AKT Questions

1. OPTIONS:
a ) Colorectal carcinoma
b ) Endometrial carcinoma
c ) Liver carcinoma
d ) Oesophageal carcinoma
e ) Ovarian carcinoma
f ) Pancreatic carcinoma
g ) Small bowel carcinoma

INSTRUCTION: For each patient below, choose the most likely diagnosis from the list above. Each option may be used once, more than once or not at all.

1 . A 60 year old woman presents with a three month history of anorexia and epigastric discomfort. Over this time, she has lost 5kgs in weight. She is now experiencing some difficulty swallowing and has vomited after meals. On examination, the abdomen seems non tender and no masses are felt; weight loss is evident.
The Correct answer is d.

2 . A 60 year old woman presents with abdominal pain and distension. She has been vomiting. She tells you that, about eight weeks ago, her bowel had become much more loose and frequent. On examination, the whole abdomen is tender and distended, with no masses felt; bowel sounds are high pitched.
The Correct answer is a.

3 . A 60 year old woman presents with a six month history of non-specific abdominal pain and bloating. She was treated for irritable bowel with no improvement. On examination, the whole abdomen is tender, especially over the caecum, with no masses felt. Pelvic examination suggests a fullness in the right fornix.
The Correct answer is e.

The alarm signs associated with oesophageal and gastric cancer are dysphagia, anorexia, vomiting and weight loss.
Patients over 50 years with any of the following for more than 6 weeks should be referred urgently for investigation of colorectal cancer:
• Rectal bleeding with change in bowel habit
• Rectal bleeding without anal symptoms
• Palpable abdominal mass
• Intestinal obstruction Retrospective studies show that women with ovarian cancer present with non specific symptoms including abdominal pain and bloating, changes in bowel habit, urinary and/or pelvic symptoms. Many have been misdiagnosed as irritable bowel.

2. OPTIONS:
a ) Amoxicillin
b ) Beclometasone inhaler
c ) Ipratropium inhaler
d ) Montelukast
e ) Prednisolone
f ) Salbutamol inhaler
g ) Salmeterol inhaler

INSTRUCTION: For each of the following patients, choose the single most appropriate drug treatment from the above list. Each option may be used once, more than once or not at all.

1 . A six year old girl is brought to see you in the surgery. Mum has noticed that she has been coughing more over the last three months since a really bad cold. Some nights she disturbs other family members with her coughing. Examination is unremarkable. She keeps well otherwise and is on no other medication.
The Correct answer is f.

2 . A 67 year old man presents to the out of hours service with a two day history of increasing shortness of breath and cough. He is coughing up clear sputum but this is not new as he tells you he is a smoker. He has no other associated symptoms. He doesn’t feel his usual inhalers are helping but all he can tell you is that he has a blue one and a brown one. He is getting SOB getting washed and dressed but can still manage. He is apyrexial, pulse 88/min, respiratory rate 18/min, chest is wheezy.
The Correct answer is e.

3 . A 26 year old man, who has had asthma since childhood, has noticed he is more wheezy recently. Usually he would rarely use his reliever inhaler but in the last month he has used it 1-2 times a day. He also uses a beclometasone inhaler and has doubled the dose of this himself to a total of 800mcg a day but feels his symptoms have not improved much. He has no other significant past medical history. Examination is normal.
The Correct answer is g.

A trial of a bronchodilator can help confirm how likely a diagnosis of asthma is. He has non purulent sputum so an antibiotic is unnecessary but oral prednisolone is recommended for an acute flare up of breathlessness affecting activities of daily living. A trial of a long acting beta 2 agonist is recommended in adults if they have inadequate symptom control with inhaled steroids at doses between 200-800mcg/day (beclometasone).

3. In patients with a diagnosis of moderately severe Chronic Obstructive Airways Disease (COPD), which one of the following treatments has been shown in a systematic review to reduce mortality?
a ) Antibiot. ics in COPD exacerbations
b ) Cardioselective beta blockers for up to 12 weeks
c ) Carbocisteine for up to 12 weeks
d ) Inhaled steroids for at least two years
e ) Daily anticholinergic therapy for more than one month

answer: A

In COPD exacerbations, with increased cough and sputum purulence, antibiotics, regardless of choice, reduce the risk of short-term mortality by 77%. Therefore their use is supported in those who are moderately to severely ill.

4. OPTIONS:
a ) Acute rotator cuff tear
b ) Adhesive capsulitis
c ) Cervical spondylosis
d ) Gout
e ) Herpes zoster
f ) Pneumothorax
g ) Polymyalgia rheumatica
INSTRUCTION: For each patient below with shoulder pain, select the single most likely diagnosis above. Each option may be used once, more than once or not at all.

1 . A 63 year old woman has a one week history of pain in the left shoulder in a C4 distribution It is unpleasant and burning in character, and unrelated to exertion. She has a full range of neck and shoulder movement.
The Correct answer is e.

2 . A 70 year old woman has a two week history of pain and stiffness in both shoulders, occurring during the night, and easing off somewhat an hour after getting up. She has found that Ibuprofen helps.
The Correct answer is g.

3 . A 35 year old man suddenly develops left shoulder pain, worse on inspiration, after a fit of coughing several days ago. He has an excellent range of shoulder movement.
The Correct answer is f.

5. OPTIONS:
a ) Dermovate ointment
b ) Emollient
c ) Hydrocortisone cream
d ) Oral antibiotic
e ) Potassium permanganate wet wraps
f ) Oral antifungal
g ) Topical tar based product

INSTRUCTION: For each scenario below, choose the single most appropriate treatment from the above options. Each option can be used once, more than once or not at all.

1 . An infant of six months is brought to you with a severe nappy rash. Having consulted the health visitor, mum has tried an antifungal cream, with no effect. You note that the rash spares the skin flexures.
The Correct answer is c.

2 . A 53 year old smoker attends with intensely itchy hands. Examination reveals pustular lesions on the palms of the hands and the soles of the feet. You think this is palmoplantar pustulosis.
The Correct answer is a.

3 . A one year old child presents with an exudative, weeping eczema.
The Correct answer is e.

6. A 65 year old man presents with a three month history of dyspnoea and ankle oedema. On examination, he has a regular pulse of 108/minute, BP 140/90 and bilateral basal crepitations. Which one of the following tests would aid your decision in referring for echocardiography?

a ) Brain natriuretic peptide (BNP)
b ) Cholesterol (Cho)
c ) Creatinine Kinase (CK)
d ) Lactose Dehydrogenase (LDH)
e ) Troponins T and I

answer: A

Brain natriuretic peptide or NT pro- BNP and/or ECG should be recorded to indicate the need for echocardiography in patients with suspected CHF. There are local variations in the availability of BNP testing.

7. A 73 year old man attends with poor urinary stream, urinary hesitancy and nocturia. He was assessed by urology and the diagnosis was made of benign prostatic hypertrophy. You decide to start finasteride. Which one of the following is a known side-effect of this drug?

a ) Baldness
b ) Ejaculation disorders
c ) Increased libido
d ) Increased PSA level
e ) Priapism

answer: B

Anti-androgens, such as Finasteride, cause ejaculation disorders and reduce libido. A low strength of Finasteride is used to treat male-pattern baldness. Anti-androgens reduce the level of prostate cancer markers.

8. A 48 year old woman presents with a 24 hour history of a painful red eye, lacrimation, photophobia and blurred vision. Her visual acuity is 6/18 in the affected eye, and 6/6 in the other. Fluorescein shows a central patch of irregular uptake of stain. Which one of the following is the most likely diagnosis?
a ) Acute iritis
b ) Bacterial conjunctivitis
c ) Blepharitis
d ) Dendritic corneal ulcer
e ) Episcleritis

Answer: D

Dendritic ulcer is caused by herpes simplex virus, requires treatment with acyclovir 3% eye ointment, and should be referred immediately for ophthalmological assessment. Use of steroid drops can result in massive ulceration and blindness.