AKT Flashcards

Question

First unprovoked seizure and driving

Answer 1

Must not drive, must notify DVLA Must not drive for 6 months after date of first seizure or 12 months if there is an underlying cause which could increase seizure risk. Group 2 licence Driving must cease 5 years from first seizure. May be restored if neurologist assess risk <2% and not on medication.

Answer 2

Group 1 While standing - can drive dont need to inform DVLA While sitting - can drive if there is an avoidable trigger that wont occur whilst driving. Otherwise must be assessed to have <20% annual risk. Group 2 Must not drive and must notify DVLA. Assessment for treatable underlying cause.

Answer 3

Must not drive and must notify DVLA Group 1 Can resume after 4 weeks if cause identified and treated. If no cause identified revoked for 6 months. Group 2 Can resume after 5 months if cause identified and treated. If no cause identified revoked for 12 months.

Answer 4

Group 1 Must not drive but need not notify DVLA. Can continue driving after 1 week if successful PCI and... - No other revascularization planned -LVEF >40% - no other disqualifying condition if not met then 4 weeks Group 2 Must not drive and must notify the DVLA. May be considered for a licence after 6 weeks if exercise tolerance met and LVEF >40%.

Answer 5

Should not fly

Answer 6

Once clinically improved

Answer 7

2 weeks after drainage 1 week post CXR

Answer 8

24 hours if flight <2 hours 48 hours if flight > 2 hours

Answer 9

NO travel >36/40 or >32/40 multiple pregnancy

Answer 10

Hb >80 safe

Answer 11

utilised to compare observed results with those that are expected under a certain hypothesis.

Answer 12

non-parametric test assesses differences between two independent groups when the dependent variable is ordinal or continuous but not normally distributed.

Answer 13

100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

Answer 14

150 micrograms (0.15 ml 1 in 1,000)

Answer 15

300 micrograms (0.3ml 1 in 1,000)

Answer 16

500 micrograms (0.5ml 1 in 1,000)

Answer 17

40% after 3 months Consider increasing from 20 to 80mg if not achieved

Answer 18

- type 1 diabetics - patients with an estimated glomerular filtration rate (eGFR) less than 60 ml/min and/or albuminuria - patients with a history of familial hyperlipidaemia

Answer 19

- total cholesterol >7.5 - family history of premature coronary artery disease (event before 60 in first degree relative)

Answer 20

1 = normal <0.5 suggests severe arterial disease. Compression treatment is contraindicated. > 0.5 - < 0.8 suggests the presence of arterial disease or mixed arterial/venous disease. 0.8 to 1.3 suggests no evidence of significant arterial disease. Compression may be safely applied in most people. > 1.3 may suggest the presence of arterial calcification, such as in some people with diabetes, rheumatoid arthritis, systemic vasculitis, atherosclerotic disease, and advanced chronic renal failure. For values above 1.5, the vessels are likely to be incompressible, and the result cannot be relied on to guide clinical decisions.

Answer 21

Increasing symptoms; Peak flow > 50-75% best or predicted; No features of acute severe asthma. Normal speech

Answer 22

Any one of the following: Peak flow 33-50% best or predicted; Respiratory rate ≥ 25/min; Heart rate ≥ 110/min; Inability to complete sentences in one breath.

Answer 23

Any one of the following in a patient with severe asthma: Peak flow < 33% best or predicted; Arterial oxygen saturation (SpO2) < 92%; Partial arterial pressure of oxygen (PaO2) < 8 kPa; Normal partial arterial pressure of carbon dioxide (PaCO2) (4.6–6.0 kPa); Silent chest; Cyanosis; Poor respiratory effort; Arrhythmia; Exhaustion; Altered conscious level; Hypotension.

Answer 24

Able to talk in sentences; Arterial oxygen saturation (SpO2) ≥ 92%; Peak flow ≥ 50% best or predicted; Heart rate ≤ 140/minute in children aged 1–5 years; heart rate ≤ 125/minute in children aged over 5 years; Respiratory rate ≤ 40/minute in children aged 1–5 years; respiratory rate ≤ 30/minute in children aged over 5 years.

Answer 25

Can’t complete sentences in one breath or too breathless to talk or feed; SpO2 < 92%; Peak flow 33–50% best or predicted; Heart rate > 140/minute in children aged 1–5 years; heart rate > 125/minute in children aged over 5 years; Respiratory rate > 40/minute in children aged 1–5 years; respiratory rate > 30/minute in children aged over 5 years.

Answer 26

Any one of: SpO2 < 92%; Peak flow < 33% best or predicted; Silent chest; Cyanosis; Poor respiratory effort; Hypotension; Exhaustion; Confusion.

Answer 27

- Patients with features of severe or life-threatening acute asthma should start treatment as soon as possible and be referred to hospital immediately following initial assessment - Patients with moderate acute asthma should be treated at home or in primary care and response to treatment assessed.

Answer 28

5mg >5 years 2.5mg 2-5 years Oxygen driven, flow rate 6 L /min If nebs not available give inhaler via spacer. Consider ipratropium bromide nebs if unresponsive

Answer 29

30 - 40 mg

Answer 30

1 = normal <0.5 suggests severe arterial disease. Compression treatment is contraindicated. > 0.5 - < 0.8 suggests the presence of arterial disease or mixed arterial/venous disease. 0.8 to 1.3 suggests no evidence of significant arterial disease. Compression may be safely applied in most people. > 1.3 may suggest the presence of arterial calcification, such as in some people with diabetes, rheumatoid arthritis, systemic vasculitis, atherosclerotic disease, and advanced chronic renal failure. For values above 1.5, the vessels are likely to be incompressible, and the result cannot be relied on to guide clinical decisions.

Answer 31

4 puffs initially followed by 2 puffs every 2 mins according to response up to 10 puffs

Answer 32

Puff every 30-60 seconds up to 10 puffs. Repeat every 10-20 mins according to response

Answer 33

If had two asthma attacks in last 12 months

Answer 34

Volume in (mls x ABV) /1000

Answer 35

Score 8 - 15

Answer 36

Score 16-19

Answer 37

Tool for brief advice in alcohol XS Feedback - compared to others Responsibility - up to them Advice - how to calculate units Menu - support groups Empathy Self efficiency - encouragement

Answer 38

EtOH XS Alters balance between excitatory and inhibitory neurotransmission, eases cravings, impacts enjoyment Some GPs

Answer 39

EtOH XS Reduces cravings by increasing side effects of drinking, headache, nausea etc Specialists only

Answer 40

EtOH XS Opioid antagonist. Reduces craving for further drinks. Reduces overall consumption >85% in GP

Answer 41

<14 units spread over 3 days No safe level

Answer 42

Breast Oesophagus Oral cavity and pharynx Liver Colorectal ‘BOCOL’

Answer 43

Hypertension Arrhythmias Strokes (haemorragic) Pneumonia / LRTI Cirrhosis of liver Epilepsy Pancreatitis

Answer 44

Low nasal bridge Flat midface Ear abnormalities Indistinct philtrum Micrognathism Thin upper lip Epicanthal folds Short palpebral fissures

Answer 45

500mcg / 0.5ml 1:1000 IM If no response repeat after 5 mins

Answer 46

300mcg / 0.3ml 1:1000 IM If no response repeat after 5 mins

Answer 47

150 mcg / 0.15ml 1:1000 IM If no response repeat after 5 mins

Answer 48

100-150mcg - 0.1-0.15ml 1:1000 IM If no response repeat after 5 mins

Answer 49

1. Horseness of voice 2. Wheeze 3. Shortness of breath 4. Shock 5. Stridor 6. Swelling of the tongue and cheek 7. Facial swelling NOT florid hives on the trunk NOT neck urticaria

Answer 50

Type I IgE mediated hypersensitivity reaction

Answer 51

Fever (last 24 hours) Purulence on tonsils Attend rapidly (<3 days after onset) Severely inflamed tonsils No cough or coryza 1 point for each 0-1 13-18% - no abx 2-3 34-40% - delayed Rx 4-5 62-65% - abx

Answer 52

Tonsillar exudate Cervical lymphadenopathy No cough or coryza Fever <15 + 1 >44 - 1 0-2 3-17% no abx 3-4 32- 68% - delayed Rx 5-6 - abx

Answer 53

1. It must be assumed that an adult is able to make his/her own decisions, unless it has been shown otherwise. 2. All reasonable help and support should be given to assist a person to make their own decisions and communicate those decisions, before it can be assumed that they have lost capacity. 3. Every adult has the right to make decisions that may appear to be unwise or strange to others. 4. If a person lacks capacity, any decisions taken on their behalf must be in their best interests. 5. If a person lacks capacity, any decisions taken on their behalf must be the option least restrictive to their rights and freedoms. 6. Capacity is decision-specific.

Answer 54

1. Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? 2. Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time –someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Answer 55

* What caused the death of the deceased? * Does the coroner need to be notified of the death? * Was the care before death appropriate? Medical examiners answer these by providing independent scrutiny, with three elements: * A proportionate review of relevant medical records * Interaction with the doctor completing the Medical Certificate of Cause of Death * Interaction with the bereaved, providing an opportunity to ask questions and to raise concerns

Answer 56

* poisoning of any kind or contact with a toxic substance * the use of a medicinal product, the use of a controlled drug or psychoactive substance * violence, trauma, injury or self-harm, neglect, including self-neglect * a person undergoing any treatment or procedure of a medical nature * an injury or disease attributable to any employment held by the person during the person's lifetime * The cause of death is unknown * The identity of the deceased in unknown * The registered medical practitioner suspects that the person died while in custody * The person's death was unnatural but does not fall within any of the above circumstances

Answer 57

They have moved outside of the practice’s area The relationship has broken down irretrievably * In cases of violence or abuse this can be immediate (police involvement generally required) * Other instances require evidence of consideration, which should include a written warning, which remains valid for 12 months * Practices should write to the PCO/NHSE with details of the affected patient * The removal takes effect on the 8th day hereafter, or 8 days after ongoing treatment ceases if relevant

Answer 58

Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment.

Answer 59

Doctor, nurse, physio, OT or pharmacist

Answer 60

* that it would have been reasonable to issue a Statement on the day of the assessment * after consideration of a written report from another doctor or registered health care professional

Answer 61

During the first 6 months of sickness, the new Statement can be issued for no longer than 3 months After six months: There is no limit on the duration of a fit note if the condition has lasted longer than six months and is clinically appropriate.

Answer 62

* Up to £116.75/week if you’re too ill to work. * Paid by employer for up to 28 weeks. * Paid from the 4th day onwards – unless a repeat episode within eight weeks. * You can’t get less than the statutory amount but you can get more if your company has a sick pay scheme.

Answer 63

* be classed as an employee and have done some work for your employer * have been ill for at least 4 days in a row (including non-working days) * earn at least £123 (before tax) per week * tell your employer you’re sick before their deadline - or within 7 days if they don’t have one

Answer 64

You can apply for Employment and Support Allowance (ESA) if you have a disability or health condition that affects how much you can work. ESA gives you: Money to help with living costs if you’re unable to work, support to get back into work if you’re able to. You can apply if you’re employed, self-employed or unemployed.

Answer 65

Personal Independence Payment (PIP) can help with extra living costs if you have both: - a long-term physical or mental health condition or disability - difficulty doing certain everyday tasks or getting around because of your condition You can get PIP even if you’re working, have savings or are getting most other benefits. There are 2 parts to PIP: a daily living part - if you need help with everyday tasks a mobility part - if you need help with getting around

Answer 66

You could get £81.90 a week if you care for someone at least 35 hours a week and they get certain benefits. You do not have to be related to, or live with, the person you care for. You do not get paid extra if you care for more than one person. If someone else also cares for the same person as you, only one of you can claim Carer’s Allowance.

Answer 67

You may be able to get Bereavement Support Payment if your partner has died. When your partner died, you must have been: - under State Pension age - living in the UK or a country that pays bereavement benefits - married to your partner, in a civil partnership with them, or living with them as if you were married Your partner must have either: - paid a certain amount of Class 1 or Class 2 National Insurance contributions in any one tax year since 6 April 1975 - died because of an accident at work or a disease caused by work

Answer 68

Maternity Allowance is a payment you can get when you take time off to have a baby. You could get it if you: - are employed but cannot get Statutory Maternity Pay (SMP) - are self-employed - have recently stopped working - take part in unpaid work for the business of your spouse or civil partner You can get Maternity Allowance for up to 39 weeks.

Answer 69

The Special Rules allow people nearing the end of life to: - get faster, easier access to certain benefits - get higher payments for certain benefits - avoid a medical assessment An adult or child is nearing the end of life when they are likely to have less than 12 months to live. The SR1 form has replaced the DS1500 form. a fast tracked claim to the following benefits (for which they are eligible): * Personal Independence Payment * Universal Credit (UC) * Employment and Support Allowance * Disability Living Allowance (DLA) for children * Attendance Allowance (AA)

Answer 70

Requires license to possess, e.g. medicinal cannabis

Answer 71

Most opioids, amphetamines, * Subject to safe custody requirements and CD register

Answer 72

Gabapentinoids, Midazolam and Temazepam, Buprenorphine * Safe custody requirements but no CD register (certain exceptions)

Answer 73

All other Benzodiazepines, anabolic steroids * Not subject to safe custody requirements, invoices kept for two years

Answer 74

Codeine/Dihydrocodeine available for OTC use * Invoices kept for two years

Answer 75

* Locked metal cabinet, anchored to wall or floor by unexposed bolts, not labelled. * Access limited to authorised individuals. * Destruction from stock must be witnessed by an authorised individual.

Answer 76

* Must be locked, left in boot of a car if necessary but never overnight * Restocking from CD cupboard must be witnessed

Answer 77

* All medication being given must be prescribed * PGD (patient group directive) * Written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment. * Signed by doctor and pharmacist * PCO level, not individual practices * Administered by qualified professional e.g. nurse, paramedic.

Answer 78

If not a registered HCP (e.g. an HCA), a PSD (Patient-Specific Directive) is required. There is no set format for PSDs written into the legislation, however a PSD must: * state the name of the patient * state the name and dose of the prescription only medicine to be administered* show evidence to confirm that the patient has been considered as an individual * include frequency/duration/start and end dates of treatment * be signed by a prescriber

Answer 79

* 2 – 8°c from manufacturer to administration * Never frozen * Protected from light * Direct from fridge where possible * Transported in a validated cool box with max-min thermometer if necessary * Can be returned if cold chain maintained

Answer 80

* Has informed patient consent (with exceptions) * Stands alone * Is written for a lay person of reasonable intelligence * Is factual (unless an opinion is sough that falls within your sphere of competence) * Is thorough and complete to the best of your reasonable ability (with certain exceptions) * Is not misleading

Answer 81

* Adverse genetic test results * Negative tests for blood-borne viruses, e.g. HIV * STIs which are resolved and from which there is no long-term health implication * Information relating to family history not obtained from the patient

Answer 82

Patients are entitled to see any medical report about them * They can request modification * If refused – the patient can attach a note disputing the views expressed * They can withdraw consent for the report to be sent * You can inform the person who commissioned the report The GMC's Good Medical Practice (2006) points out that you must be honest when writing reports and that you must not deliberately leave out relevant information.

Answer 83

Practices must: * Have a data protection officer * Provide patients with access to their notes when asked (within one month) and without charge * Request does not have to be in writing * Assume the age of consent for access to be 13 years GP practices hold * Personal data (e.g. name, address) * Sensitive personal data (e.g. medical information, religion, sexuality) * This must be retained for ten years (or until the patient is 21 years old if longer)

Answer 84

* Can be made by the patient or a third party with consent * Can be for all or part of the record * Can be ‘reason blind’ * Should be answered in 28 days

Answer 85

Data may be withheld in the following circumstances * Its release would reasonably be expected to cause significant harm to the patient’s physical or mental health * Any reference to a named third party

Answer 86

GDPR regulations only apply to the living. * Deceased records governed by Access to Health Records Act (1990) Access to deceased records: * Via NHS England or local equivalent (as data controller) * Personal representative – e.g. executor of will * Person with possible claim arising from the death * Limited to relevant information * Overridden by wishes documented in life

Answer 87

* If the patient and GP are in agreement that a record is factually incorrect, it should be amended. * This should be done in such a way that the correction is audit traceable. * If the patient believes the record to be incorrect but the GP does not, an addendum must be added to the record to this effect but the original notes should remain.

Answer 88

* Initial response within 2 working days * Full response within reasonable period as defined in policy * Extended if exceptional circumstances * Records kept for 10y (longer in children) * Can be verbal or written * Investigated and responded to by an independent person * Procedure can be discontinued if informal resolution * Must identify patient’s right to escalate to Parliamentary and Health Service Ombudsman * Could also complain to GMC * Should be made within a year of the incident or finding out about the adverse outcome

Answer 89

* Provide a safe system of work * Provide a safe place of work * Provide safe equipment * Employ safe and competent people: employers are also liable for the actions of their staff and managers * To carry out risk assessments as set out in regulations, and taking steps to eliminate or control these risks; * To inform workers fully about all potential hazards associated with any work process, including providing instruction, training and supervision; * To appoint a 'competent person' responsible for health and safety * Provide adequate facilities for staff welfare at work.

Answer 90

instant: IUD 2 days: POP 7 days: COC, injection, implant, IUS

Answer 91

an association that has arisen by chance and is not real

Answer 92

an association that has arisen by chance and is not real

Answer 93

the association is due to the presence of another factor (a confounding variable)

Answer 94

a true association not linked by a third (confounding) variable

Answer 95

If the patient is symptomatic: - fasting glucose greater than or equal to 7.0 mmol/l - random glucose greater than or equal to 11.1 mmol/l 7/11 IF asymptomatic do test x 2 HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus

Answer 96

direct switch is possible

Answer 97

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI

Answer 98

cross-tapering is recommended - an exception is fluoxetine which should be withdrawn, the leave a gap of 4-7 days prior to TCAs being started at a low dose

Answer 99

direct switch is possible

Answer 100

withdraw and then start venlafaxine at a low dose 4–7 days later

Answer 101

patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved

Answer 102

> 0 Reassure 0 to -1.5 Repeat bone density scan in 1-3 years < -1.5 Offer bone protection

Answer 103

68.3% within 1SD of the mean 95.4% within 2 SD of the mean 99.7% within 3 SD of the mean

Answer 104

fatigue, dry cough, pleuritic chest pain, and a facial rash is suggestive of drug-induced lupus erythematosus (DILE)

Answer 105

gastrointestinal disturbances, visual disturbances, and arrhythmias;

Answer 106

nausea and vomiting, as well as tremors, hair loss, and weight gain.

Answer 107

Most common causes procainamide hydralazine Less common causes isoniazid minocycline phenytoin

Answer 108

increased risk of breast cancer and cervical cancer

Answer 109

cough thought to be due to increased bradykinin levels angioedema: may occur up to a year after starting treatment hyperkalaemia first-dose hypotension: more common in patients taking diuretics

Answer 110

pregnancy and breastfeeding - avoid renovascular disease - may result in renal impairment aortic stenosis - may result in hypotension hereditary of idiopathic angioedema specialist advice should be sought before starting ACE inhibitors in patients with a potassium >= 5.0 mmol/L

Answer 111

False positive Falsely rejecting null hypothesis

Answer 112

False negative Falsely accepting null hypothesis

Answer 113

The probability of getting these results by chance. The further away from 1 the stronger the data. statistically significant if P-value <0.05 P = 0.0001 very unlikely (1 in 10,000 chance) * P = 0.01 unlikely (1% or 1 in 100 chance) * P = 0.05 fairly unlikely (5% or 1 in 20 chance) * P = 0.1 not unlikely (10% or 1 in 10 chance) * P = 0.8 very likely (80% chance)

Answer 114

risk of an event in one group / risk of an event in another group

Answer 115

1 boy is born for every 2 births, so the probability (risk) of giving birth to a boy is: 1/2 = 0.5

Answer 116

The number of times an event happens divided by the number of times it does not: * 1 boy is born for every 2 births, so the odds of giving birth to a boy are: 1:1 (or 50:50) = 1/1 = 1

Answer 117

odds of an event in one group/ odds of an event in another group e.g. risk of pneumonia in patients taking statins: * Statins odds 2231/1775 = 0.126; no statins odds 8759/80484 = 0.109 Therefore OR for pneumonia with statins versus no statins = 0.126/ 0.109 = 1.15

Answer 118

1. Systematic reviews and meta-analyses 2. Randomised controlled trials with definitive results 3. Cohort studies 4. Case control studies 5. Cross-sectional studies 6. Case reports

Answer 119

HR = treatment hazard rate/placebo hazard rate e.g. Infection rate in ‘new Rx’ group = 10% Infection rate in amoxicillin group = 40% HR = 10/40 = 0.25

Answer 120

ARR = [Infection rate in ‘new Rx’ group] - [Infection rate in amoxi group] e.g. Infection rate in ‘new Rx’ group = 10% Infection rate in amoxicillin group = 40% 40%-10% = 30%

Answer 121

RRR = How much the risk is reduced in the new Rx group compared to the control group e.g. Infection rate in ‘new Rx’ group = 10% Infection rate in amoxicillin group = 40% ARR/ control = 30/40 = 75%

Answer 122

NNT How many people need new Rx for one person to benefit. NNT = 100/ ARR Round up to the nearest whole number NNT = 1 / (adverse outcome rate with placebo - adverse outcome rate with treatment)

Answer 123

a technique for using “censored” observations: where not all patients have been followed up for the full duration of the study

Answer 124

Using more than one qualitative research method to gather data

Answer 125

The "positive likelihood ratio" (LR+) tells us how much the probability of disease increases if the test is positive: LR+ = probability of an individual with the condition having a positive test/ probability of an individual without the condition having a positive test = sensitivity/ (1 - specificity) The "negative likelihood ratio" (LR-) tells us how much it decreases if the test is negative LR- = probability of an individual with the condition having a negative test / probability of an individual without the condition having a negative test = (1-sensitivity) specificity

Answer 126

* >10: large increase in the likelihood of disease * 2 – 5: small increase in the likelihood * 1: no change in the likelihood * 0.2 - 0.5: small decrease in the likelihood * < 0.1 large decrease in the likelihood

Answer 127

* Starts with current belief (a “prior”) in whether a treatment works; updates this belief with the data; this new belief is called the “posterior”. * Reflects the way that we actually think.

Answer 128

not covering all of the population of interest (also called omission bias) or only covering some parts because it’s more convenient (also called inclusion bias).

Answer 129

exists when participants are put under some kind of pressure to provide information.

Answer 130

survey participants unable or unwilling to provide accurate or honest answers.

Answer 131

measurement methods (instrument, or observer of instrument) are consistently different between the study groups.

Answer 132

patients may drop out because the treatment made them worse - or, patients may drop out when the treatment works.

Answer 133

study results less likely to be published when they are not statistically significant or less "interesting”.

Answer 134

It is a measure of the difference between actual and expected frequencies (the frequency we would see if the null hypothesis were true). If the observed and the expected frequencies are the same, the C2 (=chi squared) value is zero

Answer 135

A measure of health loss: the impact of a disease or injury in terms of healthy years lost.

Answer 136

a variable whose values represent different categories of the same feature; examples include different blood groups, different eye colours, and different ethnic groups;

Answer 137

variables which can take any value within a given range, for instance blood pressure.

Answer 138

data that can be allocated to categories that can be “ordered”, e.g. from least to strongest; an example is the staging of malignancy;

Answer 139

A survey of experts in two or more 'rounds', in which, in the second and later rounds of the survey, the results of the previous round are given as feedback. Therefore, the experts answer from the second round on under the influence of their colleagues' opinions. So, respondents can learn from the views of others, without being unduly influenced by the people who talk loudest at meetings, or who have most prestige etc.

Answer 140

How many people, per thousand of the population, died in a given year.

Answer 141

The ratio of observed deaths in the study group to expected deaths in the general population; it can be given as a percentage. If the SMR is quoted as a ratio: o < 1 indicates fewer than expected deaths in the study group (compared with the expected deaths in the general population) o = 1 indicates observed deaths equals expected deaths o >1 indicates there were excess deaths Sometimes the SMR is expressed as a percentage, after multiplying by 100. In this case: o < 100 indicates fewer than expected deaths (compared with the expected deaths in the general population)

Answer 142

Where something is being measured regularly (e.g. number of complaints a month in an organisation), these help to distinguish between normal abnormal variation. * Points outside the ‘control limits’ (the acceptable variation range) need investigation.

Answer 143

Retrospective, they start with the event of interest and then look back for associated events. Cases: The group of people who have the condition or disease being studied Controls: A similar group of people who do not have the condition or disease. risk of ‘selection bias’: cases or controls may not be representative; risk of ‘recall bias’; can’t establish ‘cause & effect’

Answer 144

Case-control

Answer 145

Prospective; they start with a well-defined group of people and observe for future events Can be costly and time-consuming; loss to follow-up (‘attrition’) may lead to bias

Answer 146

Cohort studies

Answer 147

The most widely used DMARD. Monitoring of FBC & LFTs is essential due to the risk of myelosuppression and liver cirrhosis. Other important side-effects include pneumonitis

Answer 148

used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions

Answer 149

This statistical test is used to measure ordinal, interval or ratio scales of unpaired data. An example of an ordinal variable is Likert items e.g. a 5 point scale. This is not the correct test to compare percentages.

Answer 150

for when data is normally distributed

Answer 151

Clindamycin Doxycycline / lymecycline

Answer 152

Doxycycline - adults Amoxicillin - children Also clarithromycin, erythromycin

Answer 153

Amoxicillin Clarithromycin if pen allergic

Answer 154

Flucloxacillin

Answer 155

Metronidazole

Answer 156

pen v doxy if pen allergic

Answer 157

Azoles > nystatin Miconazole = azole

Answer 158

Topical azoles (pessary) If recurrent (>3 year) then oral fluconazole course 6 months

Answer 159

Fusidic acid topically Mupirocin if MRSA More severe then oral flucloxacillin

Answer 160

Always colonized, abx only needed if infection. Flucloxacillin Cipro + clind Oxygen gel non healing ulcers.

Answer 161

Cats always give Dogs if hand foot tendon immunocompromised Co amoxiclav Metro and clarith (human), metro and doxy (animal) if pen allergic

Answer 162

Topical terbinafine Or Imidazole if ?candida Can go to orals if not clearing

Answer 163

Oral terbinafine Must confirm with scrapings Check LFTs Apply weekly antifungal cream to prevent recurrence

Answer 164

Seek specialist advice in pregnancy, neonate and immunocompromised Consider acyclovir if <24 hours from onset AND one of : <14, severe pain, dense/ oral rash, smoker, on steroids Otherwise conservative

Answer 165

Acyclovir if >50 years old and within 72 hours of rash Or ophthalmic / ramsay hunt / eczema / non truncal involvement / pain / mod severe rash If ongoing >1week consider acyclovir 800mg 5x day 7 days

Answer 166

1) spirometry and bronchodilator reversibility 2) FeNO with uncertainty then peak flow

Answer 167

1) FeNO 2) spirometry and bronchodilator reversibility 3) peak flow variability

Answer 168

Marker of inflammation in the airways NO produced by body to vasodilate <25 ppb: Normal, and usually indicates asthma is unlikely 25–50 ppb: Intermediate, and suggests some airway inflammation and asthma may be a possibility >50 ppb: High, and strongly indicative of asthma

Answer 169

FEV1 <80% predicted FEV1 /FVC <0.7

Answer 170

- Describe how to recognise and respond to worsening asthma - Individualize the plan for the patient based on understanding - Provide advice about change in ICS and how/when to add OCS - If using peak flow use personal best rather than predicted. Step up on 25% reduction - Quadruple dose ICS as long as within range (consider stepping down after 3 months if stable)

Answer 171

5 x 1 in 5 strokes caused by AF

Answer 172

- beta blockers eg bisoprolol - rate limiting calcium channel blocker eg diltiazem - digoxin (if sedentary lifestyle or failure of above) - combination of any of the above NB do no offer amiodarone for long term rate control

Answer 173

- DC cardioversion acute or planned - Left atrial catheter ablation - Left atrial surgical ablation - Class 1c antiarrhythmics - flecainide - Pill in the pocket for PAF NB flecainide or dronedarone first line unless structural disease / HF. -use amiodarone instead

Answer 174

Liver function tests required before treatment and then every 6 months. Serum potassium concentration should be measured before treatment. Chest x-ray required before treatment Thyroid function tests should be performed before treatment, then at 6-monthly intervals, and for several months after stopping treatment Regular eye checks - corneal deposits possible

Answer 175

Idarucizmab

Answer 176

Dabigatran: A direct thrombin inhibitor Rivaroxaban: A factor Xa inhibitor Apixaban: A factor Xa inhibitor Edoxaban: A factor Xa inhibitor

Answer 177

- Tumour suppressor genes - Autosomal dominant - Can be inherited from either parent - Mutations greatly increase risk of breast and ovarian ca - Frequency ~1/400 (1/50 in ashkenazi jews) - Screening offered from age 30

Answer 178

Risk of sarcoma, adrenal, brain and breast Cancer risk 100% in women, 73% in men

Answer 179

ONE first-degree female relative diagnosed with breast cancer <40 ONE first-degree male relative diagnosed with breast cancer at any age ONE first-degree relative with bilateral breast cancer where the first primary was diagnosed <50 TWO first-degree relatives, or 1 first-degree and 1 second-degree relative, diagnosed with breast cancer at any age 1 first-degree or second-degree relative diagnosed with breast cancer at any age AND 1 first-degree or second-degree relative diagnosed with ovarian cancer at any age (1 of these should be a first-degree relative) or THREE first-degree or second-degree relatives diagnosed with breast cancer at any age.

Answer 180

Monitor liver function before therapy and during first 6 months especially in patients most at risk. Measure full blood count and ensure no undue potential for bleeding before starting and before surgery.

Answer 181

1/1,000 at 30 years then divide by 3 for every 5 years 1/50 at 45 years

Answer 182

Pre menopause - Tamoxifen Poset monopasue - Anastrazole/ tamoxifen/ raloxifene All increase risk of VTE

Answer 183

- Age >84 - Established cardiovascular disease - eGFR <60 / albuminuria - Peripheral vascular disease - Familial hypercholesterolemia - T1DM - Polycythemia vera

Answer 184

- T2DM - Smoking - Blood lipids - Level of physical activity - Diet - Salt intake - Blood pressure

Answer 185

- Age - Sex - Ethnicity - Socioeconomic status - Familial hypercholesterolemia

Answer 186

Age Sex Ethnicity Postcode Smoking Diabetes Angina / MI in relative <60 CKD AF On blood pressure treatment Rheumatoid arthritis Cholesterol BP New for Qrisk 3 SLE Severe mental illness Erectile dysfunction Migraines On steroids Antipsychotics Estimates risk of a stroke or myocardial infarction in the next 10 years. >10% start statin. Atorvastatin 20mg first line.

Answer 187

rosuvastatin 5mg , atorvastatin 20mg, simvastatin 50mg , lovastatin, pravastatin, and fluvastatin. Amount needed to achieve 40% reduction

Answer 188

Risk of ACS Age F>65 M >55 1 Vascular disease 1 Patient thinks its cardiac 1 Worse on exercise 1 Not reproducible by palpation 1 <2 low risk 3 medium >4 high

Answer 189

- Crushing retro sternal chest pain, radiating to jaw, arms, neck - Precipitated by exertion - Relieved by GTN spray after 5 mins 3 = typical chest pain 2 = atypical chest pain 1/0 = non cardiac chest pain

Answer 190

1) Beta blocker 2) Calcium channel blocker (non rate limiting eg nifedipine , amlodipine, felodipine) Diltiazem - use caution Verapamil - contraindicated 3) Long acting nitrate 4) Nicorandil, ivabradine, ranolazine Only offer >2 if awaiting revascularization or unable to have it

Answer 191

- Aspirin 75mg - ACE inhibitor - Statin (atorvastatin 80mg) - Well controlled BP - Screen for depression

Answer 192

Describes CKD C - Aause G - GFR A - Albuminuria

Answer 193

Alport syndrome is a genetic disease causing kidney damage, hearing loss, and eye problems. Learn about its symptoms, diagnosis, and treatments for kidney health.

Answer 194

CKD alone <140/90 CKD + diabetes/ pcr >70 = <130/80

Answer 195

ACE I / ARB SGLT-2 inhibitor

Answer 196

- All patients with eGFR <30 - None diabetics with ACR >70 - Haematuria with ACR >30 - 3 readings over 90 days showing deterioration in eGFR >25% - Treatment resistant hypertension (4 agents) - Genetic cause -?Renal artery stenosis - Heavy proteinuria

Answer 197

Cystatin c blood test

Answer 198

BROW Barley Rye Oats Wheat

Answer 199

No need for 7 day break If you have breakthrough bleeding then stop taking for 4 days

Answer 200

- more than 35 years old and smoking less than 15 cigarettes/day - BMI > 35 kg/m^2* - family history of thromboembolic disease in first degree relatives < 45 years - controlled hypertension (on antihypertensives) - immobility e.g. wheel chair use - carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2) - current gallbladder disease

Answer 201

- more than 35 years old and smoking more than 15 cigarettes/day - migraine with aura - history of thromboembolic disease or thrombogenic mutation - history of stroke or ischaemic heart disease - breast feeding < 6 weeks post-partum - uncontrolled hypertension - current breast cancer - major surgery with prolonged immobilisation - positive antiphospholipid antibodies (e.g. in SLE)

Answer 202

Gestational diabetes can be diagnosed by either a: fasting glucose is >= 5.6 mmol/L, or 2-hour glucose level of >= 7.8 mmol/L '5678'

Answer 203

>84 T1DM CKD 3 (eGFR <60) / proteinuria Familial hyperlipidaemia QRISK2 may underestimate CVD risk in: - HIV - serious mental health problems - medicines that can cause dyslipidaemia such as antipsychotics, corticosteroids or immunosuppressant drugs - autoimmune disorders/systemic inflammatory disorders such as systemic lupus erythematosus

Answer 204

- total cholesterol level > 7.5 mmol/L - there is a personal or family history of premature coronary heart disease (an event before 60 years in an index person or first-degree relative [parents, siblings, children])

Answer 205

Atorvastatin 20 mg should be offered if type 1 diabetics who are: older than 40 years, or have had diabetes for more than 10 years or have established nephropathy or have other CVD risk factors

Answer 206

atorvastatin 20mg should be offered to patients with CKD increase the dose if a greater than 40% reduction in non-HDL cholesterol is not achieved and the eGFR > 30 ml/min. If the eGFR is < 30 ml/min a renal specialist should be consulted before increasing the dose

Answer 207

0.15mg/kg dexamethasone single dose

Answer 208

Incubation period 1-6 hrs: Staphylococcus aureus, Bacillus cereus* 12-48 hrs: Salmonella, Escherichia coli 48-72 hrs: Shigella, Campylobacter > 7 days: Giardiasis, Amoebiasis

Answer 209

NICE suggest that a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable, although any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs). A rise greater than this may indicate underlying renovascular disease

Answer 210

dual antiplatelet therapy (aspirin plus a second antiplatelet agent) ACE inhibitor beta-blocker statin

Answer 211

dual antiplatelet therapy (aspirin plus a second antiplatelet agent) ACE inhibitor beta-blocker statin

Answer 212

dual antiplatelet therapy (aspirin plus a second antiplatelet agent) ACE inhibitor beta-blocker statin

Answer 213

nitrate prescription; patients for whom sexual activity is not advisable; history of non-arthritic optic neuropathy; retinal degeneration; use of indinavir/ketoconazole/itraconazole in patients over age 75 years (vardenafil only); heart failure and uncontrolled arrhythmia/hypertension (tadalafil only).

Answer 214

8 years However, women who are aged 45 years or over at the time of LNG-IUS insertion may retain the device until the age of 55 if used for contraception

Answer 215

ranges from 5–10 years, depending on the device. Women who are aged 40 years or more at the time of IUD insertion may retain the device until they no longer need contraception, even if this is beyond the duration of the UK marketing authorisation.

Answer 216

All licensed doctors in the UK working in the NHS and the private sector and all branches of practice need to complete a revalidation cycle once every five years via GMC

Answer 217

hyperactivity, impulsivity and inattention. Motor planning and co-ordination difficulties may be found in up to 50% of children with ADHD.

Answer 218

Burch-Wartofsky Point Scale (BWPS) Check temp, pulse, BP

Answer 219

(Used for thrombolysis) a stroke in the last three months or a convulsion-accompanying stroke.

Answer 220

the ratio of the highest recorded systolic pressure recorded in the affected leg over the highest recorded systolic pressure in either arm (whichever arm had the highest reading).

Answer 221

IQ score of 50–70 = mild learning disability. IQ score of 35–49 =moderate learning IQ score of 20–34= severe learning IQ score of < 20 =profound learning disability.

Answer 222

Aged 50 and over with any of the following unexplained symptoms: rectal bleeding abdominal pain weight loss

Answer 223

alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid

Answer 224

5mg needed for: - BMI of more than 30 kg/m² - diabetes - sickle cell disease (SCD) - thalassaemia trait - coeliac disease - on anti-epileptic medication -personal or family history of NTD ?Multiples Otherwise 400mcg + all pregnant patients take vitamin D 10mcg

Answer 225

Using Higgins I2, a value of 0% indicates statistical homogeneity. Significant statistical heterogeneity is often considered to be present if I2 is 50% or more. The heterogeneity is a measure of how different the studies included in the meta-analysis are. Ideally they would be similar.

Answer 226

within 48h of delivery, or after four weeks post-partum

Answer 227

all women aged >= 65 years and all men aged >= 75 years should be assessed. Younger patients should be assessed in the presence of risk factors, such as: previous fragility fracture current use or frequent recent use of oral or systemic glucocorticoid history of falls family history of hip fracture other causes of secondary osteoporosis, for example: hypogonadism in either sex including low testosterone in men and premature menopause in women endocrine conditions, including diabetes mellitus, Cushing's disease, hyperthyroidism conditions associated with malabsorption, including inflammatory bowel disease, coeliac disease, and chronic pancreatitis. rheumatoid arthritis and other inflammatory arthropathies. low body mass index (BMI) (less than 18.5 kg/m²) smoking alcohol intake of more than 14 units per week for women and more than 14 units per week for men.

Answer 228

FEV1/FVC <0.7

Answer 229

40 ppb or more in adults, 35 ppb or more in children

Answer 230

12% or more improvement in FEV1 and 200 ml or more volume increase

Answer 231

PC20 of 8 mg/ml or less

Answer 232

anti-malarials: primaquine ciprofloxacin sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

Answer 233

potent or very potent topical steroid eg Mometasone furoate 0.1% ointment

Answer 234

Croup 2 Sore throat 2–7 Earache 7–8 Common cold 15 Non-specific RTI 16 Bronchiolitis 21 Acute cough 25

Answer 235

5 days from onset of rash

Answer 236

4 days from onset of rash

Answer 237

2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

Answer 238

24 hours after commencing antibiotics

Answer 239

None needed

Answer 240

Until all crusted over

Answer 241

5 days from onset of swollen glands

Answer 242

Until symptoms have settled for 48 hours

Answer 243

Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment

Answer 244

Until treated

Answer 245

Until recovered

Answer 246

Group 1 licences should have a review every 3 years Group 2 licence holders should be reviewed annually. To reapply for a driving licence, the driving and vehicle licensing agency (DVLA) needs medical confirmation of improvement in sleepiness, control of breathing and adherence to treatment.

Answer 247

An SMR of 100 means that the number of deaths is the same as would be expected for the general population. A number higher than 100 implies an excess mortality rate and an SMR of 1000 is ten times that of the general population. Sometimes the SMR is not multiplied by 100, in which case SMR <1.0 indicates fewer than expected deaths and SMR >1.0 indicates more than expected deaths.

Answer 248

The event rate in the exposed group is a/(a + b) = 3000/27000 = 0.111 The event rate in the unexposed group is c/(c + d) = 100/20100 = 0.005 Therefore, the absolute risk increase is 0.11-0.005 = 0.106 Number needed to harm = 1/0.105 = 9.4 This means that, for roughly every 9 men that smoke, one is likely to die from lung cancer.

Answer 249

The DVLA states that driving should cease for a period of 6–12 months following a significant head injury.

Answer 250

1. Mild, with an FEV1 of > 80% 2. Moderate, with an FEV1 of 50–79% 3. Severe, with an FEV1 of 30–49% 4. Very severe, with an FEV1 <30%

Answer 251

SpO2 <92% FEV1 <30%

Answer 252

5 days: 30mg preg Amox Doxy or clarithromycin

Answer 253

Alzheimer's 50% Vascular 25% Lewy bodies 15% Frontotemporal <5% Mixed Autosomal dominant alzheimers Treatable causes <5%

Answer 254

21 - 26 mild cognitive impairment 10-20 moderate <10 severe

Answer 255

Anticholinesterase inhibitors - Donepezil - Rivastigmine - Galantamine

Answer 256

Risperidone (first choice) Quetiapine and haloperidol Never in lewy body Cardiac risk assessment Start low and titrate Only when causing significant distress Review and stop when indicated

Answer 257

women aged 47-73 years 50-70?? Above this age, women can continue to have screening by self-referring themselves.

Answer 258

'transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l'

Answer 259

0.15mg / kg

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