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Question 1
Correct
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Samantha is a five-year-old caucasian girl who visits her GP due to her mother's concern about her swollen tummy. She has no previous medical history and was born at full term. During the examination, she seems a little pale. A smooth mass is palpable in the right upper quadrant of her abdomen. There is no tenderness in her abdomen, and her cardiovascular and respiratory examinations are normal. There is no significant family history to note.
What is the most appropriate course of action for managing this patient?Your Answer: Urgent paediatric review within 48 hours
Explanation:A possible diagnosis for an unexplained enlarged abdominal mass in children is Wilms tumour, which is the most common renal malignancy in this age group. It typically presents as a unilateral mass in the abdomen. Therefore, it is crucial to arrange an urgent paediatric review within 48 hours for assessment and imaging, in accordance with NICE guidelines.
Delaying diagnosis by opting for an ultrasound scan within 2 weeks or a routine referral to paediatrics is not recommended. While a renal function test will be performed in secondary care, it will not alter the management of the patient.
It is worth noting that sickle cell disease can be diagnosed using haemoglobin electrophoresis, and it may present with splenomegaly (a left-sided mass). However, in the case of an unexplained enlarged abdominal mass in children, Wilms tumour should be considered as a potential diagnosis and prompt action should be taken.
Wilms’ Tumour: A Common Childhood Malignancy
Wilms’ tumour, also known as nephroblastoma, is a prevalent type of cancer in children, with a median age of diagnosis at 3 years old. It is often associated with Beckwith-Wiedemann syndrome, hemihypertrophy, and a loss-of-function mutation in the WT1 gene on chromosome 11. The most common presenting feature is an abdominal mass, which is usually painless, but other symptoms such as haematuria, flank pain, anorexia, and fever may also occur. In 95% of cases, the tumour is unilateral, and metastases are found in 20% of patients, most commonly in the lungs.
If a child presents with an unexplained enlarged abdominal mass, it is crucial to arrange a paediatric review within 48 hours to rule out Wilms’ tumour. The management of this cancer typically involves nephrectomy, chemotherapy, and radiotherapy if the disease is advanced. Fortunately, the prognosis for Wilms’ tumour is good, with an 80% cure rate.
Histologically, Wilms’ tumour is characterized by epithelial tubules, areas of necrosis, immature glomerular structures, stroma with spindle cells, and small cell blastomatous tissues resembling the metanephric blastema. Overall, early detection and prompt treatment are essential for a successful outcome in children with Wilms’ tumour.
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This question is part of the following fields:
- Children And Young People
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Question 2
Correct
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A 24-year-old man has been experiencing painful redness in his left eye for three days, along with blurred vision and sensitivity to light. He finds that the pain worsens when he tries to read. The redness is most prominent around the cornea, and the pupil on the affected side is slightly smaller and irregular compared to the right. Upon investigation, his haemoglobin, white cell count, and platelets are within normal range, but his erythrocyte sedimentation rate is elevated at 40 mm/hour. Additionally, he tests positive for HLA-B27. What is the most likely underlying cause of his eye problems?
Your Answer: Ankylosing spondylitis
Explanation:The man in question is displaying symptoms of acute anterior uveitis, which can be caused by a variety of underlying systemic diseases or may be idiopathic. Non-granulomatous uveitis is often associated with diseases related to HLA-B27, such as ankylosing spondylitis, inflammatory bowel disease, reactive arthritis, psoriatic arthritis, and Behçet’s disease. Sarcoidosis, syphilis, toxoplasmosis, and tuberculosis can also cause uveitis, but each has its own unique ocular manifestations and symptoms.
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This question is part of the following fields:
- Eyes And Vision
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Question 3
Correct
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A 65-year-old woman comes to the clinic after sustaining a Colles fracture during a fall while on vacation in Italy. The fracture clinic diagnosed her with a fragility fracture and advised her to see her GP in the UK for bone protection. She has no family history of hip fracture or osteoporosis, is a non-smoker, and doesn't drink alcohol. Her BMI is 22 kg/m2, and she has no other significant medical issues.
What is the most appropriate next step in her management?Your Answer: Arrange a dual-energy X-ray absorptiometry (DEXA) scan
Explanation:As per the current NICE CKS guidance, individuals who are above 50 years of age and have a previous fragility fracture should be referred for a DEXA scan to measure bone mineral density (BMD). It is not necessary to calculate their QFracture risk or FRAX score before arranging the scan. Even if their QFracture risk is low, they are still at risk due to their history of fragility fracture. For patients over 75 years of age who have had a fragility fracture, treatment (oral bisphosphonates as first line) should be initiated immediately without the need for a DEXA scan. However, it is important to note that this differs from the NOGG guidelines 2014, which recommend treatment for all women over 50 years who have had a fragility fracture.
Osteoporosis is a condition that weakens bones, making them more prone to fractures. When a patient experiences a fragility fracture, which is a fracture that occurs from a low-impact injury or fall, it is important to assess their risk for osteoporosis and subsequent fractures. The management of patients following a fragility fracture depends on their age.
For patients who are 75 years of age or older, they are presumed to have underlying osteoporosis and should be started on first-line therapy, such as an oral bisphosphonate, without the need for a DEXA scan. However, the 2014 NOGG guidelines suggest that treatment should be started in all women over the age of 50 years who’ve had a fragility fracture, although BMD measurement may sometimes be appropriate, particularly in younger postmenopausal women.
For patients who are under the age of 75 years, a DEXA scan should be arranged to assess their bone mineral density. These results can then be entered into a FRAX assessment, along with the fact that they’ve had a fracture, to determine their ongoing fracture risk. Based on this assessment, appropriate treatment can be initiated to prevent future fractures.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 4
Correct
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A 16-year-old boy is being examined after experiencing excessive bleeding post a tooth extraction. The test results are as follows:
Platelet count: 173 * 109/l
Prothrombin time (PT): 12.9 seconds
Activated partial thromboplastin time (APTT): 84 seconds
Based on these results, which clotting factor deficiency is the most probable cause of his bleeding?Your Answer: Factor VIII
Explanation:Haemophilia is a genetic disorder that affects blood coagulation and is inherited in an X-linked recessive manner. It is possible for up to 30% of patients to have no family history of the condition. Haemophilia A is caused by a deficiency of factor VIII, while haemophilia B, also known as Christmas disease, is caused by a lack of factor IX.
The symptoms of haemophilia include haemoarthroses, haematomas, and prolonged bleeding after surgery or trauma. Blood tests can reveal a prolonged APTT, while the bleeding time, thrombin time, and prothrombin time are normal. However, up to 10-15% of patients with haemophilia A may develop antibodies to factor VIII treatment.
Overall, haemophilia is a serious condition that can cause significant bleeding and other complications. It is important for individuals with haemophilia to receive appropriate medical care and treatment to manage their symptoms and prevent further complications.
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This question is part of the following fields:
- Haematology
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Question 5
Correct
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A 20-year-old female scheduled an appointment with her GP. She was 28-weeks pregnant and reported a rash.
She mentioned being outside in the warm weather and feeling a bite on her left lower leg. The area became extremely itchy and she spent most of the night scratching it. The next morning, she woke up with a hot, swollen, and tender spot where she had been bitten. Throughout the day, she began to feel ill and developed a fever.
Upon examination, the patient appeared fatigued. Her temperature was 38ºC, oxygen saturation was 97% on air, heart rate was 100 beats per minute, respiratory rate was 20 breaths per minute, and blood pressure was 122/81 mmHg. The examination revealed a red, hot, swollen area of tender skin on her left lower leg, measuring approximately 4 cm in diameter. The diagnosis was cellulitis.
The patient had no significant medical history, but did have a documented allergy to penicillin.
Which of the following treatment options is the most appropriate?Your Answer: Erythromycin
Explanation:If a pregnant patient has a penicillin allergy and is diagnosed with cellulitis, the recommended antibiotic is erythromycin as per the NICE antimicrobial guidance. Flucloxacillin and co-amoxiclav should not be prescribed in this case. It is important to note that doxycycline, a tetracycline antibiotic, is contraindicated in pregnancy and should not be prescribed.
Understanding Cellulitis: Symptoms, Diagnosis, and Treatment
Cellulitis is a common skin infection caused by Streptococcus pyogenes or Staphylococcus aureus. It is characterized by inflammation of the skin and subcutaneous tissues, usually on the shins, accompanied by erythema, pain, swelling, and sometimes fever. The diagnosis of cellulitis is based on clinical features, and no further investigations are required in primary care. However, bloods and blood cultures may be requested if the patient is admitted and septicaemia is suspected.
To guide the management of patients with cellulitis, NICE Clinical Knowledge Summaries recommend using the Eron classification. Patients with Eron Class III or Class IV cellulitis, severe or rapidly deteriorating cellulitis, very young or frail patients, immunocompromised patients, patients with significant lymphoedema, or facial or periorbital cellulitis (unless very mild) should be admitted for intravenous antibiotics. Patients with Eron Class II cellulitis may not require admission if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the patient.
The first-line treatment for mild/moderate cellulitis is flucloxacillin, while clarithromycin, erythromycin (in pregnancy), or doxycycline is recommended for patients allergic to penicillin. Patients with severe cellulitis should be offered co-amoxiclav, cefuroxime, clindamycin, or ceftriaxone. Understanding the symptoms, diagnosis, and treatment of cellulitis is crucial for effective management and prevention of complications.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 6
Correct
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A 27-year-old patient comes in for an emergency appointment reporting left-sided ear pain for the past two days. Upon waking up today, she noticed that her face was drooping on the left side and she was unable to fully close her left eye. Based on these symptoms, you suspect a diagnosis of Bell's Palsy. If you were to ask the patient to raise her left eyebrow, what would you expect to find and why?
Your Answer: Inability to raise the left eyebrow as Bell's palsy is due to a lower motor neuron lesion
Explanation:Bell’s palsy is a sudden, one-sided facial nerve paralysis of unknown cause. It typically affects individuals between the ages of 20 and 40, and is more common in pregnant women. The condition is characterized by a lower motor neuron facial nerve palsy that affects the forehead, while sparing the upper face. Patients may also experience post-auricular pain, altered taste, dry eyes, and hyperacusis.
The management of Bell’s palsy has been a topic of debate, with various treatment options proposed in the past. However, there is now consensus that all patients should receive oral prednisolone within 72 hours of onset. The addition of antiviral medications is still a matter of discussion, with some experts recommending it for severe cases. Eye care is also crucial to prevent exposure keratopathy, and patients may need to use artificial tears and eye lubricants. If they are unable to close their eye at bedtime, they should tape it closed using microporous tape.
Follow-up is essential for patients who show no improvement after three weeks, as they may require urgent referral to ENT. Those with more long-standing weakness may benefit from a referral to plastic surgery. The prognosis for Bell’s palsy is generally good, with most patients making a full recovery within three to four months. However, untreated cases can result in permanent moderate to severe weakness in around 15% of patients.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 7
Correct
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A 47-year-old woman seeks guidance regarding contraception options while experiencing perimenopausal symptoms. She and her partner are currently using condoms, which is satisfactory for them. Her last menstrual cycle occurred approximately 10 months ago. What advice should be given?
Your Answer: After 12 further months of amenorrhoea she may stop using condoms
Explanation:Women over the age of 40 still require effective contraception until they reach menopause, despite a significant decline in fertility. The Faculty of Sexual and Reproductive Healthcare (FSRH) has produced specific guidance for this age group, titled Contraception for Women Aged Over 40 Years. No method of contraception is contraindicated by age alone, with all methods being UKMEC1 except for the combined oral contraceptive pill (UKMEC2 for women >= 40 years) and Depo-Provera (UKMEC2 for women > 45 years). The FSRH guidance provides specific considerations for each method, such as the use of COCP in the perimenopausal period to maintain bone mineral density and reduce menopausal symptoms. Depo-Provera use is associated with a small loss in bone mineral density, which is usually recovered after discontinuation. The FSRH also provides a table detailing how different methods may be stopped based on age and amenorrhea status. Hormone replacement therapy cannot be relied upon for contraception, and a separate method is needed. The FSRH advises that the POP may be used in conjunction with HRT as long as the HRT has a progestogen component, while the IUS is licensed to provide the progestogen component of HRT.
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This question is part of the following fields:
- Maternity And Reproductive Health
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Question 8
Correct
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You are reviewing a 16-year-old girl with a diagnosis of mild depression. She has no past or current history of self harm or suicidal thoughts. She was initially seen six weeks ago and is being reviewed today for the second time over this period.
You discuss her symptoms and things are unchanged from when she was last seen four weeks ago with persistence of the mild depression. She tells you that she cannot see herself improving and is keen to engage with any help that may be appropriate.
What is the most appropriate approach in this instance?Your Answer: Offer psychological therapy in the form of individual non-directive supportive therapy, group cognitive therapy behavioural therapy, or guided self-help
Explanation:NICE Guidance on Depression in Children and Young People
NICE has released guidance on how to manage depression in children and young people. For those presenting with mild depression, a ‘watchful waiting’ approach should be taken, with a further assessment arranged two weeks later. If the depression persists after up to four weeks of watchful waiting, psychological therapies such as individual non-directive supportive therapy, group cognitive behavioural therapy, or guided self-help can be offered for a limited period of around two to three months. Antidepressant medication should not be used at this stage. If the mild depression remains unresponsive to psychological therapies after two to three months, referral to tier 2-3 CAMHS can be made for further assessment and management. This guidance aims to provide a structured approach to managing depression in children and young people, ensuring that appropriate interventions are offered at the right time.
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This question is part of the following fields:
- Children And Young People
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Question 9
Correct
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At the age of 35, Mary recently gave birth to her first child, a son named Tom, who has Down syndrome. His parents have come to terms with the diagnosis, Tom seems to be thriving in all other respects, and there is no reported family history, although Mary's husband Peter was adopted.
At the three month immunisation visit, Mary tells you that she wants to try for another child and wonders what the risk is of having another affected child. You have the option of referring your patients to the genetic clinic for chromosome analysis, if deemed suitable.
Which of the following is the single best answer to her question?Your Answer: Chromosome analysis from Tom may help answer her question
Explanation:Recurrence Risk for Down Syndrome
There is a small chance of recurrence (about 1%) for Down syndrome if it is caused by non-disjunction of chromosome 21. However, if the individual has inherited a translocation from either parent, the risk of recurrence is higher. To determine the risk, a chromosome analysis of the individual’s blood is necessary.
If the individual has a translocation between chromosomes 21 and 13 or 14 (which occurs in 3-4% of Down syndrome cases), the risk of recurrence increases to 2-3% if carried by the father and 10% if carried by the mother. If the individual has a translocation of chromosome 21 onto another chromosome 21 (known as isochromosome 21, found in 1% of cases), and it is found in either parent, then the recurrence risk is practically 100%.
Therefore, if an individual with Down syndrome has a translocation, both parents should be tested to clarify the risk. However, if the individual has a simple trisomy, the parents can be reassured that the recurrence risk is normal (1%).
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This question is part of the following fields:
- Genomic Medicine
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Question 10
Correct
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A 23-year-old man with a history of bipolar disorder is scheduled for a medication review. When inquiring about his current state, he starts discussing the vast array of emotions that exist and wonders if everyone has experienced all of them. Eventually, he spontaneously mentions that he is feeling quite good.
What is the patient exhibiting in this scenario?Your Answer: Circumstantiality
Explanation:The patient’s lengthy response to the question suggests circumstantiality, which can be a symptom of anxiety disorders or hypomania.
It is important to note that the patient has not derailed from the topic at hand, indicating that this is not an example of derailment. Incoherence would involve the patient providing nonsensical responses, which is not the case here.
While it is difficult to determine from a text-based question, pressured speech would involve the patient speaking rapidly and producing an excessive amount of spontaneous speech. Therefore, it may not be the most appropriate answer in this scenario.
Anxiety is a common disorder that can manifest in various ways. According to NICE, the primary feature is excessive worry about multiple events associated with heightened tension. It is crucial to consider potential physical causes when diagnosing psychiatric disorders such as anxiety. Hyperthyroidism, cardiac disease, and medication-induced anxiety are important alternative causes. Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants, and caffeine.
NICE recommends a stepwise approach for managing generalised anxiety disorder (GAD). The first step is education about GAD and active monitoring. The second step involves low-intensity psychological interventions such as individual non-facilitated self-help, individual guided self-help, or psychoeducational groups. The third step includes high-intensity psychological interventions such as cognitive behavioural therapy or applied relaxation, or drug treatment. Sertraline is the first-line SSRI recommended by NICE. If sertraline is ineffective, an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI) such as duloxetine or venlafaxine may be offered. If the person cannot tolerate SSRIs or SNRIs, pregabalin may be considered. For patients under the age of 30 years, NICE recommends warning them of the increased risk of suicidal thinking and self-harm and weekly follow-up for the first month.
The management of panic disorder also follows a stepwise approach. The first step is recognition and diagnosis, followed by treatment in primary care. NICE recommends either cognitive behavioural therapy or drug treatment. SSRIs are the first-line treatment. If contraindicated or no response after 12 weeks, imipramine or clomipramine should be offered. The third step involves reviewing and considering alternative treatments, followed by review and referral to specialist mental health services in the fourth and fifth steps, respectively.
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This question is part of the following fields:
- Mental Health
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Question 11
Correct
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A 68-year-old man with a history of cardiovascular disease presents with worsening shortness of breath on exertion. You suspect left ventricular failure. Identify the single test that, if normal, would make the diagnosis of heart failure highly unlikely.
Your Answer: An ECG
Explanation:Investigations for Suspected Heart Failure: Importance of ECG and Natriuretic Peptides
When a patient is suspected of having heart failure, several investigations are recommended to confirm the diagnosis and determine the underlying cause. Routine blood tests, including full blood count, urea and electrolytes, liver function tests, thyroid function tests, and blood glucose, are typically performed. However, the results of these tests alone are not sufficient to diagnose heart failure.
An electrocardiogram (ECG) is also commonly performed, although its predictive value for heart failure is limited. A normal ECG can make left ventricular systolic dysfunction unlikely, with a negative predictive value of 98%. On the other hand, an abnormal ECG may indicate the need for further testing, such as echocardiography.
Serum natriuretic peptides, which are released by the heart in response to increased pressure or volume, can also be helpful in diagnosing heart failure. If these levels are normal, the diagnosis of heart failure is less likely. However, this test is not always available or necessary in the initial investigation.
A chest x-ray can provide supportive evidence for heart failure and rule out other potential causes of breathlessness. It is important to note that oxygen saturation may be normal in heart failure, so this alone cannot be used to rule out the condition.
Echocardiography is the gold standard for diagnosing heart failure and determining the underlying cause. It is recommended in patients who have either a raised natriuretic peptide level or an abnormal ECG. By providing detailed images of the heart’s structure and function, echocardiography can help guide treatment decisions and improve outcomes for patients with heart failure.
In summary, a combination of tests is necessary to diagnose heart failure and determine the best course of treatment. The ECG and natriuretic peptides can provide important clues, but echocardiography is essential for confirming the diagnosis and identifying the underlying cause.
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This question is part of the following fields:
- Cardiovascular Health
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Question 12
Correct
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A 55-year-old woman presents with a complaint of right elbow pain. The pain has been persistent for the last four weeks and is most severe approximately 4-5cm distal to the lateral aspect of the elbow joint. The pain is exacerbated by extending the elbow and pronating the forearm. What is the probable diagnosis?
Your Answer: Radial tunnel syndrome
Explanation:Common Causes of Elbow Pain
Elbow pain can be caused by a variety of conditions, each with their own characteristic features. Lateral epicondylitis, also known as tennis elbow, is characterized by pain and tenderness localized to the lateral epicondyle. Pain is worsened by resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended. Episodes typically last between 6 months and 2 years, with acute pain lasting for 6-12 weeks.
Medial epicondylitis, or golfer’s elbow, is characterized by pain and tenderness localized to the medial epicondyle. Pain is aggravated by wrist flexion and pronation, and symptoms may be accompanied by numbness or tingling in the 4th and 5th finger due to ulnar nerve involvement.
Radial tunnel syndrome is most commonly due to compression of the posterior interosseous branch of the radial nerve, and is thought to be a result of overuse. Symptoms are similar to lateral epicondylitis, but the pain tends to be around 4-5 cm distal to the lateral epicondyle. Symptoms may be worsened by extending the elbow and pronating the forearm.
Cubital tunnel syndrome is due to the compression of the ulnar nerve. Initially, patients may experience intermittent tingling in the 4th and 5th finger, which may be worse when the elbow is resting on a firm surface or flexed for extended periods. Later, numbness in the 4th and 5th finger with associated weakness may occur.
Olecranon bursitis is characterized by swelling over the posterior aspect of the elbow, with associated pain, warmth, and erythema. It typically affects middle-aged male patients.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 13
Incorrect
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A 28-year-old woman arrived as an immigrant in the UK two years ago, and it is not clear what vaccines she has received in her own country. You enquire about her immune status relating to measles.
What is the minimum requirement to satisfy you that she is immune to measles?Your Answer: A documented history of receiving a single mumps, measles, rubella (MMR) dose
Correct Answer: Rubella-virus-specific immunoglobulin G (IgG) antibodies in the serum
Explanation:Understanding Rubella Immunity: Factors to Consider
Rubella, also known as German measles, is a viral infection that can have serious consequences for pregnant women and their unborn babies. To prevent maternal infection and congenital rubella syndrome, it is important to ensure immunity through vaccination or past infection. Here are some factors to consider when assessing rubella immunity:
– MMR Vaccine: The MMR vaccine is recommended for children and adults, with a two-dose schedule providing the best protection. A single dose can still offer high levels of immunity, but a booster may be necessary.
– Immunisation History: Individuals who have received rubella-containing vaccines in their country of origin may have some level of immunity, but it is important to verify their vaccination status. Those without a reliable history of immunisation should be assumed as unimmunised.
– Childhood History: A history of rubella in childhood may indicate immunity, but it can be difficult to diagnose. Other viral exanthems can have similar symptoms, so a clinical diagnosis may not be reliable.
– Rubella Antibodies: The presence of rubella-virus-specific IgG antibodies in the serum indicates immunity from past infection or immunisation. However, immunity can wear off over time, so it is important to check immunity levels before every pregnancy. Rubella-virus-specific IgM antibodies in the serum can indicate recent or current infection, but these antibodies can persist for up to 12 months after infection or immunisation.By considering these factors, healthcare providers can help ensure that individuals are protected against rubella and its potential complications.
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This question is part of the following fields:
- Allergy And Immunology
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Question 14
Incorrect
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A 57-year-old caucasian woman is diagnosed with stage 2 hypertension. Baseline investigations do not reveal evidence of end-organ damage. She has a history of atrial fibrillation and takes apixaban. Her ECG is normal. Her QRISK3 score is calculated as 12.4%. She has no known drug allergies. Lifestyle advice is given and appropriate follow-up is scheduled. What is the most effective supplementary treatment choice?
Your Answer:
Correct Answer: Atorvastatin and amlodipine
Explanation:According to NICE guidelines, patients who are aged 55 years or over and do not have type 2 diabetes or are of black African or African-Caribbean family origin and do not have type 2 diabetes (of any age) should be prescribed calcium-channel blockers as the first-line treatment for hypertension. In addition, this patient requires a statin for primary cardiovascular disease prevention.
Amlodipine alone is not sufficient as she requires both an antihypertensive agent and lipid-lowering therapy.
Atorvastatin and indapamide (a thiazide-like diuretic) is not the best option as indapamide is only recommended as a second-line antihypertensive agent if a calcium-channel blocker is contraindicated, not suitable or not tolerated.
Atorvastatin and ramipril is also not the best option as ACE inhibitors (or angiotensin-II receptor antagonists) are first-line for patients under the age of 55 and not of black African or African-Caribbean family origin, or those with type 2 diabetes (irrespective of age or family origin).
Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers.
Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight.
Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age.
The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added.
If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.
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This question is part of the following fields:
- Cardiovascular Health
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Question 15
Incorrect
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A 15-year-old girl is brought to the General Practitioner by her mother for a consultation. She has recently been diagnosed with a learning disability. Her mother is concerned by a report she read online that stated that the risk of premature avoidable death is greater for people with learning disability in comparison to the general population.
Which of the following is the main reason for this patient's increased risk of premature avoidable death?Your Answer:
Correct Answer: Delays with diagnosis or treatment
Explanation:Understanding the Premature Mortality of People with Learning Disabilities in the UK
A review of the deaths of six people with learning disabilities by Mencap in 2007 brought attention to longstanding concerns about the care of this population within the NHS. As a result, the Confidential Inquiry into the deaths of people with learning disabilities (CIPOLD) was conducted, which reviewed the deaths of 247 people with learning disabilities between 2010-2012. The study found that the median age of death for this group was significantly lower than that of the general UK population, and delays or problems with diagnosis or treatment were the most common reasons for premature deaths.
The study also revealed that almost all individuals in the group had one or more long-term or treatable health conditions, including epilepsy, cardiovascular disease, hypertension, dementia, and osteoporosis. Respiratory infections were the most frequent cause of death, followed by heart and circulatory disorders and cancer. Suicide was not found to be a significant contributor to premature mortality, but rates were higher in people with limited intellectual functioning.
The lack of specialist learning disability services was also identified as a barrier to appropriate care, as some doctors were not aware of Community Learning Disability Teams. However, unhealthy lifestyles, such as smoking and substance abuse, were less prevalent in this group compared to the general population.
Overall, the study highlights the need for improved access to healthcare and coordination of care for people with learning disabilities, as well as increased awareness and understanding of the Mental Capacity Act 2005.
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This question is part of the following fields:
- Neurodevelopmental Disorders, Intellectual And Social Disability
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Question 16
Incorrect
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A 55-year-old woman presents with a painful left shoulder and limited range of motion. The clinician suspects adhesive capsulitis (frozen shoulder).
Which statement is best supported by evidence?Your Answer:
Correct Answer: Spontaneous resolution occurs within 18 months to 3 years
Explanation:Understanding Frozen Shoulder: Treatment Options and Efficacy
Frozen shoulder is a common condition that causes pain and stiffness in the shoulder joint. While it is self-limiting and can resolve within 18 months to 3 years, it can still cause significant morbidity. The most effective treatments for frozen shoulder are still largely unclear, but several interventions are commonly used in general practice.
Contrary to popular belief, intra-articular corticosteroid injection may only provide small and short-term benefits for frozen shoulder. Non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief, but only after non-NSAIDs have been tried. Physiotherapy has been shown to have some benefit in the short-to-medium term, but its long-term efficacy is still uncertain.
Current evidence doesn’t adequately identify the clinical situations for which a corticosteroid injection (with or without physiotherapy) is most likely to be effective. Therefore, a combination of different treatments may be necessary to manage frozen shoulder effectively. Understanding the available treatment options and their efficacy can help patients and healthcare providers make informed decisions about managing frozen shoulder.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 17
Incorrect
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A 30-year-old woman comes to her General Practitioner complaining of joint pains and muscle aches that have been developing over the past few months. She also reports experiencing extreme fatigue and hair loss during the same period. She has been taking omeprazole for dyspepsia recently. A blood test shows positive results for anti-double-stranded deoxyribonucleic acid antibodies (anti-dsDNA).
What is the most probable diagnosis?Your Answer:
Correct Answer: Systemic lupus erythematosus (SLE)
Explanation:Connective Tissue Disorders: Differential Diagnosis Based on Antibody Subtypes
Connective tissue disorders can present with similar symptoms such as joint and muscle pains and fatigue. However, the specific antibody subtype can help differentiate between different conditions.
Systemic lupus erythematosus (SLE) is highly associated with anti-double-stranded deoxyribonucleic acid antibodies (anti-dsDNA), which has a sensitivity of 70% and is variable based on disease activity. On the other hand, drug-induced lupus erythematosus is associated with omeprazole but rarely presents with positive anti-dsDNA antibodies.
Rheumatoid arthritis is more likely to present with positive rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies, while scleroderma is associated with anti-centromere antibodies and anti-Scl-70.
Sjögren syndrome, which commonly presents with dry eyes, mouth, and skin, can also cause fatigue and joint pains. However, it is more likely to be associated with positive anti-Ro and anti-La antibodies rather than anti-dsDNA antibodies.
Therefore, understanding the specific antibody subtype can aid in the differential diagnosis of connective tissue disorders.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 18
Incorrect
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A previously well, 60-year-old hypertensive builder presents with pain, redness and swelling in the right knee, which started 12 hours ago. There is a family history of hypertension and joint problems.
What investigation is most important in identifying the cause of this patient's knee symptoms?Your Answer:
Correct Answer: HLA status
Explanation:Importance of Joint Aspiration in Identifying the Cause of Acute Monoarthropathy
This patient is presenting with an acute monoarthropathy, characterized by pain, swelling, and erythema of a single joint. To identify the cause of these knee symptoms, the most important investigation is joint aspiration. This is because more than one diagnosis is possible with the limited information given, with septic arthritis and gout being the top differentials.
Joint aspiration involves the removal of synovial fluid from the affected joint for microscopy and culture. If the cause is septic arthritis, the aspirate would be turbid or purulent, and microscopy would reveal the presence of infective organisms. This information is crucial in guiding appropriate therapy. On the other hand, if the cause is gout, the aspirate would be cloudy, and microscopy would reveal crystals.
Other investigations, such as x-rays, would not be able to differentiate between these key differential diagnoses. X-rays are of no value in septic arthritis as they only become abnormal following joint destruction. Therefore, joint aspiration is the most important investigation in identifying the cause of acute monoarthropathy.
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This question is part of the following fields:
- Musculoskeletal Health
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Question 19
Incorrect
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A 4-month-old child is scheduled to receive the pertussis vaccine, but the mother is concerned about potential health issues that may prevent the administration of the vaccine.
What would be a contraindication for giving the vaccine in this case?Your Answer:
Correct Answer: Confirmed anaphylaxis to neomycin drops
Explanation:Pertussis-Containing Vaccines: Who Should Not Receive Them?
There are very few people who cannot receive pertussis-containing vaccines. However, if there is any doubt, it is important to seek advice from a consultant paediatrician, local Screening and Immunisation team, or consultant in Health Protection rather than withholding the vaccine.
There are only two situations where the vaccine should not be given. Firstly, if an individual has had a confirmed anaphylactic reaction to a previous dose of a pertussis-containing vaccine. Secondly, if an individual has had a confirmed anaphylactic reaction to neomycin, streptomycin, or polymyxin B, which may be present in trace amounts. In these cases, it is important to avoid the vaccine and seek alternative options.
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This question is part of the following fields:
- Children And Young People
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Question 20
Incorrect
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A 28-year-old woman who is 10-weeks pregnant presents with complaints of heightened vaginal discharge accompanied by itching. Upon conducting a sexual health screening, it is discovered that she has tested positive for gonorrhoea. What is the recommended treatment for her condition?
Your Answer:
Correct Answer: IM ceftriaxone
Explanation:Gonorrhoea is best treated with intramuscular ceftriaxone, which is also safe to administer during pregnancy.
Understanding Gonorrhoea: Causes, Symptoms, and Treatment
Gonorrhoea is a sexually transmitted infection caused by the Gram-negative diplococcus Neisseria gonorrhoeae. It can occur on any mucous membrane surface, including the genitourinary tract, rectum, and pharynx. Symptoms in males include urethral discharge and dysuria, while females may experience cervicitis leading to vaginal discharge. However, rectal and pharyngeal infections are usually asymptomatic. Unfortunately, immunisation is not possible, and reinfection is common due to antigen variation of type IV pili and Opa proteins.
If left untreated, gonorrhoea can lead to local complications such as urethral strictures, epididymitis, and salpingitis, which may result in infertility. Disseminated infection may also occur, with gonococcal infection being the most common cause of septic arthritis in young adults. The pathophysiology of disseminated gonococcal infection is not fully understood but is thought to be due to haematogenous spread from mucosal infection.
Management of gonorrhoea involves the use of antibiotics. Ciprofloxacin used to be the treatment of choice, but there is now increased resistance to it. Cephalosporins are now more widely used, with a single dose of IM ceftriaxone 1g being the new first-line treatment. If sensitivities are known, a single dose of oral ciprofloxacin 500mg may be given. Disseminated gonococcal infection and gonococcal arthritis may also occur, with symptoms including tenosynovitis, migratory polyarthritis, and dermatitis.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 21
Incorrect
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A 25-year-old woman comes to her General Practitioner complaining of bilateral erythematous palms. She reports itching and the presence of some vesicles. She has observed this developing quickly at work, where she has just begun a new job as a hairdresser.
What is the most probable diagnosis?Your Answer:
Correct Answer: Allergic contact dermatitis
Explanation:Skin Conditions: Allergic Contact Dermatitis, Atopic Eczema, Scabies, Hand, Foot and Mouth Disease, and Ringworm
Skin conditions can vary in their causes and symptoms. Allergic contact dermatitis is a delayed hypersensitivity reaction that occurs upon contact with an allergen, such as nickel, hair dyes, bleaches, perfumes, fragrances, and rubber antioxidants in gloves. Atopic eczema is a chronic skin condition that presents with red, itchy skin localized to the flexor surfaces and doesn’t normally develop vesicles. Scabies is a contagious skin condition caused by exposure to mites, which is very itchy and often starts between the fingers, but it would not normally flare up while at work. Hand, foot and mouth disease is a common childhood condition caused by the Coxsackievirus, characterized by a vesicular rash on the hands, feet, and mouth. Ringworm is a fungal skin infection that is usually circular with a silver scale and can be itchy, but it would be unlikely to cause bilateral hand symptoms and doesn’t cause the vesicular rash described here.
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This question is part of the following fields:
- Allergy And Immunology
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Question 22
Incorrect
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An otherwise healthy woman of 35 years has a second attack of renal colic in two years and passes a stone. Blood urea is normal.
Which one of the following investigations would be the most important to conduct?Your Answer:
Correct Answer: Serum calcium concentration
Explanation:Recommended Investigations for Young Patients with Renal Colic
Further investigation is recommended for young patients who experience a second episode of renal colic. To begin with, a plasma calcium test is important to rule out a predisposition towards forming the most common types of urinary tract stones, which are composed of calcium oxalate and calcium phosphate. A urine culture should also be conducted to exclude concurrent infection, as infection is associated with stone formation.
Another relevant investigation is urinary amino-acid chromatography, which can help assess for cystinuria or renal tubular acidosis. However, a urinary albumin-creatinine ratio is not particularly relevant in this situation unless the patient is found to have proteinuria.
It is important to note that an x-ray of the hands, renal biopsy, or cystoscopy are not required for this type of investigation. By conducting these recommended tests, healthcare professionals can better diagnose and treat young patients with renal colic.
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This question is part of the following fields:
- Metabolic Problems And Endocrinology
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Question 23
Incorrect
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A 65-year-old man presents with a firm swelling at the base of his neck on the right hand side, just above the clavicle. He noticed it about two weeks ago. It is not painful. He is an ex-smoker who stopped smoking three years ago (before that he smoked 10 roll-up cigarettes per day for 35 years). On further questioning he has noticed a loss of appetite and weight loss of 8 lbs.
On examination he is apyrexial and has a firm non-mobile lymph node 3 cm in diameter in the right supraclavicular fossa. There are no abnormalities on examination of the respiratory system and there is no organomegaly on abdominal examination.
What is the most appropriate management strategy?Your Answer:
Correct Answer: Routine referral to an ear nose and throat specialist
Explanation:Supraclavicular Lymph Node Enlargement and Malignancy
The right supraclavicular lymph node drains the mid-section of the chest, oesophagus, and lungs. An enlarged and fixed node in this area can indicate malignancy, with the lungs being a common primary site. While glandular fever is a possibility, it is less common in this age group, and the patient is presenting with several alarm symptoms.
Empirically treating with antibiotics is not recommended, as there are no signs of an infected sebaceous cyst, the patient is not feverish, and there is no identified focus for infection. According to NICE guidance, patients with cervical or supraclavicular lymphadenopathy should undergo an urgent chest x-ray.
The NPSA’s thematic review of delayed cancer diagnosis found that 23% of lung cancer cases had diagnostic delays, although not all of these were directly attributable to general practitioners’ actions. Therefore, it is crucial to investigate any supraclavicular lymph node enlargement promptly to rule out malignancy and ensure timely treatment.
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This question is part of the following fields:
- Respiratory Health
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Question 24
Incorrect
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You are asked to see a 25-year-old patient who has presented with a pigmented skin lesion on his back. He is concerned because his father was treated for a melanoma at the age of 38.
The presence of which of the following risk factors confers the greatest risk of developing a melanoma?Your Answer:
Correct Answer: Family history of melanoma in a first degree relative
Explanation:Risk Factors for Melanoma
When evaluating a pigmented skin lesion, it is important to consider any risk factors for melanoma. There are several established risk factors, including having more than 100 common moles larger than 2 mm in size, which confers the greatest risk with an odds ratio of 7.6-7.7. Other risk factors include a family history of melanoma in a first degree relative (odds ratio of 1.8), the presence of actinic lentigines (odds ratio of 1.9-3.5), red or light-colored hair (odds ratio of 1.4-3.5), and skin that doesn’t tan easily (odds ratio of 1.98). It is important to consider these risk factors when assessing a pigmented skin lesion to determine the likelihood of melanoma.
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This question is part of the following fields:
- Population Health
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Question 25
Incorrect
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A 37-year-old woman presents with new-onset facial weakness. She had been in excellent health until last summer when, after a hiking trip, she noticed an expanding erythematous rash on her abdomen, ultimately about 8 inches in diameter and lasting about three weeks. This improved following treatment with an oral cephalosporin, but she developed six weeks of diffuse arthralgias and headaches.
She has developed acute right facial paralysis, evolving over 24 hours, with retro auricular pain, hyperacusis and a decreased sense of taste. On examination, a complete, right lower motor neurone, seventh nerve palsy is noted.
What is the most likely diagnosis?Your Answer:
Correct Answer: Lyme disease
Explanation:Possible Diagnoses for Facial Paralysis and Other Symptoms After a Walking Holiday
Facial paralysis is a common neurological manifestation of Lyme disease, which is a possible diagnosis for a patient with no specific history of tick bite but with a rash and arthralgias after a walking holiday. Sarcoidosis can also cause facial palsy but fits less well with the story. Bell’s palsy is consistent with a complete lower motor neurone seventh nerve palsy, hyperacusis, and retroarticular pain, but doesn’t explain the preceding symptoms. Multiple sclerosis is characterized by symptomatic neurological episodes that occur months or years apart and affect different anatomical locations, which doesn’t fit with a single episode of seventh nerve palsy. Ramsay Hunt syndrome would cause pain and a vesicular eruption in and around the ear and the facial palsy but not the other features, and is unlikely without the characteristic rash.
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This question is part of the following fields:
- Neurology
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Question 26
Incorrect
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What is the correct statement about megaloblastic anaemia from the given list?
Your Answer:
Correct Answer: Folic acid alone should not be given if vitamin B12 deficiency has not been ruled out
Explanation:Understanding the Importance of Vitamin B12 in Megaloblastic Anemia Treatment
Megaloblastic anemia is a condition characterized by the presence of abnormally large red blood cells. It is commonly caused by deficiencies in vitamin B12 and/or folic acid. However, it is important to note that folic acid deficiency alone is rare in developed countries and a diagnosis should be made with consideration of other nutrient deficiencies.
When treating megaloblastic anemia, it is crucial to rule out vitamin B12 deficiency before starting folic acid therapy. This is because folic acid can improve anemia but not the neurological complications of vitamin B12 deficiency, which can worsen if left untreated. Both vitamin B12 and folic acid should be given if B12 deficiency has not been ruled out or if treatment with B12 has already been initiated.
It is also important to note that the neurological and hematological complications of megaloblastic anemia can present independently of each other. Some patients may present with neurological impairment without anemia and vice versa.
Treatment with vitamin B12 can stop the progression of the condition and improve neurological deficits in most patients. However, the response to treatment may vary depending on the severity of the deficiency and the time elapsed between the onset of symptoms and initiation of therapy. Treatment with folic acid, on the other hand, is usually slow and may take weeks or months to show clinical improvement.
When using hydroxocobalamin to treat megaloblastic anemia, the dosage and frequency of injections will depend on the presence of neurological involvement. For pernicious anemia and other macrocytic anemias without neurological involvement, the initial dose is 1 mg three times a week for two weeks, followed by 1 mg every 2-3 months. For those with neurological involvement, the initial dose is 1 mg on alternate days until no further improvement, then 1 mg every two months.
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This question is part of the following fields:
- Haematology
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Question 27
Incorrect
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A 28-year-old woman with a history of type 1 diabetes mellitus complains of diarrhoea, fatigue and weight loss for the past three months. She has been on a gluten-free diet for the last four weeks and feels better. She wants to confirm if she has coeliac disease. What is the next best course of action?
Your Answer:
Correct Answer: Ask her to reintroduce gluten for the next 6 weeks before further testing
Explanation:Before undergoing testing, patients need to consume gluten for a minimum of 6 weeks. Failure to do so may result in negative results for serological tests and jejunal biopsy, especially if the patient is adhering to a gluten-free diet. To ensure accurate results, patients should consume gluten in multiple meals every day for at least 6 weeks before undergoing further testing.
Investigating Coeliac Disease
Coeliac disease is a condition caused by sensitivity to gluten, which leads to villous atrophy and malabsorption. It is often associated with other conditions such as dermatitis herpetiformis and autoimmune disorders. Diagnosis is made through a combination of serology and endoscopic intestinal biopsy, with villous atrophy and immunology typically reversing on a gluten-free diet.
To investigate coeliac disease, NICE guidelines recommend using tissue transglutaminase (TTG) antibodies (IgA) as the first-choice serology test, along with endomyseal antibody (IgA) and testing for selective IgA deficiency. Anti-gliadin antibody (IgA or IgG) tests are not recommended. The ‘gold standard’ for diagnosis is an endoscopic intestinal biopsy, which should be performed in all suspected cases to confirm or exclude the diagnosis. Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, increase in intraepithelial lymphocytes, and lamina propria infiltration with lymphocytes. Rectal gluten challenge is a less commonly used method.
In summary, investigating coeliac disease involves a combination of serology and endoscopic intestinal biopsy, with NICE guidelines recommending specific tests and the ‘gold standard’ being an intestinal biopsy. Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, and lymphocyte infiltration.
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This question is part of the following fields:
- Gastroenterology
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Question 28
Incorrect
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A parent mentions she has received a letter about her child taking part in the National Child Measurement Program, where all Year 4 & Year 8 children have their Body Mass Index measured. Data is collated nationally, and used to analyse trends and inform the planning of health services. In some areas the children and parents are not routinely informed of their individual results. How might the main purpose of this initiative be described?
Your Answer:
Correct Answer: Health surveillance
Explanation:Public health is a crucial aspect of the RCGP curriculum, with a focus on promoting health and preventing disease. GPs are required to understand the surveillance systems involved in public health. An example of a health surveillance program in the UK is the National Child Measurement Program, which involves the continuous collection, analysis, and interpretation of health-related data for public health practice. Health protection involves safeguarding the public against health threats, such as air pollution or infectious diseases. Health promotion aims to empower individuals to improve their health, such as through education on healthy eating or access to smoking cessation services. Screening involves testing a population or subgroup for a disease in its early stages to provide early treatment and improve outcomes. Examples of screening programs in the UK include breast, cervical, and bowel cancer screening. Confidential enquiries are investigations into morbidity and mortality to identify areas for improvement, such as the annual Confidential Enquiry into Maternal and Child Health (CEMACH).
Understanding Health Promotion and Surveillance
Health promotion refers to the process of empowering individuals to take control of their health and improve it. This is achieved through various means such as education, awareness campaigns, and access to healthcare services. The World Health Organisation defines health promotion as a continuous process that enables people to increase their control over their health.
On the other hand, health surveillance is the systematic collection, analysis, and interpretation of health-related data. This data is used to plan, implement, and evaluate public health practices. Health surveillance is crucial in identifying health trends and patterns, which can help in the prevention and control of diseases. An example of health surveillance is the National Child Measurement Program, which collects data on childhood obesity.
In summary, health promotion and surveillance are essential components of public health. Health promotion empowers individuals to take control of their health, while health surveillance provides valuable data that can be used to plan and implement effective public health interventions.
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This question is part of the following fields:
- Population Health
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Question 29
Incorrect
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A 9-year-old patient had a tonsillectomy 4 days ago. His father has brought him to the clinic as earlier today he noticed a small amount of bright red bleeding from his mouth. He is otherwise recovering well and has been eating and drinking normally.
What is the best course of action for managing this patient's bleeding?Your Answer:
Correct Answer: Refer immediately to ENT for assessment
Explanation:If a patient experiences bleeding after a tonsillectomy, it is important to seek urgent assessment from the operating team. While simple analgesia may be appropriate for those experiencing only pain, the presence of bleeding requires immediate attention. Prescribing oral antibiotics in the community would not be appropriate in this context, and techniques such as silver nitrate cautery should only be performed by a specialist after a thorough assessment.
Complications after Tonsillectomy
Tonsillectomy is a common surgical procedure that involves the removal of the tonsils. However, like any surgery, it carries some risks and potential complications. One of the most common complications is pain, which can last for up to six days after the procedure.
Another complication that can occur after tonsillectomy is haemorrhage, or bleeding. There are two types of haemorrhage that can occur: primary and secondary. Primary haemorrhage is the most common and occurs within the first 6-8 hours after surgery. It requires immediate medical attention and may require a return to the operating room.
Secondary haemorrhage, on the other hand, occurs between 5 and 10 days after surgery and is often associated with a wound infection. It is less common than primary haemorrhage, occurring in only 1-2% of all tonsillectomies. Treatment for secondary haemorrhage usually involves admission to the hospital and antibiotics, but severe bleeding may require surgery.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 30
Incorrect
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A 7-year-old girl is playing outside when she trips and falls, landing on the outside of her left foot. She immediately cries out in pain and looks for help. There is no significant family or personal medical history. She is assisted by a neighbor as she limps inside. She is able to put weight on her foot.
Upon examination, her left ankle is swollen, warm, and shows signs of bruising. She has limited range of motion, particularly with internal rotation, and experiences tenderness along the lateral aspect of the ankle joint below the lateral malleolus, although there is no point tenderness over the malleolus itself.
What is the most probable diagnosis?Your Answer:
Correct Answer: Ankle dislocation
Explanation:Ankle Injuries in Children and the Ottawa Ankle Rules
The history of ankle injuries in children suggests a forced internal rotation at the ankle joint, which can cause a sprain of the lateral ligaments. This type of injury requires supportive strapping, analgesia, and graduated mobilization. However, ankle sprains are less common in children than adults because their ligaments are stronger than their growth plates. As a result, the growth plate tends to fracture before the ligament tears.
In some cases, Salter-Harris Type 1 fractures and ligament tears may not show up on radiographs. Therefore, it is important to consider the patient’s history, such as tenderness over the ligament rather than bone and whether the patient is weight-bearing.
The Ottawa ankle rules are helpful in assisting GPs in the management of ankle injuries in adults and determining the need for an x-ray. A recent study published in the BMJ showed that the Ottawa ankle rules are highly accurate at excluding ankle fractures after a sprain injury. By following these guidelines, healthcare professionals can provide appropriate care for ankle injuries in children and adults.
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This question is part of the following fields:
- Children And Young People
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