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MCQs – 5 Mar 2015

Q.1

RECTAL PROLAPSE IN ELDERLY PATIENTS

Is more likely to affect men than women.

Is a recognised complication of anal surgery.

Aetiological factors include a history of constipation.

Should not be reduced outside hospital.

If incomplete can be successfully treated by injection sclerotherapy.

Q.2

APPROPRIATE MANAGEMENT OF SUSPECTED CHILD SEXUAL ABUSE IN GENERAL PRACTICE IS LIKELY TO INVOLVE

Acknowledging the ‘Paramountcy Principle’.

Having clear intra-practice child protection policies.

The GP examining the child thoroughly.

Making minimal notes in case the parents wish to read the child’s records.

Making a referral to social services.

Q.3

ARTIFICIAL TEAR SUPPLEMENTS

Use is contraindicated in the presence of any eye infection.

May help in treating acute allergic conjunctivitis.

Can be used without concern, as often as the patient wishes.

Producing watery tears, would be first choice in eyelid disorders such as ectropion or Bell’s palsy.

Are best instilled with the dropper tip in gentle contact with the eye.

Q.4

ACOUSTIC NEUROMAS

Are benign tumours.

Are never bilateral.

Patient may present with unilateral high pitched tinnitus.

May compress the fifth and seventh cranial nerves.

Are a recognised cause of visual field defects.

Q.5

REGULAR, MODERATE EXERCISE HAS BEEN SHOWN TO REDUCE THE RISK INTENSITY OF

Colorectal cancer.

Osteoarthritis.

Depression.

Diabetes.

Disability in older people.

A.1.

False. Six times more common in women, though not associated with childbirth or parity.

True. Or of piles, atony of anal sphincters.

True. With prolonged straining which stretches the pelvic floor and anal sphincter mechanism.

False. Most either reduce spontaneously or with manual assistance after defecation.

True. Or extended haemorrhoidectomy.

A.2.

True. Child’s needs above all other considerations.

True. Mirroring local or national child protection policies.

False. Examination by the non-expert will compromise forensic evidence.

False. Make clear, careful and comprehensive notes.

True. By phone, ideally followed up in writing within 48 hours .

A. 3.

False. Very soothing in mild infections such as viral conjunctivitis.

True. Irrigate allergen from the conjunctival sac.

False. If used more than four times daily suggests either severe disease or misdiagnosis and increase risk of allergy to preservative.

False. Need a viscous lubricant like Viscotears or Lacrilube (a gel lubricant).

False. Dropper tip should never touch the eye as relatively easy to contaminate the contents.

A.4.

True. Schwannomas arising from the vestibular nerve.

False. Can be in patients with neurofibromatosis type 2.

True. Also hearing loss, disequilibrium.

True. In which case patient may get otalgia, facial numbness and weakness.

False. Pituitary adenomas most likely cause of this.

A. 5.

True. High fruit/vegetable diet may also protect.

False. Exercise helps prevent osteoporosis.

True. Depression more common in those who are physically inactive.

True. Risk of developing diabetes reduced by 50% in those who take regular moderate exercise.

True. Even the very old benefit.

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