GP Flashcards
1
Q
red flags back pain
A
- <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
2
Q
yellow flags back pain
A
- 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
3
Q
presentation of bone metastases/malignancy
A
- weight loss
- long lasting pain
- doesn’t vary with mvnt
- constant day and night
4
Q
presentation of collapse fracture
A
- sudden pain
- severe and localised
- hx of osteoporosis
- new or worsening kyphosis
5
Q
presentation of seronegative spondyloarthropathy
A
- morning stiffness for > 1-2h
- young patient
- sacroiliac pain
- assymetrical swelling of individual fingers or toes
- enthesitis
- person or FH of psoriasis or IBD
6
Q
nerve root compression presentation
A
- bowel/bladder involvement,
- saddle parasthesia
- radiates down arms or legs
- sudden onset
- neuro symptoms
7
Q
management of back pain
A
- STarT tool
- movement
- analgesia
spinal manipulation by physio, osteopath, chiropracter - massage, acupuncture
- exercise
- chronic back pain: CBT, MDT
8
Q
what does STarT tool consider
A
- 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
9
Q
symptoms and their management in palliative care: drug names and class
A
- 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)
10
Q
steps in confirming death of patient
A
- 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
11
Q
how soon must a doctor see patient before death to be able to sign death certificate
A
14-28 days
12
Q
who is entitled to free prescription
A
- 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
13
Q
which medications for DM are safe during fasting
A
- DPP4 inhibitors (alogliptin)
- metformin
- glitazones
14
Q
risk factors for diabetes
A
raised BMI age > 45 FH ethnic background co-morbidities
15
Q
symptoms of diabetes
A
- tired
- polyuria, nocturia
- polydipsia
- genital trush/itch
- weight loss
- slow wound healing
- blurred eyesight
16
Q
diagnosis of DM
A
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
17
Q
treatment of DM
A
- lifestyle changes for 3 months, then repeat HbA1c: weight loss, diet, physical activity, smoking, alcohol
- meds: metformin first line
18
Q
aim of target for DM
A
- on one drug: 48
- on med that cause hypos: 53
- on 2 meds: 58
19
Q
complications of diabetes
A
- HHS
- coronary Heart disease
- neuropathy
- retinopathy
- diabetic kidney disease
- atherosclerosis
- foot amputation
- gastric issues
20
Q
DPP4 inhibitorss: examples, mode of action
A
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
21
Q
SGLT2 inhibitors examples and mode of action
A
- gliflozin
- inhibits SGLT2 to prevent kidneys reuptake of glucose from glomerular filtrate: glycosuria
22
Q
sulphonylureas examples and mode of action
A
- azides
- stimulates production of insulin from pancreas + increases effectiveness of insulin in body (can cause hypos)
23
Q
thiazolidinediones example and mechanism of action
A
- pioglitazone
- unknown
24
Q
GLP-1 MOA
A
increases insulin secretion
25
which diabetic medications increase risk of hypos
- insulin
- sulfonylureas
- meglitinides
26
which medications for diabetes promotes weight gain and weight loss
weight gain: insulin, sulfonylureas, meglitinides, glitazones
weight loss:
GLP1, metformin, SGLT2
27
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
28
who can get a CVD risk check on the NHS
patients aged 40-47
29
risk factors for CVD
```
increasing age
males
pos FH
hypercholesterolaemia
being overweight
inactivity
smoking
diabetes
poor diet
hypertension
```
30
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
31
main complications of persistant high BP
- brain: strokes, encephalopathy, confusion, headache, convulsions
- blood: elevated sugar levels
- retina of the eye: hypertensive retinopathy
- heart: MI, heart failure
- kidneys: chronic renal failure
32
diagnosis of hypertension
- measure BP in both arms, choose arm with highest reading
- if reading higher than 140/90, take reading up to 3 times and choose lowest reading
- if BP: 140/90-180/120: offer ABPM or home BP monitoring
confirm diagnosis:
- clinic BP > 140/90
- ABPM/HBPM average > 135/85
33
how often do you need to monitor BP
every 5 years
34
how do you stage hypertension
- grade 1 (mild): 140-159 / 90-99
- grade 2 (moderate): 160-179 / 100-109
- grade 3 (severe): > 180/110
35
management of hypertension
- lifestyle (diet, exercise, smoking, alcohol, caffeine, salt intake)
- medication: aged <55: A+C+D, aged > 55: C+A+D
- assess cardiovascular risk
- assess for end organ damage
36
how would you qualify hypertensive urgency
- BP > 180/110
- no target organ damage
- symptoms: headache, sob, nosebleeds, severe anxiety
37
how would you manage hypertensive urgency
oral meds
| outpatient
38
how would you qualify a hypertensive emergency
- BP> 180/120
- target organ damage
- symptoms: chest pain, sob, back pain, numbness/weakness, vision changes, difficulty speaking
39
management of hypertensive emergency
IV meds: vasodilators, Ca channel blockers, beta blockers)
| - intensve care
40
why is it important to bring the BP down over 24-28h in hypertensive crisis
risk of ischemia from hypoperfusion
41
secondary causes of hypertension
```
renal disease
pheochromocytoma
primary aldesteronism
cushing's syndrome
hypothyroidism
primary hyperparathyroidism
sleep apneoa
coarctation of the aorta
some meds
```
42
what is a cardioprotective diet
- reduce saturated fats and increase monosaturated fats (olive oil, rapseed oil)
- wholegrain foods
- rreduce sugar intake
- 5 F&V a day
- 2 portions off fish per week (1 portion of oily fish)
- 4-5 portions of unsalted nuts, seeds and legumes per week
43
what scoring system to use with acute sore throat
Centor criteria
| FeverPain score: used to predict bacterial infection
44
centor criteria
- presence of tonsillar exudate
- presence of tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever > 38°
- absence of cough
each criteria score 1 point
(absence of 3-4 signs, unlikely to be bacterial)
45
feverPAIN criteria
- fever >38
- purulence
- attend rapidly, 3 days or less
- severly inflammed tonsils
- no cough or coryza
the higher the score, the more likely it is streptococcus
46
treatment of bacterial tonsilitis
penicillin type antibiotic
47
safenetting with tonsilitis
- quinsy
- if antibiotics and rash: infectious mononucleosis
- ??
48
advanced care planning
- advanced statements (preferences, wishes, beliefs and valies regarding future care, not legally binding)
- lasting power of attorney (1. health and welfare, 2.property and financial affairs)
- advanced decisions/living will (ceiling of care, DNR, patient wishes, legally binding)
49
questions to ask when making advanced care planning
- where do they want to be (home, care home, admission if ill?)
- place of death?
- what treatments do they want (ie opoids)
- advanced decisions
- emergency planning
50
causes of confusion
```
PINCH ME
- pain
- infection (chest, urosepsis, encephalitis)
- nutrition
- constipation
- deHydration
è medication
- environment change
```
- stroke
- trauma/head injurty
- dementia/worsening dementia
- wernickes encephalopathy
- drug overdose
- alcohol
- electrolyte imbalance (hyponatraemia, hyper/hypocalcaermia, uraemia)
- vit B12 deficiency
- hypoxia
- thyroid disorder
51
what drugs cause hyponatraemia
```
PPI
SSRI
TCA
diuretics
ACEi/ARB
laxatives
antipsychotics
```
52
how do you assess confusion
4AT
- alertness
- AMT4: age, dob, current year, current location
- attention: months of year backwards
- acute and fluctuating course
53
self management of constipation
- rest feet on low stool when opening bowels
- physical activity
- increased consumption of fruit with high sorbitol content (fruit with stones)
- increased fluid intake
- responding promptly when needing to defecate
54
causes of exacerbations of COPD
```
- bacterial:
H influenza, S pneumonia, Staph aureus
- viral: influenza, parainfluenza, RSV, rhinoviruses
- Pollutants;
nitrogen dioxide, sulphur dioxide
```
55
when should you consider hospital admission for COPD
- severe sob, rapid onset of symptoms, acute confusion, cyanosis, worsening peripheral oedema, impaired consciousness
- person is unable to cope or lives alone
- reduction of activities of daily living, confined to bed or is on long term oxygen therapy (LTOT)
- significant comorbidites
- low 02 sats (<90)
56
investigations (primary care vs hospital setting) for COPD
GP: sputum samples for culture and pulse oximetry
hospital: ABG, CXR, ECG, FBC and U&E, sputum for culture, blood cultures if pyrexic
57
management of acute exacerbations of COPD
- antibiotics (if indicated
- oral corticosteroids
- oxygen (measure SaO2 if non hospital setting)
- physiotherapy
58
what management options are only available in hospital for COPD
- IV theophylline
- invasive ventilation
- NIV
59
causes of HF
- structural (valvular)
- congenital (ASD, VSD, inherited cardiomyopathies)
- rate related (AF, thyrotoxicosis, anaemia, heart block)
- pulmonary (COPD, pulmonary fibrosis)
- alcohol and drugs
- pericardial disease (chronic pericaditis due to SLE, TB, viruses)
- autoimmune disease (amyloidosis and sarcoid)
- miscellaneous (pregnancy induced cardiomyopathy, acute viral myocarditis)
60
signs/symptoms HF
- dyspnoea
- fatigue/weakness
- fluid retention (ankle swelling, weight gain, bloating/ascites)
- decreased excercise tolerance
- lightheadedness
- tachycardia
- laterally displaced apex beat, heart murmurs and gallop rhythl
- hypertension
- raised JVP
- enlarged liver
- obesity
61
diagnosis of acute HF
- Hx, exam
- bloods: FBC, U&Es, TFTs, glucose
- measure BNP (>100) and NBNP (>300)
- echo (for cardiac abnormalities)
62
management of acute HF
- diuretics
- ventilation (if struggling breathing or severe pulmonary oedema)
- beta blockers
- ACEi and aldosterone antagonist if reduced LVEF
monitor:
- renal function
- electrolytes
- heart rate
- BP
63
management of chronic heart failure
- lifestyle: reduce salt and fluid intake, stop smoking and reduce alcohol
- vaccinations: annual influenza + pneumococal vaccine
- cardiac rehab
if preserved ejection fraction:
- low/medium dose loop diuretics (furosemide)
if reduced ejection fraction:
- diuretics?
- ACEi and beta blocker
- + aldosterone if still have symptoms with beta blocker and ACEi)
64
heart failure severity classification
NYHA
1: no symptoms, and no limitation in ordinary physical activity
2. mild symptoms and slight limitation during ordinary activity
3. marked limitation in activity due to symptoms, even during less than ordinary activity
4. severe limitations. experiences symptoms even at rest
65
what does HARK stand for
- humiliate
- afraid
- rape
- kick
66
signs/symptoms of abuse/naglect
- behavioural changes (aggreeive, chalenging, disruptive, withdrawn, clingy, bed wetting, difficulty sleeping)
- ill fitting/dirty clothes
- consistently poor hygiene
- specific effort to avoid certain family members/friends without specific reason
- don't change clothes in front of othes or participate in physical activities
- frequent inuries or unexplained/unusual bites, injuries, burns or cuts
- children with problem in school (sudden lack of concentration, learning, tired or hungry)
- children reaching developmental milestones late, with no medical reason
- children drinking alcohol from young age
- children using sexual language, or have sexual knowledge, play sexual games when you wouldn't expect them to
- children with physical sexual health problems
67
what to do in case of concern for adult/child welfare in terms of abuse/neglect
- document everything
- ask questions
- discuss concerns with someone above you (named safeguarding doctor and nurse)
- refer to social services
68
core symptoms of ADHD
INATTENTION
- distractibility, unable to focus or concentrate, keep shifting activities, forgetful, cannot organise tasks)
IMPULSIVITY
- cannot wait for turns, act without thinking, interrupts conversation, no sense of danger leading to accidents)
HYPERACTIVITY
- fidgety, cannot sit still
69
diagnostic criteria for ADHD
- symptoms evident in more than one situation
- onset before 6-7 years old
- persist for 6/12
- has caused significant functional impairement
- not better accounted for my other mental disorders (ASD, depression, anxiety, schizophrenia)
70
diagnosis of depression
over 2 week period:
- persistent low mood
- anhedonia
- poor sleep
- low energy
- poor concentration and deciseveness
- low self confidence
- suicidal thoughts or acts
- agitation or slowing of movement
71
management of depression
LIFESTYLE:
- sleep hygiene (regular patterns, avoid smoking/alcohol before bed, create proper environment for sleep, regular exercise)
- 6-8 sessions of CBT or other sessions
- pharmaceutical: SSRI
72
legal age of consent (sexual)
16y
| statuatory rape if under 13
73
fraser criteria
for under 16s:
- understand the emotional and physical implications of sexual activity (risk and consequences of pregnancy and STIs)
- cannot be persuaded to inform parents or will not allow practitioner to inform parents that contraception advice has been sought)
- is going to continue having sex without contraception
- unless receives contraceptive advice/treatment, mental/physical health is likely to suffer
- if best interest to give advice/Treatment w/out parental consent
74
comorbidities affecting choice of contraception
```
CVD risk factors
hypertension
DM
epilepsy
headache/migrain
menorrhagia
fibroids
previous ectopic pregnancy
obesity
STIs/PID
smoking
VTE
```
+ age of woman
75
types of contraception
- condoms
- COC
- contraceptive implant
- contraceptive injections
- contraceptive patch
- contraceptive vaginal ring
- diaphragm and caps
- fertility awareness methods
- IUS/IUD
- progesterone only pill
- sterilisation
76
types of emergency contraception
- emergency IUD: up to 5dasy/120hr after unprotected sex and can be left in place for up to 10y
- emergency contraceptive pill with ullipristal acetate (UPA): ellaOne (delays ovulation): can be taken up to 120h after unprotected sex
- emergency contraceptive pill with levonorgestrel: delays ovulation, up to 72h after unprotected sex
