AKT General Knowledge Flashcards
Dyspepsia
1st line management - uncomplicated drug treatment
Full dose PPI for 1 month and review
Omeprazole 20mg OD
Lansoprazole 30mg OD
Pantoprazole 40mg OD
OR/and
Test for Hpylori status
H.pylori management
Drug therapy
1st line - triple therapy
PPI twice daily + Amoxicillin 1g BD + Clarithromycin 500mg BD or Metronidazole 400mg BD
- all medication is BD and high dosing for 7/7 aim is to hit it hard and fast!
If allergic to penicillin it’s clari + metro
Very effective 80-85% efficacy
Quadruple is 2nd line
PPI + metro + bismuth + tetracycline
H.pylori detection
Carbon 13 urea breath test or stool antigen - ensure the person has not taken a PPI in the past 2/52 or antibiotics in the past 4/52
Recurrent dyspepsia symptoms
Consider alternative diagnosis
Reinforce adherence and lifestyle advice
Consider H2 receptor antagonist ranitidine 150mg BD or 300mg ON
can consider referral to endoscopy
Live vaccination in childhood
Rotavirus MMR Nasal flu Shingles Chickenpox BCG
Travellers
Yellow fever
Oral typhoid
Nappy rash causes and management
- common infection associated
Inflammation usually caused by local irritation (urine/faeces) Commonly infected with candida albicans Management - leave nappy off as much as possible - Use water only to wash - dry thoroughly (pat not rub) before replacing nappy - avoid talcum powder - barrier cream if required - where infected treat - consider skin swab if needed
Localised non bullish imperative treatment
1st line
Hydrogen peroxide 1% cream 2-3 times a day for 5/7
Otherwise offer
Fusidic acid 2% 3 times a day for 5/7
Length can be increased to 7/7 if required
Treatment of widespread non bullies impertigo
Adults and paediatrics
Offer either short course topical or oral antibiotic
For ADULTS
- flucloxacillin 500mg QDS for 5/7
Or
- clarithromycin 250mg BD for 5/7
For PAEDIATRICS
- fluxloxacillin QDS for 5/7 - dose depending on age
Widespread - topical fusidic acid/oral flucloxacillin - depending on level of spread/preference/risk of complications
Bullous impertigo treatment
1st line
Flucloxacillin 500mg QDS 5/7
MMSE scores
Normal
Mild dementia
Moderate dementia
Severe dementia
Normal = 27+ Mild = 21-26 Moderate = 10-20 Severe = <10
Reporting sexual activity
Age 13-15, consenting
Age < 13
Age 13-15 inform safeguarding if meets criteria for considered they are being taking advantage of, Police do not need to be told as consenting
Age < 13 considered statutory rape
Glasgow coma score
Motor response scores
Obeys commands - 6 Localises to pain - 5 Withdraws from pain - 4 Flexion - 3 Extension - 2 None - 1
Glasgow coma score
Verbal response
Orientated - 5 Confused - 4 Inappropriate words - 3 Incomprehensible - 2 None - 1
Glasgow coma score
Eyes
Spontaneous eye opening - 4
To voice - 3
To pain - 2
None - 0
Emergency contraceptive options
How they work?
2 options:
- the emergency contraceptive pill - levonelle or ellaOne (morning after pill)
- intrauterine device (IUD or coil) (1st line)
EllaOne can be taken within 5 days of unprotected sex 30mg PO
Levonella can be taken within 3 days of unprotected sex 1.5mg PO
IUD can be fitted up to 5 days AFTER unprotected sex or up to 5 days after the earliest time you could have ovulated.
- IUD more effective than the pill - > 99% effective
- Pill is between 68-83% effective
Progesterone options work by DELAYING ovulation if the women has not ovulated. If the woman has ovulated it works by thickening cervical mucus (stopping sperm swimming) and interacts with insemination.
UKMEC
Categories 1-4 explain
Category 1 - no restriction
Category 2 - advantages > risks
Category 3 - risks > advantages - not usually recommended - refer to specialist
Category 4 - unacceptable risk : contraindicated
What to do if missed COCP
Management for
- 1 missed pill
- > 2 missed pills
How does the advice change for where they are in their cycle and IF they have had unprotected sex?
1 missed pill - take ASAP even if that means taking 2 pills together. No additional contraception required
> 2 missed pills - additional precautions for 7/7
- if missed pills are in week 1 AND had sex then require emergency contraception
- if missed pills are in week 3, OMIT the pill free interval, I.e take 2 pill packets together with no bleed.
- week 2 in cycle just use condoms for 7/7
Starting oral contraception
How long to use precautions for with
- COCP
- POP
COCP - 7/7 additional precautions
POP - 2/7 additional precautions
What is the percentage classification of
Very common SE Common Uncommon Rare Very rare
Very common - 10%+ Common - 1-10% Uncommon - 0.1-1% Rare - 0.01-0.1% Very rare - <0.01%
Hypertension guidelines
Classification
Normotensive - < 140/90
Stage 1 HTN - clinic BP 140/90 AND average BP monitoring > 135/85
Stage 2 - clinic BP > 160/100 AND average BP > 150/95
Severe HTN - clinic BP > 180 systolic or diastolic > 120
Accelerated HTN - clinic BP > 180/120 AND signs of papilloedema and/or retinal haemorrhage
Types of allergy testing and when to do them?
Also what type of reaction do they fall into
3 main types of allergy testing
RAST - looks at serum IgE level for specific antigen type 1 mediated reaction
Serum IgE level - type 1 mediated reaction, gains an indication of whether there is a general atopic state
Skin prick test - type 1 mediated reaction, test for food and drug reaction, inhaled allergens
Patch testing - non IgE mediated reaction, type 4, allergic contact dermatitis.
When to order patch test
Patch test should be used in patients with allergic contact dermatitis.
It is recommended for any patient with persistent dermatitis or atopic dermatitis that was formerly well controlled with topical therapy but becomes difficult to manage with same treatment.
Angina
First line management
Secondary prevention
1st line - Beta blocker or CCB
2nd prevention - aspirin + statin + ACE inhibitor
