General Practice Flashcards
Urinary incontinence
Types - what causes them
Questions to ask
Red flags
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types - stress and urge
stress is leakage - urine dip for infection, incontinence diary, gynae referral
urge is sudden urge. lots of small volume. may be at night.
can have mixed. RED FLAGS - haematuria, persistent UTI, poor renal function, neurology, saddle anaesthesia, back trauma. pelvic surgery
Urinary incontinence
Investigations
Managment
stress - increase activity, loose weight, DULOXETINE (SSRI), surgical
urge - less caffeine, loose weight, reduce fluid, antimuscarinic OXYBUTYNIN, review meds, diruetics can worsen. can give botox injections into detrusor muscle
Back pain
what to ask
red flags
cauda equina (local neuro - bladder, saddle, pain)
Infection (immunosuppressed, steroids, IVDU)
tumor (fever, chills, malaise, malignancy, weight loss)
renal (unwell, fever, dysuria, haematuria)
prev back problem, surgery, malignancy
occupation - heavy lifting
Back pain examination investigation management safteynet
HR, RR, temp, overlying skin changes, GAIT
SPINE, NEURO
STRAIGHT LEG RAISE - for sciatic pain
PR - anal tone - cauda equina
Ix for non mech cause. FBC, ESR, CRP, culture. MSU if renal
Mx - mechanica; - explain absence of warning signs. keep active. avoid lifting, adjust work, self help - TENS, water bottle, pysio, NSAID & paracetamol
SN - hospital ref, imaging, amitriptylline
Exacerbation of asthma
Hx what to ask
examination
assess exacerbation - sleep, activity, recent hospital, triggers, chest pain
asthma control - drug Hx, allergies, adherence, inhalers in date, technique, spacer, immunisation
HR, RR, BP, sats
chest examine
Exacerbation of asthma
Ix and management
peak flow measure, spirometry
big attack? CXR, ABG
stop smoking, reg peak flow monitoring, maximise inhaler technique, specialist nurse.
asthma attack action plan? consider incr dose. maybe add steroid or incr or add LABA if using more than 3 times a week.
LRA - monteleukast if done this.
Acute asthma attack
management
moderate - spacer salbutamol, prednisolone,.
acute severe - 33-50% PEF - oxygen for sats (above 92) cant complete sentences. bronchodulator nebulised, prednisolone. no respinse then admit
life threatening - 92 less, silent chest, cyanosis - immediate admission - same as acute severe, GP review after admission 2 days.
sore throat
what to ask examine investigations managment safteynet?
sore throat, previoys, cough, fever, appetite, malaise fatigure
EX - PHARYNX - reddness, swelling, exudate. NECK - nodes. TEMP
Ix - CENTOR - age, 13/45, exudate/swelling, tender/enlarged lymph, TEMP, absence of cough.
3-5 - culture. 5 - Abx TREAT
Mx - virus / bacteria diff. Self - parac + ibuprofen. lozenges, warm drinks, rest. Delayed prescriptions maynbe.
SN - rash, cant eat or drink, drowsy, temp >38
may get worse before gets better
sore throat
complications
indications for tonsillectomy
differentials
otitis media, sinusitis, quinsy, acute rheumatic fever
tonsillectomy if >7 episodes last year. >5 in each 2 years. or >3 in last 3 years.
pharygnitis, tonsillitis, quinsy, phalangeal malignancy, glandular fever, GORD, epiglottitis
Low mood
things to ask
differentials
story, triggers, motivation, energy, enjoynemnt, weight changes, appetitie, memory / conc, ICE
thyroid - feeling cold, weight gain, Hx
bipolar
anaemia - fatugue and shortness of breath, palp, light headedness
psychotic - unusual, out of character, heard or seen something strange that you could not explain
risk assess for self harm andd suicine. think plans, protective factors, furture plans
low mood
investigations and managment
safteynet
antidepressants - what to say and check for
Ix - depression screening tool
practical - social activities, online support, patient support leaflet,
social support, counselling CBT, blood tests, antipressants
SN - meet again in a week. contact crisis team / samaritans
ANTIDEPRESSANTS - allergies, heart problems.
theyll be no improvement for 10-21 days. worse before better. GI upset. don’t stop abruptly. see before. 6 months after recovery or 2 years if hx.
child not quite right
what to ask
differentials
NICE traffic light system
safteynet
TEMP, RASH, RESP, GI, GU, CNS - alert, irritable
examine HR, RR, Temp, Chest, Throat, Ears
URTI (+viral induced wheeze), meningitis, otitis mediam bronchiolitis, croup, epiglottitis, UTI, leukaemia (Hb, Plt, WCC), kawasaki
NICE - colour, activity, respiratory, hydration, cicrulation and fever
Safteynet – breathing difficulties, floppy, fit, nin blanching rash, persistent vomiting, fever longer than 5 days, child deteriorates
diarrhoea
what to ask
differentials
Investigations
duration, freq, stool blood . mucus, vom / abdo pain, cold sweat, weight loss, lightheaded, nigh time symtoms, previous Hx
ORIGIN - unwell contacts, eaten unusual, animal contact, foreign travel.
Ask about joint or skin problems - IBD
DD - viral gastroenteritis, colorectal cancer, IBD, IBS, diverticular, coaeliac, haemorrhoids
bloods, stool sample if acute and 2 week history
diarrhoea
management
viral gastroenteritis - viral. fluids - Dioralyte. consuder Loperamide (immodium) if needed. return to work 48 hours after symtoms settle
carcinoma - bloods FBC, UE, LFTS, clotting G+S, 2 week COLONOSCOPY
urine infection - woman
how to classify
what to ask on Hx
differerntials
Exam, Ix - what would you see
management
uncomp - otherwise healthy,
com - kidney / bladder impair, kidney involve, pregnancy
Hx - dysuria, freq, haematuria
suprapubic pain, back pain, costovertabral bodies tender
fever, rigors
DISCHARGE
DD - UTI, pyelonephritis, STI, Renal stone, endometriosis
Ix - Urine dip - nitirite and leucocyte ++++
urine microscipy to see bacteria, WBC,. can do culture
LIFE - fluids, sodium citrate, urinate after sex. paracyeramol
NITROFURANTOIN 100mg BD or TRIMETHOPRIM or CIPROFLOXACIN (if pyelo)
swollen and painful joint
differentials
what to ask
red flags
examination
inflammatory - RA, gout, pseudogout / osteoarthritis / trauma / fibro
skin - cellultitis / ulcer / blister bunion callous / ingrown tonail / insect bite / trauma, sprain
ask for range of motion affected
SEPTIC ARTHRITIS - fever, single joint, recent surgery, infection, IVDU, HIV, immunisuppressed
TRAUMA / HAEMARTHROSIS - trauma hx, sickle cell, anticoag
R A – symmetrica;, morning stiffness, positive FH
look, feel, move
swollen and painful joint - I&M for each differentaisl
septic arthritis - gonoccocal and non gonococcal
RA
Gout, pseudogout - Ix - joint fluid aspiration + blood test to look for uric acid levels in blood. Mx - cochicine + NSAIDs. allopurinol prophylaxis and diet chiange. healthy BMI, exercise. SN – severe joint swelling, med for attack doesnt wor,, temperature.
high BP
primary / 2ary HTN?
what to ask?
what to examine
ask about taking the reading
HEADACHE, VISUAL SYMP, DIZZYNESS
red flags - ST: headache, blurry, dyspnoea, dizzy, nose bleeds, haemaTURIA
LT - LVH, CVS D, stroke, retinoppathy, nephropathy
ask about PMH of CVS disease, cholestrol, diabetes
SH - occupation, smok alc, activity, diet
height weight BMI, HR, RR, Qrisk@ score
high BP
investgations
managment
FBC, UE, TFT urinalysis diabeteic ECG 24 blood pressure monitoring or reg home monitor beFORE STARTING MEDS CXR
M - repeat reading.
lifestyle - weright, activity , exercise, meds ACE INHIB. if over 55 / black – then Ca channel blocker / thiazide
ramipril / amlodopine / indapamide
ARB - candesartan
headlice
managment
— wet combing
dimeticone - physical insecticide
malthion - chemical insectide
chickenpox
what to ask in hX, exam
managment?
safteynet?
complications
PMH - preg, birth, imm, prev illness, development, unwell contacts
exam - general unwell
Mx - hydate, stay cool, nails hsort, paractemol if fever.
stay away from pegnant, immunocompromised, babies younger than 4 weeks. AWAY FROM NURSARY 5 DAYS FROM ONSET OF RASH
SN - come back if high temp, reddness sreading, less fluid, urine output going down, drowsy, concerns
bacterial superinfection, neuro (reyes, enceph), systemic inflamm
tickly bottom in a child
differentials?
m?
threadworms, dermatitis, candida, haemorrhoids
have you inspected bottom and seen worms? at night with a torch?
Ix - can do sellotape and glass slide investiga
spread via scratch and swallow
MEBENDAZOLE - househole treatment too. repeat oral treatment after 2 weeks. hot wash all bedding, carpet, underwear.
child painful ear
hx - examination?
management for the differentials
otoscope, Webber’s and rhinne’s test. examine OROPHARYNX and check for cervical lymphadenopathy
AOM - self limiting. but if systemically unwell, high risk, symtpms > 4 days, children with discharge. <2 yeras with bilateral AOM, then treat ABX AMOXACILLIN or clarythro
OE - fungal or bacterial. often with allergies, the cold, sinus prob. persisant and causing hearing problems? GLUE EAR
treat - decongestants, antihistamines, nasal steroid sprays
CHOLESTEOMA - ENT referral. red flag facial nerve palsy & neuro symp
Ear wax - can cause HL, tinnitus, dizzy, otalgia, cough. OLIVE OIL, Na bicarb, ear synringe
AOM vs OE vs OM w effusion - managment
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feeling tired all the time
what to ask
what to screen for
managment
explore sleep, activity, things changing, trigger, impact
TB / MALIG - w loss, night sweat
DEPRESSION
ANAEMIA - breathless, heavy periods, malaena
HYPOTHYROID - cold, gaining weight, losing hair
RISK ASSESS
PMH, meds
FH - mood, thyroid, anaemia
SH
MX
mood –
insomia – sleep hyegine
MEDS - Nytol. BENZODIAZEPINE - if daytime impairment. temazepam 10mg. ADDICTIVE, TOLERANCE, DRIVING
off liscence - antihistamine, trricyclic
Headache
red flags dd
think sudden and chronic
what else to ask in Hx
Exam?
management
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meningitis, extradural haematoma (traume), subdural, subarachnoid, temporal arteritis, migrane
tumour, tension headache, med overuse headache
FH of neuro, ca, headaches
obs
eyes - from cranial. palpate temporal artery for tenderness. focused neuro examination
Mx - lifetyle - headache diart, avoid triggers, hydratiom, reduce coffee, sleep hygeine
acute attack - paracteabol, NSAID, triptan
problem drinking
hx - what to ask
Ix
Mx
CAGE
binge / continuous
withdrawal symptoms
risk assess MOOD, domestic iolence, children.
Ix - bloods, LFTS, B12, folate
advice to cut down.
SN – if you find yourself struggling or need more support, symptoms of withdrawal. Samaratins
Acne
how is it caused
what to ask
Ix
Mx
cosmetics, screen for mood
DH and allergies
conservative - be careful with face, dont scratch, cosmetics
MED - TOPICAL: BENZOYL PEROXIDE – also RETINOID - reduces sebum production. ABX CREAM CLINDAMYCIN - only 8 weeks at a time
MED - SYSTEMIC - ORAL ABX LYMECYCLINE, but may reduce COCP effectiveness. ISOTRETINOIN - oral retinoid. vert teratogenic
Starting COCP
Hx what to ask
what to advise
safteynet
previous contraceptive use, screen for eligibility – migrane with aura, DVT / PE, heart disease, stroke, CA, high BP, smoker.
can use straight away if on 1-5 period, if not then condoms for 7 days. missed pills - 1 is fine - but 2 — if in week 1 emergency contraception. week 2 - take pill when remember and condoms fpr a week. week 3 – take pill and omit 7 day break.
SN - headache, calf pain or swelling, chest pain SOB, return in 3 months. Side effects are mood and menstrual changes, bloating, breast tenderness.
CHECK PT BMI
Funny turn
what to ask
examine / Ix
What happened before, during and after. during – head sumptoms, funny smell. during - injury, muscle jerks, facial weakness, post ictal — palp, chest pain, eye rolling
systems review.
examine all abs, CVS, neuro exam.
Bloods - FBC, BM, ECG
Mx - if vasovagal syncope - stay hydrated, out of sun, avoid triggers, maxmise anti-hupertensives, get up slowly.
SN - try and film the attack. if it happens again, comeback or if they get worse and more frequent. or if they bite, incontinent,
Panic attack
what to ask
examine
Ix
Mx
expore the episodes, before during after. associating symtoms. feeling hot / weight loss.
EXCLUDE - chest / jaw pain / arm pain. cough / haemoptysis / breathlessness.
explire mood.
examine HR, ascultate, RR, thyroud.
ix - FBC, TFT, ECG
Mx - anxiety is a fight of flight response. deep breathing, radio, speaking to tutor / family /self help.
safteynet - if persistent propanolol / SSRI, psychological treatments - CBT / psychotherapy.
child with a rash
red flags
examine
RF - anaphylaxis, drug reaction, meningococal septicaemia, kawasaki disease, idiopathic thrombocytic purpura, HSP
examine – obs, top to tie, ears, throat
contraceptions
what are available
contraindications
advantages / disadvantages
IUS, IUD - CI in endometrial or cervical neoplasia, PID, pregnancy, undiagnosed vaginal blleding, previous ectopic.
COCP - UKMEC4 if – migrane with aura, VTE Hx, BMI > 35, age > 50 or smoker aged > 35. then CV risk factors such as high lipid, DM,. Ifacne give dianette.
PO-depot such as a 3 monthly injection or implant.
painful eye
what to ask / differentials
red flags to look for
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can’t hear out of my ear (general)
what to ask, differentials
managmenetr
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low mood
what to ask, differentials, Ix and managment
acute cough
what to ask, differentials, managment
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chronic cough
what to ask, differentials, managment
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tingling hand
what to ask, differentials, managmenet
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heartburn
what to ask, differrentials, management
painful shoulder
Hx, DD, Ix, Dx, Rx
–
dry itchy skin
Hx, DD, Ix, Dx, Rx
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funny turn – dizziness
Hx, DD, Ix, Dx, Rx
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meds for fever, pain, impetigo, cellultis, UTI, sore throat, otitis media
dosage for paracetamol, ibuprofen, penicillin V, amoxicillin, cetirizine and chlorphenamine
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