wrong when revising Flashcards by K D

risk of NAFLD going to fibrosis, in percent

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31-year-old man has Achilles tendonitis. He has a sedentary job and cannot remember sustaining an injury. He has tried ibuprofen which helped the pain. He has psoriasis and had patellar tendonitis one year ago but is otherwise well.

Which is the SINGLE MOST appropriate next management step? Select ONE option only.

Question 109Select one:

A.
Refer to rheumatology

B.
Continue ibuprofen

C.
Change to naproxen

D.
Physiotherapy

E.
Local steroid injection

This man has recurrent enthesitis without apparent mechanical cause. As he also has psoriasis, a referral to rheumatology for a spondyloarthritis assessment would be advised.

The correct answer is: Refer to rheumatology

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least likely presentation of a maxiallry sinus tumour

frontal headache

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An urgent referral to a paediatrician is advised if the child is unable to:

Hold an object placed in their hand by five months
Reach for an object by six months
Sit unsupported by 12 months
Walk by 18 months (boys) or two years (girls)
Walk other than on tiptoes
Point at objects to share interest with others by two years
Run by two-and-a-half years

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Approximately what proportion of the population is likely to be a carer for a friend or relative at some point?

65%

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According to the National Institute for Health and Care Excellence (NICE) guidelines, up to what age does starting combined hormone replacement therapy (HRT) NOT increase a woman’s atherosclerotic cardiovascular disease (CVD) risk?

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increased risk for patients with down’s syndrome presenting as macrocytosis and hyponatraemia

hypothyroidism

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bloods presenting for patients with downs and had hypothyroidism

macrocytosis and hyponatraemia

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Normal binocular coordination becomes evident at —– and any persistent strabismus after this age is significant.

3 months

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woman on CHC with bleeding on pill free interval - what to do

swithc to a different CHC with a different progesterone

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positive likelihood ratio formula

sn/1-sp

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negative likelihood ration formula

1-sn/sp

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when to report FGM to police and when to local safeguarding

under 18 with confirmed FGM, under 18 at risk will be safeguarding

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Which of the following conditions is the SINGLE MOST likely to coexist with chronic pelvic pain?

Interstitial cystitis

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mastitis if no improvement for 48 hours (lactational)

send mcs off breastmilk and then change to co-amox

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The use of testosterone therapy is CONTRAINDICATED in women with a history of which cancer?

Hepatocellular

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termination managed with methotrexate, how long before becoming pregnant agaian

3 months

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drug recognised causes of amenorrhoea.

chlorpromazine, metoclopromide, domperidone

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breast creening - age and interval

50-70 every 3 years

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recurrent miscarriage is defined as

3 misc, does not have to be consecutive

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investugations which can be commenced in primary care for recurrent miswcarriage

Lupus anticoagulant and anticardiolipin antibodies
Pelvic ultrasound to assess for uterine anomalies
Thyroid function tests and thyroid peroxidase (TPO) antibodies

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You see a 64-year-old patient with multiple red, warm tender small joints of the hands.

What is the SINGLE MOST IMPORTANT next step? Select ONE option ONLY.

Question 37Select one:

A.
Blood tests including full blood count and inflammatory markers

B.
Serum uric acid levels

C.
Urgent referral to rheumatology

D.
Blood tests including rheumatoid factor and connective tissue autoimmune profile

E.
Plain x-ray both hands

heumatoid arthritis suggests that “adults with suspected persistent joint inflammation (synovitis) in more than 1 joint, or the small joints of the hands and feet, should be referred to rheumatology services within 3 working days of presenting in primary care

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According to current evidence, what PERCENTAGE of men who have a normal prostate specific antigen (PSA) test are subsequently found to have prostate cancer (false negative result)

15%

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Which ONE of the following investigations is MOST LIKELY to generate a FALSE POSITIVE result for the given condition? Select ONE option only.

Question 40Select one:

A.
Cancer antigen 19-9 (CA 19-9) in the diagnosis of pancreatic cancer

B.
Ultrasonography in the diagnosis of gallstones

C.
Urinary beta-human chorionic gonadotropin (B-hCG) in the diagnosis of pregnancy

D.
Antinuclear antibodies in the diagnosis of rheumatoid arthritis

E.
Echocardiography in the diagnosis of heart failure

Antinuclear antibodies in the diagnosis of rheumatoid arthritis

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test of cure needed for uti in pregnancy?

yes

The following nutritional deficiency is associated with chronic spontaneous urticaria in children

Iron

when to receive booster dose for tetanus if all doses given

10 years

neonatal diabetes associated with macrosomia or IUGR

IUGR

peristomal skin rash and ulcer - pyoderma gangrenosum - next step?

refer to secondary care, likely iwll get steroid or tacrolimus

Which one of the following organisms is the LEAST likely to be implicated in the development of pelvic inflammatory disease (PID)? Select ONE option only. Question 100Select one: A. Candida albicans B. Neisseria gonorrhoea C. Mycoplasma genitalium D. Chlamydia trachomatis E. Bacteroides species

candida

bone pain with abnormal xray and raised ALP

Paget's disease

Which of the following testicular tumours is the SINGLE MOST common in men aged over 50 years? Select ONE option only. Question 112Select one: A. Leydig cell tumour B. Non-Hodgkin's lymphoma C. Seminomatous germ cell tumour D. Non-seminomatous germ cell tumour E. Sertoli cell tumour

B. Non-Hodgkin's lymphoma

Down syndrome screening for pregnant women and when

first trimester (up to 14 weeks) usually combined test (ultrasound looking at nuchal translucency, hCG and pregnancy-associated plasma protein A). 16-20 weeks - quadruple test

A 65-year-old man with known type 2 diabetes mellitus comes to see you complaining of a one-week history of flashes and floaters affecting the lateral aspect of vision in his right eye. He describes a grey area evident in his right eye. He does not complain of any eye pain or red eye. What is the MOST likely diagnosis? Select ONE option only. Question 129Select one: A. Amaurosis fugax B. Macular degeneration C. Retinal detachment D. Glaucoma E. Uveitis

C. Retinal detachment

A 24-year-old man attends your evening surgery following an episode of collapse and jerking earlier in the day. He has a history of drug dependence. He tells you that he has not used any drugs for the last four days. This patient’s symptoms are MOST LIKELY due to abrupt withdrawal of which ONE of the following drugs? Select ONE option only. Question 137Select one: A. Cannabis B. Diazepam C. Codeine D. Mephedrone E. Methadone

Diazepam

A 45-year-old man has had ulcerative colitis for 20 years. It is usually well controlled on mesalazine 4 g daily. Having developed recent back pain, he has been taking ibuprofen 400 mg three times a day (which was prescribed for his wife). For the past week, he has had an increase in the frequency of his bowel motions which now occur four times a day and are more liquid than usual. He has had no rectal bleeding or fever. What is the SINGLE MOST appropriate drug adjustment to make? Select ONE option only. Question 138Select one: A. Add rectal prednisolone B. Stop ibuprofen C. Add oral prednisolone D. Add loperamide E. Increase mesalazine

Stop ibuprofen maximum dose of mesalazine is 4g

patient hypertensive on ARB, now planning to get pregnant, next step apart from specialst referral

switch to labetalol

A 25-year-old man has developed symptoms of agitation, restlessness and thoughts of self-harm over the past few hours. He is fidgety, easily distractible, cannot sit still and talks excessively. He has no past medical history. Which is the SINGLE MOST likely diagnosis? Select ONE option only. Question 146Select one: A. Autism spectrum disorder (ASD) B. Drug-induced C. Post-traumatic stress disorder D. Attention deficit hyperactivity disorder (ADHD) E. Generalised anxiety disorder (GAD)

B. Drug-induced

Which ONE of the following disease-modifying anti-rheumatic drugs (DMARDs) requires annual ophthalmic examination after 5 years of treatment?

Hydroxychloroquine

derm treatment which can cause influenza like illness

imiquimoid

hould be given first-line to manage troublesome hot flushes secondary to androgen deprivation therapy, initially for a period of 10 weeks.

Medroxyprogesterone

antipsychotics would offer the WORST side-effect profile for cardiovascular risk factors?

Clozapine

A 61-year-old man attends having received notification that his faecal immunochemical test (FIT) for colorectal cancer screening is abnormal. He has never had a screening before. What is his APPROXIMATE risk of having bowel cancer? Select ONE option only. Question 134Select one: A. 1% B. 2% C. 7% D. 15% E. 20%

mediterranean ethnicity - haemolytic feaures (FBC shown) after ciprofloxacin

g6pd

young woman, high aptt and low platelets, recurrent dvt

antiphospholipid

child started on amox for sore throat had rash - organism causing the infection?

EBV (can cause rash if started on ampicillin or amoxcillin)

normal hba1, pre diabetes, diabetes, target intesnification, acceptable pre surgery hba1c

normal >42 prediabetes 42-47 diabetes >=48 target 48 intesificaion 58 pre surgery less than 69

a patient on levothyroxine is at risk of developiong ewhat condition (especially if overrepalced)

osteoporosis

most common question - abx no to give for long qt

macrolides - clarithromycin, erythromycin

fungal nail infection treatment

oral terbinafine

specialist treatment for cluster headache that do not respond to treatment

high flow 02

The family of a 78-year-old palliative care patient in the last few weeks of life are asking for advice. The patient is a known diabetic on insulin. He is currently testing his blood sugars three-to-four times daily, which is causing him a lot of distress. What is the SINGLE MOST appropriate management option? Select ONE option only. Question 3Select one: A. Stop insulin therapy B. Change to metformin C. Stop blood glucose testing D. Reduce blood glucose testing to once or twice daily E. Continue current testing regimen

D. Reduce blood glucose testing to once or twice daily During the last days to weeks of life, if blood sugars are stable on the individual’s current regimen, testing can be stepped down to one or two times per day. Testing can be done at different times of the day to give a picture of the blood sugar levels over a number of days.

You see a 47-year-old lorry driver who has had lower back pain for some time. He has been using 10mg diazepam four times a day from his friend for the past 10 months. He refuses to engage with attempts to reduce the medication and says he will continue taking them. You advise him not to drive and to inform the Driver and Vehicle Licensing Agency (DVLA). How long is his licence likely to be refused or revoked for? Select ONE option only. Question 5Select one: A. 3 years B. 1 year C. 3 months D. 18 months E. 6 months

3 years for dependence on non prescribed benzos

Patient 1: Forced expiratory volume in one second (FEV1) 70% predicted, forced vital capacity (FVC) 72% predicted, FEV1/FVC = 86% Patient 2: Forced expiratory volume in one second (FEV1) 60% predicted, forced vital capacity (FVC) 85% predicted, FEV1/FVC = 62% Patient 3: Forced expiratory volume in one second (FEV1) 100% predicted, forced vital capacity (FVC) 101% predicted, FEV1/FVC = 80%

Patient 1 correct answer: Pulmonary fibrosis or kyphoscoliosis Both the FEV1 and the FVC are proportionally reduced. This is more consistent with restrictive lung disease such as pulmonary fibrosis or kyphoscoliosis. Patient 2 correct answer: Asthma or chronic obstructive pulmonary disease (COPD) The FEV1 is reduced proportionally more than the FVC. Without further history and reversibility testing however it is not possible to distinguish asthma from COPD. Patient 3 correct answer: Asthma or normal It is perfectly possible for a controlled asthmatic to have normal spirometry (and for that matter a normal peak flow). COPD by definition however would have an FEV1 of < 80% and an FEV1 / FVC < 70% even in the treated state. Pulmonary fibrosis would be associated with reduction of both FEV1 and FVC.

buorenorphine ot morphine fentanyl patch to morphine conversion

5mcg bup = 12mg mor 12mcg fen = 30 mg mor

palliative: bowel colic

hyoscine

palliative: anorexia

dexamethasone, prednisolone, progestogen

palliative: constipation first and addition

stimulant (bisacodyl, senna) then add macrogol (osmotic) after 4 days if no effect

palliative: muscle spasm

baclofen then diazepam

palliative: dry mouth

mout care

palliative: dysphagia

dexamethasone

side effect of dexamethasone in palliative care and treatment

oesophagitis, gtn sublingual before meals

antiemetic metabolic causes

haloperidol

antimetic raised IC pressure

cyclizine

antiemetic - GI causes such as stasis

metoclopromide

palliative care: Malodourous fungating tumours

metronidazole

antiemetic physical bowel obstruction

hyoscine

conversion oral morphine to subcu diamorphine subcu morphine subcu oxy

subcu diamorphine - /3 subcu morphine -/2 subcu oxy - /2

Consider urgent direct-access endoscopy referral if the patient h

as dysphagia or is over 55 years old with weight loss and any of the following: Upper abdominal pain, reflux, dyspepsia

A non-urgent direct-access endoscopy for those

aged 55 and over with: Treatment resistant dyspepsia or Upper abdominal pain with low haemoglobin levels or Raised platelet count with any of the following: Nausea or vomiting Weight loss Reflux Dyspepsia Upper abdominal pain or Nausea or vomiting with any of the following: Weight loss Reflux Dyspepsia Upper abdominal pain

NICE suggests for adults with advanced fibrosis due to NAFLD to consider

pioglitazone or vitamin E, whether they have diabetes or not.

. For people at high risk of ulceration (including previous ulceration) who require an NSAID,

consider a cox-2 or low dose ibuprofen in combination with a proton pump inhibitor.

severe oesophagitis should be treated with ]? if fails?

a full-dose proton pump inhibitors (PPIs) for eight weeks. A full dose of lansoprazole is 30 mg daily. high dose of fails (30BD)

A 42-year-old patient recently diagnosed with gallstones following an emergency department attendance with a biliary colic is asking whether any of her medication could have contributed to her gall bladder disease. Which SINGLE medication is MOST likely to have contributed? Select ONE option only. Question 7Select one: A. Semaglutide B. Amlodipine C. Metformin D. Naproxen E. Omeprazole

Medications identified as risk factors include octreotide, glucagon-like peptide-1 analogues, hormone replacement therapy (HRT) and ceftriaxone.

A 19-year-old woman presents with anorexia and marked tiredness. Over the last two months she has had recurring diarrhoea and abdominal pain with weight loss. She has not passed any blood per rectum, but has had perianal pain. She smokes, but drinks alcohol only rarely. On examination, she is pale and looks unwell. The abdomen is soft, but a mass is present in her right iliac fossa. Her body mass index is 18 kg/m2. What is the SINGLE MOST likely diagnosis? Select ONE option only. Question 9Select one: A. Colorectal Cancer B. Coeliac disease C. Crohn’s disease D. Ileal tuberculosis E. Anorexia nervosa

Clinically, this is most likely to be a case of Crohn’s disease. Abdominal pain, diarrhoea and weight loss are typical. Bloody diarrhoea is seen in about half of Crohn’s cases compared with it being present in nearly all cases of ulcerative colitis. An abdominal mass is common in Crohn's, but rare in ulcerative colitis; perianal disease (a possible cause of her perianal pain) is common in Crohn's, but again rare in ulcerative colitis. Crohn’s is more common in smokers than non-smokers. Despite these differences between Crohn’s and ulcerative colitis, a firm diagnosis, one from the other, is not made in 15–20% of patients. Crohn’s affects women more than men and most commonly the age group 15–35 years. In adolescents, a presentation with weight loss (without abdominal pain or diarrhoea) may be misdiagnosed as anorexia nervosa. Ileal tuberculosis might be suspected in the immigrant population and should be investigated with a stool culture.

(age) patients can be reassured that lower GI bleeding (in the absence of other symptoms or relevant family history), is usually benign and self-limiting. Recurrent bleeding lasting more than (time) should be investigated by referral for colonoscopy.

under 50, more than 6 weeks

Which is the SINGLE MOST likely biochemical abnormality with non-alcoholic fatty liver disease (NAFLD)? Select ONE option only. Question 16Select one: A. Isolated raised alanine aminotransferase (ALT) B. Isolated raised aspartate aminotransferase (AST) C. Isolated raised gamma-glutamyl transferase (GGT) D. Relatively greater rise in alkaline phosphatase (ALP) than alanine aminotransferase (ALT) E. Relatively greater rise in alanine aminotransferase (ALT) than aspartate aminotransferase (AST)

Relatively greater rise in alanine aminotransferase (ALT) than aspartate aminotransferase (AST) The characteristic biochemical changes of NAFLD show a relatively greater rise in alanine aminotransferase (ALT) than in aspartate aminotransferase (AST). These changes tend to reverse, and ALT levels fall as hepatic fibrosis progresses.

contribute to the Child–Pugh score in assessing severity of cirrhosis

Albumin, bilirubin, international normalised ratio (INR) and the degree of both ascites and encephalopathy

Opioid-induced bowel dysfunction is a side effect of chronic opioid use. It refers to a collection of primarily gastrointestinal motility disorders induced by opioids. These symptoms include

dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stool and delayed digestion.

parental leave - req re time working to qualify, how many weeks per child and up to when, max per year

Parents must be an employee and have at least one year’s continuous service to qualify. Parental leave is unpaid and the entitlement is up to 18 weeks’ leave for each child and adopted child, up to their 18th birthday. The limit on how much parental leave each parent can take in a year is 4 weeks for each child (unless the employer agrees otherwise).

A 35-year-old woman has been taking 10 mg of prednisolone daily for the past three months for treatment of her rheumatoid arthritis. Which is the SINGLE MOST appropriate way of assessing her risk of fragility fracture? Select ONE option only. Question 2Select one: A. Dual-energy X-ray absorptiometry (DXA) scan B. No Assessment until 75 years old C. Magnetic resonance imaging (MRI) of the lumbar spine D. QFracture E. No assessment required until age 50 years old

NICE advise that GPs should, calculate the 10-year fragility fracture risk before arranging a DXA scan. QFracture is the preferred method of calculating this, although FRAX can be used as an alternative.

A 68-year-old woman has been treated for a right sided fracture of the neck of femur following a fall after leaving a drinks party. She has been assessed at the local fracture prevention clinic and offered advice on falls prevention. DXA (Dual-energy X-ray absorptiometry) has shown a T score of -2.1 in the left neck of femur. Which of the following is the SINGLE MOST appropriate treatment advice? Select ONE option only. Question 10Select one: A. Alendronic acid 70 mg tablets weekly B. Calcichew D3 forte 2 tablets daily alone C. Lifestyle advice D. Treatment should be guided by body mass index E. Zoledronic acid 5 mg intravenous infusions every 18 months

Both NICE and SIGN recommend that patients older than 50 years have a DXA scan following a fragility fracture, without needing to undertake a fragility fracture risk assessment such as FRAX® or QFracture®. DXA scores between -1.0 and -2.5 indicate osteopenia (T score -2.5 or more negative indicates osteoporosis). This patient has osteopenia. In patients older than 65 years who have suffered a hip fracture and have osteopenia, treatment with zoledronic acid (as an infusion every 18 months for 6 years) is recommended by SIGN. This benefit is not noted for oral bisphosphonates.

A 75-year-old man with a history of gout is having a review for his chronic kidney disease. Gout is associated with the metabolic syndrome and is affected by prescribed medications. Which ONE of the following increases the risk of gout? Select ONE option only. Question 11Select one: A. Beta blockers B. Calcium channel blockers C. Fenofibrate D. Losartan E. Sodium glucose cotransporter 2 inhibitors

Beta blockers, diuretics, ACE inhibitors and aspirin increase serum urate levels and may trigger gout. Sodium glucose cotransporter 2 inhibitors, calcium channel blockers, fenofibrate and losartan all decrease urate levels.

A 50-year-old woman is generally well, has no significant past medical history and takes no medication. She smokes 20 cigarettes daily. According to the National Institute for Health and Care Excellence (NICE) guidelines, which is the EARLIEST appropriate age at which to FIRST consider assessment of her fragility fracture risk? Select ONE option only. Question 12Select one: A. 45 B. 55 C. 75 D. 65 E. 70

NICE recommends a targeted assessment of fracture risk of all women from the age of 65 and all men from the age of 75. Women and men under 65 can have a fracture risk assessment if they have additional risk factors present such as low BMI, previous fragility fracture, family history of osteoporosis, high alcohol intake and smoking. However NICE does not recommend routine assessment below 50 years unless there are major risk factors (previous fragility fractures, oral or systemic corticosteroid, premature menopause).

A 26-year-old woman has had an urticarial rash on her torso and arms that has appeared intermittently but most days for the past eight weeks. During this time, she has also felt fatigued, hot and constantly ‘on edge’. She has no dyspepsia, reflux or anorexia. She has not been able to link the rash to any particular food but is concerned a food allergy may be the cause. Which ONE of the following tests would be most helpful to arrange in this scenario? Select ONE option only. Question 6Select one: A. Cow’s milk IgE B. Liver function tests C. Coeliac serology D. Patch testing E. TFTs and thyroid autoantibodies

Autoimmune disease, including thyroid disease, can cause urticaria. The clues here include the persistent symptoms and associated fatigue, heat sensitivity and possible hyperactivity. The history is not typical of a dairy allergy or wheat intolerance and IgE testing or Coeliac serology are not typically helpful in investigating urticaria. Patch testing does not have a role in the assessment of urticaria. Checking liver function tests is unlikely to identify a cause of urticaria in this scenario. The correct answer is: TFTs and thyroid autoantibodies

A 72-year-old man has had a venous leg ulcer successfully treated over the past 16 weeks. leg lesion, hyperpigmented what is it

Haemosiderin deposition

white patch in tongue - which is painless and with pain to differentiate?

Luekoplakia - painless - urgent referral Candia and lichen planus - with pain

acute sinusitis first line, snd if no improvement or with severe illness

pen v then co-amox

A 15-year-old girl is unwell with a sore throat but no cough. On examination, she has tonsillar exudates, tender anterior cervical lymphadenopathy and a fever. Which is the SINGLE MOST likely causative organism? Select ONE option only. Question 18Select one: A. Group A Streptococcus B. Group B Streptococcus C. Group C Streptococcus D. Non-pyogenic Streptococcus E. Streptococcus pneumoniae

Group A Streptococcus

A 37-year-old woman is undergoing fertility investigations. Blood tests show she is non-immune to rubella. Which is the SINGLE MOST appropriate MINIMUM time period, if any, for which she should be advised to DELAY conception after her vaccination? Select ONE option only. Question 17Select one: A. One month B. Two months C. Three months D. Six months E. No delay necessary

one month

---- is the predominant cause of pulmonary infection in cystic fibrosis throughout childhood and the early teenage years, with ---- the next most frequently causative organism. In the late teenage years,--- becomes more common, and remains responsible for 80% of pulmonary infection throughout adult life.

Staphylococcus aureus is the predominant cause of pulmonary infection in cystic fibrosis throughout childhood and the early teenage years, with Haemophilus influenza the next most frequently causative organism. In the late teenage years, Pseudomonas aeruginosa becomes more common, and remains responsible for 80% of pulmonary infection throughout adult life.

A 68-year-old patient with known chronic obstructive pulmonary disease is looking for advice on the criteria for starting long term oxygen therapy (LTOT). Which SINGLE option is MOST appropriate? Select ONE option ONLY. Question 14Select one: A. Partial pressure of oxygen (PaO2) of < 8kPa B. Partial pressure of oxygen (PaO2) <7.3kPa in patients with pulmonary hypertension, secondary polycythaemia, or peripheral oedema from cor pulmonale C. Chronic hypoxemia oxygen saturation of <92% measured on 2 occasions at least three weeks apart and at least 5-6 weeks after an exacerbation D. Partial pressure or oxygen (PaO2) of >8kPa E. Chronic hypoxemia oxygen saturation of <88% measured on 2 occasions at least three weeks apart and at least 5-6 weeks after an exacerbation

Chronic hypoxemia oxygen saturation of <92% (measured on 2 occasions at least three weeks apart and at least 5-6 weeks after an exacerbation)

What is the SINGLE MOST useful investigation for making the diagnosis of pulmonary fibrosis? Select ONE option only. Question 15Select one: A. Bronchoscopy B. High Resolution Computed tomography C. Chest X-ray D. Sputum examination E. Pulmonary function tests

High Resolution Computed tomography

Which SINGLE ONE of the following diseases is associated with non-cystic fibrosis bronchiectasis? Select ONE option only. Question 4Select one: A. Polymyalgia rheumatica B. Diabetes mellitus C. Rheumatoid arthritis D. Hypothyroidism E. Gastro-oesophageal reflux

Rheumatoid arthritis

As the duty doctor, you are asked to deal with the result of a positive sputum culture for a patient with cystic fibrosis. The patient is asymptomatic apart from his usual intermittent dry cough. On examination his vital signs are all normal and his chest is clear. What is the SINGLE MOST appropriate management option? Select ONE option only. Question 12Select one: A. Arrange for a chest X-ray B. Start oral antibiotics C. Watch and wait D. Arrange for an urgent admission E. Repeat the sputum culture

Start oral abx n patients with cystic fibrosis, sputum cultures, cough or nasal aspirates should be checked regularly. Positive cultures should prompt aggressive management with antibiotics, irrespective of whether or not clinical symptoms are present.

A 74-year-old man has chronic obstructive pulmonary disease (COPD) and has Medical Research Council (MRC) dyspnoea Grade 2. He has a normal body mass index (BMI). He occasionally uses a salbutamol inhaler and is not functionally impaired by his COPD. He has stopped smoking and is keen to prevent any deterioration. According to current guidance, which is the SINGLE MOST appropriate management? Select ONE option only. Question 14Select one: A. Annual influenza vaccination B. Inhaled corticosteroid C. Prophylactic antibiotics D. Pulmonary rehabilitation E. Weight reduction

Annual influenza vaccination

A 38-year-old man has recently been diagnosed with COVID-19. He is concerned about the reports of patients suffering from “long COVID” and asks you about his risk of developing this condition. Which ONE of the following is a risk factor for continuing symptoms of post-acute COVID-19? Select ONE option only. Question 15Select one: A. Asthma B. Diabetes mellitus C. Low BMI D. Male sex E. Younger age

Asthma

Which TWO of the following features are MOST LIKELY to support a diagnosis of asthma in a child? Select TWO options only. Question 12Select one or more: A. Family history of eczema B. Premature delivery C. Recurrent chest tightness at night D. Recurrent moist cough E. Recurrent wheeze preceded by runny nose

Family history of eczema Recurrent chest tightness at night A family or personal history of atopy * A family history of asthma * More than one symptom such as episodic wheeze/cough/difficulty breathing/chest tightness * Wheeze confirmed by a healthcare professional on auscultation

A 69-year-old smoker has had lifelong asthma needing occasional use of a salbutamol inhaler. Eight weeks ago she was treated with amoxicillin and prednisolone for a chest infection. A chest X-ray was reported as normal and, after spirometry, she was diagnosed with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). She continues to be wheezy, breathless and has recurrent haemoptysis. In addition to stopping smoking, which of the following is the SINGLE MOST appropriate management? Select ONE option only. Question 13Select one: A. Add inhaled corticosteroid B. Add inhaled corticosteroid/long-acting beta agonist C. Refer to pulmonary rehabilitation D. Repeat spirometry E. Urgent referral to secondary care

The persistent haemoptysis with on going symptoms means that, despite a negative chest X-ray, lung cancer needs to be urgently ruled out. E. Urgent referral to secondary care

The drugs which may cause pulmonary fibrosis include:

Cytotoxic drugs e.g. busulfan, bleomycin, methotrexate, cyclophosphamide Antibiotics e.g. nitrofurantoin Cardiac drugs e.g. hydralazine, amiodarone, tocainide Opioids e.g. heroin abuse

svco:\\The jugular venous pulse has a steep y descent B. The jugular venous pulse has a prominent a wave C. The jugular venous pulse rises on inspiration D. The jugular venous pulse is raised and fixed E. The jugular venous pulse has giant v waves

The jugular venous pulse is raised and fixed

The following smokers aged in their 60s have pain in the right arm. Which ONE is most likely to have lung cancer? Select ONE option only. Question 15Select one: A. There is a small right pupil and slight ptosis B. When the patient smiles the mouth pulls to the left and the right eye does not shut C. The right pupil is larger than the left but reacts. There is no ptosis and the eyes move normally D. The right corneal reflex is absent E. There is fasciculation of the tongue

There is a small right pupil and slight ptosis The patient with a small right pupil and slight ptosis has Horner’s syndrome (ptosis, miosis and lack of sweating on the associated side). In association with arm pain (often severe and down the medial side) consider Pancoast’s syndrome. This is easily missed both by clinician and radiologist unless it is considered.

A 30-year-old seeks your advice because his cousin, who spent several months living with him and his family in the past year, has been diagnosed with pulmonary tuberculosis (TB). He is married with three children aged six to nine years of age. He is worried that he and his family have been exposed to the disease and you intend to refer him to secondary care. He has not previously been vaccinated. What is the most appropriate FIRST line test? Select ONE option only. Question 17Select one: A. Sputum culture B. Ziehl–Nielsen stain of sputum C. Interferon-gamma assay D. Mantoux test E. Chest X-ray

Mantoux testThe National Institute for Health and Care Excellence (NICE) recommends a 2-step approach to diagnosis of tuberculosis, with a Mantoux test followed by interferon-gamma assay if the Mantoux test is positive.

high risk cap tx

co-amox + clari

?crb65 - for confusion, amt score of

less than 8

A 54-year-old lady comes to see you four days after a having a general anaesthetic for repair of an inguinal hernia with fever, cough, green phlegm, tachycardia and shortness of breath. A COVID-19 test is negative. What is the SINGLE MOST likely diagnosis? Select ONE option only. Question 8Select one: A. Postoperative pneumonia B. Pulmonary embolism C. Postoperative pneumothorax D. Upper respiratory infection E. Postnasal drip

Postoperative pneumonia

HPV vaccination: how many doses needed per age group

under 25 - 1 25-45 - 2 immunocompormised - 3

depo injection for contraception interval

every 14 weeks

high prevelance HIV in numbers what is the ratio

2-5 in 1000

A 24-year-old male patient has just been diagnosed with Chlamydia trachomatis following presentation with typical symptoms of urethritis. He is asking advice about partner notification. Which SINGLE option is MOST appropriate? Select ONE option only. Question 5Select one: A. All partners since, and in the two weeks prior to, the onset of symptoms B. All partners since, and in the four weeks prior to, the onset of symptoms C. All partners since, and in the six weeks prior to, the onset of symptoms D. No sexual partner notification is needed E. All partners since, and in the twelve weeks prior to, the onset of symptoms

All partners since, and in the four weeks prior to, the onset of symptoms

If quick starting combined hormonal contraception (except Qlaira) immediately after progestogen-only emergency contraception, condoms or avoidance of sex should be advised for ----- if the woman is day ---- or beyond in her cycle. No precautions are required between days ----

If quick starting combined hormonal contraception (except Qlaira) immediately after progestogen-only emergency contraception, condoms or avoidance of sex should be advised for seven days if the woman is day six or beyond in her cycle. No precautions are required between days 1–5.

In which APPROXIMATE percentage of cases is the cause of infertility due to disorders in BOTH partners? Select ONE option only. Question 15Select one: A. 5% B. 10% C. 20% D. 40% E. 60%

A 23-year-old woman had unprotected sexual intercourse (UPSI) seven days ago. A urine pregnancy test is negative, and she starts combined hormonal contraception (CHC) immediately. After how many days from today does she require a repeat pregnancy test, if at all? Select ONE option only. Question 10Select one: A. 3 B. 5 C. 7 D. 14 E. 21 F. Not necessary

A 21-year-old nurse is commenced on carbamazepine for complex partial epilepsy. She has previously been happy on the combined oral contraceptive pill (COCP) and the epilepsy specialist nurse has advised her to seek your advice on contraception. Which of the options below is the SINGLE MOST appropriate? Select ONE option only. Question 12Select one: A. Change to depot contraceptive injection B. Change the COC to a progesterone only pill C. Leave her on her current dose of COC and reduce the carbamazepine D. Advise barrier methods due to the significant drug interaction E. Leave her on her current dose of COC and increase the carbamazepine

Change to depot contraceptive injection

You are initiating a combined oral contraceptive pill for a woman with no contraindications. Which ONE of the following contraceptives should be offered first-line? Select ONE option only. Question 12Select one: A. A pill containing 35–50 mcg ethinylestradiol and drospirenone B. A pill containing only desorgestrel C. A pill containing ≤30 mcg ethinylestradiol and levonorgestrel D. A multiphasic pill E. A pill containing estradiol valerate and dienogest

A pill containing ≤30 mcg ethinylestradiol and levonorgestrel

A 25-year-old lady tested positive for chlamydia infection. She and her partner have been treated with azithromycin. She is asking for advice on when they can resume sexual intercourse. Which option is the SINGLE MOST appropriate? Select ONE option only. Question 1Select one: A. Sexual intercourse should be avoided until a test of cure (TOC) is performed B. Sexual intercourse should be avoided for three weeks after treatment with azithromycin C. Sexual intercourse should be avoided for seven days after treatment with azithromycin D. Sexual intercourse can resume straight after treatment with azithromycin E. Sexual intercourse should be avoided for fourteen days after treatment with azithromycin

Sexual intercourse should be avoided for seven days after treatment with azithromycin

when is TOC recommended for chlamydia and when

when pregnant, poor compliance, perstent symptoms 3 weeks after abx

A 23-year-old woman is consulting with you regarding her contraceptive choices. She wants to know how effective contraceptive pills are. Which ONE of the following sets of figures about perfect use and typical use are accurate for failure rate in the first year of use? Select ONE option only. Question 2Select one: A. Failure rate with perfect use is less than 1% & with typical use is 1% B. Failure rate with perfect use 1% & with typical use is 3% C. Failure rate with perfect use is less than 1% & with typical use is 8% D. Failure rate with perfect use is 3% & with typical use is 3% E. Failure rate with perfect use is 3% & with typical use is 8%

Failure rate with perfect use is less than 1% & with typical use is 8%

According to the British HIV Association (BHIVA) guidelines, how long after exposure should a negative HIV test be repeated to exclude HIV infection? Select ONE option only. Question 7Select one: A. 45 days B. 7 days C. 35 days D. 28 days E. No requirement to repeat a negative HIV test

An 18-year-old girl presents with teenage spots. On examination she has numerous non inflamed comedones on her face but few inflammatory lesions. She would like to go on to the contraceptive pill and has no other medical history. Which ONE of the following options would be MOST suitable? Select ONE option only. Question 8Select one: A. Cerazette (desogestrel 35 microgram) B. Microgynon 30 (levonorgestrel 150 microgram + ethinyloestradiol 30 microgram) C. Marvelon (desogestrel 150 microgram + ethinyloestradiol 30 microgram) D. Noriday (norethisterone 350 microgram) E. Dianette (co-cyprindiol)

C. Marvelon (desogestrel 150 microgram + ethinyloestradiol 30 microgram)

HIV patient face looking thin and cheekbone prominent - change of meds recently, diagnosis?

Lipodystrophy in HIV infection is associated with highly active antiretroviral therapy (HAART) regimens containing protease inhibitors (PI) or nucleoside reverse transcriptase inhibitors (NRTI).

first-line treatment for mycoplasma genitalium associated pelvic inflammatory disease.

Oral moxifloxacin 400nmg once daily is used for 14 days

A 28-year-old woman has developed dysuria, frequency and a slight vaginal discharge over the past three days. Her LMP was normal, two weeks ago. An MSU was sent by the out of hours service and shows: WCC >104 WBC/mL RBC nil No growth Which is the SINGLE MOST likely diagnosis? Select ONE option only. Question 15Select one: A. Asymptomatic bacteriuria B. UTI C. Normal D. Ovulation symptoms E. Chlamydia trachomatis infection

Chlamydia trachomatis infection pyuria

A healthy 16-year-old girl consults you regarding the consequences of chlamydial infection. Which of the following statements is true? Select ONE option only. Question 17Select one: A. 50% of patients with pelvic inflammatory disease due to chlamydia will develop infertility B. It is a common cause of pneumonia C. 90% of infected females will develop pelvic inflammatory disease if untreated D. The risk of pelvic inflammatory disease is greatest after the first chlamydial infection E. It is a common cause of ectopic pregnancy

Which cancer is SINGLE MOST likely to be associated with advanced HIV disease? Select ONE option only. Question 19Select one: A. Kidney B. Prostate C. Cervix D. Breast E. Colorectal

cervix

What is the LATEST time after exposure that immunisation with hepatitis B vaccine should be given? Select ONE option only. Question 6Select one: A. Three days B. Two days C. 28 days D. One day E. Seven days

Seven days

Extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis - organism for farmers and exposure to mushroom

thermophilic actinomycetes

should be considered as a possibility when chronic gastrointestinal diseases, such as constipation, and atopic diseases, such as eczema and asthma, have not responded to treatment.

Food allergy

In allergy testing, which test is an indirect measure of cutaneous mast cell reactivity due to the presence of specific IgE? Which SINGLE option is MOST appropriate? Select ONE option only. Question 16Select one: A. Oral food challenge B. Skin prick tests C. Serum specific IgE blood tests D. Patch testing E. Diagnostic elimination of food items

Skin prick tests

A 14-year-old girl has well-controlled inflammatory bowel disease (IBD). She is concerned as she has not yet started her periods. She has breast development, as well as pubic and axillary hair growth. Her height and weight are progressing along the 25th centile. Which is the SINGLE MOST appropriate initial management option? Select ONE option only. Question 8Select one: A. Serum gonadotrophins B. Pelvic ultrasound scan C. Refer to a paediatrician D. Reassure and review in six months E. Thyroid function tests

Reassure and review in six months IBD can casue delayed menstruation

Learning disability is defined by three core criteria

lower intellectual ability (usually an IQ of less than 70); significant impairment of social or adaptive functioning; and onset in childhood

The mother of a nine-year-old boy with ADHD has kept a food diary and is convinced that his symptoms are worse after he eats anything containing artificial colouring. According to current guidance, which is the SINGLE MOST appropriate INITIAL recommendation? Select ONE option only. Question 9Select one: A. Refer to a dietician B. No dietary changes C. Few-foods diet D. Elimination diet E. Refer to a paediatrician

Refer to a dietician

downs syndrome and eye lesion

syrongomia

You visit a 67-year-old man in your local residential home. He is registered as a temporary resident and his full medical records are not available. You note that he has previously been under the care of a psychiatrist. On examination he has a bilateral resting tremor, with occasional rhythmic involuntary movements of his face. Which is the SINGLE MOST likely drug for this patient to have been taking for his psychiatric illness? Select ONE option only. Question 6Select one: A. Clozapine B. Lithium C. Lofepramine D. Flupentixol E. Sodium valproate

Flupentixol

ssri that can prolong qt the most and presents with PALPITATIONS especially if interaction with HIV meds

citalopram

You see a 49-year-old woman in your morning surgery for routine review of her bipolar affective disorder. She remains well-controlled on lithium carbonate which she has been taking for 18 months. She has no other medical issues and does not take any other medication. Which of the following is the SINGLE MOST appropriate blood monitoring regime for this patient? Select ONE option only. Question 10Select one: A. Full blood count, serum lithium, serum glucose, renal function tests and thyroid function tests every 12 months B. Serum lithium every three months, and serum glucose, cholesterol and renal function tests every six months C. Serum lithium, thyroid function, renal function and bone profile every six months D. Serum lithium every three months, and liver function, renal function and thyroid function tests every six months E. Serum lithium, thyroid function and renal function tests every 12 months

Serum lithium, thyroid function, renal function and bone profile every six months

What is the most common age range for onset of bipolar disorder? Select ONE option only. Question 4Select one: A. 20–24 years B. 30–34 years C. 35–39 years D. 25–29 years E. 15-19 years

15-19 years

Patients with depression are usually able to describe their mood, and symptoms tend to develop more rapidly than the onset of dementia. People developing dementia often lack insight or deny the need for help.

A 36-year-old man has bipolar affective disorder and is taking sodium valproate, as recommended by his secondary care specialist, for long-term mood stabilisation. In addition to a full blood count, which single ONE of the following blood tests should be annually monitored? Select ONE option only. Question 18Select one: A. Thyroid stimulating hormone B. Liver function tests C. Serum valproate levels D. Calcium E. Renal function tests

Liver function tests

Which is the antidepressant of choice for patients with bipolar disorder who develop severe depression? Select ONE option only. Question 19Select one: A. Fluoxetine B. Sertraline C. Venlafaxine D. Paroxetine E. Mirtazepine

Fluoxetine

A new mum presents to the emergency surgery worried about her 4-day old baby who has lost weight since birth. She is asking if it is normal for a baby to lose weight following birth? Which SINGLE option is MOST appropriate? Select ONE option ONLY. Question 8Select one: A. No weight loss is considered acceptable in the first week of life B. Anything up to 10% is considered acceptable weight loss in the first week of life C. Anything up to 20% is considered acceptable weight loss in the first week of life D. Anything up to 15% is considered acceptable weight loss in the first week of life E. Anything up to 5% is considered acceptable weight loss in the first week of life

Anything up to 10% is considered acceptable weight loss in the first week of life

You see a 2-month-old baby girl who is bottle fed seems to regurgitate her milk after feeds. There is no evidence of green or bilious vomiting. She doesn’t have any history of fevers and her bowels are normal. Despite the vomiting, she is still putting on weight and is not being overfed. The mother is concerned because the regurgitation is causing the baby distress and she gags occasionally. The mother is keen to try some treatment. Which of the following would be the MOST sensible initial management option? Select ONE option only. Question 11Select one: A. Reassurance only B. Proton pump inhibitor C. Hydrolysed formula D. Feed thickener E. Antacid medication

This baby seems to be struggling with gastroesophageal reflux which is very common at this age. Sometimes, no treatment is needed apart from parental reassurance. As this baby is getting distressed and gagging occasionally, treatment can be tried. A stepwise approach should be used starting with conservative measures. A trial of feed thickener can be considered before prescribing anti-reflux medication. Hydrolysed formula is used for babies with cow’s milk protein allergy.

kids on steroid for IBD when to monitor weight, if not on tx

3-6 months if active treatment/new dose 12 monthly

A three-year-old girl has an unexplained fever of 38.1°C with no obvious focal source. She is systemically well and does not need admission to hospital. What is the approximate PREVALENCE of urinary tract infection (UTI) among young children in this situation? Select ONE option only. Question 8Select one: A. <1% B. 2% C. 5% D. 10% E. 25%

The prevalence of urinary tract infection (UTI) amongst young children with a fever but no obvious source is approximately 5%.

IUD can be inserted after birth when

48 hours, 4 weeks if not breastfeedinf or 3 months i fbreastfeeding

A 27-year-old lady who is six-weeks postpartum and currently breastfeeding comes to see you with pain affecting her right breast. On examination, she is pyrexial, with a 4 cm discrete, erythematous lump affecting her right breast. What is the SINGLE MOST appropriate management option? Select ONE option only. Question 8Select one: A. Two-week-wait referral to breast surgeons B. Advise to continue breastfeeding and conservative management C. Start oral flucloxacillin 500 mg four times daily for 10–14 days D. Urgent ultrasound scan referral E. Urgent referral to breast surgeons for incision and drainage

Urgent referral to breast surgeons for incision and drainage

A 28-year-old woman has a symptomatic endometrioma of the ovary. She hopes to get pregnant. According to national guidance, which is the SINGLE MOST appropriate treatment? Select ONE option only. Question 13Select one: A. Prescribe continuous norethisterone B. Refer for oophorectomy C. Prescribe metformin D. Refer for ovarian cystectomy E. Prescribe cyclical norethisterone

Refer for ovarian cystectomy

Treating bacterial vaginosis in pregnant women will REDUCE which ONE of the following? Select ONE option only. Question 18Select one: A. Intrauterine growth retardation B. Premature rupture of membranes C. Preterm birth before 28 weeks gestation D. Recurrence of preterm birth, in women with previous preterm birth E. No evidence it significantly reduces the risk of preterm birth

No evidence it significantly reduces the risk of preterm birth

Which ONE of the following may be associated with the maternal use of potent or very potent topical steroids in pregnancy? Select ONE option only. Question 1Select one: A. Caesarian delivery B. Low Apgar score C. Premature birth D. Low birth weight E. Birth defect

Low birth weight

A 33-year-old patient presents with a headache. She is 21 weeks pregnant. She has no photophobia, neck stiffness or visual disturbances. On examination, fundoscopy is normal, she has a full range of movement of her neck and no scalp tenderness. Her blood pressure is 150/92 mmHg. What is the MOST appropriate next step? Select ONE option only. Question 4Select one: A. Prescribe labetalol B. Check for proteinuria C. Refer to the local medical assessment unit D. Prescribe ramipril E. Arrange a clotting screen

Check for proteinuria

A 37-year-old woman is undergoing fertility investigations. Blood tests show she is non-immune to rubella. Which is the SINGLE MOST appropriate MINIMUM time period, if any, for which she should be advised to DELAY conception after her vaccination? Select ONE option only. Question 18Select one: A. One month B. Two months C. Three months D. Six months E. No delay necessary

One month

A 24-year-old woman is eight-weeks pregnant and has hyperemesis gravidarum (HG). She has just been discharged from hospital after rehydration therapy and although antiemetic therapy has helped, she continues to vomit several times a day. Which is the SINGLE MOST appropriate vitamin supplementation to continue? Select ONE option only. Question 19Select one: A. C B. B6 (pyridoxine) C. B12 (hydroxocobalamin) D. B1 (thiamine) E. D

B1 (thiamine)

A 32-year-old woman is 20-weeks pregnant and has had recent antibiotic treatment for a symptomatic urinary tract infection (UTI). Which is the SINGLE MOST appropriate NEXT management step? Select ONE option only. Question 4Select one: A. Check urine culture after completing treatment B. Check urine culture only if still symptomatic C. Check urine dipstick D. Renal ultrasound E. No further action required

Check urine culture after completing treatment

Which SINGLE medication is licenced for management of refractory orthostatic hypotension? Select ONE option only. Question 20Select one: A. Bisoprolol B. Furosemide C. Nifedipine D. Midodrine E. Ivabradine

Midodrine

An 80-year-old man has suffered from hypertension for many years. He takes aspirin, perindopril and atorvastatin. In the last week he experienced a fall without warning, though he felt slightly dizzy at the time of the fall. He also says that recently he has been walking much more slowly and has tripped on a number of occasions. He did not lose consciousness. His wife has told him that his voice is getting softer. On examination, his heart rate was 68 beats/min. His blood pressure was 120/78 mmHg sitting and 100/60 mmHg standing. What is the SINGLE MOST likely cause of the fall? Select ONE option only. Question 3Select one: A. Meniere’s disease B. Cardiac arrhythmia C. Intermittent delirium D. Parkinson’s disease E. Epilepsy F. Transient ischaemic attack G. Myopathy

Previously undiagnosed Parkinson's disease should be considered as a cause of unexplained falls.

An 85-year-old woman has severe dementia and is unable to communicate verbally. Which is the SINGLE MOST significant clinical sign to indicate that she is in pain? Select ONE option only. Question 7Select one: A. Bradycardia B. Fever C. Hypotension D. Sweating E. Drowsiness

Sweating

The daughter of an 83-year-old gentleman brought him to see you with concerns about his memory. You want to assess his cognitive function. What is the SINGLE MOST appropriate tool to be used for cognitive assessment? Select ONE option only. Question 15Select one: A. 6-CIT B. FAST C. GAD-7 D. PHQ-9 E. FRAX

6-CIT

What is the SINGLE MOST common type of dementia in the UK? Select ONE option only. Question 17Select one: A. Alzheimer’s disease B. Lewy body dementia C. Vascular dementia D. Fronto-temporal dementia E. Pick’s disease

Alzheimer’s disease

Which is the SINGLE MOST appropriate primary care questionnaire to assess for frailty? Select ONE option only. Question 14Select one: A. PHQ-9 B. QRISK C. PRISMA-7 D. GPCOG E. PEONY

PRISMA-7

CKD stages 1-2-3a-3b-4-5 and egfr

1 90 2 60-89 3a - 45-59 3b 30-44 4 15-29 5 <15

Which of the following primary cancers has the HIGHEST INCIDENCE of metastatic spread to the brain? Select ONE option only. Question 10Select one: A. Breast B. Kidney C. Lung D. Malignant melanoma E. Stomach

Lung

divide morphine to morphine IV/SC morphine to diamorphine IV/SC morphine to oxycodone PO morphine to oxycodone IV/SC morphine to hydromoprhine PO

morphine to morphine IV/SC - /2 morphine to diamorphine IV/SC - /3 morphine to oxycodone PO - /1.5 morphine to oxycodone IV/SC /2 morphine to hydromoprhine PO /5

Which SINGLE ONE of the following has a higher INCIDENCE in people with psoriasis? Select ONE option only. Question 12Select one: A. Hypothyroidism B. Malignant melanoma C. Osteoarthritis D. Ovarian cancer E. Venous thromboembolism

Venous thromboembolism also depression and CVD

severe eczema, when to add oral abx apart from potent steroids

when they are generally unwell

test to differentiate allergic to contact dermatitis

patch testing

when to use patch testing and when to use skin prick test

patch testing - allergic vs contact derm diff skin prick - indirect measure of ige

scarlet fever and fifth disease both have face lesions/cheek lesions - difference?

history - scarlet fever will have sore throat and swollen glands

cutaneous manifestation ceoliac UC/IBD

dermatitis herpetiformis pyederma gangrenosum, erythema nodosum

lesion looks like acne, adult, gets worse in sunlight and after eating spicfy food, diagnosis/treatment

rosacea metronidazole gel

1FTU = weight of steroid + coverage?

500mg which covers two palmar surface so 1 FTU = 2 palmar surface

A 40-year-old man has scalp psoriasis with very thick scaling affecting most of the scalp area. After using an emollient to remove the scale, which is the SINGLE MOST appropriate next treatment for him? Select ONE option only. Question 14Select one: A. Daily hair washing with tar shampoo B. Twice daily application of fluocinolone gel C. Twice daily application of tacrolimus cream D. Once daily application of calcipotriol solution E. Once daily application of betamethasone valerate

Once daily application of betamethasone valerate

You receive a letter from the dermatology clinic regarding a 27-year-old man with severe acne. They have counselled him regarding starting isotretinoin following baseline investigations. In addition to liver function tests, which ONE of the following investigations should be performed before starting isotretinoin? Select ONE option only. Question 17Select one: A. Blood pressure B. Chest x-ray C. Visual acuity D. Serum lipids E. Renal function

Serum lipids

What is the recommended WEEKLY QUANTITY (in grams) of emollient for an adult with widespread dermatitis? Select ONE option only. Question 18Select one: A. 100 B. 50 C. 250 D. 500 E. 1000

500

A 41-year-old trans woman requires long-term oestrogen therapy. Which is the most appropriate preparation? Select one option only. Question 36Answer A. Combined oral contraceptive (50 mcg ethinylestradiol) B. Conjugated equine oestrogen tablets (Premarin) C. Diethylstilbestrol tablets D. Estradiol patch E. Progesterone gel

Estradiol patch

A 44-year-old woman presents with a three-month history of swelling of the small joints of both hands. On examination, these joints are warm, tender and swollen, consistent with a synovitis. You refer the patient to a rheumatology specialist for consideration of treatment with disease-modifying anti-rheumatic drugs (DMARDs). With regards the treatment of rheumatoid arthritis with DMARDs, which of the following statements is true? Select ONE option only. Question 64Select one: A. Early initiation of treatment with DMARDs does not limit observed radiological damage B. DMARD therapy should be withdrawn once initiated in early rheumatoid arthritis once signs and symptoms are controlled C. Low-dose oral corticosteroids can be used in combination with DMARD therapy for short-term relief of signs and symptoms D. Sequential DMARD monotherapy should be considered in patients with an inadequate response to initial DMARD therapy E. Sulfasalazine and hydroxychloroquine are the DMARDS of choice

Low-dose oral corticosteroids can be used in combination with DMARD therapy for short-term relief of signs and symptoms

prophylactic for menstrual migraines

frovatriptan or zolmitriptan not propranolol or topiramate

sodium valproate monitoring annually

FBC and LFT

In management of plaque psoriasis, which SINGLE ONE of the following represents the MAXIMUM duration (in weeks) for which a potent corticosteroid should be continuously applied to any one site on the trunk or limbs? Select ONE option only. Question 100Select one: A. 2 weeks B. 4 weeks C. 6 weeks D. 8 weeks E. 12 weeks

8 weeks

According to the ICD-10 classification of disease, which of the following symptoms is used in the diagnosis of alcohol dependence syndrome? Select ONE option only. Question 104Select one: A. Annoyance at others criticising their alcohol intake B. Deranged liver function tests C. Daily alcohol consumption exceeds 10 units D. Guilt regarding alcohol consumption E. Presence of withdrawal symptoms

Presence of withdrawal symptoms

In addition to breast cancer, BRCA 1/2 gene mutations are MOST LIKELY to be associated with which one of the following malignancies? Select ONE option only. Question 106Select one: A. Bowel B. Cervix C. Endometrium D. Ovary E. Thyroid

Ovary

treatment for cluste headache and prophylaxis what is cluster headache

headache with nasal conmgestion and rhinorrhoea tx: oxygen or sc or nasal triptan pro: verapamil

You are doing a weekend telephone triage shift for the local GP out-of-hours service. A 22-year-old man calls telling you that he developed facial swelling 2 days ago and his own GP diagnosed him with mumps yesterday. He asks you for advice regarding how long he needs to remain off work for. What is the SINGLE MOST appropriate advice to give to this patient? Select ONE option only. Question 114Select one: A. 9 days following onset of symptoms B. 5 days following onset of symptoms C. 7 days following diagnosis D. 24 hours following complete resolution of symptoms E. 3 days following onset of symptoms

5 days following onset of symptoms

Which of the following statements is TRUE when counselling a family with familial adenomatous polyposis (FAP) (autosomal dominant)? Select ONE option only. Question 128Select one: A. The condition is less likely to occur in women B. In individuals with polyps the chance of malignant transformation is 50% C. The clinical manifestation are always due to the same mutation in the FAP gene D. Colorectal screening is more appropriate than genetic testing if asymptomatic E. The inherited mutation predisposes to cancer but a spontaneous mutation in the second copy of the same gene is required to initiate carcinogenesis

The inherited mutation predisposes to cancer but a spontaneous mutation in the second copy of the same gene is required to initiate carcinogenesis

The presence of which of the following clinical features of acute rhinosinusitis is the SINGLE MOST likely to warrant a same day referral? Select ONE option only. Question 138Select one: A. Fever > 38.5 °C B. Severe unilateral facial pain C. Bilateral blood-stained nasal discharge D. Periorbital oedema E. Conjunctival injection

Periorbital oedema

A 33-year-old patient presents with a headache. She is 21 weeks pregnant. She has no photophobia, neck stiffness or visual disturbances. On examination, fundoscopy is normal, she has a full range of movement of her neck and no scalp tenderness. Her blood pressure is 150/92 mmHg. What is the MOST appropriate next step? Select ONE option only. Question 143Select one: A. Check for proteinuria B. Prescribe ramipril C. Prescribe labetalol D. Refer to the local medical assessment unit E. Arrange a clotting screen

Check for proteinuria

You see a 67-year-old patient with known type II diabetes mellitus and cardiovascular disease. He is currently on metformin, but his glycaemic control is still not to target. What is the next MOST appropriate hypoglycaemic agent? Select ONE option only. Question 198Select one: A. Sulfonylurea B. Glucagon-like peptide-1 receptor agonist (GLP-1 agonist) C. Sodium-glucose cotransporter-2 inhibitor (SGLT-2 inhibitor) D. Insulin E. Dipeptidyl peptidase 4 (DPP-4) inhibitor

Sodium-glucose cotransporter-2 inhibitor (SGLT-2 inhibitor) has cvd

You are working an evening shift for the local out-of-hours service, doing telephone triage. A 61-year-old woman calls complaining of a painful, red left eye with blurred vision for the last two hours. She has associated nausea and headache. She has no other past medical history. On examination she has a fixed mid-dilated pupil in the affected eye. What is the SINGLE MOST likely diagnosis in this patient? Select ONE option only. Acute angle closure glaucoma Retinal detachment Ocular migraine Episcleritis Anterior uveitis

Acute angle closure glaucoma

A 63-year-old man who has type 2 diabetes, hypertension, and osteoarthritis for which he takes opiate medication, complains of erectile dysfunction. He has a body mass index of 42 and drinks about 40 units of alcohol a week. Investigations reveal a low serum testosterone with low serum follicle stimulating hormone and luteinising hormone levels. Which ONE of the following is the SINGLE MOST appropriate INITIAL management option? Select ONE option only. Question 13Select one: A. Sildenafil for his erectile dysfunction B. Advice to reduce his alcohol intake C. Discuss and recommend referral to secondary care D. Stop his opiate medication Measures to reduce his weight

Discuss and recommend referral to secondary care to differentiate hypogonadism to other causes

Monitoring for testosterone replacement

PSA

At a population level, which is the SINGLE MOST likely cause of a raised gamma glutamyl transferase (GGT)? Select ONE option only. Question 11Select one: A. Angiotensin converting enzyme (ACE) inhibitor B. Alcohol excess C. Hyperglycaemia D. Raised body mass index (BMI) E. Statins

Raised body mass index (BMI)

A 24-year-old woman has been abusing cocaine for the past year and now wishes to withdraw. She asks about substitute drugs to enable her to do this. Which is the SINGLE MOST appropriate management option for withdrawal from cocaine? Select ONE option only. Question 15Select one: A. Buprenorphine B. Methylphenidate C. Methadone D. No drug therapy indicated E. Lofexidine

No drug therapy indicated

What is the MOST suitable drug for managing acute alcohol withdrawal? Select ONE option only. Question 17Select one: A. Chlordiazepoxide B. Chlormethiazole C. Thiamine D. Haloperidol E. Acamprosate

Chlordiazepoxide

You see a six-month-old boy with his mother. She is concerned that both eyes are occasionally deviating outwards. He was born by normal vaginal delivery at full term. On examination the red reflex is present bilaterally, there is no nystagmus, and the left eye intermittently deviates outwards. What is the SINGLE MOST appropriate management for this patient? Select ONE option only. Question 15Select one: A. Refer to orthoptic service B. Refer to health visitor C. Refer to paediatrician D. Advice and reassurance E. Refer to ophthalmologist

Refer to orthoptic service Normal binocular coordination becomes evident at about three months and any persistent strabismus after this age is significant.

Which of the following is the SINGLE MOST likely cause of secondary glaucoma? Select ONE option only. Question 14Select one: A. Age-related macular degeneration B. Conjunctivitis C. Optic neuritis D. Retinitis pigmentosa E. Uveitis

Uveitis

Which ONE of the following features would make functional visual loss a more likely diagnosis? Select ONE option only. Question 18Select one: A. Gradual onset of visual symptoms B. Visual fields that get larger as testing continues C. Blurring that is present all of the time D. Visual function that is worse in day-to-day life than on specific testing E. Tubular visual fields

Tubular visual fields

drusen, seen in

amd

near sighted, far away objects blurred but can read fine prnts

myopia

paroxysmal facial pain

trigeminal neuralgia rather than temporal arteritis

Answer feedback and justification: Cerebral palsy is a set of non-progressive neurological conditions that affect a child’s movement and co-ordination, caused by damage to the developing brain before, during, or soon after birth. 1 in 400 children is born with cerebral palsy: 70% spastic (lesion in cortex or internal capsule), 20% dyskinetic (lesion in basal ganglia) and 10% ataxic (lesion in cerebellum). Spastic quadriplegia as in this scenario, is usually the most severe form of cerebral palsy, caused by extensive damage to the brain. There is stiffness of all limbs and often an inability to walk. There may be difficulty in supporting the head. There can be difficulty with articulation of speech and a moderate to severe degree of learning difficulty. Epileptic seizures are common. Individuals with spastic hemiplegia are the most ambulatory of those affected with cerebral palsy. Spastic diplegia, the most common type of cerebral palsy, usually causes stiffness in the legs with difficulty walking. The individual may require a walking aid. Communication and intelligence are usually unaffected. Ataxic cerebral palsy affects balance, depth perception and fine precise movements especially of the hands, with involuntary shaking causing difficulties, e.g. with writing and tying shoelaces. Communication skills and intelligence are often unaffected; but speech can be affected. Athetoid (dyskinetic) cerebral palsy produces increased and decreased muscle tone with random uncontrolled body movements and postural problems. There is difficulty with tongue/vocal cord control which can affect speech and eating with drooling. Intelligence is not usually affected.

Frontotemporal dementia is part of a clinical spectrum and genetically associated with which other neurological disorder? Which SINGLE option is most appropriate? Select ONE option only. Question 79Answer A. Chiari malformation B. Myasthenia gravis C. Motor neurone disease D. Multiple sclerosis E. Huntington’s chorea

Motor neurone disease

A 56-year-old man has recently been diagnosed with rheumatoid arthritis. He smokes 20 cigarettes a day. His average blood pressure is 150/90 mmHg, and his total cholesterol is 6.5 mmol/l. He currently takes no medication for his arthritis. According to current evidence, which drug is MOST likely to increase his cardiovascular risk? Select ONE option only. Question 115Select one: A. Azathioprine B. Sulphasalazine C. Methotrexate D. Prednisolone E. Hydroxychloroquine

Prednisolone

(FIT) should be offered to guide referral for suspected colorectal cancer in adults: with an abdominal mass, or with a change in bowel habit, or with iron-deficiency anaemia, or aged 40 and over with unexplained weight loss and abdominal pain, or aged under 50 with rectal bleeding and either of the following unexplained symptoms: - abdominal pain - weight loss, or aged 50 and over with any of the following unexplained symptoms: - rectal bleeding - abdominal pain - weight loss, or aged 60 and over with anaemia even in the absence of iron deficiency. People with a rectal mass, an unexplained anal mass or unexplained anal ulceration do not need to be offered FIT before referral is considered. Refer adults using a suspected cancer pathway referral for colorectal cancer if they have a FIT result of

Foetal alcohol syndrome: This condition is caused by chronic alcohol consumption during pregnancy. It is estimated to be the most common non-inherited cause of learning disability. Features include microcephaly and facial abnormalities. The latter include short palpebral fissures, skin folds at the corner of the eye, low nasal bridge, thin upper lip and indistinct philtrum. Down’s syndrome: This is due to trisomy 21. Those affected tend to have a lower-than-average cognitive ability. They are likely to have a round face, prominent epicanthic folds, upsloping palpebral fissures and an oversized tongue. There is a single transverse palmar crease. Sturge–Weber syndrome: This is characterised by a capillary naevus or port wine stain which is unilateral and usually over the forehead and eyelid conforming to the 1st or the 1st and 2nd divisions of the trigeminal nerve; epilepsy occurs in 90% of cases; developmental delay (particularly of speech) and behavioural disorders occur in 50% of cases. Turner’s syndrome: This is due to due to the absence of an X chromosome in all or some cells. It is associated with short stature, low hairline, low set ears and webbing of the neck. Tuberous Sclerosis: This is a rare genetic condition affecting 1 in 6000 births. Epilepsy occurs in approximately 70%, usually presenting as infantile spasms before the age of 2 years; 50–60% have learning difficulties of varying degrees; 25% will have autistic spectrum disorder (ASD). Numerous skin signs include angiofibromas around the nose as well as Shagreen’s patch (a thickened leathery patch of skin usually found on the lower back). About 80% develop growths or cysts in their kidneys.

wrong when revising Flashcards

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