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Year 4 > General Practice > Flashcards

General Practice Flashcards

1
Q

Urinary incontinence

Types - what causes them
Questions to ask
Red flags

A

–
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

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2
Q

Urinary incontinence

Investigations
Managment

A

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

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3
Q

Back pain
what to ask
red flags

A

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

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4
Q 
Back pain
examination
investigation
management
safteynet
A

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

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5
Q

Exacerbation of asthma

Hx what to ask
examination

A

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

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6
Q

Exacerbation of asthma

Ix and management

A

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.

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7
Q

Acute asthma attack

management

A

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.

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8
Q

sore throat

what to ask
examine
investigations
managment
safteynet?
A

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

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9
Q

sore throat

complications
indications for tonsillectomy

differentials

A

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

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10
Q

Low mood

things to ask
differentials

A

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

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11
Q

low mood

investigations and managment

safteynet

antidepressants - what to say and check for

A

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.

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12
Q

child not quite right

what to ask
differentials
NICE traffic light system
safteynet

A

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

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13
Q

diarrhoea

what to ask
differentials
Investigations

A

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

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14
Q

diarrhoea

management

A

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

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15
Q

urine infection - woman

how to classify
what to ask on Hx
differerntials
Exam, Ix - what would you see

management

A

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)
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16
Q

swollen and painful joint

differentials

what to ask

red flags

examination

A

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

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17
Q

swollen and painful joint - I&M for each differentaisl

A

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.

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18
Q

high BP

primary / 2ary HTN?
what to ask?
what to examine

A

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

19
Q

high BP

investgations

managment

A 
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

20
Q

headlice

managment

A

— wet combing
dimeticone - physical insecticide
malthion - chemical insectide

21
Q

chickenpox

what to ask in hX, exam

managment?

safteynet?

complications

A

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

22
Q

tickly bottom in a child

differentials?

m?

A

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.

23
Q

child painful ear

hx - examination?
management for the differentials

A

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

24
Q

AOM vs OE vs OM w effusion - managment

A

–

25
Q

feeling tired all the time

what to ask
what to screen for

managment

A

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

26
Q

Headache

red flags dd
think sudden and chronic

what else to ask in Hx
Exam?
management

A

–
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

27
Q

problem drinking

hx - what to ask
Ix
Mx

A

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

28
Q

Acne

how is it caused
what to ask
Ix
Mx

A

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

29
Q

Starting COCP

Hx what to ask
what to advise
safteynet

A

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

30
Q

Funny turn

what to ask
examine / Ix

A

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,

31
Q

Panic attack

what to ask
examine
Ix
Mx

A

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.

32
Q

child with a rash

red flags
examine

A

RF - anaphylaxis, drug reaction, meningococal septicaemia, kawasaki disease, idiopathic thrombocytic purpura, HSP

examine – obs, top to tie, ears, throat

33
Q

contraceptions

what are available
contraindications
advantages / disadvantages

A

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.

34
Q

painful eye

what to ask / differentials
red flags to look for

A

–

35
Q

can’t hear out of my ear (general)

what to ask, differentials
managmenetr

A

–

36
Q

low mood

what to ask, differentials, Ix and managment

A
37
Q

acute cough

what to ask, differentials, managment

A

–

38
Q

chronic cough

what to ask, differentials, managment

A

–

39
Q

tingling hand

what to ask, differentials, managmenet

A

–

40
Q

heartburn

what to ask, differrentials, management

A
41
Q

painful shoulder

Hx, DD, Ix, Dx, Rx

A

–

42
Q

dry itchy skin

Hx, DD, Ix, Dx, Rx

A

–

43
Q

funny turn – dizziness

Hx, DD, Ix, Dx, Rx

A

–

44
Q

meds for fever, pain, impetigo, cellultis, UTI, sore throat, otitis media

dosage for paracetamol, ibuprofen, penicillin V, amoxicillin, cetirizine and chlorphenamine

A

–

Year 4 (7 decks)

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