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SCA > General > Flashcards

General Flashcards

1
Q

OCD Mx (2)
How long is treatment?

A
  1. CBT - ERP
  2. SSRI
  3. Continue for at least 12 months of symptoms being controlled
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2
Q

UTI Paeds - what Ix (3)

When to refer?

A

US KUB during infection if <6 months with rec UTI, OR atypical infection

US KUB within 6 weeks if <6 months with first UTI responding to rx OR >6 months with rec UTI

DMSA within 6 months all rec UTIs

Refer if <3 months old

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3
Q

How to collect a urine sample kids (2)

A
  1. Suprapubic massage (cold gauze to the bladder)
  2. Urine collection pads
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4
Q

When to refer constipation in children? (2)

A
  1. Failed rx after 4 weeks in 1yo or less
  2. > 1yo failed tx after 3 months
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5
Q

Constipation mx (3) non medication

A
  1. Diet
  2. Exercise
  3. Fluid
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6
Q

Constipation mx (2) medication

What should the maintenance dose be?

A
  1. Movicol
  2. Add in senna
  3. Half of disimpact dose
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7
Q

Cow’s milk allergy how to manage when doesn’t require referral?
How many tins per week?
When to review?
If clear improvement in symptoms what next?
BF (1) versus FF (2)

A

BF - exclude from mum’s diet, replace vit D and calcium.

FF extensively hydrolysed formula (2-3 tins per week)

If not effective then amino acid formula

R/v at 2 weeks. Arrange reintroduction if clear improvement.

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8
Q

How much should a baby drink?

A

150mls/ kg

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9
Q

Age range for febrile seizures

A

Usually around 2years, resolves age 6

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10
Q

In acute management of febrile seizures what medication would you give and when?

A

buccal midaz or rectal diaz if not resolving after 5 mins, repeat at 10

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11
Q

Suspected TIA mx

A
  1. If within 7 days then refer for assessment within 24 hours, give aspirin 300mg with PPI
  2. If >7 days then refer for specialist assessment within 1 week
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12
Q

TIA driving
1 TIA

Multiple TIAs

A

No driving for 1 month

3 months

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13
Q

Migraine acute treatment
(3)

A
  1. ibuprofen 900mg OR aspirin 900mg OR paracetamol 1000mg
  2. Triptan
  3. Offer anti-emetic
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14
Q

Migraine prophylaxis (3)

A
  1. Propranolol
  2. Topiramate
  3. Amitryptilline
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15
Q

Emergency contraception options

A
  1. Copper IUD
  2. Levenorgestral (72hrs)
  3. Ullipristal (5/7 post UPSI)
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16
Q

Copper IUD emergency contraception explained

Adv (4)
Disadv (5)

A

Most effective, <1% risk of pregnancy
Can be used any time of cycle
Good for LARC purposes.
Only one that can be used if ovulation has already taken place.

Risks HMB, dysmenorrhoea. Doesn’t protect against STIs. Not as easy to find a HCP that can do this as an emergency. It requires a procedure.
Risk of expulsion, pain and infection

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17
Q

Ullipristal + levon
Adv (4)
Disadv (4)

SE (3)

A
  1. Quick/ doesn’t require HCP
  2. Easily accessible
  3. Very effective, not effee
  4. Doesn’t protect against STIs
  5. Not a LARC
  6. Not effective after ovulation
  7. If vomits needs a repeat dose

SE headaches, dizziness, vomiting, mood disorders

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18
Q

When do you refer under a 2ww for bladder/renal cancer?

A

> =45yo with visible haematuria w/o UTI/ post rx for UTI

OR

> =60yo unexplained non-visible haematuria AND dysuria OR raised WCC on bloods

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19
Q

Leg cramps mx (4)

A
  1. Stretching
  2. Massaging
  3. Can offer quinine - poor benefit to risk ratio 200mg ON for 4 weeks
  4. If beneficial continue for 3 months
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20
Q

Quinine counselling (3)

A

Irreversible loss of vision
Arrhythmias
Important not to take an overdose (due to potential for loss of vision)

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21
Q

RF cramps (5)

A

Ageing
Exercise
Pregnancy
Dehydration
ETOH

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22
Q

Restless legs what is it

A

Uncontrollable movement of legs causing unpleasant crawling sensation. Usually worse at night and relieved by movement. Thought to be about dysfunction of dopamine in the brain.

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23
Q

Quinine contraindications (5)

A

haemolysis, optic neuritis, myasthenia gravis, tinnitus, caution if elderly with AF, heart blocks etc

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24
Q

Steroids strength

A

HC, Betnovate RD, Eumovate, Betnovate, Dermovate

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25
Q

Risk factors restless legs (3)

A

IDA, pregnancy, CKD 5

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26
Q

Drugs that can cause restless legs (9)

A

antidepressants
antipyschotics
BB
antiepileptics
antihistamiens
metoclopramide
ETOH, caffeine, chocolate

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27
Q

Restless leg syndrome mx - to prevent and reduce (5)

A
  1. Treat underlying cause such as IDA
  2. Sleep hygiene
  3. Reduce caffeine and ETOH
  4. Stop smoking
  5. Exercise
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28
Q

Restless legs mx during an attack (5)

A
  1. Stretching
  2. Heat pads
  3. Relaxation exercises
  4. Distraction
  5. Massaging
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29
Q

Restless legs mx medical (3)

A
  1. Pramipexole DA
  2. Pregabalin/ gabapentin (off licence)
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30
Q

If choosing DA for RLS e.g pramipexole how to counsel

A
  1. Ensure they are aware of impulse control disorders (compulsive gambling/ shopping/ binge eating/ hypersexuality - occurs in 20%)
  2. Can wear off after some time
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31
Q

Meniscal tear when to suspect

A

Locking, popping and giving way
Slow onset or recurring swelling

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32
Q

Mx meniscal injury

A

Rest for 48 hours, then ICE and compression bandage and raise leg where possible

If locking - urgent referral required
Otherwise 6 weeks physio then review
If ongoing refer directly to ortho routine

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33
Q

What is Henoch Schonlein purpura?
Classic age?

A

Vasculitis disorder impacting:
1. Joint pain
2. Rash across buttocks, thighs and ulnar side of upper limbs
3. Abdominal pain
4. Kidney involvement in 40% of cases

Age 3-8yo

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34
Q

HSP Ix (4)
Mx (4)

A

FBC, U+E, urinalysis, autoantibody screen

Mx
1. self limiting 4weeks to 4 months
2. discuss with paeds
3. steroids
4. NSAIDs

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35
Q

Hypercalcaemia
When to suspect?

A

Bone pain
Groans - AP, nausea, vomiting
Psychiatric illness - depression, anxiety, irritable
Fatigue, lethargy, weakness
Renal stones

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36
Q

Causes of hypercalcaemia and therefore Ix (8)

A

Malignancy - FBC, examiantion
Hyperparathyroidism - calcium, vitamin D, PTH
Myeloma - Bence Jones protein
Thyroid disease - TFTs
Liver mets - LFTs
CXR - to r/o lung ca
cortisol - if suspecting Addison’s
ACR - CKD

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37
Q

Thiazide SE (5)

A

Low sodium
Low K+
Erectile dysfunction
Gout
Raised sugar

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38
Q

Amlodipine SE (3)

A

Flushing
Peripheral oedema
AP

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39
Q

DPP4 example and SE (2)

A

sitagliptin
weight neutral
pancreatitis

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40
Q

sulfonylurea example and SE (4)

A

gliclazide
gain weight
hypoglycaemia
peripheral neuropathy
SIADH

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41
Q

SGLTs example and SE (4)

A

dapaglifozin
fourniere’s gangrene
UTIs
DKA
weight loss

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42
Q

TZD examples and SE (4)

A

Pioglitazones
Increased risk of bladder cancer
fluid retention + weight gain
liver impairment
increased risk of fractures

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43
Q

Allopurinol SE

A

Rash - stop
Use with caution in renal impairment

44
Q

Causes of a Baker’s cyst

A

Knee injury
OA
RA
Gout

45
Q

OSA -
Who to refer to do
What to ask (2)

Mx (3)

A
  1. Refer to sleep clinic
  2. Ask about driving
  3. Co-morbidities e.g COPD

CPAP
Tonsillectomy
Mandibular advanced devices

46
Q

OSA general mx

A
  1. Weight loss
  2. Exercise
  3. Smoking
  4. Diet
  5. Sleeping on side not back
47
Q

Driving and OSA

A

Must not drive until control of symptoms for 3 months if excessive sleepiness

48
Q

Bell’s palsy mx (4)

A
  1. If within 72 hours give pred
  2. Otherwise eye lubrication - eye drops BD
  3. Tape eye closed at night
  4. Avoid infection of the eye e.g swimming/ dust etc
49
Q

Bell’s palsy sx (5)

A
  1. Half face weakness (no forehead sparing, think stroke then)
  2. Difficulty in closing eye
  3. Drooling, difficulty in using mouth
  4. Change of taste
  5. Sensitivity to loud noises
50
Q

When to refer Bells?

A
  1. No improvement after 3 weeks
  2. Uncertain diagnosis
  3. Incomplete recovery after 3 months of sx
  4. Atypical features
51
Q

What is Bell’s palsy?

A

Facial nerve irritation unknown cause
Symptoms can take 5 days to peak, most will see improvement within 3 weeks, but it can take up to 6 months to fully resolve. 70% of patients will have a full recovery.

52
Q

Long term complications of Bell’s (3)

A
  1. Sykenesis - unwanted movements of the face
  2. Refer for facial therapist
  3. Chronic pain
53
Q

Mx threadworms

A
  1. Mebendazole for all contacts in the household
  2. May need a repeat dose 2 weeks later if still symptomatic
54
Q

Pregnant or <6 months old mx of threadworms (6)

Not licensed under what age?

A

6 weeks of hygiene measures as tablet is not safe in pregnancy

Not licensed to under 2yo

Hygiene measures
1. Don’t bite nails
2. Avoid itching
3. Showering each morning including perianal area to reduce eggs
4. Washing all linen and PJs daily - washing on a hot cycle will kill the eggs and worms. Do not shake as risk of spreading.
5. Washing hands thoroughly and regularly after toilet and before preparing food
6. Thoroughly dust and vacuum.

No exclusion from school is necessary

55
Q

Threadworm Ix

A

Tape test - adhesive tape applied to perianal area first thing in the morning prior to wiping or bathing.
Remove tape and put into container.
Tape may need to be done on three consecutive mornings.

56
Q

What is threadworm

A

Parasitic worm spread by faecal oral route
After scratching perianal area and then ingesting through the mouth.
Worms travel through the intestine and lay eggs in the anus.

57
Q

Measles infectivity

A

4 days prior to onset of symptoms up to four days post rash
highly infectious

58
Q

Presentation of measles

A

Prodrome fever, malaise, conjunctivitis, rhinorrhoea
Then fever
Koplik spots on the inside of mouth
Rash develops on face and behind ear before descending downwards
Usually resolves after 1 week

59
Q

Measles potential complications

A
  1. Seizures
  2. Blindness
  3. Pneumonitis
60
Q

Measles mx

A
  1. Self limiting after 1 week
  2. Notify public health england
  3. Stay away from nursery/ work/ school/ immunocompromised until at least 4 days post rash, preferably until completely better.
61
Q

Contact with measles

A

Assess vaccination status
If high risk - contact local health protection team for advice.
Immunoglobulin considered (definitely given if <6 months) - should be given within 72 hours of exposure.

Offer MMR vaccine if not already vaccinated

62
Q

Chlamydia mx

A

Doxycycline 100mg BD for 7 days OR
Azithro 1g single oral dose
TOC (test of cure) not routinely recommended

63
Q

Contact tracing chlamydia
Men

A

Men symptomatic - all contacts for 4 weeks prior to onset of symptoms

64
Q

Contact tracing chlamydia
Women

A

Women and asymptomatic men - all contacts for 6 months prior

65
Q

Gonorrhoea mx (3)

A

Cipro 500mg stat dose OR ceftriaxone 1g IM stat
Advise to abstain from sex for 7 days post treatment
Test of cure 1 week later

65
Q

Contact tracing gonorrhoea
Symptomatic men

A

All contacts 2 weeks prior to sx

66
Q

Contact tracing gonorrhoea
Women and asymptomatic men

A

All contacts within 3 months

67
Q

STI testing:

A

Chlamydia, gonorrhoea, TV self swabs/ urine within 2 weeks
Then HIV at 6 weeks
Syphilis if high risk at 3 months

68
Q

Anal fissure mx general (4)

A
  1. Avoid constipation - high fibre diet, fruit and veg and lots of water
  2. Keep the area clean and dry, pat dry
  3. Avoid with-holding stool
  4. Sit in a warm shallow bath after opening bowels can relieve pain
69
Q

Acute anal fissure mx medications (3)

A
  1. Simple analgesia
  2. Topical anaesthetic (for use before opening bowels if very painful)
  3. GTN ointment BD for 6 weeks then FU
70
Q

SE GTN ointment

A

Headache

71
Q

When to review an adult and child with anal fissure?
What to do next?

A

6 weeks, 2 weeks
Child - refer to paeds
Adult - discuss with surgeons in case diltiazem can be used instead

72
Q

AAA screening when is it done?

A

One off US age 65yo men

73
Q

Results AAA screening?

A

<3cm –> discharge
3.0 cm to 4.4 cm — surveillance, repeat scan 1 year
4.5 cm to 5.4 cm — surveillance, repeat scan 3 months.
>5.5 cm or larger— refer to vascular

74
Q

Colic when does it normally resolve?

A

Usually resolves by 6 months

75
Q

Colic general measures (4)

A
  1. Holding baby upright when feeding to stop taking in air
  2. Burping baby after feeds
  3. Gentle massage on tummy
  4. Bathing in a warm bath
76
Q

How to soothe a baby with colic? (3)

A
  1. Gentle motion
  2. White noise
  3. Remove stimuli
77
Q

Infertility general mx (7)

A
  1. Caffeine
  2. Exercise
  3. BMI
  4. Smoking
  5. ETOH
  6. Drugs
  7. Stress
78
Q

Infertility medications (2)

A
  1. Folic acid
  2. Vitamin D
79
Q

Ix infertility women (4)

A

D21 progesterone (of a 28 day cycle) (or 7 days prior)
Ovulation –> if level >30

Chlamydia, TFTs, prolactin

80
Q

Ix infertility men - explain

A

Semen analysis - must abstain from sex at least 2 max 7 days. Done near a lab so it can be transported appropriately, otherwise needs to be transported close to the body (e.g armpit)

If N, nil further action, if abnormal, repeat in 3 months. If particular anxious can do within 2-4 weeks.

If two abnormal refer to secondary care.

81
Q

When to refer for infertility?

A

<36yo, after 1 year of trying

82
Q

When to refer early for infertility? (e.g after 6 months) (women) (5)

A

> 36yo
PID
Oligomenorrhea
Previous STI
Previous pelvic surg

83
Q

Fertility treatment that may be offered?
Medical (1)
Surgical (1)

A
  1. Clomiphene - if no anovulation
  2. Surgical treatment if any tubal disorders/ endometriosis
84
Q

Explain some assisted reproduction techniques (3)

A

IUI - sperm inserted into the uterus
IVF - egg taken, sperm taken, grown in a tube and then placed into the uterus via the cervix
ICSI - injected sperm direct into ovum

85
Q

Name symptoms of ovarian hyperstimulation syndrome (6)

A

Abdominal bloating, nausea, vomiting, oedema, oliguria, acute respiratory distress syndrome

86
Q

Scabies mx/ counselling (5)

A
  1. Permethrin - once weekly for two weeks
    All over body, special attention to armpits, external genitalia, under the nails, under the breasts, buttocks, wrists etc.
  2. Wear for 8-12 hours, then wash off. If hands are washed within that time frame you will need to reapply.
  3. Apply to cool, dry, skin
  4. Highly flammable
  5. Can cause some burning or stinging, but this usually is transient.
87
Q

Scabies mx extra rules 2month - 2yo

A

Avoid around the eyes and mouth, to prevent licking
Use mittens to not put hands in mouth

88
Q

Scabies - who should be treated?

A

All household contacts, sexual contacts and close contacts within the last month. Even if asymptomatic.

89
Q

Scabies - clothing, itching info

A
  1. Wash all clothes, high temperature/ drying. OR seal in a bag for 72 hours
  2. Itching can last for four weeks after last treatment, but if persisting to seek medical attention as will need to retreat
90
Q

Angina medication mx (4)

A
  1. GTN, if you get CP take one spray under the tongue and rest, if no improvement after 5 minutes, try it again. If no improvement after another 5 minutes call 999.
  2. Aspirin
  3. BB and CCB
  4. ISMN
91
Q

Angina Ix (3)

A
  1. CVD screen
  2. ECG
  3. Referral to RACPC
92
Q

Angina mx lifestyle (6)

A
  1. Diet
  2. Smoking
  3. Exercise
  4. Stress
  5. Eating large meals
  6. Exposure to cold can exacerbate angina
93
Q

If angina with diabetes give –>

A

ACE

94
Q

Explain Lewy body dementia

A

Lewy body dementia is similar to other types of dementia - such as memory loss and reduced concentration. With Lewy body dementia, people often present with visual or auditory hallucinations and there are treatments that can be given to reduce the severity of these symptoms. Lewy bodies are bits of protein that are produced and deposited in the brain and can lead to hallucinations, issues with memory and judgement and stiff limbs.

95
Q

LBD mx (3)

A
  1. Rx to reduce hallucinations such as antipsychotics
  2. Rx to slow memory loss Acth inhibitors (donepezil), memantine etc
  3. Group therapy
96
Q

Asthma mx Adult general (4)

A
  1. Vaccinations, annual influenza
  2. Avoid triggers such as smoking, BB, NSAIDs
  3. Make sure they have a peak flow meter
  4. How to use inhalers
97
Q

Suspected RA mx + counselling (5)

A
  1. Bloods and XR including RhF
  2. If normal, but persistent synovitis refer
  3. NSAIDs for pain management
  4. Pneumococcal and influenza
  5. CVD risk
98
Q

Explain DMARDs

A

Medications used in RA and other autoimmune joint conditions. They help reduce inflammation and pain, and aid in reducing damage to the joints in order to preserve its function.

They are specialist medications which require monitoring as in some cases they can have an impact on your liver.

They do not provide immediate relief but work over a period of time and therefore the medications need to be taken long term.

99
Q

Counselling MTX

A

Take it once a week and can cause mouth ulcers or an upset stomach. In very rare cases it can reduce some of the cells in the body that are used to fight an infection.

We recommend taking folic acid once a week with the MTX so that we can reduce the risk of SE.

100
Q

Plantar fasciitis mx (5)

A
  1. Rest the foot, avoid standing for long periods of time or excessive walking
  2. Good arch support and cushioned heels
  3. Avoid walking barefoot
  4. Insoles/ heel support
  5. Weight loss
101
Q

Plantar fasciitis medical mx (2)

A
  1. Simple analgesia
  2. Ice packs covered with a towel under the foot for 15 minutes
  3. Physiotherapy
102
Q

Achilles tendinopathy explain what it is and three RF

A

An injury to the band of tissue that attaches the muscles in your calf to the heel bone - this can sometimes lead to symptoms such as pain, stiffness and swelling to the heel. Usually caused by overuse/ mechanical stressor. Resolves within a few months.

RF cipro, diabetes, raised cholesterol

103
Q

General advice achilles tendinopathy (4)

A
  1. Rest - exercise can be restarted once the pain allows
  2. Ice
  3. Simple analgesia
  4. Physio self
104
Q

Secondary care achilles tendinopathy (3)

A
  1. Physio
  2. Shockwave therapy - chronic
  3. Surgery

SCA (3 decks)

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