GP Flashcards
red flags back pain
- <20y or >50y
- fever
- pain at night, progressive or constant, pain lying flat
- alcohol or drug use
- trauma
- weight loss
- reduced appetite
- weakness, numbness
- bladder or bowel symptoms, saddle parasthesia
- hx of cancer
- thoracic pain
yellow flags back pain
- belief that pain or activity is harful or severly disabling
- fear avoiding behaviour
- sickness behaviour
- low mood
- social withdrawing
- expectation that passive treatment rather than active participation wil help
- issues with compensation system
- poor job satisfaction
- difficulty at work
- overprotective family
- lack of social support
- financial problems
presentation of bone metastases/malignancy
- weight loss
- long lasting pain
- doesn’t vary with mvnt
- constant day and night
presentation of collapse fracture
- sudden pain
- severe and localised
- hx of osteoporosis
- new or worsening kyphosis
presentation of seronegative spondyloarthropathy
- morning stiffness for > 1-2h
- young patient
- sacroiliac pain
- assymetrical swelling of individual fingers or toes
- enthesitis
- person or FH of psoriasis or IBD
nerve root compression presentation
- bowel/bladder involvement,
- saddle parasthesia
- radiates down arms or legs
- sudden onset
- neuro symptoms
management of back pain
- STarT tool
- movement
- analgesia
spinal manipulation by physio, osteopath, chiropracter - massage, acupuncture
- exercise
- chronic back pain: CBT, MDT
what does STarT tool consider
- prognostic questionnaire to identify modifiable risk factors (biopsychosocial) for pain disability
- stratifies patients into low, medium and high risk categories
- matches patient with treatment package
symptoms and their management in palliative care: drug names and class
- anorexia: dexamethasone (corticosteroid)
- pruritis: cholestyramine (bile acid sequestrants)
- muscle pain: baclofen (muscle relaxant)
- insomnia: temazepam (benzo)
- hiccups: metoclopramide (dopamine receptor antagonist)
- dyspnoea: morphine
- restlessness: haloperidol (antipsychotic)
- excessive resp secretions: hyoscine hydrobromide (antimuscarinics)
- capillary bleeding: tranexamic acid
- pain: diamorphine
- nausea: cyclizine (antihistamine)
steps in confirming death of patient
- wash hands
- identify identity of patient
- inspection of any signs of life, any resp signs or response to verbal stimulus
- pressure on fingernail to check for any response to pain
- check pupils are fixed and dilated
- feel for carotid pulse for at least 2 mins
- listen for Heart sounds for at least 2 mins
- listen for resp sounds for at least 3 mins
- wash hands, document fingings and time of death
how soon must a doctor see patient before death to be able to sign death certificate
14-28 days
who is entitled to free prescription
- over 60
- under 16
- 16-18 in full time education
- pregnant or baby in last 12 months with valid maternity exemption (MatEx)
- continuing physical disability that prevents them from going out without help from another personand have valid MedEx
- hold valid war pension exemption certificate and prescription is for accepted disability
- NHS patient
issued on application:
- permanent fistula requiring surgical dressing
- hypoadrenalism, DM, diabetes insipidus, hypoparathyroidism, myasthenia gravis, myxoedema, epilepsy
- undetrgoing treatment for cancer
which medications for DM are safe during fasting
- DPP4 inhibitors (alogliptin)
- metformin
- glitazones
risk factors for diabetes
raised BMI age > 45 FH ethnic background co-morbidities
symptoms of diabetes
- tired
- polyuria, nocturia
- polydipsia
- genital trush/itch
- weight loss
- slow wound healing
- blurred eyesight
diagnosis of DM
do HbA1c at dat 1 and day 28:
- 42-47: impaired glucose regulation
- > 48: T2DM
if HbA1c difficult to interpret: use fasting glucose > 7 as diagnosis
treatment of DM
- lifestyle changes for 3 months, then repeat HbA1c: weight loss, diet, physical activity, smoking, alcohol
- meds: metformin first line
aim of target for DM
- on one drug: 48
- on med that cause hypos: 53
- on 2 meds: 58
complications of diabetes
- HHS
- coronary Heart disease
- neuropathy
- retinopathy
- diabetic kidney disease
- atherosclerosis
- foot amputation
- gastric issues
DPP4 inhibitorss: examples, mode of action
examples: the gliptin (alogliptin)
mode of action:
- reduces hormone glucagon to decrease blood sugar levels: increased insulin secretion, deccreases gastric emptying and decreased blood glucose level
SGLT2 inhibitors examples and mode of action
- gliflozin
- inhibits SGLT2 to prevent kidneys reuptake of glucose from glomerular filtrate: glycosuria
sulphonylureas examples and mode of action
- azides
- stimulates production of insulin from pancreas + increases effectiveness of insulin in body (can cause hypos)
thiazolidinediones example and mechanism of action
- pioglitazone
- unknown
GLP-1 MOA
increases insulin secretion
which diabetic medications increase risk of hypos
- insulin
- sulfonylureas
- meglitinides
which medications for diabetes promotes weight gain and weight loss
weight gain: insulin, sulfonylureas, meglitinides, glitazones
weight loss:
GLP1, metformin, SGLT2
requirements for 2WW
- needs to be done within 24h of seing patient
- requirement: Rockwood score (clinical frailty score), recent floods (eGFR) and BMI
- need to explain to patient reason for referral
- check in with patient 3 week down to see if went to appoitment
who can get a CVD risk check on the NHS
patients aged 40-47
risk factors for CVD
increasing age males pos FH hypercholesterolaemia being overweight inactivity smoking diabetes poor diet hypertension
physical activity recommendations
- at least 150 mins moderate intensity activity or 75 mons rigorous activity (moderate: incrreased breathing but should still be able to talk, vigorous: fast breathing and difficulty talking)
- strength exercises 2x a week for major muscles (hips, legs, back, abdomen, chest, shoulders, arms
- break up long periods od sitting
- balance and coordination activities in adults > 65
