be harmful to the developing fetus?

      Your Answer: Vitamin A

      Explanation:

      To prevent birth defects, pregnant women should not consume more than 10,000IU of vitamin A per day as it can be harmful in high doses. It is recommended that they avoid taking any supplements that contain vitamin A, including regular multivitamins, during pregnancy. In the UK, supplements are now restricted to a maximum of 6,000IU of vitamin A, so if a pregnant woman has been taking one, there is no need to worry. Additionally, liver should be avoided as it contains high levels of vitamin A.

      Vitamin A, also known as retinol, is a type of fat soluble vitamin that plays several important roles in the body. One of its key functions is being converted into retinal, which is a crucial visual pigment. Additionally, vitamin A is essential for proper epithelial cell differentiation and acts as an antioxidant to protect cells from damage.

      When the body lacks sufficient vitamin A, it can lead to a condition known as night blindness. This is because retinal is necessary for the eyes to adjust to low light conditions, and a deficiency can impair this process. Therefore, it is important to ensure adequate intake of vitamin A through a balanced diet or supplements to maintain optimal health.

    • This question is part of the following fields:

      • Eyes And Vision
      14.7
      Seconds
  • Question 19 - A 28 year-old woman comes to you with a recent skin lesion. She...

    Correct

    • A 28 year-old woman comes to you with a recent skin lesion. She is in good health but is currently 16 weeks pregnant. She reports that the lesion appeared four weeks ago and has grown quickly. Upon examination, you observe a bright red, nodular lesion that is 14mm in diameter and shows signs of recent bleeding. What is the probable diagnosis?

      Your Answer: Pyogenic granuloma

      Explanation:

      Pyogenic Granuloma: A Common Benign Skin Lesion

      Pyogenic granuloma is a benign skin lesion that is relatively common. Despite its name, it is not a true granuloma nor is it pyogenic in nature. It is also known as an eruptive haemangioma. The cause of pyogenic granuloma is unknown, but it is often linked to trauma and is more common in women and young adults. The most common sites for these lesions are the head/neck, upper trunk, and hands. Lesions in the oral mucosa are common during pregnancy.

      Pyogenic granulomas initially appear as small red/brown spots that rapidly progress within days to weeks, forming raised, red/brown spherical lesions that may bleed profusely or ulcerate. Lesions associated with pregnancy often resolve spontaneously postpartum, while other lesions usually persist. Removal methods include curettage and cauterisation, cryotherapy, and excision.

      In summary, pyogenic granuloma is a common benign skin lesion that can be caused by trauma and is more common in women and young adults. It appears as small red/brown spots that rapidly progress into raised, red/brown spherical lesions that may bleed or ulcerate. Lesions associated with pregnancy often resolve spontaneously, while other lesions usually persist and can be removed through various methods.

    • This question is part of the following fields:

      • Dermatology
      7.1
      Seconds
  • Question 20 - A 45-year-old man with no previous medical history of note attends for a...

    Correct

    • A 45-year-old man with no previous medical history of note attends for a new patient check. His blood pressure is noted to be 152/100 mmHg so you arrange blood tests. The results include an eGFR of 55.
      Select the single correct diagnosis that can be made in this case.

      Your Answer: None of the above

      Explanation:

      Diagnosis of CKD and Hypertension: NICE Guidelines

      The National Institute for Health and Care Excellence (NICE) has provided guidelines for the diagnosis of chronic kidney disease (CKD) and hypertension. To diagnose CKD, more than one estimated glomerular filtration rate (eGFR) reading below 60 is required over a period of three months. Similarly, hypertension should not be diagnosed based on a single blood pressure reading, but rather through ambulatory or home blood pressure monitoring. Acute kidney injury is characterized by a significant increase in serum creatinine or oliguria, and eGFR is not a reliable indicator for its diagnosis. NICE also recommends using eGFRcystatinC to confirm or rule out CKD in individuals with an eGFR of 45-59 ml/min/1.73 m2, sustained for at least 90 days, and no proteinuria or other markers of kidney disease.

    • This question is part of the following fields:

      • Kidney And Urology
      12.5
      Seconds
  • Question 21 - A 32-year-old construction worker complains of wrist pain for the past two weeks....

    Correct

    • A 32-year-old construction worker complains of wrist pain for the past two weeks. He has no significant medical history and recently moved from Nigeria. During examination, he experiences tenderness at the base of his right thumb and radial styloid process. The pain is recreated when the wrist is deviated ulnarly. What is the probable diagnosis?

      Your Answer: De Quervain's tenosynovitis

      Explanation:

      De Quervain’s tenosynovitis is characterized by pain and tenderness on the radial side of the wrist, specifically over the radial styloid process.

      De Quervain’s Tenosynovitis: Symptoms, Diagnosis, and Treatment

      De Quervain’s tenosynovitis is a condition that commonly affects women between the ages of 30 and 50. It occurs when the sheath containing the tendons of the extensor pollicis brevis and abductor pollicis longus becomes inflamed. The condition is characterized by pain on the radial side of the wrist, tenderness over the radial styloid process, and pain when the thumb is abducted against resistance. A positive Finkelstein’s test, in which pain is elicited by ulnar deviation and longitudinal traction of the thumb, is also indicative of the condition.

      Treatment for De Quervain’s tenosynovitis typically involves analgesia, steroid injections, and immobilization with a thumb splint (spica). In some cases, surgical intervention may be necessary. With proper diagnosis and treatment, patients can experience relief from the pain and discomfort associated with this condition.

    • This question is part of the following fields:

      • Musculoskeletal Health
      12
      Seconds
  • Question 22 - A 35-year-old man presents to the Neurology Clinic with a severe, sudden-onset headache...

    Correct

    • A 35-year-old man presents to the Neurology Clinic with a severe, sudden-onset headache at the back of his head, associated with vomiting. His paternal aunt has been on dialysis since the age of 45.
      On examination, his blood pressure is 190/100 mm/Hg and he has a mass in both loins.
      Given the diagnosis, what is the likelihood that his sister is affected?

      Your Answer: 50%

      Explanation:

      Understanding the Likelihood of Genetic Diseases: A Case Study of Autosomal-Dominant Polycystic Kidney Disease

      Autosomal-dominant polycystic kidney disease (ADPCKD) affects 1 in 1000 individuals and is the most common inherited cause of serious renal disease. This case study explores the likelihood of a patient having ADPCKD based on their symptoms and family history.

      The patient presented with a headache caused by a subarachnoid haemorrhage, which is often caused by intracranial aneurysms. Individuals with ADPCKD have a higher risk of developing these aneurysms, which also rupture at a younger age than those in the general population. The patient also had hypertension, loin masses, and a family history of dialysis, all of which are indicators of ADPCKD.

      The likelihood of the patient having ADPCKD is 50%, as it is highly unlikely that both parents have the ADPCKD gene. If one parent has the gene, there is a 50% chance of inheriting it.

      It is important to note that 100% likelihood of genetic diseases is rare unless prenatal genetic testing has taken place. Prenatal testing can only be done if the specific genetic abnormality is known and can be tested for. This type of testing raises ethical implications that need to be considered.

      Understanding the likelihood of genetic diseases is crucial in making accurate diagnoses and providing appropriate treatment. In the case of ADPCKD, early detection and management can help prevent serious renal and neurological complications.

    • This question is part of the following fields:

      • Genomic Medicine
      10.2
      Seconds
  • Question 23 - A study compares the effectiveness of two treatments for hypertension. The first treatment...

    Incorrect

    • A study compares the effectiveness of two treatments for hypertension. The first treatment has a success rate of 75% whilst the second treatment has a success rate of 82%. What type of significance test should be used for comparing the two results?

      Your Answer: Wilcoxon matched-pairs

      Correct Answer: Chi-squared test

      Explanation:

      The chi-squared test is appropriate for comparing percentages.

      Types of Significance Tests

      Significance tests are used to determine whether the results of a study are statistically significant or simply due to chance. The type of significance test used depends on the type of data being analyzed. Parametric tests are used for data that can be measured and are usually normally distributed, while non-parametric tests are used for data that cannot be measured in this way.

      Parametric tests include the Student’s t-test, which can be paired or unpaired, and Pearson’s product-moment coefficient, which is used for correlation analysis. Non-parametric tests include the Mann-Whitney U test, which compares ordinal, interval, or ratio scales of unpaired data, and the Wilcoxon signed-rank test, which compares two sets of observations on a single sample. The chi-squared test is used to compare proportions or percentages, while Spearman and Kendall rank are used for correlation analysis.

      It is important to choose the appropriate significance test for the type of data being analyzed in order to obtain accurate and reliable results. By understanding the different types of significance tests available, researchers can make informed decisions about which test to use for their particular study.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      6.7
      Seconds
  • Question 24 - A 55-year-old woman presents with shortness of breath, haemoptysis, and pleuritic chest pain.

    Her...

    Incorrect

    • A 55-year-old woman presents with shortness of breath, haemoptysis, and pleuritic chest pain.

      Her medical history includes a deep vein thrombosis affecting the right leg eight years ago. She is not on any current regular medication.

      On examination, her heart rate is 108 bpm, blood pressure is 104/68, respiratory rate is 24, oxygen saturations are 94% in room air and she is afebrile. She has no calf or leg swelling.

      You suspect she might have a pulmonary embolism and there is nothing to find to suggest an alternative cause.

      You calculate her two-level PE Wells score.

      What is the most appropriate management plan?

      Your Answer: Give low molecular weight heparin and request an urgent outpatient computed tomography pulmonary angiogram

      Correct Answer: Admit as an emergency

      Explanation:

      Calculating the Wells Score for Pulmonary Embolism

      To determine the likelihood of a patient having a pulmonary embolism (PE), healthcare professionals use the Wells score. This score is calculated based on several factors, including clinical examination consistent with deep vein thrombosis, pulse rate, immobilization or recent surgery, past medical history, haemoptysis, cancer, and the likelihood of an alternative diagnosis.

      If the two-level Wells score is more than 4 points, hospital admission should be arranged for an immediate computed tomography pulmonary angiogram. If the score is 4 or lower, a D-dimer blood test should be arranged. A negative result may indicate an alternative diagnosis, while a positive result should be managed the same way as a two-level Wells score of more than 4.

      It is important to note that HASBLED and CHADS2VASC scoring are used in the management of patients with atrial fibrillation, not pulmonary embolism. By using the Wells score, healthcare professionals can quickly and accurately determine the likelihood of a patient having a PE and provide appropriate treatment.

    • This question is part of the following fields:

      • Respiratory Health
      22.4
      Seconds
  • Question 25 - As a GP in central London, you see a 10-year-old Polish boy with...

    Incorrect

    • As a GP in central London, you see a 10-year-old Polish boy with his mother. The mother reports that her son has been feeling unwell for the past four days with a runny nose and sticky eyes. Yesterday, he developed a fever of 39.1 ºC and a rash on his face. The rash has now spread all over his body, and he has lost his appetite but is drinking well. When asked about his immunization history, the mother is unsure of what he has had.

      During the examination, the patient appears coryzal and has small white spots on the inside of his cheeks. He also has a rash with flat red blotches on his face and brown blotches on his torso. All his observations are within normal limits. Based on these findings, you suspect that the patient has measles.

      The mother asks how long her son needs to stay off school.

      Your Answer: 5 days from the onset of the rash

      Correct Answer: 4 days from the onset of the rash

      Explanation:

      If a child develops measles, they should not attend school for four days after the rash appears. Measles is a highly contagious viral disease that can be severe, especially for those with weakened immune systems, young infants, and pregnant women. The best way to prevent measles is through vaccination, but there have been recent outbreaks in unvaccinated individuals in London. While the UK has achieved elimination of measles, there are still small clusters of cases. Symptoms of measles include a runny nose, cough, fever, and rash. Cases are infectious for four days before and after the rash appears, so it’s important to keep them out of school during this time. Public health officials should be notified if there is a suspected case of measles to control outbreaks through testing, contact tracing, and immunization.

      The Health Protection Agency has provided guidance on when children should be excluded from school due to infectious conditions. Some conditions, such as conjunctivitis, fifth disease, roseola, infectious mononucleosis, head lice, threadworms, and hand, foot and mouth, do not require exclusion. Scarlet fever requires exclusion for 24 hours after commencing antibiotics, while whooping cough requires exclusion for 2 days after commencing antibiotics or 21 days from onset of symptoms if no antibiotics are taken. Measles requires exclusion for 4 days from onset of rash, rubella for 5 days from onset of rash, and Chickenpox until all lesions are crusted over. Mumps requires exclusion for 5 days from onset of swollen glands, while diarrhoea and vomiting require exclusion until symptoms have settled for 48 hours. Impetigo requires exclusion until lesions are crusted and healed, or for 48 hours after commencing antibiotic treatment, and scabies requires exclusion until treated. influenza requires exclusion until the child has recovered for 48 hours.

      Regarding Chickenpox, Public Health England recommends that children should be excluded until all lesions are crusted over, while Clinical Knowledge Summaries suggest that infectivity continues until all lesions are dry and have crusted over, usually about 5 days after the onset of the rash. It is important to follow official guidance and consult with healthcare professionals if unsure about exclusion periods for infectious conditions.

    • This question is part of the following fields:

      • Children And Young People
      16.1
      Seconds
  • Question 26 - A female patient in her 40s is expressing deep concern about her lack...

    Incorrect

    • A female patient in her 40s is expressing deep concern about her lack of sexual desire over the last half year.

      When evaluating diminished libido in women, what is accurate to consider?

      Your Answer: The postmenopausal ovary no longer produces testosterone

      Correct Answer: Tibolone can improve lack of libido in postmenopausal women

      Explanation:

      Managing Low Libido in Menopausal Women

      Lubricants can provide temporary relief for menopausal women experiencing low libido, but they require frequent application and may not address the underlying issue. Measuring testosterone levels is not a reliable method for diagnosing low libido in menopausal women. While testosterone patches can benefit naturally menopausal women, they are currently only licensed for use in women who have had their ovaries removed. However, it is important to note that the postmenopausal ovary does produce testosterone. Tibolone is a medication that has been shown to improve low libido in postmenopausal women. It is important for women experiencing low libido to discuss their symptoms with their healthcare provider to determine the best course of treatment.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      16.5
      Seconds
  • Question 27 - Which of the following medical conditions disqualifies a patient from applying for a...

    Correct

    • Which of the following medical conditions disqualifies a patient from applying for a prescription exemption certificate?

      Your Answer: Psoriasis

      Explanation:

      Prescription Charges in England: Who is Eligible for Free Prescriptions?

      In England, prescription charges apply to most medications, but certain groups of people are entitled to free prescriptions. These include children under 16, those aged 16-18 in full-time education, the elderly (aged 60 or over), and individuals who receive income support or jobseeker’s allowance. Additionally, patients with a prescription exemption certificate are exempt from prescription charges.

      Certain medications are also exempt from prescription charges, such as contraceptives, STI treatments, hospital prescriptions, and medications administered by a GP.

      Women who are pregnant or have had a child in the past year, as well as individuals with certain chronic medical conditions, are eligible for a prescription exemption certificate. These conditions include hypoparathyroidism, hypoadrenalism, diabetes insipidus, diabetes mellitus, myasthenia gravis, hypothyroidism, epilepsy, and certain types of cancer.

      For patients who are not eligible for free prescriptions but receive frequent prescriptions, a pre-payment certificate (PPC) may be a cost-effective option. PPCs are cheaper if the patient pays for more than 14 prescriptions per year.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      8.3
      Seconds
  • Question 28 - A 10-year-old boy has two circular patches of hair loss in close proximity...

    Correct

    • A 10-year-old boy has two circular patches of hair loss in close proximity on his scalp. Choose the one characteristic that would indicate a diagnosis of tinea capitis instead of alopecia areata from the options provided.

      Your Answer: Scaly skin in the area of hair loss

      Explanation:

      Understanding Tinea Capitis: Causes, Symptoms, and Treatment

      Tinea capitis, also known as scalp ringworm, is a fungal infection that affects the scalp and hair follicles. It is caused by dermatophytes Microsporum spp. and Trichophyton spp. and is more common in children and people of Afro-Caribbean background. If left untreated, it can lead to permanent hair loss.

      Symptoms of tinea capitis include scaly patches on the scalp, inflammation, and pus-filled bumps known as kerion. To confirm the diagnosis, scalp scrapings including hairs and hair fragments should be examined.

      Prompt treatment with systemic terbinafine or griseofulvin is necessary. Griseofulvin is the most effective agent for Microsporum canis infections, while terbinafine is more effective for Trichophyton infections. However, terbinafine is not licensed for use in children under 12 years old.

      It is important to note that broken hairs in tinea capitis do not taper at the base, unlike the exclamation mark hairs seen in alopecia areata. Nail pitting, on the other hand, is a symptom of psoriasis and may also occur in alopecia areata. In alopecia areata, hair regrowth usually begins with fine white hairs, and onset is most common in childhood and adolescence.

      Understanding the causes, symptoms, and treatment of tinea capitis is crucial in preventing permanent hair loss and managing the infection effectively.

    • This question is part of the following fields:

      • Dermatology
      6.9
      Seconds
  • Question 29 - A 16-year-old girl presents to her health care provider with concerns about missed...

    Incorrect

    • A 16-year-old girl presents to her health care provider with concerns about missed periods and a positive pregnancy test. She has been sexually active with her 17-year-old boyfriend for the past six months, using condoms as protection. The patient expresses a desire for a termination but doesn't want to involve her parents in any way. Despite counseling on the risks of abortion and the importance of involving parents, she remains firm in her decision to seek an abortion without parental involvement. What is the best course of action for this patient?

      Your Answer: Offer her a referral to an abortion service without parental consent

      Correct Answer: Contact her parents and inform them of the situation

      Explanation:

      Gillick Competency and Abortion: Understanding the Guidelines

      Under the Gillick case, a child who is deemed competent and has a full understanding of the implications of her actions can be offered advice and treatment without parental consent. This means that if a patient requests an abortion, it can be offered with appropriate counselling and support. However, if a healthcare practitioner has conscientious objections to participating in an abortion, they must provide an alternative practitioner who will support the patient.

      It is important to note that every effort should be made to persuade the patient to inform her parents. The Gillick competency and Fraser guidelines are in place to ensure that young people are able to make informed decisions about their healthcare, but it is still important to involve parents or guardians where possible. By understanding these guidelines, healthcare practitioners can provide the best possible care for their patients while also respecting their rights and beliefs.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
      15.9
      Seconds
  • Question 30 - Which one of the following statements best describes a type II statistical error?...

    Incorrect

    • Which one of the following statements best describes a type II statistical error?

      Your Answer: The p value fails to reach statistical significance

      Correct Answer: The null hypothesis is accepted when it is false

      Explanation:

      Type II error – the false hypothesis is not rejected when it is true.

      Significance tests are used to determine the likelihood of a null hypothesis being true. The null hypothesis states that two treatments are equally effective, while the alternative hypothesis suggests that there is a difference between the two treatments. The p value is the probability of obtaining a result by chance that is at least as extreme as the observed result, assuming the null hypothesis is true. Two types of errors can occur during significance testing: type I, where the null hypothesis is rejected when it is true, and type II, where the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      6.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Infectious Disease And Travel Health (1/2) 50%
Neurology (0/1) 0%
Children And Young People (3/4) 75%
Respiratory Health (1/2) 50%
Evidence Based Practice, Research And Sharing Knowledge (0/3) 0%
Kidney And Urology (2/2) 100%
Mental Health (1/1) 100%
Maternity And Reproductive Health (0/2) 0%
Gynaecology And Breast (1/2) 50%
Gastroenterology (1/1) 100%
Metabolic Problems And Endocrinology (1/2) 50%
Allergy And Immunology (1/1) 100%
Eyes And Vision (1/1) 100%
Dermatology (2/2) 100%
Musculoskeletal Health (1/1) 100%
Genomic Medicine (1/1) 100%
Improving Quality, Safety And Prescribing (1/2) 50%
Passmed