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Phase 3a > 3a GP + Geriatrics + Miscellaneous > Flashcards

3a GP + Geriatrics + Miscellaneous Flashcards

1
Q

Can you summarise pressure ulcer staging?

A

Note: commonly on bony prominences = heels, sacrum, shoulders, occiput

Grading
- Grade 1 = erythematous skin/colour change, temperature change, firm/soft
- Grade 2 = partial-thickness skin loss affecting epidermis +/- dermis
- Grade 3 = full-thickness skin loss affecting epidermis + dermis but not through fascia // can have tunnelling and undermining
- Grade 4 = ulcer extends through the epidermis, dermis, fascia and exposes underlying bone/muscle/tendons // includes tunnelling and undermining

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2
Q

What are some risk factors for falls?

A

Previous fall
Stroke
LD
Dementia
Parkinson’s
Delirium
Fear of falling
Depression
Hypoglycaemia
DM causing neuropathy (including autonomic neuropathy)
Pain
MSK weakness/foot drop
Incontinence
Visual impairment
Sensory neuropathy
Polypharmacy (oxybutynin, diuretics, antihypertensive, alpha/beta-blockers, digoxin, sedatives)
Postural hypotension
Vertigo/problems with vestibular system/DCML

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3
Q

How would you manage someone who has fallen?

A

Who to investigate
- Anyone > 65y
- Anyone with risk factors

Investigations
- Timed up and go test
- Turn 180 degrees test

Who to refer for assessment?
- Poor results on TUGT or turn 180 degrees
- Anyone > 65y with recurrent falls in last 12 months
- Anyone with fall requiring medical attention

Multi factorial assessment
- Medication review
- Vision assessment
- Cardiovascular, neurological, gait/MSK and balance assessment
- Home hazards review
- Assess fear of falling and perceived impairment
- Assess osteoporosis risk
- Assess incontinence
- Assess previous falls

Management
- Manage underlying causes
- Medication review
- Strength and balance training

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4
Q

What is osteoporosis and how would you treat osteoporosis?

A

BMD less than - 2.5 standard deviation from T-score
Common fractures
- Vertebral wedge (anterior + more stable, no neurological compromise) or burst fracture
- Colle’s (distal radial - dinner fork deformity)
- NOF (external rotation and shortening)

Investigations
- FRAX/QFracture
- DEXA
- ALP (normal)
- Calcium (normal)
- Phosphate (normal)
- FBC, U&E, LFT, CRP, TFT

Who do you treat?
- All indicated by FRAX
- All > 75 F with fragility fracture without DEXA
- All with fragility fracture + DEXA < -2.5

Management
- Bisphosphonates (alendronate/risedronate/zolendronate) + calcium and vitamin D supplements
- Others: teriparatide/denosumab, HRT, strontium ranelate, raloxifene

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5
Q

How would you manage constipation in adults? What are some causes of constipation?

A

Constipation: < 3 spontaneous bowel movements a week

Impaction = spontaneous evacuation unlikely

Management
- 1st line = bulking laxatives (ispaghula husk)
- 2nd line = osmotic laxatives (macrogol or lactulose)
- 3rd line = stimulant laxatives (bisacodyl or senna or sodium picosulfate)
- 4th = suppository or enema

Causes
- Opioids
- Rectocele
- Hypothyroidism
- IBD and IBS
- Bowel obstruction
- Malignancy
- Dehydration
- Hypercalcaemia
- Autonomic neuropathy, MS, PD, spinal injury

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6
Q

What are the different types of urinary incontinence? Can you tell me about the different risk factors and management for each?

A

Stress

Urge

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7
Q

Can you tell me a bit about GORD in adults?

A
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8
Q

What is IBS and how do we manage it?

A
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9
Q

What is hypertension? Can you tell me about some causes, classification and management?

A
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10
Q

What is heart failure? What are some causes?

A
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11
Q

How would heart failure present? Can we give any medications?

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12
Q

Can you summarise osteoarthritis for me?

A
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13
Q

What is gout? What are the investigations and management?

A
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14
Q

Can you tell me about pseudogout?

A
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15
Q

Can you summarise rheumatoid arthritis and its presentation?

A
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16
Q

Can you tell me about how to investigate and manage rheumatoid arthritis?

A
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17
Q

Can you tell me about Crohn’s disease?

A
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18
Q

Can you tell me about ulcerative colitis?

A
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19
Q

What are some common complications of IBD?

A
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20
Q

What genetic syndromes are associated with IBD?

A

Turner’s
Trisomy 21

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21
Q

What is aortic stenosis?

A
22
Q

What is mitral regurgitation?

A
23
Q

What is peripheral arterial disease?

A
24
Q

What is aortic regurgitation?

A
25
Q

What is mitral stenosis?

A
26
Q

Can you summarise hyperthyroidism?

A
27
Q

Can you summarise hypothyroidism? What are some complications in pregnancy?

A
28
Q

What are the ‘cut-off’ levels for diagnosing diabetes?

A
29
Q

What is type 2 diabetes and how do we manage this condition?

A
30
Q

What scoring system can you use to determine the risk of developing pressure ulcers? How would you manage pressure ulcers?

A

Waterlow
Braden
Norton

Management
- Refer if grade 3 or 4 pressure ulcer or extensive ulcers
- Manage underlying risk factors and encourage mobilisation (or turn regularly)
- Ulcer itself: analgesia + clean + dress +/- debride

Antibiotics
- Do not routinely offer topical antibiotics (even if wound swab +)
- Only give systemic antibiotics if systemically unwell + positive swab culture

31
Q

What are some risk factors for developing pressure ulcers?

A

Previous pressure ulcer

Immobility
- Surgery or traumatic injury
- Spinal injury
- Cognitive impairment/dementia/LD

Affecting skin
- DM
- Cushing’s/steroid medication
- Incontinence
- Peripheral arterial disease
- Oedema

Nutritional
- Malnutrition
- Malignancy
- CKD/HF/liver disease

32
Q

Who would you assess osteoporosis risk in? When would you order a DEXA scan?

A

Risk assessment
- 65+ (F) or 75+ (M)
- Those with risk factors (recurrent falls, high dose steroids)

DEXA
- FRAX with intermediate result
- 50+ with fragility fracture
- < 40 but major osteoporotic or repeated fragility fractures

33
Q

What are some risk factors for developing osteoporosis?

A

Steroids
Hyperparathyroidism/hyperthyroidism/hypercalciuria
Alcohol and smoking
Testosterone deficiency/Turner’s
Thin
Erosive bone disease (RAS/SLE/JIA/myeloma)
Renal/liver failure (vitamin D)
Early menopause
Diet/malabsorption (IBD, coeliac)/DM

34
Q

Can you summarise fibromyalgia for me?

A
35
Q

What is chronic kidney disease (staging separate)? How would you investigate and manage?

A
36
Q

What is acute kidney injury? How would you manage?

A
37
Q

Can you tell me about the management for COPD?

A
38
Q

What is bronchiectasis?

A
39
Q

What are the commonest types of lung cancer? How would someone with lung cancer present? When would you refer?

A
40
Q

How would you manage stable angina?

A
41
Q

How would you manage unstable angina or NSTEMI?

A
42
Q

How would you manage a STEMI?

A
43
Q

Can you tell me about atrial fibrillation?

A
44
Q

How would diverticular disease and diverticulitis present? How would you investigate and manage?

A
45
Q

What can you tell me about cholecystitis?

A
46
Q

How would pyelonephritis present?

A
47
Q

What can you tell me about appendicitis?

A

Refer to paediatric notes for presentation

Only difference = can give piperacillin-tazobactam (tazocin) AND CT is investigation of choice

Paediatrics prefers USS as no radiation meaning it is safer

48
Q

Can you summarise renal stones and renal colic for me?

A
49
Q

How would you stratify the severity of DKA?

A
50
Q

How would symptomatic gallstones present?

A

Phase 3a (4 decks)

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