AKT questions, nMRCGP exam

1. Assuming Fraser competence (where applicable) which one of the following situations is generally regarded as acceptable in law?

A. A 17 year old girl appearing in a pornographic film
B. Sexual intercourse between a 20 year old male and 15 year old female
C. Sexual intercourse between a 20 year old female and 15 year old male
D. Sexual intercourse between a 15 year old boy and 14 year old girl
E. Sexual intercourse between a 15 year old girl and 12 year old boy

Answer: D

There is specific protection in law for young people under the age of 18 regarding pornographic activity. Whilst sex under the age of 16 is regarded as criminal activity by the Crown Prosecution Service action is unlikely if both parties are of a similar age.

2. A healthy 16 year old girl consults you regarding the sequelae of chlamydial infection. Which one of the following statemtents is true? [Show Discussion]

A. It is a common cause of ectopic pregnancy
B. It is a common cause of pneumonia
C. 90% of infected females will develop pelvic inflammatory disease if untreated
D. 50% of patients with pelvic inflammatory disease due to Chlamydia will develop infertility
E. The risk of pelvic inflammatory disease is greatest after the first chlamydial infection

Answer: A

43% ectopic pregnancies are due to Chlamydia. It is a rare cause of pneumonia. If untreated up to 40% of women develop PID. Of which 20% have fertility problems. The risk of PID increases with subsequent infections

3. A healthy 16 year old girl consults you regarding the sequelae of chlamydial infection. Which one of the following statemtents is true?

A. A 19 year old nurse with vaginal discharge who thinks she has Chlamydia
B. A 15 year old student who is on the COC
C. A 17 year old girl with severe learning difficulties
D. A 20 year old homeless person with no contact details
E. A 26 year old girl who’s boyfriend has recently found out he has chlamydia

Answer: B

This patient is eligible if competent.

4. Jenny is 19 and has to come to you asking for you to fill in her health insurance form for work. She was screened for chlamydia two months ago but the test was negative. Which of the following is the correct advice about the information that you can give her insurance company?

A. You can disclose that she has had the test but not the result
B. You can disclose the test and the result
C. You can always disclose the result if it was positive
D. You can disclose the result if it was negative
E. You should not disclose that the test has been done despite the result being negative

Answer: E

BMA guidance states that information should not be revealed about whether an applicant for insurance has undertaken tests for STIs – not should any negative results be disclosed. In addition doctors should not reveal information about an isolated incident of an STI that has no long term health implications or even multiple episodes of non serious STIs.

5. Sasha comes to see you after having been told that her Chlamydia screening test was positive and asks about the potential complications. Which one of the following options is the least likely complication?

A. Fitz Hugh Curtis Syndrome
B. Chronic Pelvic Pain
C. Ectopic pregnancy
D. Tubal infertility
E. Bartholinitis

Answer: E

This is rare

6. The parents of a 14 year old boy consult you regarding their son’s behaviour. Which one of the options below is most likely to indicate an underlying psychiatric illness?

A. Aggressive behaviour accompanied by mood swings
B. Covert alcohol consumption
C. Feeling irritable for several weeks
D. A diet consisting solely of junk food
E. School truancy

Answer: C

7. A 17 year old boy presents alone with anxiety and agitation. On examination he appears dishevelled and appears to be distracted. His answers are monosyllabic and he feels that he is being persecuted by the media. He denies illicit drug taking. The single most likely diagnosis is:

A. Anxiety
B. Bipolar disorder
C. Depression
D. Personality disorder
E. Schizophrenia

Answer: E

Schizophrenia. There is evidence of psychosis in this patient and he needs urgent assessment by CAMHS. Bipolar disorder could produce a psychosis but is less common in this age group as could illicit drug abuse

8. Which one of the options below makes school refusal more likely than school truancy in a 16 year old boy?

A. Hiding school absence from parents
B. Nonchalance despite poor academic achievements
C. Somatic symptoms
D. Staying away from home during truancy
E. Stealing

Answer: C

School refusers tend to be sensitive , sometimes bullied children who may have a background of unhappiness. Somatic symptoms (eg abdominal pain) would be common associations. School truants on the other hand are more likely to come from poor, sometimes dysfunctional backgrounds and to have anti social tendencies.

9. A 14 year old boy presents with features of mild depression. Pending an opinion from the Child and Adolescent Mental Health Services (CAHMS) which one of the following courses of action would be most appropriate? [Show Discussion]

A. Amitriptylene
B. Fluoxetine
C. Imipramine
D. No prescription
E. Zopiclone

Answer: D

Because of the tendency to do more harm than good anti-depressants should not be used first line in adolescents with mild depression. Zopiclone (which is not an anti-depressant) would be inappropriate in this age group.

10. You are consulted by the parents of a four year old boy. He appears to be hyperactive, impulsive and he is unable to focus his attention but his parents say that this is relatively mild and only in certain situations. They are concerned that he might have ADHD. Assuming that you will review the patient which is the single most appropriate initial course of action?

A. Prescribe methylphenidate
B. Prescribe atomoxine
C. Refer to child psychiatrist
D. Refer to health visitor
E. Refer to paediatrician

Answer: D

Bearing in mind that the symptoms are mild either this or possibly referral to a parent-training / education programme (if available). Do not initiate methylphenidate or atomoxine in primary care although they may be prescribed under shared agreements with secondary care