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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: MRCGP MCQ Discusion-1 Mon Apr 22, 2013 1:13 pm | |
| In this topic we will introduce some MRCGP MCQs and correct answer for discusion from all,so let us start by this Question: You are giving dietary advice to an obese patient who has been diagnosed with type 2 diabetes mellitus. Following recent NICE guidelines, which one of the following should not be encouraged?iaA.A
| Food products specifically targeted at diabeticsia
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| B.A
| Initial weight loss of 5-10%ia
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| C.A
| Limited substitution of sucrose-containing foods for other carbohydratesia
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| D.A
| High-fibre, low glycaemic index carbohydratesia
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| E.A
| Low-fat dairy productsia
| what the correct answer? why? ===================================== Join Our Channel in Youtube Medical Learninig Videos
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Mon Apr 22, 2013 1:17 pm | |
| The correct answer: A: Food products specifically targeted at diabetics
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Mon Apr 22, 2013 1:20 pm | |
| NICE suggest that the consumption of foods marketed specifically at diabetics should be discouraged. Diabetes mellitus: management of type 2
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NICE updated its guidance on the management of type 2 diabetes mellitus (T2DM) in 2009. Key points are listed below: Dietary advice
- encourage
high fibre, low glycaemic index sources of carbohydrates
- include low-fat dairy products and oily fish
- control the intake of foods containing saturated fats and trans fatty acids
- limited substitution of sucrose-containing foods for other carbohydrates is allowable,
but care should be taken to avoid excess energy intake
- discourage use of foods marketed specifically at people with diabetes
- initial target weight loss in an overweight person is 5-10%
HbA1c
- the general target for patients is 6.5%. HbA1c levels below 6.5% should not be pursued
- however, individual targets should be agreed with patients to encourage motivation
- HbA1c should be checked every 2-6 months until stable, then 6 monthly
Blood pressure
- target
is < 140/80 mmHg (or < 130/80 mmHg if end-organ damage is present)
- ACE inhibitors are first-line
The NICE treatment algorithm has become much more complicated following the introduction of new therapies for type 2 diabetes. We suggest reviewing this using the link provided. Below is a very selected group of points from the algorithm:
- NICE still suggest a trial of lifestyle interventions first*
- usually metformin is first-line, followed by a sulfonylurea if the HbA1c remains > 6.5%
- if the patient is at risk from hypoglycaemia (or the consequences of) then a DPP-4 inhibitor or thiazolidinedione should be considered rather than a
sulfonylurea
- meglitinides (insulin secretagogues) should be considered for patients with an erratic lifestyle
- if HbA1c > 7.5% then consider human insulin
- metformin treatment should be continued after starting insulin
- exenatide should be used only when insulin would otherwise be started, obesity is a
problem (BMI > 35 kg/m^2) and the need for high dose insulin is likely. Continue only if beneficial response occurs and is maintained (> 1.0 percentage point HbA1c reduction in 6 months and weight loss > 5% at 1 year)
Starting insulin
- usually commenced if HbA1c > 7.5%
- NICE recommend starting with human NPH insulin (isophane, intermediate acting) taken
at bed-time or twice daily according to need
Other risk factor modification
- aspirin
to all patients > 50 years and to younger patients with other significant risk factors
- the management of blood lipids in T2DM has changed slightly. Previously all patients
with T2DM > 40-years-old were prescribed statins. Now patients > 40-years-old who have no obvious cardiovascular risk (e.g. Non-smoker, not obese, normotensive etc) and have a cardiovascular risk < 20%/10 years do not need to be given a statin. We suggest reviewing the NICE T2DM guidelines for further information.
- if serum cholesterol target not reach consider increasing simvastatin to 80mg on
- if target still not reached consider using a more effective statin (e.g. Atorvastatin) or adding ezetimibe
- target total cholesterol is < 4.0 mmol/l
- if serum triglyceride levels are > 4.5 mmol/l prescribe
fenofibrate
*many local protocols now recommend starting metformin upon diagnosis ===================== Related TopicsCURRENT Medical Diagnosis and Treatment 2014 free Download Bratton's Family Medicine Board Review free download Swanson's Family Medicine Review 7th edition free Download John Murtagh's General Practice for Family Medicine free Download Oxford Handbook of General Practice free Download The Color Atlas of Family Medicine First Aid for the Family Medicine Boards free Download NMS Q & A: Family Medicine, 3rd Edition free download |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Mon Apr 22, 2013 1:22 pm | |
| Qestion 2: Each of the following drugs are known to inhibit cytochrome P450, except: ia A.A | Ketoconazoleia
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| B.A | Ciprofloxacinia
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| C.A | Erythromycinia
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| D.A | Clopidogrelia
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| E.A | Amiodaroneia
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===================== Related TopicsCURRENT Medical Diagnosis and Treatment 2014 free Download Bratton's Family Medicine Board Review free download Swanson's Family Medicine Review 7th edition free Download John Murtagh's General Practice for Family Medicine free Download Oxford Handbook of General Practice free Download The Color Atlas of Family Medicine First Aid for the Family Medicine Boards free Download NMS Q & A: Family Medicine, 3rd Edition free download |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Mon Apr 22, 2013 1:27 pm | |
| correct answer: NB: sqweqwesf erwrewfsdfs adasd dheInduction usually requires prolonged exposure to the inducing drug, as opposed to P450 inhibitors, where effects are often seen rapidly Inducers of the P450 system include
- antiepileptics: phenytoin, carbamazepine
- barbiturates: phenobarbitone
- rifampicin
- St John's Wort
- chronic alcohol intake
- griseofulvin
- smoking (affects CYP1A2, reason why smokers require more
aminophylline)
Inhibitors of the P450 system include
- antibiotics: ciprofloxacin, erythromycin
- isoniazid
- cimetidine, omeprazole
- amiodarone
- allopurinol
- imidazoles: ketoconazole, fluconazole
- SSRIs: fluoxetine, sertraline
- ritonavir
- sodium valproate
- acute alcohol intake
- quinupristin
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john
Membership NO : 1 Posts : 1672 Join date : 2011-03-27
| Subject: Re: MRCGP MCQ Discusion-1 Tue Apr 23, 2013 3:01 am | |
| Q3: A 64-year-old woman with metastatic breast cancer is brought in by her husband. Over the past two days she has developed increasingly severe back pain. Her husband reports that her legs are weak and she is having difficulty walking. On examination she has reduced power in both legs and increased tone associated with brisk knee and ankle reflexes. There is some sensory loss in the lower limbs and feet but perianal sensation is normal. What is the most likely diagnosis?ia A:Spinal cord compression at T10 B: Cauda equina syndrome C:Guillain Barre syndrome D:Hypercalcaemiaia E:Paraneoplastic peripheral neuropathy
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john
Membership NO : 1 Posts : 1672 Join date : 2011-03-27
| Subject: Re: MRCGP MCQ Discusion-1 Tue Apr 23, 2013 3:05 am | |
| Correct Answer: Spinal cord compression at T10i
why?The upper motor neuron signs point towards a diagnosis of spinal cord compression above L1, rather than cauda equina syndrome. ================================= Spinal cord compression
Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients. Extradural compression accounts for the marjority of cases, usually due to vertebral body metastases. It is more common in patients with lung, breast and prostate cancer Features:
- back pain - the earliest and most common symptom - may be worse on lying down and coughing
- lower limb weakness
- sensory changes: sensory loss and numbness
- neurological
signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion.
Management
- high-dose oral dexamethasone
- urgent oncological assessment for consideration of radiotherapy or surgery
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Tue Apr 23, 2013 9:20 am | |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Wed Apr 24, 2013 10:22 am | |
| Q4: Which one of the following prescriptions is contraindicated in pregnancy? A.Methyldopa for hypertension B.Topical clindamycin for bacterial vaginosis C.Doxycycline for malarial prophylaxisia D.Metoclopramide for vomiting E.Prednisolone for an asthma exacerbation |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Wed Apr 24, 2013 10:25 am | |
| Correct Answer: C.Doxycycline for malarial prophylaxis
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All tetracyclines should be avoided in pregnancy. It should be noted that the above prescriptions are not necessarily the recommended first-line treatments Very few drugs are known to be completely safe in pregnancy. The list below largely comprises of those known to be harmful. Some countries have developed a grading system Antibiotics
- tetracyclines
- aminoglycosides
- sulphonamides and trimethoprim
- quinolones: the BNF advises to avoid due to arthropathy in some animal
studies
Other drugs
- ACE inhibitors, angiotensin II receptor antagonists
- statins
- warfarin
- sulfonylureas
- retinoids (including topical)
- cytotoxic agents
The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Sun Apr 28, 2013 12:15 pm | |
| Q5: A 57-year-old female presents due to problems with urine leakage over the past six months. She describes frequent voiding and not always being able to get to the toilet in time. She denies losing urine when coughing or sneezing. What is the most appropriate initial treatment?ia A.Trial of oxybutynin B.Bladder retraining C.Regular toileting D.Topical oestrogen cream E.Pelvic floor muscle training |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Sun Apr 28, 2013 12:17 pm | |
| Correct Answer: B.Bladder retrainingUrinary incontinence - first-line treatment:
- urge incontinence: bladder retraining
- stress incontinence: pelvic floor muscle training
sqweqwesf erwrewfsdfs adasd dheUrinary incontinence (UI) is a common problem, affecting around 4-5% of the UK population. It is more common in elderly females. NICE released guidance on the management of UI in 2006 Causes
- overactive bladder (OAB)/urge incontinence: due to detrusor over activity
- stress incontinence: leaking small amounts when coughing or laughing
- mixed incontinence: both urge and stress
- overflow incontinence: due to bladder outlet obstruction, e.g. due to
prostate enlargement
Initial investigation
- bladder diaries should be completed for a minimum of 3 days
- urine dipstick and culture
Management depends on whether urge or stress UI is the predominant picture. If urge incontinence is predominant:
- bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually
increase the intervals between voiding)
- bladder stabilising drugs: immediate release oxybutynin is first-line
- surgical management: e.g. sacral nerve stimulation
If stress incontinence is predominant:
- pelvic floor muscle training (for a minimum of 3 months)
- surgical procedures: e.g. retropubic mid-urethral tape procedures
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Sun Apr 28, 2013 12:35 pm | |
| Q6: A 5-year-old girl is brought to surgery due to a high temperature. On examination she is noted to have an evolving purpuric rash. What is the most appropriate course of action? A.IM benzylpenicillin 150mg B.IM benzylpenicillin 300mg C.IM benzylpenicillin 600mg D.IM benzylpenicillin 900mg E.IM benzylpenicillin 1200mg |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Sun Apr 28, 2013 12:36 pm | |
| Correct Answer: C.IM benzylpenicillin 600mg The RCGP have previously fed back that doctors are expected to be familiar with emergency drug doses, and have mentioned suspected meningococcal septicaemia in particular
The current BNF should always be consulted prior to prescribing drugs you are unfamiliar with, the following is just a guide IM benzylpenicillin for suspected meningococcal septicaemia in the community< 1 year | 300 mg | 1 - 10 years | 600 mg | > 10 years | 1200 mg |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 3:56 am | |
| Q7: A 17-year-old female presents requesting advice as she forgot to take her Microgynon 30 pills on a weekend away. She is normally very good at remembering her pill but has missed days 10, 11 and 12 of her packet and it is now day 13. Although she took the day 13 pill this morning she is concerned she may become pregnant and she had unprotected sexual intercourse whilst away. What is the most appropriate management? A.No action needed B.No action needed but omit pill break at end of pack
C.Offer emergency contraception - hormonal D.Offer emergency contraception - intrauterine device E.No action needed but use condoms for next 7 days
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:03 am | |
| Correct Answet: No action needed but use condoms for next 7 daysTough question. As the patient had taken the pill for 7 days in a row previously she is protected for the next 7 days. The FFPRHC guidelines state: "after seven consecutive pills have been taken there is no need for emergency contraception" - please consult the link. The guidelines also recommend in this situation using condoms for the next 7 days Combined oral contraceptive pill: missed pill :The advice from the Faculty of Family Planning and Reproductive Health Care has changed over recent years. The following recommendations are now made for women taken a combined oral contraceptive (COC) pill containing 30-35 micrograms of ethinylestradiol If 1 or 2 pills missed (at any time in the cycle)
- take a pill as soon as possible and then continue taking pills daily, one
each day
- no additional contraceptive protection needed
If 3 or more pills missed
- take a pill as soon as possible and then continue taking pills daily, one
each day
- the women should use condoms or abstain from sex until she has taken pills
for 7 days in a row
- if pills are missed in week 1 (Days 1-7): emergency contraception should be
considered if she had unprotected sex in the pill-free interval or in week 1
- if pills are missed in week 2 (Days 8-14): after seven consecutive days of
taking the COC there is no need for emergency contraception*
- if pills are missed in week 3 (Days 15-21): she should finish the pills in
her current pack and start a new pack the next day; thus omitting the pill free interval
*theoretically women would be protected if they took the COC in a pattern of 7 days on, 7 days off ===================================== Join Our Channel in Youtube Medical Learninig Videos |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:07 am | |
| Q8: A pregnant woman presents for review. She is 24 weeks pregnant. What would be the expected symphysis-fundal height? A.13 - 15 cm B.15 - 17 cm C.17 - 19 cm D.18 - 22 cm E.22 - 26 cm
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:09 am | |
| Correct Answer: E.22 - 26 cmAfter 20 weeks, symphysis-fundal height in cm = gestation in weeksThe symphysis-fundal height (SFH) is measured from the top of the pubic bone to the top of the uterus in centimetres It should match the gestational age in weeks to within 2 cm after 20 weeks, e.g. if 24 weeks then the a normal SFH = 22 to 26 cm ===================================== Join Our Channel in Youtube Medical Learninig Videos |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:20 am | |
| Q9: You are counselling a 26-year-old man who has recently had a positive HIV test. His most recent CD4 count is 650 cells/mm^3. Which one of the following vaccinations is contraindicated? A.Oral poliomyelitis B.Yellow fever C.Pneumococcus D.Parenteral poliomyelitis E.Measles, Mumps, Rubella |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:26 am | |
| Correct Answer: A.Oral poliomyelitisHIV: immunisation : The Department of Health 'Greenbook' on immunisation defers to the British HIV Association for guidelines relating to immunisation of HIV-infected adults. A:Vaccines that can be used in all HIV-infected adults: Hepatitis A Hepatitis B Haemophilus influenzae B (Hib)
Influenza-parenteral Japanese encephalitis Meningococcus-MenC
Meningococcus-ACWY I Pneumococcus-PPV23 Poliomyelitis-parenteral (IPV) Rabies Tetanus-Diphtheria (Td) B:Vaccines that can be used if CD4 > 200
Measles, Mumps, Rubella (MMR) Varicella Yellow Fever D:Contraindicated in HIV-infected adults Cholera CVD103-HgR Influenza-intranasal Poliomyelitis-oral (OPV) Tuberculosis (BCG) ===================================== Join Our Channel in Youtube Medical Learninig Videos |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:34 am | |
| Q10: A 60-year-old man who is currently receiving chemotherapy for non-small cell lung cancer presents for review. He is currently being treated with oral calcium supplements as hypocalcaemia was detected during a recent admission. Bloods taken two days ago reveal the following: Which one of the following tests may help determine why his calcium level remains low despite calcium supplementation? A.Vitamin D B.Parathyroid hormone C.Phosphate D.Alkaline phosphatase E.Magnesium |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-1 Fri May 03, 2013 4:38 am | |
| Correct Answer: E. MagnesiumCisplatin, often used in the management of non-small cell lung cancer, is a well known cause of magnesium deficiency. Without first correcting magnesium levels it is difficult to reverse hypocalcaemia
Hypocalcaemia: causes and management | sqweqwesf erwrewfsdfs adasd dheThe clinical history combined with parathyroid hormone levels will reveal the cause of hypocalcaemia in the majority of cases Causes
- vitamin D deficiency (osteomalacia)
- chronic renal failure
- hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
- pseudohypoparathyroidism (target cells insensitive to PTH)
- rhabdomyolysis (initial stages)
- magnesium deficiency (due to end organ PTH resistance)
Acute pancreatitis may also cause hypocalcaemia. Contamination of blood samples with EDTA may also give falsely low calcium levels Management
- acute management of severe hypocalcaemia is with intravenous replacement.
The preferred method is with intravenous calcium gluconate, 10ml of 10% solution over 10 minutes
- intravenous calcium chloride is more likely to cause local irritation
- ECG monitoring is recommended
- further management depends on the underlying cause
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