AKT 3 Flashcards
A 54-year-old trans woman has been taking oestrogen therapy for 15 years. She is also taking risperidone 5 mg daily for schizoaffective disorder. She is a smoker with abody mass index(BMI)of 38 kg/m2.
Which SINGLE disease is she MOST at risk of developing? Select ONE option only.
Select one:
A.
Osteoporosis
B.
Hepatoma
C.
Prostate cancer
D.
Breast cancer
E.
Type 2 diabetes
Answerjustification andfeedback:This patient is at risk of type 2 diabetes from smoking, obesity and the risperidone. Each patient should be assessed on an individual basis and other health issues should be dealt with irrespective of the transgender treatment. Both testosterone and oestrogen increase bone density and although trans women can get both prostate and breast cancer, the incidence is thought to be low.
The correct answer is: Type 2 diabetes
You receive a letter from a solicitor requesting a copy of the medical record of a patient who has recently been involved in a road traffic accident. The patient’s written consent is enclosed.
Following receipt of this written request, within how many days are you required to supply a copy of the patient’s health record? Select ONE option only. Select one: A.28 days B.40 days C.seven days D.60 days E.14 days
ANS A.
Answer justification and feedback:Patients have a right to request access to their own medical records and can also provide consent for disclosure to third parties. A request by a patient, or a request by a third party who has been authorised by the patient, for access under theGeneral Data Protection Regulations(andData Protection Act2018) is called a subject access request (SAR). Once the request has been received and verified, the information should be provided within 28 days of receipt.
Resource:
BMA.Access to health records.
The correct answer is: 28 days
A 26-year-old trans woman is taking oestrogen therapy before undergoing gender reassignment surgery.
Which is the SINGLE MOST significant adverse event of this treatment? Select ONE option only.
Select one:
A.
Acne
B.
Hepatic cyst formation
C.
Hirsutism
D.
Type 2 diabetes
E.
Venous thrombosis
Feedback
Your answer is correct.
Answerjustification and feedback:Feminizing hormone therapy may increase the risk of venous thromboembolic disease, hypertriglyceridaemia, cardiovascular disease, hypertension, hyperprolactinaemia and prolactinoma.Male‑to‑female transgender clients on hormone therapy should be monitored for feminizing and adverse effects every three months for the first year, and then every 6–12 months.
The correct answer is: Venous thrombosis
A 54-year-old man, with a moderate learning disability, is brought to see you by his carer. She states that his behaviour has been deteriorating over the past three weeks. He has not been responding when spoken to and has not been doing things when asked. He becomes aggressive when confronted. In particular, he has refused to turn down the volume on his television and this is causing arguments with other residents.
He has been well otherwise, with no change in eating or toilet habit. He has no relevant history or medication.He answers all questions with the response “I’m fine”.
On examination, he is apyrexial, pulse and blood pressure are normal. Examination of his chest and abdomen is normal. Which of the following is the MOST LIKELY diagnosis? Select ONE option only. Select one: A.Early onset dementia B.Impacted ear wax C.Urinary tract infection D.Absence seizures E.Depression
ANS B.
Answer justification and feedback:Due to communication difficulties, people with learning disabilities may not complain of any sensory changes and, therefore, simple problems like a build up of ear wax can present in an unusual way.
One must be alert to such atypical, and often simple, explanations. There could be multiple other explanations for his changed behaviour, but, of the listed options, him becoming hard of hearing due to ear wax is the most plausible.
Resource:
RCGP.Curriculum Topic Guides: neurdevelopmental disorders, intellectual and social disability. 2019.
The correct answer is: Impacted ear wax
While your practice manager is off, a new receptionist comes to you for advice. A 53-year-old gypsy traveller is requesting to register with the practice. He currently lives in his trailer which is parked in a car park and has no fixed address. He doesn’t know how long he is staying in the area.
Which SINGLE MOSTappropriateoption? Select ONE option only.
Select one:
A.Direct him to the nearest NHS walk in centre
B.Advise the patient to register with the local homeless surgery
C.Register the patient as a temporary resident
D.Fully register the patient
E.Refuse registration as proof of address is essential for full registration
ANS D.
Answer justification and feedback:No patient should be refused registration on the grounds of a non-fixed address. As stated in NHS England guidance on how to register with a GP, anyone living in the area may be registered without proof of address or identification and may use a friend’s address or the practice address.
It is good policy to fully register Gypsy Traveller patients when they are in the area for any length of time to ensure that they are included in routine screening and child health surveillance. Patients should not be de-registered if they are away travelling for a few weeks.
Resource:
Cleemput P.Health needs of gypsy travellers.InnovAiT2018;11(12):681–688.
The correct answer is: Fully register the patient
A male employee of the practice tells you that his wife is expecting twins and he would like to take some leave. He meets all the requirements for Shared Parental Leave.
What is the MAXIMUM amount of time both parents are entitled to? Select ONE option only. Select one: A.Two weeks B.Four weeks C.Twelve weeks D.Fifty weeks E.Sixty weeks
ANS D.
Answer justification and feedback:Shared Parental Leave (SPL) gives more choice in how 2 parents can care for their child.Parents can share up to 50 weeks of leave and up to 37 weeks of pay and choose to take the leave and pay in a more flexible way (each parent can take up to 3 blocks of leave, more if their employer allows, interspersed with periods of work).
Resource:
Department for Work and Pensions (DWP) / GOV.UK.Shared Parental Leave and Pay
The correct answer is: Fifty weeks
Which ONE of thefollowing patients would be entitled to claimIndustrial Injuries Disablement Benefit for occupationaldeafness? Select ONE option only.
Select one:
A.A 34-year-old woman who works as a police firearmstraining officer and has a conductive hearing loss of50 dB in the left ear and 30 dB in the right ear
B.A 44-year-old man who works with a metal cutting disc and has a sensorineural hearing loss of 40 dB in the left ear, and a conductive hearing loss of 35 dB in the right ear
C.A 59-year-old woman who works with a wool spinning machine and has a sensorineural hearing loss of 55 dB in the left ear and 50 dB in the right ear
D.A 27-year-old man who works with a circular saw and has a conductive hearing loss of 60 dB in the left ear
E.A 70-year-old man who has previously worked with a pneumatic drill and has a sensorineural hearing loss of 25 dB in both ears
ANS C.
Answer justification and feedback:Industrial Injuries Disablement Benefit may be claimed for occupational deafness when the hearing loss is:
• Sensorineural hearing loss amounting to at least 50 dBin each ear
• The average of losses at 1, 2 and 3 kHz frequencies(main speech frequencies)
• Owing in the case of at least one ear to occupationalnoise
Resource:
Department for Work and Pensions (DWP) / GOV.UK.Industrial injuries disablement benefit.
The correct answer is: A 59-year-old woman who works with a wool spinning machine and has a sensorineural hearing loss of 55 dB in the left ear and 50 dB in the right ear
Which ONE of the following statements is TRUE regarding Carer’s allowance? Select ONE option only.
Select one:
A.The carer is not entitled to claim if the ill or disabled person is in receipt of either attendance allowance or disability living allowance
B.The carer must be over 21 years old
C.The carer must live with the ill or disabled person
D.Entitlement is affected by the carer’s personal savings
E.The carer must spend at least 35 hours per week caring for the ill or disabled person
ANS E.
Answer justification and feedback:Carer’s Allowance is a taxable benefit to help people who look after someone who is disabled:
• Carers do not have to be related or live with the person they care for
• The carer must be aged 16 years or over, and spend at least 35 hours per week caring for a person
• The ill or disabled person must be in receipt of either Attendance Allowance or Disability Living Allowance
• The carer must have been living in England, Scotland or Wales for at least 2 of the last 3 years prior to applying
Resources:
DWP.Carers allowance.
The correct answer is: The carer must spend at least 35 hours per week caring for the ill or disabled person
A phlebotomist is to be recruited to work in the practice and will be employed by the local community health partnership/ trust.
Relating to the application and interview, which of the following complies with the Equality Act 2010? Select ONE option only.
Select one:
A.Asking at the interview about health
B.Asking at the interview about disability
C.Asking about relevant skills and experience to do the job
D.Asking about the need for special help to attend the interview
E.Asking on the application form about disability
ANS C.
Answer justification and feedback:The Equality Act was introduced in 2010 and replaces previous anti-discrimination legislation, simplifying the overall process and carrying greater powers for prosecution if unlawful discrimination has occured. Itlegally protects people from discrimination in the workplace and in wider society. Employers and workplaces are required to make reasonable adjustments to the workplace in order to make it suitable for those with disabilities.
In the above example according to the Equality Act 2010, employers will generally no longer be allowed to ask questions about health or disability to prospective employees before being shortlisted for an interview or a job offer has been made.
Resources:
RCGP.Curriculum Topic Guides: consulting in general practice.2019.
The correct answer is: Asking about relevant skills and experience to do the job
Approximately what proportion of the adult UK population act as informal (unpaid) carers? Select ONE option only.
Select one:
A.
80%
B.
20%
C.
10%
D.
60%
E.
40%
ANS C.
Answer justification and feedback:It is estimated that there are seven million carers in the UK –1 in 10 people, and this figure is set to rise.
Resources:
Carers Trust.Facts about carers.
RCGP.Supporting carers in general practice.
RCGP.Carers: taking action to support carers in practice teams.
The correct answer is: 10%
67 year old lady undergoes medication review . You note she is on Bendroflumethiazide. Which of the following is a common side effect of Bendroflumethiazide A. Hypocalcaemia B. cataract C. Hypernatraemia D. Gout E. Hirsutism
D
You are conducting a medication review for a 52 year old lady. Her PMH includes : depression, type 2 DM, Osteoarthritis and recent Angina.
Which of the following medications should be stopped for this patient ?
A. Fluoxetine
B. Pioglitazone
C. Paracetamol
D. Hormone replacement therapy
E. Metformin
D
What class of medication is Sildenafil A. Phosphodiesterase Type I inhibitor B. Phosphodiesterase Type II inhibitor C. Phosphodiesterase Type III inhibitor D. Nitric oxide mimetic E. Phosphodiesterase Type V inhibitor
E
Which of the following can be used for spontaneous(rather than scheduled) sexual activity A. Avanafil B.Sildenafil C. Verdenafil D. Tasanafil E. None of the above
D
Aresearch project looking at the management of moderate hypertension divides its subjects into two groups. Group A, with 1776 subjects, receives anti-hypertensive medication. Group B, with 1800 subjects, receives a placebo. After five years the risk of a stroke in Group A is 12%, while in Group B it is 20%. What is the number needed to treat (NNT) to prevent one extra stroke? Select ONE option only. Select one: A.2.00 B.1.25 C.8.00 D.12.50 E.58.00
D
