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Phase 2a - General Practice > General Practice Key Points > Flashcards

General Practice Key Points Flashcards

1
Q

Give 3 examples of a step 3 analgesic.

A

1) morphine
2) diamorphine
3) oxycodone

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2
Q

List 2 drug classes that cannot be used in asthma.

A

1) βB

2) NSAID

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3
Q

Describe the mechanism of methotrexate. (5)

A

1) very slow reversible inhibitor of DHFR (dihydrofolate reductase)
2) inhibited folate derivative synthesis
3) inhibited purine nucleotide synthesis (A and G)
4) inhibited DNA synthesis
5) cell death

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4
Q

Give an example of a step 2 analgesic.

A

Codeine.

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5
Q

Define narrow therapeutic index.

A

Dose range that maximises efficacy whilst minimising toxicity.

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6
Q

How often is an NHS health check done?

A

Every 5 years.

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7
Q

List 6 drugs that St. John’s wort interacts with.

A

1) SSRI
2) oral contraceptive pill
3) warfarin
4) cyclosporin
5) digoxin
6) statin

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8
Q

What cells are COX-2 enzymes found in?

A

Inflammatory cells.

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9
Q

Describe peritoneal dialysis. (4)

A

1) peritoneum used as a semi-permeable membrane
2) catheter inserted into peritoneal cavity
3) fluid infused into peritoneal cavity
4) continuous process, fluid is intermittently drained and refilled

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10
Q

List 3 non-pathological causes of a raised PSA.

A

1) age
2) trauma (e.g. riding a bike)
3) sex

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11
Q

Why are opiates rarely used in chronic pain (>3 months)?

A

Too many side effects.

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12
Q

What percentage of patients get an ACE inhibit cough?

A

10-30%.

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13
Q

What is metformin’s half life?

A

5 hours.

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14
Q

List the minimum information required for a legal FP10 prescription. (5)

A

1) date
2) patient information (name, address, age)
3) drug information
4) prescribers signature
5) prescribers adress

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15
Q

List 6 side effects of opioids.

A

1) constipation
2) nausea —> vomiting
3) rash —> pruritus
4) dry mouth
5) loss of consciousness
6) dependance/tolerance

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16
Q

What is the red book?

A

Personal child health record, record of child’s health and development.

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17
Q

How is metformin secreted?

A

Unchanged, via urine.

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18
Q

What occurs in a type 1 myocardial infarction?

A

Plaque rupture.

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19
Q

What is a side effect of steroid inhalers?

A

Tongue thrush.

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20
Q

What fasting blood glucose indicates pre-diabetes?

A

5.5 - 6.9mM.

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21
Q

Define child health surveillance.

A

Programme that gives advice on social and health care throughout child’s life.

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22
Q

List the ‘big’ 5 risk factors of ischaemic heart disease.

A

1) smoking
2) diabetes mellitus
3) dyslipidaemia (inc. hypercholesterolaemia)
4) hypertension
5) family history

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23
Q

List 3 neuropathic painkillers.

A

1) amitriptyline
2) gabapentin
3) pregabalin

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24
Q

What payment is made for each prescription?

A

£8.40.

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25
Q

List 6 examinations carried out at the 8 week baby check.

A

1) feeding
2) alertness
3) eye (cataracts)
4) heart (murmur)
5) hip (developmental dysplasia of hip)
6) testicles (undescended testicles)

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26
Q

Describe how NSAIDs cause renal dysfunction. (6)

A

1) inhibit COX-1
2) inhibit prostaglandin synthesis
3) decreased afferent arteriole dilation
4) vasoconstriction of afferent arteriole
5) decreased renal perfusion
6) decreased glomerular filtrate rate

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27
Q

What percentage patients taking α blockers have retrograde ejaculation (diminished)?

A

30%.

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28
Q

List 7 things recorded in the red book.

A

1) height (GP)
2) weight (GP)
3) vaccinations (GP)
4) illnesses (parents)
5) accidents (parents)
6) medicines (parents)
7) developmental milestones (parents)

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29
Q

What is the main disadvantage of peritoneal dialysis?

A

Peritoneum membrane function declines over time.

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30
Q

List the steps of the analgesic ladder. (4)

A

1) non-opioids
2) weak opioids
3) strong opioids
4) other

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31
Q

What cells are COX-1 enzymes found in?

A

All cells.

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32
Q

What is the main advantage of peritoneal dialysis?

A

Can be done from home.

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33
Q

List 2 things patients at risk of hypoglycaemia should have in their car (e.g. DMT1).

A

1) glucose tablets

2) blood sugar testing monitor

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34
Q

Define herd immunity.

A

Resistance to spread of disease within a population as a high proportion are immune to the disease.

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35
Q

What is cocodomol. (2)

A

1) paracetamol

2) codeine

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36
Q

What doses are neuropathic painkillers used?

A

Low doses.

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37
Q

List 5 things assessed in a daily living assessment.

A

1) personal hygiene
2) dressing
3) eating
4) continence
5) mobility

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38
Q

When is haemofiltration used?

A

In critical care when haemodialysis is unavailable.

39
Q

List 3 points of the ‘knowledge of test’ heading in Wilson and Jungner screening criteria.

A

1) suitable test
2) acceptable test (to population)
3) continuous case finding (not once and for all project)

40
Q

List 2 example of a step 1 analgesic.

A

1) paracetamol

2) NSAIDs

41
Q

What is the action of tamsulosin?

A

Specific α1A and α1D adrenergic receptor blocker.

42
Q

What sex is more likely to get an ACE inhibitor cough?

A

Female.

43
Q

What enzyme do newer NSAIDs target?

A

COX-2.

44
Q

List 4 healthcare professionals that deliver the child health surveillance programme.

A

1) health visitors
2) midwifery staff
3) general practitioners
4) Sure Start children’s centres

45
Q

Who is a breast screening offered to?

A

50-70 year old women.

46
Q

What is paracetamols effect on opioids?

A

Increases potency, opiate sparring.

47
Q

What should be assumed in severe diarrhoea when taking the oral contraceptive pill?

A

Everyday with severe diarrhoea counts a day where you’ve missed the pill.

48
Q

Define screening.

A

Process of identifying apparently healthy people who may be at an increased risk of a condition. They are offered information, further tests and treatment to reduce their risk and/or any complications of the condition.

49
Q

What is the main disadvantage of haemofiltration?

A

Haemodynamically unstable.

50
Q

List 4 managements of post kidney transplant patients.

A

1) immunosuppressants (e.g. cyclosporin, azarthioprine, prednisolone)
2) avoid nephrotoxic drugs (e.g. NSAIDs, gentamicin)
3) avoid certain vaccines (esp. live) (e.g. MMR, BCG, varicella)
4) cancer screening (esp. skin, lymphoma, solid organs)

51
Q

Describe the mechanism of NSAIDs. (3)

A

1) inhibit COX-1 and COX-2
2) inhibit prostaglandin synthesis
3) anti-inflammatory

52
Q

What doesn’t occur in a type 2 myocardial infarction?

A

Plaque rupture.

53
Q

List 5 differential diagnoses for joint swelling.

A

1) rheumatoid arthritis
2) psoriatic arthritis
3) septic arthritis
4) gout
5) pseudogout

54
Q

What percentage of 80 year olds have an enlarged prostate?

A

80%.

55
Q

List 10 things modelled in QRISK2.

A

1) age
2) sex
3) medical history
4) family history
5) ethnicity
6) postcode
7) smoking/alcohol
8) BMI
9) HDL ratio
10) blood pressure

56
Q

What are spacer devices used for?

A

Increases ease of metered dose inhaler administration.

57
Q

What HbA1c indicates pre-diabetes?

A

42 - 47 mmol/mol (6.0-6.4%).

58
Q

List 3 renal functions that should be tested before prescribing ACE inhibitors and monitored during treatment.

A

1) GFR (monitoring for CKD, e.g. <60ml/min/1.73m2)
2) Na+ (monitoring for hyponatraemia)
3) K+ (monitoring for hyperkalaemia)

59
Q

List 3 tests used to monitor methotrexate.

A

1) FBC
2) LFT
3) RFT (inc. UnE)

60
Q

List 5 things measured at an annual diabetes review.

A

1) height
2) weight
3) HbA1c
4) cholesterol
5) blood pressure

61
Q

List 7 non-pharmacological managements of osteoarthritis.

A

1) exercise
2) physiotherapy
3) occupational therapist
4) hot/cold packs
5) walking aids
6) stretching/manipulation
7) joint replacement

62
Q

List 3 possible adjustments made to really excreted drugs in patients with renal impairment.

A

1) decrease dose
2) increase time between dose
3) substitute drug

63
Q

List 3 examples of a step 4 analgesic.

A

1) nerve blocker
2) epidural
3) patient controlled analgesic pump (PCA pump)

64
Q

What surgery does tamsulosin complicate?

A

Cataracts surgery (intraoperative floppy iris syndrome).

65
Q

List 3 points of the ‘treatment for disease’ heading in Wilson and Jungner screening criteria.

A

1) acceptable treatment
2) facilities for diagnosis and treatment available
3) early treatment affects prognosis

66
Q

What is an NHS health check?

A

Screening for 40-74 year olds to spot early signs and give advice to reduce risk of diabetes, heart disease, kidney disease, stroke, dementia..

67
Q

Describe haemofiltration.

A

1) blood passed over semi-permeable membrane
2) positive pressure clears water
3) solutes pulled with water
4) ultrafiltrate with ‘clean’ fluid replaces water (either pre or post dilution)

68
Q

What is QRISK2?

A

A risk assessment algorithm for cardiovascular disease.

69
Q

List 3 conditions associated with a raised PSA.

A

1) prostate cancer (acinar adenocarcinoma)
2) benign prostatic hyperplasia
3) prostatitis

70
Q

List the headings of the Wilson and Jungner screening criteria. (4)

A

1) knowledge of disease
2) knowledge of test
3) treatment of disease
4) cost considerations

71
Q

What is St. John’s wort.

A

A herbal medicine that is a symptomatic treatment of mild to moderate depression.

72
Q

What is the difference between opiate and opioid. (2)

A

1) opiate - natural

2) opioids - synthetic

73
Q

What is a key side effect of ACE inhibitors?

A

Dry tickling cough.

74
Q

List 3 ways of monitoring a drug.

A

1) plasma concentration
2) clinical effect
3) blood tests

75
Q

What is growth an important indicator of?

A

Health.

76
Q

List 3 routes of administering paracetamol.

A

1) oral
2) rectal (suppository)
3) intravenous (infusion)

77
Q

Describe haemodialysis. (2)

A

1) blood passed over semi-permeable membrane

2) dialysis fluid flows counter current

78
Q

What is aspirin generally used for?

A

Anti-platelet.

79
Q

List the 5 vaccinations in the 5 in 1 vaccine.

A

1) diphtheria
2) haemophilus influenzae B
3) pertussis
4) polio
5) tetanus

80
Q

What analgesia has little to no side effects?

A

Paracetamol.

81
Q

How often is haemodialysis done?

A

3 times a week.

82
Q

What site is blood taken from in haemodialysis?

A

Arterio-venous fistula.

83
Q

What is the action of cyclosporin? (2)

A

1) T cell specific suppressor (esp. Th1 cells)

2) inhibits IL-2 production

84
Q

How is folic acid prescribed with methotrexate? (2)

A

1) 5mg weekly

2) not on the same day as methotrexate

85
Q

What is used to assess stool consistency?

A

Bristol stool chart.

86
Q

List 3 points of the ‘knowledge of disease’ heading in Wilson and Jungner screening criteria.

A

1) important health problem
2) recognisable early stage
3) understood natural course

87
Q

List 8 NSAID contraindications.

A

1) GI bleed (inc. peptic ulcer)
2) kidney disease
3) asthma
4) inflammatory bowel disease
5) ischaemic heart disease
6) cerebrovascular disease
7) peripheral artery disease
8) congestive heart failure

88
Q

List 3 advantages of breast screening.

A

1) earlier detection
2) less invasive treatment
3) better survival

89
Q

How often are diabetes reviews?

A

Annual.

90
Q

List 5 conditions screened for in an NHS health check.

A

1) diabetes mellitus type 2
2) heart disease
3) kidney disease
4) stroke
5) dementia

91
Q

List 7 drugs with a narrow therapeutic index.

A

1) warfarin
2) digoxin
3) methotrexate
4) insulin
5) phenytoin
6) gentamycin
7) vancomycin

92
Q

How do you avoid postural hypotension side effects with α blockers?

A

Take at night.

93
Q

When is the 5 in 1 vaccine administered?

A

8 week check.

94
Q

List 8 considerations when choosing a contraception.

A

1) effectiveness
2) everyday?
3) STIs
4) inserted vaginally?
5) effect on periods
6) past medical history
7) weight
8) smoker

Phase 2a - General Practice (1 decks)

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