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  • Question 1 - A 10-week-old boy comes for his routine baby check. His parents are curious...

    Incorrect

    • A 10-week-old boy comes for his routine baby check. His parents are curious about what will be evaluated during the check-up.
      What is the most probable abnormality that will be detected as a new finding during this stage (not previously identified at or shortly after birth)? Choose ONE option only.

      Your Answer: Developmental dysplasia of the hip

      Correct Answer: Congenital heart disease

      Explanation:

      The Importance of Routine Six-Week Baby Checks

      Routine six-week baby checks are crucial in identifying potential health issues in newborns. While some conditions may be identified before or just after birth, others may not present symptoms until later in childhood. It is important to note that even a normal cardiac examination at six weeks doesn’t completely rule out congenital heart disease, as it may still manifest later on.

      Congenital hypothyroidism is typically tested for soon after birth in the heel-prick Guthrie test, along with other conditions such as phenylketonuria and cystic fibrosis. Congenital cataracts are usually diagnosed at newborn examination by the identification of absence of the red reflex, and surgery should ideally be performed before two months of age to prevent irreversible amblyopia.

      While a check for developmental dysplasia of the hip is usually carried out at or soon after birth, some late diagnoses still occur. Undescended testicles should also be detected at birth, with surgery indicated if they remain undescended at 12 months.

      In summary, routine six-week baby checks are essential in identifying potential health issues in newborns, including congenital heart disease, congenital hypothyroidism, congenital cataracts, developmental dysplasia of the hip, and undescended testicles. It is important for parents and healthcare providers to remain vigilant in monitoring a child’s health and development.

    • This question is part of the following fields:

      • Children And Young People
      56.7
      Seconds
  • Question 2 - A 7-year-old girl still wets the bed most nights. She is dry by...

    Correct

    • A 7-year-old girl still wets the bed most nights. She is dry by day. Her development has been normal and she is otherwise well. She has never had a urinary infection. There are no behavioural problems or family issues.
      What is the most appropriate management option?

      Your Answer: Enuresis alarm

      Explanation:

      Treatment Options for Enuresis: From Simple Measures to Medications

      Enuresis, or bedwetting, is a common problem among children. While most children outgrow it, some may need treatment. The first step is to try simple measures such as restricting fluid intake and encouraging regular toilet use. If bedwetting persists, an enuresis alarm may be considered as first-line treatment. Desmopressin, a medication that reduces urine production, can be used for rapid control or in combination with an alarm. However, it should be used second line after an alarm has been tried. Desmopressin with an anticholinergic medication like oxybutynin is another option, but specialist assessment is recommended. Imipramine, a tricyclic antidepressant, may be considered as a last resort after all other treatments have failed and with caution due to potential side effects. Overall, treatment options for enuresis should be tailored to the individual child and their specific needs.

    • This question is part of the following fields:

      • Children And Young People
      25.9
      Seconds
  • Question 3 - How should strong opioids be used for cancer pain management in primary care?...

    Incorrect

    • How should strong opioids be used for cancer pain management in primary care?

      Your Answer: Fentanyl patches are a suitable first line treatment for the management of severe pain

      Correct Answer: Oxycodone has a more predictable systemic bioavailability than morphine

      Explanation:

      Opioid Prescription Guidelines

      About 10-30% of patients cannot use morphine due to side effects or poor analgesic response. However, oxycodone is not shown to have fewer unwanted effects than morphine. On the other hand, hydromorphone is seven times more potent than morphine on a mg for mg basis. Fentanyl should only be used second line, and when a daily requirement is established.

      To ensure safe and appropriate opioid prescription, it is important to remember the STOPP criteria. Prescription is potentially inappropriate if a strong, oral or transdermal opioid (i.e. morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) is prescribed as first-line therapy for mild pain (WHO analgesic ladder not observed). Additionally, regular use without concomitant laxative can lead to severe constipation. Lastly, prescribing a long-acting (modified-release) opioid without a short-acting (immediate-release) opioid for breakthrough pain can result in the persistence of severe pain.

      It is important to follow these guidelines to ensure the safe and effective use of opioids in pain management.

    • This question is part of the following fields:

      • End Of Life
      77.4
      Seconds
  • Question 4 - A 55-year-old man presents with unilateral nasal obstruction caused by soft tissue swelling...

    Correct

    • A 55-year-old man presents with unilateral nasal obstruction caused by soft tissue swelling and bleeding from the same side of the nose. What is the most suitable next step?

      Your Answer: Direct specialist visualisation of the nasal passages

      Explanation:

      Unilateral Nasal Obstruction: Possible Causes and Management

      Unilateral nasal obstruction can be caused by various factors, including nasal polyps, infection, and neoplastic processes. If the obstruction is accompanied by soft tissue blockage and unilateral epistaxis, the possibility of a neoplastic process should be considered, and direct visualisation of the area in an ear, nose, and throat clinic is necessary. Nasopharyngeal carcinoma is a rare but possible cause of unilateral nasal obstruction.

      Aside from neoplastic processes, other nasal tumors that may cause unilateral nasal obstruction include inverted papilloma, sarcoma, lymphoma, olfactory neuroblastoma, and juvenile nasopharyngeal angiofibroma.

      Using nasal decongestants for prolonged periods is not recommended as it may cause rebound congestion of the nasal mucosa. Antibiotics are not normally indicated for nasal blockage caused by the common cold, influenza virus, or rhinosinusitis. Topical corticosteroids may be beneficial in allergic rhinitis and some cases of vasomotor rhinitis, while corticosteroid drops are used in the medical management of nasal polyps. Oral steroids are not typically used in the management of any form of nasal obstruction.

      In summary, the management of unilateral nasal obstruction depends on the underlying cause, and direct specialist visualisation of the nasal passages is necessary for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      16.5
      Seconds
  • Question 5 - A patient with type 1 diabetes who is 16 years old presents with...

    Correct

    • A patient with type 1 diabetes who is 16 years old presents with diarrhoea and vomiting, along with reduced oral intake. In the past day, she has experienced increased thirst and urination. Her capillary blood glucose level is 19 mmol/L, and her blood ketones are 3.6 mmol/L.

      What is the most appropriate course of action for managing this patient's condition?

      Your Answer: Admit to hospital

      Explanation:

      Diabetic ketoacidosis is a condition that can affect both Type 1 and Type 2 diabetes patients. It is identified by blood ketone levels of ≥3 mmol/L (or urine ketones of ++ or greater) in individuals with a blood glucose level of ≥11 mmol/L or a known history of diabetes. It is important to check ketones in all diabetic patients who are unwell and admit them to the hospital if their ketone levels are ≥3 mmol/L. Blood ketones are preferred over urine ketones as they provide a more accurate representation of the true blood ketone level. Patients should never discontinue their insulin treatment, even if they are unwell and eating less. During intercurrent illness, they may require higher insulin doses and should have a ‘sick day’ management plan from their diabetes team.

      Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus, accounting for around 6% of cases. It can also occur in rare cases of extreme stress in patients with type 2 diabetes mellitus. DKA is caused by uncontrolled lipolysis, resulting in an excess of free fatty acids that are converted to ketone bodies. The most common precipitating factors of DKA are infection, missed insulin doses, and myocardial infarction. Symptoms include abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and breath that smells like acetone. Diagnostic criteria include glucose levels above 11 mmol/l or known diabetes mellitus, pH below 7.3, bicarbonate below 15 mmol/l, and ketones above 3 mmol/l or urine ketones ++ on dipstick.

      Management of DKA involves fluid replacement, insulin, and correction of electrolyte disturbance. Fluid replacement is necessary as most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially, even if the patient is severely acidotic. Insulin is administered through an intravenous infusion, and correction of electrolyte disturbance is necessary. Long-acting insulin should be continued, while short-acting insulin should be stopped. Complications may occur from DKA itself or the treatment, such as gastric stasis, thromboembolism, arrhythmias, acute respiratory distress syndrome, acute kidney injury, and cerebral edema. Children and young adults are particularly vulnerable to cerebral edema following fluid resuscitation in DKA and often need 1:1 nursing to monitor neuro-observations, headache, irritability, visual disturbance, focal neurology, etc.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      37
      Seconds
  • Question 6 - A 28-year-old woman presents with chronic dandruff that worsens during the winter months...

    Incorrect

    • A 28-year-old woman presents with chronic dandruff that worsens during the winter months and has not responded to over-the-counter treatments. She reports a rash on her elbows and knees. On examination, she has silvery scale on her scalp, elbows, and knees that can be removed but causes pinpoint bleeding. The thickness of the scalp scale is not significant. What is the most suitable initial management option?

      Your Answer: Ketoconazole shampoo

      Correct Answer: Betamethasone lotion

      Explanation:

      Treatment Options for Scalp Psoriasis: NICE Guidelines and Beyond

      Scalp psoriasis is a common condition that can cause discomfort and embarrassment. One telltale sign is Auspitz’s sign, where pinpoint bleeding occurs when a scale is removed due to thinning of the epidermal layer overlying the dermal papillae. The National Institute for Health and Care Excellence (NICE) recommends using a potent corticosteroid as initial treatment for up to four weeks, followed by a different formulation or calcipotriol if necessary. Topical agents containing salicylic acid, emollients, or oils can also be used to remove scale before resuming corticosteroid treatment. However, tar-based shampoos are not recommended as a sole treatment option. A combined product containing calcipotriol and betamethasone dipropionate may be used as a first-line treatment, as it has been shown to be more effective than using the drugs separately. Overall, there are various treatment options available for scalp psoriasis, and it is important to consult with a healthcare professional to determine the best course of action.

    • This question is part of the following fields:

      • Dermatology
      25.1
      Seconds
  • Question 7 - A 28-year-old woman presents with a two week history of feeling unwell, characterised...

    Incorrect

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

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

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

      While awaiting confirmation, who should be offered antibiotics?

      Your Answer: The whole family

      Correct Answer: Nobody

      Explanation:

      Antibiotic Prophylaxis for Pertussis

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

    • This question is part of the following fields:

      • Respiratory Health
      28.4
      Seconds
  • Question 8 - If you were looking at evidence about which age group is most susceptible...

    Incorrect

    • If you were looking at evidence about which age group is most susceptible to psychiatric disturbance in patients taking Tamiflu, in what type of study would you be most likely to find it?

      Your Answer: Cohort study

      Correct Answer: Nested case-control study

      Explanation:

      Investigating Rare Case Reports of Psychiatric Disturbance and Drug Safety

      By definition, rare case reports cannot be adequately addressed in a standard clinical development program that typically involves studies in up to 5,000 patients. Therefore, conducting another randomized controlled trial (RCT) is unlikely to provide significant data. Managed healthcare databases may not offer sufficient detailed information to establish causality, and a cohort study may not have a large enough number of index events to draw conclusions about drug safety. In this scenario, a nested case-control study is the most appropriate approach to investigate any potential link between psychiatric disturbance and the drug. This type of study compares a collection of cases with control patients to identify any differences and draw conclusions about drug safety.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      29.7
      Seconds
  • Question 9 - A 27-year-old woman comes to the clinic seeking emergency contraception. She had unprotected...

    Correct

    • A 27-year-old woman comes to the clinic seeking emergency contraception. She had unprotected sex within the last 24 hours and is not currently using any regular form of birth control. Her menstrual cycle is regular, with her last period occurring 12 days ago. She has no known medical conditions. Upon reviewing her medical records, you discover that she used levonorgestrel for emergency contraception 20 days ago.

      She asks for your advice on what options are available for emergency contraception. How should you respond?

      Your Answer: She can use levonorgestrel or ulipristal, or the intrauterine copper device

      Explanation:

      It is now recommended to use both levonorgestrel and ulipristal more than once in the same menstrual cycle. According to the current guidelines from the Faculty of Sexual and Reproductive Healthcare (FSRH), if a woman has already taken either medication once or more in a cycle, she can be offered it again after further unprotected sexual intercourse in the same cycle. However, if she has already taken one medication, the other should not be taken within a certain timeframe. It is important to note that the intrauterine copper device is the most effective form of contraception and should be offered to eligible patients. Advising that no emergency contraception is needed when a woman is at risk of pregnancy is incorrect.

      Emergency contraception is available in the UK through two methods: emergency hormonal contraception and intrauterine device (IUD). Emergency hormonal contraception includes two types of pills: levonorgestrel and ulipristal. Levonorgestrel works by stopping ovulation and inhibiting implantation, and should be taken as soon as possible after unprotected sexual intercourse (UPSI) for maximum efficacy. The single dose of levonorgestrel is 1.5mg, but should be doubled for those with a BMI over 26 or weight over 70kg. It is safe and well-tolerated, but may cause vomiting in around 1% of women. Ulipristal, on the other hand, is a selective progesterone receptor modulator that inhibits ovulation. It should be taken within 120 hours after intercourse, and may reduce the effectiveness of hormonal contraception. The most effective method of emergency contraception is the copper IUD, which may inhibit fertilization or implantation. It must be inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date. Prophylactic antibiotics may be given if the patient is at high-risk of sexually transmitted infection. The IUD is 99% effective regardless of where it is used in the cycle, and may be left in-situ for long-term contraception.

    • This question is part of the following fields:

      • Gynaecology And Breast
      59.7
      Seconds
  • Question 10 - A 10-year-old girl presents to the clinic with her father, reporting a rash...

    Incorrect

    • A 10-year-old girl presents to the clinic with her father, reporting a rash on her ears that has been present for 3 days. They have just returned from a trip to Mexico. The girl complains of itchiness and discomfort. She has not experienced any fever or respiratory symptoms recently. On examination, small blisters are observed on the helix of both ears, while the rest of her skin appears normal. The patient has no prior medical history.

      What is the most probable diagnosis?

      Your Answer: Chondrodermatitis nodularis

      Correct Answer: Juvenile spring eruption

      Explanation:

      Juvenile spring eruption (JSE) is a skin condition that typically affects boys aged 5-14 years during the spring season. It is caused by sun exposure and appears as a blistering rash on the ears, causing discomfort and itchiness. The recent holiday to Tenerife suggests a possible risk factor for this condition. Treatment involves using emollients and antihistamines, and symptoms usually resolve within a week.

      The rash associated with Chickenpox starts as red macules that become raised, blister, and crust over time. It is often accompanied by cold-like symptoms and fever and tends to be more widespread, affecting the trunk and limbs. This rash typically lasts for 4-10 days. However, since the patient has a 2-day history of a blistering rash isolated to the ears, Chickenpox is an unlikely diagnosis.

      Given the patient’s short history, the characteristic rash, and the absence of any relevant medical history, eczema is an unlikely possibility.

      Chondrodermatitis nodularis is a skin condition that is commonly seen in middle-aged or elderly patients. It is characterized by small skin-colored nodules that typically appear on the helix of the ear.

      Understanding Juvenile Spring Eruption

      Juvenile spring eruption is a skin condition that occurs as a result of sun exposure. It is a type of polymorphic light eruption (PLE) that causes itchy red bumps on the light-exposed parts of the ears, which can turn into blisters and crusts. This condition is more common in boys aged between 5-14 years, and it is less common in females due to increased amounts of hair covering the ears.

      The main cause of juvenile spring eruption is sun-induced allergy rash, which is more likely to occur in the springtime. Some patients may also have PLE elsewhere on the body, and there is an increased incidence in cold weather. The diagnosis of this condition is usually made based on clinical presentation, and no clinical tests are required in most cases. However, in aggressive cases, lupus should be ruled out by ANA and ENA blood tests.

      The management of juvenile spring eruption involves providing patient education on sun exposure and the use of sunscreen and hats. Topical treatments such as emollients or calamine lotion can be used to provide relief, and antihistamines can help with itch relief at night-time. In more serious cases, oral steroids such as prednisolone can be used, as well as immune-system suppressants.

      In conclusion, understanding juvenile spring eruption is important for proper diagnosis and management. By taking preventative measures and seeking appropriate treatment, patients can manage their symptoms and improve their quality of life.

    • This question is part of the following fields:

      • Dermatology
      74.3
      Seconds
  • Question 11 - A new screening tool for lower gastrointestinal malignancies has been developed known as...

    Correct

    • A new screening tool for lower gastrointestinal malignancies has been developed known as the Faecal Immunochemical Test (FIT). The test is hoped to be an improvement on the previous stool tests as the FIT targets human haemoglobin.

      The researchers would like to determine the specificity of the FIT test for colorectal cancer in a study involving 3000 participants aged 50 and above. All participants undergo a FIT and are subsequently evaluated with colonoscopy, which is considered the gold standard test.

      Out of the 1200 participants who tested positive on the FIT, 800 were later confirmed to have colorectal cancer on colonoscopy.

      On the other hand, out of the 1800 participants who tested negative on the FIT, 100 were later found to have colorectal cancer on colonoscopy.

      What is the specificity of the FIT test for colorectal cancer in this study?

      Your Answer: 95%

      Explanation:

      The specificity of the test is 0.95 or 95%.

      Precision refers to the consistency of a test in producing the same results when repeated multiple times. It is an important aspect of test reliability and can impact the accuracy of the results. In order to assess precision, multiple tests are performed on the same sample and the results are compared. A test with high precision will produce similar results each time it is performed, while a test with low precision will produce inconsistent results. It is important to consider precision when interpreting test results and making clinical decisions.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      290.2
      Seconds
  • Question 12 - Samantha is a 30-year-old woman who visits her doctor complaining of fatigue, night...

    Correct

    • Samantha is a 30-year-old woman who visits her doctor complaining of fatigue, night sweats, and muscle pains that have been bothering her for a few months. She believes that these symptoms began after she developed a rash on her leg four months ago. She has not traveled anywhere. Samantha is upset and emotional about her symptoms.

      As part of Samantha's evaluation, which tests should be considered?

      Your Answer: Borrelia burgdorferi antibody test

      Explanation:

      Consider Lyme disease as a possible diagnosis for patients presenting with vague and unexplained symptoms such as fever, night sweats, headache, or paraesthesia. These symptoms may also include inflamed lymph nodes, neck pain, and joint/muscle aches. The causative agent of Lyme disease is Borrelia burgdorferi. Malaria is unlikely in patients with no travel history and symptoms lasting for 4 months. Scabies typically presents with an itchy rash, which is not evident in the scenario. Glandular fever may cause fatigue and muscle aches, but the absence of a sore throat and the need for a blood test for diagnosis make it less likely. Toxoplasma gondii is usually asymptomatic but may cause flu-like symptoms and muscle aches, and it is not associated with a rash.

      Lyme Disease: Symptoms and Progression

      Lyme disease is a bacterial infection that is transmitted through the bite of an infected tick. The disease progresses in two stages, with early and later features. The early features of Lyme disease include erythema migrans, which is a small papule that often appears at the site of the tick bite. This papule develops into a larger annular lesion with central clearing, resembling a bulls-eye. This occurs in 70% of patients and is accompanied by systemic symptoms such as malaise, fever, and arthralgia.

      As the disease progresses, it can lead to more severe symptoms. The later features of Lyme disease include cardiovascular symptoms such as heart block and myocarditis, as well as neurological symptoms such as cranial nerve palsies and meningitis. Patients may also experience polyarthritis, which is inflammation in multiple joints.

    • This question is part of the following fields:

      • Dermatology
      28.8
      Seconds
  • Question 13 - When managing hypertension in a diabetic patient, which of the following combinations of...

    Incorrect

    • When managing hypertension in a diabetic patient, which of the following combinations of Antihypertensive medications should be avoided, if possible?

      Your Answer: Doxazosin + beta-blocker

      Correct Answer: Beta-blocker + thiazide

      Explanation:

      Blood Pressure Management in Diabetes Mellitus

      Patients with diabetes mellitus have traditionally been managed with lower blood pressure targets to reduce their overall cardiovascular risk. However, a 2013 Cochrane review found that tighter blood pressure control did not significantly improve outcomes for patients with diabetes, except for a slightly reduced rate of stroke. As a result, NICE recommends a blood pressure target of < 140/90 mmHg for type 2 diabetics, the same as for patients without diabetes. For patients with type 1 diabetes, NICE recommends a blood pressure target of 135/85 mmHg unless they have albuminuria or two or more features of metabolic syndrome, in which case the target should be 130/80 mmHg. ACE inhibitors or angiotensin-II receptor antagonists (A2RBs) are the first-line antihypertensive regardless of age, as they have a renoprotective effect in diabetes. A2RBs are preferred for black African or African-Caribbean diabetic patients. However, autonomic neuropathy may result in more postural symptoms in patients taking antihypertensive therapy. It is important to note that the routine use of beta-blockers in uncomplicated hypertension should be avoided, especially when given in combination with thiazides, as they may cause insulin resistance, impair insulin secretion, and alter the autonomic response to hypoglycemia.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      29.3
      Seconds
  • Question 14 - A father brings his 2-year-old son to your GP clinic. The child has...

    Correct

    • A father brings his 2-year-old son to your GP clinic. The child has been experiencing symptoms of a cold for the past 2 days. Last night, he developed a barking cough and a slight fever of 37.8º.

      During the examination, you notice mild stridor when the child moves around, but there are no visible recessions. The chest sounds clear, and there is good air entry on both sides. The temperature remains at 37.8º, but all other vital signs are normal.

      What is the most appropriate course of action for management?

      Your Answer: Give a stat dose of dexamethasone 150 micrograms/kg PO

      Explanation:

      For a child with croup, a single dose of oral dexamethasone (0.15 mg/kg) should be taken immediately regardless of the severity of the illness. Croup typically begins with cold-like symptoms and progresses to a barking cough with a seal-like sound. The severity of croup can be determined by the presence of symptoms such as stridor, recessions, and distress. In this case, the child has mild croup and hospital admission is not necessary. Nebulized adrenaline is only recommended for children with severe symptoms, while a salbutamol inhaler is not effective for croup. Antibiotics are not useful for treating croup as it is a viral illness. Steroids, such as dexamethasone, have been shown to alleviate symptoms and reduce the need for hospitalization.

      Croup is a respiratory infection that affects young children, typically those between 6 months and 3 years old. It is most common in the autumn and is caused by parainfluenza viruses. The main symptom is stridor, which is caused by swelling and secretions in the larynx. Other symptoms include a barking cough, fever, and cold-like symptoms. The severity of croup can be graded based on the child’s symptoms, with mild cases having occasional coughing and no audible stridor at rest, and severe cases having frequent coughing, prominent stridor, and significant distress or lethargy. Children with moderate or severe croup should be admitted to the hospital, especially if they are under 6 months old or have other airway abnormalities. Diagnosis is usually made based on clinical symptoms, but a chest x-ray can show subglottic narrowing. Treatment typically involves a single dose of oral dexamethasone or prednisolone, and emergency treatment may include high-flow oxygen or nebulized adrenaline.

    • This question is part of the following fields:

      • Children And Young People
      42.7
      Seconds
  • Question 15 - A 35-year-old woman is concerned about breast cancer. An older cousin on her...

    Correct

    • A 35-year-old woman is concerned about breast cancer. An older cousin on her mother’s side has been diagnosed with breast cancer and she knows of one other cousin on her mother’s side with the disease. Additionally, her paternal grandmother was diagnosed with breast cancer in her seventies. She has no knowledge of any unusual cancers or gene abnormalities in the family.
      What is the most suitable course of action for this woman?

      Your Answer: Advice about breast awareness

      Explanation:

      Breast Awareness and Management for Women with a Family History of Breast Cancer

      Breast cancer is a common disease that affects many families. However, having a family history of breast cancer doesn’t necessarily mean that a woman is at substantial risk. The risk increases with the number and closeness of relatives affected and the age at which they were diagnosed. Other factors that increase the risk include the presence of certain other cancers or some gene patterns.

      The National Institute for Health and Care Excellence (NICE) has produced guidance for managing breast cancer in people with a family history of the disease. Women with only one second-degree relative with breast cancer, such as a grandmother, and who was diagnosed in her seventies, do not normally require referral. However, being breast aware is good advice for all women.

      For women considered to have a high risk, annual mammography and magnetic resonance imaging (MRI) are secondary care options for screening and detecting breast cancer. Genetic testing is also available, and referral to a specialist genetic clinic is based on several factors, including the number of people involved, closeness of the relationship, age at diagnosis, and the presence of other cancers.

      In some cases, prophylactic bilateral mastectomy may be recommended for high-risk women. This involves breast removal before cancer develops and is recommended for women with a strong family history, the presence of certain genes, previous cancer in one breast, or when biopsies show certain conditions.

      In summary, breast awareness and management for women with a family history of breast cancer involve several options, including screening, genetic testing, and prophylactic mastectomy. Women should discuss their options with their healthcare provider to determine the best course of action for their individual situation.

    • This question is part of the following fields:

      • Genomic Medicine
      33.5
      Seconds
  • Question 16 - A 48-year-old woman who has had systemic lupus erythematosus (SLE) for a number...

    Correct

    • A 48-year-old woman who has had systemic lupus erythematosus (SLE) for a number of years complains of facial swelling, which she thinks might be due to a food allergy. On examination, she has facial oedema, raised blood pressure at 170/100 mmHg and although she can only produce a small amount of urine, dipstick testing is strongly positive for blood and protein.
      Select the single most likely diagnosis.

      Your Answer: Glomerulonephritis

      Explanation:

      Understanding Nephritis, Angioedema, Chronic Liver Disease, and Hypertensive Emergencies

      Nephritis is a condition that causes haematuria, oliguria, proteinuria, facial oedema, and hypertension. It can be caused by various factors, but it is a common complication of SLE, affecting 30-55% of patients. Hypertension is a poor prognostic sign in these patients.

      Angioedema, on the other hand, causes facial swelling due to an allergic reaction and is not typically associated with renal abnormalities. Urinary tract infections do not usually cause heavy proteinuria and facial swelling. Chronic liver disease can cause hypoalbuminaemia, but it doesn’t typically cause renal abnormalities on its own.

      Hypertensive emergencies include accelerated hypertension and malignant hypertension. Both conditions result in target organ damage due to a recent increase in blood pressure to very high levels (usually ≥180 mm Hg systolic and ≥110 mm Hg diastolic). This damage is usually seen as neurological (e.g., encephalopathy), cardiovascular, or renal damage. In malignant hypertension, papilloedema is present.

    • This question is part of the following fields:

      • Kidney And Urology
      28.7
      Seconds
  • Question 17 - A 25-year-old male patient complains of mouth pain and halitosis. During examination, it...

    Incorrect

    • A 25-year-old male patient complains of mouth pain and halitosis. During examination, it is observed that he has poor dental hygiene, bleeding gums, and extensive gingival ulceration. He also has a fever of 38.0ºC. You suggest that he should visit a dentist. What other treatment alternatives should be provided?

      Your Answer: Paracetamol + oral phenoxymethylpenicillin + chlorhexidine mouthwash

      Correct Answer: Paracetamol + oral metronidazole + chlorhexidine mouthwash

      Explanation:

      Understanding Gingivitis and its Management

      Gingivitis is a dental condition that is commonly caused by poor oral hygiene. It is characterized by red and swollen gums that bleed easily. In severe cases, it can lead to acute necrotizing ulcerative gingivitis, which is accompanied by painful bleeding gums, bad breath, and ulcers on the gums.

      For patients with simple gingivitis, regular dental check-ups are recommended, and antibiotics are usually not necessary. However, for those with acute necrotizing ulcerative gingivitis, it is important to seek immediate dental attention. In the meantime, oral metronidazole or amoxicillin may be prescribed for three days, along with chlorhexidine or hydrogen peroxide mouthwash and simple pain relief medication.

      It is crucial to maintain good oral hygiene to prevent gingivitis from developing or worsening. This includes brushing teeth twice a day, flossing daily, and using mouthwash regularly. By understanding the causes and management of gingivitis, individuals can take steps to protect their oral health and prevent complications.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      47
      Seconds
  • Question 18 - Which one of the following statements regarding the metabolic syndrome is accurate? ...

    Correct

    • Which one of the following statements regarding the metabolic syndrome is accurate?

      Your Answer: Decisions on cardiovascular risk factor modification should be made regardless of whether patients meet the criteria for metabolic syndrome

      Explanation:

      The determination of primary prevention measures for cardiovascular disease should rely on established methods and should not be influenced by the diagnosis of metabolic syndrome.

      Understanding Metabolic Syndrome

      Metabolic syndrome is a condition that has various definitions, but it is generally believed to be caused by insulin resistance. The American Heart Association and the International Diabetes Federation have similar criteria for diagnosing metabolic syndrome. According to these criteria, a person must have at least three of the following: elevated waist circumference, elevated triglycerides, reduced HDL, raised blood pressure, and raised fasting plasma glucose. The International Diabetes Federation also requires the presence of central obesity and any two of the other four factors. In 1999, the World Health Organization produced diagnostic criteria that required the presence of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, and two of the following: high blood pressure, dyslipidemia, central obesity, and microalbuminuria. Other associated features of metabolic syndrome include raised uric acid levels, non-alcoholic fatty liver disease, and polycystic ovarian syndrome.

      Overall, metabolic syndrome is a complex condition that involves multiple factors and can have serious health consequences. It is important to understand the diagnostic criteria and associated features in order to identify and manage this condition effectively.

    • This question is part of the following fields:

      • Cardiovascular Health
      74.2
      Seconds
  • Question 19 - A 48-year-old man presents with complaints of blurred vision, redness and itching of...

    Incorrect

    • A 48-year-old man presents with complaints of blurred vision, redness and itching of the eyes. He reports having this chronic 'eye infection' on and off for the past four years. He has been using chloramphenicol drops without much relief. Upon examination, there is evidence of blepharitis, lid margin telangiectasia and mild conjunctival hyperaemia.
      What is the most probable diagnosis?

      Your Answer: Systemic sclerosis

      Correct Answer: Rosacea

      Explanation:

      Common Eye Conditions Associated with Systemic Diseases

      Rosacea is a skin condition that can also affect the eyes, causing chronic blepharitis, meibomian cysts, conjunctivitis, and keratitis. Ocular rosacea symptoms may occur before, during, or after skin symptoms, and may not always match the severity of skin symptoms.

      Ulcerative colitis, an inflammatory bowel disease, can cause scleritis or uveitis, which can lead to eye pain, redness, and vision loss.

      Recurrent herpes simplex can cause a linear branching corneal ulcer, known as a dendritic ulcer, as well as epithelial and disciform keratitis, resulting in foreign-body sensation, light sensitivity, redness, and blurred vision.

      Rheumatoid arthritis may be associated with episcleritis, scleritis, and dry eyes, which can cause eye pain, redness, and irritation.

      Systemic sclerosis, a connective tissue disorder, can cause eyelid tightening and telangiectasia, which are visible blood vessels on the surface of the skin, including the eyelids.

      Overall, it is important for individuals with these systemic diseases to be aware of potential eye complications and to seek prompt medical attention if they experience any changes in their vision or eye health.

    • This question is part of the following fields:

      • Eyes And Vision
      37.4
      Seconds
  • Question 20 - Which one of the following statements regarding retirement contracts is true? ...

    Incorrect

    • Which one of the following statements regarding retirement contracts is true?

      Your Answer: PMS practices receive a Minimum Practice Income Guarantee (MPIG)

      Correct Answer: PMS practices may take part in the QOF scheme

      Explanation:

      Comparison of GP Contracts

      The General Medical Services (GMS), Personal Medical Services (PMS), and Alternative Provider Medical Services (APMS) contracts differ in several ways. The GMS contract is nationally negotiated and allows GPs or qualifying health professionals to provide essential services, with optional additional services and enhanced services. The PMS contract is locally negotiated with mandatory terms and includes core and additional services similar to GMS. The APMS contract has no restriction on providers and the scope of services depends on the individual contract.

      The payment structure also varies between the contracts. GMS has a global sum with a Minimum Practice Income Guarantee (MPIG), Quality and Outcomes Framework (QOF), enhanced services, premises, and IT. PMS has a baseline set nationally and QOF, while APMS is locally negotiated.

      The type of contract also differs. GMS is open-ended and cannot be terminated unless fault is proven. PMS is usually for five years, and the contract may be terminated. APMS is usually for three years, and the contract may also be terminated.

      It is worth noting that the majority of practices are under the GMS contract, while GPs in PMS tend to have higher incomes.

    • This question is part of the following fields:

      • People With Long Term Conditions Including Cancer
      48.6
      Seconds
  • Question 21 - A 30-year-old man is concerned about his risk of HIV (human immunodeficiency virus)...

    Correct

    • A 30-year-old man is concerned about his risk of HIV (human immunodeficiency virus) after learning that his previous partner has been diagnosed with AIDS (acquired immune deficiency syndrome). Their last sexual encounter was two years ago, and he is currently in good health with no symptoms. What is the best course of action for managing his situation?

      Your Answer: Offer him testing for HIV p24 antigen and HIV antibody

      Explanation:

      The standard diagnostic and screening test for HIV now includes a combination of HIV p24 antigen and HIV antibody testing. Therefore, the correct option is to offer the patient testing for HIV p24 antigen and HIV antibody. Monitoring for those with confirmed HIV infection involves measuring CD4 lymphocyte cell count and viral load, which is not applicable in this case as the patient doesn’t have a confirmed diagnosis. A full blood count may show features suggesting HIV, but it is not a diagnostic test for HIV. NICE recommends offering an HIV test in primary care to those who request testing, have risk factors for HIV, have another sexually transmitted infection, have an AIDS-defining condition, an indicator condition, or clinical features of HIV infection. Therefore, offering the patient testing for a full blood count or stating that testing is not required as he is asymptomatic are incorrect options.

      HIV seroconversion is a process where the body develops antibodies against the virus. This process is symptomatic in 60-80% of patients and usually presents as a glandular fever type illness. The severity of symptoms is associated with a poorer long-term prognosis. The symptoms typically occur 3-12 weeks after infection and include a sore throat, lymphadenopathy, malaise, myalgia, arthralgia, diarrhea, maculopapular rash, mouth ulcers, and rarely meningoencephalitis.

      Diagnosing HIV involves testing for HIV antibodies, which may not be present in early infection. However, most people develop antibodies to HIV at 4-6 weeks, and 99% do so by 3 months. The diagnosis usually involves both a screening ELISA test and a confirmatory Western Blot Assay. Additionally, a p24 antigen test can be used to detect a viral core protein that appears early in the blood as the viral RNA levels rise. Combination tests that test for both HIV p24 antigen and HIV antibody are now standard for the diagnosis and screening of HIV. If the combined test is positive, it should be repeated to confirm the diagnosis. Some centers may also test the viral load (HIV RNA levels) if HIV is suspected at the same time. Testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure, and after an initial negative result, a repeat test should be offered at 12 weeks.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      48.2
      Seconds
  • Question 22 - A 20-year-old patient comes in requesting to start taking a combined oral contraceptive...

    Incorrect

    • A 20-year-old patient comes in requesting to start taking a combined oral contraceptive pill. During the consultation, she mentions having experienced migraine with aura in the past. She asks why the combined oral contraceptive pill is not recommended for her. How should you respond?

      Your Answer: Theoretical risk of ischaemic stroke

      Correct Answer: Significantly increased risk of ischaemic stroke

      Explanation:

      Managing Migraine in Relation to Hormonal Factors

      Migraine is a common neurological condition that affects many people, particularly women. Hormonal factors such as pregnancy, contraception, and menstruation can have an impact on the management of migraine. In 2008, the Scottish Intercollegiate Guidelines Network (SIGN) produced guidelines on the management of migraine, which provide useful information on how to manage migraine in relation to these hormonal factors.

      When it comes to migraine during pregnancy, paracetamol is the first-line treatment, while NSAIDs can be used as a second-line treatment in the first and second trimester. However, aspirin and opioids such as codeine should be avoided during pregnancy. If a patient has migraine with aura, the combined oral contraceptive (COC) pill is absolutely contraindicated due to an increased risk of stroke. Women who experience migraines around the time of menstruation can be treated with mefenamic acid or a combination of aspirin, paracetamol, and caffeine. Triptans are also recommended in the acute situation. Hormone replacement therapy (HRT) is safe to prescribe for patients with a history of migraine, but it may make migraines worse.

      In summary, managing migraine in relation to hormonal factors requires careful consideration and appropriate treatment. The SIGN guidelines provide valuable information on how to manage migraine in these situations, and healthcare professionals should be aware of these guidelines to ensure that patients receive the best possible care.

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      24.7
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  • Question 23 - A 75-year-old man is discharged after suffering a fractured neck of femur. Upon...

    Incorrect

    • A 75-year-old man is discharged after suffering a fractured neck of femur. Upon follow-up, his progress is satisfactory, but there is a need to consider secondary prevention of future fractures. What is the most appropriate course of action?

      Your Answer: Arrange DEXA scan + start strontium ranelate if T-score < -2.5 SD

      Correct Answer: Start oral bisphosphonate

      Explanation:

      Osteoporosis is a condition that weakens bones, making them more prone to fractures. The National Institute for Health and Care Excellence (NICE) has updated its guidelines on the management of osteoporosis in postmenopausal women. Treatment is recommended for women who have confirmed osteoporosis following fragility fractures. Vitamin D and calcium supplements should be offered to all women unless they have adequate intake. Alendronate is the first-line treatment, but if patients cannot tolerate it, risedronate or etidronate may be given. Strontium ranelate and raloxifene are recommended if bisphosphonates cannot be taken. Treatment criteria for patients not taking alendronate are complex and based on age, T-score, and risk factors. Bisphosphonates have been shown to reduce the risk of fractures, while vitamin D and calcium supplements have a poor evidence base. Raloxifene, strontium ranelate, and denosumab are other treatment options, but they have potential side effects and should only be prescribed by specialists. Hormone replacement therapy is no longer recommended for osteoporosis prevention due to concerns about increased rates of cardiovascular disease and breast cancer. Hip protectors and falls risk assessments may also be considered in the management of high-risk patients.

    • This question is part of the following fields:

      • Musculoskeletal Health
      21.2
      Seconds
  • Question 24 - A 35-year-old woman with rheumatoid arthritis takes oral steroids. She complains of watering...

    Incorrect

    • A 35-year-old woman with rheumatoid arthritis takes oral steroids. She complains of watering of both eyes and occasional blurred vision while working on a computer.
      What is the probable diagnosis?

      Your Answer: Diabetic retinopathy

      Correct Answer: Dry eyes

      Explanation:

      Understanding the Possible Eye Conditions Caused by Corticosteroid Treatment

      Corticosteroid treatment can cause various eye conditions, including dry eyes, cataracts, and glaucoma. Dry eye syndrome is characterized by a burning or gritty sensation, dryness, intermittent blurring of vision, redness, itching, and photosensitivity. Cataracts caused by corticosteroids are typically posterior and subcapsular, leading to gradually progressive blurring of vision. Glaucoma may also occur due to raised intraocular pressure, resulting in optic nerve damage and peripheral vision loss. However, any optic nerve damage is irreversible. In contrast, corticosteroid eye drops may be used to manage inflammatory eye disorders associated with dry eyes. Fluctuating blood sugar levels caused by corticosteroids can also result in osmotic swelling of the lens, leading to intermittent blurring of vision. Finally, a transient ischaemic attack may cause acute transient loss of vision or transient diplopia, but it is not related to corticosteroid treatment.

    • This question is part of the following fields:

      • Eyes And Vision
      27
      Seconds
  • Question 25 - What is a possible truth about idiopathic adolescent scoliosis? ...

    Correct

    • What is a possible truth about idiopathic adolescent scoliosis?

      Your Answer: Has no other anatomical clues

      Explanation:

      Understanding Scoliosis Examination

      During scoliosis examination, it is important to take note of certain anatomical clues such as waist asymmetry, uneven shoulders, and humps in the lumbar or thoracic area. Non-structural scoliosis is often caused by unequal leg length, while idiopathic adolescent scoliosis is of the structural type and is usually noticed during the early adolescent growth spurt, particularly in girls. When bending, the structural type is exaggerated while the non-structural type is improved. Proper identification of these factors is crucial in determining the appropriate treatment plan for scoliosis patients.

    • This question is part of the following fields:

      • Musculoskeletal Health
      60.3
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  • Question 26 - A 55-year-old man presents to his General Practitioner reporting ongoing distress following the...

    Incorrect

    • A 55-year-old man presents to his General Practitioner reporting ongoing distress following the sudden death of his wife 12 months ago following a cardiac arrest. He took three months off work to ‘deal with’ his wife’s death and then returned to his full-time role. He lives alone and reports that he has been unable to ‘bounce back’. He thinks of his wife’s death often and it distresses and distracts him. He has been sleeping poorly, has missed several shifts and was finally dismissed from his job. He feels isolated and a sense of responsibility that he did not ‘look after his wife’.
      What is the most likely underlying diagnosis?

      Your Answer: Normal grief reaction

      Correct Answer: Complicated grief

      Explanation:

      Understanding Different Types of Grief and Trauma Reactions

      Grief and trauma can manifest in various ways, and it is essential to differentiate between different types of reactions to provide appropriate support and treatment. Complicated grief is a type of grief that persists in its intensity, hindering a person’s ability to engage in normal activities and causing feelings of shame or guilt. This type of grief can last for an extended period, and the person may struggle to accept the death, leading to isolation and loneliness. On the other hand, post-traumatic stress disorder (PTSD) can result from a distressing event, causing intrusive symptoms such as vivid and distressing memories or flashbacks. Normal grief reactions follow the Kubler Ross model, with stages of denial, anger, bargaining, depression, and acceptance. However, if the intense feelings of grief persist, it may indicate complicated grief. Major depressive disorder (MDD) shares some symptoms with complicated grief, but the context of the loss is crucial in distinguishing between the two. Acute stress reaction is a transient disorder that develops in response to exceptional physical and mental stress, subsiding within hours or days, and is not indicated in this case. Understanding these different types of grief and trauma reactions can help in providing appropriate support and treatment to those who need it.

    • This question is part of the following fields:

      • End Of Life
      15.1
      Seconds
  • Question 27 - Which one of the following statements concerning toddler colic is incorrect? ...

    Incorrect

    • Which one of the following statements concerning toddler colic is incorrect?

      Your Answer: Occurs in up to 20% of infants

      Correct Answer: Is most common at around 6 months of age

      Explanation:

      Babies who are under 3 months old are usually the ones who experience infantile colic.

      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.

    • This question is part of the following fields:

      • Children And Young People
      15.4
      Seconds
  • Question 28 - You see a child who you are investigating for coeliac disease. Their serology...

    Incorrect

    • You see a child who you are investigating for coeliac disease. Their serology test result is positive.

      What would be the next step in your management?

      Your Answer: Advise the patient to stop eating gluten-containing foods and monitor their response

      Correct Answer: No intervention

      Explanation:

      Diagnosis of Coeliac Disease

      Patients who are suspected of having coeliac disease and have positive serology test results should be referred to a gastroenterologist for further investigation. The gastroenterologist will perform an endoscopy and intestinal biopsy to confirm or exclude the diagnosis of coeliac disease. It is important for patients to continue eating gluten-containing foods until the biopsy is performed to ensure accurate results.

      While dietary advice may be helpful if coeliac disease is confirmed, it is more appropriate to first seek a referral to a gastroenterologist. There is no need to repeat the serology test if it is positive. For more information on how to interpret coeliac serology results, refer to the link provided below. Proper diagnosis and management of coeliac disease can greatly improve a patient’s quality of life.

    • This question is part of the following fields:

      • Gastroenterology
      18.1
      Seconds
  • Question 29 - A 35-year-old man has severe athlete's foot. His toenail is also infected. He...

    Incorrect

    • A 35-year-old man has severe athlete's foot. His toenail is also infected. He is taking griseofulvin. He tells you that he has read something about fathering children when taking this drug.

      Which of the following is correct?

      Your Answer: Griseofulvin is safe to take when trying for a baby

      Correct Answer: He should not father a child within six months of finishing griseofulvin

      Explanation:

      Medications to Avoid for Prospective Fathers

      When prescribing medication, it is crucial to consider the potential effects on both men and women who may be trying to conceive. While women are often advised to avoid certain drugs during pregnancy, it is easy to overlook the impact on prospective fathers. For instance, men taking griseofulvin should not father a child during treatment and for six months afterward.

      It is important to be aware of other medications that may present problems for men who are trying to conceive. While not an exhaustive list, some examples include chemotherapy drugs, certain antibiotics, and medications for autoimmune disorders. It is essential to discuss these risks with male patients and encourage them to inform their healthcare provider if they are trying to conceive. By taking these precautions, we can help ensure the health and well-being of both parents and their future children.

    • This question is part of the following fields:

      • Dermatology
      49.2
      Seconds
  • Question 30 - What is considered a 'red flag' that requires urgent specialist referral for suspected...

    Incorrect

    • What is considered a 'red flag' that requires urgent specialist referral for suspected cancer?

      Your Answer:

      Correct Answer: A 55-year-old woman who had an episode of post menopausal bleeding whilst on HRT

      Explanation:

      Early Detection of Cancer in Primary Care

      Early detection of cancer in primary care is crucial for improving survival and outcomes. Clinicians rely on identifying ‘red flag’ symptoms that should prompt urgent referral for specialist investigation. NICE guidelines have been published to help clinicians identify these symptoms and clarify who should be referred with speed. For instance, people aged 45 and over with unexplained visible haematuria without urinary tract infection should be referred using a suspected cancer pathway referral.

      In some cases, urgent referral is not necessary, but careful monitoring and follow-up are required. For example, a 50-year-old woman with bilateral eczematous skin on her left breast should be treated with topical treatment for the eczematous patch and referred if the eczema doesn’t respond to treatment. However, unilateral eczema around the nipple could represent Paget’s disease and would warrant urgent referral.

      Similarly, any postmenopausal woman who presents with vaginal bleeding should be referred urgently immediately. If a woman on hormone replacement therapy presents with postmenopausal bleeding, the HRT should be stopped, and an urgent referral made if any persistent or unexplained bleeding doesn’t resolve over a six-week period.

      In some cases, further investigation is required before referral. For instance, a 70-year-old man with a persistent cough for the last four weeks that is not improving should be referred for an urgent chest x-ray. Further management/investigation would depend on the results of the x-ray and the pattern of any ongoing symptoms. Immediate urgent referral for suspected cancer is not indicated at this point.

      Finally, it is essential to consider other factors that could explain the symptoms. For example, a 39-year-old’s low Hb could be explained by her menorrhagia. Overall, early detection of cancer in primary care requires careful consideration of symptoms, risk factors, and appropriate referral pathways.

    • This question is part of the following fields:

      • Population Health
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

Children And Young People (3/4) 75%
End Of Life (0/2) 0%
Ear, Nose And Throat, Speech And Hearing (1/2) 50%
Metabolic Problems And Endocrinology (1/2) 50%
Dermatology (2/4) 50%
Respiratory Health (0/1) 0%
Evidence Based Practice, Research And Sharing Knowledge (1/2) 50%
Gynaecology And Breast (1/1) 100%
Genomic Medicine (1/1) 100%
Kidney And Urology (1/1) 100%
Cardiovascular Health (1/1) 100%
People With Long Term Conditions Including Cancer (1/1) 100%
Infectious Disease And Travel Health (0/1) 0%
Maternity And Reproductive Health (0/1) 0%
Musculoskeletal Health (0/2) 0%
Eyes And Vision (1/1) 100%
Gastroenterology (1/1) 100%
Population Health (0/1) 0%
Passmed