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?
AStopping the combined oral contraceptive pill
BReducing alcohol intake to below 5 units per week
CAchieving and maintaining BMI <25 kg/m² through weight loss
DUndertaking regular vigorous physical activity 150 minutes weekly
EAdopting a plant-based Mediterranean diet low in processed foods
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?
ABMI ≥25 kg/m² with commitment to dietary changes
BBMI ≥28 kg/m² with obesity-related comorbidities
CBMI ≥30 kg/m² with commitment to dietary and lifestyle changes
DBMI ≥32 kg/m² after failed conservative management
EBMI ≥35 kg/m² or BMI ≥30 kg/m² with comorbidities
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?
AContact ophthalmology to confirm urgent referral has been received and processed
BReassure that ophthalmology will contact her within 2 weeks of screening report
CArrange repeat diabetic eye screening in 3 months to monitor progression
DRefer urgently to ophthalmology via GP pathway in case screening referral was missed
EOptimize glycaemic and blood pressure control and wait for screening programme referral
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