1
Q
What are the differences between cost-effectiveness, cost-benefit, cost-utility and cost-minimisation analyses?
A
- Cost-effectiveness: Compares cost per single outcome (e.g. cost per life saved).
- Cost-benefit: Assigns monetary value to all outcomes.
- Cost-utility: Uses QALYs to measure benefit.
- Cost-minimisation: Compares cost only when outcomes are equivalent.
2
Q
Which sensory modalities are lost in syringomyelia?
A
Pain and temperature (dissociated sensory loss), with preserved vibration and proprioception
3
Q
Which joints are affected by neuropathic (Charcot) arthropathy in syringomyelia?
A
Shoulder joints
4
Q
Which acetylcholinesterase inhibitor is licensed for Parkinson’s-related dementia?
A
Rivastigmine
5
Q
Are extraocular muscles usually involved in motor neurone disease?
A
No they are typically spared
6
Q
What is the BNP threshold for echocardiogram within 6 weeks?
A
400–2000 pg/mL.
7
Q
What BNP level warrants urgent (2-week) echocardiogram and cardiology review?
A
> 2000 pg/mL.
8
Q
Do ACE inhibitors or beta-blockers improve mortality in heart failure with preserved ejection fraction?
A
No they do not
9
Q
What drug class should be added for heart failure with reduced ejection fraction (LVEF <40%)?
A
Aldosterone antagonist (e.g. spironolactone).
10
Q
What are the effects of aromatase inhibitors (e.g. anastrozole, letrozole) on bone health?
A
Increased risk of osteoporosis
11
Q
What is the most common inherited thrombophilia?
A
Factor V Leiden (Activated protein C resistance).
12
Q
What defines osteopenia on DEXA scan?
A
T score between -1 and -2.5
13
Q
What does the Z-score represent?
A
Bone density adjusted for age, sex, and ethnicity.
14
Q
When should bisphosphonates be started in a patient aged ≥50 on ≥7.5 mg prednisolone for ≥3 months?
A
Immediately, no tests needed
15
Q
What should be prescribed immediately for postmenopausal women with osteoporotic vertebral fractures?
A
bisphosphonate
16
Q
What is the diagnostic test for primary hyperaldosteronism?
A
Aldosterone-renin ratio
17
Q
Features of primary hyperaldosteronism?
A
Hypertension, hypokalaemia, metabolic alkalosis.
18
Q
What are the classical triad of Graves’ disease?
A
Ophthalmopathy, pretibial myxoedema, thyroid acropachy
19
Q
What is the initial levothyroxine dose in adults under 65 with no heart disease? What about those with heart disease?
A
1.6 mcg/kg/day.
In heart disease start with 25-50 mcg/day
20
Q
What are the risk factors for endometrial cancer?
A
Obesity, HRT, family history, tamoxifen, nulliparity, early menarche, late menopause.
21
Q
What are protective factors against endometrial cancer?
A
Coffee/tea drinking, COCP use, progesterone-releasing IUD.
22
Q
What is first line for infertility in PCOS? What is second?
A
1st = Clomifene
2nd = metformin
23
Q
Up to what gestation can a woman with an uncomplicated pregnancy fly?
A
36 weeks
24
Q
When is anti-D prophylaxis given in pregnancy?
A
28 & 34 weeks
25
When is COCP contraindicated post-pregnancy?
First 21 days (due to VTE risk).
26
What are the indications for 5 mg folic acid in pregnancy?
BMI ≥30, diabetes, sickle cell, thalassaemia, antiepileptic use, previous NTD, or family history.
27
How is gestational diabetes diagnosed?
Fasting glucose ≥5.6 mmol/L or 2-hour glucose ≥7.8 mmol/L.
28
When should insulin be started immediately in gestational diabetes?
Fasting glucose ≥7 mmol/L.
29
When should fasting glucose be repeated postpartum in gestational diabetes?
6–13 weeks after delivery.
30
What should be avoided in pregnancy for candidiasis treatment?
Clotrimazole pessary applicator.
31
What does “ECO” mnemonic stand for in missed COCP pills?
E = Emergency contraception (week 1)
C = Condoms (week 2)
O = Omit pill-free break (week 3)
32
What is the primary mode of action of the Nexplanon implant?
Inhibits ovulation.
33
How long does Nexplanon last?
3 years
34
What should women do with their normal oral contraception once they have taken ulipristal acetate (“EllaOne”)?
Wait 5 days before starting hormonal contraception; use barrier for 7 days total.
35
Malignancies particularly associated with thrombocytosis?
Lung, endometrial, gastro-oesophageal, colorectal, ovarian, renal.
36
What is the typical appearance of erythrasma?
Well-defined, brown-pink patches with fine scaling in skin folds.
37
What is Porphyria Cutanea Tarda characterised by?
Photosensitivity, bullae on sun-exposed areas, fragile skin.
38
What is Freiberg’s disease?
Infarction and flattening of 2nd metatarsal head due to interrupted blood supply.
39
What causes Roseola infantum (Sixth disease)?
Human herpesvirus 6 (HHV-6).
40
What is Meigs’ syndrome?
Benign ovarian fibroma + ascites + pleural effusion.
41
What is first-line antibiotic for pyelonephritis in children?
Cefalexin
42
What prophylaxis is given to contacts of meningococcal meningitis?
Oral ciprofloxacin or rifampicin.
43
What antibiotic is recommended for whooping cough (within 21 days)?
Azithromycin or clarithromycin.
44
Drugs contraindicated in breastfeeding?
Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides, lithium, benzodiazepines, aspirin, carbimazole, methotrexate, sulfonylureas, amiodarone, cytotoxics.
45
Which SSRI has the highest discontinuation symptoms?
Paroxetine
46
Which antiepileptic may cause weight loss and paraesthesia?
Topiramate
47
Which drug can precipitate acute angle-closure glaucoma?
Amitriptyline
48
Which drug inhibits digoxin clearance, increasing its concentration?
Diltiazem
49
Which pain medication is safest in renal impairment?
Fentanyl
50
Which drugs should be avoided in Parkinson’s disease?
Prochlorperazine, metoclopramide, haloperidol, fluphenazine, chlorpromazine, sulpiride, etc.
51
Which antiemetic is first-line in pregnancy?
Promethazine or cyclizine
52
What drugs can cause rhinitis?
ACEi, Alpha/beta blockers, aspirin, CCBs, decongestants, alcohol, chlorpromazine.
53
What lobe of the lung is typically affected by rheumatoid lung fibrosis?
Lower lobes.
54
What comorbidities are associated with rheumatoid arthritis?
Hypertension, IHD, osteoporosis, depression.
55
Which SSRI should be combined with olanzapine for bipolar depression?
Fluoxetine
56
What PHQ-9 score indicates severe depression?
Greater than or equal to 16
57
What is a nocebo effect?
Negative outcomes caused by negative expectations of treatment
58
How long must Group 1 and group 2 license holders avoid driving after TIA or stroke?
Group 1 = 1 month
Group 2 = 1 year
59
What deaths need reported to coroner include?
Sudden/unexpected, within 24h of admission, industrial disease, during surgery/anaesthetic, suicide, neglect, poisoning, in custody, etc.
60
When should mefloquine malaria prophylaxis be started?
2–3 weeks before travel (or up to 1–2 days before if last minute).
61
How long should malaria prophylaxis be continued after leaving endemic area?
4 weeks
62
Which antimalarial is available over the counter?
Chloroquine/proguanil.
63
How long is cannabis detectable in urine with heavy use?
Up to 27 days
64
How long are long-acting benzodiazepines detectable in urine?
Up to 7 days
65
What is Attendance Allowance (AA)?
Tax-free benefit for those over State Pension age needing help with personal care.
66
In pregnancy, the risk of DVT/VTE is how many times higher than in non-pregnant women?
5-10 times
67
At age 95, what % population will have dementia?
25%
68
In accordance with Department of Health guidance, brief intervention in excessive alcohol consumption is effective in what number of patients?
1 in 8
69
In the latest NICE guidance on heavy menstrual blood loss which treatment option reduces the blood loss by 43%?
COCP
70
A 15-year-old girl presented with spots on the face and forehead. On examination you see few pustules on both cheeks and the chin and few comedones on the forehead, chin and cheeks. What is the most likely diagnosis from the following?
Mild acne
71
In the Centor scoring for sore throats, at what age does the patient lose a point to their score?
Over 44
72
A 40 year old woman had a cholecystectomy 2 weeks ago. She presents to ED with jaundice, fever and dark urine. What is the single investigation most likely to find the cause?
ERCP
73
A patient with established osteoarthritis of his right hip asks your advice as to how he should use a walking stick. How would you respond?
Encourage him to use it on the left side and ensure that the top of the walking stick comes up to the distal crease of his wrist
74
In a patient with proven PTSD of more than 1 month duration, what is the SECOND line treatment in accordance with the latest NICE guidance?
SSRI
75
According to the Freedom of Information Act 2000, how long does the practice have to respond to a request for information?
20 days
76
In chronic heart failure, with reference to using a pacemaker, which of the following chambers of the heart are most commonly paced?
Right ventricle, right atrium and left ventricle
77
What percentage of abnormal liver function tests will still be abnormal if you repeat the test after a month?
84%
78
According to the international continence society definition in LUTs: A patient with daytime urinary frequency, nocturia, urgency and incontinence has symptoms of what?
Storage symptoms
79
What are the symptoms of hyponatraemia?
lethargy, anorexia, N+V, coma, reduced reflexes
80
A 60 year old smoker has increasing pain in both buttocks, thighs and calves on walking. He has recently started to get erectile dysfunction. Femoral and distal pulses are absent in both limbs. What is the SINGLE most likely site of arterial obstruction?
Aorto-iliac
81
Type 2 diabetes forms what percentage of all diabetes in the UK?
90%
82
You do a study in your practice comparing costs to treat depression using either Prozac or generic Fluoxetine. The outcome measure in your study is improvement in mental health. This is an example of what sort of analysis?
cost minimisation analysis
83
What percentage of abnormal liver function tests will still be abnormal if you repeat the test after a month?
84%
84
What is the first line management for a formula fed infant with GORD?
feeds reduced to 150ml/kg per day
85
A child presents with lethargy, fever and headache associated with a 'slapped-cheek' rash spreading to the proximal arms and extensor surfaces. What is the likely cause?
erythema infectiosum
86
What is a requirement post delivery for all breech babies?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
87
How does oral lichen plans normally present?
buccal white-lace pattern lesions and ulcers
88
What can be given for apthous mouth ulcers?
A short course of a low potency topical corticosteroid is an appropriate treatment for mouth ulcers
89
What can be used to identify refractory errors as a cause of blurred vision?
A pinhole occluder
90
What is the drug of choice in patients with compensated cirrhosis to prevent variceal haemorrhage
Carvediol
91
How do we manage barretts oesophagus?
high-dose PPI and endoscopic surveillance
92
Blood stained nipple discharge think...?
Papilloma
93
What drugs can trigger haemolysis in G6PD deficiency?
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas
94
If required, what Abx is used to manage campylobacter?
Clarithromycin
95
What is the treatment for guarddiasis?
Metronidazole
96
Monitoring requirements of lithium
body-weight or BMI, serum electrolytes, eGFR, and thyroid function every 6 months during treatment with lithium
97
The Hba1c target for patients on a drug which may cause hypoglycaemia?
53
98
In what patients taking prednisolone would we start bisphosphonates straight away rather than waiting on DEXA?
Postmenopausal women, men age over 50, who are treated with oral glucocorticoids for over 7.5 mg/day prednisolone or the next 3 months
99
What are the symptoms of osteomalacia?
Bone pain, tenderness and proximal myopathy (--> waddling gait)
100
Symptoms of Osteochondritis dissecans
knee pain after exercise, locking and 'clunking'
101
What is a good first line anti-emetic for intracranial causes of nausea and vomiting?
Cyclizine
102
How would you describe good inhaler technique?
Whilst using an inhaler, you should ideally hold your breath for 10 seconds after pressing down on the canister
103
What are the side effects of cyclosporin?
everything is increased - fluid, BP, K+, hair, gums, glucose
104
What is the most appropriate study design to investigate an infectious outbreak?
Case control
105
Vascular dementia accounts for what % of cases of dementia?
25%
106
Describe the pathological state of T2DM
Mainly a reduction in number and function of beta cells with a variable degree of insulin resistance
107
In Endometriosis what is the average delay to diagnosis in the UK? In years
8 years
108
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