AKT Questions

1. Which of the following statements about encompresis is true?

A. it cannot be diagnosed before the age of four.
B. it involves the voluntary passage of faeces.
C. it I particularly a common problem in lower socioeconomic groups.
D. it is best managed with a coercive approach to potty training.
E. it is more common in females.

Answer: A

Encompresis is the involuntary passage of fully formed faeces and is not a diagnosis that can be made before the age of four. It is an uncommon disorder but much more common in boys. Coercive potty training is likely to worsen the condition. Organic disorders such as Hirschprung's disease must be excluded before psychiatric management is considered. The treatment of choice includes behavioural management, such as the use of a start chart, along with parental counselling or family therapy to help modify hostile attitudes.

2. A 34-year-old man presents to his GP with a 6-month Hx of back pain with no recent Hx of trauma. There are no red flag symptoms. He works long hours as an IT technician. You see from the notes that he has presented in the past with intermittent episodes of back stiffness and occasional neck ache. He is otherwise fit and well, though he was treated with a steroid injection for plantar fascitis last year. On examination, he has no neurological signs but does have reduced range of movement in his cervical spine, particularly for extension. Which one of the following options is the most likely diagnosis?

A. ankylosing spondylitis
B. mechanical back pain
C. osteoarthritis
D. rheumatoid arthritis
E. wedge fracture

Answer: A

AS has prevalence of approximately 1 in 2200 and affects men twice as frequently as women. It tends to present n young men with morning back pain and stiffness. As progressive spinal fusion occurs there can be reduced spinal movement, with kyphosis and sacroiliac joint pain. It is associated with plantar fascitis, lung fibrosis, inflammatory bowel disease and amyloidosis. X-ray of the spine might show a "bamboo spine" with vertebral fusion. The diagnosis is associated with HLA-B27 positivity.

3. Which one of the following food items has the highest glycaemic index?

A. cucumber
B. oranges.
C. peanuts
D. potatoes
E. tomatoes

Answer: D

The GI index and nutrition are popular in the exam as this is important with regard to diabetes and also dieting. Foods with low GI give a smaller rise in blood glucose and are said to result in better glycaemic control in diabetes. Potatoes have a high GI, whereas cucumber has the lowest.

4. Which one of the following is true of psoriasis?

A. topical steroids should be the mainstay of treatment.
B. oral steroids cause pustular psoriasis
C. psoriatic arthropathy never occurs in the absence of a typical rash.
d. Methotrexate is only used to treat the arthropathy.
E. can be cured outright.

Answer: B

Topical steroids are used to treat psoriasis, but second line and for short periods. Oral steroids can produce dramatic pustular psoriasis. Psoriatic arthropathy can occur without skin changes but usually there are nail changes. Methotrexate is used to treat psoriasis without arthropathy and at this point in time the disease is not curable.

5. A 19-year old man has had perineal pain for the past 3 days and has developed fever. He also describes dysuria. On rectal examination he is found to have a tender boggy prostate gland. Which one of the following actions is the most appropriate next step?

A. an HIV test should be organised as soon as possible.
B. a urine sample should be obtained for culture.
C. antibiotics should be started only after any culture results are received.
D. rectal tissue should be swabbed and sent to the laboratory.
E. the prostate should be massaged to obtain Prostatic fluid for culture.

Answer: B

This patient has symptoms consistent with acute prostatitis. Fever, arthralgia, low abdominal pain and a urethral discharge are all common symptom. Diagnosis is made by urine culture. Prostatic massage should be avoided as it can allow the infection to disseminate and will be painful to the patient.

6. A 55-year-old patient has longstanding treated hypertension. He has had his eGFR measured on annual basis. Last year his eGFR was estimated at 54 ml/min/1.73m2. This year he has an unexplained fall in eGFR to 41 ml/min/1.73m2. He feels otherwise well. Which one of the following actions is the most appropriate?

A. arrange renal US and only refer to renal team if US is abnormal.
B. repeat eGFR in 6 months.
C. repeat eGFR in one year.
D. routine OP referral to the renal team.
E. urgent OP referral to the renal team

Answer: D

Patients who have an unexplained fall in eGFR might warrant routine referral to the renal team. An unexplained annual fall in eGFR of >15% is considered significant by the renal association. NICE guidelines also suggest referral for patients with a fall in eGFR. Those with at least a 5-ml/min unexplained fall in eGFR over one year (or less) should be referred. A renal US is also indicated in these patients.

7. A child has just registered with your practice because his family has moved to the area. He has recently been diagnosed with hereditary spherocytosis. Which one of the following statements about this condition is true?

A. it is X-linked recessive condition.
B. it is associated with aplastic crises
C. it is usually diagnosed incidentally in adulthood on routine blood testing
D. patients should be treated with vit. B12 supplementation.
E. there is usually no clinical signs.

Answer: B

Hereditary spherocytosis is an autosomal recessive condition that affects 1 in 5000 live births. It usually presents in childhood as jaundice or with aplastic crises, usually triggered by parvovirus infections. Most children receive folic acid supplementation. Splenomegaly is common. It is rarely diagnosed in adulthood.