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Question 1
Incorrect
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A 48-year-old woman presents as an emergency appointment with recurrent attacks of chest tightness and palpitations. She was advised to seek immediate attention should a recurrence occur. She reports feeling unwell while out shopping, experiencing chest tightness, rapid palpitations, sweating, lightheadedness, and pins and needles in her fingers. She is unsure what triggers these episodes. Her past medical history includes treatment for asthma and anxiety following her divorce a few years ago. She appears pale and sweaty, with a rapid regular pulse of 122 beats per minute and blood pressure of 220/115 mmHg. Heart sounds are normal, chest is clear, and she has a slight fine tremor. Urine dipstick testing reveals glycosuria+++, nitrites and leucocytes are negative. ECG shows sinus tachycardia. What is the underlying diagnosis?
Your Answer: Panic attack
Correct Answer: Thyrotoxicosis
Explanation:Diagnosing Chest Tightness and Palpitations in Primary Care
Symptoms of chest tightness and palpitations are common in primary care, but diagnosing the underlying cause can be challenging. Episodic symptoms often require catching the symptoms during an attack to make an accurate diagnosis. Patients may describe a previous attack, but positive examination findings are often lacking when they are asymptomatic. Therefore, history is crucial, and patients should seek review when experiencing symptoms.
In this case, the patient presented with high blood pressure, tachycardia, and glycosuria during an attack. The episodic nature of the symptoms suggested panic attacks, phaeochromocytoma, or a paroxysmal tachyarrhythmia such as Wolff-Parkinson-White (WPW) syndrome. However, WPW typically causes paroxysmal supraventricular tachycardia and would not cause glycosuria. Panic attacks would not cause glycosuria, and the severity of the hypertension would go against this diagnosis. Phaeochromocytoma unifies the history and clinical features and is the underlying disorder.
Phaeochromocytoma is a rare tumour that produces catecholamines and causes episodes of hypertension, chest tightness, sweating, tremor, and flushing. Glycosuria occurs in approximately 30% of patients during an attack. Diagnosis is made by a 24-hour urine collection for metanephrines, and surgical removal is the treatment of choice.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 2
Incorrect
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32-year-old Sarah is on methadone 60mg once a day to manage her symptoms from heroin withdrawal. She collects her methadone daily from the pharmacy and is supervised consuming it. One Friday morning Sarah fails to turn up to the pharmacy. What should the pharmacist do in this situation?
Your Answer:
Correct Answer: Give him his usual 60mg methadone when he turns up the next day on Thursday and forfeit the dose from the day before
Explanation:Understanding Opioid Misuse and its Management
Opioid misuse is a serious problem that can lead to various complications and health risks. Opioids are substances that bind to opioid receptors, including natural opiates like morphine and synthetic opioids like buprenorphine and methadone. Signs of opioid misuse include rhinorrhoea, needle track marks, pinpoint pupils, drowsiness, watering eyes, and yawning.
Complications of opioid misuse can range from viral and bacterial infections to venous thromboembolism and overdose, which can lead to respiratory depression and death. Psychological and social problems such as craving, crime, prostitution, and homelessness can also arise.
In case of an opioid overdose, emergency management involves administering IV or IM naloxone, which has a rapid onset and relatively short duration of action. Harm reduction interventions such as needle exchange and testing for HIV, hepatitis B & C may also be offered.
Patients with opioid dependence are usually managed by specialist drug dependence clinics or GPs with a specialist interest. Treatment options may include maintenance therapy or detoxification, with methadone or buprenorphine recommended as the first-line treatment by NICE. Compliance is monitored using urinalysis, and detoxification can last up to 4 weeks in an inpatient/residential setting and up to 12 weeks in the community. Understanding opioid misuse and its management is crucial in addressing this growing public health concern.
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This question is part of the following fields:
- Smoking, Alcohol And Substance Misuse
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Question 3
Incorrect
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A new anti-epileptic drug is being tested for adolescents with absence seizures. The control group consists of 300 adolescents while 200 adolescents are given the new drug. After 6 months, 80 adolescents in the control group had a seizure while only 10 adolescents in the group taking the new medication had a seizure. What is the relative risk reduction?
Your Answer:
Correct Answer: 75%
Explanation:Understanding Relative Risk in Clinical Trials
Relative risk (RR) is a measure used in clinical trials to compare the risk of an event occurring in the experimental group to the risk in the control group. It is calculated by dividing the experimental event rate (EER) by the control event rate (CER). If the resulting ratio is greater than 1, it means that the event is more likely to occur in the experimental group than in the control group. Conversely, if the ratio is less than 1, the event is less likely to occur in the experimental group.
To calculate the relative risk reduction (RRR) or relative risk increase (RRI), the absolute risk change is divided by the control event rate. This provides a percentage that indicates the magnitude of the difference between the two groups. Understanding relative risk is important in evaluating the effectiveness of interventions and treatments in clinical trials. By comparing the risk of an event in the experimental group to the control group, researchers can determine whether the intervention is beneficial or not.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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Question 4
Incorrect
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What is the correct statement about attention-deficit hyperactivity disorder and its treatment?
Your Answer:
Correct Answer: Sleep disturbance is a common side-effect of methylphenidate
Explanation:Management of ADHD in Children and Adults
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. Diagnosis and management of ADHD should be done by a specialist trained in the disorder. Management of ADHD includes drug-based and non-drug-based approaches such as cognitive behavioural therapy, social skills training, and family support.
Methylphenidate, an amphetamine derivative, is commonly used in drug-based treatment of ADHD. However, sleeplessness and anxiety are common side effects during initiation. Growth monitoring, blood pressure, and pulse should be monitored initially and subsequently if there are clinical concerns, as growth retardation and raised blood pressure are potential side effects. An ECG may be necessary if there is a history or family history of cardiac disease.
Ongoing prescriptions of methylphenidate are usually supplied by the GP under shared-care arrangements. Sedative drugs are not used in the management of ADHD. It is important to note that at least 15-20% of children with ADHD continue to have full ADHD as adults, and as many as 65% may continue to have problematic symptoms that interfere with their academic or work potential.
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This question is part of the following fields:
- Neurology
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Question 5
Incorrect
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What is the food item with the highest glycaemic index (GI)?
Your Answer:
Correct Answer: Potatoes
Explanation:The Importance of GI and Nutrition in Diabetes and Dieting
The GI and nutrition are crucial factors to consider when it comes to managing diabetes and maintaining a healthy diet. In exams, questions related to these topics are common. Foods with a low GI are recommended for people with diabetes as they cause a smaller increase in blood glucose levels, resulting in better glycaemic control.
For instance, potatoes have a high GI, which means they can cause a rapid spike in blood sugar levels. On the other hand, cucumber has the lowest GI, making it an excellent choice for people with diabetes. By understanding the GI and nutrition of different foods, individuals can make informed choices about what they eat, which can help them manage their diabetes and maintain a healthy weight.
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This question is part of the following fields:
- Population Health
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Question 6
Incorrect
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A young woman who is ten weeks pregnant comes to you with an erythematous rash, mild fever and enlarged glands in her neck. You suggest taking a blood test to check if she is immune to rubella since there is no record of her being immunised. She asks about the potential risk to her baby if she does have rubella. What is the percentage of infants that may develop congenital rubella syndrome and potential birth defects if a woman contracts rubella at ten weeks gestation?
Your Answer:
Correct Answer: Up to 90%
Explanation:Maternal Rubella Infection in Pregnancy
Maternal rubella infection during pregnancy can lead to fetal loss or congenital rubella syndrome (CRS). CRS is characterized by various abnormalities such as cataracts, deafness, cardiac defects, microcephaly, retardation of intrauterine growth, and inflammatory lesions in the brain, liver, lungs, and bone marrow.
If the infection occurs within the first eight to ten weeks of pregnancy, up to 90% of surviving infants may experience damage, often with multiple defects. However, the risk of damage decreases to about 10-20% if the infection occurs between 11 and 16 weeks of gestation. Infections after 16 weeks of pregnancy are rare and typically only result in deafness, with no other fetal damage reported up to 20 weeks of pregnancy.
Overall, maternal rubella infection during pregnancy can have severe consequences for the developing fetus, highlighting the importance of vaccination and prevention measures.
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This question is part of the following fields:
- Children And Young People
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Question 7
Incorrect
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A 47-year-old woman visits the clinic. She began using a combined hormone replacement therapy (HRT) containing oestrogen and progestogen to alleviate her menopausal symptoms half a year ago. She was still experiencing periods when she started HRT.
Today, she seeks advice as she has entered a new relationship after being celibate for the past three years. She inquires about alternative contraceptive methods aside from using condoms. What would be the best answer to provide her?Your Answer:
Correct Answer: The addition of a progestogen-only pill is the most appropriate method
Explanation:Although the progestogen-only pill can be used in combination with HRT, it cannot serve as the sole progestogen component. Women aged 40 and above can use the combined oral contraceptive pill, which is classified as UKMEC2. For women over 45 years, Depo-Provera is also classified as UKMEC2.
Women over the age of 40 still require effective contraception until they reach menopause, despite a significant decline in fertility. The Faculty of Sexual and Reproductive Healthcare (FSRH) has produced specific guidance for this age group, titled Contraception for Women Aged Over 40 Years. No method of contraception is contraindicated by age alone, with all methods being UKMEC1 except for the combined oral contraceptive pill (UKMEC2 for women >= 40 years) and Depo-Provera (UKMEC2 for women > 45 years). The FSRH guidance provides specific considerations for each method, such as the use of COCP in the perimenopausal period to maintain bone mineral density and reduce menopausal symptoms. Depo-Provera use is associated with a small loss in bone mineral density, which is usually recovered after discontinuation. The FSRH also provides a table detailing how different methods may be stopped based on age and amenorrhea status. Hormone replacement therapy cannot be relied upon for contraception, and a separate method is needed. The FSRH advises that the POP may be used in conjunction with HRT as long as the HRT has a progestogen component, while the IUS is licensed to provide the progestogen component of HRT.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 8
Incorrect
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A 42-year-old patient on your practice list has a BMI of 52 kg/m² and is interested in bariatric surgery. They have no co-morbidities or contraindications for surgery.
What should be the next course of action?Your Answer:
Correct Answer: Refer for bariatric surgery
Explanation:For adults with a BMI greater than 50 kg/m², bariatric surgery can be considered as the first-line option without any restrictions on referral. However, if the patient has medical conditions that are affected by weight, referral for surgery can be considered at a BMI greater than 35 kg/m². The decision to undergo surgery will involve an anaesthetic risk assessment based on various factors. Patients with a BMI greater than 40 kg/m² can be referred for bariatric surgery without the need for a medical condition affected by weight. While a dietary management plan may be beneficial, it is not necessary to delay the request for surgical consideration by another 6 months. Orlistat can be tried while waiting for surgical assessment, but it doesn’t need to delay the referral.
Bariatric Surgery for Obesity Management
Bariatric surgery has become a significant option in managing obesity over the past decade. For obese patients who fail to lose weight with lifestyle and drug interventions, the risks and expenses of long-term obesity outweigh those of surgery. The NICE guidelines recommend that very obese patients with a BMI of 40-50 kg/m^2 or higher, particularly those with other conditions such as type 2 diabetes mellitus and hypertension, should be referred early for bariatric surgery rather than it being a last resort.
There are three types of bariatric surgery: primarily restrictive operations, primarily malabsorptive operations, and mixed operations. Laparoscopic-adjustable gastric banding (LAGB) is the first-line intervention for patients with a BMI of 30-39 kg/m^2. It produces less weight loss than malabsorptive or mixed procedures but has fewer complications. Sleeve gastrectomy reduces the stomach to about 15% of its original size, while the intragastric balloon can be left in the stomach for a maximum of six months. Biliopancreatic diversion with duodenal switch is usually reserved for very obese patients with a BMI of over 60 kg/m^2. Roux-en-Y gastric bypass surgery is both restrictive and malabsorptive in action.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 9
Incorrect
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A 6-year-old girl with persistent social interaction difficulties is undergoing assessment by a multidisciplinary team for a psychological developmental disorder. During her earlier years, there were no indications of developmental abnormalities and there is no delay or retardation in her language or cognitive development. Nevertheless, her parents report that she obsessively arranges her toys in a specific order every day and becomes upset if this routine is disrupted. According to the ICD-10 diagnostic criteria, what is the probable diagnosis?
Your Answer:
Correct Answer: Autism spectrum disorder
Explanation:The child is exhibiting symptoms of autism and Asperger’s syndrome, including difficulty with social interaction and repetitive behavior. However, there are no indications of delayed language or cognitive development, which are common in autism. Attention deficit disorder may also be a factor, as the child struggles with attention and persistence. While obsessive compulsive disorder could be a possibility due to the child’s preoccupation with counting toys, it is unlikely to explain the social interaction difficulties. Reactive attachment disorder of childhood is not a likely explanation, as the child’s behavior doesn’t align with the symptoms of this disorder.
Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects social interaction, communication, and behavior. It can be diagnosed in early childhood or later in life and is more common in boys than girls. Around 50% of children with ASD also have an intellectual disability. Symptoms can range from subtle difficulties in understanding and social function to severe disabilities. While there is no cure for ASD, early diagnosis and intensive educational and behavioral management can improve outcomes. Treatment involves a comprehensive approach that includes non-pharmacological therapies such as applied behavioral analysis, structured teaching methods, and family counseling. Pharmacological interventions may also be used to reduce symptoms like repetitive behavior, anxiety, and aggression. The goal of treatment is to increase functional independence and quality of life while decreasing disability and comorbidity.
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This question is part of the following fields:
- Children And Young People
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Question 10
Incorrect
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A father brings his 2-month-old daughter to the clinic. He expresses his concern about her constant crying in the evenings, which has been happening since birth. The baby also arches her back when crying. However, she appears to be content during the day and is exclusively breastfed, with regular wet and soiled nappies and appropriate weight gain. The physical examination reveals no abnormalities.
What advice would be most suitable in this scenario?Your Answer:
Correct Answer: Advise simple measures such as holding, gentle motion and white noise
Explanation:The baby is displaying signs that suggest infantile colic, which typically begins in the first few weeks of life and resolves by 3-4 months of age. The crying usually occurs in the late afternoon or evening, and the baby may arch their back or draw their knees up to their abdomen while crying. The symptoms appear to be ongoing but occasional, as the baby is happy during the day.
Although antimuscarinics have been shown to be effective, they come with serious adverse effects and are not recommended. Simeticone (Infacol) is commonly used, but there is no evidence to support its use and it is not recommended by CKS. Gaviscon is not necessary as there is no indication of gastro-oesophageal reflux. Low-lactose formula and paracetamol are also not recommended.
Since the baby is happy during the day, it is unlikely that they have cow’s milk protein allergy, which is rare in breastfed infants. Therefore, there is no need for the mother to exclude dairy from her diet.
Understanding Infantile Colic
Infantile colic is a common condition that affects infants under three months old. It is characterized by excessive crying and pulling up of the legs, usually worse in the evening. This condition affects up to 20% of infants, and its cause is unknown.
Despite its prevalence, the use of simeticone and lactase drops is not recommended by NICE Clinical Knowledge Summaries. These drops are commonly used to alleviate the symptoms of infantile colic, but their effectiveness is not supported by evidence. Therefore, it is important to seek medical advice before using any medication to treat infantile colic.
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This question is part of the following fields:
- Children And Young People
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Question 11
Incorrect
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An 80-year-old man has been taking warfarin for atrial fibrillation for the past 3 months but is having difficulty controlling his INR levels. He wonders if his diet could be a contributing factor.
What is the one food that is most likely to affect his INR levels?Your Answer:
Correct Answer: Spinach
Explanation:Foods and Factors that Affect Warfarin and Vitamin K Levels
Warfarin is a medication used to prevent blood clots, but its effectiveness can be reduced by consuming foods high in vitamin K. These foods include liver, broccoli, cabbage, Brussels sprouts, green leafy vegetables (such as spinach, kale, and lettuce), peas, celery, and asparagus. It is important for patients to maintain a consistent intake of these foods to avoid fluctuations in vitamin K levels.
Contrary to popular belief, tomatoes have relatively low levels of vitamin K, although concentrated tomato paste contains higher levels. Alcohol consumption can also affect vitamin K levels, so patients should avoid heavy or binge drinking while taking warfarin.
Antibiotics can also impact warfarin effectiveness by killing off gut bacteria responsible for synthesizing vitamin K. Additionally, cranberry juice may inhibit warfarin metabolism, leading to an increase in INR levels.
Overall, patients taking warfarin should be mindful of their diet and avoid excessive consumption of vitamin K-rich foods, alcohol, and cranberry juice.
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This question is part of the following fields:
- Cardiovascular Health
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Question 12
Incorrect
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A 14-year-old boy presents with excessive bleeding during a routine dental extraction. Upon examination, petechial skin haemorrhages are observed. Blood tests reveal:
- Hb: 12.3 g/dl
- Plt: 255 * 109/l
- WBC: 7.9 * 109/l
- PT: 13.3 secs
- APTT: 39 secs
- Factor VIII activity: 87%
What is the probable diagnosis?Your Answer:
Correct Answer: Von Willebrand's disease
Explanation:Von Willebrand’s disease is the most probable diagnosis due to the presence of a petechial skin rash, along with a slightly increased APTT and decreased factor VIII activity.
Understanding Von Willebrand’s Disease
Von Willebrand’s disease is a genetic bleeding disorder that is inherited in an autosomal dominant or recessive manner. It is the most common inherited bleeding disorder, and it behaves like a platelet disorder. Patients with this condition often experience epistaxis and menorrhagia, while haemoarthroses and muscle haematomas are rare.
The disease is caused by a deficiency or abnormality in von Willebrand factor, a large glycoprotein that promotes platelet adhesion to damaged endothelium and serves as a carrier molecule for factor VIII. There are three types of von Willebrand’s disease: type 1, which involves a partial reduction in vWF and accounts for 80% of cases; type 2, which is characterized by an abnormal form of vWF; and type 3, which involves a total lack of vWF and is inherited in an autosomal recessive manner.
To diagnose von Willebrand’s disease, doctors may perform a bleeding time test, measure APTT, and check factor VIII levels. Defective platelet aggregation with ristocetin is also a common finding. Treatment options include tranexamic acid for mild bleeding, desmopressin to raise levels of vWF, and factor VIII concentrate. The type of von Willebrand’s disease a patient has doesn’t necessarily correlate with their symptoms, but common themes include excessive mucocutaneous bleeding, bruising without trauma, and menorrhagia in females.
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This question is part of the following fields:
- Haematology
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Question 13
Incorrect
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A 75 year old man has come for a surgical consultation regarding an ambulatory blood pressure monitoring reading of 142/84 mmHg. He has no history of coronary heart disease, renal disease or diabetes, and is only taking lansoprazole regularly. His 10-year cardiovascular risk score was recently assessed to be 8%. Which of the following should be included in his management plan for follow up?
Your Answer:
Correct Answer: Lifestyle advice
Explanation:When a patient is diagnosed with stage 2 hypertension, regardless of their age, it is recommended to start antihypertensive medication and reinforce lifestyle advice.
Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers.
Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight.
Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age.
The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added.
If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.
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This question is part of the following fields:
- Cardiovascular Health
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Question 14
Incorrect
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A 65-year-old man complains of increasing stiffness and pain in his right knee and seeks medical attention. He denies any history of trauma, locking, or giving way. Upon examination, an x-ray reveals the following findings:
Plain film: right knee
Moderate degenerative changes indicative of osteoarthritis. Intra-articular calcification, possibly a loose body.
What is the best course of action for managing this patient's condition?Your Answer:
Correct Answer: Continue to manage as per osteoarthritis guidelines
Explanation:According to the recent guidelines by NICE, there is no requirement to refer a patient with x-ray evidence of a loose body if they are asymptomatic and not experiencing locking.
The Role of Glucosamine in Osteoarthritis Management
Glucosamine is a natural component found in cartilage and synovial fluid. Several double-blind randomized controlled trials have reported significant short-term symptomatic benefits of glucosamine in knee osteoarthritis, including reduced joint space narrowing and improved pain scores. However, more recent studies have produced mixed results. The 2008 NICE guidelines do not recommend the use of glucosamine, and a Drug and Therapeutics Bulletin review advised against prescribing it on the NHS due to limited evidence of cost-effectiveness. Despite this, some patients may still choose to use glucosamine as a complementary therapy for osteoarthritis management. It is important for healthcare professionals to discuss the potential benefits and risks of glucosamine with their patients and to consider individual patient preferences and circumstances.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 15
Incorrect
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You are summoned from a bustling city GP practice to visit a 5-year-old child by their parents, having been seen earlier in the same day.
Despite the absence of a rash, you suspect that the child may have bacterial meningitis. The medical record indicates that the child is allergic to penicillin. You inquire with the mother who confirms that the child had a previous serious reaction immediately after taking penicillin a few years ago that necessitated hospitalization.
You have benzylpenicillin in your bag, but would need to return to the surgery to retrieve a different antibiotic. An ambulance is waiting to transport the child directly to a nearby hospital.
What is the most appropriate course of action to take urgently in the community?Your Answer:
Correct Answer: No antibiotic treatment, urgent hospital transfer only
Explanation:Treatment for Suspected Bacterial Meningitis
When a child is suspected of having bacterial meningitis, urgent hospital transfer should be the priority if possible. If transfer is delayed, parenteral antibiotics should be administered, with intramuscular or intravenous benzylpenicillin being the antibiotic of choice. However, benzylpenicillin should only be withheld in a child with a clear history of anaphylaxis after a previous dose. A history of rash following the use of penicillin is not a contraindication. If hospital transfer is not possible, parenteral antibiotics should be given. The British National Formulary advises that cefotaxime may be an alternative in penicillin allergy, and chloramphenicol may be used if there is a history of immediate hypersensitivity reaction to penicillin or cephalosporins. It is important to note that if a child is suspected of having bacterial meningitis without a non-blanching rash, they should be transferred directly to secondary care without giving parenteral antibiotics. This information is based on guidelines from NICE CG102.
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This question is part of the following fields:
- Children And Young People
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Question 16
Incorrect
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You see a 35-year-old male patient who is interested in starting a family with his partner. However, he is worried about the possibility of passing on a learning difficulty to his child. He mentions that his cousin has a learning difficulty that he believes is inherited. What is the most common cause of inherited learning difficulty that his cousin may have?
Your Answer:
Correct Answer: Fragile X syndrome
Explanation:The most common cause of inherited learning disability is Fragile X syndrome (FXS), although not all individuals with FXS have a learning disability. FXS can range from mild to severe cognitive or intellectual disabilities and is also the most common known cause of autism or ‘autistic-like’ behaviors. Down’s syndrome, on the other hand, is caused by an extra chromosome 21 and all individuals with Down’s syndrome have some form of learning disability. Williams syndrome (WS) is a rare genetic condition affecting chromosome 7 and typically results in mild to moderate intellectual disability with particular difficulties in visual-spatial tasks. Autism spectrum disorder (ASD) is not an inherited cause of learning difficulty and its exact cause is currently unknown, although it may be a result of genetic predisposition, environmental factors, or unknown factors.
Childhood syndromes are a group of medical conditions that affect children and are characterized by a set of common features. Patau syndrome, also known as trisomy 13, is a syndrome that presents with microcephaly, small eyes, cleft lip/palate, polydactyly, and scalp lesions. Edward’s syndrome, or trisomy 18, is characterized by micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers. Fragile X syndrome is a condition that causes learning difficulties, macrocephaly, a long face, large ears, and macro-orchidism. Noonan syndrome presents with a webbed neck, pectus excavatum, short stature, and pulmonary stenosis. Pierre-Robin syndrome is characterized by micrognathia, posterior displacement of the tongue, and cleft palate. Prader-Willi syndrome presents with hypotonia, hypogonadism, and obesity. William’s syndrome is characterized by short stature, learning difficulties, a friendly and extroverted personality, and transient neonatal hypercalcaemia. Finally, Cri du chat syndrome, also known as chromosome 5p deletion syndrome, presents with a characteristic cry due to larynx and neurological problems, feeding difficulties and poor weight gain, learning difficulties, microcephaly, micrognathism, and hypertelorism. It is important to note that Pierre-Robin syndrome has many similarities with Treacher-Collins syndrome, but the latter is autosomal dominant and usually has a family history of similar problems.
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This question is part of the following fields:
- Children And Young People
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Question 17
Incorrect
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A mother brings her 2-year-old daughter to see you as she thinks she is experiencing a lot of pain in her mouth. Upon conducting a thorough assessment of the healthy child, you observe a swollen and tender upper gum with no other abnormalities and diagnose her with teething. What would be the most appropriate advice to give in this situation?
Your Answer:
Correct Answer: Reassure and advice simple analgesia and cooling treatments
Explanation:Teething is a natural process where baby teeth emerge through the gums, usually starting around 6 months of age. Symptoms are generally mild and include pain, increased biting, drooling, gum-rubbing/sucking, irritability, wakefulness, and possibly a slight increase in temperature. The recommended initial management is to provide reassurance and advise on self-care measures such as gentle gum rubbing and allowing the child to bite on a clean and cool object. Paracetamol or ibuprofen suspension can be given to infants 3 months or older. It is not recommended to use choline salicylate gels, topical anaesthetics, or complementary therapies like herbal teething powder. A further dental opinion is not necessary as teething is a normal process.
Teething: Symptoms, Diagnosis, and Treatment Options
Teething is the process of primary tooth eruption in infants, which typically begins around 6 months of age and is usually complete by 30 months of age. It is characterized by a subacute onset of symptoms, including gingival irritation, parent-reported irritability, and excessive drooling. These symptoms occur in approximately 70% of all children and are equally prevalent in boys and girls, although girls tend to develop their teeth sooner than boys.
During examination, teeth can typically be felt below the surface of the gums prior to breaking through, and gingival erythema will be noted around the site of early tooth eruption. Treatment options include chewable teething rings and simple analgesia with paracetamol or ibuprofen. However, topical analgesics or numbing agents are not recommended, and oral choline salicylate gels should not be prescribed due to the risk of Reye’s syndrome.
It is important to note that teething doesn’t cause systemic symptoms such as fevers or diarrhea, and these symptoms should be treated as warning signs of other systemic illness. Additionally, teething necklaces made from amber beads on a cord are a common naturopathic treatment for teething symptoms but represent a significant strangulation and choking hazard. Therefore, it is crucial to avoid their use.
In conclusion, teething is a clinical diagnosis that can be managed with simple interventions. However, it is essential to be aware of potential hazards and to seek medical attention if systemic symptoms are present.
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This question is part of the following fields:
- Children And Young People
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Question 18
Incorrect
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A 45 year-old man complains of constant fatigue. Despite his tanned appearance, he denies having been on vacation. During examination, pigmentation is noted on the palmar creases and buccal mucosa.
What underlying condition could be responsible for these findings?Your Answer:
Correct Answer: Addison's disease
Explanation:Addison’s disease is a condition where the adrenal glands do not produce enough hormones. The symptoms may start slowly and include fatigue. One common sign is hyperpigmentation, which affects areas such as skin creases, the inside of the cheeks, and scars. This happens because the hormone ACTH, which is made by the pituitary gland to stimulate the adrenals, has a similar precursor molecule to MSH, a hormone that affects skin color. As a result, increased ACTH levels can cause higher MSH levels and skin darkening. In cases of kidney failure, the skin may appear yellowish or pale due to anemia.
Addison’s disease is the most common cause of primary hypoadrenalism in the UK, with autoimmune destruction of the adrenal glands being the main culprit, accounting for 80% of cases. This results in reduced production of cortisol and aldosterone. Symptoms of Addison’s disease include lethargy, weakness, anorexia, nausea and vomiting, weight loss, and salt-craving. Hyperpigmentation, especially in palmar creases, vitiligo, loss of pubic hair in women, hypotension, hypoglycemia, and hyponatremia and hyperkalemia may also be observed. In severe cases, a crisis may occur, leading to collapse, shock, and pyrexia.
Other primary causes of hypoadrenalism include tuberculosis, metastases (such as bronchial carcinoma), meningococcal septicaemia (Waterhouse-Friderichsen syndrome), HIV, and antiphospholipid syndrome. Secondary causes include pituitary disorders, such as tumours, irradiation, and infiltration. Exogenous glucocorticoid therapy can also lead to hypoadrenalism.
It is important to note that primary Addison’s disease is associated with hyperpigmentation, while secondary adrenal insufficiency is not.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 19
Incorrect
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You are monitoring a 40-year-old male patient who has recently finished a two-week Helicobacter pylori treatment for dyspepsia. If he has ceased his eradication therapy today and is not on any other medication, what is the earliest time frame for conducting a urea breath test to confirm eradication?
Your Answer:
Correct Answer: In 4 weeks time
Explanation:To undergo a urea breath test, one must not have taken antibiotics within the last four weeks and must not have taken any antisecretory drugs, such as PPI, within the last two weeks.
Tests for Helicobacter pylori
There are several tests available to diagnose Helicobacter pylori infection. One of the most common tests is the urea breath test, where patients consume a drink containing carbon isotope 13 enriched urea. The urea is broken down by H. pylori urease, and after 30 minutes, the patient exhales into a glass tube. Mass spectrometry analysis calculates the amount of 13C CO2, which determines the presence of H. pylori. However, this test should not be performed within four weeks of treatment with an antibacterial or within two weeks of an antisecretory drug.
Another test is the rapid urease test, also known as the CLO test. This test involves mixing a biopsy sample with urea and pH indicator, and a color change indicates H. pylori urease activity. Serum antibody tests remain positive even after eradication, and the sensitivity and specificity are 85% and 80%, respectively. Culture of gastric biopsy provides information on antibiotic sensitivity, with a sensitivity of 70% and specificity of 100%. Gastric biopsy with histological evaluation alone has a sensitivity and specificity of 95-99%. Lastly, the stool antigen test has a sensitivity of 90% and specificity of 95%.
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This question is part of the following fields:
- Gastroenterology
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Question 20
Incorrect
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You are requested by district nurses to visit a patient at home to assess his medication. He is an 80-year-old man with terminal prostate cancer and widespread metastases. His pain is currently well managed by taking Morphine Sulphate SR tablets, 60mg twice a day. However, his overall condition has deteriorated, and he is experiencing difficulty swallowing the tablets, as well as increased agitation. Your recommendation is to initiate a syringe driver containing Diamorphine and a small dose of Midazolam subcutaneously to replace the oral Morphine tablets. What would be the appropriate dosage of sc Diamorphine to prescribe over a 24-hour period?
Your Answer:
Correct Answer: 10 mg
Explanation:Converting Oral Morphine to SC Diamorphine: A Guide
When converting oral Morphine to SC Diamorphine, it is important to remember that the 24-hour total SC Diamorphine dose required will be approximately one-third of the 24-hour total oral Morphine dose. This means that the ratio of Morphine PO to Diamorphine SC is 3:1.
For example, if a patient is taking MST SR 60 mg bd, which is a total of 120 mg/24 hrs PO, the 24-hour total Diamorphine SC dose required will be 120/3 = 40 mg. It is crucial to double-check the direction of your conversion to avoid calculation errors.
Prescribing medication can be a complex process, and it is important to take the necessary precautions to ensure accuracy and patient safety. By following this guide, healthcare professionals can confidently convert oral Morphine to SC Diamorphine with ease.
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This question is part of the following fields:
- End Of Life
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Question 21
Incorrect
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A menopausal woman in her early 50s comes to discuss a change in hormone replacement therapy (HRT) with you. She is experiencing PMS type symptoms, breast tenderness, and low mood with her current formulation. She finds it difficult to cope with the mood swings and the hot flashes are very troublesome despite wearing loose fitting clothing and opening windows at night. She doesn't have any risk factors preventing the use of HRT. She has never had any operations, has 2 grown up children by normal delivery, and uses no contraception.
Which of the following would be most appropriate to use instead?Your Answer:
Correct Answer: Tibolone
Explanation:Dealing with Progestogenic Side Effects of HRT
When a woman experiences progestogenic side effects from her current hormone replacement therapy (HRT), there are several options for managing the symptoms. However, the best solution is switching to Mirena and oestrogen therapy. The levonorgestrel-releasing intrauterine system (IUS), also known as Mirena, delivers progestogen locally to the uterus, resulting in low systemic levels of levonorgestrel. This can significantly reduce bleeding and amenorrhoea in women experiencing persistent progestogenic adverse effects from systemic HRT. The levonorgestrel-releasing IUS is also appropriate for women who require contraception along with HRT in the perimenopause or have heavy withdrawal bleeds on sequential HRT.
Oral oestrogen therapy alone is not suitable for women with an intact uterus as they require endometrial protection. Topical oestrogen therapy is generally used for women with vaginal atrophy and will not treat vasomotor symptoms. Tibolone can be used but is not as effective as combined HRT. The copper coil doesn’t offer endometrial protection. Therefore, the best viable option is oral oestrogen with protection afforded by the Mirena coil, which is licensed for this use.
It is important to note that management of side effects of HRT is an important topic that may appear in exams. It is advisable to read through references to be fully prepared to answer questions correctly.
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This question is part of the following fields:
- Improving Quality, Safety And Prescribing
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Question 22
Incorrect
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A 62-year-old woman presents with complaints of recurrent episodes of dizziness. She has been previously healthy. She reports experiencing repeated episodes of the room spinning around her in a horizontal plane, which occur multiple times a day. Each episode lasts for approximately 10 seconds and seems to happen when she turns in bed, lies down, or sits up from a supine position. There are no other accompanying symptoms, and she is not taking any medication. A standard neurological examination reveals no abnormalities. What is the most likely diagnosis?
Your Answer:
Correct Answer: Benign positional paroxysmal vertigo
Explanation:Differential Diagnosis for Benign Positional Paroxysmal Vertigo
Benign positional paroxysmal vertigo (BPPV) is a disorder characterized by short episodes of vertigo that are specifically positional in nature. The cause of BPPV is inner ear dysfunction, where otoliths become detached from the maculae and enter the semicircular canals. The diagnosis of BPPV can be confirmed through a Dix-Hallpike test, which involves observing the patient’s eyes for nystagmus after a quick change in head position.
Other potential causes of vertigo were considered and ruled out in this case. Labyrinthitis, which typically presents with hearing changes and nausea/vomiting, was deemed unlikely. Migraine, which can cause vertigo but is usually accompanied by headaches, was also ruled out. Posterior circulation stroke was considered but deemed unlikely due to a normal neurological examination. Postural hypotension was also ruled out as the patient experienced difficulties with turning in bed and lying down as well as standing up.
Overall, the differential diagnosis for BPPV involves ruling out other potential causes of vertigo through a thorough examination and consideration of the patient’s symptoms.
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This question is part of the following fields:
- Neurology
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Question 23
Incorrect
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A 4-year-old boy is brought to his General Practitioner (GP) by his mother, who has concerns about his mobility. He is having progressive difficulty with standing from the floor. He was able to sit unaided at 12 months and walk at 22 months. He has not been able to run, tending to ‘waddle’ if he tries.
On examination, he has wasting to the quadriceps and calves, and a positive Gowers sign.
What is the most likely diagnosis?Your Answer:
Correct Answer: Duchenne muscular dystrophy (DMD)
Explanation:The case involves a boy with DMD, a common childhood-onset muscular dystrophy with X-linked recessive inheritance. Symptoms include developmental delay, inability to run, waddling gait, and wasting of leg muscles. DDH, BMD, cerebral palsy, and T1DM are ruled out as possible causes.
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This question is part of the following fields:
- Genomic Medicine
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Question 24
Incorrect
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Samantha is a 6-year-old who has been brought to the clinic by her mother to request a referral for an adenotonsillectomy. She has experienced 3 severe episodes of acute tonsillitis in the past year and 4 episodes the year before, resulting in her missing a total of 5 days of school. Despite this, she has been informed that she doesn't meet the criteria for an adenotonsillectomy. What is the reason for her not meeting the referral criteria?
Your Answer:
Correct Answer: Needs 5 or more bouts of acute tonsillitis in each of the preceding 2 years
Explanation:The criteria for adenotonsillectomy in recurrent tonsillitis, as recommended by SIGN, state that a patient should have at least five or more bouts of acute tonsillitis in each of the preceding two years. Jodie, who has had three and four bouts of acute tonsillitis over the past two years, doesn’t meet this minimum requirement.
Tonsillitis and Tonsillectomy: Complications and Indications
Tonsillitis is a condition that can lead to various complications, including otitis media, peritonsillar abscess, and, in rare cases, rheumatic fever and glomerulonephritis. Tonsillectomy, the surgical removal of the tonsils, is a controversial procedure that should only be considered if the person meets specific criteria. According to NICE, surgery should only be considered if the person experiences sore throats due to tonsillitis, has five or more episodes of sore throat per year, has been experiencing symptoms for at least a year, and the episodes of sore throat are disabling and prevent normal functioning. Other established indications for a tonsillectomy include recurrent febrile convulsions, obstructive sleep apnoea, stridor, dysphagia, and peritonsillar abscess if unresponsive to standard treatment.
Despite the benefits of tonsillectomy, the procedure also carries some risks. Primary complications, which occur within 24 hours of the surgery, include haemorrhage and pain. Secondary complications, which occur between 24 hours to 10 days after the surgery, include haemorrhage (most commonly due to infection) and pain. Therefore, it is essential to weigh the benefits and risks of tonsillectomy before deciding to undergo the procedure.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 25
Incorrect
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A 32-year-old man comes to the clinic worried about his bone health. He has a history of polycystic-kidney disease leading to chronic kidney disease.
He is a non-smoker and abstains from alcohol. His BMI is 23 kg/m2. His mother suffered a hip fracture at the age of 52.
What would be the most suitable course of action for management?Your Answer:
Correct Answer: Refer to the osteoporosis clinic and arrange a dual-energy X-ray absorptiometry (DEXA) scan
Explanation:Osteoporosis is a condition that weakens bones, making them more prone to fractures. When a patient experiences a fragility fracture, which is a fracture that occurs from a low-impact injury or fall, it is important to assess their risk for osteoporosis and subsequent fractures. The management of patients following a fragility fracture depends on their age.
For patients who are 75 years of age or older, they are presumed to have underlying osteoporosis and should be started on first-line therapy, such as an oral bisphosphonate, without the need for a DEXA scan. However, the 2014 NOGG guidelines suggest that treatment should be started in all women over the age of 50 years who’ve had a fragility fracture, although BMD measurement may sometimes be appropriate, particularly in younger postmenopausal women.
For patients who are under the age of 75 years, a DEXA scan should be arranged to assess their bone mineral density. These results can then be entered into a FRAX assessment, along with the fact that they’ve had a fracture, to determine their ongoing fracture risk. Based on this assessment, appropriate treatment can be initiated to prevent future fractures.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 26
Incorrect
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A 28-year-old woman presents with a week long history of an offensive smelling greenish-yellow vaginal discharge with associated dysuria but not frequency. She doesn't complain of lower abdominal pain but admits to dyspareunia.
She has not been seen by you personally at the clinic and has social problems with frequent episodes of homelessness. She is unkempt and admits to sleeping on the streets. She refuses your request that she should be seen at the local genito-urinary medicine (GUM) clinic but asks you for treatment so that she can leave. Her scant records are full of did not attend entries.
Examination reveals a greenish-yellow discharge but is otherwise unremarkable and you suspect that this lady has uncomplicated gonorrhoea.
According to the latest NICE guidance, what is the single most appropriate approach for this woman?Your Answer:
Correct Answer: Azithromycin 1g orally as a single dose
Explanation:Approaching a Question on Gonorrhoea Treatment
When faced with a question on gonorrhoea treatment, it is important to exercise judgement and use examination technique to narrow down the options. For instance, if a patient is asking for treatment and has a history of non-compliance with previous follow up, referring them to gynaecology and taking a swab may not be useful if they are refusing referral to a genito-urinary medicine (GUM) clinic.
In such a scenario, the three treatment options left are the focus. While it is important to have some understanding of the guidance, even if one is unfamiliar with the individual drugs and doses, knowing that the current first line recommendation involves IM Ceftriaxone as a single dose can help narrow down the choices. This approach is useful in the actual AKT examination, where one may not know everything, but can increase their chances of success by logically narrowing down the options.
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This question is part of the following fields:
- Sexual Health
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Question 27
Incorrect
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A 38-year-old man visits his primary care physician complaining of headaches on the left side of his face and watery eyes for the past two weeks. He reports experiencing approximately two episodes per day, each lasting about 30 minutes. What is the probable diagnosis?
Your Answer:
Correct Answer: Cluster headache
Explanation:Daily occurrence of eye pain, lacrimation, and nasal stuffiness in episodes – indicative of cluster headache.
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.
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This question is part of the following fields:
- Neurology
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Question 28
Incorrect
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A 25-year-old man with a history of well-managed asthma presents with a 10-hour history of a pruritic rash. He mentions having recently recuperated from a mild upper respiratory tract infection. The patient has a diffuse urticarial rash on his trunk and limbs. There are no signs of mucosal swelling, he is stable hemodynamically, and his chest is clear upon auscultation.
What is the most effective course of treatment?Your Answer:
Correct Answer: Oral non-sedating antihistamine
Explanation:The first-line treatment for acute urticaria is oral non-sedating antihistamines. These include cetirizine, fexofenadine, or loratadine. Urticarial rash is caused by inflammatory mediators released during mast cell activation, with histamine being the principal mediator. H1 receptor antagonists inhibit this process. Non-sedating antihistamines are preferred over sedating antihistamines as they do not cause significant drowsiness, as they do not cross the blood-brain barrier. Intramuscular adrenaline is not indicated for acute urticaria, as it is only used in suspected anaphylaxis. Oral steroids may be prescribed in addition to a non-sedative oral antihistamine if the symptoms are severe. Topical antihistamines are not recommended by NICE for the management of acute urticaria.
Urticaria is a condition characterized by the swelling of the skin, either locally or generally. It is commonly caused by an allergic reaction, although non-allergic causes are also possible. The affected skin appears pale or pink and is raised, resembling hives, wheals, or nettle rash. It is also accompanied by itching or pruritus. The first-line treatment for urticaria is non-sedating antihistamines, while prednisolone is reserved for severe or resistant cases.
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This question is part of the following fields:
- Dermatology
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Question 29
Incorrect
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A 35-year-old patient who is on methotrexate for psoriasis presents because her 6-year-old son has been suffering from Chickenpox and she is concerned about developing it. She has not previously had Chickenpox herself and is currently well, with no symptoms or rash.
What advice should be given to this patient?Your Answer:
Correct Answer: Test for varicella antibodies and give varicella-zoster immunoglobulin
Explanation:Patients who are on long-term steroids or methotrexate and have weakened immune systems should be given VZIG if they come into contact with Chickenpox and have no antibodies to varicella. Although Chickenpox is usually a mild illness, it can be dangerous for those who are immunosuppressed or pregnant.
If a patient has been exposed to varicella, they should be offered active post-exposure prophylaxis with varicella-zoster immunoglobulin. It is important to test people who have had significant exposure to Chickenpox and are immunocompromised for varicella-zoster antibody, regardless of their history of Chickenpox.
It is inappropriate to wait for up to 21 days to see if symptoms appear or take no action because this patient is immunosuppressed and is at risk of severe varicella infection. Similarly, stopping her methotrexate would not be appropriate as the immunosuppressive effects would take time to wear off.
Managing Chickenpox Exposure in At-Risk Groups
Whilst Chickenpox is usually a mild condition in children with normal immune systems, it can cause serious systemic disease in at-risk groups. Pregnant women and their developing fetuses are particularly vulnerable. Therefore, it is crucial to know how to manage varicella exposure in these special groups.
To determine who would benefit from active post-exposure prophylaxis, the following criteria should be met: significant exposure to Chickenpox or herpes zoster, a clinical condition that increases the risk of severe varicella (such as immunosuppression), and no antibodies to the varicella virus. Ideally, all at-risk exposed patients should have a blood test for varicella antibodies. However, post-exposure prophylaxis should not be delayed past 7 days after initial contact.
Patients who meet the above criteria should be given varicella-zoster immunoglobulin (VZIG). The management of Chickenpox exposure in pregnancy is an important topic that is covered in more detail in a separate entry to the textbook.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 30
Incorrect
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A researcher wants to investigate dietary variations between patients aged 50-60 years with impaired glucose tolerance (HbA1c 42-47 mmol/mol) and those without impaired glucose tolerance (HbA1c <42 mmol/mol). The participants who agree to take part are requested to maintain a food journal for two weeks. The researcher is worried that the participants' eating habits during this observed period may deviate from their regular routine, impacting the accuracy of the study.
What is the term used to describe this phenomenon?Your Answer:
Correct Answer: Hawthorne effect
Explanation:The Hawthorne effect refers to a situation where a group alters its behavior because it is aware of being observed. This could manifest in participants in a study eating more healthily during the observation period. A ceiling effect occurs when an independent variable no longer has an impact on a dependent variable because the maximum effect has been reached. Observer bias occurs when a researcher records information that differs from reality due to their expectations or desires. The Gibbons-Hawking effect is a theory of general relativity that may be better suited for discussion in a different forum.
Understanding Bias in Clinical Trials
Bias refers to the systematic favoring of one outcome over another in a clinical trial. There are various types of bias, including selection bias, recall bias, publication bias, work-up bias, expectation bias, Hawthorne effect, late-look bias, procedure bias, and lead-time bias. Selection bias occurs when individuals are assigned to groups in a way that may influence the outcome. Sampling bias, volunteer bias, and non-responder bias are subtypes of selection bias. Recall bias refers to the difference in accuracy of recollections retrieved by study participants, which may be influenced by whether they have a disorder or not. Publication bias occurs when valid studies are not published, often because they showed negative or uninteresting results. Work-up bias is an issue in studies comparing new diagnostic tests with gold standard tests, where clinicians may be reluctant to order the gold standard test unless the new test is positive. Expectation bias occurs when observers subconsciously measure or report data in a way that favors the expected study outcome. The Hawthorne effect describes a group changing its behavior due to the knowledge that it is being studied. Late-look bias occurs when information is gathered at an inappropriate time, and procedure bias occurs when subjects in different groups receive different treatment. Finally, lead-time bias occurs when two tests for a disease are compared, and the new test diagnosis the disease earlier, but there is no effect on the outcome of the disease. Understanding these types of bias is crucial in designing and interpreting clinical trials.
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This question is part of the following fields:
- Evidence Based Practice, Research And Sharing Knowledge
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