GP Flashcards
Up and til what age are newborns offered regular health and development reviews?
2 years old
When is the heel prick test performed on newborns?
at 5 and 8 days after birth
What does a heel prick test screen for?
sickle cell disease (SCD)
cystic fibrosis (CF)
congenital hypothyroidism (CHT)
phenylketonuria (PKU)
medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (HCU)
When is the first new baby review performed?
in the first 1-2 weeks after birth
What occurs at the 6-8 week check?
Comprehensive physical examination of baby (eyes, heart, hips, testicles, weight, length, circumference)
Discussion of baby vaccinations
Check up on mother’s mental + physical health as well
When are the baby vaccinations offered?
8 weeks
12 weeks
16 weeks
12 months
Before child starts school (around 4)
When are baby reviews performed?
Just after birth
1-2 weeks
6-8 weeks
9-12 months
2-2.5 years
What vaccination is given at 8 weeks?
5 in 1 (diphtheria, tetanus, whooping cough, polio and Hib disease)
What are the routes of administration for paracetamol?
PO (oral), rectally (PR), intravenously (IV)
What is the pain ladder?
Guidelines for the use of drugs in the management of pain
What are the steps in the pain ladder?
- Non-opioid analgesics (e.g. NSAIDs) ± adjuvant analgesic
- Weak opioids ± non-opioid ± adjuvant analgesic
- Strong-opioid analgesic ± non-opioid ± adjuvant analgesic
- Minimal invasive intervention ± non-opioid ± adjuvant analgesic
What is an adjuvant analgesic?
Drugs with a primary indication other than pain but which have analgesic properties e.g. antidepressants, local anaesthetics, corticosteroids, bisphosphonates
What is the method of action of NSAIDs?
Inhibit the action of cyclooxygenase enzymes which catalyse the conversion of arachidonic acid into prostaglandin H2, the precursor of PGs and thromboxane. Their effects are anti-inflammatory, antipyretic and analgesic
What are Non-selective vs selective NSAIDs?
Non-selective NSAIDs block both COX-1 and COX-2 inhibitors (high risk of side effects)
Selective NSAIDs block only COX-2
What are the possible side effects of non-selective NSAIDs?
easy bleeding, skin rash
bronchospasm
dyspepsia, n+v, gastric ulceration, haemorrhage
nephritis
What are 3 examples of NSAIDs?
Aspirin
Ibuprofen
Naproxen
What are 2 examples of selective NSAIDs?
etoricoxib
celecoxib
What is the difference between COX-1 and COX-2?
COX-1 = active in normal physiology
COX-2 = active in inflammatory response
What are the investigations for IBD?
Routine bloods: FBC, U+Es, TFTs
CRP (blood test)
Faecal calprotectin (stool sample)
Endoscopy with biopsy (GS)
USS, CT + MRI
What are the main differences between UC and Crohn’s disease?
- Crohn’s affects the whole GI tract (mouth->anus) and UC affects the lower GI tract only (colon->rectum)
- in Crohn’s the inflammation affects the entire thickness of the intestinal lining, UC is only the innermost lining
- CD = patchy affected areas, UC = uniformly affected
- complications of CD = strictures, fissures + fistulas, complications of UC = haemorrhage + toxic megacolon
- Smoking causing increased risk of CD but decreased of UC
- cancer risk is higher with UC
What are the differences between IBD and IBS?
- IBD = chronic, incurable digestive disease, IBS = functional bowel disorder
- IBD can cause urgency, fatigue, weight loss and malnutrition alongside the abdominal cramps, bloating, gas, mucus in stool, diarrhoea and/or constipation seen in IBS
- IBD can cause permanent damage to GI tract but IBS just causes inflammation
- surgery is often implicated in IBD treatment but not for IBS
- IBD can cause complications affecting joints, eyes, kidneys, skin and bones whereas main complication of IBS is impaired QOL
What are the red flag signs/symptoms for IBS/IBD?
weight loss
blood in stools
anaemia
fever
urgency
abdominal pain
What are the mechanisms of action of antidiarrhoeals?
- Adsorbents - help eliminate the causative toxin or bacteria by coating the walls of the GI tract and binding the pathogen for elimination in the stool
- Antimotility agents - slow peristalsis either by acting on the smooth muscle of the GI tract to inhibit propulsive motility and decrease gastric acid secretion (anticholinergics), or by decreasing the flow of fluids and electrolytes in the bowel and slowing the movement of the bowel to reduce the number of bowel movements (opioid-like)
- Probiotics - help to restore normal bacteria in the lower GI tract
What are examples of antidiarrhoeals of the 3 types?
Adsorbents: bismuth subsalicyclate
Antimotility: hyoscyamine (anticholinergic), loperamide (opiate-like)
Probiotics: lactobacillus
What are the methods of action of laxatives?
- Osmotic laxatives - draw water into the lumen to increase intestinal peristalsis
- Bulk-forming agents - draw water into the stool forming a soft, bulky mass, which stimulates intestinal peristalsis
- Stimulant laxatives - irritate nerve endings in the intestinal walls, thereby stimulating smooth muscle contraction and intestinal peristalsis
- Emollient laxatives - act as surfactant that allows the water to penetrate the stool and make it softer
Give an example of each of the 4 types of laxatives?
Osmotic - magnesium hydroxide (milk of magnesia), lactulose
Bulk-forming agent - methylcellulose, polycarbophil
Stimulant - bisacodyl, senna
Emollient - docusate
What occurs when someone taking the combined oral contraceptive pill (cOCP) has diarrhoea?
Severe diarrhoea (6-8 watery stools in 24 hrs) causes decreased absorption in the GI lumen and so the pill may not be absorbed or only partially absorbed reducing its contraceptive effect.
What other contraceptive options should be considered for patients who have severe diarrhoea or chronic bowel disorders?
progesterone only pill, IUD, IUS, condoms, injections, implant