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  • Question 1 - What is a true statement about mumps infection? ...

    Incorrect

    • What is a true statement about mumps infection?

      Your Answer: It can cause meningo-encephalitis

      Correct Answer: Sterility commonly follows orchitis

      Explanation:

      Mumps: Symptoms and Complications

      Mumps is a viral infection that has an incubation period of 14-21 days. It can affect any of the salivary glands, but sometimes only one gland is affected. In rare cases, mumps can cause meningoencephalitis, which is inflammation of the brain and its surrounding tissues.

      One of the common complications of mumps is orchitis, which is inflammation of the testicles. This occurs in around 25% of cases and can cause pain, swelling, and fever. However, sterility is a relatively uncommon complication following orchitis.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      25.9
      Seconds
  • Question 2 - A 50-year-old man with a history of stage 3 chronic kidney disease (CKD)...

    Correct

    • A 50-year-old man with a history of stage 3 chronic kidney disease (CKD) attends his annual check-up with his General Practitioner. He reports feeling well.
      During the examination, his haemoglobin (Hb) level is measured at 107 g/l (normal range: 125–165 g/l), and his mean cell volume (MCV) is 86 fl (normal range: 80–100 fl). Iron studies come back normal.
      What is the most appropriate course of action for managing this patient?

      Your Answer: Refer the patient to nephrology for erythropoietin consideration

      Explanation:

      Management of Renal Anaemia in CKD Patients

      Patients with chronic kidney disease (CKD) and anaemia may require referral to nephrology for erythropoietin treatment if their hemoglobin (Hb) levels are below 110 g/l or if they experience symptoms such as tiredness, shortness of breath, lethargy, and palpitations. Other causes of anaemia should be ruled out before considering erythropoiesis-stimulating agents to maintain Hb levels between 100-120 g/l in adults. Endoscopy may be necessary in cases of iron-deficiency anaemia, but not in normocytic anaemia with normal iron studies. Iron-replacement therapy is not required in this case. Referral to nephrology is necessary for patients with CKD and renal anaemia, diagnosed when Hb levels drop below 110 g/l. Waiting for Hb levels to drop below 10.0 g/dl before referral is not recommended.

    • This question is part of the following fields:

      • Kidney And Urology
      27.6
      Seconds
  • Question 3 - A 70-year-old retired carpenter visits his GP seeking strong pain relief for his...

    Incorrect

    • A 70-year-old retired carpenter visits his GP seeking strong pain relief for his lower back pain. He has been experiencing the pain for six weeks and saw another GP two weeks ago who advised him to take regular Paracetamol and Ibuprofen with PPI cover. During his previous visit, a PR exam was conducted, which was normal, and a PSA blood test was within the normal range. He reports feeling more tired than usual and complains of persistent nausea, but otherwise feels well. On examination, his observations are within the normal range, and there is no specific bony tenderness. His spine has a normal range of movement, and no focal neurology is detected. Based on NICE guidelines for suspected cancer, what is the most appropriate course of action?

      Your Answer: Arrange direct access X-ray

      Correct Answer: Offer a FBC, Calcium, Plasma viscosity or ESR to assess for myeloma

      Explanation:

      According to the latest NICE Guidelines for suspected cancer (June 2015), individuals aged 60 and above with persistent bone pain, particularly back pain, or unexplained fracture should be offered a FBC, calcium and plasma viscosity or ESR to assess for myeloma. Additionally, those with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma should be offered very urgent protein electrophoresis and a Bence Jones protein urine test within 48 hours. In cases where the plasma viscosity or ESR and presentation are consistent with possible myeloma, very urgent protein electrophoresis and a Bence Jones protein urine test should be considered. If the results of protein electrophoresis or a Bence Jones protein urine test suggest myeloma, referral should be made within 2 weeks. These guidelines have been updated in 2015.

      Understanding Multiple Myeloma: Features and Investigations

      Multiple myeloma is a type of cancer that affects the plasma cells in the bone marrow. It is most commonly found in patients aged 60-70 years. The disease is characterized by a range of symptoms, which can be remembered using the mnemonic CRABBI. These include hypercalcemia, renal damage, anemia, bleeding, bone lesions, and increased susceptibility to infection. Other features of multiple myeloma include amyloidosis, carpal tunnel syndrome, neuropathy, and hyperviscosity.

      To diagnose multiple myeloma, a range of investigations are required. Blood tests can reveal anemia, renal failure, and hypercalcemia. Protein electrophoresis can detect raised levels of monoclonal IgA/IgG proteins in the serum, while bone marrow aspiration can confirm the diagnosis if the number of plasma cells is significantly raised. Imaging studies, such as whole-body MRI or X-rays, can be used to detect osteolytic lesions.

      The diagnostic criteria for multiple myeloma require one major and one minor criteria or three minor criteria in an individual who has signs or symptoms of the disease. Major criteria include the presence of plasmacytoma, 30% plasma cells in a bone marrow sample, or elevated levels of M protein in the blood or urine. Minor criteria include 10% to 30% plasma cells in a bone marrow sample, minor elevations in the level of M protein in the blood or urine, osteolytic lesions, or low levels of antibodies in the blood. Understanding the features and investigations of multiple myeloma is crucial for early detection and effective treatment.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
      49.1
      Seconds
  • Question 4 - A 58-year-old retired male visits your clinic concerned about his alcohol consumption after...

    Incorrect

    • A 58-year-old retired male visits your clinic concerned about his alcohol consumption after watching a show about 'functioning alcoholics'. He confesses to drinking a 750ml bottle of beer every night - to a total of 4 bottles per week. You check the label and find out that the beer is 5% alcohol by volume (abv). What is the total number of units of alcohol this patient consumes in a week?

      Your Answer: 30 units

      Correct Answer: 27 units

      Explanation:

      Understanding Alcohol Units

      Alcohol consumption can have negative effects on our health, which is why it is important to understand the recommended guidelines for safe drinking. In 2016, the Chief Medical Officer proposed new guidelines that recommend men and women should drink no more than 14 units of alcohol per week. To put this into perspective, one unit of alcohol is equal to 10 mL of pure ethanol. The strength of an alcoholic drink is determined by the alcohol by volume (ABV), which can vary depending on the type of drink. For example, a 25ml single measure of spirits with an ABV of 40% is equal to one unit of alcohol.

      To calculate the number of units in a drink, you can multiply the number of millilitres by the ABV and divide by 1,000. For instance, half a 175ml ‘standard’ glass of red wine with an ABV of 12% is equal to 1.05 units. It is important to note that pregnant women should not drink alcohol at all, as it can lead to long-term harm to the baby.

    • This question is part of the following fields:

      • Smoking, Alcohol And Substance Misuse
      32
      Seconds
  • Question 5 - Sarah is a 74-year-old woman who had an unprovoked deep vein thrombosis two...

    Correct

    • Sarah is a 74-year-old woman who had an unprovoked deep vein thrombosis two months ago for which she takes apixaban. She presents to her GP following a 20-minute episode of unilateral arm weakness that occurred 2 hours ago and has now completely resolved. Her neurological examination is normal.

      What should her initial management be?

      Your Answer: Immediate referral to the emergency department for imaging

      Explanation:

      If a patient is suspected of having a TIA and is taking warfarin, a DOAC, or has a bleeding disorder, they must be admitted immediately for imaging to rule out a haemorrhage.

      For patients without these conditions, administering 300 mg of aspirin immediately and then evaluating them by a specialist within 24 hours is recommended. The primary secondary prevention method is taking clopidogrel 75 mg once daily.

      Referring patients to neurology as a routine measure would cause an unnecessary delay in treatment.

      A transient ischaemic attack (TIA) is a brief period of neurological deficit caused by a vascular issue, lasting less than an hour. The original definition of a TIA was based on time, but it is now recognized that even short periods of ischaemia can result in pathological changes to the brain. Therefore, a new ’tissue-based’ definition is now used. The clinical features of a TIA are similar to those of a stroke, but the symptoms resolve within an hour. Possible features include unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, or loss of balance, visual problems, sudden transient loss of vision in one eye (amaurosis fugax), diplopia, and homonymous hemianopia.

      NICE recommends immediate antithrombotic therapy, giving aspirin 300 mg immediately unless the patient has a bleeding disorder or is taking an anticoagulant. If aspirin is contraindicated, management should be discussed urgently with the specialist team. Specialist review is necessary if the patient has had more than one TIA or has a suspected cardioembolic source or severe carotid stenosis. Urgent assessment within 24 hours by a specialist stroke physician is required if the patient has had a suspected TIA in the last 7 days. Referral for specialist assessment should be made as soon as possible within 7 days if the patient has had a suspected TIA more than a week previously. The person should be advised not to drive until they have been seen by a specialist.

      Neuroimaging should be done on the same day as specialist assessment if possible. MRI is preferred to determine the territory of ischaemia or to detect haemorrhage or alternative pathologies. Carotid imaging is necessary as atherosclerosis in the carotid artery may be a source of emboli in some patients. All patients should have an urgent carotid doppler unless they are not a candidate for carotid endarterectomy.

      Antithrombotic therapy is recommended, with clopidogrel being the first-line treatment. Aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel. Carotid artery endarterectomy should only be considered if the patient has suffered a stroke or TIA in the carotid territory and is not severely disabled. It should only be recommended if carotid stenosis is greater

    • This question is part of the following fields:

      • Neurology
      44.2
      Seconds
  • Question 6 - A 61-year-old man with ischaemic heart disease experiences chest pain while climbing stairs....

    Correct

    • A 61-year-old man with ischaemic heart disease experiences chest pain while climbing stairs. He uses his sublingual glyceryl trinitrate (GTN) spray. What is the most likely side-effect profile of taking the GTN spray?

      Your Answer: Hypotension + tachycardia + headache

      Explanation:

      Understanding Nitrates and Their Effects on the Body

      Nitrates are a type of medication that can cause blood vessels to widen, which is known as vasodilation. They are commonly used to manage angina and treat heart failure. One of the most frequently prescribed nitrates is sublingual glyceryl trinitrate, which is used to relieve angina attacks in patients with ischaemic heart disease.

      The mechanism of action for nitrates involves the release of nitric oxide in smooth muscle, which activates guanylate cyclase. This enzyme then converts GTP to cGMP, leading to a decrease in intracellular calcium levels. In the case of angina, nitrates dilate the coronary arteries and reduce venous return, which decreases left ventricular work and reduces myocardial oxygen demand.

      However, nitrates can also cause side effects such as hypotension, tachycardia, headaches, and flushing. Additionally, many patients who take nitrates develop tolerance over time, which can reduce their effectiveness. To combat this, the British National Formulary recommends that patients who develop tolerance take the second dose of isosorbide mononitrate after 8 hours instead of 12 hours. This allows blood-nitrate levels to fall for 4 hours and maintains effectiveness. It’s important to note that this effect is not seen in patients who take modified release isosorbide mononitrate.

    • This question is part of the following fields:

      • Cardiovascular Health
      31.4
      Seconds
  • Question 7 - You are reviewing current guidance in relation to the use of non-HDL cholesterol...

    Incorrect

    • You are reviewing current guidance in relation to the use of non-HDL cholesterol measurement with regards lipid modification therapy for cardiovascular disease prevention.
      Which of the following lipoproteins contribute to 'non-HDL cholesterol'?

      You are reviewing current guidance in relation to the use of non-HDL cholesterol measurement with regards lipid modification therapy for cardiovascular disease prevention.

      Which of the following lipoproteins contribute to 'non-HDL cholesterol'?

      Your Answer: LDL and VLDL cholesterol

      Correct Answer: LDL, IDL and VLDL cholesterol

      Explanation:

      The Importance of Non-HDL Cholesterol in Statin Treatment

      NICE guidelines recommend that high-intensity statin treatment for both primary and secondary prevention of cardiovascular disease should aim for a greater than 40% reduction in non-HDL cholesterol. Non-HDL cholesterol includes LDL, IDL, and VLDL cholesterol. In the past, LDL reduction has been used as a marker of statin effect. However, non-HDL reduction is more useful as it takes into account the atherogenic properties of IDL and VLDL cholesterol, which may be raised even in the presence of normal LDL levels.

      Using non-HDL cholesterol also has other benefits. Hypertriglyceridaemia can interfere with lab-based LDL calculations, but it doesn’t impact non-HDL calculation, which is measured by a different method. Additionally, a fasting sample is not required to measure non-HDL cholesterol, making sampling and monitoring easier. Overall, non-HDL cholesterol is an important marker to consider in statin treatment for cardiovascular disease prevention.

    • This question is part of the following fields:

      • Cardiovascular Health
      24.5
      Seconds
  • Question 8 - You think that an 80-year-old man has dementia.

    Which one of the following is...

    Correct

    • You think that an 80-year-old man has dementia.

      Which one of the following is more suggestive of vascular dementia than Alzheimer's?

      Your Answer: Emotional lability

      Explanation:

      Emotional lability in Vascular Dementia

      Emotional lability, which refers to sudden and exaggerated changes in mood or emotions, is a common symptom in patients with vascular dementia. This type of dementia is caused by reduced blood flow to the brain, leading to damage in different areas of the brain. Emotional lability can manifest as sudden outbursts of anger, crying spells, or inappropriate laughter.

      On the other hand, other symptoms such as memory loss, confusion, and difficulty with language and communication are more suggestive of Alzheimer’s disease. It is important to differentiate between the two types of dementia as they have different underlying causes and may require different treatment approaches.

    • This question is part of the following fields:

      • Older Adults
      15.9
      Seconds
  • Question 9 - A 58-year-old man with a history of hypertension experiences sudden onset of severe...

    Incorrect

    • A 58-year-old man with a history of hypertension experiences sudden onset of severe chest pain, radiating to the back and left shoulder. On examination, he is hemiplegic, with pallor and sweating. His heart rate is 120 bpm and his blood pressure is 174/89 mmHg, but 153/72 mmHg when measured on the opposite arm.
      What is the most probable diagnosis?

      Your Answer: Myocardial infarction

      Correct Answer: Dissection of the thoracic aorta

      Explanation:

      Differential diagnosis of hemiplegia in a patient with chest pain

      Aortic dissection, myocardial infarction, intracranial haemorrhage, ruptured thoracic aneurysm, and ruptured ventricular aneurysm are among the possible causes of chest pain and hemiplegia in a patient with a history of hypertension. Aortic dissection is the most likely diagnosis, given the abrupt onset and maximal severity of chest pain at onset, as well as the potential for carotid involvement and limb blood pressure differences. Myocardial infarction may also cause chest pain but is less likely to present with hemiplegia. Intracranial haemorrhage may cause hemiplegia but is more likely to present with a headache. Ruptured thoracic aneurysm may cause acute chest, back, or neck pain, but is unlikely to cause hemiplegia. Ruptured ventricular aneurysm is a complication of myocardial infarction but typically doesn’t rupture. A careful differential diagnosis is essential for appropriate management and prognosis.

    • This question is part of the following fields:

      • Cardiovascular Health
      25.7
      Seconds
  • Question 10 - An 18-year-old patient visits his General Practitioner with worries about the appearance of...

    Incorrect

    • An 18-year-old patient visits his General Practitioner with worries about the appearance of his chest wall. He is generally healthy but mentions that his father passed away 10 years ago due to heart problems. Upon examination, he is 195 cm tall (>99th centile) and slender, with pectus excavatum and arachnodactyly. The doctor suspects that he may have Marfan syndrome. What is the most prevalent cardiovascular abnormality observed in adults with Marfan syndrome? Choose ONE answer only.

      Your Answer:

      Correct Answer: Aortic root dilatation

      Explanation:

      Cardiac Abnormalities in Marfan Syndrome

      Marfan syndrome is an inherited connective tissue disorder that affects various systems in the body. The most common cardiac complication is aortic root dilatation, which occurs in 70% of patients. Mitral valve prolapse is the second most common abnormality, affecting around 60% of patients. Beta-blockers can help reduce the rate of aortic dilatation and the risk of rupture. Aortic dissection, although not the most common abnormality, is a major diagnostic criterion of Marfan syndrome and can result from weakening of the aortic media due to root dilatation. Aortic regurgitation is less common than mitral regurgitation but can occur due to progressive aortic root dilatation and connective tissue abnormalities. Mitral annular calcification is more frequent in Marfan syndrome than in the general population but is not included in the diagnostic criteria.

    • This question is part of the following fields:

      • Cardiovascular Health
      0
      Seconds
  • Question 11 - Can you rearrange the following types of research studies in their correct order...

    Incorrect

    • Can you rearrange the following types of research studies in their correct order according to their level of evidence, starting with the highest level on the left and ending with the lowest level on the right: systematic review of RCTs, RCTs, cohort, case-control, cross-sectional, case-series? Take your time and try to recall the hierarchy.

      Your Answer:

      Correct Answer: Systematic review of RCTs, RCTs, cohort, case-control, cross-sectional, case-series

      Explanation:

      Levels and Grades of Evidence in Evidence-Based Medicine

      In order to evaluate the quality of evidence in evidence-based medicine, levels or grades are often used to organize the evidence. Traditional hierarchies placed systematic reviews or randomized control trials at the top and case-series/report at the bottom. However, this approach is overly simplistic as certain research questions cannot be answered using RCTs. To address this, the Oxford Centre for Evidence-Based Medicine introduced their 2011 Levels of Evidence system which separates the type of study questions and gives a hierarchy for each. On the other hand, the GRADE system is a grading approach that classifies the quality of evidence as high, moderate, low, or very low. The process begins by formulating a study question and identifying specific outcomes. Outcomes are then graded as critical or important, and the evidence is gathered and criteria are used to grade the evidence. Evidence can be promoted or downgraded based on certain circumstances. The use of levels and grades of evidence helps to evaluate the quality of evidence and make informed decisions in evidence-based medicine.

    • This question is part of the following fields:

      • Evidence Based Practice, Research And Sharing Knowledge
      0
      Seconds
  • Question 12 - Ms. Smith is a 62-year-old woman with lung cancer. She has a husband...

    Incorrect

    • Ms. Smith is a 62-year-old woman with lung cancer. She has a husband and two children; her son has been closely involved in decision making regarding her care throughout her illness and she has previously conferred Power of Attorney for Health and Welfare to him, whereas her daughter only visits very infrequently.
      Ms. Smith has been very clear that she wishes not to receive artificial ventilation if she were to lose capacity. She is worried that her daughter will want to do anything she can to keep her alive. Therefore, Ms. Smith completed an Advance Decision to Refuse Treatment (ADRT) stating she wishes not to receive artificial ventilation at the end of life.
      What conclusions can you draw regarding the ARDT?

      Your Answer:

      Correct Answer: It will come in to force as soon as Mr James signs it

      Explanation:

      Advance Decisions to Refuse Treatment (ADRTs)

      An Advance Decision to Refuse Treatment (ADRT) is a legally binding document that comes into force once a person loses capacity. It is applicable and valid, and family members cannot override it. It is important to note that there is no legal definition of next of kin.

      For an ADRT that refuses potentially life-sustaining treatment to be valid, it must be written, signed, and witnessed. It should also include a statement indicating that the person completing the ADRT accepts the consequences, even if it means their life is at risk.

      A Lasting Power of Attorney for Health and Welfare can only override the ADRT if it was made after the ADRT and the attorney has the authority to give or refuse consent for treatment related to the ADRT.

      It is essential to complete an ADRT when one is 18 years or older and has the capacity to do so. The document comes into force when the person loses capacity.

    • This question is part of the following fields:

      • End Of Life
      0
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  • Question 13 - A 32-year-old woman has come for her regular appointment at your GP surgery...

    Incorrect

    • A 32-year-old woman has come for her regular appointment at your GP surgery and has just discovered that she is 6 weeks pregnant. She is seeking assistance with quitting smoking during her pregnancy and wants to discuss treatment options. At present, she smokes 10 cigarettes per day and due to her hectic schedule, she believes that she won't be able to attend frequent meetings.

      What is the most suitable smoking cessation therapy to suggest to her?

      Your Answer:

      Correct Answer: Nicotine replacement therapy

      Explanation:

      Pregnant women who smoke should be offered nicotine replacement therapy, but varenicline and bupropion should not be given as they are not safe for them.

      Although referring the patient to a stop smoking clinic would be appropriate, it may not be feasible for her to attend regular meetings.

      While the effects of e-cigarette vapour on the foetus are unknown, NICE advises against discouraging pregnant women who are already using e-cigarettes to quit smoking.

      Nicotine replacement therapy is the only approved treatment for smoking cessation during pregnancy.

      Smoking cessation is the process of quitting smoking. In 2008, NICE released guidance on how to manage smoking cessation. The guidance recommends that patients should be offered nicotine replacement therapy (NRT), varenicline or bupropion, and that clinicians should not favour one medication over another. These medications should be prescribed as part of a commitment to stop smoking on or before a particular date, and the prescription should only last until 2 weeks after the target stop date. If unsuccessful, a repeat prescription should not be offered within 6 months unless special circumstances have intervened. NRT can cause adverse effects such as nausea and vomiting, headaches, and flu-like symptoms. NICE recommends offering a combination of nicotine patches and another form of NRT to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past.

      Varenicline is a nicotinic receptor partial agonist that should be started 1 week before the patient’s target date to stop. The recommended course of treatment is 12 weeks, but patients should be monitored regularly and treatment only continued if not smoking. Varenicline has been shown in studies to be more effective than bupropion, but it should be used with caution in patients with a history of depression or self-harm. Nausea is the most common adverse effect, and varenicline is contraindicated in pregnancy and breastfeeding.

      Bupropion is a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist that should be started 1 to 2 weeks before the patient’s target date to stop. There is a small risk of seizures, and bupropion is contraindicated in epilepsy, pregnancy, and breastfeeding. Having an eating disorder is a relative contraindication.

      In 2010, NICE recommended that all pregnant women should be tested for smoking using carbon monoxide detectors. All women who smoke, or have stopped smoking within the last 2 weeks, or those with a CO reading of 7 ppm or above should be referred to NHS Stop Smoking Services. The first-line interventions in pregnancy should be cognitive behaviour therapy, motivational interviewing, or structured self-help and support from NHS Stop Smoking Services. The evidence for the use of NRT in pregnancy is mixed, but it is often used if the above measures fail. There is no evidence that it affects the child’s birthweight. Pregnant women

    • This question is part of the following fields:

      • Maternity And Reproductive Health
      0
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  • Question 14 - A recently graduated nurse at the nearby hospital receives hepatitis B vaccination. After...

    Incorrect

    • A recently graduated nurse at the nearby hospital receives hepatitis B vaccination. After three months of completing the primary course, the following outcomes are observed:

      Outcome Anti-HBs: 10 - 100 mIU/ml
      Reference A protective immunity is indicated by an antibody level of >100 mIU/ml.

      What is the best course of action to take?

      Your Answer:

      Correct Answer: Give one further dose of hepatitis B vaccine

      Explanation:

      Understanding Hepatitis B: Causes, Symptoms, Complications, Prevention, and Management

      Hepatitis B is a virus that spreads through exposure to infected blood or body fluids, including from mother to child during birth. The incubation period is typically 6-20 weeks. Symptoms of hepatitis B include fever, jaundice, and elevated liver transaminases. Complications of the infection can include chronic hepatitis, fulminant liver failure, hepatocellular carcinoma, glomerulonephritis, polyarteritis nodosa, and cryoglobulinemia.

      Immunization against hepatitis B is recommended for at-risk groups, including healthcare workers, intravenous drug users, sex workers, close family contacts of an individual with hepatitis B, individuals receiving regular blood transfusions, chronic kidney disease patients, prisoners, and chronic liver disease patients. The vaccine is given in three doses and is typically effective, although around 10-15% of adults may not respond well to the vaccine.

      Management of hepatitis B typically involves antiviral medications such as tenofovir, entecavir, and telbivudine, which aim to suppress viral replication. Pegylated interferon-alpha was previously the only treatment available and can still be used as a first-line treatment, but other medications are increasingly being used. A better response to treatment is predicted by being female, under 50 years old, having low HBV DNA levels, being non-Asian, being HIV negative, and having a high degree of inflammation on liver biopsy.

      Overall, understanding the causes, symptoms, complications, prevention, and management of hepatitis B is important for both healthcare professionals and the general public. Vaccination and early detection and treatment can help prevent the spread of the virus and reduce the risk of complications.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
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  • Question 15 - Giuseppe is a 39-year-old man who has been advised by a colleague that...

    Incorrect

    • Giuseppe is a 39-year-old man who has been advised by a colleague that immunisations should be offered to men who have sex with men (MSM).

      Giuseppe has been in a relationship with his boyfriend for the past 6 months and has another male sexual partner.

      What immunisations should Giuseppe be recommended for?

      Your Answer:

      Correct Answer: Hepatitis A

      Explanation:

      Men who engage in sexual activity with other men should be offered immunization against hepatitis A, according to the Green Book guidelines. It is recommended that MSM with multiple sexual partners be informed about the risks of hepatitis A and the importance of maintaining good personal hygiene. Immunization should be offered to these individuals, especially during periods of outbreaks. Additionally, MSM should also be offered vaccination for hepatitis B and HPV. Unfortunately, there is currently no vaccine available for hepatitis C, hepatitis D, gonorrhea, or genital herpes. However, these STIs can be treated with medication.

      Understanding Hepatitis A: Symptoms, Transmission, and Prevention

      Hepatitis A is a viral infection that affects the liver. It is usually a mild illness that resolves on its own, with serious complications being rare. The virus is transmitted through the faecal-oral route, often in institutions. The incubation period is typically 2-4 weeks, and symptoms include a flu-like prodrome, abdominal pain (usually in the right upper quadrant), tender hepatomegaly, jaundice, and deranged liver function tests.

      While complications are rare, there is no increased risk of hepatocellular cancer. An effective vaccine is available, and it is recommended for people travelling to or residing in areas of high or intermediate prevalence, those with chronic liver disease, patients with haemophilia, men who have sex with men, injecting drug users, and individuals at occupational risk (such as laboratory workers, staff of large residential institutions, sewage workers, and people who work with primates).

      It is important to note that the vaccine requires a booster dose 6-12 months after the initial dose. By understanding the symptoms, transmission, and prevention of hepatitis A, individuals can take steps to protect themselves and others from this viral infection.

    • This question is part of the following fields:

      • Infectious Disease And Travel Health
      0
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  • Question 16 - Choose the option that would be the LEAST probable reason for referring a...

    Incorrect

    • Choose the option that would be the LEAST probable reason for referring a patient with atrial fibrillation for rhythm control (cardioversion) if they were elderly.

      Your Answer:

      Correct Answer: Longstanding atrial fibrillation

      Explanation:

      Cardioversion for Atrial Fibrillation: NICE Guidelines and Considerations

      The National Institute for Health and Care Excellence (NICE) recommends referral to a cardiologist for rhythm-control treatment (cardioversion) in certain cases of atrial fibrillation. These include atrial fibrillation with a reversible cause, heart failure primarily caused or worsened by atrial fibrillation, and new-onset atrial fibrillation. If onset is known to be within 48 hours, referral to an acute medical unit is recommended for immediate cardioversion without anticoagulation treatment. Pharmacological cardioversion is often used as a first-line therapy, with electrical cardioversion reserved for non-responders. However, cardioversion may be less successful or not recommended in cases of long-standing atrial fibrillation, significant valve problems, cardiomegaly, or multiple recurrences of atrial fibrillation.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 17 - A 26-year-old man comes to you with complaints of a persistent sore throat...

    Incorrect

    • A 26-year-old man comes to you with complaints of a persistent sore throat and occasional hoarseness that has been bothering him for a few months. He expresses concern that there may be something lodged in his throat, but he is able to swallow without difficulty. He denies any significant weight loss and has no notable medical or family history.

      During your examination, you observe mild redness in the oropharynx, but the neck appears normal and there are no palpable masses.

      What would be the best course of action in this case?

      Your Answer:

      Correct Answer: Prescribe a trial of a proton pump inhibitor

      Explanation:

      Understanding Laryngopharyngeal Reflux

      Laryngopharyngeal reflux (LPR) is a condition that occurs when stomach acid flows back into the throat, causing inflammation in the larynx and hypopharynx mucosa. It is a common diagnosis, accounting for approximately 10% of ear, nose, and throat referrals. Symptoms of LPR include a sensation of a lump in the throat, hoarseness, chronic cough, dysphagia, heartburn, and sore throat. The external examination of the neck should be normal, with no masses, and the posterior pharynx may appear erythematous.

      Diagnosis of LPR can be made without further investigations in the absence of red flags. However, the NICE cancer referral guidelines should be reviewed for red flags such as persistent, unilateral throat discomfort, dysphagia, and persistent hoarseness. Lifestyle measures such as avoiding fatty foods, caffeine, chocolate, and alcohol can help manage LPR. Additionally, proton pump inhibitors and sodium alginate liquids like Gaviscon can also be used to manage symptoms.

      In summary, Laryngopharyngeal reflux is a common condition that can cause discomfort and inflammation in the throat. It is important to be aware of the symptoms and seek medical attention if red flags are present. Lifestyle measures and medication can help manage symptoms and improve quality of life.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
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  • Question 18 - During an injury involving valgus displacement and external rotation of the knee, which...

    Incorrect

    • During an injury involving valgus displacement and external rotation of the knee, which ligament is most commonly torn?

      Your Answer:

      Correct Answer: Medial collateral

      Explanation:

      Common Knee Injuries and Diagnostic Tests

      Knee injuries are common among young athletes participating in sports that involve aggressive knee flexion. Of all knee injuries, those to the medial side are the most frequent. Symptoms include pain and swelling over the medial aspect of the knee joint, instability with side-to-side movement, and tenderness along the course of the medial collateral ligament. Medial collateral ligament injuries often occur in association with cruciate and meniscal injuries, which should be excluded.

      The valgus stress test is a diagnostic test used to measure the amount of joint-line opening of the medial compartment of the knee when a valgus stress is applied at the ankle. A proficient tester may be able to quantify the amount of joint-line opening to determine the severity of the tear of the medial collateral complex of ligaments.

      Other knee injuries include anterior cruciate, lateral collateral, patellar, and posterior cruciate injuries. Anterior cruciate ligament injuries are most often a result of low-velocity, non-contact deceleration injuries and contact injuries with a rotational component. Lateral collateral ligament injuries may be due to a direct blow to the medial aspect of the knee or a varus stress. Patellar tendon ruptures are relatively infrequent and often the result of chronic tendon degeneration or sudden contraction of the quadriceps. Posterior cruciate injuries are most often due to hyperflexion, such as from a fall on a flexed knee or a car accident.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 19 - You see a 7-week old baby girl with her dad. He is worried...

    Incorrect

    • You see a 7-week old baby girl with her dad. He is worried as she has episodes where she cries uncontrollably and pulls her legs up to her tummy. She appears to be in pain and he is unable to calm her down. The crying doesn't seem to be related to feeding. The episodes last for around 30 minutes to 1 hour and occur for a total of about 3 hours a day. He finds it difficult to soothe her and is feeling exhausted.

      She is breastfed and is feeding well. She is growing appropriately and is having normal wet and dirty nappies.

      During the examination, she appears to be a healthy and content baby. No abnormalities are found.

      Which statement below, regarding infantile colic, is accurate?

      Your Answer:

      Correct Answer: Colic is associated with crying which most often occurs in the late afternoon or evening

      Explanation:

      Infantile colic is characterized by repeated episodes of excessive and inconsolable crying in an otherwise healthy and thriving infant. This condition typically begins in the first few weeks of life and resolves by around 3-4 months of age. The crying often occurs in the late afternoon or evening and may be accompanied by the infant drawing its knees up to its abdomen or arching its back. Colic affects both breastfed and bottle-fed infants and occurs equally in both sexes. However, it can lead to complications such as parental stress, anxiety, and depression, sleep deprivation, family tension, and attachment difficulties between parent and infant. It may also result in premature cessation of breastfeeding or weaning onto solid foods, as well as an increased risk of child maltreatment.

      Understanding Infantile Colic

      Infantile colic is a common condition that affects infants under three months old. It is characterized by excessive crying and pulling up of the legs, usually worse in the evening. This condition affects up to 20% of infants, and its cause is unknown.

      Despite its prevalence, the use of simeticone and lactase drops is not recommended by NICE Clinical Knowledge Summaries. These drops are commonly used to alleviate the symptoms of infantile colic, but their effectiveness is not supported by evidence. Therefore, it is important to seek medical advice before using any medication to treat infantile colic.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 20 - A 39-year-old lady presents with a mild cellulitis of the hand. She has...

    Incorrect

    • A 39-year-old lady presents with a mild cellulitis of the hand. She has no significant medical history and is not taking any regular medication. A finger prick blood glucose test shows a reading of 4.5 mmol/l. There are no complications and she appears to be in good health. You decide to prescribe flucloxacillin 500 mg qds. As per NICE guidelines, what is the standard duration for this course of antibiotics?

      Your Answer:

      Correct Answer: 10 to 14 days

      Explanation:

      NICE Guidance on Cellulitis and Erysipelas Treatment

      NICE has recently updated its guidance on the treatment of cellulitis and erysipelas with NG141. According to the new guidelines, Flucloxacillin 500mg qds is the first choice treatment for people over the age of 18. The recommended course of treatment is an oral course for 5 to 7 days. However, if a person is severely unwell or unable to take oral medication, a twice daily course of the intravenous antibiotic may be necessary. Based on clinical assessment, a longer course of up to 14 days may be needed. It is important to note that skin takes time to return to normal, and full resolution at 5 to 7 days is not expected.

    • This question is part of the following fields:

      • Dermatology
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  • Question 21 - You see a 65-year-old man who has right sided scrotal swelling which appeared...

    Incorrect

    • You see a 65-year-old man who has right sided scrotal swelling which appeared suddenly last week and is painful. He has no other relevant past medical history.

      On examination, he has what feels like a varicocele in his right scrotum. He has a swelling which feels like a 'bag of worms' and is above his right testicle. It remains there when he lies down.

      You discuss the fact that you think he has a varicocele with the patient. Which statement below is correct?

      Your Answer:

      Correct Answer: About 90% of varicoceles occur on the left side

      Explanation:

      It is common for men with a varicocele to experience pain or a sensation of heaviness or dragging in the scrotum. However, a varicocele on the right side alone is uncommon and requires referral to a urologist. Additionally, around 25% of men with abnormal semen parameters are found to have a varicocele, and this condition affects 40% of infertile men.

      Understanding Varicocele: Symptoms, Diagnosis, and Management

      A varicocele is a condition characterized by the abnormal enlargement of the veins in the testicles. Although it is usually asymptomatic, it can be a cause for concern as it is associated with infertility. Varicoceles are more commonly found on the left side of the testicles, with over 80% of cases occurring on this side. The condition is often described as a bag of worms due to the appearance of the affected veins.

      Diagnosis of varicocele is typically done through ultrasound with Doppler studies. This allows doctors to visualize the affected veins and determine the extent of the condition. While varicoceles are usually managed conservatively, surgery may be required in cases where the patient experiences pain. However, there is ongoing debate regarding the effectiveness of surgery in treating infertility associated with varicocele.

      In summary, varicocele is a condition that affects the veins in the testicles and can lead to infertility. It is commonly found on the left side and is diagnosed through ultrasound with Doppler studies. While conservative management is usually recommended, surgery may be necessary in some cases. However, the effectiveness of surgery in treating infertility is still a topic of debate.

    • This question is part of the following fields:

      • Kidney And Urology
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  • Question 22 - A 65-year-old woman presents to an early morning duty appointment with complaints of...

    Incorrect

    • A 65-year-old woman presents to an early morning duty appointment with complaints of increasing fatigue, abdominal pain, vomiting, and excessive thirst over the past week. She has a history of well-controlled hypertension with amlodipine and takes atorvastatin. She recently started a six-week course of high-dose colecalciferol, prescribed by another GP, but has only taken one dose so far. On examination, she appears fatigued and drowsy, but her observations are unremarkable. Urgent blood tests are ordered, and the results show a Hb of 124 g/L, platelets of 224 * 109/L, WBC of 6.4 * 109/L, Na+ of 141 mmol/L, K+ of 4.0 mmol/L, urea of 6.9 mmol/L, creatinine of 100 µmol/L, calcium of 3.7 mmol/L, phosphate of 1.1 mmol/L, magnesium of 1.0 mmol/L, and TSH of 3.24 mU/L. Looking back at her blood results from the previous week, her calcium was 2.56 mmol/L, phosphate was 1.2 mmol/L, magnesium was 0.8 mmol/L, and vitamin D was 7 nmol/L. Based on these findings, she is admitted directly under the acute medical team for further management. What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Primary hyperparathyroidism

      Explanation:

      If a patient with coexistent hyperparathyroidism undergoes rapid vitamin D replacement, it can lead to toxicity. In the case of this woman, she requires urgent admission under the medical team due to severe hypercalcaemia. The cause is likely vitamin D toxicity and unidentified primary hyperparathyroidism. Previous blood tests indicate a severe vitamin D deficiency, but her calcium level is at the higher end of normal, suggesting an overactive parathyroid gland that was masked by the low vitamin D. Testing for parathyroid hormone prior to administering vitamin D could have clarified this. It is advisable to seek advice from endocrinology before rapid vitamin D replacement if the baseline corrected calcium is >2.5. While multiple myeloma can cause hypercalcaemia, it doesn’t occur as rapidly. Paget’s disease causes an increased ALP with a normal calcium level, and thyrotoxicosis due to Graves disease can cause hypercalcaemia due to increased bone turnover, but a suppressed TSH would be expected.

      Vitamin D supplementation has been a topic of interest for several years, and recent releases have provided some clarity on the matter. The Chief Medical Officer’s 2012 letter and the National Osteoporosis Society’s 2013 UK Vitamin D guideline recommend that certain groups take vitamin D supplements. These groups include pregnant and breastfeeding women, children aged 6 months to 5 years, adults over 65 years, and individuals who are not exposed to much sun, such as housebound patients.

      Testing for vitamin D deficiency is not necessary for most people. The NOS guidelines suggest that testing may be appropriate for patients with bone diseases that may be improved with vitamin D treatment, such as osteomalacia or Paget’s disease, and for patients with musculoskeletal symptoms that could be attributed to vitamin D deficiency, such as bone pain. However, patients with osteoporosis should always be given calcium/vitamin D supplements, and individuals at higher risk of vitamin D deficiency should be treated regardless of testing. Overall, vitamin D supplementation is recommended for certain groups, while testing for deficiency is only necessary in specific situations.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
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  • Question 23 - A 50-year-old woman comes to you complaining of experiencing electric shock sensations and...

    Incorrect

    • A 50-year-old woman comes to you complaining of experiencing electric shock sensations and dizziness in her arms and legs for the past three days. She has a medical history of chronic pain, depression, and schizophrenia. When you inquire about her medications and drug use, she seems hesitant to provide a clear response.

      What could be the probable reason behind her symptoms?

      Your Answer:

      Correct Answer: SSRI discontinuation syndrome

      Explanation:

      SSRI discontinuation syndrome can cause symptoms such as dizziness, electric shock sensations, and anxiety when SSRIs are suddenly stopped or reduced. It is possible that the woman in question has decided to stop taking her antidepressants. On the other hand, alcohol withdrawal typically results in anxiety, tremors, and sweating. Neuroleptic malignant syndrome is a rare reaction that can occur with antipsychotic use and may cause fever, confusion, and muscle rigidity. Opiate withdrawal may cause anxiety, sweating, and gastrointestinal symptoms like diarrhea and vomiting.

      Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression, with citalopram and fluoxetine being the preferred options. They should be used with caution in children and adolescents, and patients should be monitored for increased anxiety and agitation. Gastrointestinal symptoms are the most common side-effect, and there is an increased risk of gastrointestinal bleeding. Citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in certain patients. SSRIs have a higher propensity for drug interactions, and patients should be reviewed after 2 weeks of treatment. When stopping a SSRI, the dose should be gradually reduced over a 4 week period. Use of SSRIs during pregnancy should be weighed against the risks and benefits.

    • This question is part of the following fields:

      • Mental Health
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  • Question 24 - A 4-year-old boy struggles with temper tantrums, shyness and communication delay. His mother...

    Incorrect

    • A 4-year-old boy struggles with temper tantrums, shyness and communication delay. His mother is concerned he may have autism.
      What is the SINGLE ‘red flag’ feature that would make you most concerned that this boy might have an autistic spectrum disorder?

      Your Answer:

      Correct Answer: Lack of response to his name

      Explanation:

      Recognizing Early Signs of Autism in Children

      Autistic spectrum disorders are often diagnosed after the age of three years, but parents may have concerns about their child’s development by 18 months. While a specialist diagnosis is required, general practitioners should be aware of warning signs. These include lack of social interactions, impaired communication, repetitive behavior, restricted interests, and difficulty regulating emotions. However, some behaviors that may seem concerning are actually normal parts of child development, such as copying gestures and exhibiting defiant behavior. It is important to note that language delay is a feature of autism, but only linking two words together in speech is a normal milestone that usually occurs between 20 and 24 months. When observing a child, it is crucial to look for a combination of these signs and seek professional evaluation if there are concerns.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 25 - A 76-year-old woman presents to your clinic with a gradual onset of visual...

    Incorrect

    • A 76-year-old woman presents to your clinic with a gradual onset of visual disturbance. She reports difficulty in recognizing facial details and increasing difficulty in reading. She also experiences bending of road edges while driving and sees a floating grey patch in her vision. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Age related macular degeneration

      Explanation:

      The most probable diagnosis for this description is age-related macular degeneration (ARMD). In the initial stages, patients may experience difficulty in reading or identifying details. A common symptom of ARMD is the perception of straight lines appearing bent or distorted, as mentioned in the description. This can be assessed in a clinical setting using an Amsler grid.

      Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by degeneration of the central retina (macula) and the formation of drusen. The risk of ARMD increases with age, smoking, family history, and conditions associated with an increased risk of ischaemic cardiovascular disease. ARMD is classified into dry and wet forms, with the latter carrying the worst prognosis. Clinical features include subacute onset of visual loss, difficulties in dark adaptation, and visual hallucinations. Signs include distortion of line perception, the presence of drusen, and well-demarcated red patches in wet ARMD. Investigations include slit-lamp microscopy, colour fundus photography, fluorescein angiography, indocyanine green angiography, and ocular coherence tomography. Treatment options include a combination of zinc with anti-oxidant vitamins for dry ARMD and anti-VEGF agents for wet ARMD. Laser photocoagulation is also an option, but anti-VEGF therapies are usually preferred.

    • This question is part of the following fields:

      • Eyes And Vision
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  • Question 26 - What is meant by the term 'power of the study' in the design...

    Incorrect

    • What is meant by the term 'power of the study' in the design of a randomised controlled trial?

      Your Answer:

      Correct Answer: The probability of a statistically significant treatment effect if the true treatment difference is at a prespecified level

      Explanation:

      Understanding Power Analysis in Statistical Studies

      Power analysis is a statistical tool used to determine the sample size required in a study to detect a significant difference at a predetermined level of significance and size of effect. It is an essential step in planning a study and helps researchers to avoid underpowered or overpowered studies.

      The predetermined level of significance is usually set at 0.05, which means that there is a 5% chance of obtaining a significant result by chance alone. The size of effect is the difference between the treatment and control groups that is considered clinically significant.

      It is important to note that the size of effect used in power analysis may not necessarily correspond to a clinically significant difference. Therefore, it is crucial to consult with experts in the field to determine an appropriate size of effect.

      In summary, power analysis is a crucial step in planning a study and helps researchers to determine the appropriate sample size needed to detect a significant difference at a predetermined level of significance and size of effect.

    • This question is part of the following fields:

      • Population Health
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  • Question 27 - A 65-year-old woman presents with a feeling of shortness of breath and choking,...

    Incorrect

    • A 65-year-old woman presents with a feeling of shortness of breath and choking, on lying down. Some six months earlier she had been diagnosed with atrial fibrillation. On examination, she has a goitre. Plain radiography confirms retrosternal extension, which is presumed to be contributing to her shortness of breath. Her thyroid-stimulating hormone (TSH) level is less than 0.04 mIU/l (normal range 0.17 - 3.2 mIU/l). Thyroid autoantibodies are negative.
      Which of the following diagnoses best fits with this patients clinical picture?

      Your Answer:

      Correct Answer: Toxic multinodular goitre

      Explanation:

      Toxic multinodular goitre is a condition that commonly affects women over 55 years of age and is more prevalent than Graves’ disease in the elderly. It is characterized by a goitre that obstructs and extends retrosternally, which may cause atrial fibrillation. The preferred treatment is surgery, but the patient should first be made euthyroid with carbimazole. Graves’ disease, on the other hand, is an autoimmune disorder that accounts for 75% of thyrotoxicosis cases. It is characterized by hyperthyroidism, diffuse goitre, and eye changes. Hashimoto’s thyroiditis is another autoimmune thyroiditis that initially causes hyperthyroidism followed by hypothyroidism. It is characterized by the aggressive destruction of thyroid cells, resulting in a goitre and high levels of autoantibodies against thyroid peroxidase. Thyroglossal cyst is a cyst that forms from a persistent thyroglossal duct and presents as an asymptomatic midline neck mass. Thyroid carcinoma, on the other hand, presents as a non-tender thyroid nodule with normal thyroid function tests.

    • This question is part of the following fields:

      • Metabolic Problems And Endocrinology
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  • Question 28 - A 50-year-old obese man has hyperpigmented, thickened, velvety skin, with surrounding skin tags...

    Incorrect

    • A 50-year-old obese man has hyperpigmented, thickened, velvety skin, with surrounding skin tags in both axillae.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acanthosis nigricans

      Explanation:

      Differential Diagnosis for Hyperpigmented Skin: Acanthosis Nigricans, Erythrasma, Melasma, Necrobiosis Lipoidica Diabeticorum, and Post-Inflammatory Hyperpigmentation

      Hyperpigmented skin can be caused by a variety of conditions. One possible cause is acanthosis nigricans, which presents with thick, velvety skin in the neck and flexures, often accompanied by skin tags. This condition is commonly associated with obesity and hereditary factors. However, it can also be a sign of an internal malignancy, particularly gastric cancer.

      Another possible cause of hyperpigmented skin is erythrasma, a bacterial infection that causes pink-red macules that turn brown, typically in the groin and axilla. However, the bilateral distribution of the pigmentation in this case makes erythrasma less likely.

      Melasma is another condition that can cause hyperpigmentation, but it typically presents with symmetrical blotchy brown pigmentation on the face. The distribution described in the scenario makes melasma less likely.

      Necrobiosis lipoidica diabeticorum is a rare condition that affects the shins of people with diabetes. However, the distribution of the pigmentation in this case rules out this condition as a cause.

      Finally, post-inflammatory hyperpigmentation can occur after trauma such as burns, causing flat macules. However, it doesn’t cause skin thickening, as described in this case.

      In summary, the differential diagnosis for hyperpigmented skin includes acanthosis nigricans, erythrasma, melasma, necrobiosis lipoidica diabeticorum, and post-inflammatory hyperpigmentation. A thorough evaluation is necessary to determine the underlying cause and appropriate treatment.

    • This question is part of the following fields:

      • Dermatology
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  • Question 29 - Sara is a 26-year-old woman who has presented to her GP with difficulty...

    Incorrect

    • Sara is a 26-year-old woman who has presented to her GP with difficulty breathing. She has a history of asthma and has been using her salbutamol inhaler regularly, but it has not been effective. Upon examination, bilateral wheezing is heard. Her oxygen saturation is 93%, and her peak expiratory flow is 190 L/min. Her usual peak flow is 400 L/min. After administering a nebulizer, her peak flow only increases to 200 L/min.

      What is the next step in managing this patient?

      Your Answer:

      Correct Answer: Refer her to the medical registrar for admission

      Explanation:

      The patient’s peak flow has dropped to 40% of normal, indicating a severe exacerbation of asthma. According to NICE guidelines, admission is recommended if severe attack features persist after a bronchodilator trial. As the peak flow has not improved, hospitalization is necessary.

      Administering another nebulizer is not advisable as the patient requires close monitoring and may need multiple nebulizers. Increasing the inhaled steroid dose and sending the patient home is also not recommended as it may lead to adverse outcomes.

      Prescribing 40 mg prednisolone for 5 to 7 days is suitable for patients who can be treated at home, but not for this patient with severe asthma requiring inpatient assessment and management.

      Antibiotics are only prescribed if the patient has no severe or life-threatening asthma features and shows signs of infection. As the patient’s asthma has not improved despite initial treatment, sending them home with antibiotics is not appropriate.

      Understanding Acute Asthma: Symptoms and Severity

      Acute asthma is a condition that is typically observed in individuals who have a history of asthma. It is characterized by worsening dyspnea, wheezing, and coughing that doesn’t respond to salbutamol. Acute asthma attacks may be triggered by respiratory tract infections. Patients with acute severe asthma are classified into three categories: moderate, severe, or life-threatening.

      Moderate acute asthma is characterized by a peak expiratory flow rate (PEFR) of 50-75% of the best or predicted value, normal speech, a respiratory rate (RR) of less than 25 breaths per minute, and a pulse rate of less than 110 beats per minute. Severe acute asthma is characterized by a PEFR of 33-50% of the best or predicted value, inability to complete sentences, an RR of more than 25 breaths per minute, and a pulse rate of more than 110 beats per minute. Life-threatening acute asthma is characterized by a PEFR of less than 33% of the best or predicted value, oxygen saturation levels of less than 92%, a silent chest, cyanosis or feeble respiratory effort, bradycardia, dysrhythmia or hypotension, and exhaustion, confusion, or coma.

      It is important to note that a normal pCO2 in an acute asthma attack indicates exhaustion and should be classified as life-threatening. Understanding the symptoms and severity of acute asthma can help healthcare professionals provide appropriate treatment and management for patients experiencing an acute asthma attack.

    • This question is part of the following fields:

      • Respiratory Health
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  • Question 30 - An 80-year-old woman presents for evaluation after sustaining a Colles' fracture while grocery...

    Incorrect

    • An 80-year-old woman presents for evaluation after sustaining a Colles' fracture while grocery shopping. She is seeking advice on further treatment options for bone protection. The patient has a history of hypertension, which is managed with amlodipine 5 mg and indapamide 1.5 mg, and no other significant medical history. On physical examination, her BMI is 24 kg/m2, and her blood pressure is 146/82 mmHg. Laboratory results reveal a hemoglobin level of 131 g/L (115-160), a white cell count of 4.2 ×109/L (4-10), and a platelet count of 195 ×109/L (150-400). Her sodium level is 140 mmol/L (134-143), potassium level is 5.0 mmol/L (3.5-5.0), eGFR is 37 ml/min/1.73m2 (below 75), albumin level is 39 g/L (36-47), and calcium level is 2.25 mmol/L (2.2-2.5). Her T score is −2.7 (> −2.5). What is the recommended first-line therapy for this patient?

      Your Answer:

      Correct Answer: Calcium alone

      Explanation:

      Treatment Options for Osteoporosis

      Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It is most common in postmenopausal women. Alendronate is a recommended treatment for preventing bone fractures in postmenopausal women who have already had a fracture and have been diagnosed with osteoporosis. Bisphosphonates are the most appropriate initial treatment for osteoporosis, as long as the estimated glomerular filtration rate (eGFR) is not below 35.

      For patients who are unable to take bisphosphonates or other treatments, or in those with severe osteoporosis as defined by T-score, strontium ranelate was recommended as an alternative. However, the manufacturers stopped supplying it to the UK in August 2017. Teriparatide, a parathyroid hormone (PTH) analogue, is reserved for use in the most severely osteoporotic patient group. It is important to note that any treatment should be started after a full cardiovascular risk assessment.

    • This question is part of the following fields:

      • Musculoskeletal Health
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SESSION STATS - PERFORMANCE PER SPECIALTY

Ear, Nose And Throat, Speech And Hearing (0/1) 0%
Kidney And Urology (1/1) 100%
Metabolic Problems And Endocrinology (0/1) 0%
Smoking, Alcohol And Substance Misuse (0/1) 0%
Neurology (1/1) 100%
Cardiovascular Health (1/3) 33%
Older Adults (1/1) 100%
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