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  • Question 1 - A 67-year-old man with type 2 diabetes has recently been initiated on insulin...

    Incorrect

    • A 67-year-old man with type 2 diabetes has recently been initiated on insulin therapy. He has a history of a heart attack 3 years ago and is currently taking a beta-blocker, calcium channel blocker, ace-inhibitor, statin, and GTN-spray. Which of his medications may cause a decreased recognition of hypoglycemic symptoms after starting insulin treatment?

      Your Answer: Statin

      Correct Answer: Beta-blocker

      Explanation:

      Beta-blockers are a class of drugs that are primarily used to manage cardiovascular disorders. They have a wide range of indications, including angina, post-myocardial infarction, heart failure, arrhythmias, hypertension, thyrotoxicosis, migraine prophylaxis, and anxiety. Beta-blockers were previously avoided in heart failure, but recent evidence suggests that certain beta-blockers can improve both symptoms and mortality. They have also replaced digoxin as the rate-control drug of choice in atrial fibrillation. However, their role in reducing stroke and myocardial infarction has diminished in recent years due to a lack of evidence.

      Examples of beta-blockers include atenolol and propranolol, which was one of the first beta-blockers to be developed. Propranolol is lipid-soluble, which means it can cross the blood-brain barrier.

      Like all drugs, beta-blockers have side-effects. These can include bronchospasm, cold peripheries, fatigue, sleep disturbances (including nightmares), and erectile dysfunction. There are also some contraindications to using beta-blockers, such as uncontrolled heart failure, asthma, sick sinus syndrome, and concurrent use with verapamil, which can precipitate severe bradycardia.

    • This question is part of the following fields:

      • Cardiovascular Health
      103.6
      Seconds
  • Question 2 - An 80-year-old male presented with cough, dyspnoea and fever.

    He has a mild early...

    Incorrect

    • An 80-year-old male presented with cough, dyspnoea and fever.

      He has a mild early Alzheimer's dementia and type 2 diabetes mellitus for which he takes metformin 500 mg tds. On examination, he has sats of 96% on air, has a pulse of 90 bpm, blood pressure of 110/50 mmHg, a temperature of 37.6°C and a respiration rate of 32/min. There is no neck stiffness nor abnormal neurology.

      Chest examination reveals bibasal crackles and decreased breath sounds in the left lung base.

      Blood samples were taken that morning and a call to the lab reveals the following:

      Haemoglobin 129 g/L (115-165)
      White cell count 16.6 ×109/L (4-11)
      93% neutrophils -
      5% band forms -
      2% lymphocytes -
      Platelets 420 ×109/L (150-400)
      Urea 8.2 mmol/L (2.5-7.5)

      Which of the following is the most appropriate treatment for this patient?

      Your Answer:

      Correct Answer: Oral ciprofloxacin

      Explanation:

      Scoring Systems for Decision Making in Pneumonia Treatment

      When it comes to deciding whether to treat or admit a patient with pneumonia, scoring systems can be helpful. The CURB-65 severity score and the CRB-65 score are two commonly used systems. The CRB-65 score is recommended for use in primary care and assigns one point for each of confusion, respiratory rate of 30/min or more, systolic blood pressure below 90 mmHg (or diastolic below 60 mmHg), and age 65 years or older. Patients with a score of 0 are at low risk of death and do not require hospitalization, while those with a score of 1 or 2 are at increased risk and should be considered for referral and assessment. Patients with a score of 3 or more are at high risk and require urgent hospital admission. The CURB-65 score is used for patients with a score of 2 or more to be admitted, while those with a score of 0-1 may be admitted if there are other issues. While an experienced GP may admit a patient regardless of the score, understanding these systems is important for medical exams.

    • This question is part of the following fields:

      • Older Adults
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  • Question 3 - Samantha is a 30-year-old woman who underwent cervical cancer screening 2 years ago....

    Incorrect

    • Samantha is a 30-year-old woman who underwent cervical cancer screening 2 years ago. The result showed positive for high-risk human papillomavirus (hrHPV) but her cervical cytology was normal.

      She underwent repeat testing after 12 months and again tested positive for hrHPV with normal cytology. Her next screening was scheduled for another 12 months.

      Recently, Samantha underwent her scheduled screening. The results indicate that she is still hrHPV positive and her cytology is normal.

      What would be the most appropriate course of action now?

      Your Answer:

      Correct Answer: Refer for colposcopy

      Explanation:

      According to the NICE guidelines on cervical cancer screening, if an individual’s second repeat smear at 24 months is still positive for high-risk human papillomavirus (hrHPV), they should be referred for colposcopy. Prior to this, if an individual is positive for hrHPV but receives a negative cytology report, they should have the HPV test repeated at 12 months. If the HPV test is negative at 12 months, they can return to routine recall. However, if they remain hrHPV positive and cytology negative at 12 months, they should have a repeat HPV test in a further 12 months. If they become hrHPV negative at 24 months, they can safely return to routine recall.

      Understanding Cervical Cancer Screening Results

      The cervical cancer screening program has evolved significantly in recent years, with the introduction of HPV testing allowing for further risk stratification. The NHS now uses an HPV first system, where a sample is tested for high-risk strains of human papillomavirus (hrHPV) first, and cytological examination is only performed if this is positive.

      If the hrHPV test is negative, individuals can return to normal recall, unless they fall under the test of cure pathway, untreated CIN1 pathway, or require follow-up for incompletely excised cervical glandular intraepithelial neoplasia (CGIN) / stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer. If the hrHPV test is positive, samples are examined cytologically, and if the cytology is abnormal, individuals will require colposcopy.

      If the cytology is normal but the hrHPV test is positive, the test is repeated at 12 months. If the repeat test is still hrHPV positive and cytology is normal, a further repeat test is done 12 months later. If the hrHPV test is negative at 24 months, individuals can return to normal recall, but if it is still positive, they will require colposcopy. If the sample is inadequate, it will need to be repeated within 3 months, and if two consecutive samples are inadequate, colposcopy will be required.

      For individuals who have previously had CIN, they should be invited for a test of cure repeat cervical sample in the community 6 months after treatment. The most common treatment for cervical intraepithelial neoplasia is large loop excision of transformation zone (LLETZ), which may be done during the initial colposcopy visit or at a later date depending on the individual clinic. Cryotherapy is an alternative technique.

    • This question is part of the following fields:

      • Gynaecology And Breast
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  • Question 4 - How should the medication 'methotrexate 15 mg weekly' be entered on the repeat...

    Incorrect

    • How should the medication 'methotrexate 15 mg weekly' be entered on the repeat medication screen for a patient who was previously taking a lower dose and has completed all necessary monitoring as per shared care protocol, based on a letter received from the rheumatology department of the local hospital?

      Your Answer:

      Correct Answer: Methotrexate tablets 2.5 mg (six per week)

      Explanation:

      Methotrexate Dosage Policy

      Methotrexate is only available in 10 mg and 2.5 mg strengths, with no 5 mg formulation. However, there have been cases where two different strengths were co-prescribed, leading to potential medication errors. One patient received 10 mg tablets instead of the required 2.5 mg tablets, prompting a complaint and highlighting the need for caution. To prevent such incidents, it is recommended that only one strength of methotrexate is prescribed.

      Most Local Health Boards (LHBs) and Primary Care Trusts (PCTs) advise that dosages in primary care should be multiples of the 2.5 mg formulation. This policy aims to reduce the risk of errors and ensure consistent dosing. Patients should also be advised to double-check their prescription and request slips to avoid confusion. By following these guidelines, healthcare providers can help ensure safe and effective use of methotrexate.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 5 - What is the highest ranked source of evidence in the hierarchy of evidence...

    Incorrect

    • What is the highest ranked source of evidence in the hierarchy of evidence based medicine?

      Your Answer:

      Correct Answer: Meta-analysis

      Explanation:

      Hierarchy of Evidence Grades

      The strength of evidence provided by different study types is ranked in a hierarchy. This hierarchy is important to understand when making clinical decisions based on research. The National Institute for Health and Care Excellence (NICE) documents these evidence grades in Chapter 6 of their Guidelines manual (PMG6).

      The strongest level of evidence is provided by meta-analyses, followed by randomized controlled trials (RCTs), controlled studies without randomization, quasi-experimental studies, non-experimental descriptive studies, and finally expert committee reports, opinions, and clinical experience.

      It is crucial to consider the strength of evidence when interpreting research findings and applying them to clinical practice. By understanding the hierarchy of evidence grades, healthcare professionals can make informed decisions that are based on the most reliable and robust evidence available.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
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  • Question 6 - A 57-year-old woman visits her GP complaining of experiencing indigestion for the past...

    Incorrect

    • A 57-year-old woman visits her GP complaining of experiencing indigestion for the past two months. She is in good health, has never had a similar episode before, and is not taking any regular medication. Notably, she has not experienced any recent weight loss or vomiting, and her abdominal examination is normal. What is the best initial course of action?

      Your Answer:

      Correct Answer: Lifestyle advice + one month course of a full-dose proton pump inhibitor

      Explanation:

      As per the revised NICE guidelines of 2015, there is no need for an immediate endoscopy referral for her. However, if she fails to respond to treatment, a non-urgent referral would be advisable.

      Management of Dyspepsia and Referral Criteria for Suspected Cancer

      Dyspepsia is a common condition that can be managed through a stepwise approach. The first step is to review medications that may be causing dyspepsia and provide lifestyle advice. If symptoms persist, a full-dose proton pump inhibitor or a ‘test and treat’ approach for H. pylori can be tried for one month. If symptoms still persist, the alternative approach should be attempted.

      For patients who meet referral criteria for suspected cancer, urgent referral for an endoscopy within two weeks is necessary. This includes patients with dysphagia, an upper abdominal mass consistent with stomach cancer, and patients aged 55 years or older with weight loss and upper abdominal pain, reflux, or dyspepsia. Non-urgent referral is recommended for patients with haematemesis and patients aged 55 years or older with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with symptoms such as nausea, vomiting, weight loss, reflux, dyspepsia, or upper abdominal pain.

      Testing for H. pylori infection can be done through a carbon-13 urea breath test, stool antigen test, or laboratory-based serology. If symptoms have resolved following a ‘test and treat’ approach, there is no need to check for H. pylori eradication. However, if repeat testing is required, a carbon-13 urea breath test should be used.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 7 - A 27-year-old woman who is 16 weeks pregnant arrives at the Emergency Department...

    Incorrect

    • A 27-year-old woman who is 16 weeks pregnant arrives at the Emergency Department with a worsening of her asthma symptoms. After receiving nebulised salbutamol, she stabilises and you are requested to assess her before discharge. She reports using only a salbutamol inhaler (100 mcg) as needed and identifies grass pollen as the most common trigger. Her current peak flow is 380 l/min (predicted 440 l/min) and her inhaler technique is satisfactory. What is the most suitable course of action?

      Your Answer:

      Correct Answer: Add inhaled beclomethasone 200mcg bd

      Explanation:

      During pregnancy, it is safe to use short-acting/long-acting beta 2-agonists, inhaled and oral corticosteroids as recommended by the British Thoracic Society (BTS) guidelines, even if the patient has asthma that is not well-controlled with a SABA.

      The management of asthma in adults has been updated by NICE in 2017, following the 2016 British Thoracic Society (BTS) guidelines. One of the significant changes is in ‘step 3’, where patients on a SABA + ICS whose asthma is not well controlled should be offered a leukotriene receptor antagonist, not a LABA. NICE doesn’t follow the stepwise approach of the previous BTS guidelines, but to make the guidelines easier to follow, we have added our own steps. It should be noted that NICE doesn’t recommend changing treatment in patients who have well-controlled asthma simply to adhere to the latest guidance.

      The steps for managing asthma in adults are as follows: for newly-diagnosed asthma, a short-acting beta agonist (SABA) is recommended. If the patient is not controlled on the previous step or has symptoms >= 3/week or night-time waking, a SABA + low-dose inhaled corticosteroid (ICS) is recommended. For step 3, a SABA + low-dose ICS + leukotriene receptor antagonist (LTRA) is recommended. Step 4 involves a SABA + low-dose ICS + long-acting beta agonist (LABA), and LTRA should be continued depending on the patient’s response. Step 5 involves a SABA +/- LTRA, and switching ICS/LABA for a maintenance and reliever therapy (MART) that includes a low-dose ICS. Step 6 involves a SABA +/- LTRA + medium-dose ICS MART, or changing back to a fixed-dose of a moderate-dose ICS and a separate LABA. Step 7 involves a SABA +/- LTRA + one of the following options: increasing ICS to high-dose (only as part of a fixed-dose regime, not as a MART), a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline), or seeking advice from a healthcare professional with expertise in asthma.

      It is important to note that the definitions of what constitutes a low, moderate, or high-dose ICS have changed. For adults, <= 400 micrograms budesonide or equivalent is considered a low dose, 400 micrograms - 800 micrograms budesonide or equivalent is a moderate dose, and > 800 micrograms budes

    • This question is part of the following fields:

      • Respiratory Health
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  • Question 8 - A 60-year-old woman with type II diabetes mellitus has developed persistent proteinuria. Renal...

    Incorrect

    • A 60-year-old woman with type II diabetes mellitus has developed persistent proteinuria. Renal function tests reveal a glomerular filtration rate [GFR] of 49 ml/minute/1.73 m2), similar levels were found four months previously. Her blood pressure today is 140/88 mmHg.
      Which of the following medications is most likely to improve the patient's renal prognosis?

      Your Answer:

      Correct Answer: Angiotensin-converting enzyme (ACE) inhibitors

      Explanation:

      Treatment Options for Chronic Kidney Disease

      Chronic kidney disease (CKD) is defined by the presence of kidney damage or decreased kidney function for three months or more. Patients with proteinuria of any cause can benefit from treatment with angiotensin-converting enzyme (ACE) inhibitors, which improve renal prognosis and reduce cardiovascular risk. Blood pressure control with medications like doxazosin can also improve renal outcomes, but blocking the renin-angiotensin aldosterone system is most effective in halting disease progression. Antiplatelet therapy with aspirin is recommended for secondary prevention of cardiovascular disease, while vitamin D supplementation is used to treat deficiency in later stages of CKD and CKD-mineral and bone disorders. Statins like atorvastatin should be offered to all CKD patients to reduce the risk of cardiovascular disease.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 9 - A 5-year-old boy is brought by his mother to the Out-of-hours (OOH) walk-in...

    Incorrect

    • A 5-year-old boy is brought by his mother to the Out-of-hours (OOH) walk-in centre. She reports that he is thought to have an allergy to peanuts and is waiting for an Allergy Clinic outpatient appointment. He has eaten a piece of birthday cake at a party about 30 minutes ago and has quickly developed facial flushing, with swelling of the lips and face. He has become wheezy and is now unable to talk in complete sentences.
      What is the most appropriate management option?

      Your Answer:

      Correct Answer: Administer 300 µg 1: 1000 adrenaline IM

      Explanation:

      Correct and Incorrect Management Options for Anaphylaxis

      Anaphylaxis is a potentially life-threatening allergic reaction that requires immediate management. The correct management options include administering adrenaline 1:1000 intramuscularly (IM) at appropriate doses based on the patient’s age and weight. However, there are also incorrect management options that can be harmful to the patient.

      One incorrect option is administering chlorphenamine IM. While it is a sedating antihistamine, it should not be used as a first-line intervention for airway, breathing, or circulation problems during initial emergency treatment. Non-sedating oral antihistamines may be given following initial stabilisation.

      Another incorrect option is advising the patient to go to the nearest Emergency Department instead of administering immediate drug management. Out-of-hours centres should have access to emergency drugs, including adrenaline, and GPs working in these settings should be capable of administering doses in emergencies.

      It is also important to administer the correct dose of adrenaline based on the patient’s age and weight. Administering a dose that is too high, such as 1000 µg for a 7-year-old child, can be harmful.

      In summary, the correct management options for anaphylaxis include administering adrenaline at appropriate doses and avoiding incorrect options such as administering chlorphenamine IM or advising the patient to go to the nearest Emergency Department without administering immediate drug management.

    • This question is part of the following fields:

      • Allergy And Immunology
      0
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  • Question 10 - You are reviewing the recent results for a 23-year-old patient in your general...

    Incorrect

    • You are reviewing the recent results for a 23-year-old patient in your general practice. A vaginal swab has come back positive for Chlamydia trachomatis. The patient has a history of asthma and is allergic to penicillin. She is currently 12 weeks pregnant. You have contacted the genitourinary clinic for contact tracing and treatment for her partner. What is the most suitable prescription for her treatment?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      In the case of treating Chlamydia during pregnancy, erythromycin would be the most appropriate option among the listed antibiotics. Amoxicillin, azithromycin, or erythromycin can be used to treat Chlamydia during pregnancy. However, since the patient is allergic to penicillin, amoxicillin is not suitable. Doxycycline, which is the first-line treatment for uncomplicated Chlamydia in non-pregnant individuals, is not recommended during pregnancy due to its teratogenic effects. Co-amoxiclav is also not appropriate for treating Chlamydia and is contraindicated in this patient due to their penicillin allergy.

      Chlamydia is the most common sexually transmitted infection in the UK caused by Chlamydia trachomatis. It is often asymptomatic but can cause cervicitis and dysuria in women and urethral discharge and dysuria in men. Complications include epididymitis, pelvic inflammatory disease, and infertility. Testing is done through nuclear acid amplification tests (NAATs) on urine or swab samples. Screening is recommended for sexually active individuals aged 15-24 years. Doxycycline is the first-line treatment, but azithromycin may be used if contraindicated. Partners should be notified and treated.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
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Cardiovascular Health (0/1) 0%
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