General Flashcards
1
Q
OCD Mx (2)
How long is treatment?
A
- CBT - ERP
- SSRI
- Continue for at least 12 months of symptoms being controlled
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
3
Q
How to collect a urine sample kids (2)
A
- Suprapubic massage (cold gauze to the bladder)
- Urine collection pads
4
Q
When to refer constipation in children? (2)
A
- Failed rx after 4 weeks in 1yo or less
- > 1yo failed tx after 3 months
5
Q
Constipation mx (3) non medication
A
- Diet
- Exercise
- Fluid
6
Q
Constipation mx (2) medication
What should the maintenance dose be?
A
- Movicol
- Add in senna
- Half of disimpact dose
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.
8
Q
How much should a baby drink?
A
150mls/ kg
9
Q
Age range for febrile seizures
A
Usually around 2years, resolves age 6
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
11
Q
Suspected TIA mx
A
- If within 7 days then refer for assessment within 24 hours, give aspirin 300mg with PPI
- If >7 days then refer for specialist assessment within 1 week
12
Q
TIA driving
1 TIA
Multiple TIAs
A
No driving for 1 month
3 months
13
Q
Migraine acute treatment
(3)
A
- ibuprofen 900mg OR aspirin 900mg OR paracetamol 1000mg
- Triptan
- Offer anti-emetic
14
Q
Migraine prophylaxis (3)
A
- Propranolol
- Topiramate
- Amitryptilline
15
Q
Emergency contraception options
A
- Copper IUD
- Levenorgestral (72hrs)
- Ullipristal (5/7 post UPSI)
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
17
Q
Ullipristal + levon
Adv (4)
Disadv (4)
SE (3)
A
- Quick/ doesn’t require HCP
- Easily accessible
- Very effective, not effee
- Doesn’t protect against STIs
- Not a LARC
- Not effective after ovulation
- If vomits needs a repeat dose
SE headaches, dizziness, vomiting, mood disorders
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
19
Q
Leg cramps mx (4)
A
- Stretching
- Massaging
- Can offer quinine - poor benefit to risk ratio 200mg ON for 4 weeks
- If beneficial continue for 3 months
20
Q
Quinine counselling (3)
A
Irreversible loss of vision
Arrhythmias
Important not to take an overdose (due to potential for loss of vision)
21
Q
RF cramps (5)
A
Ageing
Exercise
Pregnancy
Dehydration
ETOH
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.
23
Q
Quinine contraindications (5)
A
haemolysis, optic neuritis, myasthenia gravis, tinnitus, caution if elderly with AF, heart blocks etc
24
Q
Steroids strength
A
HC, Betnovate RD, Eumovate, Betnovate, Dermovate
25
Risk factors restless legs (3)
IDA, pregnancy, CKD 5
26
Drugs that can cause restless legs (9)
antidepressants
antipyschotics
BB
antiepileptics
antihistamiens
metoclopramide
ETOH, caffeine, chocolate
27
Restless leg syndrome mx - to prevent and reduce (5)
1. Treat underlying cause such as IDA
2. Sleep hygiene
3. Reduce caffeine and ETOH
4. Stop smoking
5. Exercise
28
Restless legs mx during an attack (5)
1. Stretching
2. Heat pads
3. Relaxation exercises
4. Distraction
5. Massaging
29
Restless legs mx medical (3)
1. Pramipexole DA
2. Pregabalin/ gabapentin (off licence)
30
If choosing DA for RLS e.g pramipexole how to counsel
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
31
Meniscal tear when to suspect
Locking, popping and giving way
Slow onset or recurring swelling
32
Mx meniscal injury
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
33
What is Henoch Schonlein purpura?
Classic age?
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
34
HSP Ix (4)
Mx (4)
FBC, U+E, urinalysis, autoantibody screen
Mx
1. self limiting 4weeks to 4 months
2. discuss with paeds
3. steroids
4. NSAIDs
35
Hypercalcaemia
When to suspect?
Bone pain
Groans - AP, nausea, vomiting
Psychiatric illness - depression, anxiety, irritable
Fatigue, lethargy, weakness
Renal stones
36
Causes of hypercalcaemia and therefore Ix (8)
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
37
Thiazide SE (5)
Low sodium
Low K+
Erectile dysfunction
Gout
Raised sugar
38
Amlodipine SE (3)
Flushing
Peripheral oedema
AP
39
DPP4 example and SE (2)
sitagliptin
weight neutral
pancreatitis
40
sulfonylurea example and SE (4)
gliclazide
gain weight
hypoglycaemia
peripheral neuropathy
SIADH
41
SGLTs example and SE (4)
dapaglifozin
fourniere's gangrene
UTIs
DKA
weight loss
42
TZD examples and SE (4)
Pioglitazones
Increased risk of bladder cancer
fluid retention + weight gain
liver impairment
increased risk of fractures
43
Allopurinol SE
Rash - stop
Use with caution in renal impairment
44
Causes of a Baker's cyst
Knee injury
OA
RA
Gout
45
OSA -
Who to refer to do
What to ask (2)
Mx (3)
1. Refer to sleep clinic
2. Ask about driving
3. Co-morbidities e.g COPD
CPAP
Tonsillectomy
Mandibular advanced devices
46
OSA general mx
1. Weight loss
2. Exercise
3. Smoking
4. Diet
5. Sleeping on side not back
47
Driving and OSA
Must not drive until control of symptoms for 3 months if excessive sleepiness
48
Bell's palsy mx (4)
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
Bell's palsy sx (5)
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
When to refer Bells?
1. No improvement after 3 weeks
2. Uncertain diagnosis
3. Incomplete recovery after 3 months of sx
4. Atypical features
51
What is Bell's palsy?
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
Long term complications of Bell's (3)
1. Sykenesis - unwanted movements of the face
2. Refer for facial therapist
3. Chronic pain
53
Mx threadworms
1. Mebendazole for all contacts in the household
2. May need a repeat dose 2 weeks later if still symptomatic
54
Pregnant or <6 months old mx of threadworms (6)
Not licensed under what age?
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
Threadworm Ix
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
What is threadworm
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
Measles infectivity
4 days prior to onset of symptoms up to four days post rash
highly infectious
58
Presentation of measles
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
Measles potential complications
1. Seizures
2. Blindness
3. Pneumonitis
60
Measles mx
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
Contact with measles
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
Chlamydia mx
Doxycycline 100mg BD for 7 days OR
Azithro 1g single oral dose
TOC (test of cure) not routinely recommended
63
Contact tracing chlamydia
Men
Men symptomatic - all contacts for 4 weeks prior to onset of symptoms
64
Contact tracing chlamydia
Women
Women and asymptomatic men - all contacts for 6 months prior
65
Gonorrhoea mx (3)
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
Contact tracing gonorrhoea
Symptomatic men
All contacts 2 weeks prior to sx
66
Contact tracing gonorrhoea
Women and asymptomatic men
All contacts within 3 months
67
STI testing:
Chlamydia, gonorrhoea, TV self swabs/ urine within 2 weeks
Then HIV at 6 weeks
Syphilis if high risk at 3 months
68
Anal fissure mx general (4)
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
Acute anal fissure mx medications (3)
1. Simple analgesia
2. Topical anaesthetic (for use before opening bowels if very painful)
3. GTN ointment BD for 6 weeks then FU
70
SE GTN ointment
Headache
71
When to review an adult and child with anal fissure?
What to do next?
6 weeks, 2 weeks
Child - refer to paeds
Adult - discuss with surgeons in case diltiazem can be used instead
72
AAA screening when is it done?
One off US age 65yo men
73
Results AAA screening?
<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
Colic when does it normally resolve?
Usually resolves by 6 months
75
Colic general measures (4)
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
How to soothe a baby with colic? (3)
1. Gentle motion
2. White noise
3. Remove stimuli
77
Infertility general mx (7)
1. Caffeine
2. Exercise
3. BMI
4. Smoking
5. ETOH
6. Drugs
7. Stress
78
Infertility medications (2)
1. Folic acid
2. Vitamin D
79
Ix infertility women (4)
D21 progesterone (of a 28 day cycle) (or 7 days prior)
Ovulation --> if level >30
Chlamydia, TFTs, prolactin
80
Ix infertility men - explain
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
When to refer for infertility?
<36yo, after 1 year of trying
82
When to refer early for infertility? (e.g after 6 months) (women) (5)
>36yo
PID
Oligomenorrhea
Previous STI
Previous pelvic surg
83
Fertility treatment that may be offered?
Medical (1)
Surgical (1)
1. Clomiphene - if no anovulation
2. Surgical treatment if any tubal disorders/ endometriosis
84
Explain some assisted reproduction techniques (3)
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
Name symptoms of ovarian hyperstimulation syndrome (6)
Abdominal bloating, nausea, vomiting, oedema, oliguria, acute respiratory distress syndrome
86
Scabies mx/ counselling (5)
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
Scabies mx extra rules 2month - 2yo
Avoid around the eyes and mouth, to prevent licking
Use mittens to not put hands in mouth
88
Scabies - who should be treated?
All household contacts, sexual contacts and close contacts within the last month. Even if asymptomatic.
89
Scabies - clothing, itching info
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
Angina medication mx (4)
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
Angina Ix (3)
1. CVD screen
2. ECG
3. Referral to RACPC
92
Angina mx lifestyle (6)
1. Diet
2. Smoking
3. Exercise
4. Stress
5. Eating large meals
6. Exposure to cold can exacerbate angina
93
If angina with diabetes give -->
ACE
94
Explain Lewy body dementia
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
LBD mx (3)
1. Rx to reduce hallucinations such as antipsychotics
2. Rx to slow memory loss Acth inhibitors (donepezil), memantine etc
3. Group therapy
96
Asthma mx Adult general (4)
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
Suspected RA mx + counselling (5)
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
Explain DMARDs
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
Counselling MTX
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
Plantar fasciitis mx (5)
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
Plantar fasciitis medical mx (2)
1. Simple analgesia
2. Ice packs covered with a towel under the foot for 15 minutes
3. Physiotherapy
102
Achilles tendinopathy explain what it is and three RF
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
General advice achilles tendinopathy (4)
1. Rest - exercise can be restarted once the pain allows
2. Ice
3. Simple analgesia
4. Physio self
104
Secondary care achilles tendinopathy (3)
1. Physio
2. Shockwave therapy - chronic
3. Surgery
