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  • Question 1 - A 25-year-old woman comes in for pre-employment evaluation as she is starting work...

    Correct

    • A 25-year-old woman comes in for pre-employment evaluation as she is starting work as a nurse on a pediatric ward next month. She has received all her childhood and school-aged vaccinations but cannot recall if she had Chickenpox as a child.

      What vaccine is most likely required before she can start her new job?

      Your Answer: Varicella vaccine

      Explanation:

      For healthcare workers who do not have natural immunity to varicella, the most appropriate course of action is to administer a varicella vaccine. While a diphtheria, pertussis, and tetanus booster may be recommended by the employer, it is not necessary in this case as the patient has a history of vaccination. Hepatitis A vaccine is typically only given to those who travel and is not routinely required for employment. While an influenza vaccine may be suggested by the employer, the patient’s most pressing need is likely the varicella vaccine. While a measles, mumps, and rubella vaccination may be considered, it is not the most urgent vaccination needed for employment.

      Varicella-Zoster Vaccination: Protection Against Chickenpox and Shingles

      Varicella-zoster is a herpesvirus that causes Chickenpox and shingles. There are two types of vaccines available to protect against these infections. The first type is a live attenuated vaccine that prevents primary varicella infection or Chickenpox. This vaccine is recommended for healthcare workers who are not immune to VZV and for individuals who are in close contact with immunocompromised patients.

      The second type of vaccine is designed to reduce the incidence of herpes zoster or shingles caused by reactivation of VZV. This live-attenuated vaccine is given subcutaneously and is offered to patients aged 70-79 years. The vaccine is also available as a catch-up campaign for those who missed out on their vaccinations in the previous two years of the program. However, the shingles vaccine is not available on the NHS to anyone aged 80 and over because it seems to be less effective in this age group.

      The main contraindication for both vaccines is immunosuppression. Side effects of the vaccines include injection site reactions, and less than 1 in 10,000 individuals may develop Chickenpox. It is important to note that vaccination is the most effective way to prevent varicella-zoster infections and their complications.

    • This question is part of the following fields:

      • Dermatology
      22.2
      Seconds
  • Question 2 - A 54-year-old man has scheduled a meeting to discuss his struggles with poor...

    Correct

    • A 54-year-old man has scheduled a meeting to discuss his struggles with poor concentration and feeling sleepy while working. He works as a truck driver and frequently has to operate heavy machinery. His spouse has noticed that he experiences brief pauses in breathing while sleeping at night and occasionally makes choking sounds.

      The patient is currently receiving treatment for hypertension and benign prostatic hyperplasia. His Epworth sleepiness scale score is 16.

      Considering his condition, what is the best course of action for the patient to take regarding operating heavy machinery?

      Your Answer: He is required to inform the DVLA and stop driving

      Explanation:

      If a person has mild, moderate, or severe obstructive sleep apnoea (OSA) that causes excessive daytime sleepiness, they must inform the Driver Vehicle and Licensing Agency (DVLA). Excessive sleepiness refers to sleepiness that can negatively impact driving. The severity of OSA is determined by the number of apnoea/hypopnoea episodes per hour (apnoea-hypopnoea index [AHI]). Mild OSA is defined as an AHI of 5-14 per hour, moderate OSA is an AHI of 15-30 per hour, and severe OSA is an AHI of more than 30 per hour. If a person is diagnosed with OSA and experiences enough sleepiness to impair driving, they must inform the DVLA and stop driving. In this case, there is no need to retake a driving assessment, and the GP will not inform the DVLA initially. However, if the patient fails to inform the DVLA after multiple reminders and being informed that the GP may break confidentiality, the GP will inform the DVLA. If a person is being investigated for or has a diagnosis of OSA but doesn’t experience daytime sleepiness severe enough to impair driving, they do not need to inform the DVLA or stop driving. If a person is successfully using continuous positive airway pressure (CPAP) or an intra-oral device and their symptoms are controlled to the point where they no longer impair driving, they should inform the DVLA but do not need to stop driving.

      Understanding Obstructive Sleep Apnoea/Hypopnoea Syndrome

      Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a condition that causes interrupted breathing during sleep due to a blockage in the airway. This can lead to a range of health problems, including daytime somnolence, respiratory acidosis, and hypertension. There are several predisposing factors for OSAHS, including obesity, macroglossia, large tonsils, and Marfan’s syndrome. Partners of those with OSAHS often complain of excessive snoring and periods of apnoea.

      To assess sleepiness, patients may complete the Epworth Sleepiness Scale questionnaire, and undergo the Multiple Sleep Latency Test (MSLT) to measure the time it takes to fall asleep in a dark room. Diagnostic tests for OSAHS include sleep studies (polysomnography), which measure a range of physiological factors such as EEG, respiratory airflow, thoraco-abdominal movement, snoring, and pulse oximetry.

      Management of OSAHS includes weight loss and the use of continuous positive airway pressure (CPAP) as a first-line treatment for moderate or severe cases. Intra-oral devices, such as mandibular advancement, may be used if CPAP is not tolerated or for patients with mild OSAHS without daytime sleepiness. It is important to inform the DVLA if OSAHS is causing excessive daytime sleepiness. While there is limited evidence to support the use of pharmacological agents, they may be considered in certain cases.

    • This question is part of the following fields:

      • Cardiovascular Health
      19.3
      Seconds
  • Question 3 - A 12-month-old girl is brought to the General Practitioner (GP) for a check-up....

    Correct

    • A 12-month-old girl is brought to the General Practitioner (GP) for a check-up. The parent is questioned about the child's developmental milestones.
      Which of the following is this child most likely to be able to achieve by its current age?

      Your Answer: Finger feed

      Explanation:

      Developmental Milestones for Infants: Typical Achievements by 14-21 Months

      Infants develop at different rates, but most achieve certain skills by certain ages. By 14 months, most infants can finger feed themselves. By 19 months, they can use a spoon and fork, as well as run. By 20 months, they can take off clothes with help, and by 21 months, they can walk up steps. These milestones are important markers of typical development for infants.

    • This question is part of the following fields:

      • Children And Young People
      12.2
      Seconds
  • Question 4 - A 40-year-old accountant has come to seek your advice regarding driving restrictions. He...

    Incorrect

    • A 40-year-old accountant has come to seek your advice regarding driving restrictions. He recently experienced a seizure and was referred to a neurologist for further investigation. Despite showing symptoms of a seizure, all tests, including EEG and imaging, came back normal. The neurologist concluded that it was a solitary fit and advised against medication. The patient has been discharged from further follow-up but was instructed to inform the DVLA. He has come to you for guidance on how long he should refrain from driving his car after the initial seizure.

      Can you provide information on the potential causes of seizures in adults?

      Your Answer: 6 months

      Correct Answer: 1 month

      Explanation:

      Understanding DVLA Driving Restrictions for Patients with Neurological Conditions

      There are important pieces of information to consider when it comes to driving restrictions for patients with neurological conditions. In the case of a banking assistant who experienced a solitary seizure, the latest DVLA guidance suggests refraining from driving for six months after the seizure. This applies to Group 1 entitlement drivers, which includes cars and motorcycles. If the patient was an HGV driver, the restriction would be five years.

      It’s important to note that this was an isolated seizure with normal test results and no medication. If the patient had epilepsy, the driving restriction would be one year following the attack. It’s crucial to be familiar with the latest guidance and any new changes, as questions about driving restrictions often come up in the MRCGP exam.

      Understanding the impact of these restrictions on patients’ working and personal lives is also important. As part of the curriculum map for neurological problems, candidates should have an understanding of the current DVLA restrictions on driving, particularly with regard to epilepsy. It’s essential to be aware of any new restrictions or amendments and to pass on this information to patients. By staying informed, doctors can help patients navigate the potential consequences of driving restrictions.

    • This question is part of the following fields:

      • Neurology
      27
      Seconds
  • Question 5 - A 68-year-old non-smoker complains of bone pain, constipation and malaise. Initial tests show...

    Correct

    • A 68-year-old non-smoker complains of bone pain, constipation and malaise. Initial tests show an increased serum calcium level. The physical examination is unremarkable. What is the most beneficial tumour marker investigation for this patient? Choose ONE answer.

      Your Answer: Prostate specific antigen (PSA)

      Explanation:

      Tumour Markers and their Clinical Applications

      Monoclonal antibodies are utilized to detect serum antigens associated with specific malignancies. These tumour markers are most useful for monitoring response to therapy and detecting early relapse. However, with the exception of PSA, tumour markers do not have sufficient sensitivity or specificity for use in screening.

      PSA, or prostate specific antigen, is a useful marker for screening for prostate cancer, although population screening is controversial. It can also be used to detect recurrence of the malignancy and is useful in the investigation of adenocarcinoma of unknown primary. Hypercalcaemia and bone pain may suggest metastatic carcinoma, which is common in prostate cancer.

      CA 19-9, AFP, beta-HCG, and CEA are other tumour markers that are used for different types of cancer. CA 19-9 is helpful in establishing the nature of pancreatic masses, AFP is a marker for hepatocellular carcinoma, beta-HCG is used in the diagnosis and management of gestational trophoblastic disease and non-seminomatous germ-cell tumours of the testes, and CEA is used to detect relapse of colorectal cancer.

      In conclusion, tumour markers have various clinical applications in the diagnosis, treatment, and monitoring of cancer. However, their sensitivity and specificity may vary, and they should be used in conjunction with other diagnostic tools for accurate diagnosis and management of cancer.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      590.4
      Seconds
  • Question 6 - A father brings his 15-month-old daughter into surgery. Since yesterday she seems to...

    Incorrect

    • A father brings his 15-month-old daughter into surgery. Since yesterday she seems to be straining whilst passing stools. He describes her screaming, appearing to be in pain and pulling her knees up towards her chest. These episodes are now occurring every 15-20 minutes. This morning he noted a small amount of blood in her nappy. She is taking around 50% of her normal feeds and vomiting 'green fluid' every hour. On examination, she appears irritable and lethargic but is well hydrated and apyrexial. On examination, her abdomen seems distended but no discrete mass is found.

      What is the most likely diagnosis?

      Your Answer: Constipation

      Correct Answer: Intussusception

      Explanation:

      Understanding Intussusception

      Intussusception is a medical condition where one part of the bowel folds into the lumen of the adjacent bowel, usually around the ileocecal region. This condition is most common in infants between 6-18 months old, with boys being affected twice as often as girls. Symptoms of intussusception include severe, crampy abdominal pain, inconsolable crying, vomiting, and bloodstained stool, which is a late sign. During a paroxysm, the infant will draw their knees up and turn pale, and a sausage-shaped mass may be felt in the right upper quadrant.

      To diagnose intussusception, ultrasound is now the preferred method of investigation, which may show a target-like mass. Treatment for intussusception involves reducing the bowel by air insufflation under radiological control, which is now widely used first-line compared to the traditional barium enema. If this method fails, or the child has signs of peritonitis, surgery is performed. Understanding the symptoms and treatment options for intussusception is crucial for parents and healthcare professionals to ensure prompt and effective management of this condition.

    • This question is part of the following fields:

      • Children And Young People
      138.4
      Seconds
  • Question 7 - A 50-year-old woman presents with jaundice and itching.
    Which of the following results would...

    Correct

    • A 50-year-old woman presents with jaundice and itching.
      Which of the following results would most strongly support the diagnosis of primary biliary cholangitis?

      Your Answer: Antimitochondrial antibodies

      Explanation:

      Understanding Primary Biliary Cholangitis: Diagnostic Tests and Markers

      Primary biliary cholangitis is an autoimmune disease that affects the biliary system, causing intrahepatic cholestasis and leading to cell damage, fibrosis, and cirrhosis. While there is no single definitive test for this condition, several markers can help diagnose and monitor it.

      Antimitochondrial antibodies are present in 90-95% of individuals with primary biliary cholangitis, but are only found in 0.5% of normal controls. Anti-smooth muscle antibodies are also nonspecific, as they can be positive in connective tissue disease and chronic infections. Similarly, around 35% of patients with primary biliary cholangitis have positive antinuclear antibodies, but this is not specific to the condition.

      Elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are common in primary biliary cholangitis, but significant elevations of alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (GGT) are usually more prominent. Additionally, a polyclonal increase in IgM (sometimes associated with elevated IgG) is typical but not specific to this condition.

      Overall, a combination of these diagnostic tests and markers can help identify and monitor primary biliary cholangitis.

    • This question is part of the following fields:

      • Gastroenterology
      30.8
      Seconds
  • Question 8 - A 5-year-old boy has a chest infection and needs antibiotics.

    Which of the following...

    Incorrect

    • A 5-year-old boy has a chest infection and needs antibiotics.

      Which of the following treatments would you advise?

      Your Answer: Amoxicillin

      Correct Answer: Tetracyclines

      Explanation:

      Best Antibiotic Choice for Children

      When it comes to choosing an antibiotic for children, it’s important to consider their age and potential side effects. In this circumstance, Amoxicillin would be the best choice due to its effectiveness and safety profile. Quinolones and tetracyclines should be avoided in childhood, while co-trimoxazole has limited indications and nitrofurantoin would not be effective. It’s crucial to consult with a healthcare professional before administering any medication to children.

    • This question is part of the following fields:

      • Children And Young People
      5.7
      Seconds
  • Question 9 - A 20-year-old woman with a history of anorexia nervosa has a body mass...

    Incorrect

    • A 20-year-old woman with a history of anorexia nervosa has a body mass index (BMI) of 16 kg/m2. She has lost 2 kg steadily over the past four weeks. She is unable to sit up from lying flat without using her hands or to stand from the squatting position without using her hands. Lanugo is present. Her hands feel cold to the touch.
      Which feature of the patient’s physical examination would be most suggestive of impending high risk to life?

      Your Answer: Rate of weight loss

      Correct Answer: Inability to sit up or squat without using the hands

      Explanation:

      Identifying High Risk Factors in Anorexia Nervosa

      Anorexia nervosa is a serious eating disorder that can lead to life-threatening complications. The Royal College of Psychiatrists in the United Kingdom has issued guidance on recognising medical emergencies in eating disorders. Here are some key factors to consider when assessing the risk to life in anorexia nervosa:

      Sit up–Squat–Stand (SUSS) test: This test involves asking a patient to sit up from a lying position and to stand up from a squatting position without using their hands. Inability to do this is associated with impending high risk to life.

      Rate of weight loss: A weight loss of 500-999 g per week presents a moderate risk to life, whereas weight loss of >1 kg per week confers a high risk.

      BMI: A BMI of greater than 15 kg/m2 represents a low impending risk to life, whereas a BMI of <13 kg/m2 is a high risk. Cool peripheries: Although cool peripheries may be seen on examination in anorexia nervosa, they are not associated with a high risk to life. However, a core temperature of less than 35 °C is. Lanugo: Lanugo is a covering of soft downy hair often seen in people with anorexia, but it is not identified as being associated with an increased risk to life in anorexia nervosa. By considering these factors, healthcare professionals can identify high-risk patients and provide appropriate interventions to prevent life-threatening complications.

    • This question is part of the following fields:

      • Mental Health
      30
      Seconds
  • Question 10 - A 28-year-old patient visits your clinic seeking travel and immunisation advice for an...

    Incorrect

    • A 28-year-old patient visits your clinic seeking travel and immunisation advice for an upcoming trip overseas. The patient has Addison's disease and takes hydrocortisone and fludrocortisone on a daily basis. She plans to bring extra medication with her and has been advised by her travel agent to obtain a letter from you confirming the need to carry injections. During the consultation, she asks what she should do if she experiences vomiting.

      What guidance would you provide?

      Your Answer: Use her emergency injection of 100 mg hydrocortisone immediately, then call a doctor, saying Addison's emergency

      Correct Answer: Take 20 mg hydrocortisone orally immediately

      Explanation:

      Sick Day Rules for Patients with Addison’s Disease

      Patients with Addison’s disease need to follow specific sick day rules to avoid catastrophic consequences. There are four scenarios that may be tested in the AKT exam: a patient with a temperature >37.5 degrees or treated with antibiotics, a patient who is vomiting, a patient with nausea, and a patient who has sustained major trauma and is at significant risk of shock.

      According to the Addison’s Clinical Advisory Panel, patients must double their normal dose of hydrocortisone for a fever of more than 37.5 C or for infection/sepsis requiring antibiotics. For severe nausea, patients should take 20 mg hydrocortisone orally and sip rehydration/electrolyte fluids. On vomiting, patients should use the emergency injection (100 mg hydrocortisone) immediately and then call a doctor, saying Addison’s emergency. After a major injury, patients should take 20 mg hydrocortisone orally immediately to avoid shock.

      It is essential to ensure that the anaesthetist and surgical team, dentist, or endoscopist are aware of the need for extra oral medication and that they have checked the ACAP surgical guidelines for the correct level of steroid cover, available at www.addisons.org.uk/publications. By following these sick day rules, patients with Addison’s disease can manage their condition effectively and avoid potential complications.

    • This question is part of the following fields:

      • Urgent And Unscheduled Care
      36.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Dermatology (1/1) 100%
Cardiovascular Health (1/1) 100%
Children And Young People (1/3) 33%
Neurology (0/1) 0%
Metabolic Problems And Endocrinology (1/1) 100%
Gastroenterology (1/1) 100%
Mental Health (0/1) 0%
Urgent And Unscheduled Care (0/1) 0%
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