General Practice Flashcards
What are the differentials for back pain?
Mechanical - muscle sprain/strain
Fracture
Malignancy
Infection e/g, osteomyelitis
What are the red flags for cauda equina syndrome?
Bilateral sciatica
Progressive bilateral neurological deficit of the legs
Impairment of urinary flow or bowel flow
Saddle anaesthesia
What are the red flags for a spinal fracture?
Sudden onset severe pain
Pain relieved by lying down
History of trauma (may be minor in those with osteoporosis)
Point tenderness over vertebral body
What are the red flags for back pain for cancer?
>50 years Gradual onset Severe pain Pain worse at night Pain worse when coughing or sneezing Thoracic back pain Radicular pain Weight loss Past history of cancer
What are the red flags for back pain and infection?
Fever Tuberculosis - or recent UTI Diabetes History of IVDU HIV infection Immunocompromised
What are the 2 vitamins which alcohol addicts may be short on and should be supplemented during withdrawal of alcohol?
Folic acid (vitamin B12) - as alcohol affects the body’s ability to absorb folate
Thiamine (B1) - low thiamine is often seen in alcoholics
What condition is low thiamine related to?
Brain disorder
Wernicke-korsaoff syndrome (WKS)
What medications should alcoholic be put on when helping with detoxification?
Give an example
Benzodiazepines
Example: chloradiazepoxide
When would you need to inform the DVLA if you have diabetes?
If you have had 2 episodes of severe hypoglycaemia in the last 12 months
If you are unable to recognise when a hypoglycaemic episode starts
If you have experienced a disabling hypo while driving
If you have other medical conditions which could effect your ability to drive e.g, vision problems, circulation/sensation problems
How would you advise a diabetic to manage their diabetes during Ramadan?
High risk patients (for hypoglycaemia) and those who have diabetic complications are advised not to fast
Patients taking sulphonylureas (e.g, glicazide) - should stop taking these as they have a side effect of hypoglycaemia
What is the centor criteria?
Used to predict bacterial infection in patients with sore throat:
- presence of tonsillar exudate
- fever
- absence of cough
- cervical lymphadenopathy
At what score on the centor criteria would you prescribe antibiotics?
If they were scoring a 3 or a 4 - this is suggestive of bacterial infection
Offer 2 day delayed prescription if wary
What is the Fraser criteria
The guidelines for prescribing contraception in a girl under the age of 16
- they understand the advice
- they cannot be persuaded to inform their parents
- they are likely to have sexual intercourse with or without treatment
- unless they receive treatment/advice then their mental health may suffer
What is the mode of action of the IUD (copper coil)?
Prevents fertilisation by causing decreased sperm motility and survival (possibly due to effect of copper ions)
What is the most of action of the IUS (mirena)?
Progesterone based (levonorgestrel)
Levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening
How many days after insertion is the IUS effective?
7 days
What is the effect of the IUS (mirena coil) on periods?
Initial frequent uterine bleeding and spotting
Later women typically have intermittent light menses with some women becoming amenorrhoeic
What are the risks of implantation of the IUS and IUD?
Perforation - 2 per 1000 insertions
Ectopic pregnancy - as if they were to get pregnant it would be more likely be in the tubes
Infection - small increase in PID in first 20 days after insertion
Expulsion - risk is 1 in 20, more likely to occur in first 3 months
What is the most of action of the combined oral contraceptive pill?
Inhibits ovulation by tricking your body into thinking it is pregnant already - hormones mimic pregnancy hormones
What is the mode of action of the progesterone only pill?
Thickens cervical mucus
What is the method of action of the implant?
Inhibits ovulation
Also thickens cervical mucus
What are the absolute contraindications to starting the combined contraceptive pill?
> 35 years old and smoking >15 cigarettes a day
Migraine with aura
History of VTE or thrombogenic mutation e.g factor V Leiden
History of stroke or ischaemic heart disease
Breast feeding <6 weeks post-partum
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
How often is the depo injectable contraceptive given?
Every 3 months
What is the mode of action of the depo injection for contraception?
Inhibits ovulation
Also causes cervical mucus thickening and endometrial thinning
What are the adverse effects of the injection?
Irregular bleeding
Weight gain
May increase risk of osteoporosis
Not quickly reversible and fertility may return after a varying time (up to 12 months)
What are the differential for a swollen ankle?
Cellulitis Septic arthritis DVT Inflammatory arthritis Gout Oedema Sprain/fracture
Which medications can cause hyponatraemia?
ACE inhibitors Diuretics PPIs - omeprazole Antidepressants- SSRIs NSAIDs
What is rescue pack for COPD?
Owned by patients with COPD
They are given to patients who are identified as being able to benefit from prompt use of steroids and/or antibiotics
Steroids are to be taken if the patient notices an increased SOB affecting activities of daily living
Antibiotics are to be taken during symptoms of chest infection - if they have more discoloured sputum
What is the HARK questionnaire for domestic abuse?
H - Humiliation
A - Afraid
R - Rape
K - Kick
