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Medical Finals contents: Monthly quiz PDA's Links Credits Your comments Who are we? |
| Medical Finals contents: Welcome Finals advice Written exams Clinical revision X-Rays Mock final OSCE's | |
Medical Finals contents: Monthly quiz PDA's Links Credits Your comments Who are we? |
GP MCQ questions |
Contributor: Dr Gerry Gormley MD MRCGP November 2005 |
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| (1) | A 74 year old patient attends your GP surgery 10 days after experiencing an episode of shingles.
She now complains of persistent pain in that area. You make a diagnosis of post-hepatic neuralgia. Which of the following is the single best treatment? |
| (a) Oral Acyclovir |  | |
| (b) Gabapentin | | |
| (c) Oral hydrocortisone | | |
| (d) Topical Acyclovir (cream) | | |
| (e) Topical Non-steroidal anti-inflammatory gel | |
| (2) | A 38 yr old teacher presents with back pain.
Which one of the following symptoms would indicate a serious pathology and hence require immediate referral/further assessment? |
| (a) Pain made worse by movement | | |
| (b) Perineal anaesthesia | | |
| (c) Aged between 20 to 55yrs at initial presentation | | |
| (d) Pain radiating to a leg | | |
| (e) Numbness in one leg | |
| (3) | Which one of the following statements is true for prostate cancer? |
| (a) PSA testing is effective in screening for prostate cancer | | |
| (b) Is the 3rd commonest cancer (excluding non melanoma skin cancer) in men | | |
| (c) There is a National Screening programme for prostate cancer in the NHS | | |
| (d) 80% of patients with prostate cancer have a non-aggressive form | | |
| (e) Prostate cancer does not spread to bone | |
| (4) | Which of the following types of patient are not recommended to have influenza immunization? |
| (a) > 65 years of age | | |
| (b) Hypertension | | |
| (c) Diabetic | | |
| (d) Chronic renal failure | | |
| (e) Carer of an elderly patient | |
| (5) | A 70 year-old retired GP attends you surgery complaining of reduced hearing.
An audiogram reveals that she has sensorineural deafness. What is the most likely cause? |
| (a) Ear wax | | |
| (b) Perforation | | |
| (c) Barotramua | | |
| (d) Presbyacusis | | |
| (e) Otosclerosis | |
| (6) | A 52 yr old secretary presents to her GP with right elbow pain. A diagnosis of "tennis elbow" is made.
Which of the following statements is the most correct in "tennis elbow" ? |
| (a) Tenderness can be elicited over the lateral epicondyle | | |
| (b) Pain is experienced on the lateral aspect of the elbow during forced wrist flexion | | |
| (c) Periarticular injection of corticosteroid is the first line treatment for tennis elbow | | |
| (d) Usually presents bilaterally | | |
| (e) Is an uncommon condition of the elbow | |
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| 1 | (b) Gabapentin - Gabapentin is an effective anti-neuropathic pain agent, although developed and still used in the treatment of epilepsy. Topical & oral acyclovir medication has little effect on post-hepatic neurology, but may help in the early stages of shingles in certain patients (e.g. the elderly) |
| 2 | (b) Perineal anaesthesia - Perineal anaesthesia and sphincter dysfunction are orthopaedic/neurosurgical emergencies and require immediate referral. These are red flag signs. |
| 3 | (d) 80% of patients with prostate cancer have a non-aggressive form - Prostate cancer is the commonest cancer in men and it’s incidence is increasing. Evidence would suggest that screening for prostate cancer by PSA testing in men may cause more harm than good. The majority of patients with prostate cancer have a non aggressive form; men who have prostate cancer will die with prostate cancer rather than of prostate cancer. Prostate cancer can spread to bone especially the lumbar spine, cause sclerotic metastases. |
| 4 | (b) Hypertension - Under current guidance the following groups are recommend to receive the influenza vaccination: >65yrs, Diabetic patients, Chronic chest conditions (e.g. asthma/COPD), Patients with cardiac vascular conditions (MI, angina, heart failure - but not hypertension), Residents of long stay care institutions & carers of elderly patients |
| 5 | (d) Presbyacusis - In this age group presbyacusis is the likeliest cause. Ear wax, barotrauma, perforation & otosclerosis cause conductive hearing loss. |
| 6 | (a) Tenderness can be elicited over the lateral epicondyle - Tennis elbow is the commonest condition of the elbow with an incidence of 1-3% per yr. The main clinical features of lateral epicondylitis include the symptom of pain on the lateral aspect of the elbow, tenderness over the lateral epicondyle & pain experienced on forced wrist extension. First line treatment includes modification of activities, physiotherapy & analgesia. If conservative treatment fails one may consider a periarticular injection with corticosteroid. Bilateral tennis elbow is uncommon and in these cases you should consider fibromyalgia as a potential cause. |