Round Up Email June 2019

Question 1

Cyclist syndrome – a 42 year-old gentleman is a keen cyclist and has noted per perineal and pelvic pain that is exacerbated by "sitting down". He has read a cycling magazine and is concerned he may have "cyclist syndrome": Pudendal neuralgia

1) Which statement regarding "cyclist syndrome" is false?

This condition in men may be misdiagnosed as "prostatitis"
A pudendal nerve block can serve as both a diagnostic and therapeutic tool
The Nantes criteria for diagnosis includes objective sensory loss on clinical examination

Question 2

Sundowning – this is a phenomenon where there is a sudden the sudden appearance of neuropsychiatric symptoms such as agitation, confusion and anxiety in a chronologic fashion, usually during late afternoon or early evening. There is evidence that this syndrome may affect up to 25% of patients with dementia.: Sundown syndrome

2) Which statement regarding "Sundowning" is false?

equivalent to a delirium that is precipitated by diminished illumination, and can also be confused with depression or dementia
degeneration of the suprachiasmatic nucleus may be a causative factor
melatonin is the treatment of choice

Question 3

ELF test – NICE have suggested to consider using the enhanced liver fibrosis (ELF) test in people who have been diagnosed with non-alcoholic fatty liver disease (NAFLD) to test for advanced liver fibrosis. : Enhanced liver fibrosis (ELF) score

3) Which statement regarding the ELF test is false?

consider using the enhanced liver fibrosis (ELF) test in people who have been diagnosed with non-alcoholic fatty liver disease (NAFLD) to test for advanced liver fibrosis
ELF test can be falsely raised if a patient has a reduced folate
if NAFLD and ELF test >= 10.51 then can diagnose people with advanced liver fibrosis

Question 4

High HDL – raised HDL, in general, helps to reduce cardiovascular risk. However in some instances e.g. chronic alcohol usage, then an associated raised HDL does not confer the associated reduction in cardiovascular risk: High or increased HDL cholesterol

4) Which statement regarding raised HDL is false

A raised HDL may occur if taking phenytoin
A raised HDL may occur in chronic alcohol usage
A raised HDL may occur if taking atenolol

Question 5

Exercise in the prevention of Type 2 diabetes – a 45 year old lady has been recently diagnoses with "prediabetes" with an HbA1c of 45. She has asked you about the benefits of exercise in prevention of type diabetes.: Metformin in the prevention of onset of type 2 diabetes

5) Which statement regarding exercise in the prevention of Type 2 diabetes is false?

Interventions involving physical activity have been shown to reduce the risk of developing Type 2 Diabetes by between 47 and 58% in high-risk group
Evidence from the Diabetes Prevention Study showed that the most effective intervention for preventing or delaying the onset of type 2 diabetes is intensive lifestyle modification rather than metformin treatment
Lifestyle interventions do not have a "legacy effect" ie an ongoing benefit from those who undertook previous lifestyle modification in terms of continuing reduction in reduction of type 2 diabetes risk

Question 6

Nicorandil and mouth ulcers – a 56 year old man with stable CHD had been referred on a 2ww referral because of a persistent mouth ulcer for 4 weeks. After specialist review the cause of the mouth ulcer was identified as the nicorandil medication for his IHD.: Nicorandil and mouth ulcer

6) Which statement regarding Nicorandil is false?

Nicorandil use is associated with increased incidence of perianal ulceration
Nicorandil use has been associated with increased incidence of Crohn's disease
Nicorandil use has been associated with increased risk of gastrointestinal ulceration