GP Flashcards
When do mothers have their checks after giving birth?
after giving birth and 6-8 weeks
What kind of things should you ask in a babycheck
Bladder and bowl function (can be constipated after birth)
Pain (if rectus muscle splits ==> Examing abdomen
Vaginal prolapse (do pelvic floor exercises)
How long should a women not drive after c sections?
6 weeks
What is locia?
Bleeding after giving birth. at can last around 6 weeks afterwards
What Safeguarding issues should you look for at a baby check
FGM (going abroad)
Domestic abuse
Drug/alcohol intake
Discuss contraception as well
What mental health checks can you use to look for post natal depression
PHQ-9 and Edinburgh Postnatal depression scale
What Examinations would you do at a 8 week baby check?
Blood pressure, weigh, vaginal examination if necesscary, check abdomen
Women with gestational diabetes need a Hba1c
What 3 things do you track on a baby 0-1 growth chart
Weight
Length
Head Circumference
What is in the 6 in one Vaccination should occur in at 8 weeks?
6 in one
6 in 1 vaccine (DTaP/IPV/Hib/HepB) which protects
against diptheria, tetanus, pertussis (whooping cough), polio, Haemophilus
influenzae type b and hepatitis B
What other 3 vacinations, other than the 6 in one, is given at 8 weeks?
the pneumococcal vaccine, rotavirus
vaccine, Men B vaccine.
List some ways in which paracetamol can be administered
orally (PO) via tablet, capsule, suspension,
orodispersible tablet or effervescent tablet, per-rectum (pr) via suppository,
intra-venous (iv) via solution for infusion.
after giving birth and 6-8 weeks
When do mothers have their checks after giving birth?
Depression Medications: How do SSRIs work?
Blocks the reuptake of serotonin back into the cells, so more stays outside, to try and lift the mood. Dose can be increased if necesscary
Depression Medications: How do TCAs work?
Tricyclicv Antidepressanets, eg anatripoline, not used often now:
block the reuptake of serotonin and norepinephrine in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft. The increased concentrations of norepinephrine and serotonin in the synapse likely contribute to its anti-depressive effect
Depression Medications: How do SNRIs work?
Selective Norepinephrine reuptake inhibitor, newer eg vendofaxcine,
SNRIs block the reabsorption (or reuptake) of serotonin and norepinephrine back into the nerve cells that released them.
Both of these neurotransmitters are associated with distinct brain structures and functions and impact various processes such as mood and energy in somewhat different ways.
Give some psychological symptoms of depression
Continuous low mood or sadness
feeling hopeless and helpless
having low self-esteem
feeling tearful
feeling guilt-ridden
feeling irritable and intolerant of others
having no motivation or interest in things
finding it difficult to make decisions
not getting any enjoyment out of life
feeling anxious or worried
having suicidal thoughts or thoughts of harming yourself
Give some physical symptoms of depression
moving or speaking more slowly than usual
changes in appetite or weight (usually decreased, but sometimes increased)
constipation
unexplained aches and pains
lack of energy
low sex drive (loss of libido)
changes to your menstrual cycle
disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning
Give 2 social symptoms of depression
avoiding contact with friends and taking part in fewer social activities
neglecting your hobbies and intere
What can St Johns Wort be used for? What is it also known as?
St John’s wort is a herbal medicine used to treat mental health problems. The botanical name for St John’s wort is Hypericum perforatum, and it is sometimes marketed and sold as ‘Hypericum’. It contains many active substances, including hypericin and hyperforin, which are thought to affect mood.
Today St John’s wort is mainly used as an over-the-counter remedy to treat mild or moderate depression.
What are the 4 main continence mechanisms?
internal sphincter
external sphincter
Pelvic floor muscles
Prostate in men
What are the 3 types of Lower Urinary Tract symptoms? Give examples of each
Storage - eg frequency, urgency, nocturia, incontinence
Voiding - Poor flow, straining, Hesitancy, Terminal Dribbling
Post Micturition - Sensation of incomplete voiding, Post - micturition dribbling
What are some investigations you can do for a patient presenting with LUTs?
Post void bladder scan
U and Es
Bladder diary
Urine dipstick
PR/DRE exam
Flowmetry
Take a History
What are some LUTs? Think of Mnemonic
FUNI SHID
Frequency
Urgency
Nocturia
Incontinence
Straining
Hesitancy
Intermittent stream
Dribbling
What is a key medication given in rheumatoid arthritis?
Methotrexate
What should you give alongside methotrexate?
Folic acid
it is contraindicated in pregnancy.
What is the mode of action for methotrexate?
Methotrexate is a folate antagonist.
Methotrexate inhibits dihydrofolate reductase (DHFR), the enzyme that reduces folic acid to tetrahydrofolic acid
This leads in a deficiency in the cellular pools of thymidylate and purines. ======>leads to a decrease in nucleic acid synthesis.
Therefore, methotrexate interferes with DNA synthesis, repair, and cellular replication.
Outline some differences between osteoarthritis and rheumatoid arthritis
Rheumatoid - most common systemic (whole-body) autoimmune disease
Caused by autoimmune, - so inflammation of joints is primary
Can damage other organs, not just joints
Will often affect multiple joints, symmetrically
RA also causes flu-like symptoms, such as fever and malaise (a general unwell feeling).
Usually affects MCP and PIP joints in hand, not DIP.
Earlier onset
Morning stiffness for more than 30 mins
Osteoarthritis - most common arthritis
Caused by wearing down of articular cartilage between bones, any inflammatory is secondary
Is limited to just effecting the joints
Does not cause systemic, flu like symptoms
Typically later onset than RA
Pain in 1st Carpo-metacrapal
morning stiffness passes in less than 30 minutes
usually affects DIP
What things should you ask a patient when taking a history for epilepsy?
Whether they’ve any seizures before
Any triggering factors
any prodromal features/aura
How long it lasted
Family history of seizures
Allergies
Drugs/Alcohol history
Character of seizure - Tongue biting, incontinence, loss of consciousness
Time taken to recover
Drug history
Tiredness/stress levels,
Whether they drive
Occupation
What is the management for someone with status epilepticus?
ABCDE approach - secure airway and give oxygen.
IV bolus—to stop seizures: eg lorazepam 4mg (in hostpial)
Give 2nd dose of lorazepam if no response after 10–20min
Or Buccal Midazolam, or rectal diazepam (try cannulating a fitting person)
Then Phenytoin if second dose doesn’t work.
Get ITU/Anaesthetist help!!
Treatment of epilepsy - how does Lamotrigine and Carbamazepine work
Lamotrigine and Carbamazepine both inhibit voltage gated pre synaptic Na+ channels - therefore reduces pre synaptic excitability
Treatment of epilepsy - how does sodium valproate work?
inhibits an enzyme that leads to an increase in an inhibitor of GABA transaminase ==> Therefore GABA is broken down less
aka leads to an increase in GABA/inhibitory neurotransmission
What is a contraindication for using Sodium Valporate?
All females of childbearing age (15-45)
Sodium Valporate is Teratogenic
Can also damage liver, and cause hepatitis
Instead use Lamotrigine
What are the rules around driving with epilepsy?
(Adults with a one off seizure, known epileptics, those driving a HGV vehicle)
Adults who present with anisolatedseizure:
- Should stop driving for6 months, providingno cause is foundon brain imaging and there is no epileptiform activity on EEG
Known epileptics
Patients must be seizure-free for12 monthsbefore they may qualify for a driving license
If the patientdrives a heavy goods vehicle (HGV):
- They must be seizure-free for5 yearsbefore they can start driving
name some common side effects of amitriptyline.
Amitriptyline has significant anticholinergic properties.
The anticholinergic properties decrease the effect of the parasympathetic nervous system and give characteristic symptoms:
blurred vision, confusion, dry mouth, urinary retention.
What is the MOA of the combined oral contracpetive pill?
Suppress GnRH from anterior pituitary gland, so decreased LH and FSH. LH triggers ovulation
