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  • Question 1 - A 24-year-old woman has plantar warts. Her mother has read that they are...

    Incorrect

    • A 24-year-old woman has plantar warts. Her mother has read that they are caused by human papillomavirus (HPV). She is aware of the link with cervical cancer and is concerned.
      Select from the list the type of HPV infection that is most commonly associated with the development of cervical cancer.

      Your Answer: Anogenital warts

      Correct Answer: Asymptomatic infection

      Explanation:

      Understanding Human Papillomavirus (HPV) and its Association with Cancer

      Human papillomavirus (HPV) is a virus that infects the skin and mucosae of the upper respiratory and anogenital tracts. With about 100 types of HPV, 40 of them infect the genital tract. HPV is classified as either ‘high-risk’ or ‘low-risk’ types, depending on their association with cancer. HPV16 is responsible for over 50% of all cervical cancers, while HPV18 is responsible for over 15%. Although most high-risk infections are transient and cause no clinical problems, persistent infection by a high-risk HPV type is the most important factor for the development of cancer. Types 6 and 11 are associated with anogenital warts and are included in one of the HPV vaccines (Gardasil®) along with types 16 and 18. It is recommended that individuals receive the HPV vaccine to prevent the development of cancer.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
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  • Question 2 - A new screening test called FingerChol has been developed to diagnose hyperlipidaemia with...

    Incorrect

    • A new screening test called FingerChol has been developed to diagnose hyperlipidaemia with a point-of-care finger-prick test. To evaluate the effectiveness of the test, 200 participants aged 50 and above are screened with the FingerChol test. These patients also undergo the gold-standard test (formal lipid profile blood test) for comparison.

      The results obtained are shown in the table below:

      Hyperlipidaemic Not hyperlipidaemic
      Positive FingerChol test 60 40
      Negative FingerChol test 20 80

      What is the positive predictive value of the FingerChol test for this population?

      Your Answer: 33%

      Correct Answer: 60%

      Explanation:

      The positive predictive value (PPV) is calculated by dividing the number of true positives by the total number of positive test results, which represents the probability of actually having the disease if the test result is positive. For example, if there are 30 true positives and 20 false positives, the PPV would be 60%.

      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
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      Seconds
  • Question 3 - The following patients all attend for a medication review in your afternoon clinic....

    Incorrect

    • The following patients all attend for a medication review in your afternoon clinic. They all have atrial fibrillation (AF) and are taking multiple medications.

      Which patient should discontinue anticoagulation?

      Your Answer: A 51-year-old woman with hypertension and diabetes

      Correct Answer: An 80-year-old man who has undergone left atrial appendage closure, surgically preventing clots from entering the bloodstream

      Explanation:

      Even after undergoing catheter ablation for atrial fibrillation, patients must continue taking anticoagulants for an extended period based on their CHA2DS2-VASc score.

      Atrial fibrillation (AF) is a heart condition that requires prompt management. The management of AF depends on the patient’s haemodynamic stability and the duration of the AF. For haemodynamically unstable patients, electrical cardioversion is recommended. For haemodynamically stable patients, rate control is the first-line treatment strategy, except in certain cases. Medications such as beta-blockers, calcium channel blockers, and digoxin are commonly used to control the heart rate. Rhythm control is another treatment option that involves the use of medications such as beta-blockers, dronedarone, and amiodarone. Catheter ablation is recommended for patients who have not responded to or wish to avoid antiarrhythmic medication. The procedure involves the use of radiofrequency or cryotherapy to ablate the faulty electrical pathways that cause AF. Anticoagulation is necessary before and during the procedure to reduce the risk of stroke. The success rate of catheter ablation varies, with around 50% of patients experiencing an early recurrence of AF within three months. However, after three years, around 55% of patients who have undergone a single procedure remain in sinus rhythm.

    • This question is part of the following fields:

      • Cardiovascular Health
      256.3
      Seconds
  • Question 4 - What is the term for a drug that has its own effects but...

    Incorrect

    • What is the term for a drug that has its own effects but doesn't treat the condition it is prescribed for?

      Your Answer: A placebo substitute

      Correct Answer: An active placebo

      Explanation:

      Understanding the Placebo Effect

      The placebo effect refers to the phenomenon where a patient experiences an improvement in their condition after receiving an inert substance or treatment that has no inherent pharmacological activity. This can include a sugar pill or a sham procedure that mimics a real medical intervention. The placebo effect is influenced by various factors, such as the perceived strength of the treatment, the status of the treating professional, and the patient’s expectations.

      It is important to note that the placebo effect is not the same as receiving no care, as patients who maintain contact with medical services tend to have better outcomes. The placebo response is also greater in mild illnesses and can be difficult to separate from spontaneous remission. Patients who enter randomized controlled trials (RCTs) are often acutely unwell, and their symptoms may improve regardless of the intervention.

      The placebo effect has been extensively studied in depression, where it tends to be abrupt and early in treatment, and less likely to persist compared to improvement from antidepressants. Placebo sag refers to a situation where the placebo effect is diminished with repeated use.

      Overall, the placebo effect is a complex phenomenon that is influenced by various factors and can have significant implications for medical research and treatment. Understanding the placebo effect can help healthcare professionals provide better care and improve patient outcomes.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      262.6
      Seconds
  • Question 5 - An 80-year-old man has been taking warfarin for atrial fibrillation for the past...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 6 - The main reason for the increased mortality risk in patients with rheumatoid arthritis,...

    Incorrect

    • The main reason for the increased mortality risk in patients with rheumatoid arthritis, compared to the general population, is:

      Your Answer:

      Correct Answer: Cardiovascular disease

      Explanation:

      Rheumatoid arthritis and other inflammatory joint diseases increase the risk of premature death, mainly due to cardiovascular disease, which is comparable to the risk in diabetes mellitus. Traditional risk factors and the inflammatory effect of rheumatoid arthritis on the endothelium contribute to this increased risk. In addition to cardiovascular disease, infection, respiratory disease, and malignancies are also leading causes of excess mortality in rheumatoid arthritis. Patients with rheumatoid arthritis have an increased risk of developing certain types of cancer, which may be due to inflammation and medication effects. Concurrent therapy, often immunosuppressive, may contribute to mortality in rheumatoid arthritis, with drugs such as steroids linked to heart attacks and kidney function decline. Kidney disease is also more common in people with rheumatoid arthritis. Patients with rheumatoid arthritis are at increased risk of anxiety, depression, and low self-esteem, with high levels of associated mortality and suicide. Disability and loss of function can lead to depression, but medication side-effects, gender, or age may also contribute.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 7 - A 50-year-old man has long-standing treated hypertension. He has had his estimated glomerular...

    Incorrect

    • A 50-year-old man has long-standing treated hypertension. He has had his estimated glomerular filtration rate (eGFR) measured on an annual basis. Last year, his eGFR was estimated at 56 ml/minute/1.73 m². This year, he has an unexplained fall in eGFR to 41 ml/minute/1.73 m². This is confirmed by a second blood sample. He feels otherwise well.
      What is the most appropriate action?

      Your Answer:

      Correct Answer: Routine outpatient referral to the renal team

      Explanation:

      Referral and Management of Chronic Kidney Disease Patients

      Chronic kidney disease (CKD) is a common condition that requires appropriate management to prevent progression and complications. The National Institute for Health and Care Excellence (NICE) has provided guidelines on when to refer CKD patients for specialist assessment. Patients with a glomerular filtration rate (GFR) less than 30 ml/min/1.73 m2, albumin creatinine ratio (ACR) of 70 mg/mmol or more, sustained decrease in GFR, poorly controlled hypertension, rare or genetic causes of CKD, or suspected renal artery stenosis should be referred for review by a renal team.

      In addition to referral, patients with CKD may require further investigations such as renal ultrasound. An ultrasound is indicated in patients with rapid deterioration of eGFR, visible or persistent microscopic haematuria, symptoms of urinary tract obstruction, family history of polycystic kidney disease, or GFR drops to under 30. However, the results of an ultrasound should not determine referral.

      Patients with CKD require regular monitoring, but the frequency of monitoring depends on the stage and progression of the disease. Patients with a rapid drop in eGFR, like the patient in this case, require specialist input and should not continue with annual monitoring. However, urgent medical review is only necessary in cases of severe complications such as hyperkalaemia, severe uraemia, acidosis, or fluid overload.

      In summary, appropriate referral and management of CKD patients can prevent complications and improve outcomes. NICE guidelines provide clear indications for referral and investigations, and regular monitoring is necessary to track disease progression.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 8 - A 45-year-old man presents for a follow-up of his hypertension. He is of...

    Incorrect

    • A 45-year-old man presents for a follow-up of his hypertension. He is of Caucasian descent. He was diagnosed with essential hypertension six months ago and was prescribed ramipril, which has been increased to 10 mg daily. He also has a medical history of hypercholesterolemia and gout, and he takes atorvastatin 20 mg once nightly.

      He provides a set of home blood pressure readings with an average of 140/95 mmHg.

      What is the best course of action for managing his condition?

      Your Answer:

      Correct Answer: Add amlodipine

      Explanation:

      For a patient with poorly controlled hypertension who is already taking an ACE inhibitor, the recommended medication to add would be either a calcium channel blocker or a thiazide-like diuretic. In this case, since the patient has a history of gout, a calcium channel blocker like amlodipine would be the most appropriate choice. Losartan, an A2RB drug, should not be used in combination with ACE inhibitors. The maximum daily dose of ramipril is 10 mg. The target home readings for this patient would be less than 135/85 mmHg.

      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.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 9 - A 28-year-old man comes to his General Practitioner complaining of several episodes of...

    Incorrect

    • A 28-year-old man comes to his General Practitioner complaining of several episodes of haematospermia over the past few weeks. He denies any urinary symptoms or pain and reports no other unusual bleeding. He is generally healthy and not on any regular medications.
      What is the most probable diagnosis? Choose ONE option only.

      Your Answer:

      Correct Answer: Chlamydial infection

      Explanation:

      Causes of Haematospermia in a Young Adult

      Haematospermia, the presence of blood in semen, can be a distressing symptom for men. In those under 40 years of age, infections are the most common cause, with sexually transmitted infections (STIs) such as chlamydia being a likely culprit, especially in the absence of urinary symptoms. Haemophilia A, a genetic disorder that affects blood clotting, is unlikely to present with haematospermia as the first symptom, especially in a young adult. Malignant hypertension, a rare and severe form of high blood pressure, can cause end-organ damage but is an unusual cause of haematospermia. Prostate cancer, which is more common in older men, can also cause haematospermia, but is usually associated with urinary symptoms and erectile dysfunction. Prostatitis, an inflammation of the prostate gland, can cause haematospermia and other symptoms such as pain and fever, but is less common than UTIs or STIs. A thorough medical history, physical examination, and appropriate investigations can help identify the underlying cause of haematospermia and guide treatment.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 10 - A ten-year-old boy with a history of asthma and eczema comes to the...

    Incorrect

    • A ten-year-old boy with a history of asthma and eczema comes to the urgent GP clinic complaining of a cough. Upon entering the room, he appears to be in good health and is able to speak in complete sentences. His oxygen saturation levels are at 97% in air, his peak expiratory flow is at 60% of expected, his heart rate is at 115/min, and his respiratory rate is at 28/min. During chest examination, widespread wheezing is observed.

      What is the recommended course of action for managing this patient?

      Your Answer:

      Correct Answer: Oral prednisolone and salbutamol via a spacer: one puff every 30-60 seconds to a maximum of 10 puffs

      Explanation:

      As expected, the child’s respiratory rate is less than 30 breaths per minute and heart rate is less than 125 beats per minute. The appropriate treatment for this asthma attack is oral prednisolone and salbutamol via a spacer, with one puff every 30-60 seconds up to a maximum of 10 puffs. It is important to administer steroid therapy to all children experiencing an asthma attack. High flow oxygen and salbutamol nebuliser are not necessary as the child’s SP02 is already at 97%.

      The management of acute asthma attacks in children depends on the severity of the attack. Children with severe or life-threatening asthma should be immediately transferred to the hospital. For children with mild to moderate acute asthma, bronchodilator therapy and steroid therapy should be given. The dosage of prednisolone depends on the age of the child. It is important to monitor SpO2, PEF, heart rate, respiratory rate, use of accessory neck muscles, and other clinical features to determine the severity of the attack.

    • This question is part of the following fields:

      • Children And Young People
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SESSION STATS - PERFORMANCE PER SPECIALTY

Infectious Disease And Travel Health (0/1) 0%
Evidence Based Practice, Research And Sharing Knowledge (0/2) 0%
Cardiovascular Health (0/1) 0%
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