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  • Question 1 - A 50-year-old obese man with a history of type 2 diabetes mellitus presents...

    Correct

    • A 50-year-old obese man with a history of type 2 diabetes mellitus presents to the clinic for a review. He reports feeling well and asymptomatic. However, his recent annual blood tests have shown slightly abnormal liver function tests:

      - Bilirubin 20 µmol/L (3 - 17)
      - ALP 104 u/L (30 - 100)
      - ALT 53 u/L (3 - 40)
      - γGT 58 u/L (8 - 60)
      - Albumin 38 g/L (35 - 50)

      A liver ultrasound performed during his follow-up visit reveals fatty changes. All other standard liver screen bloods, including viral serology, are normal. The patient's alcoholic intake is within recommended limits.

      What would be the most appropriate next test to perform?

      Your Answer: Enhanced liver fibrosis blood test

      Explanation:

      For patients with non-alcoholic fatty liver disease, it is advised to undergo enhanced liver fibrosis (ELF) testing to assist in the detection of liver fibrosis. A typical patient with this condition is someone who is overweight and has type 2 diabetes mellitus. According to NICE guidelines, if NAFLD is discovered by chance, an ELF blood test should be conducted to evaluate for the presence of advanced liver disease.

      Non-Alcoholic Fatty Liver Disease: Causes, Features, and Management

      Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disease in developed countries, primarily caused by obesity. It is a spectrum of disease that ranges from simple steatosis (fat in the liver) to steatohepatitis (fat with inflammation) and may progress to fibrosis and liver cirrhosis. NAFLD is believed to be the hepatic manifestation of the metabolic syndrome, with insulin resistance as the key mechanism leading to steatosis. Non-alcoholic steatohepatitis (NASH) is a term used to describe liver changes similar to those seen in alcoholic hepatitis but without a history of alcohol abuse.

      NAFLD is usually asymptomatic, but patients may present with hepatomegaly, increased echogenicity on ultrasound, and elevated ALT levels. The enhanced liver fibrosis (ELF) blood test is recommended by NICE to check for advanced fibrosis in patients with incidental findings of NAFLD. If the ELF blood test is not available, non-invasive tests such as the FIB4 score or NAFLD fibrosis score may be used in combination with a FibroScan to assess the severity of fibrosis. Patients with advanced fibrosis should be referred to a liver specialist for further evaluation, which may include a liver biopsy to stage the disease more accurately.

      The mainstay of treatment for NAFLD is lifestyle changes, particularly weight loss, and monitoring. There is ongoing research into the role of gastric banding and insulin-sensitizing drugs such as metformin and pioglitazone in the management of NAFLD. While there is no evidence to support screening for NAFLD in adults, it is essential to identify and manage incidental findings of NAFLD to prevent disease progression and complications.

    • This question is part of the following fields:

      • Gastroenterology
      48.3
      Seconds
  • Question 2 - A 4-year-old child presents with a sore throat and cough. He vomited twice...

    Correct

    • A 4-year-old child presents with a sore throat and cough. He vomited twice in the past 24 hours. He is drinking and passed urine four hours ago. He has no rash. He has had tonsillitis twice in the past and his mother now requests antibiotics. There is nil of note in past medical history, and he is not on any medications.

      On examination, the child is alert. His temperature is 38.9°C, HR 130, RR 30, and CRT<2 sec. There are no recessions or rash, chest clear, eardrums pink, tonsils large and red with fine white exudate, normal cervical lymph nodes.

      Based on the NICE 'traffic light' system, what is the most appropriate management for this 4-year-old child?

      Your Answer: Advise on fluids and antipyretics and send home with worsening advice

      Explanation:

      Management of a Child with Sore Throat

      This child doesn’t exhibit any life-threatening symptoms or signs of bacterial tonsillitis. The presence of fever and tonsillar exudate suggests a viral sore throat, which doesn’t require antibiotics. It is important to explain to the parents that antibiotics are unlikely to help and may contribute to bacterial resistance. Instead, regular analgesia and fluids should be given, and safety-netting advice provided. Antibiotics may be prescribed immediately for certain groups, such as those with three or more Centor criteria, systemic illness, or pre-existing comorbidities. It is also important to inform parents about the average length of the illness. As a GP who helped develop the NICE guidelines, I recommend following these management strategies for children with sore throat.

    • This question is part of the following fields:

      • Children And Young People
      103.4
      Seconds
  • Question 3 - A 32-year-old man seeks guidance from his General Practitioner. He has struggled with...

    Correct

    • A 32-year-old man seeks guidance from his General Practitioner. He has struggled with alcoholism for 8 years, but has recently completed a successful in-patient drug rehabilitation program. What advice can the GP offer to help him maintain sobriety?

      Your Answer: Join a local Alcoholics Anonymous group

      Explanation:

      Treatment Options for Alcoholics

      For individuals struggling with alcoholism, active involvement in Alcoholics Anonymous (AA) is often the most effective way to prevent relapses. AA requires complete abstinence from alcohol, which is crucial for those with a high tolerance to alcohol who are at risk of relapsing even with moderate drinking. However, medications such as disulfiram should only be administered under medical supervision due to potentially fatal side effects. Naltrexone can be prescribed in conjunction with a support program to aid in recovery.

    • This question is part of the following fields:

      • Smoking, Alcohol And Substance Misuse
      74.6
      Seconds
  • Question 4 - A 60-year-old man has a history of alcohol dependence disorder for several years....

    Correct

    • A 60-year-old man has a history of alcohol dependence disorder for several years. He is currently experiencing confusion, double vision, and an unsteady gait. Additionally, his short term memory is poor. He reports abstaining from alcohol for the past week. What is the urgent vitamin requirement for this patient?

      Your Answer: Vitamin B1

      Explanation:

      Urgent Treatment Needed for Wernicke’s Encephalopathy

      Explanation: The most probable diagnosis for the patient is Wernicke’s encephalopathy, a neurological disorder caused by thiamine deficiency. The patient requires immediate treatment with vitamin B1 (thiamine) to prevent further damage to the brain. It is crucial to administer thiamine as soon as possible to avoid irreversible brain damage and potential death. Therefore, urgent medical attention is necessary to ensure the patient’s recovery.

    • This question is part of the following fields:

      • Smoking, Alcohol And Substance Misuse
      62.9
      Seconds
  • Question 5 - What is the expected number of newly diagnosed men with rheumatoid arthritis in...

    Incorrect

    • What is the expected number of newly diagnosed men with rheumatoid arthritis in South Bridge practice each year, given an incidence rate of 1.5 per 10000 men per year?

      Your Answer: 3

      Correct Answer: 10.2

      Explanation:

      Understanding Incidence and Prevalence

      This question is easy if you understand the difference between incidence and prevalence and are careful with your calculations. The question asks for the incidence of rheumatoid arthritis in men, which is 1.5 men per 10,000 population. Therefore, in a population of 20,000, the answer is 3. It’s important to be precise with calculations, as it’s easy to make mistakes in the heat of an exam. If the question had asked for incidence in both men and women, the answer would be 5.1 per 10,000, or 10.2 in a population of 20,000. If the question had asked for prevalence, the answer would be 200. Remembering the difference between incidence and prevalence is key to answering questions like this accurately.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      42.6
      Seconds
  • Question 6 - A 56-year-old man comes to the clinic complaining of severe pain and redness...

    Incorrect

    • A 56-year-old man comes to the clinic complaining of severe pain and redness in his big toe. He appears to be in good health and there are no signs of infection or fever. He reports a history of gout and suspects that it has returned. He is currently on a regular dose of allopurinol. What would be the most suitable course of action?

      Your Answer: Stop allopurinol and commence colchicine

      Correct Answer: Continue allopurinol and commence colchicine

      Explanation:

      Patients with an acute flare of gout who are already on allopurinol treatment should not discontinue it during the attack, as per the current NICE CKS guidance. Colchicine is a suitable option for acute gout treatment, and oral steroids can be used if colchicine or NSAIDs are not tolerated. Hospital review on the same day is not necessary unless there are red flag features or evidence of a septic joint. Aspirin is not recommended for gout treatment.

      Gout is caused by chronic hyperuricaemia and is managed acutely with NSAIDs or colchicine. Urate-lowering therapy (ULT) is recommended for patients with >= 2 attacks in 12 months, tophi, renal disease, uric acid renal stones, or prophylaxis if on cytotoxics or diuretics. Allopurinol is first-line ULT, with a delayed start recommended until inflammation has settled. Lifestyle modifications include reducing alcohol intake, losing weight if obese, and avoiding high-purine foods. Other options for refractory cases include febuxostat, uricase, and pegloticase.

    • This question is part of the following fields:

      • Musculoskeletal Health
      54.4
      Seconds
  • Question 7 - A 56-year-old man presents with a painful rash on his lower back that...

    Incorrect

    • A 56-year-old man presents with a painful rash on his lower back that has been bothering him for the past 7 days. He had visited the doctor 4 days ago and was prescribed aciclovir for shingles, but the pain persists despite taking paracetamol, ibuprofen, codeine, and amitriptyline. The pain is described as a severe burning sensation with a mild itch, which is affecting his daily functioning and sleep.

      During the examination, the man's temperature is recorded at 37ºC. The rash is located on the left lower back and is characterized by closely grouped red papules and vesicles with surrounding erythema.

      What would be the most appropriate course of action for managing this man's condition?

      Your Answer: Morphine

      Correct Answer: Prednisolone

      Explanation:

      If simple analgesia and neuropathic analgesia are not effective in treating refractory pain in shingles, corticosteroids such as prednisolone can be used, but only for acute shingles. This is according to the NICE CKS guideline, which recommends considering oral corticosteroids in the first 2 weeks following rash onset in immunocompetent adults with localized shingles if the pain is severe, but only in combination with antiviral treatment. In the case of a patient who has been on antiviral treatment for seven days and has tried several analgesics without relief, a course of prednisolone would be an appropriate treatment option. Chlorphenamine, an antihistamine medication, may help alleviate itching symptoms but is not the most appropriate treatment option for severe pain. Flucloxacillin, an antibiotic, is not necessary unless there is evidence of co-existing cellulitis. Fluoxetine, a selective serotonin reuptake inhibitor, has no role in shingles management. Morphine, an opioid medication, may be considered if the pain doesn’t respond to corticosteroids.

      Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.

    • This question is part of the following fields:

      • Dermatology
      84.7
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  • Question 8 - A mother brings her 4-year-old girl who is known to have Down's syndrome...

    Correct

    • A mother brings her 4-year-old girl who is known to have Down's syndrome to surgery, as she is worried about her vision. Which of the following eye issues is the least commonly linked with Down's syndrome?

      Your Answer: Retinal detachment

      Explanation:

      Vision and Hearing Issues in Down’s Syndrome

      Individuals with Down’s syndrome are at a higher risk of experiencing vision and hearing problems. When it comes to vision, they are more likely to have refractive errors, which can cause blurred vision. Strabismus, a condition where the eyes do not align properly, is also common in 20-40% of individuals with Down’s syndrome. Cataracts, which can cause cloudiness in the eye lens, are more prevalent in those with Down’s syndrome, both congenital and acquired. Recurrent blepharitis, an inflammation of the eyelids, and glaucoma, a condition that damages the optic nerve, are also potential issues.

      In terms of hearing, otitis media and glue ear are very common in individuals with Down’s syndrome. These conditions can lead to hearing problems, which can affect speech and language development. It is important for individuals with Down’s syndrome to receive regular vision and hearing screenings to detect and address any issues early on.

    • This question is part of the following fields:

      • Children And Young People
      30.5
      Seconds
  • Question 9 - A 19-year-old woman presents to her General Practitioner because she is concerned about...

    Correct

    • A 19-year-old woman presents to her General Practitioner because she is concerned about her weight, which is 56 kg. Her body mass index (BMI) is 18 kg/m2. She also reports prolonged fasts, sometimes not eating for a few days. She denies using laxatives or diuretics to help her lose weight. She is scared of putting on weight and has missed her last three periods. She has no known medical comorbidities.
      What is the most likely diagnosis?

      Your Answer: Anorexia nervosa

      Explanation:

      Understanding Eating Disorders: Differential Diagnosis

      Eating disorders are complex mental health conditions that can have serious physical and psychological consequences. When a patient presents with symptoms of an eating disorder, it is important to consider a range of differential diagnoses to ensure appropriate treatment. Here, we explore the key features of several eating disorders and related conditions, including anorexia nervosa, personality disorders, avoidant restrictive food intake disorder (ARFID), bulimia nervosa, and depression. By understanding the unique characteristics of each disorder, healthcare professionals can make an accurate diagnosis and provide effective support for patients with eating disorders.

    • This question is part of the following fields:

      • Mental Health
      22.8
      Seconds
  • Question 10 - A 7-month-old infant has sensorineural deafness and a ventricular septal defect. Her mother...

    Incorrect

    • A 7-month-old infant has sensorineural deafness and a ventricular septal defect. Her mother gives a history of medication for acne, which was stopped when she realised she was pregnant.
      Which of the following drugs is most likely to cause these defects?

      Your Answer: Oxytetracycline

      Correct Answer: Isotretinoin

      Explanation:

      Acne Medications and Pregnancy: Risks and Precautions

      Acne is a common skin condition that affects many people, including pregnant women. However, not all acne medications are safe to use during pregnancy. Here are some important things to know about the risks and precautions of using acne medications during pregnancy.

      Isotretinoin is a highly effective medication for reducing sebum secretion, but it is also highly teratogenic. Women who take isotretinoin must have a negative pregnancy test before treatment and use effective contraception during and after the course. Congenital deafness and central nervous system and heart defects may occur in children exposed to isotretinoin in utero.

      Topical retinoids, such as topical isotretinoin and topical retinoin, have a very low absorption rate through the skin. However, there are some reports of birth defects associated with their use, so women should avoid using them during pregnancy until more data is collected.

      Clindamycin, a topical and systemic antibiotic, has no reported adverse effects in pregnancy. Minocycline and oxytetracycline are less effective for acne treatment but are also less teratogenic. However, tetracyclines can stain bones and teeth, so they should be stopped if pregnancy occurs. Erythromycin is a more suitable antibiotic for pregnant women with acne.

      In summary, pregnant women with acne should consult with their healthcare provider before using any acne medication. It is important to weigh the potential risks and benefits of each medication and take appropriate precautions to ensure the safety of both the mother and the fetus.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      14.6
      Seconds
  • Question 11 - A 6-year-old girl was admitted to hospital the previous day following a 3-day...

    Correct

    • A 6-year-old girl was admitted to hospital the previous day following a 3-day history of a diarrhoeal illness, which had then developed into bloody diarrhoea. The mother telephones the clinic to say she is very ill and has developed blood spots in the skin and had nosebleeds. She says they are also worried about her kidneys.
      What is the most likely diagnosis?

      Your Answer: Disseminated intravascular coagulation

      Explanation:

      Understanding Disseminated Intravascular Coagulation: A Guide for General Practitioners

      Disseminated intravascular coagulation (DIC) is a serious condition that can occur in response to another illness or trauma. In DIC, the coagulation mechanism is activated inappropriately and in a diffuse way, leading to thrombosis or, more commonly, haemorrhage due to the depletion of clotting factors and platelets. DIC is often fatal and associated with organ failure, with bleeding from at least three unrelated sites being typical in the acute form.

      DIC can be triggered by a variety of factors, including infections such as gastroenteritis (e.g. Escherichia coli O157), malignancy (especially leukaemia), and septicaemia (e.g. meningococcal septicaemia). While bleeding is a feature in two-thirds of cases, renal involvement occurs in a quarter of cases, and limb ischaemia can lead to loss of digits or limbs.

      As a general practitioner, it is important to have some knowledge of DIC to respond to any questions that may arise. When presented with a patient with severe and widespread bleeding with kidney injury, DIC is more likely to be the cause than other conditions such as acute leukaemia, haemophilia A, von Willebrand disease, or meningococcal septicaemia.

      By understanding DIC and its potential triggers and symptoms, general practitioners can better support their patients and provide appropriate referrals for further treatment.

    • This question is part of the following fields:

      • Haematology
      226.8
      Seconds
  • Question 12 - You are evaluating a 28-year-old female patient who is being treated by a...

    Incorrect

    • You are evaluating a 28-year-old female patient who is being treated by a rheumatologist. Despite taking methotrexate and sulfasalazine, she did not experience satisfactory results and is now on leflunomide. The rheumatologist has advised her to continue taking her combined oral contraceptive pill, but she is interested in starting a family in the future. What is the recommended waiting period after discontinuing leflunomide before attempting to conceive?

      Your Answer:

      Correct Answer: At least 2 years

      Explanation:

      Women and men who are taking leflunomide must use effective contraception for a minimum of 2 years and 3 months respectively after discontinuing the medication, similar to the requirements for thalidomide.

      Leflunomide: A DMARD for Rheumatoid Arthritis

      Leflunomide is a type of disease modifying anti-rheumatic drug (DMARD) that is commonly used to manage rheumatoid arthritis. It is important to note that this medication has a very long half-life, which means that its teratogenic potential should be taken into consideration. As such, it is contraindicated in pregnant women, and effective contraception is essential during treatment and for at least two years after treatment in women, and at least three months after treatment in men. Caution should also be exercised in patients with pre-existing lung and liver disease.

      Like any medication, leflunomide can cause adverse effects. Some of the most common side effects include gastrointestinal issues such as diarrhea, hypertension, weight loss or anorexia, peripheral neuropathy, myelosuppression, and pneumonitis. To monitor for any potential complications, patients taking leflunomide should have their full blood count (FBC), liver function tests (LFT), and blood pressure checked regularly.

      If a patient needs to stop taking leflunomide, it is important to note that the medication has a very long wash-out period of up to a year. To help speed up the process, co-administration of cholestyramine may be necessary. Overall, leflunomide can be an effective treatment option for rheumatoid arthritis, but it is important to carefully consider its potential risks and benefits before starting treatment.

    • This question is part of the following fields:

      • Gynaecology And Breast
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  • Question 13 - A 25-year-old male is admitted to the acute medical unit after a paracetamol...

    Incorrect

    • A 25-year-old male is admitted to the acute medical unit after a paracetamol overdose. He later admits to multiple episodes of impulsive self-harm and overdoses. He reports that his recent overdose was triggered by a fight with his mom and concerns that she will no longer want to see him. He describes long-standing feelings of emptiness and doesn't like the way he looks.

      What is the most probable personality disorder underlying this behavior?

      Your Answer:

      Correct Answer: Borderline personality disorder

      Explanation:

      The correct diagnosis for the patient described is borderline personality disorder. This disorder is characterized by emotional instability, impulsive behavior, fear of abandonment, and unstable self-image. Patients often experience feelings of emptiness and engage in self-harm. Childhood trauma or abuse is often associated with the development of this disorder.

      Narcissistic personality disorder is not the correct diagnosis. This disorder is characterized by an exaggerated sense of self-importance, lack of empathy, and entitlement.

      Paranoid personality disorder is also not the correct diagnosis. Patients with this disorder are suspicious of others and may see hidden meanings in things or believe in conspiracy theories.

      Dependent personality disorder is not the correct diagnosis either. Patients with this disorder struggle to make decisions and require reassurance and support from others. They fear being alone and cope best in relationships. However, there is no evidence of this in the patient described.

      Personality disorders are a set of maladaptive personality traits that interfere with normal functioning in life. They are categorized into three clusters: Cluster A, which includes odd or eccentric disorders such as paranoid, schizoid, and schizotypal; Cluster B, which includes dramatic, emotional, or erratic disorders such as antisocial, borderline, histrionic, and narcissistic; and Cluster C, which includes anxious and fearful disorders such as obsessive-compulsive, avoidant, and dependent. These disorders affect around 1 in 20 people and can be difficult to treat. However, psychological therapies such as dialectical behaviour therapy and treatment of any coexisting psychiatric conditions have been shown to help patients.

    • This question is part of the following fields:

      • Mental Health
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  • Question 14 - A 25-year-old man presents to his General Practitioner with complaints that on waking...

    Incorrect

    • A 25-year-old man presents to his General Practitioner with complaints that on waking that morning, the right side of his neck was very painful. On examination, his neck is deviated to the right side where there is palpable muscle spasm and local tenderness. He is otherwise well and there is no history of trauma or drug-taking.
      What is the single most likely diagnosis?

      Your Answer:

      Correct Answer: Acute torticollis

      Explanation:

      Possible Causes of Neck Pain: An Overview

      Neck pain is a common complaint that can be caused by various conditions. Here are some possible causes of neck pain and their characteristics:

      Acute Torticollis
      Acute torticollis is a condition that results from local musculoskeletal irritation, causing pain and spasm in neck muscles. It usually resolves within 24-48 hours, but recurrence is common.

      Acute Cervical Disc Prolapse
      Acute cervical disc prolapse occurs when the inner gelatinous substance breaks through the annulus of the disc, causing compression of the spinal cord or surrounding nerve. Patients may experience neck pain with associated numbness or paraesthesiae.

      Cervical Spondylosis
      Cervical spondylosis is a degenerative disease that affects the neck and becomes more common with advancing age. It usually presents with neck pain or stiffness, muscle spasms, and grinding or clicking noises with neck movements.

      Multiple Sclerosis
      Multiple sclerosis is an autoimmune condition that causes repeated episodes of inflammation of the nervous tissue, resulting in the loss of the insulating myelin sheath. It presents with neurological symptoms and not neck pain.

      Retropharyngeal Abscess
      Retropharyngeal abscess is an abscess that forms in the space between the prevertebral fascia and the constrictor muscles. Patients with this condition may be unwell and often present with fever and dysphagia and may have secondary torticollis.

      In conclusion, neck pain can be caused by various conditions, and it is important to seek medical attention if the pain persists or is accompanied by other symptoms.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 15 - A 75-year-old woman is concerned about the possibility of developing dementia. What are...

    Incorrect

    • A 75-year-old woman is concerned about the possibility of developing dementia. What are the typical initial symptoms of Alzheimer's disease?

      Your Answer:

      Correct Answer: Progressive memory impairment, apraxia and dysphasia

      Explanation:

      Understanding the Symptoms of Alzheimer’s Disease

      Alzheimer’s disease (AD) is a neurodegenerative disorder that primarily affects the brain’s temporoparietal cortex. The most common symptom of AD is progressive memory loss, which is often accompanied by other cognitive deficits such as apraxia, aphasia, acalculia, and visuospatial dysfunction. However, it is important to note that not all cognitive deficits are indicative of AD. For example, the combination of progressive memory impairment and pyramidal signs is an unusual presentation for AD, as pyramidal signs are not typically associated with this condition. Similarly, personality changes and extrapyramidal signs are unlikely to be caused by AD, as these symptoms are more commonly seen in frontotemporal dementia. While some patients with advanced stages of AD may experience seizures or myoclonic jerks, these symptoms are not typically present during the early stages of the disease. Overall, a thorough understanding of the symptoms of AD is crucial for accurate diagnosis and effective treatment.

    • This question is part of the following fields:

      • Mental Health
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  • Question 16 - A 67-year-old male comes to the GP with a history of hearing loss...

    Incorrect

    • A 67-year-old male comes to the GP with a history of hearing loss for 6 months due to ototoxicity from furosemide. Upon examination, he has severe bilateral sensorineural hearing loss and can only hear spoken words if they are within 10 cm of him. He has been using hearing aids for 4 months, but they are not very effective. What aspect of his history indicates that cochlear implantation may be necessary?

      Your Answer:

      Correct Answer: Duration of hearing aid use

      Explanation:

      Before considering a cochlear implant as a management strategy for hearing loss in adults, a failed trial of hearing aids for at least 3 months is generally required, regardless of the cause, age at the time of hearing loss, duration, or severity of the condition. In the case of this patient, the duration of his hearing aid use is the most significant factor suggesting the appropriateness of a cochlear implant.

      A cochlear implant is an electronic device that can be given to individuals with severe-to-profound hearing loss. The suitability for a cochlear implant is determined by audiological assessment and/or difficulty developing basic auditory skills in children, and a trial of appropriate hearing aids for at least 3 months in adults. The causes of severe-to-profound hearing loss can be genetic, congenital, idiopathic, infectious, viral-induced sudden hearing loss, ototoxicity, otosclerosis, Ménière disease, or trauma. Prior to an assessment for the cochlear implant, patients should have exhausted all medical therapies aimed at targeting any underlying pathological process contributing to the loss of hearing.

      Surgical implantation may be complicated by infection, facial paralysis due to nerve injury intra-operatively, cerebrospinal fluid (CSF) leakage, and meningitis. Patients are discharged for the postoperative physical recovery of the implantation site and generally return to outpatient clinic 3-5 weeks post-op for device stimulation. Contraindications to consideration for cochlear implant include lesions of cranial nerve VIII or in the brain stem causing deafness, chronic infective otitis media, mastoid cavity or tympanic membrane perforation, and cochlear aplasia.

      The device has both internal and external components. Externally, the microphone recognises the environmental sound and sends it to the sound processor. This, in turn, transforms the impulses received into a digital signal that which is then transferred to the transmitter coil. The transmitter coil conveys the signal to the internal components. Internally, a receiver, which magnetically connected to, and sits directly above the transmitter coil, and receives the impulses from the external apparatus which are then processed by a set of electrodes. The electrodes do the work that would be performed by the inner ear hair cells in a ‘normal’ ear. The brain can then process these signals to comprehend sound.

      Rechargeable batteries can be used to power the apparatus and life span depends upon usage and the individual device. Hearing link describes cochlear implants as ‘…the world’s most successful medical prostheses in that less than 0.2% of recipients reject it or do not use it and the failure rate needing reimplantation is around 0.5%.’ It is important for patients to demonstrate an understanding of what to expect from cochlear implantation, including comprehension of the likely limitations of the device. Patients should also demonstrate an interest in using the

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
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  • Question 17 - Emma is a 28-year-old woman who comes to see you for a follow-up...

    Incorrect

    • Emma is a 28-year-old woman who comes to see you for a follow-up visit. You initially saw her 2 months ago for low mood and referred her for counselling. She states she is still feeling low and her feelings of anxiety are worsening. She is keen to try medication to help.

      Emma has a 5-month-old baby and is breastfeeding.

      Which of the following is the most appropriate medication for Emma to commence?

      Your Answer:

      Correct Answer: Sertraline

      Explanation:

      Breastfeeding women can safely take SSRIs such as sertraline or paroxetine as the amount of antidepressant passed on to the infant through breast milk is very low and not considered harmful. Therefore, it is recommended that women with postnatal depression continue to breastfeed while receiving antidepressant treatment.

      Understanding Postpartum Mental Health Problems

      Postpartum mental health problems can range from mild ‘baby-blues’ to severe puerperal psychosis. To screen for depression, healthcare professionals may use the Edinburgh Postnatal Depression Scale, which is a 10-item questionnaire that indicates how the mother has felt over the previous week. A score of over 13 indicates a ‘depressive illness of varying severity’, and the questionnaire includes a question about self-harm. The sensitivity and specificity of this screening tool are over 90%.

      ‘Baby-blues’ are seen in around 60-70% of women and typically occur 3-7 days following birth. This condition is more common in primips, and mothers are characteristically anxious, tearful, and irritable. Postnatal depression affects around 10% of women, with most cases starting within a month and typically peaking at 3 months. The features of postnatal depression are similar to depression seen in other circumstances.

      Puerperal psychosis affects approximately 0.2% of women and usually occurs within the first 2-3 weeks following birth. The features of this condition include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations). Reassurance and support are important for all these conditions, but admission to hospital is usually required for puerperal psychosis, ideally in a Mother & Baby Unit. Cognitive behavioural therapy may be beneficial, and certain SSRIs such as sertraline and paroxetine may be used if symptoms are severe. While these medications are secreted in breast milk, they are not thought to be harmful to the infant. However, fluoxetine is best avoided due to its long half-life. There is around a 25-50% risk of recurrence following future pregnancies.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
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  • Question 18 - Your practice plans to grow its list size, take on more staff, and...

    Incorrect

    • Your practice plans to grow its list size, take on more staff, and possibly take over the work of a neighbouring practice from which two GPs are retiring in the next five years. Before you start planning how to achieve these aims you decide to do a SWOT analysis of the factors involved.

      Which one of the following forms part of the acronym in the term SWOT analysis?

      Your Answer:

      Correct Answer: Threats

      Explanation:

      Understanding SWOT Analysis

      SWOT analysis is a strategic planning tool that helps organisations identify their Strengths, Weaknesses, Opportunities, and Threats. It is a method used to evaluate the internal and external factors that may impact an organisation or plan. The analysis can be used to develop a clear objective and form part of an overall strategic planning programme.

      The process involves identifying the strengths and weaknesses of an organisation’s internal factors, such as its resources, capabilities, and culture. It also considers the external factors, such as market trends, competition, and regulatory changes. By identifying these factors, organisations can develop strategies to maximise their strengths, address their weaknesses, take advantage of opportunities, and mitigate threats.

      SWOT analysis is widely used in various industries, including healthcare. For instance, in the NHS, it can be used to manage change and improve patient care. In the Better Care Together initiative, a SWOT analysis was conducted to identify the strengths, weaknesses, opportunities, and threats of the healthcare system in Morecambe Bay. This helped the organisation develop a strategic plan to improve patient care and outcomes.

      In summary, SWOT analysis is a valuable tool for organisations to evaluate their internal and external factors and develop strategies to achieve their objectives.

    • This question is part of the following fields:

      • Leadership And Management
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  • Question 19 - The laboratory reports a sodium level of 118 mmol/L from a routine blood...

    Incorrect

    • The laboratory reports a sodium level of 118 mmol/L from a routine blood test for an 85 year old woman who has recently been prescribed sertraline for low mood and takes amlodipine for hypertension. Upon calling the patient, she reports feeling well. What is the appropriate course of action?

      Your Answer:

      Correct Answer: Arrange emergency admission

      Explanation:

      A sodium level of 118 mmol/L is classified as severe hyponatremia, which is a potentially life-threatening condition. Emergency admission is necessary, especially if the onset of hyponatremia is acute (less than 48 hours). This is because the brain cells can swell due to the movement of water from the extracellular to the intracellular compartment, which can cause cerebral edema, increased intracranial pressure, seizures, coma, or even cardio-respiratory arrest. Hyponatremia can also be classified based on its biochemical severity and rate of onset, with mild, moderate, and severe levels of hyponatremia and acute or chronic onset.

      Hyponatremia is a condition where the sodium levels in the blood are too low. If left untreated, it can lead to cerebral edema and brain herniation. Therefore, it is important to identify and treat hyponatremia promptly. The treatment plan depends on various factors such as the duration and severity of hyponatremia, symptoms, and the suspected cause. Over-rapid correction can lead to osmotic demyelination syndrome, which is a serious complication.

      Initial steps in treating hyponatremia involve ruling out any errors in the test results and reviewing medications that may cause hyponatremia. For chronic hyponatremia without severe symptoms, the treatment plan varies based on the suspected cause. If it is hypovolemic, normal saline may be given as a trial. If it is euvolemic, fluid restriction and medications such as demeclocycline or vaptans may be considered. If it is hypervolemic, fluid restriction and loop diuretics or vaptans may be considered.

      For acute hyponatremia with severe symptoms, patients require close monitoring in a hospital setting. Hypertonic saline is used to correct the sodium levels more quickly than in chronic cases. Vaptans, which act on V2 receptors, can be used but should be avoided in patients with hypovolemic hyponatremia and those with underlying liver disease.

      It is important to avoid over-correction of severe hyponatremia as it can lead to osmotic demyelination syndrome. Symptoms of this condition include dysarthria, dysphagia, paralysis, seizures, confusion, and coma. Therefore, sodium levels should only be raised by 4 to 6 mmol/L in a 24-hour period to prevent this complication.

    • This question is part of the following fields:

      • Urgent And Unscheduled Care
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  • Question 20 - A 16-year-old girl comes to you with acne. Upon examination, you observe several...

    Incorrect

    • A 16-year-old girl comes to you with acne. Upon examination, you observe several whiteheads and blackheads, but no facial scarring. The patient expresses interest in treatment. What is the initial course of action in this scenario?

      Your Answer:

      Correct Answer: Topical retinoid

      Explanation:

      For the treatment of mild acne, the NICE guidance recommends starting with a topical retinoid or benzoyl peroxide. This is particularly appropriate for boys. However, if the patient is female, a combined oral contraceptive may be prescribed instead of a retinoid due to the teratogenic effects of retinoids. Mild acne is characterized by the presence of blackheads, whiteheads, papules, and pustules. While scarring is unlikely, the condition can have a significant psychosocial impact. If topical retinoids and benzoyl peroxide are poorly tolerated, azelaic acid may be prescribed. Combined treatment is rarely necessary. Follow-up should be arranged after 6-8 weeks to assess the effectiveness and tolerability of treatment and the patient’s compliance.

      Acne vulgaris is a common skin condition that usually affects teenagers and is characterized by the obstruction of hair follicles with keratin plugs, resulting in comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the number and type of lesions present. Treatment for acne typically involves a step-up approach, starting with single topical therapy and progressing to combination therapy or oral antibiotics if necessary. Tetracyclines are commonly used but should be avoided in certain populations, and a topical retinoid or benzoyl peroxide should always be co-prescribed to reduce the risk of antibiotic resistance. Combined oral contraceptives can also be used in women, and oral isotretinoin is reserved for severe cases under specialist supervision. Dietary modification has no role in the management of acne.

    • This question is part of the following fields:

      • Dermatology
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  • Question 21 - A 60-year-old man presents to the clinic for follow-up. He has been experiencing...

    Incorrect

    • A 60-year-old man presents to the clinic for follow-up. He has been experiencing increasing difficulty with swallowing and feels like food is getting stuck shortly after he swallows. He has resorted to blending most of his meals and has lost 4 kg in weight over the past two months. He has also developed a hoarse voice recently.
      The patient has a history of knee osteoarthritis and regularly takes ibuprofen. He has a BMI of 21 kg/m2 and no cervical lymphadenopathy is noted.
      Laboratory results show:
      - Hb 98 g/L (135-180)
      - WCC 7.4 ×109/L (4.5-10)
      - PLT 182 ×109/L (150-450)
      - Na 137 mmol/L (135-145)
      - K 4.7 mmol/L (3.5-5.5)
      - Cr 115 µmol/L (70-110)
      Based on these findings, you suspect an upper esophageal cancer.
      What is the most important next step?

      Your Answer:

      Correct Answer: Trial of omeprazole

      Explanation:

      Urgent Referral for Upper GI Endoscopy in Suspected Oesophageal Carcinoma

      This patient’s medical history is indicative of an oesophageal carcinoma in the upper third, which is commonly associated with smoking and exposure to human papillomavirus. Although there are no signs of cervical lymphadenopathy, urgent referral to a gastroenterologist for upper GI endoscopy is necessary to rule out any underlying cancer.

      Barium swallow is not recommended as upper GI endoscopy is a more effective option that allows for early tissue diagnosis. Helicobacter pylori testing is only useful in cases of potential duodenal ulcer disease, which is not the case here.

      Stopping ibuprofen and trying omeprazole are not appropriate options as they may delay the diagnosis of any underlying oesophageal lesion. Therefore, urgent referral for upper GI endoscopy is the best course of action in suspected cases of oesophageal carcinoma.

    • This question is part of the following fields:

      • Urgent And Unscheduled Care
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  • Question 22 - A 65-year-old woman presents reporting that she experiences vaginal pressure when she strains....

    Incorrect

    • A 65-year-old woman presents reporting that she experiences vaginal pressure when she strains. She has a history of mild cognitive impairment and severe osteoarthritis. She has very poor mobility in her back, wrists and hands. Her body mass index is 35 kg/m2. Examination reveals a moderate uterine prolapse with a cystocele and a rectocele. The patient reports that she is still sexually active. She reports she cannot reliably attend follow-up at the surgery.
      Why would a ring pessary likely be contraindicated in this patient?

      Your Answer:

      Correct Answer: Inability to attend follow-up care

      Explanation:

      Considerations for Ring Pessary Use in Patients with Specific Conditions

      Ring pessaries are a non-surgical option for managing pelvic organ prolapse. However, certain patient factors must be considered before recommending this treatment.

      Inability to attend follow-up care is a significant concern for patients using ring pessaries. These devices need to be changed every six months, and patients with poor mobility may require assistance from a healthcare provider. Failure to change the pessary can lead to infection and other complications. Therefore, patients who cannot attend follow-up appointments may not be suitable candidates for ring pessary use.

      Obesity is a risk factor for pelvic organ prolapse, but it is not a contraindication for ring pessary use. In fact, weight loss may help alleviate the condition along with pessary use.

      Age is not a barrier to pessary insertion. In fact, ring pessaries are often used in older or frailer patients where surgery is less desirable.

      Sexual activity is not a contraindication for ring pessary use. Patients can leave the pessary in during intercourse, but some may find it uncomfortable. In such cases, the ring can be removed and reinserted after intercourse, or an alternative type of pessary can be tried.

      Mild cognitive impairment doesn’t preclude pessary use, but patients may require additional follow-up to ensure the device is removed and replaced every six months.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 23 - A woman who is pregnant with twins wants advice about air travel while...

    Incorrect

    • A woman who is pregnant with twins wants advice about air travel while pregnant. It will be a ten-hour flight. There have been no complications during this pregnancy. She wants to know how late into the pregnancy she is allowed to fly.

      What would you advise her about air travel for an uncomplicated twin pregnancy?

      Your Answer:

      Correct Answer: Most airlines will not let a person fly after week 28 of pregnancy

      Explanation:

      Flying while pregnant with twins

      When it comes to flying while pregnant with twins, there are certain restrictions that airlines impose. Unlike a single, uncomplicated pregnancy where the limit is week 37, most airlines will not allow pregnant women carrying twins or more to fly after week 32. This is due to the increased risks of certain medical conditions while travelling in the air that are compounded by pregnancy, as well as the higher risk of going into labor.

      Aside from these restrictions, pregnant women should also be advised on DVT prophylaxis, especially for flights longer than four hours. This includes walking when possible, in-seat exercises, keeping hydrated, and wearing compression stockings. The Royal College of Obstetricians and Gynaecologists (RCOG) provides a helpful patient leaflet on this topic.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
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  • Question 24 - A 65-year-old female presents with a complaint about her legs. She is typically...

    Incorrect

    • A 65-year-old female presents with a complaint about her legs. She is typically healthy and doesn't take any regular medications. She reports experiencing an intense urge to move her legs in the evenings and when in bed, describing it as fidgety, twitchy legs. This has been affecting her sleep and occurs daily. Although massaging and stretching her legs provide some relief, she finds her symptoms both intrusive and tiresome. Her husband also reports being awakened several times by her sudden leg jerks during the night, which she seems to have no control over. Recent blood tests are normal, including a normal full blood count, ferritin, renal function, liver function, bone profile, thyroid function, fasting glucose, and inflammatory markers. What treatment options may be helpful for her symptoms?

      Your Answer:

      Correct Answer: Baclofen

      Explanation:

      Restless Legs Syndrome: Symptoms, Causes, and Treatment Options

      Restless Legs Syndrome (RLS) is a condition where patients experience an intense desire to move their legs, particularly in the evenings and at night. This can lead to sleep disturbance and involuntary leg jerks. It is important to rule out secondary causes such as diabetes, hypothyroidism, and renal disease, as well as consider a patient’s drug history as certain medications can be the underlying cause of symptoms. Non-pharmacological approaches such as stretching, massage, and warmth can be effective in mild cases, but drug treatment should be considered for frequent or intrusive symptoms. Ropinirole and levodopa are commonly used medications for RLS, with levodopa being the drug of choice for intermittent symptoms. It is important to consult with a healthcare professional for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
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  • Question 25 - A 70-year-old man with atrial fibrillation takes digoxin. He visited his General Practitioner...

    Incorrect

    • A 70-year-old man with atrial fibrillation takes digoxin. He visited his General Practitioner (GP) reporting discomfort and swelling in his ankles, and was prescribed Drug X alongside his current medication. After two weeks, he experiences nausea, diarrhoea, and reports seeing yellow. What is the probable identity of Drug X?

      Your Answer:

      Correct Answer: Furosemide

      Explanation:

      Medications and their interactions in a case of digoxin toxicity

      Digoxin toxicity is a serious condition that can present with gastrointestinal upset, changes to vision, hypokalaemia, and cardiac arrhythmias. Co-prescribing of a thiazide or loop diuretic can increase the risk of digoxin toxicity by reducing potassium levels. Other risk factors for digoxin toxicity include age, poor renal function, and calcium-channel blockers.

      Amiodarone can be used in atrial fibrillation but should only be prescribed in secondary care and would not be prescribed for the ankle swelling that may have led to the digoxin prescription. Propranolol and sotalol do not interact with digoxin and would not have caused the symptoms of digoxin toxicity. Warfarin doesn’t interact with digoxin and would not be prescribed to treat the original symptoms of ankle swelling. It is important to consider medication interactions and risk factors when prescribing medications to avoid adverse effects such as digoxin toxicity.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
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  • Question 26 - A 25-year-old woman with a history of type 1 diabetes becomes very unwell...

    Incorrect

    • A 25-year-old woman with a history of type 1 diabetes becomes very unwell with increased respiratory rate, drowsiness and thirst.

      On examination she is pyrexial 38°C, just about communicating, and smells of acetone. Her BP is 100/60 mmHg with a pulse of 105, her glucose is 27.5.

      How would you manage her?

      Your Answer:

      Correct Answer: Review next day

      Explanation:

      Diabetic Ketoacidosis: A Serious Condition Requiring Hospital Management

      Diabetic ketoacidosis is a life-threatening condition that occurs due to absolute insulin deficiency, which is almost exclusively seen in type 1 diabetes. It carries a mortality rate of up to 5% and requires immediate hospital management.

      The accumulation of ketones in the body leads to metabolic acidosis, which is compensated for by respiratory mechanisms. Hyperkalaemia is often present at the time of presentation, but it can be resolved quickly with insulin therapy and fluid resuscitation.

      It is important to note that starting antibiotics or increasing insulin in a domiciliary setting is not appropriate for managing diabetic ketoacidosis. This condition requires prompt medical attention and close monitoring to prevent complications and improve outcomes.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
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  • Question 27 - A 50-year-old man with a history of hypertension and type II diabetes mellitus...

    Incorrect

    • A 50-year-old man with a history of hypertension and type II diabetes mellitus presents with intermittent chest pain which tends to occur when out walking. He describes the pain as radiating to his neck, jaw, and left arm. He feels dizzy and short of breath. The symptoms tend to last for around five minutes after he stops walking and then resolve.
      What feature is most indicative of angina in a patient complaining of chest pain?

      Your Answer:

      Correct Answer: Radiation to the throat and jaw

      Explanation:

      Understanding Angina Symptoms: What to Look Out For

      Angina is a type of chest pain that occurs when the heart muscle doesn’t receive enough oxygen-rich blood. Here are some common symptoms associated with angina:

      Radiation to the throat and jaw: Chest pain that radiates to the throat and jaw is typical of angina.

      Prolonged pain: Anginal pain is typically exertional and quickly relieved by rest or glyceryl trinitrate (GTN spray) within around five minutes. It is not typically prolonged.

      Associated dizziness: Pain associated with palpitations or dizziness is less likely to be angina than other attributable causes.

      Associated shortness of breath: Shortness of breath can occur in both cardiac and pulmonary causes of chest pain and so is not specific to angina.

      Pain associated with taking a breath in: Pain associated with breathing is likely to be associated with pulmonary or musculoskeletal causes of chest pain, rather than angina.

      It’s important to note that these symptoms can also be indicative of other health issues, so it’s always best to consult with a healthcare professional if you experience any chest pain or discomfort.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 28 - A 3-year-old girl is brought in by her father with symptoms of croup....

    Incorrect

    • A 3-year-old girl is brought in by her father with symptoms of croup. You decide to administer dexamethasone. Her weight is 12kg.

      The British National Formulary recommends:

      Dexamethasone (for croup):
      A single dose of 150 micrograms/kg by mouth is effective
      Oral solution, sugar-free, dexamethasone (as sodium phosphate) 2 mg/5ml

      What is the accurate dosage of dexamethasone?

      Your Answer:

      Correct Answer: 3.75ml

      Explanation:

      According to instructions, a dose of dexamethasone can be administered at a rate of 150 micrograms per kilogram. This is equivalent to 0.15 milligrams per kilogram. The patient weighs 10 kilograms, so they require a single dose of 1.5 milligrams. The medication is available in an oral suspension form with a concentration of 2 milligrams per 5 milliliters. Therefore, 1.5 milligrams divided by 2 milligrams equals 0.75. Multiplying 0.75 by 5 milliliters gives a single dose of 3.75 milliliters.

      Drug Dose Calculations Made Simple

      Drug dose calculations are becoming increasingly important due to the rise of prescription errors. These errors can result in serious harm to patients, which is why it is crucial to ensure that the calculations are correct. Although the calculations themselves are relatively straightforward, it is easy to make a mistake.

      Most calculations involve drugs given as solutions or infusions. To calculate the correct dose for a patient’s weight, you need to multiply the weight by the recommended dosage. For example, if a child weighs 18kg and the recommended dosage for paracetamol is 20 mg/kg, the calculation would be 18 x 20 = 360mg.

      Paracetamol oral suspension is available in a concentration of 120mg/5ml. To determine the amount of oral suspension to give, divide the total dose by the concentration of the oral suspension. In this case, 360 mg divided by 120 mg equals 3. Multiply this by the volume of the oral suspension, which is 5ml, to get the final dose of 15ml.

      By following these simple steps, you can ensure that drug dose calculations are accurate and prevent any potential harm to patients.

    • This question is part of the following fields:

      • Improving Quality, Safety And Prescribing
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  • Question 29 - Samantha, aged 55, presents with sudden onset dizziness described as 'the room spinning'...

    Incorrect

    • Samantha, aged 55, presents with sudden onset dizziness described as 'the room spinning' which started three days ago. She has been unable to leave her home due to constant dizziness and nausea that accompanies it. She reports that movement seems to worsen her symptoms and denies any changes to her hearing. Apart from a recent cold, she has had no other health problems in recent years and has no past medical history except for a hysterectomy ten years ago.

      After conducting a Dix-Hallpike test and examining her ear canals, which both proved normal, you diagnose her with vestibular neuronitis. She asks if there is anything she can take to alleviate her symptoms.

      What advice would you give her?

      Your Answer:

      Correct Answer: One week trial of prochlorperazine

      Explanation:

      Patients with peripheral vertigo may experience distressing symptoms, such as those caused by vestibular neuronitis and labyrinthitis. To alleviate these symptoms in the short term, a sedating antihistamine like prochlorperazine can be prescribed for up to one week. However, longer courses of treatment may delay vestibular compensation and hinder recovery.

      Haloperidol, which has a low affinity for histamine receptors, may not be effective in treating vertigo and could cause unwanted side effects. Cetirizine, a non-sedating antihistamine, would not address the nausea or vertigo symptoms. Betahistine, a histamine analogue, is only licensed for treating vertigo, tinnitus, and hearing loss associated with Meniere’s disease. While it may be considered for persistent symptoms, it is an unlicensed use and not recommended by NICE guidance.

      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 30 - A father comes to see you for some advice regarding immunisation of his...

    Incorrect

    • A father comes to see you for some advice regarding immunisation of his toddler son who is HIV positive. He is not sure if his son is able to have the usual routine childhood immunisations.

      You review his clinical record and discuss things further. The child is well at present with no clinical or biochemical evidence of immunosuppression.

      What do you advise?

      Your Answer:

      Correct Answer: She should only receive 'inactivated' vaccines and 'live' vaccines are absolutely contraindicated

      Explanation:

      Immunisation for HIV-positive patients

      Immunisation is a crucial aspect of managing HIV-positive patients. Inactivated vaccines are safe to administer as they pose no risk of infection. However, the response to the vaccine may not be as effective as in immunocompetent individuals. Live vaccines carry a risk of infection, and therefore, certain restrictions apply. For instance, the MMR vaccine is a live vaccine that requires an assessment of immune status before administration. The Department of Health recommends that HIV-positive individuals receive the MMR vaccine according to national guidelines, provided they do not have severe immunosuppression. However, for children under 12, CD4 counts may not be an accurate assessment of immune status, and expert assessment is advised. In conclusion, routine immunisations can be safely given to HIV-positive individuals without evidence of immunosuppression, but specialist advice should be sought to clarify this.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
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SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (1/1) 100%
Children And Young People (2/2) 100%
Smoking, Alcohol And Substance Misuse (2/2) 100%
Evidence Based Practice, Research And Sharing Knowledge (0/1) 0%
Musculoskeletal Health (0/1) 0%
Dermatology (0/1) 0%
Mental Health (1/1) 100%
Maternity And Reproductive Health (0/1) 0%
Haematology (1/1) 100%
Passmed