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Question 1
Correct
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A 25-year-old medical student is required to give a blood sample to check his hepatitis B status. He received a course of vaccinations nine months ago.
Which of the following is this patient’s blood test most likely to show?
Your Answer: Anti-HBs
Explanation:Understanding Hepatitis B Test Results
Hepatitis B is a viral infection that affects the liver. Testing for hepatitis B involves checking for various antibodies and antigens in the blood. Here is a breakdown of what each result means:
Anti-HBs: This antibody indicates that a person has been vaccinated against hepatitis B.
Anti-HBsAb + anti-HBc: The presence of both antibodies suggests that a person has had a past infection with hepatitis B and is now immune.
Anti-HBeAb: This antibody indicates that a person is less infectious and is recovering from an acute infection.
HBsAg + HBcAg: The presence of both antigens suggests that a person is currently infected with hepatitis B.
Immunoglobulin M to HBcAg: The presence of this antibody indicates that a person has recently been infected with hepatitis B.
Understanding these test results can help healthcare providers diagnose and manage hepatitis B infections.
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This question is part of the following fields:
- Allergy And Immunology
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Question 2
Correct
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A 36-year-old woman comes to the clinic with facial swelling that started 6 hours ago. She is a busy lawyer and has important court cases this week. During the examination, her lips are found to be swollen. Her blood pressure is 118/72 mmHg and her pulse rate is 80 beats per minute. She reports no breathing difficulties or stridor.
What is the most suitable course of treatment for this patient?Your Answer: Loratadine
Explanation:The symptoms and signs exhibited by this woman suggest the presence of angioedema, which is a condition characterized by swelling of the connective tissue beneath the skin in response to a trigger. Unlike anaphylaxis, angioedema doesn’t affect breathing or vital signs. antihistamines are effective in treating this condition, while adrenaline is not necessary as it is primarily used to treat anaphylaxis. Hydrocortisone is also used to treat anaphylaxis, but it is not recommended for angioedema. Furosemide is typically prescribed for leg swelling caused by heart failure and is not suitable for treating angioedema. Chlorphenamine and loratadine are both effective in reducing swelling caused by angioedema, but since the woman has an important job that requires full concentration, loratadine would be the better option as it is a non-sedating antihistamine.
Understanding Angioedema: Causes and Treatment
Angioedema is a condition characterized by swelling beneath the skin, which can be caused by different allergens. The treatment for this condition varies depending on the underlying cause, but it often involves the use of antihistamines. Angioedema can be triggered by a variety of factors, including food allergies, insect bites, medication reactions, and genetic factors. The swelling can occur in different parts of the body, such as the face, lips, tongue, throat, and hands. In some cases, angioedema can be life-threatening, especially if it affects the airways and causes difficulty breathing.
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This question is part of the following fields:
- Allergy And Immunology
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Question 3
Correct
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You are instructing a woman on the proper use of an EpiPen. What is the most suitable guidance regarding the injection site?
Your Answer: Anterolateral aspect of the middle third of the thigh
Explanation:The anterolateral aspect of the middle third of the thigh is the recommended site for injecting IM adrenaline.
Anaphylaxis is a severe and potentially life-threatening allergic reaction that affects the entire body. It can be caused by various triggers, including food, drugs, and insect venom. The symptoms of anaphylaxis typically develop suddenly and progress rapidly, affecting the airway, breathing, and circulation. Swelling of the throat and tongue, hoarse voice, and stridor are common airway problems, while respiratory wheeze and dyspnea are common breathing problems. Hypotension and tachycardia are common circulation problems. Skin and mucosal changes, such as generalized pruritus and widespread erythematous or urticarial rash, are also present in around 80-90% of patients.
The most important drug in the management of anaphylaxis is intramuscular adrenaline, which should be administered as soon as possible. The recommended doses of adrenaline vary depending on the patient’s age, with the highest dose being 500 micrograms for adults and children over 12 years old. Adrenaline can be repeated every 5 minutes if necessary. If the patient’s respiratory and/or cardiovascular problems persist despite two doses of IM adrenaline, IV fluids should be given for shock, and expert help should be sought for consideration of an IV adrenaline infusion.
Following stabilisation, non-sedating oral antihistamines may be given to patients with persisting skin symptoms. Patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic, and an adrenaline injector should be given as an interim measure before the specialist allergy assessment. Patients should be prescribed two adrenaline auto-injectors, and training should be provided on how to use them. A risk-stratified approach to discharge should be taken, as biphasic reactions can occur in up to 20% of patients. The Resus Council UK recommends a fast-track discharge for patients who have had a good response to a single dose of adrenaline and have been given an adrenaline auto-injector and trained how to use it. Patients who require two doses of IM adrenaline or have had a previous biphasic reaction should be observed for a minimum of 6 hours after symptom resolution, while those who have had a severe reaction requiring more than two doses of IM adrenaline or have severe asthma should be observed for a minimum of 12 hours after symptom resolution. Patients who present late at night or in areas where access to emergency care may be difficult should also be observed for a minimum of 12
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This question is part of the following fields:
- Allergy And Immunology
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Question 4
Correct
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A 50-year-old man contacts the General Practitioner out of hours service for advice. He had a renal transplant five months ago. His family had a viral illness last week, which they managed with self-care and over the counter medications. He now complains of feeling unwell for the past three days. He reports feeling tired, with a fever and a headache and a mild sore throat. He can eat and drink and he has no rash.
You suspect that he may be experiencing an acute renal transplant rejection.
Which of the following signs or symptom would you most expect to see?Your Answer: Lower limb swelling
Explanation:Symptoms of Acute Renal Transplant Rejection
Acute renal transplant rejection can occur after a kidney transplant and is characterized by reduced urine output, leading to oliguria and water retention. This can result in swelling of the limbs or abdomen and face. Malaise and fatigue are common symptoms, but they are also present in upper respiratory tract infections. Fever may also be present, but it is a nonspecific symptom found in many infections. Polyuria, or excessive urine output, is not typically seen in acute renal transplant rejection. Headache is a nonspecific symptom and may be present in both acute infections and graft rejection.
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This question is part of the following fields:
- Allergy And Immunology
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Question 5
Correct
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What is the appropriate advice to give to a patient with a confirmed food allergy?
Your Answer: Food allergens may be encountered by routes other than ingestion e.g. skin contact, inhalation
Explanation:Managing Food Allergies and Intolerances
Food allergies and intolerances can be managed through food avoidance. Elimination diets should only exclude foods that have been confirmed to cause allergic reactions, and the advice of a dietician may be necessary. It is important to read food labels carefully, although not all potential allergens are included. Cross contact of allergens during meal preparation should be avoided, and high-risk situations such as buffets and picnics should be avoided as well. It is also important to note that there is a possibility of food allergen cross-reactivity, such as between cows’ milk and goats’ milk or between different types of fish. Additionally, there is a risk of exposure to allergens through routes other than ingestion, such as skin contact or inhalation during cooking.
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This question is part of the following fields:
- Allergy And Immunology
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Question 6
Correct
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A 25-year-old woman is treated in the Emergency Department (ED) following an anaphylactic reaction to a wasp sting. She presents to her General Practitioner (GP) a few days later as she is worried about the possibility of this happening again and is seeking advice on what she should do if it does.
What is the most appropriate initial self-management advice for this patient?Your Answer: Self-administer an intramuscular (IM) injection of adrenaline
Explanation:How to Self-Administer an Intramuscular Injection of Adrenaline for Anaphylaxis
Anaphylaxis is a severe and potentially life-threatening allergic reaction that requires immediate treatment. The most effective treatment for anaphylaxis is intramuscular (IM) adrenaline, which can be self-administered using adrenaline auto-injectors (AAIs) such as EpiPen® and Jext®.
Before using an AAI, patients should receive proper training on their use. The recommended dose of adrenaline for adults is 0.3 mg, while for children up to 25-30 kg, it is 0.15 mg. Patients should carry two doses with them at all times, as the dose may need to be repeated after 5-15 minutes.
It is important to note that a cold compress is not an effective treatment for anaphylaxis, as it is a systemic reaction. Similarly, taking an oral antihistamine should not delay treatment with IM adrenaline.
If experiencing anaphylaxis, it is crucial to administer the IM adrenaline injection immediately and then seek medical attention. Contacting emergency services is recommended, but should not delay self-administration of the injection. Additionally, if stung by a bee, the sting should be scraped out rather than plucked to avoid squeezing more venom into the skin.
In summary, knowing how to self-administer an IM injection of adrenaline is crucial for those at risk of anaphylaxis. Proper training and carrying two doses of the medication at all times can help ensure prompt and effective treatment in case of an emergency.
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This question is part of the following fields:
- Allergy And Immunology
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Question 7
Correct
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A 25-year-old woman presents to the General Practice Surgery where she has recently registered. She is experiencing sneezing, an itchy nose, and itchy, watery eyes. She suspects that her symptoms are due to allergies and would like to undergo comprehensive allergy testing to inform her workplace and make necessary adjustments. She also wonders if she should carry an EpiPen.
What is the most probable cause of this patient's allergy?Your Answer: Seasonal rhinitis
Explanation:Common Allergic and Non-Allergic Conditions: Causes and Differences
Seasonal rhinitis, atopic eczema, chronic urticaria, lactose intolerance, and coeliac disease are common conditions that can cause discomfort and distress. Understanding their causes and differences is important for proper diagnosis and treatment.
Seasonal rhinitis, also known as hay fever, is caused by allergens such as tree pollen, grass, mould spores, and weeds. It is an IgE-mediated reaction that occurs at certain times of the year.
Atopic eczema can be aggravated by dietary factors in some children, but less frequently in adults. Food allergy should be suspected in children who have immediate reactions to food or infants with moderate or severe eczema that is not well-controlled.
Chronic urticaria may have an immunological or autoimmune cause, but can also be idiopathic or caused by physical factors, drugs, or dietary pseudo allergens. It presents with a rash.
Lactose intolerance is due to an enzyme deficiency and is different from milk allergy, which is IgE-mediated. It can occur following gastroenteritis.
Coeliac disease is an autoimmune condition that affects the small intestine in response to gluten exposure. It is not a gluten allergy.
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This question is part of the following fields:
- Allergy And Immunology
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Question 8
Correct
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A 32-year-old woman presents to the General Practice Surgery with multiple skin lesions that she has noticed over the past few weeks. She is a single mother and works as a waitress, and has a long history of smoking and poor engagement with health and social services.
On examination, she is overweight with a body mass index (BMI) of 30 kg/m2 (normal range: 20-25 kg/m2), with obvious cigarette burns on her arms. She has multiple small (ranging from 2-12 mm in diameter), flat, purple bruise-like lesions across her chest, back and arms.
What causative agent is associated with the most likely underlying diagnosis?Your Answer: Human herpesvirus-8 (HHV-8)
Explanation:The patient in this case has Kaposi’s sarcoma, a common tumor found in individuals with HIV infection. The tumor presents as dark purple/brown intradermal lesions that resemble bruises and can appear anywhere on the skin or oropharynx. Since HIV often goes undiagnosed, it is important to consider this diagnosis in patients with risk factors. This patient has a history of IV drug use and poor engagement with services, making it possible that they have never been tested for HIV. The patient is underweight with a low BMI, which could be a sign of HIV infection. Kaposi’s sarcoma is caused by the human herpesvirus-8 (HHV-8), also known as Kaposi’s Sarcoma-associated herpesvirus (KSHV).
Shingles, caused by the varicella-zoster virus, is not related to Kaposi’s sarcoma. Cytomegalovirus (CMV) is a herpesvirus that can cause serious infections in immunocompromised individuals, but it is not associated with Kaposi’s sarcoma. Human papillomavirus (HPV) is linked to cervical cancer and is not a herpesvirus. Herpes simplex virus (HSV) causes oral and genital herpes, but it is not responsible for Kaposi’s sarcoma.
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This question is part of the following fields:
- Allergy And Immunology
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Question 9
Correct
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A 28-year-old woman arrived as an immigrant in the UK two years ago, and it is not clear what vaccines she has received in her own country. You enquire about her immune status relating to measles.
What is the minimum requirement to satisfy you that she is immune to measles?Your Answer: Rubella-virus-specific immunoglobulin G (IgG) antibodies in the serum
Explanation:Understanding Rubella Immunity: Factors to Consider
Rubella, also known as German measles, is a viral infection that can have serious consequences for pregnant women and their unborn babies. To prevent maternal infection and congenital rubella syndrome, it is important to ensure immunity through vaccination or past infection. Here are some factors to consider when assessing rubella immunity:
– MMR Vaccine: The MMR vaccine is recommended for children and adults, with a two-dose schedule providing the best protection. A single dose can still offer high levels of immunity, but a booster may be necessary.
– Immunisation History: Individuals who have received rubella-containing vaccines in their country of origin may have some level of immunity, but it is important to verify their vaccination status. Those without a reliable history of immunisation should be assumed as unimmunised.
– Childhood History: A history of rubella in childhood may indicate immunity, but it can be difficult to diagnose. Other viral exanthems can have similar symptoms, so a clinical diagnosis may not be reliable.
– Rubella Antibodies: The presence of rubella-virus-specific IgG antibodies in the serum indicates immunity from past infection or immunisation. However, immunity can wear off over time, so it is important to check immunity levels before every pregnancy. Rubella-virus-specific IgM antibodies in the serum can indicate recent or current infection, but these antibodies can persist for up to 12 months after infection or immunisation.By considering these factors, healthcare providers can help ensure that individuals are protected against rubella and its potential complications.
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This question is part of the following fields:
- Allergy And Immunology
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Question 10
Correct
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What is the most common identified trigger of anaphylaxis in adolescents?
Your Answer: Food
Explanation:Anaphylaxis is a severe and potentially life-threatening allergic reaction that affects the entire body. It can be caused by various triggers, including food, drugs, and insect venom. The symptoms of anaphylaxis typically develop suddenly and progress rapidly, affecting the airway, breathing, and circulation. Swelling of the throat and tongue, hoarse voice, and stridor are common airway problems, while respiratory wheeze and dyspnea are common breathing problems. Hypotension and tachycardia are common circulation problems. Skin and mucosal changes, such as generalized pruritus and widespread erythematous or urticarial rash, are also present in around 80-90% of patients.
The most important drug in the management of anaphylaxis is intramuscular adrenaline, which should be administered as soon as possible. The recommended doses of adrenaline vary depending on the patient’s age, with the highest dose being 500 micrograms for adults and children over 12 years old. Adrenaline can be repeated every 5 minutes if necessary. If the patient’s respiratory and/or cardiovascular problems persist despite two doses of IM adrenaline, IV fluids should be given for shock, and expert help should be sought for consideration of an IV adrenaline infusion.
Following stabilisation, non-sedating oral antihistamines may be given to patients with persisting skin symptoms. Patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic, and an adrenaline injector should be given as an interim measure before the specialist allergy assessment. Patients should be prescribed two adrenaline auto-injectors, and training should be provided on how to use them. A risk-stratified approach to discharge should be taken, as biphasic reactions can occur in up to 20% of patients. The Resus Council UK recommends a fast-track discharge for patients who have had a good response to a single dose of adrenaline and have been given an adrenaline auto-injector and trained how to use it. Patients who require two doses of IM adrenaline or have had a previous biphasic reaction should be observed for a minimum of 6 hours after symptom resolution, while those who have had a severe reaction requiring more than two doses of IM adrenaline or have severe asthma should be observed for a minimum of 12 hours after symptom resolution. Patients who present late at night or in areas where access to emergency care may be difficult should also be observed for a minimum of 12
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This question is part of the following fields:
- Allergy And Immunology
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