AKT Questions

1. OPTIONS:

a ) Amyotrophic lateral sclerosis
b ) Cerebrovascular accident
c ) Gastro-oesophageal reflux
d ) Hypoparathyroidism
e ) Hypothyroidism
f ) Laryngeal carcinoma
g ) Recurrent laryngeal nerve palsy

INSTRUCTION: For each of the patients below, choose the most likely cause of hoarseness above. Each option can be used once, more than once or not at all.

A. A 37 year old woman with a BMI of 34 has a history of dyspepsia. She is presenting with hoarseness which is worse in the morning.

The Correct answer is c.
B . A 68 year old man describes difficulty swallowing over the last few months. He is experiencing difficulties walking. He now presents with hoarseness.

The Correct answer is a.
C . A 53 year old woman, who underwent thyroid surgery four weeks ago, is now presenting with hoarseness.

The Correct answer is g.

2. Although hypothyroidism can cause vocal changes, hoarseness which is worse in the morning is likely to be associated with GORD. Obesity predisposes to GORD. Hoarseness, dysphagia and other motor symptoms are most likely to be caused by motor neurone disease (amyotrophic lateral sclerosis). Neck surgery can result in recurrent laryngeal nerve palsy in 1-2% of cases.

3. A double-blind, randomised, placebo-controlled trial, conducted in primary care, of a new drug for stroke prevention shows statistical and clinical evidence that the drug is superior to placebo in preventing stroke. In deciding whether or not to use this new drug, which one of the following statistics is most useful?

a ) NNK (Number Needed to Know)
b ) NNT (Number Needed to Treat)
c ) RRR (Relative Risk Reduction)
d ) CER (Control Event Rate)
e ) RRI (Relative Risk Increase)

Answer: B

The NNT (Number Needed to Treat) calculates the number of patients a clinician needs to treat in order to prevent one additional adverse outcome.

4. “The expanding use of qualitative research methodology has allowed us to gain knowledge about the characteristics, complexities and interrelationships of phenomena such as an individual’s experiences, emotions, beliefs and motives” (David Silverman, 2004). By applying this methodology in the primary care setting, we can obtain a greater understanding of the patients’ perspective and use this to improve patient health, the health care system and health service delivery. Which one of the following terms would you most associate with Qualitative rather than Quantitative research?

a ) Purposive sampling
b ) Controlled trials
c ) Randomisation
d ) Confidence interval
e ) Double blind

Answer: A

The randomised double blind controlled trial is the gold standard in quantitative research. Prospective studies can be used in Quantitative and Qualitative studies. Confidence intervals are used in statistics in relation to numeric data in Quantitative research. Purposive sampling is a sampling method used in Qualitative Research and is the selection of the most productive sample to answer the research question.

5. Your Practice Manager, of 10 years standing, has been off work for the last six months, with a diagnosis of Multiple Sclerosis. She contacts the Partners and asks if she can have a meeting and this is agreed. During the meeting, she confirms the diagnosis, stating that she realises the consequences of her physical impairment and its effect on her employability. Her mood and behaviour are entirely normal. She states that she is having some difficulties with normal day-to-day activities such as climbing stairs, doing housework, going shopping etc. She states that she wishes to return to work, as she is confident she can carry out all her previous management duties. She realises that getting to her upstairs office could be problematical and a whole day’s work could be overtiring. As her employer, which two management decisions would be most appropriate?

a ) Take her back as Practice Manager on a flexible, part-time basis
b ) Enforce her to take early ill-health retirement
c ) Revamp her working place environment
d ) Take her back as a Telephonist on a flexible ,part-time basis
e ) Take her back as Practice Manager only on a full time basis
f ) Tell her to keep getting sickness certificates from her Doctor
g ) Terminate her employment

The correct answers are, a, c.

Discrimination occurs against a disabled person if an employer treats someone less favourably than others who do not have a disability. The employer has a duty to look at whether there are any reasonable adjustments that can help the disabled person return to work (e.g. Changing hours, changing the local work place environment). The Disability Discrimination Act (2005) extends the definition of discrimination to people with progressive conditions such as Cancer, Multiple Sclerosis, and H.I.V.