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General Med > gen med 6 summ > Flashcards

gen med 6 summ Flashcards

1
Q

Describe the evaluation of physical and mental development of a 9 month old baby

  • measurement of
    • height, weight, body mass,
    • head and chest circumference,
    • dentition, development of sensory receptors, movement and speech
A

Height - NB=48-52- upper limit 52 +(2cmx 9mo) 18 = 66-70cm

Weight(NB=2.5-3.5kg. gain 600g/mo) 2.5-3.5 +(600 x9) = 7.9=8.9kg

Head circumference 34 at birth + 1cm a month + n 9 = 43cm

chest circ+ 30.5-33 plus no of mo

o At 9 months – motor crawling, sits unsupported, pincer,

o Speech – polysyllabic babble

o Social – fear of strangers, peak a boo

Dentition: check for upper central incisor, upper lateral incisor eruption and lower central incisor eruption

  • lower central incisior 6-10months)
  • upper central incisor-8-12months,
  • upper lateral incisior-9-13 months,
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2
Q

Describe the content and aims of the 3 main areas of preventive medicine

A
  • Primary prophylaxis comprises both the healthy individual and those at risk.
    • The GP rolehere is to prevent the occurrence of a disease
  • Secondary prophylaxis is the early detection of a disease, before onset of symptoms.
    • provide early treatment which aims to improve disease prognosis and reduce it’s frequency
  • Tertiary prophylaxis (dispensarization, follow-up).
    • prevents the progression and complications of a disease in people already suffering from different diseases,
    • prolong their lives and exert a positive effect on their quality of life
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3
Q

Describe 5 non-verbal signs and related to them diseases

A
  1. Body-language/kinesis: Parkinson’s disease tremor, bradykinesia, masked facies (hypomimia)
  2. Touching: hypoesthesia (Beriberi disease, ulnar nerve palsy), hyperesthesia (peripheral neuropathy-diabetes/chronic alcohol abuse), anaesthesia.
  3. Paralanguage: TONE, SPEED, LOUDNESS OF VOICE - stroke patient (apraxia), dyslexia (specific learning disorder)
  4. Proxemics: autism spectrum disorders
  5. General appearance: cachexia in malnutrition, cyanosis or pitting edema (pulmonary/cardiac disease), ascites (liver/renal failure), necrotic toes (vascular disease),icterus (jaundice). Schizophrenia (neglected hygiene)
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4
Q

Describe general advice on how to feed, keep healthy and bring up an 8 month old child

A

feeding

  • Feed 5x per day with 3.5 hr interval
  • 100+10xmonth: 180ml per meal
  • new food should be introduced step by step patiently
  • variety of foods: baby cereal, fruits and veg, and mashed or pureed meats.
  • check if they’re feeding:
    • Diapers are changed after every feeding, presence of stool and urine
    • Follow the growth curve=gains 20g/ day min

caring

  • Keep track of the immunization schedules
  • cords are out of reach, lamps, tv and furniture are secure.
  • keep away small toy pieces or objects that are lying.- developed pincer grasp mouth tactile
  • Motor games, sensory games and communication games
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5
Q

Describe 5 behavioural risk factors

A

Smoking

Unhealthy diet

Alcohol abuse

Low physical activity

stress

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6
Q

5 Characteristics of General practice/family medicine

A
  1. Initial contact with the health care system,
    1. free access provided, for any type of medical condition.
    2. Acts as a “gate keepers” within the health care system, should be available to patients 24 hours a day, 7 days a week.
    3. Coordination and effective utilization of health care resources, in cooperation with other medical specialists.
    4. refer patient to out of hospital consultation by a medical specialists or hospitalization.
    5. The GP activities include both non-medical/medical activities and functions in close cooperation with the health care and social units and structures.
  2. Responsibility for the health of the community as a whole
  3. Decision making based on the frequency of the disease in the community.
  4. The GP should know the incidence structure their region, which assist them with decision making
  5. Early detection of health problems
  6. management of acute and chronic medical conditions in a given patients
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7
Q

Describe 5 consecutive phases of the family circle

A
  1. Unattached Adult-the main issue occurring in this first stage is accepting parent offspring separation
  2. Newly married Adult-Young couples starting newly married life
  3. Pre-school age children-The young couple has a child. All the activities related to growth and development of the child
  4. School age children-sleep nutrition are affected
  5. Teenage child-most challenging is management of chronic disease
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8
Q

Follow-up observation in general practice about patient with ischemic heart disease

A
  • sx is sternocardia/angina pectoris
  • Follow up = monitoring of patients/diseases and control of the disease development.
    • ECG,
    • lipid profilefollowed up.
    • blood pressure
      rx: usuals: rdece rf, lifestyle change, pain management etc
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9
Q

delivering bad news: BiCH SFP was bad

A
  1. Background-be completely familiar with the patient situation before delivering the news, enough time for discussion and make decision who will attend the consultation
  2. Clarifying what the patient already knows-start with information that is already familiar with the patient which gives information to what extend the patient or family understand the situation
  3. How much does the patient want to know-every person has the right to refuse to receive information about their medical status or to ask someone else to speak on their behalf
  4. Sharing information-information should be presented gradually, the patient should be encouraged to ask questions
  5. Feelings- denial, anger, bargaining, depression and acceptance. The patient and their family need to react emotionally. In such situation nonverbal signs are of vital importance
  6. Planning subsequent actions- the patient and family should know what to expect next- a_dditional medical procedures_, organizing medical care in home or hospital setting
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10
Q

effective performing of the consultation includes

A

Opening of the consultation

Elucidation of the health problem

Negotiation of action for achieving a solution of the health problem

Closing of the consultation

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11
Q

describe 5 communicative techniques:

A
  1. Greeting-specify how the patients want to be called
  2. Inviting-the patient is invited and shown where to sit down
  3. Social contact/transition-primary consultation: pay attention and obtain personal information familiar patien: a short social conversation before the medical
  4. Orientation-examination will encourage free and easy sharing of health problems
  5. Active listenin-direct the consultation to the cause of the particular appointment
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12
Q

Follow up observation in general practice in a patient with diabetes mellitus

A
  1. body mass index
  2. blood pressure, pulse,
  3. lipid profile & Fasting lipids
  4. ECG
  5. HBA1c test
  6. Referral to an ophthalmologist yearly for retinal examination
  7. Urine glucose, check for proteinuria and do a ketone test
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13
Q

KÜBler-Ross stages for delivery bad news UDABAR

A

o uncertainty

o denial- disbelief (“no-not me”)

o anger- it’s not fair, why me”)- directed at medical staff/ healthy ppl

o depression- God says nah you’re dying G

o bargaining-bargaining with Go

o acceptance-patient given up the struggle for life, sleeps, withdraws o

o restoration of inner balance

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14
Q

diff betwe gerontology and geriatrics

A

Gerontology: study of physical and psychological changes that occur in old age

Geriatrics: is the branch of general medicine concerned with
rehabilitative, psychological and socialaspects of illness in the elderly

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15
Q

define a medical consultation

A

direct or indirect interaction between physician and patient with the use of comm verbal or non verbal, discussing health related issues

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16
Q

characteristics of GP related person-centred care

A
  • consideration the patient’s environment in which the health problem comes from and base consultation on that
  • consultation should based on phys-pt relationship respecting autonomy of pt
  • communicate w/ pt and give priority to what they decide
  • continuous and prolonged care
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17
Q

definition for verbal communication?

A

communication through spoken and written words

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18
Q

WHO, 2002, gives the following definition of palliative care

A

approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

The purpose is ensuring quality of life

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19
Q

Patients under home healthcare are divided into several groups

moppn

A

Medico-psychological care

Medical-social services

Occupational, speech + language therapy

Physical therapy

Nursing care

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20
Q

5 groups of difficult patients and give your opinion why these patients are difficult

A

The Sherman tank –always on the attack and doesn’t worry about being polite, just get their points across in anyway they can.

The exploder-temper tantrum, raging outbursts, out of control.

The know it all -expert on all matters, feels others are stupid

The staller-indecisive, lack-follow through, cannot make up their minds

The complainer-finds fault in everything,

The clam-silent, just says “yes or no” refuse to cooperate, won’t effectively communicate, hard to open to us

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21
Q

General practitioner activity for reproductive health

WHAT DOES REPRODUCTIVE HEALTH INCLUDE

A

Sexual and reproductive health(educate teens, premarital)

Sexual transmitted diseases(education and prevention)

Family planning( contraception)

preg Women’s consultation

Prenatal and postnatal consultations

Screening of oncological diseasesof the breast and uterus(screens)

reproductive health includes

  1. to be able to have safe, satisfactory sex life
  2. to have ability to reproduce and decide whether to have children & no of children
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22
Q

male hormonal contraception

A
  1. LH-RH agonist (chemical castration) and GnRH agonists (both for prostate cancer treatment also, decrease testosterone level)
  2. Anti- androgens (cyproterone acetate),
  3. estrogensor androgens or a combination of both
  4. LH-RH agonist + antiandrogen >complete androgen blockade
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23
Q

classical contraception

A
  1. Coitus interruptus: withdrawal before ejaculation
  2. Saxonian intercourse (retrograde ejaculation)
  3. Coitus hispanicus - ejaculation in vaginal vestibular (due to acidic pH which kills sperm)
  4. Sexual abstinence infertile period of women
  • natural methods (calendar method, basil body temperature method, cervical mucosa method)
  • Hormonal methods: oral contraceptive
  • Barrier method: male condom, cervical cap
  • Intrauterine pessary
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24
Q

3 action areas of EBM

A
  1. The patient treatment is based on scientific evidence
  2. Published scientific literature
  3. Public health: creates n_ew scientific strategies_ and effective health care
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25
Q

A 51 year old female has had fatigue, weakness and shortness of breath with exertion during the past 4-5 days. Symptoms were exacerbated by activity and relieved by rest and lying supine. He also felt palpations intermittently. The patient denied abdominal pain, chest pain, congestion, nausea, vomiting, diarrhoea, constipation, dysuria, headache, chills, hemoptysis, neck pain, rash or sore throat.

Past medical history: Diabetes mellitus non-insulin dependent Physical examination:

o General appearance: pale, non-icteric
o Eyes: sclera non-icteric
o Chest: clearto auscultation bilaterally
o CVS: mild tachycardia, no hypotension
o Abdomen: soft, non-tender, non-distended. Positive bowel signs o No lymphadenopathy

  1. most likely diagnosis?
  2. confrim dg?
  3. dx?
  4. lab?
A
  1. LHF: cause lungs are clear bilaterally and sob. STABLE ANGINA
  2. ECG, XRAY, CT angio= Gold
  3. myocarditis, endocarditis, pericarditis, asthma? MI,
  4. FBC, cardiac enzymes, spirometry, lipid profile, glucose, c-rxtive,
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26
Q

Describe the advantage of homecare

A
  • Observant physician can obtain additional information about his patient during the home visit.
  • One-one attention
  • patients feels at ease + is more likely to confide
  • Family support
  • Familiar surrounding
  • More independence
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27
Q

Describe the evaluation of physical and mental development of a 7 month old baby

measurement of height, weight, body mass, head and chest circumference, dentition,

development of sensory receptors, movement and speech)

A

height: 50 cm + (2x7) = 64 cm
weight: 2.5-3.5 + (0.6x7) =7.7

head circ= 34+7= 41cm

chesst circ: 30.5-33 + 7 =40 cm

gross motor: sits w/o support, Fine motor:

speech: polysyllabic babble
social: fear of strangers

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28
Q

feed and take care of a 6 year old

A

feeding

  • Breastfeeding for the first 4 - 6 months
  • 160ml on each feeding (100 + no of months)
  • after 4 months include Mashed fruits and veg are during one meal a day mixed with milk

caring

  • assist the Childs development by
    • talking to them, playing with them,
    • choosing games and toys appropriate for their age.
  • 6 mo of first year they should take care of speech development.
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29
Q

ask to be performed by the GP in the process of consulting are

A

Opening of the consultation

Elucidation of the health problem

Negotiation of action for achieving a solution of the health problem

Closing of the consultation

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30
Q

regular observation of normal pregnancy include

A

first visit

  • history
  • ,gyne status: 1st visit, 4 mo, prn
  • Due date

first trimester visit: 1x/ mo 2x mo 9/10

  • bp, blood type, US
  • anthropometric asses
  • US 16-20 wk
  • FHR: 1x 5,6,7 2x 9,10
  • clinical lab:
    • blood:hb, mch,mcv,
    • urine: gluc, ketones, urobillinogen
    • vag smear rpt 9 mo
    • huv, hep b, syph

post natal - 42 days

  • blood 1x
  • bp
  • uterine invol, genital bleeding mental status
  • mammary develop 2x(7th day& 30th)
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31
Q

what do you do at 7 mo w/ bcg

A

Check for BCG mark, children w/o mark

are given Mantoux test + if it’s negative,

give BCG vaccine.

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32
Q

concept of palliative care describes the care for patients as

A
  • relieve pain and suffering alongside rx
  • intergrate spiritual and psychological aspects
  • ensure qol-
  • allow attidute to death as natural process
  • team apporoach to meet needs of family
  • suppoert of family
    *
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33
Q

General criteria used by GP’s at the selection of the patients, which are suitable for home health care

A
  • long term care: chronic disease / palliative care
  • phone call confirmation before hoe visit
  • weighing the urgency of home visit with hospital referal
  • previous knowledge of the health of the pt
    *
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34
Q

WHO’s definition of reproductive health

A

State or condition free of disease and disturbances in reproduction system in both sexes

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35
Q

Definitions specific for the male reproductive problems

A

primary male infertility: man’s past and present failure to impregnate a woman.

secondary male infertility:

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36
Q

Mechanical contraception and surgical reversal methods

A
  1. Male surgery:
  • Vasectomy – very common + effective method , damage of scrotal and inguinal part of the vas deferens
  • Vasovasotomy = Reversing operation – reversal of vas deferens discontinuity in vasectomy
  • Vasostomy = Implantation of epididymis
  • vasoepididymostomy -> anastomosis between vas deferens and epididymis
  • Vaso-orchidostomy = Anastomoses or implantation of vas deferens in testicles
  • Mechanical obstruction = at any level at pathway of sperm transport may lead to azoospermia, and male contraception
  1. Female surgery: Tubal Ligations &removal of fallopian tube(salpingectomy)
  2. Mechanical – barrier method (male condoms, cervical caps cervical sponges)
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37
Q

MAIN POSTULATE OF EBM ???

A

Any clinical decision and every technological operation should be based on the strict scientific evidence

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38
Q

female GP consultation for different age groups

A

teens and young women: health promotion activities regarding hygiene of sexual organs

pregnant/young mums: observation for entire preg and regular check ups

middle aged to older women: Prevention and early diagnosis, timely and effective treatment of gynaecological diseases. and pre cancer

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39
Q

6 years old child and his parents visit the General practitioner. The child complains of thirst, lost of weight, frequent urination and skin itching for 1 month. The day of consultation epigastric pain appeared, nausea and vomiting. No fever

  1. dx
  2. dg
  3. lab tests
  4. confirm lab test
A
  1. db ketoacidosis( itch and thirst and ab pain), hyperuricemia(itcing) gilbert syndrome
  2. diabetes type 1
  3. random blood glucose,OGTT, Hb1Ac, urine analysis(ketones/ glucose) bilirubin lvls, uric acid lvls
  4. OGTT
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40
Q

describe moro reflex and dg value

A

ends at 3-4 months abduction, adduction, crying

  • over 4 mo= neurological disease
  • assymetrical: hemiparesis, brachial plexus injury, calvicular fracture
  • abscence in legs: lower spine injury, developmental displasia of hip
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41
Q

signs of pain in infants

A

crying

cooing

fist shrink

suck pacifier

contraction and relaxation of body

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42
Q

pro’s and con;s of natural contraception

A

pro’s

  1. no cost,
  2. no risk to health,
  3. no secondary effects
  4. doesn’t interfere w/ breast feeding
  5. increases knowledge about reproductive cycle

con’s

  1. no STD protection
  2. not effecient
  3. requires regular periods
  4. vaginal infections affect cervical mucus method
43
Q

pro;s and cons of CONDOMS

A

prondoms

  1. low cost
  2. easily accesible
  3. prolong erection
  4. No side effects
  5. protect from most STD

condom cons

  1. low effeciency
  2. efficiency depends on correct use
  3. latex allergy
  4. have to apply it immediatley before sex- deads the mood
44
Q

intrauterine pessary pro’s and cons

A

pessary pro’s

  1. fast
  2. continous effect
  3. don;t interfere w/ sexual intercourse

cons of pessary

  1. perfect health of reproductive system required
  2. bleeding in 1st 3 months
  3. increased menses in 1st 3 mo
45
Q

pro’s and cons of hormonal contraception

A

pro’s

  1. very high efficiency
  2. doesnt affect sexual intercourse
  3. long term effect
  4. decreases amount of menses- dysmenorhea releif
  5. prevents ovarian cysts
  6. prevents endometriosis and endometrial cancer

cons

  1. emotional instability
  2. require regular strict use for efficiency
  3. some cause weight gain
  4. increase risk of fibroids
  5. increase coagulation risk
46
Q

what is the GP practice

A

General Practice is clinical and academic discipline with its own educational content
and scientific research, based on evidence and clinical activities specifically oriented to
primary health care

47
Q

how often should a child up to 1 year visit the General practice in terms of child consultation

A

Every month-

  • measure height weight, head+chest circum,
  • assess neurological and mental development.

1 and 4 months-hip joints

6 and 12 months- FBC, urine test.

48
Q

Primary practices (GP) perform a package of medical and non-medical services, which requires a list of specific resources:

A
  • Medical training
  • Medical personnel
  • Financing
  • Medical equipment and supplies o
  • Health facilities
49
Q

what is the paternalisgic approach

A
  • Doctor has role of the parent and has a directive role
  • one way transfer of knowledge of physician to pt
  • Patient is submissive and has passive role
  • doctor is expert and pt should cooperate
50
Q

what is communication

A

process of interaction between ipeople by means of different signed systems – >verbal and non-verbal.

51
Q

whart is a competancy

A

factors that determine succesful performance

consists of skills, job attitude and knowledge

52
Q

complications of nephrolithiasis

A

acute pyelonephritis

abscess

infective hydronephrosis

loss of renal function

urosepsis

urinarty fistula

53
Q

what is empty nest syndrome

A

psychological conditions affecting parents (women) when kids leave home characterized by

  • sadness and loss
  • common around autumn / after marriage
54
Q

list family issues

A
  1. undiagnosed mental conditions
  2. single parent/ divorce
  3. drug addiction/ substance abuse
  4. infertility
  5. familiy member w/ chronic or terminal illness
55
Q

EVIDENCE BASED MEDICINE DIVISIONS

A
  • mandatory
  • reccomended
  • optional

e.g. varicocele

mandatory is Physical exam

reccomended is US

optional is doppler which can detect assoc patholigies e.g. HYDROCELE/ EPIDIDYMITIS

56
Q

descending order of scientific evidences according to their reliabilitiy

MYSEEC

A
  1. meta analysis
  2. systemic review
  3. evidence from clinical trials
  4. expert analysis
  5. clinical appraisal of evidence
57
Q

CATEGORIES OF RECCOMENDATIONS OF EBM according to OXFORD CENTRE

A

Level 1: level of evidence obtained from meta-analysis or clinical trials with precise protocol – level 1a + 1b

Level 2: level 2A and 2B, grade of recommendation latest system (strong and weak)

Level 3

Level 4

?????????

58
Q

3 model’s of consultation

A

Berne’s Transactional model 3 states of ego:

  1. parent (authority, critical/caring)
  2. adult (logical)
  3. child (intuitive, spontaneous/dependent)

Byne & Long model helps with structure of consultation

  • ​DR establishes relationghip with patient & tries to find reason for visiting
  • verbal&physical exam,
  • consider the problem and plan of action, ends consultation

Stott & Davis model = 4 areas to be explored in each consultation.

  1. manage presenting problem
  2. manage continuing problems
  3. modification of self-seeking behaviours
  4. opportunistic health promotion
59
Q

Describe all 7 questions in Hellman model of consultation:

(list and describe them all)

A
  1. What has happened – organizing symptoms and signs into recognizable pattern and giving it a name or identity.
  2. Why has it happened – explains etiology
  3. Why has it happened to me – tries to r_elate the illness to aspects of the patient,_ such as behaviour, diet, body build, personality or Heredity
  4. Why now – concerns the timing of the illness and its mode of onset – sudden or slow
  5. What would happen if nothing was done about it this considers it’s unlikely course outcomes prognosis and dangers
  6. What are its likely effects on other people – loss of income or employment, strain on family relationships
  7. What should I do about it/who should I turn for further help – strategies for treating condition including self medication, consultation with friends or family, or going to see a doctor
60
Q

approaches to GP practice

A

hollistic: physical,biological, social = pt oriented

pure bio: disease oriented

pure social

anthropological

transactioal: give and take

61
Q

5 groups of symptoms in patient need palliative care in general practice

A
  1. pain- analgesics
  2. depression- anti depressants
  3. cachexia and anorexia
  4. dyspnoea
  5. constipation- change rx or give laxative
  6. insomnia- hypnotics

7. fever + neutropenia (lec)- antipyretics(nsaids, paracetamol)

8. fatigue (lec)

9. malignant wounds lec) - regular redressing of wound

62
Q

signs of HF

A

Hydrostatic edema - handbook

o Fatigue & shortness of breath are cardinal symptoms

o Orthopnea

o Cheyne-stokes respiration (cyclic respiration)

o Acute pulmonary edema

o (congestion of liver - lead to RUQ pain)

63
Q

what is te end point of evidence based medicine

A

trusted evidence

informed decision

better health

64
Q

levels of health care in bulgaria

A

primary: outpatient clinics/ group practices

secondary : specialized non hospital structure

tertiary: hospitals and hospices

65
Q

5 types of addictions

A

Substance addiction: 1. Alcohol, 2.tobacco, 3.Opiod & Cocaine addiction

Process addictions: 4. Gambling, 5. shopping, 6. internet 7. food

Social: Alcohol, tobacco, caffeine

Medical: Opioid Analgesics, anxiolytics and hypnotics.

Recreational drug use: Cocaine, cannabis

Behavioural addiction: Gaming, shopping, sex, social media

66
Q

types of substance abuse and their signs

A
  • stimulant
    • caffeine nicotine, cannabis, cocaine
    • increased sympathetic tone, hyperactivity, alertness
  • depressant
    • opiates: morphine, codeine,
    • pain relief, reduced pain sensitivity, euphoria, respiratory depression, coma
  • hallucinogen= LSD
  • sedative, anxiolytic, hypnotic
    • BDZ phenobarb
    • anxiety disorders, depress respiratory and CDV centres
  • alchohol
    • Reduced coordination, reduced concentration, aggression, impaired judgment, slurred speech.
67
Q

what is meta communication

A

communication that indicates h_ow verbal information should be interpreted_ & concerns stimuli surrounding the verbal communication that also have meaning, and w_hich may or may not be congruent,_ supportive or contradictory of that verbal communication.

68
Q

signs of pain in adult

A
  1. facial grimace
  2. agitation
  3. tense and uneasy- draw up legs
  4. guarding, immobility
  5. small or slow movements
69
Q

pain in infants

A
  1. facial expression – squeezing eyes shut
  2. high pitched cry that lasts longer than usual
  3. behaving irritably
  4. not eating or sleeping
70
Q

neonatal screening

A
  • PKU, galactosemia,cystic fibrosis
  • Congenital Adrenal hyperplasia, Congenital Hypothyroidism,
  • SCID,
71
Q

describe mumps

A
  • acute systemic viral disease caused by virus paramoxyvirus typically affecting school children in late winter/early spring
  • sx:
    • inflamm of salivary gland mainly parotid.
      • other: orchitis, meninges,
    • rash
  • prog: ends in seven days. orchitis can be tender for weeks
72
Q

Describe Galant reflex and it’s diagnostic value

A
  • ventral suspension (face down) and stroking down in the paravertebral area on one side.
  • response is: swinging of the pelvis towards the stimulated side (laterally flex).
  • Disappears in 3-4 months.

Diagnostic value

  1. Absence= sensory loss in the case of a myelomeningocele.
  2. Persistence; can affect the child’s ability to sit, poor posture (scoliosis
73
Q

Mantoux: what is it? How to perform it? How to interpret it?

A

check immunity against TB in children w/o the BCG scar on their shoulder after previous immunisation.

  • no scar: inject 5 IU Purified protein derivatives intradermally
    • check skin in 3 days fir rxn
    • induration of 5mm or more is positive in HIV patients
    • 15mm+ is considered positive in persons with no known risk factors
74
Q

information provided in ECG

A
  1. electrical activity of heart
  2. detection of electrolyte disturbances
  3. screening of IHD in stress test
  4. non cardiac: pulmonary embolism, hypothermia
75
Q

types of consultation

A

direct: face 2 face
indirect: virtual phone, medical records

76
Q

dehydration complciations in children

A
  1. hypovolemic shock
  2. seizure_ electrolyte imbalance
  3. UTI, renal stones, kidney failure
77
Q

screening for prostate cancer

A
  1. DRE &PSA test
  2. transretal US
  3. Computed Axial Tomography
  4. BIOPSY_ confirm dg and exclude prostate cancer
78
Q

ECG for Acute ANTERIOR MI

SALI

A
  1. septal: V1,V2
  2. anterior: V3&V4
  3. lateral: , avL,V5,V6
  4. inferior: I,III, avF

ANTERIOR

  • ST elevation in V3&V4
  • reciprocal reduction in II,III,avF
79
Q

define melena

A

tar like stook d/2 bleedig in the upper GIT

80
Q

defenie open and closed questions

A

open: allow long answers with more information ‘ tell me more about x’
closed: structure information to provide a simple answer after open Q

81
Q

EXAMPLES of DIRECT BLOCKAGE OF SPERM

A

gonadotoxic:

chemo, radiation, immune therapy w/ antibodoes

82
Q

activity of GP in basic prophylactics

A
  1. primary prophylaxis: healthy and risk pts
  2. assess risk factors & bad habits
  3. health promotion and education
83
Q

sperm production and sperm transport

A

sperm production

  • produced in the germ epithelia of seminiferous tubules
  • spermatogonia-mitosis-spermatocyts-meisis-spermatids-spermatogen-spermatoa

sperm transport

  • from seminiferous tubules via rete testis to epidydimis where they are stored and mature into spermatozoa
84
Q

describe rubella

A

acute viral disease in kids and adults caused by rubella virus

  • sx: characteristic rash, lymphadenopathy and fever
    • maculopapular rash is 1st sx lasts for 3 days -> hemmorhagic exanthema
      • requires isolation
  • prognosis: supportive rx, lasts
  • CONGENITAL RUBELLA- during preg
    • Congenital heart disease, Cataract, Deafness
85
Q

risk of toxoplasmosis for the fetus

A

risk of toxoplasmosis increases as time passes

  • First trimester: 15% of fetus infected
  • Second trimester: 30% of fetus infected
  • Third trimester: 60% of fetus infected

severity of fetal condition decrease w/ time

RF: cat contact, undercooked meat, unwashed veg

86
Q

paediatric consultation

A

physical assesment

mental assesment

feeding and care of the child

87
Q

morphological and functional features of growing and developing children’s organism

A

list of physio organ changes

88
Q

follow up for HTN PT

A

CDV: bp, pulse ecg, lipid profile

vascular atheroslerosis; palpate pedal pulse, doppler

nervous system: angiography MRI

renal failure: creatinine, urine analysis for proteinurua,

visual: ocular fundus exam

89
Q

Principles of CPR

A
  1. restore effective circulation and ventilation
  2. avoid excessive ventilation
  3. prevent irreversible cerebral damage due to anoxia which may occur inas little as 4 mins
  4. provide good quality compressions
  5. minimise interruptions to chest compressions
90
Q

technique of active listening

A

 Observe

 Listen

 Paraphrasing-to convey interest, encourage to keep talking

 Verbalising emotions: shows that one understands

 Summarizing: review progress, establish a basis for further discussion

 Clarifying: clarify what is said, helps the speaker

 Encouraging

 balancing

91
Q

Legal aspect of evidence based medicine

DOG the law

A
  • Doctor are protected by the law
  • On the other side patients should be encourage in making clinical decisions
  • Good collaboration between the doctor –patient is strongly needed
92
Q

Definition of family cycle

A

emotional and intellectual stages you pass through from childhood to your retirement years as a member of a family are called the family cycle

93
Q

Goals of geriatric care

KEMS geriatric sugar dad

A

 keep the people as independent as possible in their own home

 Early detection and appropriate treatment of disease

 Maintenance of maximum independence consistent with irreversible disease and disability

 Sympathetic care and support during terminal illness

94
Q

triad of female athlete

A
  1. Osteoporosis
  2. Amenorrhea
  3. Eating disorders – anorexia , bulimia
95
Q

Types of financing of health care

BIMCARE

A

Budget Insurance Mixed

96
Q

sx of diff types of tumour

penilw

testicular

bladder

renal

A

penile tumour

  • skin thickening/ colour change
  • ulcer / sore
  • red lumps beneath foreskin
  • small crusty lumps

Testicular

  • lump/enlargement in either testicle
  • heaviness and pain in scrotum
  • sudden fluid accum in scrotum
  • A dull ache in the abdomen/ groin

bladder cancer

  • blood clots in urine
  • burning during urination
  • frequency and nocturia
  • difficulty passing urine

renal cancer

  • hematuria
  • unilateral lower back pain w/ mass
  • fatigue, loss of appetite and weight loss
  • fever w/o infection
97
Q

complication of catheterization

A

colonization by bacteria –> UTI – >urosepsis /septicaemia

98
Q

what is the NEIGHBOUR MODEL

A
  1. First stage – connecting the doctor establishes a rapport with the patient
  2. Second stage – summarizing the doctor states this summary to the patient (of why the patient has come).
  3. Third stage – handover – the doctor and patient make a plan together
  4. Fourth stage – safety netting – a contingency plan is formed and this covers the patient and the doctor if the doctor has got the diagnosis wrong or if something unprecedented happens.
  5. Fifth stage – housekeeping – helps to acknowledge and deal with any emotions arising from the consultation before we see the next patient.
99
Q

what is safety netting

A

creating a contingency plan relevant to that patient, to ensure that the plan works out and that the patient is safe in any foreseen or unforeseen eventualities.

100
Q

SOURCE OF INFO FOR EBM

A
  1. electronic database
  2. medical journal
  3. monograph
  4. systemic review and short communication
  5. meta analysis
  6. clinical practical guidlines
  7. clinical trials
101
Q

gp practices are what?

A
  1. outpatiet clinical for individuals
  2. group medical practices for primary care
102
Q

disadvantages of home care

A
  1. pt isn UNDER 24 HR SUPERVISION
  2. risk of FATALITY?
  3. patient could EXAGGERATE or give FALSE info
  4. high risk of NEGLECT
103
Q

red flag signs doe cauda equina / serious back pain

4ADRRRIP

A
  1. abnormal gait w/p heel toe ambulation
  2. absent perineal reflex
  3. acute bilateral sciatica
  4. acute urinary retention
  5. Drop foot
  6. recent dg of mg
  7. recent infec
  8. recument worsening of pain
  9. IV drug abuse
  10. progresseive neuromotor/sensory loss
    11.

General Med (7 decks)

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