General Practise Learning objectives Flashcards
What preventative activities should be undertaken by GPs in patients of Middle age (45-49) e.g What screening questions to ask? (2 marks) what measurements/tests to be performed) (1.5 marks)
Screening
Also what are important tools risk calculator tools to be used in this age group?
e.g AUSDRISK/Absolute CV risk/ Osteoporosis
Preventative activities by age
Middle age (45-49)
Ask
- SNAP screen - smoking every visit ; NAP at least every 2 years
- Depression screen
- Signs of skin cancer - any new or changing lesions?
- Family Hx screening questionnaire
Measure
- BMI (weight and height) + waist circumference
- BP
- Fasting lipids - every 5 years as part of CV assessment
PerformScreening
- Cervical cancer screen - every 5 years from 25
- Vaccination
- Influenza vaccination - recommend for all; particularly for at risk
- Pneumococcal - ATSI and chronic lung disease
- DTPA - pregnant
Calculate
- AUSDRISK - every 3 years from 40 for low risk or every 1 year for high risk
- Absolute CV risk - every 2 years 45+
- Osteoporosis risk factors - post-menopausal women and men >50
What preventative activities should be conducted in middle age 50-64yr
(all the previous screening for 25-49)
Middle age 50-64y
- As above PLUS (45-49 yr)
Screening
- CRC - FOBT every 2 years from 50
- Breast cancer - mammogram every 2 years from 50
- Cervical cancer - every 5 years
What are Elderly 65+ preventative activites needed to be conducted at GP?
As with all others, plus think, immunizations, af, falls prevention, Vision and hearing, dementia screening, Nutrition, nutrition in chronic diseases?
Elderly 65+
Immunisation
- Influenza - annually for all 65+ (PBS)
- Pneumococcal - one dose 65+ unless predisposing condition
- HZV - single dose 60+
SNAP
- Physical activity - 30 minutes moderate intensity on most if not all days
- Smoking & alcohol cessation
AF
- ECG everyone 65+
Falls prevention Screen
- All 65+ every 12 months
Moderate-high risk (past falls or risk factors) - every 6 months
3 questions
- How many falls in the past 12 months?
- Are you presenting following a fall?
- Difficulty with walking or balance?
Any positive –> falls risk assessmnet
Falls risk assessment
- Hx (risk factors) -falls, balance, vision, mobility, medications, chronic disease, neurological disease
- Exam - postural BP & pulse, TUG test, visual acuity and fields, neurological, CV for for arrhythmia
- Tools - falls risk assessment tools
Management
- Doctor - medication review (psychotropics, anticholinergics, sedatives, orthostatic hypotension)
- Physio or exercise physiologist - refer for balance specific exercise program
- OT home assessment - for those mod-high risk
- Ophthalmologist or optometrist - cataracts or visual acuity/fields deficit
- Podiatrist - walking and feet issues
Vision and hearing
- Snellen chart - if symptomatic or requested
- Hearing impairment screen - every 12 months by finger rub at 5cm + ask about hearing difficulty
Dementia
- Low risk - no benefit of screening
- Mod risk- Symptomatic, high CV risk, ATSI, family Hx, depression –> screen
How
- Ask - how is your memory?
- Cognitive assessment - GP assessment of cognition, MMSE, Kimberley Indigenous Cognitive Assessment tool
Prevention
- Physical activity by guidelines
- Social engagement
- Cognitive training
- Mediterranean diet
- Smoking cessation
Physical activity
- Screen - every 2 years
Recommendations
- 150 -300 minutes a week of moderate physical activity OR
- 75-150 minutes a week of vigorous
Nutrition
Screening and MxAll adult patients every 2 years
- Ask about - portion sizes of fruits and vegetables/day, sodium intake, saturated fat intake
- Advise to follow NHRMC dietary guidelines
- High risk patients every 6 monthsInclude
- Overweight/obese, high CV absolute risk, personal history of CVD, family Hx CVD (1o relative), type 2 DM
What
- Lifestyle advice to reduce sat fat, sodium and increase fruit and veg intake
- Provide information
- Refer to dietician
- Rough dietary guidelines
Vegetables - 5 serves
- Fruit - 2 serves
- Carbohydrates - 6 serves
- Dairy - 2.5
- Lean meat - 2.5
What are Nutritional guides for prevention and managment chronic diseases such as 1) Cardiovascular (CVD reducing) 2) T2DM 3) CKD
Reducing CVD risk
- Fat - lower saturated and trans fats
- ≥ 2 serves of oily fish
- Lower salt
- Limit alcohol
- Reduce red meat
Type 2 DM
- Low fat
- Low GI CHOs - reduce simple sugars
CKD
- Varies with stage of disease
- Dietary restrictions
- Protein restricted diet
- Na+ restriction
- K+ restriction
- Fluid restriction - amount depends on GFR, oedema, hypertension
- Oral sodium bicarbonate to maintain HCO3-
What is obesity? What is the epidemiology in Australia? Screening for obesity? Who is at high risk?
What are the classificaions of obesity, based on BMI, Waist circumference
What are the 5 As of Management of obesity ?
Obesity
Epidemiology
- Almost 2/3 Australians overweight
- 28% obese
- 25% children overweight or obese
Screening
- General population - BMI every 2 years
- High risk (ATSI, known CV disease, DM) - annually
- Known overweight - every 6 months
Management
- Ask - concerns about their weight
- Assess - BMI, waist circumference, diet, exercise, stage of change
- Advise - health benefits (CVD, DM etc.), change diet (2500kJ energy deficit), increase exercise (5x week 60 minutes of moderate intensity activity)
- Assist - set goals (achievable 5% loss initially –> significant benefits just from this), refer to dietician or exercise physiologist/program
- Arrange - follow-up in 2 weeks, bariatric surgery if BMI > 35 with comorbidities and unresponsive to lifestyle change
Outline hx, motivational interviewing, bio/psycho/social+pharmacotherapy for SMOKING cessation:
8 Minute OSCE easily
Smoking cessation
- Intro
- History (ASK)HPC
- Smoking - type; quantify pack years; past attempts to quit; withdrawal symptoms
- Lung cancer screen - cough, sputum, blood, SOB, wheeze, hoarseness, weight loss
- CV screen - chest pain, palpitations, ankle swelling, orthopnoea, PND
PMHx
- Social*
- ICE
- SNAP - alcohol important
- Other drugs
- Home - marriage, kids etc.
- Occupation
- Family history
- CV disease
- Lung cancer
Motivational interview
Ask
- Above
Assess
- Stage of change - are you ready to quit?
Advise
- Risks - increased CV risk, increased cancer risk particularly lung and pancreatic cancer which are generally incurable, COPD/pneumonia etc., never too late to quit
- Benefits - much of the lung damage is reversible with time, minimise risks above, money, energy improve, fitness will improve
- SEs of quitting - weight gain, withdrawal
Assist
- Bio - pharmacotherapy (if >10/day)
- Psycho - offer Quitline, strategies (e.g. walk instead of smoke)
- Social (behavioural) - avoid cues to smoke, avoid situations that will tempt you, ask friends and family for support, alternatives (exercise)
Arrange
- Set a date - ask for a commitment
- Follow-up - appropriate time to check progress
Pharmacotherapy (assist)Nicotine replacement therapy
- Gum, patches
Varenicline (Champix)
- Works by reducing craving and withdrawal symptoms
Most effective
- 12 week therapy
- SEs - nausea, neuropsychiatric (depressive symptoms, agitation)
Buproprion
- Risks - seizures
What is the australian childhood immunization schedule? Ages, Antigens, routes comments
What are Qld Immunisations for adolescents and adults? e.g starting in school
What are the current childhood vaccinations schedule in Australia? What are the ages and intervals? Which ones are live?
What is the route these immunizations are taken - and at what ages?
What vaccines are inactivated? Purified compoonent? Synthetic? Live (most important)?
What is Vaccination catch up? What are the principles of catch up vaccinations?
What are live vaccines? Who cannot they be given too? What is Pre-vaccination assessment for live vaccines?
RouteMost given IM at 90 degrees
- <12 months - thigh (less fat)
- >12 months - deltoid
MMRV
- Given subcut - 45 degrees
Rotavirus - PO
Hep B at birth
- Babies get severe Hep B - develop chronic disease and cirrhosis
Healthcare workers
- dTpa - immunity proven
- Hep B - immunity proven
- MMRV - immunity proven
- Annual influenza
Vaccine types
- Inactivated - hepatitis A, polio, influenza, tetanus
- Purified component - acellular pertussis, polysaccharide vaccines
- Synthetic - conjugate (Hib, meningococcal C), recombinant (hepatitis B, HPV) vaccines
- Live - rotavirus, MMRV
Catch up
Welfare/child care benefits REQUIRE either
- Fully vaccinated children
- To be on a recognised catch up schedule
Catch up schedules
- Children <10 should be commenced on a catch up schedule covering the vaccines usually given throughout childhood
- Requires same amount of doses split up over a prolonged period >1 year
- Children >10 should be commenced on a catch up schedule but don’t require
- HiB
- Rotavirus
- Pneumococcal
Live vaccines
Virulence reduced greatly
- MMRV*
- Rotavirus*
- Also - YF, BCG, OPV (not routinely given in Australia)
Administration of more than one live vaccine
- Either give at the same time or 4 weeks apart (otherwise poor immune response)
Immunosuppression and household immunosuppressed contacts
- Cannot give live to immunosuppressed
- Can give to children with household contact immunosuppressed EXCEPT OPV (risk of paralysis) - all encouraged (only a very small risk of transmission of rotavirus –> benefit outweighs harm)
- Advise to keep away from immunosuppressed contact for a week or 2
Pre-vaccination assessment for live vaccines
- Are they immunosuppressed e.g. chemotherapy, steroid therapy? (small chance of causing actual disease)
- Are you pregnant? (possible teratogen)
- Have you had a vaccine recently? (cannot give 2 live vaccines within 4 weeks as interferes with immune response)
- Have you been given IgG recently? (reduces immune response to vaccine)
What vaccines are lives? What is important about giving these vacinations?
What pre-vaccination assessment is avaliable to live vaccines?
What are absolute contraindications to vaccines?
What are FALSE contrainidications to vaccination?
Live Vaccines:
Virulence reduced greatly
Live vaccines
- MMRV*
- Rotavirus*
- Also - YF, BCG, OPV (not routinely given in Australia)
- Administration of more than one live vaccine
- Either give at the same time or 4 weeks apart (otherwise poor immune response)
Immunosuppression and household immunosuppressed contacts
- Cannot give live to immunosuppressed
- Can give to children with household contact immunosuppressed EXCEPT OPV (risk of paralysis) - all encouraged (only a very small risk of transmission of rotavirus –> benefit outweighs harm)
- Advise to keep away from immunosuppressed contact for a week or 2
Pre-vaccination assessment for live vaccines
- Are they immunosuppressed e.g. chemotherapy, steroid therapy? (small chance of causing actual disease)
- Are you pregnant? (possible teratogen)
- Have you had a vaccine recently? (cannot give 2 live vaccines within 4 weeks as interferes with immune response)
- Have you been given IgG recently? (reduces immune response to vaccine)
What are common adverse effects of vaccination? 1) common 2) rare
What are signs and symptoms of measles? Ix?
Adverse effects
Common
- Febrile illness
- Pain/erythema/hematoma at injection site
- Rash
Rare
- Febrile convulsion
- Anaphylactic shock - very rare
- Intussusception - rotavirus
Measles
- Eliminated from Australia
Sx
- Fever
- 3 Cs - coryza, cough, conjunctivitis
- Rash - maculopapular on trunk
- Koplik’s spots - white on buccal mucosa
Complications
- Pneumonia
- Encephalitis
- Thrombocytopenia
Ix
- IgM Abs
- PCR
PEP for contact with measles
- MMR if <72 hours
- Ig - if >72 hours ONLY if at risk of severe complications (pregnant, <12 months etc.)
What are the main objectives of vaccination couenselling? What are common myths to dispel? What is herd immunity? What are the benefits of vacciniation?
Objectors
Dispelling myths
- No evidence of autism
- False paper that has since been retracted due to conflict of interest
Toxins
- All components are stringently tested over many years by the TGA
- Safety of vaccines is closely monitored
- All current components are safe
- Since anti-vax movement there has been outbreaks of fatal disease - pertussis and measles
Unnatural or weaken immune system
- Strengthen it
- Use body’s natural defence mechanism to combat infection
- No mercury in vaccines since 2000
Herd immunity
- If parent relying on herd immunity –> state that this requires 90% vaccine coverage, however, vaccines not 100% effective and some communities have lower rates hence your child is not covered
Give benefits
- Gives immunity to many potentially fatal diseases
- Serious adverse effects are extremely rare - much more likely to be affected actual disease
- Vaccinating everyone gives protection through herd immunity to vulnerable people in the community who cannot be immunised/immunosuppressed –> so also helping others
Possible Vaccination OSCES!
Possible OSCEs!!!
Child with febrile convulsions from vaccine causing developmental delays with his brother who have not received any more vaccines
- Catch up program for brother - not a contraindication
- Catch-up vaccination for the kid with the febrile convulsion (not a CI as not anaphylactic)
Mother worried about toxins in vaccine (aluminium and thiouracil)
- Required for proper function of the vaccine
- Research shows they do not cause disease
Pregnant wants to get vaccinated
- Live contraindicated - theoretical risk to foetus
- All others ok
Pregnant come back in for postpartum check found not immune to varicella Can she get vaccinated if breastfeeding?
- YES (ASAP) - maternal Abs do not reduce response to own immunisation, even live vaccines
- 1 week post-partum developed chickenpox worried newborn will contract
- Should she be worried? Yes
- Supportive treatment for mother
- Can treat child - give VZV Ig to child prophylactically (particularly if premature)
- Child receives vaccine at normal age of 18 months - may not have an appropriate immune response earlier
Baby come for 4 month vaccines and mother tells you her mother is on chemotherapy
- Give the vaccines - can stay in house but keep grandma away from faeces (rotavirus)
Man has Sx of measles over 2 days and been in contact with case of measlesWhat public health measures do you put in place
- Notify authorities
- Must recall everyone who was present in the clinic when man presented and find out who was vaccinated –> vaccinate those who were not
- What are the stages of change? (motivational intervieiwing)
- What are the 5 As of motivational interviewinig?
- Outline an applied example stages of change
- What are the benefits and strengths of these models for motivational interviewing
- Outline an applied example stages of change
- How and when are these best applied in medical practise? (give 6 examples)
Stages of change
Pre-contemplation
- Advise of the dangers neutrally without imposing and rolling with resistance
- Encourage considering change
Contemplation
- Motivational interviewing including discussing pros and cons
- Build confidence and commitment
Preparation
- Negotiate a plan with CLEAR GOALS
- Build confidence
Action
- Positive reinforcement
- Discuss overcoming barriers and rewards
Maintenance
- Positive reinforcement
- Signs of relapse
Relapse
- Reinforce it as a learning experience
- Provide support
- Reassess stage
5 A’s
Ask
- Risk factors
Assess
- Level of use/vice
- Stage of change - intention and optimism
Advise
- Brief advice on level of use
- Motivational interviewing
- Written information
Assist
- Pharmacotherapies
- Self-monitoring
Arrange
- Refer - services, support groups, phone & counselling (Quitline)
Motivational interviewing
Relation to stages of change
- MI is a technique used to move patients through the stages of change through resolution of their ambivalence
Techniques
- What are your concerns with X?
- Elicit pros & cons of changing - elicit from patient to understand their ambivalence
- Contrast possible outcomes - what would a future be like if you didn’t stop X? what would a future be like if you did?
Stages of MI
Stage 1 = building motivation (OARS)
- Open ended questions
- Affirmations - compliment or show understanding
- Reflections - explore patients motivations by rewording their statements
- Summarising - ensure mutual understanding
Stage 2 = strengthening commitment (MI TECHNIQUES = PIGS)
- Pros vs cons - what would be the benefits of changing? What would be the cons?
- Importance ruler: 0-10 where 0 is not important and 10 is extremely important where would you be –> why not 0? What would help you move to 10?
- Goal setting
- Scenario of possible outcomes
Stage 3
- Negotiate a plan
- What changes are you thinking of making?
Spirit RULE
- Resist righting reflex
- Understand motivations
- Listen with empathy
- Empower patient
GRACE model
- Generate a gap
- Roll with resistance
- Avoid arguments
- Can do attitude
- Express empathy
Benefits/strengths
- Targets patient motivation to change
- Aim is not to tell them what to do
- You have to aspire to evoke motivation by developing repour with the patient then exploring the underlying motivators of their behaviour as well as the factors that prevent them from change –> its personal and patient centred
Decision balance
- Gives the opportunity for the patient to reflect on the potential outcomes of their behaviour
- Effective technique is to simplify –> if you go down this path what do you think the outcome will be? –> Now what about if you followed this path? –> how good could your life be?
- Gives opportunity to identify barriers and develop strategies on how to overcome them
Applications
- Substance addiction - smoking, drugs, alcohol etc.
- Lifestyle - exercise, diet
- Psychiatry - patterns of behaviours
- Gambling
- Proper use of medications - e.g. insulin
What are the most common STIs in Australia?
What are the risks associated with STIs?
Who Should be screened? How are they screened?
What do you need to screen for in pregnancy?
Who are at higher risk for STIs? What and how frequent should they be screened?
Most common
- Chlamydia
- Gonorrhoea
- Hepatitis B
- Syphilis
- HIV
Risks
- Women with untreated chlamydia infection have a risk of innfertility
Screening: All sexually active people ≤29
- Chlamydia screen - PCR of urine sample or genital swab (first catch)
Pregnant
- Hep B, Hep C, HIV, syphilis
High risk
- Who - MSM, ATSI, high risk sexual behaviour, sex workers
- What - chlamydia, gonorrhoea + serology for HIV, syphilis
IVDU
- Screen for Hep C, Hep B and HIV
What are genital warts? What is the prognosis? How are they treated?
Genital warts
Rx
- Spontaneous 9-12 months (most want removed)
Rx
- Cryotherapy
- Podophylin
- Imiquimod
Herpes Clinical
- Primary - flu like vesciles
- Ulcers - from vesicles
- Severe Knife like pain
Differential diagnosis:
Infection - Herpes Syphilis, donvanosis, LGV, Chancroid
- Trauma -
- Herpes
- Syphilis mechanical/chemical
- Allergic
- Neoplastic
- Secondary - Infestartions, lichren sclerosis
Diagnosis:
1) Clinical diagnosis
2) Swab for herpes PCR - if want to confirm
3)
How do you write a standard RPS prescription?
What details are needed on the script: give example
Contact details at the top;
- personal prescriber number (where “1234567” is on the above sample);
- patient’s name and address;
- tick either PBS or RPBS boxes;
- tick the “Brand substitution box not permitted” box if necessary;
- drug name (generic name preferable) and strength;
- dosing amount and frequency;
- quantity of the medication and number of repeats (if applicable);
- signature and date
Learning objectives - Know from GP outline
What preventive activites should be complete prior to prgnancy? (what age range)
What should be considered in preconception care?
- Every women of reproductive age should be considered for preconception care
- Inteventions should aim to identify and modify biochemical, behavioural and social risks to a women throughout pregnancy
Preconception care should include
- Reproductive planning and effective use of contraception to prevent unplanned pregnancy
- Reproductive history- Ask - any problems with previous pregnancies?(infant death, fetal loss, birth defects (NTD), Low birth weight, preterm/gestational diabetes
- Medical history: Any conditions that could effect pregnancy - Chronic diseases such as- Diabetes, thyroid disease, hypertension, epilepsy, thrombophilia? Consider management is optimal for early pregnancy, given that early embryogenesis will occur prior to any consultation in pregnancy
- Medication use - Review all current medication, OTC, vitamins
- Family history/genetic history - genetic conditions in family e.g CF? Downs? Consanguity
- Substance use history- Couensel about tobacco, alcohol and drug use in pregnancy
- Vaccinations: Ascertain, Immunity to hepatitis B and rubella - routine serological testing - Recommended vaccinations- (red book) - MMR, Varicella (in those without a clear history of chickenpox or non-immune on testing, Influenza, DTPA (diptheria, tetanus, acelluar pertussis)
Specific Advice (SNAP)
- Folic acid supplementation0.5mg per day of folic acid - at least one month prior to pregnancy and for the first three months after conception 5mg per day (patients at increased risk - e.g anticonvulsant therapy, pre pregnancy DM, BMI >30, previous NTD in child)
- Iodine supplementation: 150ug each day
- Healthy weight, nutrition and excecise: Discuss weight management, recommened moderate intensity excercise andasses risk of nutritional deficiencies (vegan, lactose intolerant and calicium, iron, vit d deficiency)
- Psychosocial Health: Discuss perinatal mental health, including anxiety/depression. Other MH conditions psychosocial, or psychiatric isssues and treatments, use of medication. AND increased risk of excaerbation of mood disorders in pregnancy and post partum. Mental health screening should include a psychosocial assessment
- Smoking, alcohol and illegal drug cessation:
- Toxins: TORCH Infection: Toxoplasmosis. (other- e.g syphilis, varicella, mumps, parvovirus and HIV, listerosis), Rubella, Cytomegalovirus, Herpes simplex
General physical examination:
- Conduct a breast examination if it is due, Perform a CST before pregnancy, BMI, BP, oral cavity
What are TORCH infections, and for each what should be avoided?
Outline preconception Preventive interventions - e.g folate, iodine,
What is the role of genetic couenselling and testing?
What is a screening tool to assist taking a family history?
In order to identify patients who may be at risk of a genetic disorder, a comprehensive family history must be taken from all patients, and this should be regularly updated. A family history should include f irst-degree and second-degree relatives on both sides of the family and ethnic background. Age of onset of disease and age of death should be recorded where available.
What genetic conditions should be screened in GP (red book)
List the genetic conditions that can be screened at GP level?
Clinical genetic services provide testing, diagnosis, management and counselling for a wide range of genetic
conditions.
Reasons for referral include:
- diagnosis of a genetic condition
- family history of a genetic condition
- recurrence risk counselling (eg risk of recurrence in a future pregnancy)
- pregnancy counselling (eg preconception, consanguinity)
- prenatal screening and testing
- presymptomatic and predictive testing for adult-onset disorders (eg cancer)
- discussions surrounding genetic testing
- arranging of genetic testing.
Conditions to be screened for in genetic testing/couenselling of patients in GP?
e.g
CF, Downs, Fragile X syndrome, Haemoglobinopathies and thalaseeaemias, Breast and colon cancer, Familial hypercholesterolaemia, Heridtary haemochromatsosis (HFE geen)
What is the family history screening questionaire?
- What does it assist in?
- can help identify individuals who may require more detailed assessment of their family history of cancer, heart disease or diabetes.
- This tool can be used as part of the patient’s assessment at their first visit to a practice. If patients are uncertain about their family history, they can be asked to discuss the FHSQ with their relatives prior to completing the questionnaire.
- For patients with low literacy, the FHSQ may need to be completed with the support of a healthcare professional.
- A positive response to any question requires follow-up with a more detailed assessment of the family history.
- As family history can change it is recommended that the FHSQ be repeated at least every three years.
What is the criteria for diagnosis of familial hypercholestrolaemia? (DUTCH lipid clinic criteria)
Components of criteria include:
1) Family history
2) Clinical hisotory
3) Physical examination (including LDL levels)
4) Startification (score)
What is the modified UK Simon Broome criteria?
Modified UK Simon Broome criteria
- Deoxyribonucleic acid (DNA) mutation
- Tendon xanthomas in patient or first-degree or second-degree relative
- Family history myocardial infarction (MI) <50 years of age in second-degree relative or <60 years of age in
first-degree relative - Family history of cholesterol >7.5 in first-degree or second-degree relative
- Cholesterol >7.5 (adult) or >6.7 (aged <16 years)
- Low-density lipoprotein-cholesterol >4.9 (adult) or >4.0 (aged <16 years)
Definite: (5 or 6) + 1
Probable: (5 or 6) + 2
Possible familial hypercholesterolaemia: (5 or 6) + (3 or 4)
What are Preventive activities in children and young people (0-19) according to red book?
What should be done for each age? (assessment and preventive counselling and advice, health promotion, )
Age - Neonatal
2,4,6, 12 and 18 months and 3 years
3.5 years- 5 years -
6-13 years
14-19 years
Neonatal- What should be done? Assessment? Preventive counselling and advice
1) promote immunisation (austrlalian immunization handbook)
2) Assessment:
3) Preventive counselling and advice
What are Preventive activities in children and young people (0-19) according to red book?
What should be done for each age? (assessment and preventive counselling and advice, health promotion, )
–> 2, 4, 6,12 and 18 months; and 3 years
1) Immunization
2) Assessment
3) Health promootion
4) Preventive counselling and advice
What are Preventive activities in children and young people (0-19) according to red book?
What should be done for each age? (assessment and preventive counselling and advice, health promotion, )
- 5 years to 5 years.
1) immunization
2) Assessment
3) Preventive counselling and advice
What preventive activites need to be complete for child aged 6-13 years (as per redbook)
1) Assessment
2) Preventive and counselling and advice
What preventive activites need to be complete for child aged 14-19 years (as per redbook)
1) Immunization
2) Assessment
3) Prventive counselling and advice
Assessing developmental progress in children?
What is a PEDs tool and how can it be useful for parents and GP?
What are the “red flags” Early intevention referral guide? (for children 0-5 years)
What preventive acitvities should be undertaken in middle age? (45-49) According to the GP red book: - How often should you oppurtunistically screen low irsk patients in this age group?
1) What should you ask about?
2) What should you measure?
3) What should you perform?
4) What should you calculate for these patients?
Ask about: SNAP, depression, skin cancer, preconception care, FHQ (family history)
Meausre: Height, weight, BMI, WC, BP, fasting lipid
Perform: HPV every 5years (CST), Mammography, 23 valent pneumococcal and infuelnza (ATSI), DTPA for pregnancy, genetic testing as part of preconception
Calculate: Risk of diabetes using the (AUSDRISK), Review fracture risk factorrs for women> 45years, absolute CV risk score.
What are the preventive activites as for the red book for ages between 50-64 years of age? (red book)
Ask, Measure, perform, calculate (AMPC)
What are preventive activities in older age? (red book) (65 Plus)
What are important considerations when seeing an older patient for preventive activities (e.g medications) ]
What immunizations are recommended from 65?
What are preventive activities in older age? (red book) (65 Plus) (physical activity)
What benefits does it have in this age group (physical activity)
What are the recommentations for older people? (sedentary and physical activity)
The following are Australia’s physical activity and sedentary behaviour guidelines for older people (www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#chba):
Older people:
- should do some form of physical activity, no matter what their age, weight, health problems or abilities
- should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibilit
- should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days
- who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up to the recommended amount, type and frequency of activity
- who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to.
s.
What are preventive activities in older age? (red book) (65 Plus) (
When and what should you do as part of a falls assessment?
Who is at risk? (moderate)
What are the three most important questions to ask a patient at this age to assess falls risk?
What does a falls intervention/preventive screen entail? (e.g Hx, Physical exam, cognitive and functional impairments screen- GPCOG-, prescribe home excercisei increasing strength)
When and what should you do as part of a falls assessment? Falls risk question continued answer (red book)
Ask:
- Have you had two or more falls in the past 12 months?
- Are you presenting following a fall?
- Are you having difficulty with walking or balance?
Comprehensive history should include:
- If the answers to any of these are positive, complete a multifactorial risk assessment including obtaining relevant medical history, completing a physical examination, and performing cognitive and functional assessments
- History should include:
- –– detailed history of falls (eg how many falls?, at home or outdoors?, patient perception of causes, any fear of falling)
- –– multiple medications, and specific medications (eg psychotropic medications)
- –– impaired gait, balance and mobility
- –– foot pain and deformities, and unsafe footwear
- –– home hazards
- –– bifocal or multifocal spectacle use
- –– incontinence
- –– recent discharge from hospital
- –– chronic illness such as stroke, multiple sclerosis (MS), Parkinson’s disease, cognitive impairment/dementia
- –– vitamin D deficiency/poor sun exposure if housebound or in a care facility
Physical examination should include:
–– impaired visual acuity, including cataracts
–– reduced visual fields
–– muscle weakness
–– neurological impairment
–– cardiac dysrhythmias
–– postural hypotension
–– six-metre walk, balance, sit-to-stand*
• Cognitive and functional impairments should include:
–– dementia/cognitive impairment assessment (eg General Practitioner
Assessment of Cognition [GPCOG])
–– activities of daily living and home assessment as appropriate (eg by
occupational therapist)
–– falls risk–assessment tools
–– if unsteady, gait and mobility assessment by physiotherapist
There are many fall risk–assessment tools. However, reports from researchers
are variable, so no single tool can be recommended for implementation in all
settings or for all subpopulations within each setting
- Prescribe or refer for a home-based excercise program and or encourage participation in a community based program, particularly targetting balance and whihc may include strength and endurance
- For specific excercises - refer to excercise physiologist
- Needs to be done for atleast 2 hours per week
- Regular review medication
- Anticholinergic load should be reviewed
- OT home review for home assessment
- MDT- podiatry, phyi, optometrists
- Investigate causes of dizziness
What preventive measure need to be assessed for patients over 65 (Visual and hearing impairment) (Red Book)
What preventive measure need to be assessed for patients over 65 (Dementia) (Red Book)
How do you identify risks? (average, moderate risk) What should be done?
Dementia: Preventive interventions? Case finding and confirmation:
Ask? Symptom review?
Hx? SMMSE? GPCOG? KICA?
Physical examination?
Ask;
Symptoms?
What are early intervention and prevention techniques for dementia?
Communicable diseases;
What role does the GP play in prevention and management of communicable diseases?
What is the ACIR and VIVAS?
How is consent taken with vaccinations? (benefits/harms)
What about vaccinations for special high risks groups (e.g Aplenia)
Health inequity: What are the key equity issues and who is at risk? (what do they need to be aware of?)
What can GPs do? - (what does evidence support?)
Outline the main requirments from the national immunisation program/schedule:
Birth?
6-8 weeks?
4 months?
6 months>? Who?
12 months?
12- 18 months?
18 months?
18-24 months?
4 years?
10-15 years? (+/-) School based programs? Gp catch up?
Immunisation schedule:
15-49 years
Prgenant women?
50 years and over?
65 years and over?
What vaccines are recommended but not funded in the National immunisation program?
Soon After birth? Who ? What vaccine?
What should all travellers, parents and carers (of < 6 month olds), healthcare workers?
What vaccines should all healthworkers have?
MSM? IVDU?
Sexually transmissible infections:
What it the most common STI seen in GP?
What is the worst complication of STIs?
What STIs should you consider in ATSI populations?
STI History? - Outline: What needs to be included?
What is contact tracing? What are the names of services that can assist with this?
Outline Sexual history:
OSCE stop check list 2 pages
What ages Should you SCREEN for STIS (in particular Chlamydia and other STIS)
What is the risk of infertily in undiagnosed Chlamydia in women?
What STIs should you screen for in high risk patients? Who are “high”, risk?
How often should MSM be screened? What for?
When should you screen for hepatitis C?
What should all pregnant women be screened for?
Risk assessment: STIs - Identifying risks:
Outline different level of “risks” associated with different populations?
What should be done for each of these groups? (e.g low risk patients? Medium risk patients? High risk patients? Highest risk patients?
How often should these be done in these individuals?
What are the two major tests to detect sexually transmissible infections?
What is the technique required for each?
What is the prevalence of chlamydia?
How should partners/ sexual partners be contacted and treated when they have had sex with a known STI positive individual?
Prevention of chronic disease:
What are the most important lifestyfle risk factors?
What chronic diseases do they contribute mostly to in GP?
What is the 5’As? (organises assessment and management of behavioural risk factors in primary health care) Where else can this be implemented???
(e.g Drugs and alcohol, all chronic disease risk factors- prevention)
