00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - You encounter a 36-year-old woman who complains of vaginal discharge. She has a...

    Incorrect

    • You encounter a 36-year-old woman who complains of vaginal discharge. She has a history of bacterial vaginosis (BV) and has been treated for it around five times in the past year. A high vaginal swab reveals BV once again, and her vaginal pH remains >4.5. She is bothered by the unpleasant odor and requests further treatment. She has had a copper intrauterine device (IUD) for three years.

      In addition to prescribing a 7-day course of oral metronidazole, what other recommendations could you make?

      Your Answer: Screen and treat her male partner

      Correct Answer: Consider removing the IUD and advising the use of an alternative form of contraception

      Explanation:

      There is not enough evidence to recommend any specific treatment for recurrent BV in primary care. However, in women with an intrauterine contraceptive device and persistent BV, it may be advisable to remove the device and suggest an alternative form of contraception.

      Bacterial vaginosis (BV) is a condition where there is an overgrowth of anaerobic organisms, particularly Gardnerella vaginalis, in the vagina. This leads to a decrease in the amount of lactobacilli, which produce lactic acid, resulting in an increase in vaginal pH. BV is not a sexually transmitted infection, but it is commonly seen in sexually active women. Symptoms include a fishy-smelling vaginal discharge, although some women may not experience any symptoms at all. Diagnosis is made using Amsel’s criteria, which includes the presence of thin, white discharge, clue cells on microscopy, a vaginal pH greater than 4.5, and a positive whiff test. Treatment involves oral metronidazole for 5-7 days, with a cure rate of 70-80%. However, relapse rates are high, with over 50% of women experiencing a recurrence within 3 months. Topical metronidazole or clindamycin may be used as alternatives.

      Bacterial vaginosis during pregnancy can increase the risk of preterm labor, low birth weight, chorioamnionitis, and late miscarriage. It was previously recommended to avoid oral metronidazole in the first trimester and use topical clindamycin instead. However, recent guidelines suggest that oral metronidazole can be used throughout pregnancy. The British National Formulary (BNF) still advises against using high-dose metronidazole regimens. Clue cells, which are vaginal epithelial cells covered with bacteria, can be seen on microscopy in women with BV.

    • This question is part of the following fields:

      • Gynaecology And Breast
      78.4
      Seconds
  • Question 2 - You receive a 'friend request' on Facebook from a patient of a similar...

    Incorrect

    • You receive a 'friend request' on Facebook from a patient of a similar age to yourself who you had a consult with earlier that day. What would be the most appropriate course of action to take?

      Your Answer: Accept friendship request to avoid damaging rapport but don't message the patient

      Correct Answer: Decline friendship request and write a polite letter to the patient explaining it would be inappropriate

      Explanation:

      The General Medical Council has issued specific guidelines regarding the use of social media by doctors. According to these guidelines, if a patient contacts a doctor through their private profile regarding their care or other professional matters, the doctor should make it clear that they cannot mix social and professional relationships. The text implies that there is a risk of blurring boundaries if a doctor finds a patient attractive and receives a friend request from them. Therefore, it would be appropriate to decline the request. However, this doesn’t warrant removing the patient from the practice list. As long as professional boundaries are maintained, the patient can continue to receive care from the doctor.

      Duties of a Doctor According to the General Medical Council

      The General Medical Council has outlined the duties of a doctor in providing care to patients. The first and foremost duty is to prioritize the care of the patient. This includes protecting and promoting the health of patients and the public, providing a good standard of practice and care, and keeping professional knowledge and skills up to date. Doctors must also recognize and work within the limits of their competence and work with colleagues in the best interest of patients.

      In addition to providing medical care, doctors must treat patients with respect and dignity. This includes treating patients politely and considerately and respecting their right to confidentiality. Doctors must also work in partnership with patients, listening to their concerns and preferences, providing information in a way they can understand, and respecting their right to make decisions about their treatment and care.

      Finally, doctors must act with honesty, integrity, and without discrimination. They must act without delay if they believe that they or a colleague may be putting patients at risk and never abuse the trust of patients or the public’s trust in the profession.

      Overall, the duties of a doctor are to provide the best possible care to patients while respecting their rights and acting with honesty and integrity.

    • This question is part of the following fields:

      • Consulting In General Practice
      87.9
      Seconds
  • Question 3 - A 43-year-old woman comes to the clinic seeking guidance on contraception. She has...

    Incorrect

    • A 43-year-old woman comes to the clinic seeking guidance on contraception. She has entered a new relationship but is uncertain if she needs contraception due to her suspicion of being in menopause. She is currently experiencing hot flashes and has not had a period in 9 months. What is the best course of action to recommend?

      Your Answer: Contraception is needed until 12 months after her last period

      Correct Answer: Contraception is needed until 24 months after her last period

      Explanation:

      Contraception is still necessary after menopause. Women who are over 50 years old should use contraception for at least 12 months after their last period, while those under 50 years old should use it for at least 24 months after their last period.

      Understanding Menopause and Contraception

      Menopause is a natural biological process that marks the end of a woman’s reproductive years. It typically occurs when a woman reaches the age of 51 in the UK. However, prior to menopause, women may experience a period known as the climacteric. During this time, ovarian function starts to decline, and women may experience symptoms such as hot flashes, mood swings, and vaginal dryness.

      It is important for women to understand that they can still become pregnant during the climacteric period. Therefore, it is recommended to use effective contraception until a certain period of time has passed. Women over the age of 50 should use contraception for 12 months after their last period, while women under the age of 50 should use contraception for 24 months after their last period. By understanding menopause and the importance of contraception during the climacteric period, women can make informed decisions about their reproductive health.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      83.4
      Seconds
  • Question 4 - A 40-year-old male comes to his GP complaining of experiencing dull pain in...

    Correct

    • A 40-year-old male comes to his GP complaining of experiencing dull pain in the orbital area, redness in the eye, tearing, and sensitivity to light for the past 4 days. During the examination, the doctor notices an irregular, constricted pupil. What is the best course of action for management?

      Your Answer: Steroid + cycloplegic eye drops

      Explanation:

      Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. This condition is often associated with HLA-B27 and may be linked to other conditions such as ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small and irregular pupils, intense sensitivity to light, blurred vision, redness in the eye, tearing, and a ring of redness around the cornea. In severe cases, pus and inflammatory cells may accumulate in the front chamber of the eye, leading to a visible fluid level. Treatment for anterior uveitis involves urgent evaluation by an ophthalmologist, cycloplegic agents to relieve pain and photophobia, and steroid eye drops to reduce inflammation.

    • This question is part of the following fields:

      • Eyes And Vision
      27.9
      Seconds
  • Question 5 - Which one of the following would not be considered a normal variant on...

    Correct

    • Which one of the following would not be considered a normal variant on the ECG of an athletic 29-year-old man?

      Your Answer: Left bundle branch block

      Explanation:

      Normal Variants in Athlete ECGs

      When analyzing an athlete’s ECG, there are certain changes that are considered normal variants. These include sinus bradycardia, which is a slower than normal heart rate, junctional rhythm, which originates from the AV node instead of the SA node, first degree heart block, which is a delay in the electrical conduction between the atria and ventricles, and Mobitz type 1, also known as the Wenckebach phenomenon, which is a progressive lengthening of the PR interval until a beat is dropped. It is important to recognize these normal variants in order to avoid unnecessary testing or interventions.

    • This question is part of the following fields:

      • Cardiovascular Health
      38.1
      Seconds
  • Question 6 - A 65-year-old woman is seen for follow-up. You had previously seen her with...

    Incorrect

    • A 65-year-old woman is seen for follow-up. You had previously seen her with chronic shortness of breath and symptoms of heart failure. After primary care investigation, she was urgently referred to the cardiologists due to an abnormal ECG and elevated brain natriuretic peptide level. The echocardiogram performed by the cardiologists confirmed a diagnosis of heart failure with left ventricular dysfunction.
      Her current medications include: lisinopril 10 mg daily, atorvastatin 20 mg daily, furosemide 20 mg daily, and pantoprazole 40 mg daily.
      During examination, her blood pressure is 130/80 mmHg, pulse rate is 75 beats per minute and regular, her lungs are clear, and heart sounds are normal. There is no peripheral edema.
      What is the most appropriate next step in her pharmacological management at this point?

      Your Answer: No additional medication indicated

      Correct Answer: Add in bisoprolol

      Explanation:

      Beta-Blockers for Heart Failure Patients

      Beta-blockers are recommended for all patients with heart failure due to left ventricular systolic dysfunction, regardless of age or comorbidities such as peripheral vascular disease, interstitial pulmonary disease, erectile dysfunction, diabetes, or chronic obstructive pulmonary disease without reversibility. However, asthma is a contraindication to beta-blocker use.

      Bisoprolol, carvedilol, or nebivolol are the beta-blockers of choice for treating chronic heart failure due to left ventricular systolic dysfunction. These three beta-blockers have been proven effective in clinical trials and have prognostic benefits. Bisoprolol and carvedilol reduce mortality in all grades of stable heart failure, while nebivolol is licensed for stable mild to moderate heart failure in patients over the age of 70.

      Even if a patient with heart failure is currently well and showing no signs of fluid overload, beta-blockers are still recommended due to their prognostic benefits.

    • This question is part of the following fields:

      • Older Adults
      115.4
      Seconds
  • Question 7 - A 55-year-old man complains of back pain, fever, and chills persisting for the...

    Correct

    • A 55-year-old man complains of back pain, fever, and chills persisting for the last four weeks. He recently visited a sheep farm in Cyprus two months ago. His chest x-ray and urine culture are normal. The doctor suspects Brucellosis. What test is most likely to confirm the diagnosis?

      Your Answer: Brucella serology

      Explanation:

      The Knowledge and skills guide of the 2019 RCGP Curriculum includes zoonotic diseases such as leptospirosis and brucellosis.

      Understanding Brucellosis

      Brucellosis is a disease that can be transmitted from animals to humans, and is more commonly found in the Middle East and among individuals who work with animals such as farmers, vets, and abattoir workers. The disease is caused by four major species of bacteria: B. melitensis (sheep), B. abortus (cattle), B. canis and B. suis (pigs). The incubation period for brucellosis is typically 2-6 weeks.

      Symptoms of brucellosis are nonspecific and may include fever and malaise, as well as hepatosplenomegaly and spinal tenderness. Complications of the disease can include osteomyelitis, infective endocarditis, meningoencephalitis, and orchitis. Leukopenia is also commonly seen in patients with brucellosis.

      Diagnosis of brucellosis can be done through the Rose Bengal plate test for screening, but other tests are required to confirm the diagnosis. Brucella serology is the best test for diagnosis, and blood and bone marrow cultures may be suitable in certain patients, although these tests are often negative.

      Management of brucellosis typically involves the use of doxycycline and streptomycin. It is important for individuals who work with animals to take precautions to prevent the transmission of brucellosis, such as wearing protective clothing and practicing good hygiene.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      112.9
      Seconds
  • Question 8 - A 75-year-old man takes 2 x co-dydramol 10/500 tablets, four times daily for...

    Correct

    • A 75-year-old man takes 2 x co-dydramol 10/500 tablets, four times daily for arthritis of his knee. During a routine medicines review over the phone, he reveals that he's been buying paracetamol from the local supermarket for the past 2 months and supplements his co-dydramol with an additional paracetamol tablet four times a day.

      You inform him that his prescribed medication contains paracetamol and that he's effectively taking 3 x 500mg paracetamol tablets four times a day. A total of 12 tablets a day. He weighs 70Kg.

      What is the threshold amount of paracetamol taken over a 24 hour period that would be required for medical admission and n-acetylcysteine infusion?

      Your Answer: 50 mg/Kg

      Explanation:

      Harmful Levels of Paracetamol

      When it comes to harmful levels of paracetamol, patients are divided into two groups: those who have taken an acute overdose and those who have taken a staggered overdose, which includes patients who may have taken therapeutic excess over a period of time. Surprisingly, even modest amounts of paracetamol can be harmful, especially for frail elderly patients.

      According to the British National Formulary, a staggered overdose involves ingesting a potentially toxic dose of paracetamol over more than one hour, with the possible intention of causing self-harm. Therapeutic excess is the inadvertent ingestion of a potentially toxic dose of paracetamol during its clinical use. In these cases, patients who have taken more than 150 mg/kg of paracetamol in any 24-hour period are at risk of toxicity and should be commenced on acetylcysteine immediately, unless it is more than 24 hours since the last ingestion, the patient is asymptomatic, the plasma-paracetamol concentration is undetectable, and liver function tests, serum creatinine and INR are normal.

      It’s important to note that there is no set number of tablets that can cause toxicity as it depends on the patient’s weight. Rarely, toxicity can occur with paracetamol doses between 75-150 mg/kg in any 24-hour period, and clinical judgement of the individual case is necessary to determine whether to treat those who have ingested this amount of paracetamol. For small adults, this may be within the licensed dose, but ingestion of a licensed dose of paracetamol is not considered an overdose. The doctor may not be informed until after the event, so familiarity with the timescales is also important.

    • This question is part of the following fields:

      • Urgent And Unscheduled Care
      81.5
      Seconds
  • Question 9 - Whilst completing your medical reports one afternoon, you are disturbed by one of...

    Correct

    • Whilst completing your medical reports one afternoon, you are disturbed by one of the receptionists who is shouting for help.
      You run into the reception area to find the mother of a 7-month-old child shouting that her child has been stung by a bee. The practice nurse is preparing to give oxygen.
      The child appears distressed and has stridor. The lips are swollen. You have made a quick ABC assessment, diagnosed anaphylaxis and decided to give adrenaline. Beside the child, your practice nurse has opened the emergency bag and you are presented with vials of epinephrine (adrenaline) 1:1000 solution.
      How much of this epinephrine would you administer?

      Your Answer: 0.05 ml

      Explanation:

      Anaphylactic Reactions: Causes, Symptoms, and Management

      Anaphylactic reactions can vary in severity and may be delayed by several hours. The most common triggers are foods, bee and wasp stings, and drugs. Symptoms may include itching, redness, and swelling. Beta-blockers can worsen the reaction by blocking the response to adrenaline. Unlike a vasovagal attack, anaphylaxis is usually accompanied by a rapid heartbeat.

      Initial management of anaphylaxis involves administering high-flow oxygen, laying the patient flat, and elevating their legs to combat hypotension. If the patient is experiencing respiratory distress or shock, epinephrine should be given intramuscularly. It is recommended that practices have vials of epinephrine 1:1000 solution on hand, along with the necessary syringes and needles.

      The recommended doses of epinephrine vary by age, with adults and children over 12 years receiving 0.5 ml (500 micrograms), children aged 6-12 receiving 0.3 ml (300 micrograms), and children under 6 receiving 0.15 ml (150 micrograms). Chlorpheniramine and hydrocortisone may also be given intramuscularly, but hydrocortisone is of secondary value in the initial management of anaphylaxis.

    • This question is part of the following fields:

      • Urgent And Unscheduled Care
      60.9
      Seconds
  • Question 10 - A 32-year-old woman presents to the clinic with complaints of urinary incontinence. She...

    Correct

    • A 32-year-old woman presents to the clinic with complaints of urinary incontinence. She recently gave birth to her second child through vaginal delivery about two months ago and has resumed exercising. However, she experiences incontinence during aerobics and jogging. On physical examination, she appears healthy with a blood pressure of 120/80 and a BMI of 24 kg/m2. Abdominal examination is normal. What is the best course of action for managing her condition?

      Your Answer: Refer her for supervised pelvic floor exercises

      Explanation:

      Treatment Options for Urinary Incontinence

      Urinary incontinence (UI) is a common condition that affects many women. Stress or mixed UI can be treated with supervised pelvic floor muscle training, which should be offered as first-line treatment for at least three months. Bladder training, oxybutynin, or solifenacin are treatments for overactive bladder, while sacral nerve stimulation is used for detrusor overactivity in patients who have failed conservative treatment. Pelvic floor exercises are effective in preventing and treating stress incontinence, and supervised exercises have been shown to improve symptoms post-pregnancy. Electrical stimulation or surgical referral are other options if exercises are ineffective. Urodynamic investigations before initial treatment do not improve outcomes.

    • This question is part of the following fields:

      • Kidney And Urology
      55.8
      Seconds
  • Question 11 - A 65-year-old woman with a past medical history of type 2 diabetes, hypertension...

    Correct

    • A 65-year-old woman with a past medical history of type 2 diabetes, hypertension and hypercholesterolaemia presents as an emergency. She was at home when she suddenly experienced weakness in her right arm and slurred speech. Her husband noticed that her face appeared droopy on one side and she had difficulty raising her right arm. The episode lasted for over an hour before things returned to normal. Her husband brought her to the clinic for evaluation. On examination, her blood pressure is 162/94 mmHg, she is in sinus rhythm at 72 bpm and there are no focal neurological findings. She reports feeling back to normal. The diagnosis is a transient ischaemic attack. What is the most appropriate management plan?

      Your Answer: Give aspirin 300 mg and arrange urgent assessment by a specialist stroke physician within 24 hours

      Explanation:

      Updated Guidance for TIA Management

      The old ABCD2 scoring system for TIA management has been replaced by updated guidance. If a patient has had a TIA within the last week, immediate administration of 300 mg aspirin is recommended. Urgent assessment by a specialist stroke physician should be arranged within 24 hours, unless the patient has a bleeding disorder or is taking an anticoagulant, in which case immediate admission for urgent assessment and imaging is necessary. If the patient is taking low-dose aspirin regularly, the current dose should be continued until reviewed by a specialist. If aspirin is contraindicated, management should be discussed urgently with the specialist team. These updated guidelines aim to improve the management of TIA and reduce the risk of stroke.

    • This question is part of the following fields:

      • Neurology
      110
      Seconds
  • Question 12 - A 24-year-old male visits his GP 3 weeks after a car accident, worried...

    Incorrect

    • A 24-year-old male visits his GP 3 weeks after a car accident, worried about experiencing heightened anxiety, fatigue, and headaches. He had undergone a CT scan of his brain immediately after the incident, which showed no anomalies. After 6 months, his symptoms have disappeared. What was the probable cause of his initial symptoms?

      Your Answer: Post-traumatic stress disorder

      Correct Answer: Post-concussion syndrome

      Explanation:

      Post-traumatic stress disorder typically has a delayed onset of symptoms and a protracted course.

      Understanding Post-Concussion Syndrome

      Post-concussion syndrome is a condition that can occur after a person experiences even a minor head injury. It is characterized by a range of symptoms that can persist for weeks or even months after the initial injury. The most common symptoms of post-concussion syndrome include headaches, fatigue, anxiety or depression, and dizziness.

      Individuals who experience post-concussion syndrome may find that their symptoms interfere with their daily activities and quality of life. They may struggle to concentrate or remember things, and they may feel irritable or moody. In some cases, post-concussion syndrome can also cause sleep disturbances or sensitivity to light and noise.

      While the exact cause of post-concussion syndrome is not fully understood, it is believed to be related to changes in brain function that occur after a head injury. Treatment for post-concussion syndrome may involve a combination of medications, therapy, and lifestyle changes to manage symptoms and promote healing. With proper care, many people with post-concussion syndrome are able to recover fully and return to their normal activities.

    • This question is part of the following fields:

      • Mental Health
      25.2
      Seconds
  • Question 13 - A 65-year-old man with oesophageal cancer is having difficulties with taking regular oral...

    Incorrect

    • A 65-year-old man with oesophageal cancer is having difficulties with taking regular oral morphine medications. After consulting with the oncology team, it is decided to switch him to transdermal fentanyl patches. He is currently taking 50 mg twice daily of modified-release oral morphine which has been effectively managing his pain. You prescribe a fentanyl '25' patch which provides the same level of pain relief. What instructions do you give the patient when starting to use the patches?

      Your Answer:

      Correct Answer: Continue to use the oral modified-release morphine for 72 hours following patch initiation

      Explanation:

      Considerations for Drug Delivery in Palliative Care

      Drug delivery is a crucial aspect to consider in palliative care, as patients may have difficulties with certain formulations or preparations. For instance, some patients may have trouble swallowing medication due to dysphagia, while others may be intolerant to specific preparations. In such cases, transdermal fentanyl and buprenorphine can be used as alternatives.

      However, it’s important to note that transdermal preparations may not be suitable for patients who require treatment for acute pain or those with variable pain relief needs. This is because the route of administration affects the pharmacokinetics, resulting in a delay in achieving a steady state.

      When switching from oral morphine preparations to transdermal fentanyl, the British National Formulary (BNF) provides a section on equivalent doses. For example, 60 mg daily of oral morphine equates to the fentanyl ’25’ patch. However, if the opioid problem is hyperalgesia, it’s recommended to cut the dose of the new opioid by one quarter to one half of the equivalent dose.

      It’s essential to consult the palliative care section in the BNF for further details on other dose equivalencies. Fentanyl patches should be applied every 72 hours, and patients may require extra analgesia for up to 24 hours after the patch is started due to its slow onset of action. Doses of the patch can be adjusted at 72-hour intervals.

      If a patient is taking a long-acting 12-hourly morphine, the patch should be applied when the last dose is given. On the other hand, if a patient is taking a short-acting morphine, it should be continued four hourly for the first 12 hours of patch use. By considering these drug delivery factors, healthcare professionals can provide effective pain relief for patients in palliative care.

    • This question is part of the following fields:

      • End Of Life
      0
      Seconds
  • Question 14 - A 75 year-old man is referred by his GP to the memory clinic...

    Incorrect

    • A 75 year-old man is referred by his GP to the memory clinic and is diagnosed with mild vascular dementia. He has a medical history of chronic obstructive pulmonary disease and early peripheral vascular disease. Which medication listed below would be the best option for treating his cognitive symptoms?

      Your Answer:

      Correct Answer: None of the above

      Explanation:

      Acetylcholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, are a class of drugs used to treat cognitive symptoms in mild to moderate Alzheimer’s dementia. The goal is to slow down the rate of decline, and approximately half of patients respond positively to the medication. However, it is challenging to determine the individual response as it is unknown how much deterioration would have occurred without the medication. Memantine, a glutamate receptor antagonist, is another drug used in Alzheimer’s disease and is recommended by NICE for severe dementia or when anticholinesterase inhibitors are not suitable. Rivastigmine can also be prescribed for dementia associated with Parkinson’s disease. Unfortunately, there are currently no medications available to treat cognitive symptoms in vascular dementia.

      Understanding the Causes of Dementia

      Dementia is a condition that affects millions of people worldwide, and it is caused by a variety of factors. The most common causes of dementia include Alzheimer’s disease, cerebrovascular disease, and Lewy body dementia. These conditions account for around 40-50% of all cases of dementia.

      However, there are also rarer causes of dementia, which account for around 5% of cases. These include Huntington’s disease, Creutzfeldt-Jakob disease (CJD), Pick’s disease, and HIV (in 50% of AIDS patients). These conditions are less common but can still have a significant impact on those affected.

      It is also important to note that there are several potentially treatable causes of dementia that should be ruled out before a diagnosis is made. These include hypothyroidism, Addison’s disease, B12/folate/thiamine deficiency, syphilis, brain tumours, normal pressure hydrocephalus, subdural haematoma, depression, and chronic drug use (such as alcohol or barbiturates).

      In conclusion, understanding the causes of dementia is crucial for effective diagnosis and treatment. While some causes are more common than others, it is important to consider all potential factors and rule out treatable conditions before making a final diagnosis.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 15 - Linda, a 26-year-old woman, visits you a week after giving birth to her...

    Incorrect

    • Linda, a 26-year-old woman, visits you a week after giving birth to her first child because she feels exhausted. She had gestational diabetes during her pregnancy and stopped taking metformin and insulin after delivery. However, she is concerned that her fatigue may be due to persistent diabetes. She has not experienced any symptoms of polydipsia or polyuria. You suggest performing a capillary glucose test, which yields a result of 5 mmol/L. She feels relieved but asks if there is any additional follow-up required.

      When would you recommend that Linda have a fasting plasma glucose test to rule out ongoing diabetes after giving birth?

      Your Answer:

      Correct Answer: 6 weeks

      Explanation:

      For women who have had gestational diabetes, it is recommended to offer a fasting plasma glucose test at 6 weeks after giving birth to rule out diabetes. This is in line with NICE guidelines, which suggest testing between 6-13 weeks postpartum. Testing at 10 days or 2 weeks is not sufficient to accurately assess the risk of developing type 2 diabetes. After 13 weeks, HbA1c testing can be used instead of fasting plasma glucose, but testing at 20 weeks or later is not recommended.

      Gestational diabetes is a common medical disorder that affects around 4% of pregnancies. It can develop during pregnancy or be a pre-existing condition. According to NICE, 87.5% of cases are gestational diabetes, 7.5% are type 1 diabetes, and 5% are type 2 diabetes. Risk factors for gestational diabetes include a BMI of > 30 kg/m², previous gestational diabetes, a family history of diabetes, and family origin with a high prevalence of diabetes. Screening for gestational diabetes involves an oral glucose tolerance test (OGTT), which should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.

      To diagnose gestational diabetes, NICE recommends using the following thresholds: fasting glucose is >= 5.6 mmol/L or 2-hour glucose is >= 7.8 mmol/L. Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week and taught about self-monitoring of blood glucose. Advice about diet and exercise should be given, and if glucose targets are not met within 1-2 weeks of altering diet/exercise, metformin should be started. If glucose targets are still not met, insulin should be added to the treatment plan.

      For women with pre-existing diabetes, weight loss is recommended for those with a BMI of > 27 kg/m^2. Oral hypoglycaemic agents, apart from metformin, should be stopped, and insulin should be commenced. Folic acid 5 mg/day should be taken from preconception to 12 weeks gestation, and a detailed anomaly scan at 20 weeks, including four-chamber view of the heart and outflow tracts, should be performed. Tight glycaemic control reduces complication rates, and retinopathy should be treated as it can worsen during pregnancy.

      Targets for self-monitoring of pregnant women with diabetes include a fasting glucose level of 5.3 mmol/l and a 1-hour or 2-hour glucose level after meals of 7.8 mmol/l or 6.4 mmol/l, respectively. It is important to manage gestational diabetes and pre-existing diabetes during pregnancy to reduce the risk of complications for both the mother and baby.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      0
      Seconds
  • Question 16 - A 35-year-old woman presents to the clinic for her lab results. She is...

    Incorrect

    • A 35-year-old woman presents to the clinic for her lab results. She is currently 28 weeks pregnant and has undergone a glucose tolerance test.

      The lab findings are as follows:

      Fasting glucose 6.9 mmol/L
      2-hour glucose 8.5 mmol/L

      What would be the best course of action to take next?

      Your Answer:

      Correct Answer: Insulin

      Explanation:

      If a woman is diagnosed with gestational diabetes and her fasting glucose level is equal to or greater than 7 mmol/l, immediate insulin (with or without metformin) should be initiated.

      In this scenario, the patient’s fasting glucose level is above 7 mmol/L, indicating the need for immediate insulin therapy (with or without metformin). The diagnosis of gestational diabetes is based on a fasting plasma glucose level of > 5.6 mmol/L or a 2-hour plasma glucose level of >/= 7.8 mmol/L.

      While dietary advice is an essential aspect of diabetes management, it is not sufficient in this case due to the elevated fasting glucose level.

      Gliclazide is not a suitable option for gestational diabetes treatment because sulfonylureas are not recommended during pregnancy due to the risk of neonatal hypoglycemia.

      Metformin may be used in the management of gestational diabetes, but in cases where the fasting glucose level is equal to or greater than 7 mmol/L, insulin is the preferred treatment option. Insulin and metformin can be used together to manage gestational diabetes.

      Since both the fasting glucose and 2-hour glucose levels are elevated, there is no need to repeat the test as the diagnosis of gestational diabetes is conclusive.

      Gestational diabetes is a common medical disorder that affects around 4% of pregnancies. It can develop during pregnancy or be a pre-existing condition. According to NICE, 87.5% of cases are gestational diabetes, 7.5% are type 1 diabetes, and 5% are type 2 diabetes. Risk factors for gestational diabetes include a BMI of > 30 kg/m², previous gestational diabetes, a family history of diabetes, and family origin with a high prevalence of diabetes. Screening for gestational diabetes involves an oral glucose tolerance test (OGTT), which should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.

      To diagnose gestational diabetes, NICE recommends using the following thresholds: fasting glucose is >= 5.6 mmol/L or 2-hour glucose is >= 7.8 mmol/L. Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week and taught about self-monitoring of blood glucose. Advice about diet and exercise should be given, and if glucose targets are not met within 1-2 weeks of altering diet/exercise, metformin should be started. If glucose targets are still not met, insulin should be added to the treatment plan.

      For women with pre-existing diabetes, weight loss is recommended for those with a BMI of > 27 kg/m^2. Oral hypoglycaemic agents, apart from metformin, should be stopped, and insulin should be commenced. Folic acid 5 mg/day should be taken from preconception to 12 weeks gestation, and a detailed anomaly scan at 20 weeks, including four-chamber view of the heart and outflow tracts, should be performed. Tight glycaemic control reduces complication rates, and retinopathy should be treated as it can worsen during pregnancy.

      Targets for self-monitoring of pregnant women with diabetes include a fasting glucose level of 5.3 mmol/l and a 1-hour or 2-hour glucose level after meals of 7.8 mmol/l or 6.4 mmol/l, respectively. It is important to manage gestational diabetes and pre-existing diabetes during pregnancy to reduce the risk of complications for both the mother and baby.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      0
      Seconds
  • Question 17 - A 16-year-old secretary presents to you with an increased dry cough and an...

    Incorrect

    • A 16-year-old secretary presents to you with an increased dry cough and an intermittently wheezy chest at night, eight weeks after seeing the respiratory nurse at the surgery. She reports no fevers and no difficulties in breathing. Currently, she is taking Fostair (Beclomethasone diproprionate 100 mcg/Formetorol fumarate 6 mcg) combination inhaler, 1 puff twice daily, and salbutamol as needed for shortness of breath. Previously, she was using Clenil (Beclomethasone 100 mcg), but feels that the new inhaler has helped slightly since her last appointment with the nurse. According to the latest SIGN/BTS guidance, what would be the next step in managing her asthma?

      Your Answer:

      Correct Answer: Increase the Fostair to two puffs twice daily

      Explanation:

      Managing Chronic Asthma in Adults

      When managing chronic asthma in adults, it is important to consider the patient’s current treatment plan and symptoms. In this scenario, the patient is already taking a combination inhaler and is experiencing suboptimal control of her asthma. It is important to note that this is not an acute attack and the children’s guidelines do not apply. Antibiotics are not recommended as the symptoms are not consistent with an infective exacerbation. Increasing the usage of salbutamol is also not recommended as the patient needs better overall control of her symptoms. Instead, the dose of the inhaled corticosteroid should be increased, which is in line with the next step in the treatment of asthma in adults according to the British Thoracic Society guidelines. It is important for healthcare professionals to be familiar with both SIGN and NICE guidance and be able to compare and contrast their advice.

    • This question is part of the following fields:

      • Respiratory Health
      0
      Seconds
  • Question 18 - A 70-year-old woman is discharged from hospital following an operation. Methicillin-resistant Staphylococcus aureus...

    Incorrect

    • A 70-year-old woman is discharged from hospital following an operation. Methicillin-resistant Staphylococcus aureus (MRSA) has been grown from a wound swab.
      Select from the list the most common cause of a hospital-acquired wound infection.

      Your Answer:

      Correct Answer: Insufficient hand disinfection

      Explanation:

      Preventing Nosocomial Infections in Hospitals: Identification, Control, and Measures

      Insufficient hand disinfection is the leading cause of wound infections acquired in hospitals. The primary objective of hospital infection control is to prevent nosocomial infections. To achieve this, clinical and epidemiological investigations must first identify hospital-acquired infections as either endemic or epidemic. Identifying and typing the isolates causing nosocomial infections can help recognize organisms that are epidemiologically linked. Invasive multiresistant organisms, such as MRSA, often require infection-control measures to prevent their spread, which can minimize the use of expensive and sometimes toxic antibiotics required for their prophylaxis and treatment.

      Epidemic outbreaks can be controlled by measures that interrupt the spread of infection, such as the use of gowns, gloves, and careful hand-washing by those attending patients. Transfer of colonized or infected patients to a single room or an isolation ward is a physical means of preventing spread. Patients infected with the same organism can be grouped together and attended to by a cohort of nurses not involved with uninfected patients. Identification of additional carriers and elimination of colonization may be necessary for some epidemic outbreaks. Although controlled trials demonstrating the efficacy of such measures have not been performed, many observational studies support their use.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      0
      Seconds
  • Question 19 - A 42-year-old woman comes to you complaining of fatigue and absence of menstrual...

    Incorrect

    • A 42-year-old woman comes to you complaining of fatigue and absence of menstrual periods. She reports not having had a period for the past four months and has gained some weight. You order an FBC, U&E and LFTs, which all come back normal except for an elevated alkaline phosphatase level. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Primary biliary cholangitis

      Explanation:

      Pregnancy is one of the possible causes of raised alkaline phosphatase, which could be the case based on the patient’s history. To confirm this, a urinary HCG test is recommended. However, the combination of fatigue, absence of menstrual periods, weight gain, and elevated alkaline phosphatase suggests a more probable diagnosis of primary biliary cholangitis, especially considering the patient’s age and gender. This is typically accompanied by severe itching and some degree of dyslipidemia. On the other hand, hypothyroidism usually results in menorrhagia. It is important to consider these potential causes when evaluating a patient with elevated alkaline phosphatase levels.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      0
      Seconds
  • Question 20 - A 30-year-old patient who has been under your care for four years contacts...

    Incorrect

    • A 30-year-old patient who has been under your care for four years contacts you over the phone, requesting antibiotics for a suspected UTI. She complains of dysuria and frequency for the past two days and had a confirmed UTI with the same symptoms last year. As per GMC guidelines, what would be the most suitable course of action?

      Your Answer:

      Correct Answer: Antibiotics can be prescribed, with normal safeguards and advice

      Explanation:

      GMC Guidelines for Prescribing and Managing Medicines and Devices

      Prescribing and managing medicines and devices is a crucial aspect of a doctor’s role. The General Medical Council (GMC) has published guidelines for good practice in prescribing medicines, which were last updated in 2008. The principles of prescribing include only prescribing drugs to meet the identified needs of patients and avoiding treating oneself or those close to them. Doctors with full registration may prescribe all medicines except those in Schedule 1 of the Misuse of Drugs Regulations 2001.

      To ensure that doctors prescribe in patients’ best interests, the guidelines recommend keeping up to date with the British National Formulary (BNF), National Institute for Health and Care Excellence (NICE), and Scottish Intercollegiate Guidelines Network (SIGN). Doctors should also report adverse reactions to medicines to the Committee on the Safety of Medicines through the Yellow Card Scheme. If a nurse or other healthcare professional without prescribing rights recommends a treatment, the doctor must ensure that the prescription is appropriate for the patient and that the professional is competent to have recommended it.

      The guidelines also address doctors’ interests in pharmacies, emphasizing the importance of ensuring that patients have access to information about any financial or commercial interests the doctor or their employer may have in a pharmacy. When it comes to prescribing controlled drugs for oneself or someone close, doctors should avoid doing so whenever possible and should be registered with a GP outside their family. If no other person with the legal right to prescribe is available, doctors may prescribe a controlled drug only if it is immediately necessary to save a life, avoid serious deterioration in the patient’s health, or alleviate otherwise uncontrollable pain.

      Finally, the guidelines provide recommendations for remote prescribing via telephone, email, fax, video link, or a website. While this is supported, doctors must give an explanation of the processes involved in remote consultations and provide their name and GMC number to the patient if they are not providing continuing care. By following these guidelines, doctors can ensure that they prescribe and manage medicines and devices in the best interests of their patients.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 21 - A new antiplatelet agent has been proven to reduce the risk of heart...

    Incorrect

    • A new antiplatelet agent has been proven to reduce the risk of heart attack in a year from 15% in patients treated with conventional treatment to 10% in patients treated with conventional treatment plus the new agent.

      The cost of this new drug is £150 per month.

      How much extra would a hospital need to spend over the course of a year to prevent one heart attack?

      Your Answer:

      Correct Answer: £30,000

      Explanation:

      Calculation of Cost to Prevent Stroke

      The calculation of the cost to prevent a stroke involves determining the absolute risk reduction and the number needed to treat. In this case, the absolute risk reduction is 4%, which means that 25 patients would need to be treated to prevent one stroke. Assuming a cost of £100 per month for 12 months, the total cost to prevent a stroke would be £30,000. This calculation is important for healthcare providers and policymakers to consider when making decisions about the allocation of resources for stroke prevention.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      0
      Seconds
  • Question 22 - A 12-year-old girl presents with a six-month history of intermittent nosebleeds from both...

    Incorrect

    • A 12-year-old girl presents with a six-month history of intermittent nosebleeds from both nostrils. She has prominent Little’s area vessels on both sides of her nasal septum. What is the most suitable course of action?

      Your Answer:

      Correct Answer: Unilateral nasal cautery and antibiotic cream

      Explanation:

      Treatment Options for Epistaxis (Nosebleeds)

      Epistaxis, or nosebleeds, can be a common occurrence and can often be managed with simple interventions. Here are some treatment options:

      Unilateral Nasal Cautery and Antibiotic Cream
      Chemical cautery using a silver nitrate stick can be used to produce local chemical damage in the mucosa. After cautery, Naseptin® cream should be applied to the nostrils four times daily for ten days. This treatment option is effective for most cases of epistaxis.

      Ear, Nose, and Throat Specialist Referral
      Referral to an ear, nose, and throat specialist should be considered if the person has recurrent episodes of epistaxis and is at high risk of having a serious underlying cause.

      Anterior Nasal Packing
      If bleeding continues despite cautery or if a bleeding point cannot be seen, the nose can be packed with nasal sponges or ribbon gauze.

      Bilateral Nasal Cautery
      Only one side of the septum should be cauterized, as there is a small risk of septal perforation resulting from decreased vascularization to the septal cartilage. A 4–6-week interval between cautery treatments is recommended.

      Iron Tablets
      Iron tablets are not appropriate without a diagnosis of anemia.

      Managing Epistaxis: Treatment Options to Consider

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 23 - In your practice area there is sheltered accommodation for a small number of...

    Incorrect

    • In your practice area there is sheltered accommodation for a small number of young adults with general learning disability.
      Which of the following is the correct statement concerning general learning disability?

      Your Answer:

      Correct Answer: Expressive language skills may be better than receptive skills

      Explanation:

      Understanding General Learning Disability: Causes, Symptoms, and Management

      General learning disability is a condition characterized by incomplete or arrested development of the mind, which is evident from childhood. This term is now recommended in the United Kingdom to replace outdated terms such as mental handicap and mental retardation. The majority of patients have mild learning disability, with an Intelligence Quotient (IQ) of 50-70. The causes of this condition are varied, including genetic, metabolic, and events during pregnancy, childbirth, and the postnatal period. Patients with general learning disability often have associated physical, psychological, and behavioral problems.

      Psychotropic drugs are commonly used to manage behavioral problems, but they are rarely beneficial. Before resorting to medication, doctors should first check for any sources of discomfort, such as earache or toothache. When communicating with patients, it is important to address them directly and obtain as much history as possible from them. However, doctors should also be aware that there may be incongruence between receptive and expressive verbal skills, and patients may not fully understand the questions being asked.

      Most adults with general learning disability have limited economic opportunities. It is important to understand this condition and provide appropriate support and management to improve the quality of life for patients and their families.

    • This question is part of the following fields:

      • Neurodevelopmental Disorders, Intellectual And Social Disability
      0
      Seconds
  • Question 24 - An 80-year-old woman presents for medical review. She has a medical history of...

    Incorrect

    • An 80-year-old woman presents for medical review. She has a medical history of hypertension, angina, and osteoarthritis. Her current medications include aspirin 75 mg OD, ramipril 5 mg OD, bisoprolol 10 mg OD, simvastatin 40 mg OD, paracetamol 1g QDS, and topical ketoprofen gel PRN. She reports that despite using paracetamol and topical NSAID, she still experiences pain in her hands and knees due to osteoarthritis. What would be the most appropriate next step in her pharmacological management?

      Your Answer:

      Correct Answer: Prescribe an oral paracetamol and codeine combination (for example, co-codamol)

      Explanation:

      Pharmacological Management of Osteoarthritis

      Here we have a patient with knee and hand osteoarthritis who is currently taking oral paracetamol and a topical anti-inflammatory but still experiences symptoms. The next step in treatment options would be an oral NSAID, COX-2 inhibitor, or opioid analgesic. However, since the patient has a cardiac history and is already taking aspirin, an opioid analgesic would be the safest option. It is important to consider the potential risks and benefits of NSAID use, particularly their potential gastrointestinal, liver, and cardio-renal toxicity.

      To add an opioid analgesic, oral codeine can be prescribed and combined with paracetamol in a co-codamol. It is recommended to initiate patients on separate products, starting at a low dose and titrating as needed. This allows for determining what works best for the patient and avoiding unnecessary medication with increased side-effect risk. Dose reduction of paracetamol is also gaining momentum in patients aged 70 or over, which should be considered when using co-products.

      In summary, the pharmacological management of osteoarthritis should be carefully considered, taking into account the patient’s medical history and potential risks and benefits of different treatment options.

    • This question is part of the following fields:

      • Musculoskeletal Health
      0
      Seconds
  • Question 25 - A 63-year-old poorly controlled, diabetic man comes back to your clinic with persistent...

    Incorrect

    • A 63-year-old poorly controlled, diabetic man comes back to your clinic with persistent swelling and pain in his left ankle over the past 4 weeks. He was previously evaluated by one of your colleagues who ordered an ankle x-ray. The result revealed significant disruption and subluxation of the tarsometatarsal joints. His HbA1c level was 74mmol/mol two months ago.

      What condition is the patient most likely suffering from?

      Your Answer:

      Correct Answer: Charcot joint

      Explanation:

      When a patient with poorly controlled diabetes presents with foot pain lasting more than a week, it is important to consider the possibility of Charcot joint. While septic arthritis should be ruled out in a hot swollen joint, this patient’s symptoms have persisted for several weeks, making septic arthritis less likely. Gout or pseudogout may also be considered, but typically affect the 1st MTPJ and are often recurrent. An anterior talo-fibular ligament tear could be a potential cause of forefoot pain and swelling, but would require a history of trauma. Ultimately, Charcot joint should be considered as a possible diagnosis in this patient.

      Understanding Charcot Joints

      A Charcot joint, also known as a neuropathic joint, is a condition where a joint becomes severely damaged due to a loss of sensation. While it was previously caused by syphilis, it is now commonly seen in diabetic patients. Despite the degree of joint disruption, Charcot joints are typically less painful than expected due to the sensory neuropathy. However, patients may still experience some degree of pain, with 75% reporting it. The joint is often swollen, red, and warm.

      Charcot joints are characterized by extensive bone remodeling and fragmentation, particularly in the midfoot. This condition can cause significant disability and deformity if left untreated. Therefore, early diagnosis and management are crucial to prevent further damage and improve outcomes.

    • This question is part of the following fields:

      • Musculoskeletal Health
      0
      Seconds
  • Question 26 - An 80-year-old woman comes to her General Practitioner complaining of generalised muscle aches...

    Incorrect

    • An 80-year-old woman comes to her General Practitioner complaining of generalised muscle aches and pains that have been increasing in severity. She reports that the symptoms occur in her upper arms and are not accompanied by any head or neck symptoms. She also mentions that the symptoms worsen after rest. A recent blood test shows her ESR to be 98 mm/hr (normal range: 0–29 mm/hr). Her weight and appetite are stable, and she is a diet-controlled diabetic. What is the most likely diagnosis? Choose ONE option only.

      Your Answer:

      Correct Answer: Polymyalgia rheumatica (PMR)

      Explanation:

      Differential Diagnosis for Generalized Muscle Aches and Elevated ESR

      Polymyalgia rheumatica (PMR) is a likely diagnosis for a patient presenting with generalized proximal muscle aches and an elevated ESR, especially if they are over the age of 50. Treatment with prednisolone can quickly resolve symptoms and confirm the diagnosis. Cervical spondylosis may cause cervical pain and stiffness worsened by movement, but typically exhibits normal ESR levels. Giant-cell arteritis (GCA) presents with headache and scalp tenderness, along with significantly elevated ESR levels. Immediate specialist referral is required due to the risk of vision loss. Multiple myeloma (MM) can present with a variety of symptoms, including hypercalcaemia, anaemia, renal impairment, and bone pain, but the patient in question doesn’t describe any of these symptoms specifically. The ESR is typically increased in MM, but this is not specific. Rheumatoid arthritis typically presents with an insidious symmetrical polyarthritis, often with nonspecific systemic symptoms, and the ESR is usually raised.

    • This question is part of the following fields:

      • Musculoskeletal Health
      0
      Seconds
  • Question 27 - A 48-year-old woman presents to her General Practitioner with a 3-week history of...

    Incorrect

    • A 48-year-old woman presents to her General Practitioner with a 3-week history of intermittent rectal bleeding. She says she doesn't usually look but has noticed blood within her stools on several occasions over the past few weeks. She is a non-smoker and is normally fit and well, with no significant family history or past medical history. A diagnosis of colonic carcinoma is suspected.
      Which of the following presenting symptoms would most support this diagnosis?

      Your Answer:

      Correct Answer: Abdominal pain

      Explanation:

      Symptoms and Possible Underlying Pathologies: A Case Study

      Abdominal pain, abdominal bloating, alternating diarrhea and constipation, macrocytic anemia, and mucous per rectum are all symptoms that can indicate different underlying pathologies. In the case of a patient under 50 years old presenting with rectal bleeding, abdominal pain may suggest a more serious underlying pathology, such as colorectal cancer. According to NICE guidance, a suspected cancer pathway referral should be considered in such cases. Abdominal bloating, on the other hand, is more likely to be a symptom of irritable bowel disease. Alternating diarrhea and constipation, as well as mucous per rectum, are indicators of functional bowel disorders, such as irritable bowel syndrome. Finally, macrocytic anemia, while not associated with colorectal cancer, may warrant further investigation if found. Understanding the different symptoms and their possible underlying pathologies is crucial in making an accurate diagnosis and providing appropriate treatment.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 28 - What genetic condition would affect the age at which breast cancer screening should...

    Incorrect

    • What genetic condition would affect the age at which breast cancer screening should begin?

      Your Answer:

      Correct Answer: BRCA

      Explanation:

      Genetic Mutations and Cancer Risk

      Genetic mutations can increase an individual’s risk of developing cancer. However, not all mutations increase the risk of breast cancer. Only the BRCA1 and BRCA2 mutations are associated with an increased risk of breast cancer. Women who carry these mutations should not follow the usual screening program. Instead, they should have yearly MRI scans starting at age 30.

      Other genetic conditions also predispose individuals to different types of cancer. Familial adenomatous polyposis (FAP) increases the risk of early onset bowel cancer. Multiple endocrine neoplasia type 1 (MEN1) puts people at risk of parathyroid cancer, carcinoid, insulinoma, gastrinomas, angiofibromas, pituitary tumors, collagenomas, and lipomas. Von Hippel-Lindau (VHL) syndrome increases the risk of renal cell carcinoma, phaeochromocytoma, and retinal and CNS haemangioblastomas, as well as other rarer forms of cancer. Blount syndrome is a disorder of the tibial growth plate leading to bowing.

      If women think they have a high risk of breast cancer due to family history but do not know if they carry BRCA or TP53 gene, they can be referred to a specialist breast clinic to have their risk assessed. It is important to be aware of these genetic mutations and conditions to take appropriate measures to reduce the risk of cancer.

    • This question is part of the following fields:

      • Genomic Medicine
      0
      Seconds
  • Question 29 - A 15-year-old sustains an injury playing football and presents with pain in the...

    Incorrect

    • A 15-year-old sustains an injury playing football and presents with pain in the thigh and a shorter leg.

      Possible diagnoses include which of the following?

      Your Answer:

      Correct Answer: Slipped femoral epiphysis

      Explanation:

      Slipped Upper Femoral Epiphysis

      Slipped upper femoral epiphysis is a condition that primarily affects boys aged 10 to 15. It occurs when the upper femoral epiphysis slips in a posterior inferior direction with respect to the femur. The exact cause of this condition is unclear, but it has been suggested that hormonal or calcification abnormalities may play a role. Obese children with delayed secondary sexual development or tall thin boys are particularly susceptible.

      Symptoms of slipped upper femoral epiphysis include rest pain, limp, pain on movement, reduced range of abduction and internal rotation, and an externally rotated and shortened affected leg. It is important to note that musculoskeletal disease doesn’t typically present with a shortened leg.

      Other conditions that may be mistaken for slipped upper femoral epiphysis include Perthes’ disease, Osgood-Schlatter syndrome, and chondromalacia patellae. Perthes’ disease is avascular necrosis of the femoral head in childhood, while Osgood-Schlatter syndrome is an overuse syndrome associated with physical exertion before skeletal maturity. Chondromalacia patellae is softening of the articular cartilage of the patella usually caused by indirect trauma.

    • This question is part of the following fields:

      • Children And Young People
      0
      Seconds
  • Question 30 - A 30-year-old man from Iraq is diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. What...

    Incorrect

    • A 30-year-old man from Iraq is diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. What is the safe antibiotic that can be prescribed to him?

      Your Answer:

      Correct Answer: Co-amoxiclav

      Explanation:

      Drugs to Avoid in G6PD Deficiency

      G6PD deficiency is a genetic disorder that affects the red blood cells and can lead to haemolytic anaemia. Certain drugs and substances can trigger a haemolytic crisis in individuals with G6PD deficiency. Here are some drugs that should be avoided:

      1. Quinolones: Ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, and ofloxacin.

      2. Sulphonamides: Co-trimoxazole (sulphamethoxazole and trimethoprim).

      3. Nitrofurantoin.

      4. Antimalarials: Chloroquine, primaquine, and quinine.

      5. Chloramphenicol.

      6. Isoniazid.

      7. Dapsone.

      8. Sulphonylureas such as glibenclamide.

      9. Vitamin K analogues.

      10. Aspirin (a dose up to 1 g daily is usually harmless) and paracetamol.

      11. Probenecid.

      12. Ascorbic acid.

      13. Isosorbide dinitrate.

      It is also important to avoid fava beans, severe infections, diabetic ketoacidosis, and acute kidney injury as they can also trigger a haemolytic crisis. However, co-amoxiclav is not known to precipitate haemolysis. G6PD deficiency was first discovered during an investigation of haemolytic anaemia occurring in some individuals treated for malaria with primaquine. It is important to consult with a healthcare provider before taking any medication if you have G6PD deficiency.

    • This question is part of the following fields:

      • Haematology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gynaecology And Breast (0/1) 0%
Consulting In General Practice (0/1) 0%
Maternity And Reproductive Health (0/1) 0%
Eyes And Vision (1/1) 100%
Cardiovascular Health (1/1) 100%
Older Adults (0/1) 0%
Infectious Disease And Travel Health (1/1) 100%
Urgent And Unscheduled Care (2/2) 100%
Kidney And Urology (1/1) 100%
Neurology (1/1) 100%
Mental Health (0/1) 0%
Passmed