Early Years GP Flashcards
Give some example components of the 8 week baby check?
- Barlow’s test - adduct hip with thumb, unstable hip will sublux/dislocate
- Palmar grasp reflex
- Sucking reflex
- Head circumference
Describe the red book?
- Personal child health record
- Used until the age of 2
- Weight, height, vaccinations
- Growth charts
What vaccines are given at 8 weeks?
- 6-in-1 vaccine
- Pneumococcal (PCV) vaccine
- Rotavirus vaccine
- MenB
What vaccines are given at 12 weeks?
- 6-in-1 vaccine (2nd dose)
2. Rotavirus vaccine (2nd dose)
What vaccines are given at 16 weeks?
- 6-in-1 vaccine (3rd dose)
- Pneumococcal (PCV) vaccine (2nd dose)
- MenB (2nd dose)
What are the common MSK exam components?
- Look: Walking aids? Gait? Scars? Muscle wasting?
- Feel: knee palpation, tendon reflexes, patellar tap, sweep test
- Move: knee flexion and extension
Describe the levels of the analgesic ladder
- NSAIDs
- Weak opioids
- Strong opioids e.g. methadone
- Nerve block, epidurals, PCA pump
What are some common opioid side effects?
- Constipation
- Dry mouth
- Confusion
What are some treatments for osteoarthritis?
- Exercise
- Weight loss
- Appropriate footwear
- NSAIDs
Describe the NHS health check for diabetes?
- 40-74 years old, every 5 years
- Spots early signs of: kidney disease, heart disease, type 2 DM, dementia
- Heart age, BMI, BP, cholesterol, alcohol use, physical activity, diabetes risk
- How to improve your results
What does the QRISK factor include and what does it measure?
Prediction algorithm for cardiovascular disease
Includes smoking, diabetes, ethinicity, BP, BMI, etc
Describe some management strategies for type to diabetes?
- DESMOND education programme
- HbA1c target: 48 mmol/mol
- Metformin > Linagliptin > Glicazide > Insulin
Risk factors for type 2 diabetes?
Age BMI Male gender Ethnicity, Family hx Waist measurement High BP
Describe the diabetic annual review?
- Annual
- Height, weight, BP, HbA1c, cholesterol
- Discuss any issues, advice on lifestyle, review blood glucose control
What does an atherosclerotic plaque consist of?
- Necrotic core
- Lipids
- Connective tissue
- Fibrous cap
What are foam cells?
• Macrophages that localise to fatty deposits on a blood vessel, ingest LDL > foamy appearance
Describe the process of atherosclerotic plaque formation?
- Injury to endothelial cells leading to dysfunction
- Inflammatory cytokines released
- Attraction of leukocytes - adhesion, rolling, migration
- Leukocytes take up LDL = foam cells
- Growth of lipid core
a. Fatty streaks
b. Intermediate lesion
c. Advanced lesion with fibrous cap - Plaque rupture and thrombosis
- Ischaemic event in the coronary artery = MI!!
What is the management IHD?
MONA
M orphine
O xygen
N itrates
A spirin
What are some other common causes of chest pain that may be mistaken for MI?
• IHD, pleurisy, pneumothorax, trauma, oesophageal pain, pericarditis, aortic dissection, mesothelioma, aortic stenosis.
What are the important questions to ask when someone has a chronic bowel disorder?
- Contact with anyone else with diarrhoea?
- Travel hx?
- Presence of blood? Mucus?
- Abdo pain?
- Family Hx of bowel problems?
- Bloating?
- Weight loss?
- Consistency? (watery etc.)
What are the differentials for diarrhoea?
- Infective diarrhoeas, IBD
- molitility disorders
- GI malignancy, malabsorption
- blind loop obstruction
- cholera
What investigations can be done for diarrhoea?
- Faecal calprotectin
- Faecal occult blood test
- Stool microscopy and culture
- Bloods
What is the treatment for rheumatoid arthritis?
- Methotrexate, azathioprine, sulfasalazine, infliximab
- NSAIDs, monitor CRP, low dose corticosteroids
- OT, physio, dietician, podiatrist
Describe rheumatoid arthritis?
- Inflammatory
- Symmetrical
- Small joints of the hands and feet
- Morning stiffness >30mins
- Swan neck & Boutonniere deformities
- RF and anti-CCP positive
Describe oestoarthritis?
- Degenerative
- Loss of cartilage, bone remodelling, inflammation
- Heberden’s at DIP, Bouchard’s at PIP
What are lower urinary tract symptoms? (8)
- Frequency
- Hesitancy
- Overflow incontinence
- Stress or urgency incontinence
- Post micturition dribbling
- Urinary retention
- Incomplete voiding
- Intermittency
What is PSA testing?
The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood.
PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells
Describe pros/cons of PSA testing?
- PSA levels are not very accurate
- Only ⅓ of people with high PSA develop cancer
- RCTs disagree on the benefits of screening
- Tests are invasive
What investigations are done for prostate cancer?
- DRE of prostate
- Transurethral USS
- Biopsy
- PSA levels
- Bone scan/CT/MRI for mets
What do urine dip results measure?
leukocytes neutrophils protein pH blood ketones bilirubin glucose etc.
What is the treatment for benign prostate enlargement?
- Watch and wait
- Alpha 1 blockers - tamulsoin
- 5 alpha reductase inhibitors - finasteride
- TURP
What are the causes of chronic kidney disease?
- Hypertension nephropathy
- Diabetic nephropathy
- Analgesic nephropathy
What are the risk factors/associations with CKD?
- Family hx
- Smoking
- Diabetes
- CVD
- AKI
- HTN
What monitoring is carried out for chronic kidney disease?
- Monitored regularly depending on severity of kidney impairment
- Proteinuria assessed at least annually
What management is carried out for chronic kidney disease?
- Reduce CVS risks
- BP control: sys <140, dias <90
- Nutrition and exercise
- Osteoporosis prevention
- Renal replacement therapy
Describe NHS breast cancer screening?
NHS breast screening:
• Women 50-71
• Every 3 years
• Mammogram: X-ray at 2 different angles
What are the benefits of breast screening?
o Early detection causing: o Less need for chemo o Less need for mastectomy o Higher survival o 1300 lives saved/yr
What are the negatives of breast screening
o Over tx
o Unnecessary distress
o False negative - 1 in 2500
o X-ray radiation
What abnormalities can there be in the breasts?
o Asymmetry
o Areas of calcification
o Areas of increased density
o Thickened skin
What is looked at during a breast exam?
- Skin: erythema? Puckerin? Peau d’orange
- Nipple: retraction? Discharge? Scaling?
- Mass: moves? hard/dense/craggy? Size? Shape?
- Clock-face method of palpation
Describe the diagnosis of breast cancer?
- Hx and exam
- Imaging
- Core or punch biopsy
What are the risk factors for breast cancer?
BRCA1, BRCA2, HRT
What are some of the treatments for breast cancer?
Tamoxifen: oestrogen receptor blocker
Aromatase inhibitor: lowers total systemic oestrogen
Herceptin: used in HER2 positive cancer
What are the risk factors of depression?
- Female
- Past hx of depression
- Significant illness e.g. chronic pain, disability
- Psychosocial problems e.g. divorce, unemployment
How is depression screened for?
- PHQ-9: Sleep, appetite, energy, concentration, suicidal thoughts etc.
- GAD-7: nervous, anxious, worrying, can’t relax, restless, irritable etc.
What is the management of depression?
- Watchful waiting
- CBT
- SSRI
- Monitoring
What is the prognosis of someone with depression?
- Average length of an episode of depression is 6-8 months
* With mild depression, spontaneous recovery is likely
What should you ask about a cough?
- Duration
- Character
- Nocturnal (asthma!!)
- Any other atopic symptoms
- Sputum
- Exacerbating factors
- Blood
What should you ask about shortness of breath?
- Duration
- Steps climbed/distance walked before onset
- Diurnal variation
- Environment/circumstances
What is stridor?
High pitched wheeze
What are crepitations?
Crackling rattling sound
Describe asthma?
Recurrent episodes of dyspnoea, cough, wheeze.
Type 1, IgE mediated hypersensitivity.
Intrinsic = non-allergic e.g. cold, exercise, stress Extrinsic = atopic or occupational
Describe the process of asthma?
Process:
- External environmental factor e.g. cigarette smoke
- Produces allergens
- Allergen picked up by dendritic cells
- Presented to Th2 cells
- Th2 cells produce cytokines IL-4, IL-5
- IL-4 triggers IgE production, IgE coats mast cells, mast cells release: histamine, prostaglandins, leukotrienes
- IL-5 activates eosinophils, promotes immune response by releasing more cytokines
- SM around bronchioles spasms
- ^mucous secretion
- Airways narrow
- Vascular permeability
Asthma treatment?
SABA for acute exacerbations Regular preventer - low dose ICS e.g. beclometasone Initial add on - LABA e.g. salmeterol Increase ICS Oral steroid tablet
Describe occupational asthma?
- Serial PEFR at home and at work
- Every two hours
- Four weeks
- At least 3 consecutive days at work
- IgE measurements: biological agents e.g. flour
Describe asthma testing?
- PEFR 4 times a day
- FEV1
- FVC
- Reversibility testing
