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GP Flashcards

1
Q

What is Stage 1 HTN?

A

Clinical BP 140/90 to 159/99
OR
ABPM 135/85 to 149/94

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2
Q

What is Stage 2 HTN

A

Clinical BP 160/100 to 180/120
OR
ABPM >150/95

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3
Q

What is Sage 3/Severe HTN

A

Clinical systolic >180 or clinical diastolic >120

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4
Q

How should a HBPM be conducted correctly?

A

For each blood pressure recording, 2 consecutive measurements taken 1 min apart with person seated AND blood pressure recorded twice daily ideally in morning and evening AND blood pressure recording continues for at least 4 days (Ideally 7 days)

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5
Q

What are the 2 types of HTN?

A
  1. Essential HTN = unknown cause (95%)

2. Secondary HTN = known cause (5%)

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6
Q

What can secondary HTN be caused by?

A
  1. Renal –> GN, PCKD, renovascular (atheromatous due to smoking or PVD in older)
  2. Endocrine –> Conns, Cushing’s, Phaeochromocytoma, Actomeglay
  3. Coarctation of aorta
  4. pregnancy
  5. Steroids
  6. Pill
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7
Q

Name 4 risk factors for HTN

A
  1. Obesity
  2. Increasing age
  3. Lack of exercise
  4. Family History of HTN or CAD
  5. Metabolic Syndorme –> DM
  6. Black ancestry
  7. Increase alcohol intake
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8
Q

Name 3 symptoms of HTN

A
  1. Usually asymptomatic
  2. Headaches
  3. Visual changes –> decreased acuity, floaters
  4. Dyspnoea
  5. Chest pain
  6. Nose bleeds or subconjunctival haemorrhages
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9
Q

Name 5 first line investigations

A
  1. Lipids
  2. Urinalysis
  3. FBC –> Hb
  4. U&Es
  5. LFTs
  6. TSH
  7. HbA1c
  8. ABPM/HBPM
  9. QRISK score
  10. ECG
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10
Q

What is the QRISK score?

A

Risk of having a cardiovascular event within the next 10 years

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11
Q

What is involved in calculating someone’s QRISK?

A 
o	Age
o	Sex
o	Ethnicity
o	Smoking status 
o	Diabetes status 
o	Angina/heart attack in 1st degree relative <60 
o	CKD stage 3, 4 or 5 
o	AF
o	Blood pressure treatment 
o	Migraine 
o	Rheumatoid arthritis 
o	SLE 
o	Severe mental illness 
o	Atypical antipsychotic medication 
o	Corticosteroids 
o	Erectile dysfunction 
o	Cholesterol:HDL ratio 
o	Systolic BP and a standard deviation of it 
o	BMI
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12
Q

What are the outcomes of QRISK scores?

A 
<10% = low risk 
10-15% = moderate risk (start statin and modify lifestyle)
>20% = high risk
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13
Q

What lifestyle modifications would you suggest for someone with HTN?

A
  • Reduce salt and fat intake
  • Weight loss
  • Reduce alcohol consumption
  • Smoking cessation
  • Increase exercise
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14
Q

What is the target BP for adults with HTN <80 years old?

A

<140/90

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15
Q

What is the target BP for adults with HTN >80 years old?

A

<150/90

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16
Q

What is the target BP for adults with HTN who have Diabetes?

A

<135/85

<130/80 if nephropathy or retinopathy

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17
Q

What is the pharmacological treatment of those aged <55 and not black who have HTN?

A
  1. ACEi or ARB
    • CCB
    • thiazide like diuretic
    • Spirolactone (K+ < 4.5) or Alpha or Beta Blocker (K+ >4.5)
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18
Q

What is the pharmacological treatment of those aged >55 or black who have HTN?

A
  1. CCB
    • ACEi or ARB
    • thiazide like diuretic
    • Spirolactone (K+ < 4.5) or Alpha or Beta Blocker (K+ >4.5)
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19
Q

What is the pharmacological treatment of those with diabetes who have HTN?

A
  1. ACEi or ARB
    • CCB
    • thiazide like diuretic
    • Spirolactone (K+ < 4.5) or Alpha or Beta Blocker (K+ >4.5)
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20
Q

Name 3 ACEi that can be used in the treatment of HTN

A
  1. Ramipril
  2. Enalapril
  3. Perindopril
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21
Q

Give 3 potential side effects of ACEi

A
  1. Cough (+ rash) –> due to increased kinin
  2. Hypotension –> dizziness
  3. AKI
  4. Arrhythmias due to Hyperkalaemia
  5. Erectile dysfunction
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22
Q

How do ACEi work?

A

Suppressing ACE which prevents angiotensin I converting to angiotensin II which decreases pressure in heart and therefore workload of heart
Increase Bradykinin levels which causes vasodilation

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23
Q

What must you monitor in a patients taking ACEi?

A

Serum Na+ and K+, BP and renal function (U&Es and eGFR)

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24
Q

Name 3 ARBs that can be used in the treatment of HTN

A
  1. Candesartan
  2. Valsartan
  3. Losartan
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25
Q

Name 3 possible side effects of ARBs

A
  1. Postural hypotension
  2. Headache
  3. Diarrhoea
  4. Renal impairment
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26
Q

Name 3 CCBs that can be used to treat HTN and what channels do they act on?

A
  1. Amlodipine
  2. Felodipine
  3. Verapamil
  4. Nifedipine
  5. Diltizem
    Act of L-type Ca2+ channels
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27
Q

Give 3 potential side effects of CCBs

A
  1. Headache
  2. Oedema
  3. Dizziness and drowsiness
  4. ED
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28
Q

Name 2 thiazide diuretics that could be used to treat HTN

A
  1. Bendroflumethiazide

2. Indapamide

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29
Q

Give 3 possible side effects of thiazide diuretics

A
  1. ED
  2. Electrolyte disturbances
  3. Hyperuricaemia –> gout
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30
Q

What is the mechanism of action of thiazide like diuretics?

A

Inhibits the sodium chloride transporter at the distal portion of the ascending limb and the first part of the distal tubule
This increases water clearance and the excretion of sodium and chloride through the renal tubular epithelium

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31
Q

Name 3 beta blockers that can be used in the treatment of HTN

A
  1. Atenolol
  2. Propranolol
  3. Bisoprolol
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32
Q

Give 3 potential side effects of beta blockers

A
  1. Fatigue
  2. Headache
  3. Bradycardia
  4. Hypotension
  5. ED
  6. Cold peripheries
  7. Bronchospasm
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33
Q

What is the mechanism of action of beta blockers?

A

Block the release of adrenaline and noradenaline –> slowing heart rate and reducing force of the heart

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34
Q

What should you monitor in a patient taking beta blockers?

A

Heart rate and BP

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35
Q

Define Cardiac Failure

A

A complex clinical syndrome of signs/symptoms that suggest the efficiency of the heart as a pump is impaired. The heart is unable to deliver blood at a rate that meets the metabolic demands of the body

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36
Q

What are the 3 main types of cardiac failure and what causes them?

A
  1. LVSD - often due to IHD
  2. RVSD - often secondary to LVSD
  3. Diastolic HF
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37
Q

What is the ejection fraction?

A

Compares the amount of blood in the heart and amount of blood pumped out
- The percentage helps describer how well the heart is pumping blood to the body

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38
Q

What is considered heart failure with reduced ejection fraction?

A

Ejection fraction <40%

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39
Q

Briefly explain the pathophysiology of cardiac failure

A

When the heart fails, compensatory mechanisms attempt to maintain CO. AS HF progresses, these mechanisms are exhausted and become pathophysiological

  1. Sympathetic activation
  2. RAAS activation
  3. Natriuretic peptide release
  4. Ventricular hypertrophy
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40
Q

Give 5 risk factors for developing heart failure

A
  1. History of MI and Coronary Artery Disease
  2. DM
  3. Dyslipidaemia (increased LDL)
  4. Old age
  5. Male sex
    HTN
  6. Valvular heart disease
  7. Obesity
  8. Sedentary lifestyle
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41
Q

Name 3 causes of Heart failure

A
  1. Pump failure –> Heart muscle disease (IHD), restricted filling (constrictive pericarditis), anti-arrhythmic drugs
  2. Excessive preload –> mitral regurgitation or fluid overload
  3. Chronic excessive after load –> aortic stenosis, HTN
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42
Q

What are the 3 cardinal symptoms of cardiac failure?

A
  1. SOB
  2. Fatigue
  3. Peripheral oedema
    Also
  4. PND
  5. Orthopnoea
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43
Q

Give 3 signs of cardiac failure

A
  1. Tachycardia
  2. Raised JVP
  3. Displaced apex beat
  4. Added heart sounds (S3, gallop rhythm)
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44
Q

What investigations may you want to do to determine whether someone has cardiac failure?

A
  1. BNP levels
  2. CXR
  3. Echo
  4. ECG
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45
Q

What is pro BNP?

A 
Inactive peptide (hormone) that is released when the walls of the heart are stretched or there is pressure overload on the heart 
- Acts on the kidneys to cause fluid and sodium loss in the urine
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46
Q

How is pro BNP measured?

A 
<400pg/ml = normal, HF less likely 
>400 = Echo in 6 weeks 
>2000 = Echo within 2 weeks
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47
Q

Why may someone have a increased proBNP?

A
  1. > 70 years old
  2. Left ventricular hyeprtrophy
  3. Isachamia
  4. Tachycardia
  5. Renal dysfunction (eGFR <60)
  6. COPD
  7. DM
  8. Cirrhosis of liver
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48
Q

Why may someone have a decreased proBNP?

A
  1. Obesity
  2. African Caribbean heritage
  3. Drugs –> diuretics, BB, ACEi/ARB, MRA
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49
Q

What is eGFR?

A

Estimated glomerular filtration rate = measure of how well your kidneys are working as a filter
- Low GFR = kidneys filtering less

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50
Q

What are the stages of CKD?

A 
Stage 1 = >90 ml/min
Stage 2 (mild) = 60-89 ml/min 
Stage 3a (mild-moderate) = 45-59 ml/min
Stage 3b (moderate-severe) = 30-44 ml/min 
Stage 4 (severe) = 15-29 ml/min 
Stage 5 (kidney failure) = <15 ml/min
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51
Q

What might you see on a CXR of someone with cardiac failure?

A 
ABCDE 
A --> Bat wing alveolar oedema 
B --> Kerley B lines 
C --> Cardiomegaly 
D --> Dilated prominent upper lobe vessels 
E --> PLeural effusions
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52
Q

Why is an ECHO done in someone with suspected heart failure?

A

It will show whether there is preserved or reduced ejection fraction

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53
Q

Briefly describer the NYHA classification for cardiac failure?

A

Class 1 = no limitation, asymptomatic
Class 2 = slight limitation, mild HF
Class 3 = marked limitation, moderate HF
Class 4 = inability to carry out physical activity without discomfort, severe HF

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54
Q

Describe the management of HF

A
  1. Lifestyle modification
  2. Main pharmacological benefits are from vasodilator therapy not LV stimulants
    • 1st line = ACEi, BB
    • 2nd line = 3. ARB, Mineralocorticoid Receptor Antagonist (MRA/aldosterone antagonists),
    • Diuretics for symptom relief
    • Nitrates and NEP inhibitors can be used too
  3. Surgery –> valve replacement and LV remodelling
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55
Q

How would heart failure with reduced ejection fraction be treated pharmacologically?

A

ACEi, BB, ARB, Spirolactone, diuretics

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56
Q

How would heart failure with preserved ejection fraction be treated pharmacologically?

A

Diuretics

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57
Q

What is the mechanism of action of a loop diuretic?

A

Reversibly inhibit the Na+/2Cl-/K+ co-transporter in the thick ascending Loop of Henle where one third of sodium is reabsorbed

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58
Q

Name 2 loop diuretics

A
  1. Furosemide

2. Bumetanide

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59
Q

What is the mechanism of action of a MRA?

A

MRA = Aldosterone antagonist
Act at the cortical collecting duct to reduce the absorption of sodium and water and increase the excretion of Hydrogen and potassium

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60
Q

Give an example of an aldosterone antagonist

A

Spirolactone

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61
Q

What must you monitor in a patients taking MRAs?

A

Serum Na+ and K+, BP and renal function (U&Es and eGFR)

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62
Q

What is the prognosis of cardiac failure?

A

5 year mortality = 75%

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63
Q

Give examples of primary prevention methods for cardiac failure?

A
  1. Healthy lifestyle
  2. Reducing alcohol intake
  3. Smoking cessation
  4. QRISK
  5. Statins
  6. Correct aggravating factors –> e.g. AF, HTN, DM
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64
Q

Give examples of secondary prevention methods for cardiac failure

A
  1. Regularly checking BP

2. Regularly checking blood cholesterol

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65
Q

Give examples of tertiary prevention methods for cardiac failure

A
  1. Exercise based cardiac rehabilitation
  2. Revascularisation procedures –> PCI, CABG
  3. Implantable defibrillators
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66
Q

What is the NICE traffic light system used for in paediatrics?

A

It is clinical risk score designed to assist with the assessment and management of febrile children under 5 years old

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67
Q

What are the 5 main categories that are assessed the NICE traffic light system?

A
  1. Colour - skin, tongue, lips
  2. Activity - response, smile, crying etc.
  3. Respiratory
  4. Circulation and hydration
  5. Other - temperature, rigours, swelling, rash, neck stiffness, seizures etc.
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68
Q

How would you manage a child with a green score on the NICE traffic light risk assessment?

A

You would manage them at home + safety net
Encourage regular fluids, observe for dehydration, monitor for rash, and regularly review the child. Tell the parents to contact a medical professional if parental concern increases

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69
Q

How would you manage a child with a amber score on the NICE traffic light risk assessment?

A

You could refer the child to a paediatric or specialist for further investigation or manage them at home and safety net

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70
Q

How would you manage a child with a red score on the NICE traffic light risk assessment?

A

Urgent referral to a hospital for specialist assessment

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71
Q

What is the FeverPAIN Criteria?

A

Used to determine if a tonsillitis illness is viral or bacterial and whether antibiotics should be prescribed

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72
Q

What is assessed in the FeverPAIN Criteria?

A
  • Fever (during past 24hrs)
  • Purulence (pus on tonsils)
  • Attended rapidly (within 3 days after symptom onset)
  • Severely inflamed tonsils
  • No cough or coryza (inflammation fo mucus membranes in the nose)
    Each scores 1 point = higher score suggests more severe symptoms and likely bacterial (strep)
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73
Q

How would you manage a child with a score of 0-1 on the FeverPAIN criteria?

A

13-18% likelihood of isolating streptococcus –> NO antibiotics

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74
Q

How would you manage a child with a score of 2-3 on the FeverPAIN criteria?

A

34-40% likelihood of isolating streptococcus –> Delayed prescription of Abx if not better

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75
Q

How would you manage a child with a score of 4-5 on the FeverPAIN criteria?

A

62-65% likelihood of isolating streptococcus –> give Antibiotics

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76
Q

What is safety netting?

A
  1. Verbal and/or written advice about warning signs/symptoms with a plan of action should these be noticed
  2. Arrange follow-up at a specific time and place
  3. Liaising with other health care professionals to ensure direct access should the child require it
    Advice needs to be clear and easy to follow
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77
Q

Give 3 signs of dehydration in children

A
  1. Sunken fontanelle
  2. Dry mouth
  3. Sunken eyes
  4. Absence of tears
  5. Poor overall appearance
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78
Q

Give 3 common causes of pyrexia in children

A
  1. URTI
  2. Tonsilitis
  3. Otitis media
  4. UTI
  5. Pneumonia
  6. Measles
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79
Q

Give 3 less common causes of pyrexia in children

A
  1. Meningitis
  2. Septicaemia
  3. Epiglottitis
  4. Malignancy
  5. Kawasaki Disease
  6. TB
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80
Q

Name 3 notifiable disease that you may see in paediatrics

A
  1. Meningitis
  2. Diphtheria
  3. Measles
  4. Mumps
  5. Meningococcal septicaemia
  6. Rubella
  7. Smallpox
  8. Scarlet fever
  9. Tetanus
  10. Whooping cough
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81
Q

What vaccinations should a child have at 8 weeks?

A
  1. Diphtheria, tetanus, pertussis (DTaP), Polio (IPV), Haemophilius influenza (HibB), Hep B (6 in 1)
  2. Men B
  3. Rotavirus
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82
Q

What vaccinations should a child have at 12 weeks?

A
  1. Diphtheria, tetanus, pertussis (DTaP), Polio (IPV), Haemophilus influenza (HibB), Hep B = 6 in 1
  2. PCV
  3. Rotavirus
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83
Q

What vaccinations should a child have at 16 weeks?

A
  1. Diphtheria, tetanus, pertussis (DTaP), Polio (IPV), Haemophilus influenza (Hib), Hep B = 6 in 1
  2. Men B
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84
Q

What vaccinations should a child have at 1 year?

A
  1. Haemophilus influenza (HibB)
  2. Men B and C
  3. Pneumococcal (PCV)
  4. MMR
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85
Q

What vaccinations should a child have at 2-6 years?

A

Influenza vaccine

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86
Q

What vaccinations should a child have at 3 years 4 months?

A
  1. Diphtheria, tetanus, pertussis (DTaP)
  2. Polio (IPV)
  3. MMR
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87
Q

What vaccinations should a child have at 12-13 years old?

A

HPV

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88
Q

What vaccinations should a child have at 14 years?

A
  1. Diphtheria
  2. Tetanus
  3. Polio (IPV)
  4. Men ACWY (up to age 25)
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89
Q

Name 3 groups of people who are less likely to have vaccines?

A
  1. Homeless
  2. Refugees/asylum seekers
  3. Children in care
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90
Q

Define intellectual disability

A

Term used when there are limits to a person’s ability to learn at an expected level and function in daily life

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91
Q

Define Dementia

A

Chronic decline in memory

Affects memory and is typically caused by anatomic changes in the brain, has slow onset and is generally irreversible

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92
Q

Name 4 risk factors for developing dementia

A
  1. Increasing age
  2. Cognitive impairments
  3. Learning disabilities
  4. Family History
  5. Downs syndrome
  6. CVD risk factors –> DM, smoking, hypercholesterolaemia, HTN
  7. Parkinson’s
  8. Alcohol Abuse
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93
Q

What are the 3 main aspects of dementia?

A
  1. Cognitive impairment
  2. Behavioural and psychological symptoms
  3. Difficulties with ADLs
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94
Q

Give 3 common presenting symptoms of dementia

A
  1. Short term memory loss - amnesia
  2. Communication problems - aphasia
  3. Difficulty with daily tasks - apraxia
  4. Anxious
  5. Agnosia - difficulty recognising faces and places
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95
Q

Give 4 types of dementia

A
  1. Alzheimers
  2. Vascular dementia
  3. Lewy bodies
  4. Fronto-temporal
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96
Q

Give 2 histological signs of Alzheimers

A
  1. Plagues of B-amyloid aggregation

2. Neuronal reduction

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97
Q

Give the main features of Alzheimers

A
  1. Early episodic memory impairment

2. Gradual deterioration

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98
Q

Describe the treatment for Alzheimer’s

A

Anticholinesterase inhibitors

  • Donepezil
  • Rivastigmine
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99
Q

What symptoms might you see in someone with vascular dementia?

A
  • Gait and attention problems
  • Personality changes
  • Focal neurological signs
  • More sudden onset than AD
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100
Q

With what type of dementia would you associate TIA’s?

A

Vascular dementia

- Also associated with HTN

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101
Q

What symptoms might you see in someone with Lewy body Dementia?

A
  • Repeated falls
  • Transient LOC
  • Autonomic dysfunction
  • Hallucinations
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102
Q

What disease is often associated Lewy body dementia?

A

Parkinson’s Disease

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103
Q

What symptoms might you see in someone with Fronts-temporal dementia?

A
  • Personality change
  • Behavioural disturbances
  • Memory and perception may be relatively preserved
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104
Q

Which disease is fronto-temporal dementia often associated with?

A

MND

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105
Q

Name 3 dementia screening tools that can be used in primary care

A
  1. 6-CIT (out of 28, >8 = significant, higher = worse)
  2. MMSE (out of 30, <18 = some form of cognitive impairment, lower = worse)
  3. GP-COG
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106
Q

What investigations might you do in a ‘confusion screen’?

A
  1. Vital signs
  2. Bloods
    • FBC –> infection, anaemia, malignancy
    • U&E –> hypo/hyper Na+
    • LFT –> liver failure with encephalopathy
    • Coagulation/INR –> intracranial bleeding
    • TFTs –> hypo/hyper thyroidism
    • Calcium –> hyper/hypo Ca
    • B12/folate/haematinics –> deficiency
    • Glucose/HbA1c –> hypo/hyperglcyaemia
    • Blood cultures
    • Inflammatory markers
    • Drug levels –> toxicity of digoxin, lithium or alcohol
  3. Urine tests = MCS MSU
  4. Sputum culture
  5. CXR –> rule out pneumonia
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107
Q

What are specialist investigations you may do if you suspect someone has dementia?

A
  1. MRI/CT head –> rule out intracranial pathology
  2. ECG –> arrhythmias
  3. EEG –> if evidence of any seizures
  4. LP –> if meningism
  5. Check anticholinergic burden
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108
Q

Give 4 differential diagnoses for dementia

A
  1. Normal age related memory changes
  2. Delirium
  3. Mild cognitive impairment
  4. Depression
  5. Normal pressure hydrocephalus
  6. Sensory deficits
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109
Q

Describe the management of dementia

A
  1. Refer for formal diagnosis
  2. Open and sensitive discussion with patient and family
  3. Encourage use of memory aids –> notebooks, medication dispensers
  4. Dementia drugs
  5. Refer to services –> admiral nurses and charities
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110
Q

Where would you refer someone who you suspect has dementia?

A
  1. Memory clinic

2. Old age psychiatrist

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111
Q

Name 3 services available for dementia sufferers

A
  1. Dementia UK and Dementia Friends
  2. Alzheimers society Sheffield
  3. Admiral nurses
  4. Age UK
  5. Memory Clinic
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112
Q

Define Delirium

A

Acute, fluctuating syndrome of disturbed consciousness, attention, cognition and perception
Affects mainly attention and is typically caused by acute illness or drug toxicity and is often reversible = disturbance of consciousness with reduced ability to focus, sustain or shift attention

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113
Q

What are the types of delirium?

A
  1. Hyperactive –> marked by increased motor activity, agitations, hallucinations, inappropriate behaviour and vigilance
  2. Hypoactive –> marked by lethargy with a decrease in motor activity (poorer prognosis)
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114
Q

Give 4 signs of delirium

A
  • Easily distracted
  • Less aware of where they are or what time it is (Disorientation)
  • Suddenly not be able to do something as well as normal
  • Unable to speak clearly or follow a conversation
  • Sudden mood swings
  • Have hallucinations – seeing or hearing things, often frightening
  • Have delusions or become paranoid
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115
Q

Name 4 possible causes of delirium

A

PINCH ME

  1. Pain
  2. Infection
  3. Nutrition
  4. Constipation
  5. Hydration
  6. Medications/metabolic
  7. Environment
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116
Q

What is the CAM criteria for dementia?

A

Confusion Assessment Methods Criteria = diagnostic algorithm based on the 4 cardinal symptoms of delirium

  • Need to have 1, 2 AND either 3 or 4 present
    1. Sudden onset confusion
    2. Inattention
    3. Disorganised thinking
    4. Altered level of consciousness
117
Q

How is delirium treated?

A

Treat the underlying cause

118
Q

What is mental capacity?

A

The patients ability to make a decision about their care

119
Q

What are the 5 key principles of the MCA?

A
  1. Person must be assumed to have capacity unless it is established that he lacks capacity
  2. A person is not to be treated as unable to make a decision unless all practical steps to help them to do so have been taken without success
  3. A person is not to be treated as unable to make a decision merely because it is an unwise decision
  4. An act done, or decision made under this act or on behalf of a person who lacks capacity must be done or made in their best interests
  5. Before decision is made, regard to whether the purpose for which it is needed can be effectively achieved in a way that is less restrictive to that person’s rights and freedom
120
Q

What 4 questions can be asked to assess mental capacity?

A
  1. Does the patient Understand the information relevant to the decision?
  2. Can the patient Retain the information?
  3. Can they use the information to Weigh up the options and make a decision?
  4. Can they Communicate their decision to you?
121
Q

What is DOLS?

A

Deprivation of Liberty Safeguards
DOLS are part of the MCA, the safeguards aim to ensure that people in care homes or hospitals who lack capacity are looked after in a way that has their best interests at heart

122
Q

What questions should be asked when determining whether something is in the patients best interests?

A
  1. What are the patient’s past/present wishes or feelings relating to the decision?
  2. What are the patient’s values and beliefs relating to the decision?
  3. Are there any other factors that the patient would want to be considered?
  4. What are the risks/benefits of each option?
  5. Consider other factors e.g. future implications and safety concerns
123
Q

What is an IMCA?

A

Independent Mental Capacity Advocate = a legal safeguard for people who lack capacity
They represent people when there is no one independent of service –> e.g. no family members/friends

124
Q

What is the ICD-10 criteria for depression?

A
  1. Persistent low mood
  2. Loss of interest
  3. Fatigue or low energy
125
Q

Give 5 risk factors for depression

A
  1. Female
  2. Past history or family history of depression
  3. Chronic illness
  4. Alcohol/substance misuse
  5. Traumatic events –> bereavement, abuse
  6. Lack of social support
  7. Low socioeconomic status
126
Q

Give 5 physical symptoms of depression

A
  1. Sleep disturbance
  2. Unexplained aches/pains
  3. Appetite change
  4. Loss of libido
  5. Changes to menstrual cycle
  6. Weight change
  7. Slowness or fidgety
127
Q

Give 5 psychological symptoms of depression

A
  1. Continuous low mood
  2. Feeling hopeless
  3. Tearful
  4. Guilty
  5. Lacking motivation/interest
  6. Anxious
128
Q

Give 3 social symptoms of depression

A
  1. Less productive at work/school
  2. Avoiding contact with friends/family
  3. Neglecting hobbies and interests
  4. Difficult relationships
129
Q

Give 5 differentials for depressions

A
  1. Dementia
  2. Hypothyroidism
  3. Parkinson’s disease
  4. Chronic disease
  5. Grief
  6. Anxiety disorders
  7. Bipolar diorders
  8. Cancer
130
Q

What investigations might you do in someone with depression and why?

A

Bloods –> glucose, U&Es, LFT, TFT, Ca, FBC, ESR/CRP
Imaging if there are features suspicious of an intracranial lesion
Done to exclude any organic cause

131
Q

Name a screening tool for depression that can be used in primary care

A

PHQ-9

- Higher the score = more severe (out of 27)

132
Q

How would you among mild-moderate depression?

A
  1. Active monitoring
  2. Low intensity psychological intervention –> IAPT, CBT
  3. Encourage lifestyle changes such as exercise, smoking cessation and healthy diet
133
Q

How would you manage moderate-severe depression?

A
  1. High intensity psychological intervention

2. Anti-depressant –> SSRIs, SSNRI, NASSAs, TCA, MAOIs

134
Q

Name 3 Selective Serotonin Reuptake Inhibitors (SSRIs)

A
  1. Fluoxetine
  2. Citalopram
  3. Sertraline
135
Q

Name a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SSNRI)

A

Duloxetine

Venlafaxine

136
Q

Name a Noradrenaline and specific serotogenic antidepressants (NASSAs)

A

Mirtazapine

137
Q

Name a Tricyclic antidepressant (TCA)

A
  1. Amitriptyline

2. Clomipramine

138
Q

Name a Monoamine oxidase inhibitor (MAOI)

A
  1. Tranylcypromine

2. Phenelzine

139
Q

Give 5 risk factors for suicide

A
  1. Previous suicide attempt
  2. Family history of suicide
  3. History of self-harm
  4. Feeling hopeless
  5. History of substance misuse
  6. Relationship problems
  7. Access to harmful means –> medications, weapons etc
140
Q

What questions may you ask to assess someones suicide risk?

A
  1. Do you ever feel hopeless and that life is not worth living?
  2. Do you ever think about taking your own life?
  3. Have you made any plans to end your own life?
  4. Do you have the means for doing this available to you?
  5. What has kept you from acting on these thoughts?
141
Q

Briefly describe section 2 of the mental health act

A

Admission for assessment –> allows compulsory admission for up to 28 days for assessment

142
Q

Briefly describe section 3 of the mental health act

A

Admission for treatment –> allows compulsory admission for up to 3 months for treatment

143
Q

Briefly describe section 4 of the mental health act

A

Emergency admission –> compulsory admission for 72 Hours

144
Q

Briefly describe section 135 of the mental health act

A

A magistrate can authorise forced entry into a property where it is believed that a person is suffering from a mental health disorder

145
Q

Briefly describe section 136 of the mental health act

A

Used by police to take someone suffering from a mental health disorder form a public place to a place of safety

146
Q

Give 4 physical signs of anxiety

A
  1. Restless
  2. Difficulty falling asleep due to racing thoughts
  3. Dizziness
  4. GI Disturbance –> Nausea, diarrhoea, constipation
  5. Increased HR, BP and sweating
  6. Muscle tension
  7. Shortness of breath
147
Q

Give 3 psychological symptoms of anxiety

A
  1. Excessive worry
  2. Uncontrollable racing thoughts
  3. Difficulty concentration due to agitation or racing thoughts
  4. Sense of dread and fearing the worst
  5. Feeling tense and nervous and unable to relax
  6. Rumination = thinking about bad experiences over and over again
148
Q

Name 3 possible causes of anxiety

A
  1. Family history
  2. Female
  3. Traumatic events
  4. Other mental health problems
  5. Chronic illness
  6. Medications –> antidepressants, corticosteroids, OCP
  7. Menopause
149
Q

Name 4 differential diagnosis of anxiety

A
  1. Generalised anxiety
  2. Social anxiety
  3. Panic disorders
  4. Phobias
  5. PTSD
  6. Obsessive Compulsive disorders
  7. Health anxiety
  8. Body dysmorphic disorder (BDD)
150
Q

What is generalised anxiety?

A

Regular or uncontrollable worries about many different things in everyday life
- Subjective experience of nervousness

151
Q

What is social anxiety?

A

Experience of extreme fear or anxiety triggered by social situation (parties, workplaces, or everyday situations where you have to speak to a different person)

152
Q

What is a panic disorder?

A

Having regular or frequent panic attacks without clear cause or trigger

153
Q

What are the characteristic features of panic disorders?

A
  • Crescendo of the anxiety usually resulting in an exit from the direction
  • Somatic symptoms –> palpitations, sweating, trembling,SOB, chest pain, dizziness
  • Secondary fear of dying/losing control
154
Q

What is a phobia?

A

Extreme fear or anxiety triggered by a particular situation

- HAve anticipatory features

155
Q

Give 2 examples of phobia

A
  1. Agoraphobia = crowds, public places, leaving home
  2. Claustrophobia = small, enclosed spaces
  3. Arachnophobia = spiders
  4. Social phobia
156
Q

What is PTSD?

A

Anxiety problems have occurred after going through something you found traumatic, flashbacks and nightmares that feel like you are reliving the fear

157
Q

What are the characteristic features of PTSD?

A
  • Hyperarousal –> persistently heightened perception of current threat
  • Avoidance of situation/activities
  • Emotional numbing
  • Re-experiencing –> flashbacks, nightmares
158
Q

What are obsessive compulsive or related disorders?

A

Anxiety problems involve repetitive thoughts, behaviours and urges including
- OCD
- Body dysmorphic disorder (BDD)
- Body-focused repetitive behaviour disorders
- Hypochondriasis (health anxiety disorder)
- Hoarding disorder
Typically, repetitive thoughts are intrusive and distressing and the repetitive behaviours are compulsive habitual means or reducing distress which become difficult for the person to control

159
Q

What screening tool for anxiety can be used in primary care?

A

GAD-7 Questionnaire

- Out of 21, >5 = mild, >10 = moderate, >15 = severe anxiety

160
Q

Describe the treatment of anxiety

A
  1. Psychoeduction, sleep hygiene, self guided CBT, relaxation techniques
  2. CBT
  3. Pharmacological treatments
161
Q

What pharmacological treatments can be used for the treatment of anxiety?

A
  • SSRI = sertraline, citalopram
  • SNRI = duloxetine
  • Pregabalin (if SSRI/SNRI are CI, avoid is history of substance misuse)
  • Beta blockers –> propranolol for situational anxiety, more for the physical effects
162
Q

What is the Mental State Examination (MSE)?

A

Gives you a snapshot of a patient’s emotion, thoughts, and behaviour at he time of observation
- Can help identify the presence and severity of mental health conditions and the risk a patient poses to themselves and/or others

163
Q

What is included in a MSE?

A
  1. Appearance and behaviour
  2. Speech
  3. Mood and Affect
  4. Thought
  5. Perception
  6. Cognition
  7. Insight
164
Q

Give 3 physical effects of drug use

A
  1. Complications of injecting
  2. Overdose
  3. Poor pregnancy outcomes
  4. Blood borne virus trasmission
  5. Side effects of opiates/cocaine
165
Q

Give 3 social effects of drug use

A
  1. Effects on families and relationships
  2. Imprisonment
  3. Social exclusion
166
Q

Give 3 psychological effects fo drug use

A
  1. Fear of withdrawal
  2. Craving
  3. Guilt
167
Q

Give 3 signs of addiction

A
  1. Cravings
  2. Tolerance
  3. Compulsive drug seeking behaviour
  4. Physiological withdrawal state
168
Q

When treating substance misuse, what are the treatment aims?

A
  1. Reduce harm to user, friends and family
  2. To improve health
  3. To stabilise lifestyle and reduce illicit drug use
  4. Crime reduction
  5. Reduce risk taking behaviour and blood borne virus transmission
169
Q

Briefly describe the different methods of treatment of substance misuse

A
  1. Harm reduction
  2. Detoxification –> Lofexidine, Buprenorphine
  3. Maintenance –> Methadone
  4. Relapse prevention –> Naltrexone
  5. Psychological interventions
  6. Alternative therapies
170
Q

What are the aims of basic harm reduction in substance misuse?

A
  1. Action to prevention death –> not injecting/injecting safely, reduce amount taken
  2. Action to prevent BBV transmission –> not sharing needles, safe sex, Hep A/B vaccination
  3. Refer to specialist services
171
Q

Opioid misuse: in what type of people would maintenance therapy be indicated?

A
  1. Those who have been addicted for a long time

2. IVDU

172
Q

How could you prevent relapse in opioid use?

A
  1. Provide plenty of support
  2. Naltrexone tablets
  3. Stabilise and offer maintenance therapy
173
Q

What is the mechanism of action of heroin?

A

Acts at opiate receptors

Addictive because it is high reward for minimal effort

174
Q

Give 3 effects of heroin

A
  1. Euphoria
  2. Intense relaxation
  3. Drowsiness
175
Q

Give 3 adverse effects of heroin

A
  1. Dependence
  2. Withdrawal
  3. Physical complications
  4. Overdose
176
Q

How could you treat a heroin addiction?

A

Provide a substitute –> methadone

177
Q

What is the mechanism of action of cocaine?

A

Blocks re-uptake of mood enhancing neurotransmitters at the synapse leading to feelings of intense pleasure

178
Q

Give 3 effects of cocaine

A
  1. Confidence
  2. Euphoria
  3. Impulsivity
  4. Alertness
179
Q

Give 3 adverse effects of cocaine

A
  1. Anxiety
  2. HTN
  3. Arrhythmias
  4. Dysphoria
  5. Depression
  6. Paranoia
  7. Psychosis
180
Q

How can you treat a cocaine addiction?

A

No substitute so harm reduction –> advice on risky behaviour, safe sex, BBV advice, HepB/C testing

181
Q

What formula is used to work out how many units of alcohol are in a drink?

A

Strength of drink (%ABV) X Volume (ml) / 1000

182
Q

Describe the metabolism of ethanol into water and carbon dioxide

A

Ethanol –> ADH –> acetaldehyde –> ALDH –> acetate –> CO2 + H2O

183
Q

What is the recommended alcohol units?

What is considered problem drinking?

A

Recommended = 14 units per week, spread over at least 3 days
Problem drinking = prolonged alcohol use above the defined limits

184
Q

What is problem drinking characterised by?

A
  • Craving
  • Tolerance
  • Continuing to drink despite harmful consequences
  • Preoccupation with alcohol
185
Q

Give 5 causal factors for problem drinking

A
  1. Occupation factors
  2. Availability of alcohol
  3. Advertising
  4. Peer group
  5. Gender
  6. Biological variability
  7. Family
186
Q

Give 3 reasons why women are drinking increasingly more

A
  1. It is more socially acceptable
  2. They have more disposable income
  3. More drinks are targeted at women
187
Q

Define harmful drinking

A

Pattern of alcohol consumption causing health problems directly related to alcohol

188
Q

Who would you screen for alcohol dependency?

A
  • Relevant physical conditions –> HTN, GI disorders, liver disorders
  • Relevant mental health problems –> anxiety, depression, other mood disorders
  • Those who have been assaulted
  • At risk of self-harm
  • Regularly experience accidents or minor trauma
  • Who regularly attend GUM clinical or seek emergency contraception?
189
Q

Name 2 alcohol screening tools

A
  1. CAGE

2. AUDIT

190
Q

What are the questions asked in CAGE?

A
  1. Have you ever thought about Cutting down?
  2. Have you ever felt Annoyed by people telling you to cut down?
  3. Have you ever felt Guilty about your drinking?
  4. Eye opener – have you ever had a drink first thing in the morning?
191
Q

What questions are asked in AUDIT?

A

AUDIT-C = first 3 questions of full AUDIT questionnaire
1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day?
3. How often do you have >6 units on a single occasion?
>8 = hazardous drinking, >16 - harmful, >20 = possible dependency

192
Q

What are the best markers of alcohol use on blood tests?

A

GGT and MCV –> both raised

193
Q

Name 3 public health interventions that help to reduce alcohol abuse

A
  1. Minimum price per unit and reduce supply
  2. Screening and brief intervention
  3. Drinkaware campaigns
194
Q

What are the most common causes of death due to alcohol?

A
  1. Accidents and violence
  2. Malignancies
  3. Cerebrovascular disease
  4. CHD
195
Q

Give 5 alcohol related health problems

A
  1. GI problems
  2. Liver disease –> 50% fatty liver, 20% cirrhosis
  3. CV problems –> increased risk of hyperlipidaemia, HTN, AF
  4. Neurological problems
  5. Birth defects –> low birth weight, FAS
  6. Malignancy
196
Q

Name 3 cancer that are commonly associated with alcohol

A
  1. Head and neck
  2. Liver
  3. Pancreatic
  4. Stomach
  5. Colon
  6. Rectum
  7. Breast
197
Q

Name 3 symptoms of alcoholic hepatitis

A
  1. Anorexia
  2. Nausea
  3. Abdominal pain
  4. Weight loss
198
Q

Give 3 symptoms of mild alcohol withdrawal

A
  1. HTN
  2. Tachycardia
  3. Anorexia
  4. Anxiety
  5. Insomnia
  6. Diaphoresis
  7. Irritability
  8. Headache
  9. Fine tremor
199
Q

Give 3 symptoms of moderate alcohol withdrawal

A
  1. Worsening mild symptoms
  2. Agitation
  3. Coarse tremor
200
Q

What is delirium tremens?

A

= severe alcohol withdrawal

Short lived toxic confused state due to reduced alcohol intake in alcohol dependent individuals

201
Q

Name 3 symptoms of delirium tremens

A
  1. Confusion/delirium
  2. Seizures = generalised tonic clonic
  3. Hallucinations –> auditory, visual or tactile
  4. Tremor
  5. Hyperthermia subsequent to psychomotor agitation
202
Q

How can you treat delirium tremens?

A

Detoxification using benzodiazepines –> Lorazepam

203
Q

What disease can result from thiamine deficiency?

A

Wernicke’s encephalopathy

204
Q

What are the triad of symptoms seen in Wernicke’s encephalopathy?

A
  1. Acute confusion
  2. Ataxia
  3. Opthalmoplegia
205
Q

How do you treat Wernicke’s encephalopathy?

A

IV or IM thiamine

206
Q

What complication can arise if you fail to treat Wernicke’s encephalopathy?

A

Korsakoff syndrome = non reversible

207
Q

Alcohol dependancy: What is brief intervention?

A

Short, evidence-based, structured conversation about alcohol consumption to motivate and support individual considering change in alcohol habits

  • Support networks, risk about drinking, advice about reducing drinking
  • Emotional issue around drinking an drinking diaries
  • Tips for social drinking
208
Q

Alcohol dependancy treatment: When should abstinence be recommended?

A
  • If on antipsychotics, metronidazole or terbinafine
  • Have liver or heart disease
  • Are pregnancy or becoming pregnant
209
Q

Alcohol dependancy treatment: When should withdrawal medications be give?

A
  • Alcohol dependency of >20 units a day

- Previously experienced withdrawal symptoms

210
Q

Name 4 possible alcohol withdrawal medications and how they work

A
  1. Acamprosate –> relieves cravings
  2. Disulfiram –> make you suffer when drinking
  3. Naltrexone –> block opioid receptors in the brain
  4. Nalmefene –> opioid system modulator
211
Q

What is the first line treatment for alcohol withdrawals?

A

Chlordiazepoxide hydrochloride or diazepam

212
Q

Describe the aetiology of vaginal discharge

A
  1. Physiological causes –> puberty, pregnancy, ovulation
  2. Infection
  3. Foreign bodies
  4. Malignancy
213
Q

Name 3 organisms that can cause abnormal vaginal discharge

A
  1. Bacterial vaginosis
  2. Candida
  3. Trichomoniasis
214
Q

What discharge would you classically get with Trichomoniasis?

A

Frothy yellow/green offensive smelling discharge

- can also have itching and dysuria, strawberry cervix

215
Q

What discharge would you classically get with Bacterial vaginosis?

A

Profuse, thin, whitish/grey, offensive smelling discharge

216
Q

How would you diagnose BV?

A

Amsels Criteria = need 3/4 of criteria

  1. Thing white homogenous discharge
  2. Clue cells on microscopy wet mount
  3. pH of vaginal fluid >4.5
  4. Release of fishy odour on adding alkali
217
Q

What discharge would you classically get with Candida?

A

Thick, curd like white discharge (cottage cheese)

Vulval itching/soreness is also associated with thrush

218
Q

Give 4 symptoms/signs of chlamydia

A
  1. Asymptomatic = 60-70%
  2. Discharge –> pale, thick
  3. Dysuria
  4. Irregular bleeding –> PCB, IMB
  5. Pelvic pain
  6. Cervical motion tenderness
219
Q

Give 4 symptoms of gonorrhoea

A
  1. Asymptomatic (less than chlamydia)
  2. Discharge = odourless, purulent, green/yellow
  3. Low abdominal pain
  4. Irregular bleeding
  5. Dysuria
220
Q

How would you treat Trichonomasis?

A

Metronidazole 2g single oral dose
OR
Metronidazole 400-500mg BD for 5-7 days

221
Q

How would you treat BV?

A

Metronidazole 2g single oral dose
OR
Metronidazole 400-500mg BD for 5-7 days

222
Q

How would you treat candida?

A

Clotrimazole 500mg pessary +/- topical clotrimazole cream
OR
Fluconazole single dose (CI in pregnancy)

223
Q

How would you treat chlamydia?

A

Azithromycin single dose OR doxycycline BD for 7 days

Pregnant = erythromycin bd 10-14 days

224
Q

How would you treat gonorrhoea?

A

IM ceftriaxone 1g –> if sensitivities are not known
- Ceftriaxone IM stat + Azithromycin stat
Oral ciprofloxacin 500mg –> if sensitivities are known

225
Q

Give 3 possible symptoms of herpes

A
  1. Painful blisters
  2. Vaginal/urethral discharge
  3. Local oedema
  4. Tingling/neuropathic pain in genital are, lower back, buttocks or legs
226
Q

Give 3 risk factors of someone having a STI if they present with abnormal vaginal discharge

A
  1. Multiple partners
  2. Not using contraception
  3. Under 25
  4. Previous STI
  5. New partner
227
Q

What STIs can be screened for using a blood test?

A
  1. HIV

2. Syphilis

228
Q

How are chlamydia and gonorrhoea screened for>

A

NAAT
In women = vulvo-vaginal or endocervical swab
In men = first catch urine

229
Q

When is the best time to get tested for STIs?

A
  • Gonorrhoea = 2-30 days after exposure
  • Trichomoniasis = 5-28 days after exposure
  • Chlamydia = 1-3 weeks after exposure
  • Syphilis = 10 days – 3 months after exposure
  • Herpes = 2 weeks – 3 months after exposure
  • Hepatitis B = 3 weeks – 2 months after exposure
  • HIV = 4 weeks - 3 months after exposure
  • Hepatitis C = anytime up to 6 months after exposure
230
Q

Describe the mechanism of action of the COCP

A

Negative feedback effect of oestrogen prevents LH surge and so inhibits ovulation
The progesterone inhibits proliferation of the endometrium therefore creating unfavourable conditions for implantation
The thickness of the cervical mucus increases too

231
Q

Give 3 advantages of combined hormonal contraception

A
  1. More effective that barrier methods
  2. Periods tend to be lighter and less painful
  3. Reduce risk of ovarian, uterus and colon cancer
232
Q

Give 3 disadvantages of combined hormonal contraception

A
  1. User dependent
  2. Increased risk of VTE
  3. Small increased risk of breast and cervical cancer
  4. Doesn’t protect against STIs
  5. Headaches
  6. Mood swings
233
Q

Who might combined hormonal contraception be contraindicated in?

A
  • BMI >35
  • Smokers aged >35
  • Family history of VTE
  • History of migraines with aura
234
Q

What is used to provide guidance on what method of contraception women should be on?

A

UKMEC = Determines what methods of contraception are safe to use –> screening and contraindications
4 categories –> category 4 = complete contraindication

235
Q

Give 3 examples of progesterone only contraception

A
  1. Progesterone only Pill (POP)
  2. Implant
  3. Injection = Depo-Provera
236
Q

What is the mechanism of action of the progesterone only pill (POP)?

A

Thickens cervical mucus thereby preventing sperm penetration, delays ovum transport, inhibits ovulation, and provides an endometrium hostile to implantation

237
Q

Give an example, an advantage and a disadvantage of the POP

A 
Cerazette 
Advantages 
   1. Can be used if COCP is CI
   2. More effective than barrier methods 
Disadvantages 
   1. User deppend 
   2. Irregular periods 
   3. Doesn't protect against STIs
238
Q

Give an advantage and disadvantage of the contraceptive implant

A

Advantages
1. Extremely effective and lasts 3 years
2. Safe during breast feedings
Disadvantages
1. Irregular periods/bleeding
2. Fitting and removal can cause pain
3. Doesn’t protect against STIs

239
Q

Give an advantage and disadvantage of the contraceptive injection

A 
Advantages 
   1. Extremely effective and lasts 3 months
   2. No known interactions
   3. Can be use din women with BMI >35 
Disadvantages 
   1. Irregular periods/bleeding
   2. Osteoporosis risk with long term use
   3. Doesn't protect against STIs
   4. Weight gain
240
Q

What is the mechanism of action of the levonorgestrel IUS (minera coil)?

A

Acts mainly via its progestognenic effect on the endometrium, which prevents implantation of the fertilised ovum
Changes in cervical mucus also inhibit the penetration of sperm into the uterus

241
Q

Give an advantage and disadvantage of the Minera Coil

A 
Advantages 
   1. Extremely effective and lasts 3-5 years
   2. Periods are usually lighter 
   3. Safe to use when breastfeeding
Disadvantages 
   1. Irregular periods
   2. Headaches, acne, breast tenderness
   3. Doesn't protect against STIs
242
Q

What is the mechanism of action of the Copper IUD?

A

Inhibits fertilisation by its toxic effect on sperm and ova

If fertilisation does occur, the Cu-IUD has an anti-implantation effect

243
Q

Give an advantage and disadvantage of the Copper IUD

A

Advantages
1. Extremely effective and lasts 5-10 years
2. No hormonal side effects
3. Can be used as emergency contrception
Disadvantages
1. Periods may become heavier or more painful
2. Perforation of uterus
3. Doesn’t protect against STIs

244
Q

Teenage pregnancy can result in what negative outcomes for both mother and child?

A
  1. Poor health
  2. Lower academic achievement
  3. Lower socioeconomic status
  4. Lower self esteem
  5. Under achievement at work
245
Q

Give 3 reasons why teenagers may discontinue contraception

A
  1. Side effects –> acne, weight gain etc
  2. Mood changes
  3. Fertility concerns
  4. Bleeding patterns
246
Q

What are the Fraser Guidelines?

A

The following criteria judge the competence of a young person to make decisions about contraception without parental consent

  1. The patient understands the advice given
  2. The patient cannot be persuaded to inform their parents
  3. It is likely that the patient will continue to have sexual intercourse with or without contraception
  4. The patient’s physical or mental health may suffer as a result of withholding contraceptive advice or treatment
  5. It is in the best interests of the patient and the doctor to provide contraception advice and treatment without parental consent
247
Q

What is Gillick Competence?

A

Children under the age of 16 can consent to medical treatment if they have sufficient maturity and judgement to enable them fully to understand what is proposed
- Decision by decision basis
For a young person under the age of 16 to be competent, she/he should have
- Ability to understand that there is a choice and that choices have consequences
- Ability to weigh information and arrive at a decision
- A willingness to make a choice
- An understanding of the nature and purpose of the proposed intervention
- An understanding of the proposed interventions risks and side effects
- An understanding of the alternatives to the proposed intervention and the risks attached to them
- Freedom from undue pressure

248
Q

Give 3 advantages of a friend or family member acting as an interpreter

A
  1. Readily available –> useful in emergency
  2. Trusted by patient
  3. Provides vital clinical information
  4. Provides accurate cultural context
249
Q

Give 3 disadvantages of a friend or family member acting as an interpreter

A
  1. Threat to confidentiality and safeguarding concerns
  2. Could dissuade patient from disclosing information
  3. Poor grasp of medical terminology
  4. Embarrassing or emotionally distressing
  5. Difficult to check accuracy of interpretation
250
Q

Give 3 advantages of a using a professional interpreter

A
  1. Non judgemental and confidential
  2. Degree of assurance
  3. Neutral and passive
  4. Cultural context
251
Q

Give 3 red flag symptoms of a cough

A
  1. Haemoptysis
  2. Hoarseness
  3. Peripheral oedema with weight Gian
  4. Prominent dyspnoea
  5. Smokers
  6. Systemic symptoms
  7. Swallowing difficulties
252
Q

Give 4 possible symptoms of TB

A
  1. Cough >3 weeks, usually productive and can contain blood
  2. Dyspnoea - gradually increasing
  3. Night sweats
  4. Fatigue
  5. Fever
  6. Weight loss
253
Q

What investigations would you do for latent TB?

A
  1. Mantoux test

2. Interferon Gamma Release Assay (if active TB excluded and +ve Mantoux)

254
Q

What induration on a Mantoux test gives a positive result for TB?

A

> 5mm

255
Q

Who should have a Mantoux test?

A
  • Those who are 18-65 years old who are close contacts of a person with pulmonary or laryngeal TB
  • Immunocompromised adults
  • New entrants from high incidence countries
  • Healthcare worker who have not had BCG or are a new entrant from a high incidence country
  • Children under 18
256
Q

How is latent TB diagnosed?

A

Positive Mantoux test AND positive IGRA

257
Q

What investigations are done for suspected active TB?

A
  • TB culture samples –> 3 resp smaples, 1 early morning
  • CXR
  • NAAT
  • Bloods
258
Q

What stain is used for TB microscopy?

A

Ziehl Neelsen stain for acid fast bacilli

259
Q

What stain is used for TB cultures?

A

Lowenstein Jensen media

260
Q

What is the treatment for latent TB?

A

Isoniazid for 6 months
AND
Rifampicin for 3 months

261
Q

What is the treatment for active TB?

A

Rifampicin and Isoniazid for 6 months
Pyrazinamide and Ethambutol for 2 months
(All are hepatotoxic drugs)

262
Q

Give a side effect of Rifampicin

A

Red/orange discolouration of secretions –> urine, tears

263
Q

Give a side effect of Isoniazid

A

Peripheral neuropathy

- Prescribed with pyridoxine (B6) to reduce this risk

264
Q

Give a side effect of Pyrazinamide

A

Hyperuricaemia –> gout

265
Q

Give a side effect of Ethambutol

A

Colour blinding

Reduced visual acuity

266
Q

What other management considerations need to be thought of when dealing with someone with TB?

A
  1. Contact Tracing
    • Screen close contacts
  2. Notify Public health
  3. Test for other infectious diseases
267
Q

When should PHE be notified of a TB case?

A

Within 3 working days of making or suspecting the diagnosis

Within 24 hours if immediate public health action will be needed

268
Q

Give 3 potential causes of homelessness

A

Relationship breakdown due to

  1. Mental illness
  2. Domestic abuse
  3. Dispute with parents
  4. Bereavement
269
Q

Give 3 groups of people who are more vulnerable to homelessness

A
  1. Substance misusers
  2. Failed asylum seekers
  3. People who are/have been in care
  4. Ex-service men and women
  5. LGBTQ+
270
Q

What health problems do homeless adults face?

A
  1. Infectious disease –> TB, hepatitis
  2. Dental problems
  3. Respiratory problems
  4. Injuries following violence/rape
  5. Sexual health problems
  6. Serious mental illness - schizophrenia, depression
  7. Malnutrition
271
Q

What barriers to care do homeless people face?

A
  1. Difficulty accessing health care
  2. Lack of integration between primary care services and other agencies
  3. People may not prioritise health when there are other more immediate health problems
  4. May not know where to find help
  5. Communication difficulties
272
Q

Define refugee

A

A person granted asylum and refugee status in the UK

  • They have the rights of a UK citizen
  • After 5 years of refugee status –> can apply for Indefinite Leave to Remain (ILR) and after a year of ILR can apply for British citizenship
273
Q

Define asylum seeker

A

A person applying fo refugee status

They are entitled to £35 a week, housing and NHS care

274
Q

What barriers to care do asylum seekers and refugees face?

A
  1. Language/cultural/communication problems
  2. Money/other priorities
  3. Different perceptions of care
  4. Racism, prejudice, discrimination, stigma
  5. May not understand how the NHS works
  6. Lack of knowledge about where to get help
275
Q

What health problems do refugees and asylum seekers face?

A
  1. Injuries from war/travelling
  2. No previous health surveillance/immunisations
  3. Malnutrition
  4. Injuries from torture and sexual abuse
  5. Blood borne and infectious disease
  6. Untreated chronic disease
  7. PTSD, depression, psychosis
276
Q

Define social exclusion

A

The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society

277
Q

Give 3 causes of loneliness

A
  1. Poor health, sensory impairment
  2. Poverty
  3. Housing issues
  4. Fear of crime
  5. Lack of transport
  6. Discrimination
278
Q

Give 3 signs of loneliness

A
  1. Talkative, clinging
  2. Lives alone
  3. Recent bereavement or transition
  4. Mobility problems or sensory impairment
279
Q

Give 3 national initiative to combat loneliness

A
  1. Age UK
  2. Silverline
  3. Dementia Friends
280
Q

Give 3 Sheffield initiatives to combat loneliness

A
  1. Age Better
  2. Active Sheffield
  3. Darnall Dementia Care
281
Q

What is erectile dysfunction?

A

The inability to attain and maintain an erection sufficient for satisfactory sexual performance

282
Q

Give 3 risk factors for erectile dysfunction

A
  1. Lifestyle factors –> obesity, smoking, alcohol
  2. Hypercholesterolaemia
  3. HTN
  4. DM
283
Q

Give 5 potential causes of erectile dysfunction

A
  1. Neuro –> brain injury/spinal cord disease
  2. CV disease –> atherosclerosis, HTN
  3. Psychogenic –> psychosexual disorders, depression, anxiety
  4. Endocrine –> thyroid disease
  5. Medications –> BB, diuretics, antidepressants
284
Q

ED: what points in a history are suggestive of a psychogenic cause?

A
  1. Sudden onset
  2. Early collapse
  3. Problematic relationship
285
Q

ED: what points in a history are suggestive of a organic cause?

A
  1. Gradual onset
  2. Normal ejaculation
  3. Normal libido
  4. RFs present
286
Q

What investigations might you do to determine the cause of someones erectile dysfunction?

A
  1. Fasting glucose
  2. HbA1c
  3. Lipid profile
  4. FSH/LH/Prolactin
287
Q

Briefly describe the management of ED

A
  1. Treat RF’s
  2. Refer for counselling
  3. Phosphodiesterase inhibitors e.g. Tadalafil
  4. Vacuum devices
  5. Injections
  6. Penile prosthesis
288
Q

Name a phosphodiesterase inhibitor and describe how they work

A

Tadalafil, Viagra

Increase the blood flow to the corpus cavernous

289
Q

Give 3 potential side effects of phosphodiesterase inhibitors

A
  1. Headaches
  2. Flushing
  3. Indigestion
  4. Priapism
  5. Impaired vision

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