Screening & Prevention Practice Questions

Q: A 55-year-old woman with a BMI of 32 kg/m² attends for weight management support. She has tried multiple diets without sustained success. She has no other medical conditions. She asks about pharmacological options for weight loss. According to NICE guidance, what is the threshold for considering orlistat in this patient?

BMI ≥30 kg/m² with commitment to dietary and lifestyle changes. ***BMI ≥30 kg/m² with commitment to dietary and lifestyle changes*** - According to **NICE guidelines**, orlistat is indicated for adults with a **BMI of 30 kg/m² or more** as a primary threshold, even in the absence of comorbidities. - The prescription of orlistat must always be part of a comprehensive weight management program that includes **dietary modification**, increased physical activity, and **behavioral support**. *BMI ≥25 kg/m² with commitment to dietary changes* - A **BMI of 25 kg/m²** signifies **overweight**, for which pharmacological interventions like orlistat are not typically recommended by NICE. - Management at this stage primarily focuses on **lifestyle modifications**, including diet and exercise, without drug therapy. *BMI ≥28 kg/m² with obesity-related comorbidities* - Orlistat can be considered at a **BMI of 28 kg/m² or more** but specifically requires the presence of **obesity-related comorbidities**, such as type 2 diabetes or hypertension. - The patient in this scenario has **no other medical conditions**, meaning this specific threshold does not apply to her. *BMI ≥32 kg/m² after failed conservative management* - While the patient's BMI is 32 kg/m², this specific value is not the **minimum NICE threshold** for initiating orlistat, which is **BMI ≥30 kg/m²**. - Adhering to the established guidelines ensures appropriate and timely access to pharmacological support for eligible individuals. *BMI ≥35 kg/m² or BMI ≥30 kg/m² with comorbidities* - This threshold is generally more aligned with the criteria for referral to **bariatric surgery** rather than the initial prescription of orlistat. - Applying this higher criterion would unnecessarily delay pharmacological intervention for patients who meet the lower, more appropriate threshold for orlistat.

Q: A 46-year-old man attends for cardiovascular risk assessment. He drinks 6 pints of beer (4.5% ABV) on Friday and Saturday nights. He works in construction and is physically active. BMI is 27 kg/m², BP 134/84 mmHg. He asks about reducing his drinking. According to current UK Chief Medical Officers' guidelines, how many units of alcohol does he consume weekly?

30.6 units. ***30.6 units***- Alcohol units are calculated using the formula: **Volume (ml) × ABV (%) / 1000**. One UK pint is **568 ml**, making one 4.5% ABV beer equal to **2.556 units**.- The patient consumes 12 pints per week (6 on Friday and 6 on Saturday), so total consumption is **12 × 2.556 = 30.672 units**, which is significantly above the **UK Chief Medical Officers' low-risk limit of 14 units** weekly.*14 units*- This represents the **maximum recommended weekly limit** for both men and women in the UK to keep health risks low.- While a target for reduction for this patient, it does not reflect his current actual intake of **12 pints** per week.*24 units*- This value would imply that each pint contains exactly **2 units**, which is not accurate for a 4.5% ABV beer.- A pint of 4.5% ABV beer is actually **2.556 units**, making 12 pints total **30.6 units**.*36 units*- This figure would suggest an incorrect calculation where each pint is assumed to be **3 units**, which is typically associated with stronger beers (around 5.3% ABV).- Using the precise **4.5% ABV** given, the correct calculation yields **30.6 units**.*42 units*- This value would result from assuming approximately **3.5 units per pint**, which is characteristic of much stronger lagers or ciders (around 6% ABV).- The accurate calculation based on the specified **4.5% ABV** confirms the patient's intake is **30.6 units**.

Question 1

A 43-year-old woman presents asking about strategies to reduce her breast cancer risk. Her mother was diagnosed with breast cancer at age 48 and her maternal aunt at age 52. She has no personal history of breast disease. Clinical examination is normal. She takes the combined oral contraceptive pill and drinks 10 units of alcohol weekly. Her BMI is 26 kg/m². After appropriate genetic assessment, she is found not to carry BRCA mutations. Which lifestyle modification would provide the greatest reduction in her breast cancer risk?

Accepted Answer

Reducing alcohol intake to below 5 units per week

Answer

Stopping the combined oral contraceptive pill

Answer

Achieving and maintaining BMI <25 kg/m² through weight loss

Answer

Undertaking regular vigorous physical activity 150 minutes weekly

Answer

Adopting a plant-based Mediterranean diet low in processed foods

Question 2

A 55-year-old woman with a BMI of 32 kg/m² attends for weight management support. She has tried multiple diets without sustained success. She has no other medical conditions. She asks about pharmacological options for weight loss. According to NICE guidance, what is the threshold for considering orlistat in this patient?

Accepted Answer

BMI ≥30 kg/m² with commitment to dietary and lifestyle changes

Answer

BMI ≥25 kg/m² with commitment to dietary changes

Answer

BMI ≥28 kg/m² with obesity-related comorbidities

Answer

BMI ≥32 kg/m² after failed conservative management

Answer

BMI ≥35 kg/m² or BMI ≥30 kg/m² with comorbidities

Question 3

A 71-year-old woman with type 2 diabetes for 18 years attends for review. Her diabetic eye screening report from 2 weeks ago shows 'proliferative diabetic retinopathy with new vessels at disc in left eye'. She reports no visual symptoms. Her HbA1c is 72 mmol/mol, BP 156/88 mmHg. She has not yet received any ophthalmology appointment. What is the most appropriate action?

Accepted Answer

Contact ophthalmology to confirm urgent referral has been received and processed

Answer

Reassure that ophthalmology will contact her within 2 weeks of screening report

Answer

Arrange repeat diabetic eye screening in 3 months to monitor progression

Answer

Refer urgently to ophthalmology via GP pathway in case screening referral was missed

Answer

Optimize glycaemic and blood pressure control and wait for screening programme referral

Question 4

A 29-year-old woman attends for preconception counselling. She is planning pregnancy with her partner. She had one previous pregnancy 3 years ago with uncomplicated vaginal delivery. She takes no regular medications and has no chronic conditions. Which of the following screening tests should be offered before conception?

Accepted Answer

Rubella immunity only, as other infections are tested in pregnancy

Answer

No infectious disease screening needed as she had testing in previous pregnancy

Answer

Rubella immunity, HIV, hepatitis B, and syphilis serology

Answer

Full sexually transmitted infection screen including chlamydia and gonorrhoea

Answer

HIV and syphilis testing only if high-risk factors identified

Question 5

A 46-year-old man attends for cardiovascular risk assessment. He drinks 6 pints of beer (4.5% ABV) on Friday and Saturday nights. He works in construction and is physically active. BMI is 27 kg/m², BP 134/84 mmHg. He asks about reducing his drinking. According to current UK Chief Medical Officers' guidelines, how many units of alcohol does he consume weekly?

Accepted Answer

30.6 units

Answer

14 units

Answer

24 units

Answer

36 units

Answer

42 units

Screening & Prevention — MCQs

Screening & Prevention — MCQs

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