Screening & Prevention Practice Questions

Question 1

A 76-year-old woman with dementia (MMSE 18/30), Parkinson's disease, type 2 diabetes, and recurrent falls is brought by her daughter for medication review. Current medications include: co-careldopa 25/100 three times daily, ropinirole 8mg three times daily, quetiapine 25mg twice daily, metformin 500mg twice daily, gliclazide 40mg twice daily, alendronic acid 70mg weekly, calcium/vitamin D, and PRN paracetamol. She has had three falls in the past two months. Her daughter reports increasing confusion and hallucinations. Blood glucose monitoring shows values between 4.8-8.2 mmol/L. Which medication intervention should be prioritised?

Accepted Answer

Reduce ropinirole as dopamine agonists cause hallucinations and should be withdrawn first

Answer

Reduce co-careldopa dose as dopaminergic medications contribute to hallucinations and falls

Answer

Stop quetiapine immediately as antipsychotics worsen Parkinson's disease motor symptoms

Answer

Review and rationalise diabetes medications given risk of hypoglycaemia contributing to falls

Answer

Stop alendronic acid as bisphosphonates increase fall risk in elderly patients

Question 2

A 72-year-old man with chronic kidney disease stage 4 (eGFR 24 ml/min/1.73m²), type 2 diabetes, hypertension, and gout presents for medication review. His current medications include: metformin 1g twice daily, gliclazide 80mg twice daily, ramipril 10mg once daily, amlodipine 10mg once daily, aspirin 75mg once daily, atorvastatin 80mg once daily, allopurinol 100mg once daily, and omeprazole 20mg once daily. His HbA1c is 58 mmol/mol, and he reports intermittent episodes of feeling 'shaky and sweaty'. Which medication requires MOST urgent modification?

Accepted Answer

Metformin should be stopped immediately due to risk of lactic acidosis

Answer

Allopurinol should be increased to 300mg daily for adequate urate control

Answer

Ramipril should be reduced due to advanced chronic kidney disease

Answer

Gliclazide should be reviewed and reduced due to hypoglycaemia risk

Answer

Aspirin should be stopped as cardiovascular protection is inadequate at this dose

Question 3

Understanding the concept of 'diagnostic uncertainty' in managing undifferentiated symptoms in primary care involves recognizing that certain presentations cannot be immediately diagnosed. Which of the following statements best describes the evidence-based approach to managing diagnostic uncertainty?

Accepted Answer

Safety-netting with clear instructions for re-consultation if symptoms persist, worsen, or new features develop is an essential component of managing uncertainty

Answer

Immediate referral to secondary care is always appropriate when a diagnosis cannot be made in primary care to ensure patient safety

Answer

Extensive investigation should be undertaken immediately to exclude all possible serious diagnoses before adopting a watch-and-wait approach

Answer

Patients should be reassured that the absence of abnormal findings on initial tests means serious pathology is excluded and no follow-up is needed

Answer

Empirical treatment should be started for the most likely diagnosis to avoid delays in management

Question 4

A 67-year-old woman with multimorbidity attends for a comprehensive medication review. She has six chronic conditions: heart failure, atrial fibrillation, type 2 diabetes, hypothyroidism, osteoporosis, and depression. She takes 11 regular medications. According to NICE guidance on multimorbidity (NG56), which approach is MOST important when prioritising her care during this consultation?

Accepted Answer

Establish the patient's priorities for treatment and quality of life outcomes

Answer

Focus on achieving optimal disease-specific targets for each individual condition

Answer

Systematically review medications starting with those prescribed most recently

Answer

Concentrate on reducing the total number of medications to fewer than 10

Answer

Prioritise management of conditions with the highest mortality risk first

Question 5

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 6

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 7

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 8

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 9

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

Question 10

A 58-year-old woman attends for NHS Health Check. She has a BMI of 28 kg/m², BP 128/82 mmHg, and smokes 10 cigarettes daily. Bloods show total cholesterol 5.2 mmol/L, HDL 1.4 mmol/L, HbA1c 39 mmol/mol. Her QRISK3 score is 8.5%. She is motivated to improve her health. What is the most evidence-based lifestyle intervention to offer?

Accepted Answer

Smoking cessation support with varenicline or combination NRT

Answer

Exercise programme targeting 150 minutes moderate activity per week

Answer

Weight loss programme targeting 5-10% body weight reduction

Answer

Mediterranean diet advice with emphasis on reducing saturated fat

Answer

Combined lifestyle intervention addressing all modifiable risk factors

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