Common GP conditions

Question 1

hard, raised, nodular skin lesion which may be ulcerated or keratinising. Mostly on head and neck

Answer 1

Squamous cell carcinoma

Question 2

Ulcerated centre with raised edges. Pearly or waxy nodules. Telanietctatic area around lesion.

Answer 2

Basal cell carcinoma

Question 3

Differential for a keratinising skin lesion

Answer 3

Keratocanthoma

Question 4

Referral checklist for suspected malignant melanoma - 2 week wait.

Answer 4

Weighted 7-point checklist.
2 points for:
Change in size, irregular shape, irregular colour.
1 point for:
Diameter over 0.7cm, inflammation, oozing and change in sensation.

Question 5

Most common type of prostate cancers

Answer 5

Adenocarcinomas (glandular cells)

Question 6

Most common place for prostate cancer met

Answer 6

Bone causing fragility and bone pain.

Question 7

Risk factors for prostate cancer

Answer 7

Age (over 50)
Black ethnicity.
FHx
Obesity and weight,

Question 8

Tool for risk stratification of localized prostate cancer

Answer 8

Gleason score (includes PSA) and TNM clinical staging.

Question 9

Signs and symptoms of prostate cancer

Answer 9

lower urinary tract symptoms e.g. freuqency, urgency, hesitancy, dribbling or poor stream. 
Lower back or bone pain.
Lethargy.
Erectile dysfunction.
Haematuria.
Weight loss and anorexia.

Question 10

Investigations for prostate cancer

Answer 10

DRE - hard and nodular.
Raised PSA levels.
Transrectal US and biopsy.

Question 11

Management of prostate cancer

Answer 11

dependent on advance stage of cancer.
radical = prostatectomy, radiotherapy.
Adjuvant horomne therapy.

Question 12

Criteria for antibiotics in sore throats

Answer 12

Centor:

• Tonsillar exudate
• Tender anterior cervical lymphadenopathy or lymphadenitis
• History of fever (over 38°C)
• Absence of cough

Question 13

4 AKI causing drugs

Answer 13

Diuretics
ACE inhibitor
NSAIDs
Metformin

Question 14

What to consider when prescribing a drug

Answer 14

NO TEARS
Need of medication.
Open questions on adherence.
Tests and monitoring
Evidence and guidelines for use of medication
Adverse effects
Risk reduction/prevention
Simplification and switches

Question 15

What is a medication review?

Answer 15

Structure examination of patient’s medicines with the aim of reaching a mutual agreement on the treatment plan while optimising the impact of medicines, minimising side effects and reducing waste.
- USE STOPP-START toolkit for medicines review!!

Question 16

Old people and prescribing

Answer 16

• Age related organ damage = adverse effects more likely.
• Multiple co-morbidities = more drugs = more interactions or contraindications.
• USE STOPP-START toolkit for medicines review!!

Question 17

Poor renal function and medications

Answer 17

Reduced renal excretion can lead to toxicity.
Sensitivity to drug if elimination is impaired.
More side effects
Not as effective.

Question 18

Local and systemic causes of an itch

Answer 18

Local = eczema, folliculitis, ringworm/tinea, insect bite.
Systemic = liver disease, CKD, polycythaemia rubra vera (after hot bath), lymphoma.

Question 19

beta blocker which increases QT interval

Answer 19

Sotalol, can cause ventricular arrhythmia.

Question 20

3 reasons to deprescribe

Answer 20

Patient choice
Risk outweighs benefit
Not relevant.

Question 21

Age of mental capacity act

Answer 21

16

Question 22

The Mental Capacity Act’s 5 main principles.

Answer 22

• Assumed to have capacity unless established otherwise.
• Duty to support patients to make decisions and provide appropriate help in making decision.
• Able to make unwise or eccentric decisions.
• If lack capacity any action must be done in best interests of patients,
• Least restrictive intervention.

Question 23

Deprivation of liberty safeguards

Answer 23

Care-homes and hospitals are allowed to lawfully detain a patient OVER THE AGE OF 18 who lacks capacity if the action is in the best interests of the patient and to protect them from harm.
Need supervisory, local authority to approve.
Can not be done if advanced directive states refusal of treatment wanting to be give.
Lasting Power of Attorney decision is against DOLS.

Question 24

Got no family or friends and lack capacity who turns up to best interest meeting?

Answer 24

Independent Mental Capacity Advocate.

Question 25

Mental Capacity Act - who can be affected?

Answer 25

Applies to anyone aged 16 and over who are unable to make decisions for themselves (lack capacity).

Question 26

Lasting Power of Attorney

Answer 26

Anyone over 18years can formally appoint a person or persons to look after health, welfare and financial decisions if in the future they lack capacity to make decisions for themselves.

Question 27

Testing capacity in under 16yrs

Answer 27

Gillick Competence.
Children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options.

Question 28

Contraceptive advice for under 16yrs

Answer 28

Fraser guidelines.
Doctor can give contraception to under 16year old if:
- patient understands the advice given.
- patient can not be persuaded to inform parents/carer.
- patient will continue to engage in sexual intercourse with or without contraception.
- not receiving contraception will harm the patient’s physiological or physical health.
- it is the the patient’s best interest to give advice and contraceptive treatment without parental consent.

Question 29

When is sexual activity a criminal offence

Answer 29

Any child <13 years old needs child protection referral.

Question 30

What about children aged 16 and 17

Answer 30

If satisfy the understand, retain, weight-up and communicate areas then can consent to Rx.
However, of they refuse Rx this decision can be over-ridden by parents or court to ACT IN BEST INTEREST.