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  • Question 1 - A 59-year-old lady, whose mother has osteoporosis but no fractures, visited your clinic...

    Incorrect

    • A 59-year-old lady, whose mother has osteoporosis but no fractures, visited your clinic seeking advice.

      She has never smoked, doesn't use steroids, has no significant health issues, and has never experienced a fracture. Her menopause began at age 52. She has no other risk factors for osteoporosis. She refuses to take medication but wants to know about lifestyle modifications that can lower her chances of developing osteoporosis.

      What is the most suitable course of action to manage this patient's concerns?

      Your Answer: Her daily calcium intake is 800 mg per day so you would prescribe a calcium supplement to reduce her risk of fracture

      Correct Answer: She should be encouraged to undertake weight-bearing aerobic exercise and resistance exercise which have been shown to increase spine bone density in postmenopausal women

      Explanation:

      Exercise and Management of Osteoporosis in Postmenopausal Women

      A Cochrane Review has found that postmenopausal women can increase their bone mineral density (BMD) through various exercises such as aerobics, weight-bearing, and resistance exercises. However, a DXA scan may not be necessary for women who do not meet the 1999 RCP guidance or NICE criteria for bisphosphonate use. Additionally, calcium supplementation may not reduce fractures in otherwise healthy women over 50 years old, and HRT is not recommended as a first-line intervention due to associated risks. Hormone replacement therapy can be used to maintain bone density in women with premature menopause until they reach age 50. It is important to consider individual risk factors and appropriate interventions for the management of osteoporosis in postmenopausal women.

    • This question is part of the following fields:

      • Musculoskeletal Health
      55.4
      Seconds
  • Question 2 - A 23-year-old female contacts you seeking guidance. She missed taking her Microgynon 30...

    Correct

    • A 23-year-old female contacts you seeking guidance. She missed taking her Microgynon 30 pill yesterday. For the past 14 days, she has been sexually active with her partner. She is currently on her fifth day of a new pill packet and has not missed any other pills.

      What advice would you provide?

      Your Answer: Take the missed pill as soon as possible, no additional measures needed

      Explanation:

      If one COCP pill is missed, the patient should take the last pill as soon as possible, but no additional action is required.

      The Faculty of Sexual and Reproductive Healthcare (FSRH) has updated their advice for women taking a combined oral contraceptive (COC) pill containing 30-35 micrograms of ethinylestradiol. If one pill is missed at any time during the cycle, the woman should take the last pill, even if it means taking two pills in one day, and then continue taking pills daily, one each day. No additional contraceptive protection is needed. However, if two or more pills are missed, the woman should take the last pill, leave any earlier missed pills, and then continue taking pills daily, one each day. She should use condoms or abstain from sex until she has taken pills for seven days in a row. If pills are missed in week one, emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week one. If pills are missed in week two, after seven consecutive days of taking the COC, there is no need for emergency contraception. If pills are missed in week three, she should finish the pills in her current pack and start a new pack the next day, thus omitting the pill-free interval. Theoretically, women would be protected if they took the COC in a pattern of seven days on, seven days off.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      24.5
      Seconds
  • Question 3 - A 14-year-old patient is admitted to the Emergency Department with abdominal pain, polyuria...

    Incorrect

    • A 14-year-old patient is admitted to the Emergency Department with abdominal pain, polyuria and polydipsia which have particularly worsened over 72 hours. His parents called an ambulance when he became confused and unwell. After an initial workup, he is given a new diagnosis of type I diabetes and is found to be in diabetic ketoacidosis (DKA). His father tells the admitting doctor that the patient’s maternal grandparents both have diabetes.
      Which of the following most reliably suggests that a patient presenting with diabetes has the type 1 variety?

      Your Answer: Onset below 20 years of age

      Correct Answer: History of recent weight loss

      Explanation:

      Understanding the Factors that Differentiate Type I and Type II Diabetes

      Type I diabetes is characterized by the autoimmune destruction of pancreatic beta cells, which produce insulin. This results in absolute insulin deficiency, leading to the use of fat and muscle for energy and rapid weight loss. On the other hand, type II diabetes is associated with insulin resistance, but some insulin is still being produced and is at least partially effective. Factors that differentiate the two types include the presence of diabetic retinopathy, family history of diabetes, hypertriglyceridaemia, and onset age. Recent weight loss is a better predictor of type I diabetes.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      37.3
      Seconds
  • Question 4 - A 65-year-old Caucasian smoker presents to you with a two month history of...

    Incorrect

    • A 65-year-old Caucasian smoker presents to you with a two month history of a cough. The cough is non-productive, but he has coughed up spots of blood on occasion. He has also lost 10 pounds in weight, which he attributes to a reduced appetite since his wife started a healthy eating regime at home.

      Upon examination, he has lost weight, but he is afebrile and appears to be in good health. His 4-year-old grandson whom he sees twice a week has recently been diagnosed with whooping cough, and he wonders if he could have whooping cough as well.

      What is the most probable diagnosis?

      Your Answer: Tuberculosis

      Correct Answer: Malignancy

      Explanation:

      Managing a Patient Who is a Contact of an Infectious Disease

      When managing a patient who is a contact of an infectious disease, it is crucial to consider the full differential diagnosis and take an overview of the clinical picture. In this case, the patient presented with haemoptysis, which could be a symptom of various conditions.

      Bronchopneumonia is a possible cause, but it typically presents with fever and general malaise. Chronic bronchitis is unlikely to result in haemoptysis, and tuberculosis is not probable in a Caucasian man with no history of travel or contact with the disease. Pertussis is also not a likely cause of haemoptysis.

      The most probable diagnosis, which needs to be ruled out, is malignancy. Therefore, a thorough evaluation and appropriate testing should be conducted to determine the underlying cause of the patient’s symptoms.

    • This question is part of the following fields:

      • Population Health
      46.9
      Seconds
  • Question 5 - A 35-year-old teacher complains of low mood and poor sleep for ten days....

    Incorrect

    • A 35-year-old teacher complains of low mood and poor sleep for ten days. She has been working very hard in preparation for a school inspection due next week. She got married eight months ago and denies any problems at home. She is looking forward to a planned trip to Italy in two months time.

      She has been fit and well up to this point with no personal or family history of mental health problems. Her only medication is Microgynon 30. She has several good friends who have noticed that she is not herself and who wonder if she is depressed. She has taken to drinking half a bottle of wine every night while working late.

      After fully assessing her, what is likely to be the best way to approach her management?

      Your Answer:

      Correct Answer: General advice and active monitoring

      Explanation:

      Management of Subthreshold Depressive Symptoms

      This patient is currently experiencing subthreshold depressive symptoms that have lasted for less than two weeks. The cause of her symptoms is likely due to a stressful period at work, which is expected to end soon. Fortunately, she has a strong support network. According to NICE guidance on Depression in adults (CG90), medication is not recommended at this stage. Instead, CBT should be considered for persistent subthreshold depressive symptoms. St John’s wort is not recommended due to its interaction with the oral contraceptive pill and lack of evidence of effective dose and variation between preparations. NICE has suggested that short term dynamic psychotherapy be evaluated in a formal research setting. After a thorough assessment, the patient should be advised on sleep hygiene and reducing alcohol intake. She should also receive written information about depression and be scheduled for a follow-up appointment within two weeks at most.

    • This question is part of the following fields:

      • Mental Health
      0
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  • Question 6 - A 38-year-old woman comes to the General Practitioner for an urgent appointment. She...

    Incorrect

    • A 38-year-old woman comes to the General Practitioner for an urgent appointment. She has a diffuse headache, which she describes as severe. The headache is acute, having developed within the last three hours. She lost consciousness for a brief period. There is no significant past medical history.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Subarachnoid haemorrhage

      Explanation:

      When a patient presents with a sudden, severe headache, subarachnoid haemorrhage should be considered as a possible cause, with or without loss of consciousness. Menigeal irritation may take some time to appear. In cases of epilepsy, postictal headaches are common, lasting between six and 24 hours. Cluster headaches are characterized by rapid onset and unilateral pain around the eye, temple or forehead, often accompanied by lacrimation or rhinorrhoea. Migraines are also unilateral and may be preceded by an aura, with associated nausea and vomiting. TIAs usually present with focal neurological symptoms, rather than headaches, and loss of consciousness is not typical.

    • This question is part of the following fields:

      • Neurology
      0
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  • Question 7 - A 27 year-old female patient, who is not pregnant, reports experiencing dysuria, urinary...

    Incorrect

    • A 27 year-old female patient, who is not pregnant, reports experiencing dysuria, urinary frequency, and low abdominal pain for the past two days. She denies having a fever or loin pain and is not currently menstruating. Upon conducting a urine dip, it was discovered that she has 3+ leucocytes, nitrites, and 2+ blood. The patient has no prior history of UTI. What is the appropriate course of action for managing this condition?

      Your Answer:

      Correct Answer: Send a urine sample for culture and treat with oral antibiotics for 3 days

      Explanation:

      For women with haematuria and suspected UTI, NICE recommends urine culture and sensitivity to confirm infection. Treatment with trimethoprim or nitrofurantoin for 3 days is recommended, which may be extended to 5-10 days in certain cases. After treatment, urine should be re-tested for blood. Persistent haematuria requires urgent referral to exclude urological cancer. For non-visible haematuria in women under 50, urine albumin/creatinine ratio and serum creatinine levels should be measured. Referral to a renal physician is necessary if there is proteinuria or declining eGFR, and referral to a urologist is needed if eGFR is normal and there is no proteinuria.

      Urinary tract infections (UTIs) are common in adults and can affect different parts of the urinary tract. Lower UTIs are more common and can be managed with antibiotics. For non-pregnant women, local antibiotic guidelines should be followed, and a urine culture should be sent if they are aged over 65 years or have visible or non-visible haematuria. Trimethoprim or nitrofurantoin for three days are recommended by NICE Clinical Knowledge Summaries. Pregnant women with symptoms should have a urine culture sent, and first-line treatment is nitrofurantoin, while amoxicillin or cefalexin can be used as second-line treatment. Asymptomatic bacteriuria in pregnant women should also be treated with antibiotics. Men with UTIs should be offered antibiotics for seven days, and a urine culture should be sent before starting treatment. Catheterised patients should not be treated for asymptomatic bacteriuria, but if they are symptomatic, a seven-day course of antibiotics should be given, and the catheter should be removed or changed if it has been in place for more than seven days. For patients with signs of acute pyelonephritis, hospital admission should be considered, and local antibiotic guidelines should be followed. The BNF recommends a broad-spectrum cephalosporin or a quinolone for 10-14 days for non-pregnant women.

    • This question is part of the following fields:

      • Kidney And Urology
      0
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  • Question 8 - A 65-year-old man has been diagnosed with primary open angle glaucoma. He inquires...

    Incorrect

    • A 65-year-old man has been diagnosed with primary open angle glaucoma. He inquires about the potential impact on his vision if the condition is left untreated.

      Your Answer:

      Correct Answer: Impairs peripheral visual fields

      Explanation:

      The main impact of glaucoma is on the patient’s visual field, as it causes an optic neuropathy. This typically starts with peripheral vision loss and can progress to tunnel vision if left untreated. While visual acuity may also be affected, it is not as commonly impacted as the visual field.

      Glaucoma is a condition where the optic nerve is damaged due to increased intraocular pressure (IOP). Primary open-angle glaucoma (POAG) is a type of glaucoma where the peripheral iris doesn’t cover the trabecular meshwork, which is responsible for draining aqueous humour from the eye. POAG is more common in older individuals, with up to 10% of those over 80 years of age affected. Genetics, Afro-Caribbean ethnicity, myopia, hypertension, diabetes mellitus, and corticosteroid use are all risk factors for POAG. POAG may present with peripheral visual field loss, decreased visual acuity, and optic disc cupping, which can be detected during routine optometry appointments.

      Fundoscopy signs of POAG include optic disc cupping, optic disc pallor, bayonetting of vessels, and cup notching. Optic disc cupping occurs when the cup-to-disc ratio is greater than 0.7, indicating a loss of disc substance. Optic disc pallor indicates optic atrophy, while bayonetting of vessels occurs when vessels have breaks as they disappear into the deep cup and reappear at the base. Cup notching usually occurs inferiorly where vessels enter the disc, and disc haemorrhages may also be present.

      The diagnosis of POAG is made through a series of investigations, including automated perimetry to assess visual field, slit lamp examination with pupil dilatation to assess optic nerve and fundus for a baseline, applanation tonometry to measure IOP, central corneal thickness measurement, and gonioscopy to assess peripheral anterior chamber configuration and depth. The risk of future visual impairment is assessed using risk factors such as IOP, central corneal thickness (CCT), family history, and life expectancy. If POAG is suspected, referral to an ophthalmologist is necessary for further evaluation and management.

    • This question is part of the following fields:

      • Eyes And Vision
      0
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  • Question 9 - A 35-year-old man has depression which has not responded to a monoamine oxidase...

    Incorrect

    • A 35-year-old man has depression which has not responded to a monoamine oxidase inhibitor (MAOI). You stop the MAOI and wish to prescribe a selective serotonin reuptake inhibitor (SSRI).

      How long should you wait before starting the SSRI?

      Your Answer:

      Correct Answer: 3 days

      Explanation:

      Starting SSRI after MAOI

      When switching from a MAOI to an SSRI, it is important to wait at least two weeks before starting the new medication. MAOIs can inhibit the enzymes responsible for breaking down certain neurotransmitters, such as noradrenaline and 5-hydroxytryptamine (5HT). This can lead to a buildup of these neurotransmitters in the body, which can cause severe drug reactions if an SSRI is started too soon. It may take up to two weeks for the enzymes to resume normal activity after stopping a MAOI, so it is important to wait until this wash-out period is over before starting an SSRI. This information is consistent with the guidelines provided by the British National Formulary (BNF) and is commonly tested on the Applied Knowledge Test (AKT) for medical professionals.

    • This question is part of the following fields:

      • Mental Health
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  • Question 10 - What other screening method has strong evidence for its effectiveness in detecting bowel...

    Incorrect

    • What other screening method has strong evidence for its effectiveness in detecting bowel cancer besides faecal occult blood testing for those aged 60-74?

      Your Answer:

      Correct Answer: Flexible sigmoidoscopy

      Explanation:

      Bowel Screening and the Benefits of Flexible Sigmoidoscopy

      Bowel screening is a crucial aspect of healthcare, and it has been offered to those aged 60-69 using faecal occult blood testing. From July 2006 to December 2010, over 5 million people participated in bowel screening, and over 7,000 cancers were detected, with over 40,000 patients undergoing polyp removal. The screening has now been extended to those aged 70-74 and is offered every two years.

      One alternative and complementary bowel screening modality to faecal occult blood testing is flexible sigmoidoscopy. A randomised control trial funded by Cancer Research UK was conducted between 1994 and 2010, covering 14 UK centres. The study found that flexible sigmoidoscopy is a safe test and confers a significant and sustained long-term benefit if offered as a one-off procedure between the ages of 55 and 64. The trial data suggest that flexible sigmoidoscopy could prevent approximately 3,000 cancers a year.

      Based on these findings, flexible sigmoidoscopy is being piloted to be incorporated into the current bowel screening programme over the next few years. This test is a reliable and effective way to detect bowel cancer and prevent it from developing further. It is essential to continue to promote bowel screening and encourage people to participate in these life-saving tests.

    • This question is part of the following fields:

      • Population Health
      0
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  • Question 11 - A mother brings her 5-year-old daughter into surgery as she suspects she may...

    Incorrect

    • A mother brings her 5-year-old daughter into surgery as she suspects she may have head lice. Which of the following statements about head lice is not true?

      Your Answer:

      Correct Answer: Children should be excluded from school until treatment has been started

      Explanation:

      It is not recommended to exclude children from school due to head lice.

      Understanding Head Lice: Causes, Symptoms, and Management

      Head lice, also known as pediculosis capitis or ‘nits’, is a common condition in children caused by a parasitic insect called Pediculus capitis. These small insects live only on humans and feed on our blood. The eggs, which are grey or brown and about the size of a pinhead, are glued to the hair close to the scalp and hatch in 7 to 10 days. Nits, on the other hand, are the empty egg shells and are white and shiny. They are found further along the hair shaft as they grow out.

      Head lice are spread by direct head-to-head contact and tend to be more common in children who play closely together. It is important to note that head lice cannot jump, fly, or swim. When newly infected, cases have no symptoms, but itching and scratching on the scalp occur 2 to 3 weeks after infection. There is no incubation period.

      To diagnose head lice, fine-toothed combing of wet or dry hair is necessary. Treatment is only indicated if living lice are found. A choice of treatments should be offered, including malathion, wet combing, dimeticone, isopropyl myristate, and cyclomethicone. Household contacts of patients with head lice do not need to be treated unless they are also affected. It is important to note that school exclusion is not advised for children with head lice.

      In conclusion, understanding the causes, symptoms, and management of head lice is crucial in preventing its spread. By taking the necessary precautions and seeking appropriate treatment, we can effectively manage this common condition.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 12 - A 28-year-old woman presents with a two week history of feeling unwell, characterised...

    Incorrect

    • A 28-year-old woman presents with a two week history of feeling unwell, characterised by one week of catarrhal illness, followed by a dry hacking cough, which is now paroxysmal, and she has vomited twice after coughing.

      On examination, she is afebrile, and her chest sounds clear. She was previously well, but she is unsure of her vaccination history as she lived abroad as a child.

      She lives with her husband and two children, aged 18 months and 8. The children have not been immunised against pertussis. You suspect she may have pertussis.

      While awaiting confirmation, who should be offered antibiotics?

      Your Answer:

      Correct Answer: Nobody

      Explanation:

      Antibiotic Prophylaxis for Pertussis

      When managing a suspected or confirmed case of pertussis, it is important to offer prophylactic antibiotics to reduce transmission if the case presents within 21 days of onset and a vulnerable contact is present in the household. All household contacts, regardless of age or immunisation status, should be offered antibiotics. Antibiotics may not alter the clinical course of the illness, but they can eliminate the organism from the respiratory tract, reducing person-to-person transmission. Vulnerable contacts include newborn infants, unimmunised or partially immunised infants or children up to 10 years, pregnant women, healthcare workers, immunocompromised individuals, and those with chronic illnesses. The maternal pertussis vaccine programme has been highly effective in preventing disease for infants less than 2 months of age. Therefore, the definition of vulnerable infants has been amended to include unimmunised infants born ≤32 weeks, unimmunised infants born >32 weeks whose mothers did not receive maternal pertussis vaccine after 16 weeks and at least 2 weeks before delivery, and infants aged 2 months or over who are unimmunised or partially immunised. It is important for GPs to understand and implement national guidelines for respiratory problems, including the management of pertussis.

    • This question is part of the following fields:

      • Respiratory Health
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  • Question 13 - A 55-year-old man presents to his General Practitioner concerned that he may be...

    Incorrect

    • A 55-year-old man presents to his General Practitioner concerned that he may be at an increased risk of developing colon cancer. His father died at the age of 56 from a sigmoid colon adenocarcinoma. His brother, aged 61, has just undergone a colectomy for a caecal carcinoma.
      What is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Refer for one-off colonoscopy aged 55

      Explanation:

      Screening Recommendations for Patients with Family History of Colorectal Cancer

      Patients with a family history of colorectal cancer may be at an increased risk of developing the disease. The British Society of Gastroenterology and the Association of Coloproctology for Great Britain and Ireland have produced screening guidelines for patients with family history profiles that place them in a moderate-risk category.

      Colonoscopy is recommended for patients with a family history of two first-degree relatives with a mean age of less than 60 years with colorectal cancer, starting at the age of 55. Abdominal ultrasound examination doesn’t have a role in screening for or diagnosing colorectal cancer.

      Patients with an increased risk should not be advised that they have no increased risk. Instead, they should be screened appropriately. Faecal immunochemical tests (FIT) are used to detect blood in the stool and are used in the national bowel cancer screening programme. However, patients with a higher risk, given their family history, should be offered earlier screening with colonoscopy rather than waiting until they are eligible for the national screening programme. False positives and negatives are possible with FIT, making colonoscopy a more reliable screening option for high-risk patients.

      Therefore, it is important for patients with a family history of colorectal cancer to be aware of the screening recommendations and to discuss their individual risk and screening options with their healthcare provider.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 14 - Liam is a 22-year-old man who has tested positive for gonorrhoea from a...

    Incorrect

    • Liam is a 22-year-old man who has tested positive for gonorrhoea from a urethral swab taken last week. Despite being advised to attend a sexual health clinic, he is unwilling to do so and has requested that you prescribe him treatment.

      He has a fear of needles and refuses intramuscular ceftriaxone.

      What is the most suitable alternative oral regimen available?

      Your Answer:

      Correct Answer: Cefixime and azithromycin

      Explanation:

      When treating patients with gonorrhoea, a combination of oral cefixime and oral azithromycin is typically used if the patient refuses an intramuscular injection of ceftriaxone. However, NICE recommends that gonorrhoea should only be treated in primary care if specialist services are not available within a reasonable timeframe or if the patient chooses not to attend despite receiving appropriate information and advice.

      If uncomplicated anogenital gonorrhoea needs to be treated in primary care, a single dose of ceftriaxone 1g intramuscular injection is the preferred option. However, alternative regimens may be necessary if the patient has an allergy, needle phobia, or other contraindications. In such cases, cefixime orally as a single dose plus azithromycin orally is recommended.

      It’s important to note that azithromycin resistance is high, and the clinical efficacy of azithromycin doesn’t always correlate with in vitro susceptibility testing. Therefore, a single oral dose of azithromycin would not be the most appropriate option.

      While doxycycline, erythromycin, and ofloxacin are all possible choices for treating chlamydia, they are not effective in treating gonorrhoea.

      Understanding Gonorrhoea: Causes, Symptoms, and Treatment

      Gonorrhoea is a sexually transmitted infection caused by the Gram-negative diplococcus Neisseria gonorrhoeae. It can occur on any mucous membrane surface, including the genitourinary tract, rectum, and pharynx. Symptoms in males include urethral discharge and dysuria, while females may experience cervicitis leading to vaginal discharge. However, rectal and pharyngeal infections are usually asymptomatic. Unfortunately, immunisation is not possible, and reinfection is common due to antigen variation of type IV pili and Opa proteins.

      If left untreated, gonorrhoea can lead to local complications such as urethral strictures, epididymitis, and salpingitis, which may result in infertility. Disseminated infection may also occur, with gonococcal infection being the most common cause of septic arthritis in young adults. The pathophysiology of disseminated gonococcal infection is not fully understood but is thought to be due to haematogenous spread from mucosal infection.

      Management of gonorrhoea involves the use of antibiotics. Ciprofloxacin used to be the treatment of choice, but there is now increased resistance to it. Cephalosporins are now more widely used, with a single dose of IM ceftriaxone 1g being the new first-line treatment. If sensitivities are known, a single dose of oral ciprofloxacin 500mg may be given. Disseminated gonococcal infection and gonococcal arthritis may also occur, with symptoms including tenosynovitis, migratory polyarthritis, and dermatitis.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
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  • Question 15 - A 25-year-old woman presents with secondary amenorrhoea and galactorrhoea.

    What is the most appropriate...

    Incorrect

    • A 25-year-old woman presents with secondary amenorrhoea and galactorrhoea.

      What is the most appropriate first investigation to perform?

      Your Answer:

      Correct Answer: Prolactin level

      Explanation:

      Investigating Secondary Amenorrhoea with Galactorrhoea

      Any patient who presents with secondary amenorrhoea, the absence of menstrual periods for at least three consecutive months, should first have pregnancy ruled out before further investigation. This is because pregnancy can cause secondary amenorrhoea and may also lead to galactorrhoea, the production of breast milk in a non-lactating individual.

      If pregnancy is ruled out, the next step is to measure prolactin levels. Hyperprolactinaemia, a condition where there is an excess of prolactin in the blood, can cause both secondary amenorrhoea and galactorrhoea. Further investigation may be necessary to determine the underlying cause of hyperprolactinaemia, which can include pituitary tumors, medication side effects, or other medical conditions.

      In summary, investigating secondary amenorrhoea with galactorrhoea requires ruling out pregnancy and measuring prolactin levels to determine the underlying cause of the condition.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
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  • Question 16 - A middle-aged businesswoman visits you to discuss her medication for rheumatoid arthritis. Her...

    Incorrect

    • A middle-aged businesswoman visits you to discuss her medication for rheumatoid arthritis. Her condition is worsening and she now requires a walking aid to move around. She is concerned about the financial burden of her condition and asks if she is eligible for any government assistance, given that she has been a taxpayer for most of her life. She mentions that she still pays higher rate tax on her pensions and investments. Can you advise her on whether she qualifies for Personal Independence Payment (PIP)?

      Your Answer:

      Correct Answer: Higher rate tax payers are not eligible for PIP

      Explanation:

      Understanding Personal Independence Payment (PIP)

      Personal Independence Payment (PIP) is a government benefit that provides financial assistance to individuals with long-term conditions or disabilities that are expected to last for at least 12 months. PIP is divided into two components: Daily Living and Mobility, each with standard and enhanced rates. Unlike other benefits, PIP is not income-related and is not affected by earnings, savings, or taxes. It is available to anyone, regardless of their employment status.

      To qualify for PIP, an individual must have required assistance with daily living or mobility activities for at least three months and be reasonably likely to need help for the next nine months. However, individuals can submit a claim for PIP during the first three months of needing assistance. It is important to note that PIP is based on how a person’s condition affects them, not the condition itself. This means that the severity of the condition is not the only factor considered when determining eligibility for PIP.

    • This question is part of the following fields:

      • Consulting In General Practice
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  • Question 17 - A 45-year-old woman comes to your GP clinic complaining of recurrent episodes of...

    Incorrect

    • A 45-year-old woman comes to your GP clinic complaining of recurrent episodes of dizziness, which she describes as a sensation of the room spinning. She has experienced five such episodes in the past month, each lasting for one or two days and accompanied by nausea, which has prevented her from going to work. She reports no symptoms between episodes and has a history of migraines in her 20s but is otherwise healthy. During these episodes, she is sensitive to loud noises but denies any hearing loss or tinnitus. Neurological examination, Dix-Hallpike, and examination of both ear canals are unremarkable. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Vestibular migraine

      Explanation:

      Consider vestibular migraine as a possible cause of episodic vertigo in patients with a history of migraines. The timing and duration of vertigo symptoms can help differentiate between different causes. Benign paroxysmal positional vertigo typically causes brief episodes of vertigo, while Meniere’s disease causes longer episodes with accompanying hearing loss, tinnitus, or ear fullness. Labyrinthitis and vestibular neuronitis can cause sudden onset of constant vertigo, but not the episodic nature described in this case. Given the duration, episodic nature, phonophobia, and history of migraines, vestibular migraine is the most likely diagnosis. The International Classification of Headache Disorders provides diagnostic criteria for vestibular migraine, including a history of migraines and moderate to severe vestibular symptoms lasting between 5 minutes and 72 hours, with at least half of the episodes associated with migrainous features such as headache, photophobia, phonophobia, or visual aura. Other potential causes should be ruled out.

      Vertigo is a condition characterized by a false sensation of movement in the body or environment. There are various causes of vertigo, each with its own unique characteristics. Viral labyrinthitis, for example, is typically associated with a recent viral infection, sudden onset, nausea and vomiting, and possible hearing loss. Vestibular neuronitis, on the other hand, is characterized by recurrent vertigo attacks lasting hours or days, but with no hearing loss. Benign paroxysmal positional vertigo is triggered by changes in head position and lasts for only a few seconds. Meniere’s disease, meanwhile, is associated with hearing loss, tinnitus, and a feeling of fullness or pressure in the ears. Elderly patients with vertigo may be experiencing vertebrobasilar ischaemia, which is accompanied by dizziness upon neck extension. Acoustic neuroma, which is associated with hearing loss, vertigo, and tinnitus, is also a possible cause of vertigo. Other causes include posterior circulation stroke, trauma, multiple sclerosis, and ototoxicity from medications like gentamicin.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
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  • Question 18 - Sarah is a 50-year-old woman who has recently started experiencing pain in her...

    Incorrect

    • Sarah is a 50-year-old woman who has recently started experiencing pain in her fingers bilaterally when exposed to cold temperatures. She has also observed that her fingers change colour from white to blue and then red. Apart from blepharitis, she has no significant medical history. However, she does report some stiffness in her hands upon waking up.

      What would be the optimal approach to managing this patient?

      Your Answer:

      Correct Answer: Refer to rheumatology

      Explanation:

      Patients who are suspected to have secondary Raynaud’s phenomenon should be referred to secondary care, particularly if they exhibit joint stiffness and dry eyes. Rheumatology, not orthopaedics, is the appropriate specialty for referral.

      To manage Raynaud’s symptoms, it is important to keep the hands and feet warm. If lifestyle changes are not effective, nifedipine (not amlodipine) may be considered as a treatment option.

      If an underlying autoimmune disease is present, prednisolone may be prescribed as a treatment.

      Raynaud’s phenomenon is a condition where the arteries in the fingers and toes constrict excessively in response to cold or emotional stress. It can be classified as primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon) depending on the underlying cause. Raynaud’s disease is more common in young women and typically affects both sides of the body. Secondary Raynaud’s phenomenon is often associated with connective tissue disorders such as scleroderma, rheumatoid arthritis, or systemic lupus erythematosus. Other causes include leukaemia, cryoglobulinaemia, use of vibrating tools, and certain medications.

      If there is suspicion of secondary Raynaud’s phenomenon, patients should be referred to a specialist for further evaluation. Treatment options include calcium channel blockers such as nifedipine as a first-line therapy. In severe cases, intravenous prostacyclin (epoprostenol) infusions may be used, which can provide relief for several weeks or months. It is important to identify and treat any underlying conditions that may be contributing to the development of Raynaud’s phenomenon. Factors that suggest an underlying connective tissue disease include onset after 40 years, unilateral symptoms, rashes, presence of autoantibodies, and digital ulcers or calcinosis. In rare cases, chilblains may also be present.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 19 - A 25-year-old woman visits the clinic and asks for progestogen-only birth control due...

    Incorrect

    • A 25-year-old woman visits the clinic and asks for progestogen-only birth control due to her mother's recent breast cancer diagnosis.

      What are the characteristics of progestogen-only contraception?

      Your Answer:

      Correct Answer: Causes HDL levels to rise

      Explanation:

      Understanding the Effects of Hormonal Contraceptives on the Body

      Hormonal contraceptives are widely used by women to prevent unwanted pregnancies. However, it is important to understand the effects of these contraceptives on the body. The combined oral contraceptive pill contains ethinyl oestradiol, which is metabolized in the liver. Changes in hepatic function may affect the metabolism of this hormone. While it has no clinically significant effect on liver, kidney, adrenal or thyroid function, it can increase high density lipoprotein (HDL) and decrease low density lipoprotein (LDL). On the other hand, progesterone, which is found in progestogen-only methods, increases LDL and decreases HDL.

      Progestogen-only methods are recommended for women with certain medical conditions such as hypertension, superficial thrombophlebitis, history of thromboembolism, biliary tract disease, thyroid disease, epilepsy, and diabetes without vascular disease. These methods have no deleterious effect on blood pressure. Additionally, the progestogen-only pill is recommended for lactating women as the oestrogen component of the combined pills may interfere with lactation.

      It is important to consult with a healthcare provider to determine the best contraceptive method for individual needs and medical history. Understanding the effects of hormonal contraceptives on the body can help women make informed decisions about their reproductive health.

    • This question is part of the following fields:

      • Sexual Health
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  • Question 20 - You speak with a 27-year-old care assistant who works in the local residential...

    Incorrect

    • You speak with a 27-year-old care assistant who works in the local residential care home. She has a sore throat, fever and rash. She requests antibiotics as she is eager to get back to work for her night shifts in 2 days. Her 4-year-old son recently had a course of antibiotics following a similar presentation.

      On examination, she has a fine rough feeling rash on her torso and her tongue appears red and swollen. Her observations are normal.

      Given the likely diagnosis, what advice from the options below would be most appropriate to give?

      Your Answer:

      Correct Answer: Advise her that you need to contact the Local Health Protection Agency (HPA) and she should not go into work. If she doesn't consent, confirm that you will still need to inform the HPA

      Explanation:

      Kindly request that she notifies her workplace and the Local Health Protection Agency (HPA) and arranges a discussion with them regarding her return date.

      Sharing patient information is crucial for providing safe and effective care, especially in multi-disciplinary teams. However, it is important to ensure that information is shared in a legal and ethical manner while facilitating access to those who require it. Inappropriate sharing of information can have significant consequences for the clinician-patient relationship and the wider profession. Patients generally expect some information to be shared with those involved in their care, but if they object, the information should not be disclosed unless it is justified for the public interest or the patient lacks capacity. It is important to explain the potential consequences of not sharing personal information and reach a compromise where possible.

      When sharing information, it is essential to access it to support the patient’s direct care or be satisfied that it is being shared for that purpose. Patients should be informed about how their personal information will be used, and they have the right to object. It is also crucial to ensure that anyone who receives the information understands that it is given in confidence. When sharing information with friends or relatives, it is necessary to establish the patient’s wishes and gain explicit consent. In cases where the patient lacks capacity, it is essential to consider various factors, such as the patient’s beliefs and values, before disclosing information.

      Disclosing information without the patient’s express consent is generally not allowed, except when required by law or justified in the public interest. In exceptional circumstances, such as gunshot wounds and knife injuries, the police should be informed, but personal information should not be disclosed initially. It is crucial to follow the relevant guidelines to avoid inappropriate information sharing and maintain transparency between the doctor and patient.

    • This question is part of the following fields:

      • Consulting In General Practice
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  • Question 21 - In an emergency surgery one morning you see a 12-year-old patient with an...

    Incorrect

    • In an emergency surgery one morning you see a 12-year-old patient with an infective exacerbation of asthma. She is under the respiratory specialist at the local hospital as she has had longstanding problems with poor disease control. Her current medications consist of salbutamol 2 puffs PRN, Symbicort 400/6 2 puffs BD, montelukast 10 mg OD and theophylline 400 mg BD. She is allergic to penicillin.

      She reports a one week history of progressive chest tightness and cough productive of green purulent phlegm. Following your assessment you feel she warrants antibiotic treatment.

      Which of the following antibiotics is the most appropriate to prescribe?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      The Importance of Drug Interactions in Theophylline Metabolism

      Theophylline is a medication that undergoes hepatic metabolism, making it susceptible to interactions with other drugs. These interactions can either increase or decrease its metabolism, affecting its plasma concentration and ultimately its clinical effectiveness. Due to its narrow therapeutic index, concurrent prescription of drugs that affect its metabolism can lead to toxicity or limit its effectiveness.

      Certain antibiotics, such as azithromycin, ciprofloxacin, clarithromycin, and erythromycin, can increase the plasma concentration of theophylline if co-prescribed. Therefore, it is important to consider these interactions when prescribing medications to patients taking theophylline.

      In cases where the patient is penicillin allergic, doxycycline is a safe option as it doesn’t interfere with theophylline metabolism. By being aware of these interactions, healthcare professionals can ensure the safe and effective use of theophylline in their patients.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
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  • Question 22 - A 45-year-old patient presents with a 36-hour history of varicella zoster in the...

    Incorrect

    • A 45-year-old patient presents with a 36-hour history of varicella zoster in the T4 dermatome. She complains of severe pain in the skin supplied by T4.

      What is the most appropriate management?

      Your Answer:

      Correct Answer: Prednisolone

      Explanation:

      Treatment options for herpes zoster

      Aciclovir and famciclovir are effective medications for treating herpes zoster, reducing the time to healing and associated pain. Aciclovir is the most cost-effective option as it is now available as a generic medication. Early use of steroids can also reduce the amount of analgesia required and the length of illness.

      A clinical review published in the BMJ emphasized the importance of appropriate treatment for herpes zoster to control acute symptoms and reduce the risk of longer-term complications. NICE updated their guidance in 2010, recommending amitriptyline or pregabalin as first-line treatments for post-herpetic neuralgia. CKS also issued guidance, which is generally in line with NICE, but they caution against using carbamazepine due to potential serious adverse effects and lack of a license for primary care treatment.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
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  • Question 23 - A 50-year-old woman schedules a routine appointment to discuss her menopausal symptoms. She...

    Incorrect

    • A 50-year-old woman schedules a routine appointment to discuss her menopausal symptoms. She has been experiencing hot flashes, mood swings, and insomnia for the past year. Her friend recently started hormone replacement therapy (HRT) for similar symptoms and found it to be very helpful. The patient is interested in trying HRT and has already read about the potential risks of breast and ovarian cancer on the NHS website. She has no medical history and is not taking any medications, but she does mention that her sister has had multiple blood clots and is currently taking blood thinners.

      What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Prescribe transdermal combined HRT

      Explanation:

      When prescribing hormone replacement therapy (HRT), it is important to consider the risk of venous thromboembolism in women. Transdermal HRT is recommended as a first line for those at risk. A family history of deep vein thrombosis (DVT) doesn’t necessarily rule out HRT, but should be taken into account. Oestrogen-only HRT should only be given to women without a uterus, as it can increase the risk of endometrial cancer. Topical oestrogen is generally safe, but only provides relief for localised urogenital symptoms. In cases where HRT is not an option, selective serotonin reuptake inhibitors (SSRIs) may be considered as an alternative treatment for menopause.

      Hormone Replacement Therapy: Uses and Varieties

      Hormone replacement therapy (HRT) is a treatment that involves administering a small amount of estrogen, combined with a progestogen (in women with a uterus), to alleviate menopausal symptoms. The indications for HRT have changed significantly over the past decade due to the long-term risks that have become apparent, primarily as a result of the Women’s Health Initiative (WHI) study.

      The most common indication for HRT is vasomotor symptoms such as flushing, insomnia, and headaches. Other indications, such as reversal of vaginal atrophy, should be treated with other agents as first-line therapies. HRT is also recommended for women who experience premature menopause, which should be continued until the age of 50 years. The most important reason for giving HRT to younger women is to prevent the development of osteoporosis. Additionally, HRT has been shown to reduce the incidence of colorectal cancer.

      HRT generally consists of an oestrogenic compound, which replaces the diminished levels that occur in the perimenopausal period. This is normally combined with a progestogen if a woman has a uterus to reduce the risk of endometrial cancer. The choice of hormone includes natural oestrogens such as estradiol, estrone, and conjugated oestrogen, which are generally used rather than synthetic oestrogens such as ethinylestradiol (which is used in the combined oral contraceptive pill). Synthetic progestogens such as medroxyprogesterone, norethisterone, levonorgestrel, and drospirenone are usually used. A levonorgestrel-releasing intrauterine system (e.g. Mirena) may be used as the progestogen component of HRT, i.e. a woman could take an oral oestrogen and have endometrial protection using a Mirena coil. Tibolone, a synthetic compound with both oestrogenic, progestogenic, and androgenic activity, is another option.

      HRT can be taken orally or transdermally (via a patch or gel). Transdermal is preferred if the woman is at risk of venous thromboembolism (VTE), as the rates of VTE do not appear to rise with transdermal preparations.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
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  • Question 24 - A 54-year-old woman with a BMI of 26 presents to the diabetic clinic...

    Incorrect

    • A 54-year-old woman with a BMI of 26 presents to the diabetic clinic with poor glycaemic control while on gliclazide 160mg bd. Her latest blood results reveal a HbA1c of 9.4%. Her laboratory values are as follows: Na+ 139 mmol/l, K+ 4.1 mmol/l, urea 8.4 mmol/l, creatinine 180 µmol/l, ALT 25 iu/l, and yGT 33 iu/l. What medication should be added to her treatment plan?

      Your Answer:

      Correct Answer: Pioglitazone

      Explanation:

      Considering her overweight status, adding metformin would be a logical choice. However, due to the elevated creatinine levels, pioglitazone would be a more suitable alternative. It is important to note that if the creatinine level exceeds 130 µmol/l (or eGFR falls below 45 ml/min), the metformin dosage should be reassessed and discontinued if the creatinine level exceeds 150 µmol/l (or eGFR falls below 30 ml/min). It is worth noting that pioglitazone may cause weight gain, which could be problematic given her BMI of 26.

      Thiazolidinediones: A Class of Diabetes Medications

      Thiazolidinediones are a type of medication used to treat type 2 diabetes. They work by activating the PPAR-gamma receptor, which helps to reduce insulin resistance in the body. However, one medication in this class, rosiglitazone, was withdrawn in 2010 due to concerns about its cardiovascular side effects.

      The PPAR-gamma receptor is a type of nuclear receptor found inside cells. It is normally activated by free fatty acids and is involved in regulating the function and development of fat cells.

      While thiazolidinediones can be effective in treating diabetes, they can also have some adverse effects. These can include weight gain, liver problems (which should be monitored with regular liver function tests), and fluid retention. Because of the risk of fluid retention, these medications are not recommended for people with heart failure. Recent studies have also suggested that there may be an increased risk of fractures and bladder cancer in people taking thiazolidinediones, particularly pioglitazone.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
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  • Question 25 - The importance of comprehending the function of grief in palliative care lies in...

    Incorrect

    • The importance of comprehending the function of grief in palliative care lies in aiding patients and their caregivers in managing it. What is the typically acknowledged sequence of the phases of bereavement?

      Your Answer:

      Correct Answer: Denial, anger, bargaining, depression, acceptance

      Explanation:

      Understanding the Five Stages of Grief: Insights from Dr. Elisabeth Kübler-Ross

      Dr. Elisabeth Kübler-Ross is known for her pioneering work in supporting and counseling individuals experiencing personal trauma, grief, and grieving, particularly in relation to death and dying. Her ideas, particularly the five stages of grief model, have been widely used to help people cope with emotional upheavals resulting from various life events.

      The first stage is denial, which involves a conscious or unconscious refusal to accept the reality of the situation. This can be a defense mechanism that some people use to cope with traumatic changes. However, denial can also hinder the healing process if it is not addressed.

      The second stage is anger, which can manifest in different ways. People may direct their anger towards themselves or others, especially those close to them. It is important to understand that anger is a natural response to grief and to remain non-judgmental when dealing with someone who is upset.

      The third stage is bargaining, which often involves attempting to make deals with a higher power or trying to negotiate a better outcome. However, this rarely provides a sustainable solution for grief.

      The fourth stage is depression, which can include feelings of sadness, regret, fear, and uncertainty. It is a sign that the person is beginning to accept the reality of the situation.

      The final stage is acceptance, which varies depending on the individual’s circumstances. It is an indication that the person has achieved some emotional detachment and objectivity. People who are dying may enter this stage long before their loved ones, and they must go through their own unique stages of grief.

      While Kübler-Ross’s concepts were developed through extensive interviews with dying patients, some have criticized her one-size-fits-all approach as being too simplistic. Not everyone will experience all of these stages, and they may not occur in a specific order. Nonetheless, understanding these stages can provide valuable insights into the grieving process and help individuals cope with emotional upheavals resulting from various life events.

    • This question is part of the following fields:

      • End Of Life
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  • Question 26 - A 32-year-old male smoker presents with sudden and severe pain on the left...

    Incorrect

    • A 32-year-old male smoker presents with sudden and severe pain on the left side of his head, which has occurred four times this week. He reports that the pain is not throbbing and denies any visual disturbances or aura. Upon examination, there is profuse rhinorrhea, lacrimation, and swelling of the left eyelid. Additionally, the patient has partial ptosis and miosis on the left side. Further questioning reveals that both the patient and his father experience this pain every two years or so. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Cluster headache

      Explanation:

      This case depicts the manifestation of a cluster headache, which is accompanied by several risk factors such as being a young male smoker with a positive family history. The occurrence of partial Horner’s syndrome is a common symptom in cluster headaches, but the primary autonomic symptoms are rhinorrhoea, nasal congestion, and lacrimation.

      Although the absence of visual disturbances like photophobia or blurred vision makes acute closed-angle glaucoma less probable, it is still advisable to consider this condition in such a presentation.

      While it is possible to have migraines without aura, the non-throbbing nature of the pain makes this diagnosis less likely.

      The one-sided pain distribution is inconsistent with a typical tension headache, which is usually described as a ‘tight band’ around the head.

      The sudden onset and recurrence every two years make the presence of a brain tumour less likely.

      Cluster headaches are a type of headache that is known to be extremely painful. They are called cluster headaches because they tend to occur in clusters that last for several weeks, usually once a year. These headaches are more common in men and smokers, and alcohol and sleep patterns may trigger an attack. The pain is typically sharp and stabbing, and it occurs around one eye. Patients may experience redness, lacrimation, lid swelling, nasal stuffiness, and miosis and ptosis in some cases.

      To manage cluster headaches, acute treatment options include 100% oxygen or subcutaneous triptan. Prophylaxis involves using verapamil as the drug of choice, and a tapering dose of prednisolone may also be effective. It is recommended to seek specialist advice from a neurologist if a patient develops cluster headaches with respect to neuroimaging. Some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania, and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Patients with these conditions should be referred for specialist assessment as specific treatment may be required, such as indomethacin for paroxysmal hemicrania.

    • This question is part of the following fields:

      • Neurology
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  • Question 27 - A small-randomised control trial is conducted to examine the impact of a new...

    Incorrect

    • A small-randomised control trial is conducted to examine the impact of a new medication on the frequency of headaches in individuals aged 50 and above. Participants are randomly assigned to receive either the new medication or a placebo. The frequency of their headaches is evaluated after a two-week period using the following scale: “Never”, “Rarely”, “Sometimes”, “Often”, “Always”.

      Which statistical test is most appropriate for analyzing the findings of this study?

      Your Answer:

      Correct Answer: Mann-Whitney U-test

      Explanation:

      The appropriate statistical test for comparing the ordinal data from this small-randomised control trial is the Mann-Whitney U-test. This test is used for non-parametric data from two independent groups. McNemar’s test is not appropriate as it is used for paired nominal data, while the Student’s t-tests require parametric data.

      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
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  • Question 28 - In a patient with atrial fibrillation, which option warrants hospital admission or referral...

    Incorrect

    • In a patient with atrial fibrillation, which option warrants hospital admission or referral for urgent assessment and intervention the most?

      Your Answer:

      Correct Answer: Apex beat 155 bpm

      Explanation:

      Urgent Admission Criteria for Patients with Atrial Fibrillation

      The National Institute for Health and Care Excellence has provided guidelines for urgent admission of patients with atrial fibrillation. These guidelines recommend urgent admission for patients who exhibit a rapid pulse greater than 150 bpm and/or low blood pressure with systolic blood pressure less than 90 mmHg. Additionally, urgent admission is recommended for patients who experience loss of consciousness, severe dizziness, ongoing chest pain, or increasing breathlessness. Patients who have experienced a complication of atrial fibrillation, such as stroke, transient ischaemic attack, or acute heart failure, should also be urgently admitted. While other symptoms may warrant a referral, these criteria indicate the need for immediate medical attention.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 29 - A 76-year-old man has been experiencing widespread aches and pains in his chest,...

    Incorrect

    • A 76-year-old man has been experiencing widespread aches and pains in his chest, back, and hips for several months. He also reports difficulty with urinary flow and frequent nighttime urination. What is the most suitable course of action?

      Your Answer:

      Correct Answer: Check prostate-specific antigen (PSA) levels

      Explanation:

      Prostate Cancer and Prostatism: Symptoms and Diagnosis

      Patients with prostatism who experience bony pain should be evaluated for prostate cancer, as it often metastasizes to bone. A digital rectal examination should be performed after taking blood for PSA, as the prostate will typically feel hard and irregular in cases of prostate cancer. While chronic urinary retention and urinary infection may be present, investigations should focus on identifying the underlying cause rather than providing symptomatic treatment with an α-blocker. Without a confirmed diagnosis of benign prostatic hyperplasia, finasteride should not be prescribed.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 30 - A 32-year-old stock-market trader presents with an 8 week history of upper abdominal...

    Incorrect

    • A 32-year-old stock-market trader presents with an 8 week history of upper abdominal pain that comes on in the evening and also wakes him up in the early hours of the morning. His symptoms are relieved by food and milk.
      Select the single most likely diagnosis from the list below.

      Your Answer:

      Correct Answer: Peptic ulcer disease

      Explanation:

      Common Gastrointestinal Disorders and their Symptoms

      Peptic ulcer disease, chronic pancreatitis, cirrhosis, gallstones, and reflux oesophagitis are some of the most common gastrointestinal disorders. Peptic ulcers are often caused by non-steroidal anti-inflammatory drugs, alcohol, tobacco consumption, and Helicobacter pylori. The main symptom is epigastric pain, which is characterised by a gnawing or burning sensation and occurs after meals. Relief by food and alkalis is typical of duodenal ulcers, while food and alkalis provide only minimal relief in gastric ulcers.

      Chronic pancreatitis causes intermittent attacks of severe pain, often in the mid-abdomen or left upper abdomen, and may be accompanied by diarrhoea and weight loss. Cirrhosis is often asymptomatic until there are obvious complications of liver disease, such as coagulopathy, ascites, variceal bleeding, or hepatic encephalopathy. Gallstones cause biliary colic, which is characterised by sporadic and unpredictable episodes of pain localised to the epigastrium or right upper quadrant. Obstructive jaundice may occur, and localising signs may be absent unless cholecystitis complicates the situation.

      Reflux oesophagitis typically presents with heartburn, upper abdominal discomfort, regurgitation, and chest pain. There is no clear evidence to suggest that the stress of modern life or a steady diet of fast food causes ulcers. It is important to seek medical attention if any of these symptoms persist or worsen.

    • This question is part of the following fields:

      • Gastroenterology
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Musculoskeletal Health (0/1) 0%
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Metabolic Problems And Endocrinology (0/1) 0%
Population Health (0/1) 0%
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