NB Medical Hot Topics Course Autumn 2013 MCQ Answers

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1 NB Medical Hot Topics Course Autumn 2013 MCQ Answers 1. What percentage of patients aged 65 and over have 3 or more chronic conditions? A. 20% B. 35% C. 50% D. 65% E. 80% 65% of patients aged 65 and older have 3 or more chronic conditions. Multimorbidity is the norm, but despite this the vast majority of research and guidelines are based on single-disease models which may not necessarily be applicable. 2. Which of the following is NOT a correct definition of malnutrition? A. BMI <18.5 B. Unintentional weight loss of >10% within the past 12 months C. BMI <20, and unintentional weight loss of > 5% within the past 3 to 6 months Malnutrition is defined as: BMI <18.5, unintentional weight loss >10% within the past 3-6 months, or BMI <20 and unintentional weight loss of >5% within the past 3-6 months. 3. Which of the following patients are recommended to be tested for vitamin D deficiency? A. Pregnant women B. People with pigmented skin C. People aged >65 years D. People with musculoskeletal symptoms that could be attributed to vitamin D deficiency E. People with osteoporosis The only people recommended to be tested for vitamin D deficiency are people with bone disease (e.g. osteomalacia) whose outcomes may be improved by vitamin D treatment or people with musculoskeletal symptoms that could be attributed to vitamin D deficiency. Several groups such as pregnant women, people at risk of deficiency (e.g. those with pigmented skin), people >65 years and people with osteoporosis are recommended to have supplementation without testing. 4. In a patient with resistant hypertension already taking triple therapy of a calcium channel blocker, ACE inhibitor and thiazide like diuretic, assuming their K+ is <4.5mmol/l, what is the preferred fourth medication? A. High dose thiazide B. Furosemide

2 C. Spironolactone D. Hydralazine New guidance recommends that the fourth medication for resistant hypertension should be spironolactone if the patient has K+ <4.5, otherwise consider a high dose thiazide. 5. Which of the following components of a lipid profile has the greatest variation in non-fasting patients? A. Total cholesterol B. HDL C. LDL D. Triglycerides Variation in lipid profiles between fasting and non-fasting samples are minimal. variations, LDL up to 10% and triglycerides up to 20%. TC and HDL have insignificant 6. In patients with minor stroke or high risk TIA, if starting treatment within 24 hours what combination is more effective at preventing recurrence than using aspirin alone? A. Aspirin + clopidogrel B. Aspirin + dipyridamole MR BD C. Aspirin + warfarin D. Clopidogrel + warfarin E. None of the above The CHANCE study shows that aspirin and clopidogrel is superior to aspirin alone in preventing recurrence of minor stroke or TIA if started within 24 hours of the primary event. 7. What does the BMJ recommend is the appropriate target HbA1c in older people with multi-morbidity, cognitive impairment or risk of hypos and/or falls? A. 53mmol/mol (7%) B. 58.5mmol/mol (7.5%) C. 64mmol/mol (8%) D. 69mmol/mol (8.5%) E. 75mmol/mol (9%) The BMJ recommends a target HbA1c of 58.5mmol/mol in older patients who are well; 64mmol/mol is they have multi-morbidity, cognitive impairment or risk of hypos and/or falls; and 69mmol/mol if they have an end-stage chronic illness.

3 8. Which of the following antipsychotic medications is most likely to cause weight gain? A. Olanzapine B. Risperidone C. Quetiapine D. Aripiprazole E. Amisulpride Olanzapine commonly causes weight gain, which can lead to the development of cardiovascular risk factors and, ultimately, disease. Quetiapine and risperidone are less likely to cause weight gain, with the lowest risk being from the expensive aripirazole or amisulpride. 9. Which of the following is the most common type of eating disorder? A. Anorexia nervosa B. Bulimia nervosa C. Eating disorder not otherwise specified Eating disorder not otherwise specified is now the most commonly diagnosed eating disorder. 10. NICE recommends which of the following as first line treatment for acute migraine? A. Paracetamol B. Ibuprofen C. Triptan D. Codeine phosphate E. Triptan + paracetamol or ibuprofen F. Codeine phosphate + paracetamol NICE now recommends a combination of triptan + paracetamol/ibuprofen as first line acute treatment for migraine. 11. Which of the following causes of lower leg pain in runners presents with exertional lower leg pain along the posterotibial border, typically from first impact when exercising which is diffuse in nature and generally tender in the absence of visible signs? A. Medial tibial stress syndrome B. Chronic exertional compartment syndrome C. Stress fracture This describe medial tibial stress syndrome or shin splints. develops gradually over 5-10 minutes of exercise. Stress fractures have point tenderness and CECS

4 12. What reduction is seen in severe rotavirus diarrhoea cases after childhood vaccination? A % B % C % D % Introduction of the two dose rotavirus vaccine, Rotarix, is planned for September 2013 in under 6 month olds. It reduces the rate of severe rotavirus diarrhoea by 86% and all-cause severe diarrhoea by 40% with no increase in significant adverse events. 13. Which of the following treatments has evidence demonstrating a reduction in the duration of symptoms of the common cold? A. Amoxicillin B. Zinc lozenges C. Vitamin C D. Probiotics Both zinc lozenges and vitamin C have evidence showing a reduction in the duration of symptoms of the common cold. Probiotics and vitamin C may also reduce the incidence of colds. 14. What percentage of people with cellulitis will have a recurrence within 1 year? A. 1% B. 2% C. 5% D. 10% E. 20% Around 10% of people with cellulitis will have a recurrence within 1 year. 15. Which of the following statements is incorrect regarding hereditary haemochromatosis? A. 1 in 250 people of Northern European origin are affected B. Abnormal LFTs are the most common presentation C. Serum iron and transferrin saturation are the best blood markers of disease D. Blood letting is the primary treatment E. Siblings have a 1 in 4 chance of having the condition Hereditary haemochromatosis should be suspected in patients with a raised ferritin and transferrin saturation >45%. Diagnosis is made using genetic testing.

5 16. Which of the following is a low FODMAP food? A. Onions B. Mushrooms C. Wheat D. Milk E. Bananas Bananas are an example of a low FODMAP food. IBS. Low FODMAP foods can very useful in the management of 17. Which of the following should be avoided in the management of menopausal flushing in patients taking tamoxifen for breast cancer? A. Fluoxetine B. Venlafaxine C. Gabapentin D. Clonidine Fluoxetine and paroxetine (and possibly other SSIRs) should be avoided as they can interfere with tamoxifen. Venlafaxine is the treatment of choice. 18. Which of the following family histories of breast cancer should prompt referral to breast clinic for assessment for familial breast cancer chemoprevention? A. Father B. Sister aged 48 with bilateral disease C. Mother had ovarian cancer aged 63, auntie had breast cancer aged 52 D. Grandmother and 2 aunties had breast cancer, age unknown E. All of the above All of the above should be offered referral to a breast specialist for consideration of chemoprevention. 19. What is the minimum age a tympanic thermometer is recommended for use with a child? A. No limit B. 1 week C. 4 weeks D. 8 weeks E. 12 weeks Tympanic thermometers should not be used in infants under 4 weeks old an electronic axillary thermometer is recommended.

6 20. Using an initial low energy liquid diet with ongoing support, what percentage of patients managed to loss >15kg in weight at 12 months? A. 10% B. 25% C. 33% D. 50% One third of patients who entered this Scottish weight loss trial lost >15kg in weight at 12 months.