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Question 1
Incorrect
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A 50-year-old woman is suffering from a fungating metastatic breast cancer and is experiencing distress due to the foul-smelling discharge from the affected breast. This is causing significant social embarrassment. What is the best treatment option to alleviate this symptom?
Your Answer: Dry dressings
Correct Answer: Oral metronidazole or gel
Explanation:Managing Foul Odors in Palliative Care
In palliative care, patients with fungating tumors may experience unpleasant smells caused by anaerobic organisms. Metronidazole is a medication that can help improve these odors by targeting the infecting organisms. Additionally, charcoal dressings can be used to absorb malodorous substances and provide some relief to patients.
It is important for healthcare professionals to be familiar with prescribing in palliative care. The British National Formulary (BNF) offers a helpful section on this topic, including introductory information that is often tested in exams. By utilizing these resources and strategies, healthcare providers can effectively manage foul odors and improve the quality of life for their patients in palliative care.
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This question is part of the following fields:
- General Practice
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Question 2
Correct
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A 9-month-old infant comes to the clinic with a complaint of fever (39°C) and a rash that started on the legs and has now spread to the limbs and trunk. The rash is purplish, non-palpable, and non-blanching. What is the most probable diagnosis?
Your Answer: Meningococcal septicaemia
Explanation:Meningococcal septicaemia causes a non-blanching purpuric eruption. Other conditions such as giant urticaria, measles rash, haemophilia, and HSP have different symptoms and presentations.
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This question is part of the following fields:
- General Practice
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Question 3
Correct
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The parents of an 8-year-old child are worried about his recent bed wetting, as he has been consistently dry at night for the past two years. What steps should be taken for this child?
Your Answer: Investigate for secondary causes
Explanation:Possible Causes of Bed Wetting in Children
Bed wetting is not normal for children who have been dry for a significant period of time. It is important to rule out other possible causes such as psychological effects, urinary tract infections, and diabetes. Psychological effects are the most common cause of bed wetting in children. This may be due to stress, anxiety, or other emotional issues. Urinary tract infections can also cause bed wetting as they can irritate the bladder and cause the child to feel the need to urinate frequently. Diabetes can also be a cause of bed wetting as it can affect the body’s ability to regulate urine production. It is important to consult a healthcare professional if bed wetting persists in order to determine the underlying cause and provide appropriate treatment.
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This question is part of the following fields:
- General Practice
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Question 4
Correct
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A 27-year-old female visits her GP complaining of left-sided ear pain with discharge. Upon examination, the GP diagnoses otitis media and prescribes oral erythromycin due to the patient's penicillin allergy. The patient has a history of severe asthma and takes salbutamol and budesonide inhalers regularly, as well as montelukast 10 mg once daily, aminophylline (as Phyllocontin Continus) 225 mg twice daily, and receives omalizumab infusions at her local respiratory center. Which of her regular medications require a dosage adjustment while she is taking antibiotics?
Your Answer: Aminophylline
Explanation:Drug Interactions with Erythromycin
Erythromycin is a macrolide antibiotic that is safe to use in patients with penicillin allergies. However, it has many interactions that can limit its use. Macrolide antibiotics inhibit the cytochrome P450 hepatic enzyme system, which metabolizes many drugs. This inhibition leads to drug accumulation and an increased risk of toxicity and side effects. Aminophylline is a drug used to treat bronchial asthma that inhibits phosphodiesterase and has an antagonistic effect at adenosine receptors. When co-administered with erythromycin, aminophylline levels in the serum rise, leading to adenosine receptor blockade and toxicity. Other methylxanthine derivatives, such as caffeine, can also cause toxic effects when used with macrolides. Salbutamol is a beta-2 adrenergic agonist drug used to cause bronchodilation in asthma treatment. There is a theoretical risk of increase in QT interval prolongation with this class of drugs, which is exaggerated by concurrent use of macrolide antibiotics. Budesonide is an inhaled corticosteroid used to reduce bronchoconstriction in asthma treatment. It is metabolized by the cytochrome P450 system, and there is a theoretical risk of interaction with macrolides. Omalizumab is a monoclonal antibody used in patients with severe asthma with proven IgE mediated sensitivity. It causes few drug interactions, but it may precipitate an anaphylactic reaction in susceptible individuals at administration.
Overall, erythromycin has many drug interactions that can limit its use. It is important to be aware of these interactions and adjust drug regimens accordingly to avoid toxicity and side effects.
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This question is part of the following fields:
- General Practice
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Question 5
Incorrect
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A 14-year-old boy comes to the clinic with his parents who are worried about his recurring abdominal pain, loss of appetite, and nausea that has been going on for two months. The pain is severe, occurs in the mornings, is intermittent, and can happen even during vacations. The boy's weight is average, and there are no abnormalities found during the examination. What is the probable diagnosis?
Your Answer: School avoidance
Correct Answer: Abdominal migraine
Explanation:Abdominal Migraine: Recurrent Episodes of Midline Abdominal Pain in Children
Abdominal migraine is a disorder that mainly affects children and is characterized by recurrent episodes of midline abdominal pain. The pain can last from 1 to 72 hours and there is complete normality between episodes. The intensity of the pain is moderate to severe and is usually felt around the umbilicus or poorly localized. During the attacks, patients may experience anorexia, nausea, and vomiting. Marked pallor is commonly noted, although some patients may appear flushed. The pain is severe enough to interfere with normal daily activities and can cause intense misery. However, the attacks are self-limiting and resolve spontaneously, and patients are symptom-free between episodes.
This condition is unlikely to be school avoidance as the symptoms are episodic and can occur outside of school times. Abdominal migraine is an idiopathic disorder, meaning that the cause is unknown.
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This question is part of the following fields:
- General Practice
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Question 6
Correct
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A 14-year-old girl comes to see you, the practice nurse, after getting an open wound on her right arm while playing basketball. Upon examination, you find a 5 cm wound that is dirty and contains dirt. What is the best course of action for tetanus vaccination in this patient?
Your Answer: If his immunisation status is uncertain he should receive tetanus immunoglobulin and vaccine
Explanation:Tetanus Vaccination and Treatment for Tetanus Prone Wounds
When it comes to tetanus vaccination, individuals who have completed the full five-course of the vaccine are not recommended to receive any further doses if they suffer a tetanus prone wound. However, there is some disagreement over whether or not to administer Tetanus Immune Globulin (TIG) to those who are known to be fully immunized. Some sources suggest giving TIG for all high-risk wounds, while others recommend it only if five years have passed since the last dose. It is important to consult with a healthcare professional to determine the best course of action in the event of a tetanus prone wound. Proper vaccination and treatment can prevent the potentially fatal effects of tetanus.
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This question is part of the following fields:
- General Practice
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Question 7
Incorrect
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A 7-year-old boy has been diagnosed with mumps.
Which of the following complications would be unexpected for this condition?Your Answer: Oophoritis
Correct Answer: Disseminated intravascular coagulation
Explanation:Clinical Manifestations and Sequelae of Mumps
Mumps is a viral infection that commonly affects the salivary glands, causing parotitis, oophoritis, and orchitis. However, it can also lead to acute pancreatitis. In addition to these clinical manifestations, mumps can result in various sequelae, including meningoencephalitis, arthritis, transverse myelitis, cerebellar ataxia, and deafness. These conditions can occur as a result of the virus spreading to other parts of the body, such as the brain, spinal cord, and joints. However, disseminated intravascular coagulation (DIC) is not typically associated with mumps.
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This question is part of the following fields:
- General Practice
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Question 8
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A 50-year-old man is being evaluated after being hospitalized six weeks ago for an inferior myocardial infarction that was treated with thrombolysis. He has been prescribed atenolol 50 mg daily, aspirin, and rosuvastatin 10 mg daily upon discharge. He has quit smoking after his MI and is now curious about which foods he should steer clear of.
Which of the following foods should he avoid?Your Answer: Cheese
Explanation:Post-MI Diet Recommendations
Following a myocardial infarction (MI), patients are advised to make dietary changes to reduce the risk of another cardiac event. It is recommended to avoid foods high in saturated fat, such as cheese, milk, and fried foods. Instead, a diet rich in high-fiber, starch-based foods, along with five servings of fresh fruits and vegetables daily and oily fish, is recommended.
However, it is important to note that the National Institute for Health and Care Excellence (NICE) advises against the use of omega-3 capsules and supplements to prevent another MI. While a healthy diet can provide the necessary nutrients, supplements are not recommended as they have not been proven to be effective in preventing cardiac events. It is important for patients to consult with their healthcare provider for personalized dietary recommendations following an MI.
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This question is part of the following fields:
- General Practice
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05
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44
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