GP Flashcards

Question

umbilical Granuloma

Answer 1

The umbilicus should dry, blacken and separate about 1 week after birth Granuloma often described as a persistently wet umbilicus check for infection (antibiotics needed) Exclude patent urachus Use silver nitrate cautery stick

Answer 2

Very common Usually ages up to 3 months Repeated, unstoppable crying with rigid body and red face Knees drawn up - no real association with abdo pain More often in evening No known cause, usually resolves spontaneously Parents can try colic drops (break down excess GI gas) Not evidence for Cow’s milk allergy or need to change feeds

Answer 3

Issues around inconsistent sleep pattern, night feeding Parental exhaustion All babies have different sleep patterns “Sleep when your baby sleeps” Baby should sleep in the same room as parent for 6 months (night and day) Newborn can be as high as 18 hours By 4 months, twice as long asleep at night as during the day From 6 months night feeds may not be necessary (12 hours sleep)

Answer 4

ymptoms usually develop within a week of cow's milk introduction, although they may be delayed for several weeks. Reactions may be triggered by food ingestion, inhalation, or skin contact (rare). The trigger is usually cow's milk, however, it may be cow's milk protein in maternal breast milk in infants who are exclusively breastfed (rare in IgE-mediated allergy). IgE-mediated reactions usually occur following a small amount of milk, whereas non-IgE-mediated reactions usually occur after ingestion of larger volumes of milk. Most affected children present by six months of age; onset is rare after 12 months of age. Skin reactions - such as an itchy rash or swelling of the lips, face and around the eyes digestive problems – such as stomach ache, vomiting, colic, diarrhoea or constipation hay fever-like symptoms – such as a runny or blocked nose eczema that does not improve with treatment In severe cases can cause anaphylaxis

Answer 5

Removing all cows' milk from the child's diet for a period of time. If baby is formula-fed, can prescribe special infant formula. If baby is exclusively breastfed, the mother will be advised to avoid all cows' milk products. Child should be assessed around every 6 to 18 months to see if they have grown out of their allergy.

Answer 6

FAILURE TO GROW AT THE EXPECTED RATE Mild? fall across two centile lines Severe? fall across three centile lines.

Answer 7

Most sensitive indicator in infants and young children? weight In older children? height

Answer 8

most common=Not enough food (95%) This can be due to poverty, socioeconomic difficulties, emotional deprivation, unskilled feeding, Organic causes * Decreased appetite, e.g. psychological or secondary to chronic illness. * Inability to ingest, e.g. GI structural or neurological problems. * Excessive food loss, e.g. severe vomiting (gastro-oesophageal refl ux disease (GORD), pyloric stenosis, dysmotility), diabetes mellitus (urine). * Malabsorption (see b p.334). * Increased energy requirements, e.g. congenital heart disease, cystic fi brosis, malignancy, sepsis. * Impaired utilization, e.g. various syndromes, IEM, endocrinopathies.

Answer 9

History age of onset of FTT, and timing of weaning, food diary, meal times description, previous IUGR, other sx (D&V, fatigue), health of other children dietary history from dietician Examination: Growth and systems Signs of organic disease: distended abdo, chronic resp disease, heart failure, If organic disease possible FBC, ESR/CRP, U&E, creatinine, total protein and albumin, Ca2+,PO4 3 – , LFT, immunoglobulins, coeliac antibody screen Urinalysis - ncluding M, C&S. Further investigations: are indicated if there are suggestive symptoms or the faltering growth is severe, IEM screen, karyotype, serum lead (pica), sweat test, upper endoscopy and small intestinal biopsy, CXR, bone age, skeletal survey (NAI), abdominal US, head CT/MRI, oesophageal pH monitoring, ECG, faecal occult blood.

Answer 10

Provide dietetic input, whatever the cause, to support nutritional correction and education. Identify and correct associated comorbidities, e.g. developmental delay Input from a psychologist and social services may be useful Important to manage effectively as severe FTT may be associated with developmental and behavioural impairment

Answer 11

<6m and severe FTT

Answer 12

Increases in the early weeks of life and peaks around 6-8 weeks of age and usually improves by 3-4 months of age.

Answer 13

Truly excessive crying Sudden onset Parental post-natal depression may be a factor in presentation

Answer 14

Raised intracranial pressure (ICP) (could be infection or injury) Injury eg clavicle fracture, non-accidental injury Incarcerated inguinal hernia Infection e.g. urinary tract infection Corneal foreign body/abrasion

Answer 15

Hunger – insufficient breastmilk? More likely if losing centiles Excessiveness tiredness Non-IgE cow milk / soy protein allergy Lactose overload/malabsorption Gastro-oesophageal reflux disease

Answer 16

Exclude medical cause Parental education and reassurance. It is often helpful to explain to caregivers the potential causes of crying that have been excluded and the reasons for excluding each condition. Assess parental emotional state and mother-baby relationship: invite the parent/s to talk about how stressful it is to care for a baby who cries persistently. ascertain whether the parent is worried that she/he is depressed screen for postnatal depression using the Edinburgh Postnatal Depression Scale

Answer 17

Transient/physiological in infants- ? Why ◦ Short, narrow oesophagus. ◦ Delayed gastric emptying. ◦ Shorter, lower oesophageal sphincter that is slightly above, rather than below, the diaphragm. ◦ Liquid diet and high caloric requirement, putting a strain on gastric capacity. ◦ Larger ratio of gastric volume to oesophageal volume. * consumption of relatively large quantities of liquid feeds and the fact that infants are frequently recumbent Risk Factors Pre-mature Cerebral palsy Repaired Diaphragmatic hernia Repaired Oesophageal atresia Obesity Hiatus Hernia

Answer 18

Pneumonia * Dental erosions * Otitis media * Reflux oesophagition

Answer 19

Suspect GORD in an infant (up to 1 year of age) or child if they present with regurgitation and one or more of the following: ◦ Distressed behaviour shown, for example, by excessive crying, crying while feeding, and adopting unusual neck postures. ◦ Hoarseness and/or chronic cough. ◦ A single episode of pneumonia. ◦ Unexplained feeding difficulties, for example, refusing to feed, gagging, or choking. ◦ Faltering growth. * Note that: ◦ Children over 1 year of age may present with heartburn, retrosternal pain, and epigastric pain. ◦ Additional features such as episodic torticollis with neck extension and rotation may indicate the presence of Sandifer's syndrome.

Answer 20

Frequent, forceful (projectile) vomiting-Suggests hypertrophic pyloric stenosis in infants up to 2 months old. Bile-stained (green or yellow-green) vomit -Suggests intestinal obstruction. Abdominal distension, tenderness, or palpable mass-Suggests intestinal obstruction or another acute surgical condition. Blood in vomit (not caused by swallowed blood from a nosebleed or ingested from a cracked maternal nipple)- Suggests an important and potentially serious bleed from the oesophagus, stomach, or upper gut. Bulging fontanelle or altered responsiveness (for example lethargy or irritability)-Suggests raised intracranial pressure (for example caused by meningitis). Rapidly increasing head circumference (more than 1 cm each week); persistent morning headache and vomiting worse in the morning-Suggests raised intracranial pressure (for example caused by hydrocephalus or a brain tumour). Blood in the stool-Suggest a variety of conditions, including bacterial gastroenteritis and infant cows’ milk protein allergy. Chronic diarrhoea- Suggests cows’ milk protein allergy. With, or at high risk of, atopy-Suggests cows' milk protein allergy. Dysuria-Suggests a urinary tract infection (UTI), especially when accompanied by featured such as fever irritability, lethargy, jaundice, haematuria, and offensive urine. Appearing unwell or fever-Suggests infection. Onset of regurgitation and/or vomiting after 6 months of age or persisting after 1 year of age-Suggests a cause other than reflux, for example UTI.

Answer 21

Reassurance and review * For breastfed infants with frequent regurgitation and marked distress: * If symptoms persist despite breastfeeding assessment and advice: ◦ Consider prescribing a 1–2 week trial of alginate therapy (for example Gaviscon® Infant). * For formula-fed infants with frequent regurgitation and marked distress * Reduce the volume of feeds only if this is excessive for the child's weight (a total feed volume of 150 mL/kg body weight over 24 hours [6–8 times a day] is usually recommended), then * Offer a 1–2 week trial of smaller, more frequent feeds (while maintaining an appropriate total daily amount of milk) unless the feeds are already small and frequent, then * Offer a 1–2 week trial of feed thickeners, such as a pre-thickened formula (for example Enfamil AR® and SMA Staydown®) or a thickener that can be added to the usual infant formula (for example Instant Carobel®). * If this stepped care approach is not successful, stop the thickened formula and offer a 1–2 week trial of alginate therapy (Gaviscon® Infant) added to formula. * If symptoms improve after a 1–2 week trial of alginate therapy: ◦ Continue with the treatment. ◦ Advise the parents or carers to stop treatment at regular intervals (for example every 2 weeks) in order to see if symptoms have improved and if it is possible to stop treatment completely. * Trial of PPI/H2 receptor antagonist 4 weeks if still troublesome symptoms. * Referral to paeds.

Answer 22

Seek help from NSPCC helpline All practices have a Local Safeguarding Children Board. Document all concerns FGM you must report to the police If child is in immediate danger – consider the police If only considering maltreatment, gather advice and have review appt

Answer 23

stress a lack of sleep depression anxiety skipping meals alcohol use

Answer 24

Migraines may have a genetic cause, since the condition tends to run in families. Other factors that could trigger it include: stress anxiety hormone changes in females bright or flashing lights tobacco use caffeine and alcohol consumption sleeping too much or too little strong smells certain foods, such as: chocolate matured cheeses processed meats

Answer 25

Auras, emotional, stress, tiredness, food, bright lights, alcohol, chocolate

Answer 26

- Headache symptoms coincide with menstrual period, few days before and after

Answer 27

Using medication for over 3 months, not helping = triptans, opioids, paracetamol, aspirin, NSAIDs >15 days a month

Answer 28

Severe unilateral pain, red eye, short to few hour duration Repeated attacks then pain free period

Answer 29

udden onset, thunderclap headache 🡪 SAH Neck stiffness + Photophobia 🡪 Meningitis New onset cognitive dysfunction/personality change 🡪 Lesion / haemorrhage Decreased level of consciousness 🡪 raised intracranial pressure Recent history of head trauma (<3months) 🡪 Subdural haemorrhage Tender temporal region + jaw pain 🡪 Temporal artertitis

Answer 30

seizures, neausea, drowsiness, visual changes, speech problems, personality changes, progressive weakness/paralysis

Answer 31

education, stress, sleep, smoking

Answer 32

A classification of skin based on how it reacts to sun exposure A combination of constitutional colour (melanin) + UV sensitivity (tanning) They are used mainly for classifying skin types for dermatological treatments or research studies

Answer 33

Sudden onset itching Rash covering entire body Rash is non-blanching Type of itching – burning = indicative of Hodgkin Fevers / Night sweats / weight loss

Answer 34

Eczema – inflammation of dermis and epidermis usually by IgE hypersensitivity reactio Dry skin – commonly seen in elderly patients due to trophic changes or venous changes on the legs and arms. Psoriasis – Autoimmune condition causing abnormal keratinocyte growth infections like scabies hives/allergies - histamine release leads to fluid in dermis

Answer 35

Always emollient. Better ones are more paraphing based emollients and oat milk based. Zeroveen and Atroveen are good choices as little to no reactive compounds. Topical steroid: 1%hydrocortisone cream to start 0.025% Betnovate 0.05% Betnovate Dermovate Beyond this – Specialist level care is required but Broad immunomodulators like Tacrolimus or Monoclonal antibody therapy

Answer 36

topical potent steroids + topical vit D emollients salicylic acid can reduce scaliness light therapy methotrexate and DMARDs

Answer 37

Wash all bedding and clothing and isolate contact with clothes and bedding to prevent spread Permethrin 5% cream as an insecticide. To treat the itch: Topical Tea tree oil and Calamine lotion can sooth the skin, Antihistamines orally can help calm the itch. Topical steroids can be used if this doesn’t work but needs prescription

Answer 38

Usually, Hives are best treated with OTC antihistamines like cetirizine Sometimes, if hives persist, can trial local creams like Menthol creams. Severe hives that aren’t going with usual treatments can need oral steroids like a short course of prednisolone Chronic Urticaria can require Cyclosporins, Leukotriene receptor antagonists and Antibodies like Omaluzimab

Answer 39

Renal failure Liver disease Iron deficiency anaemia Polycythaemia Hyper/hypothyroidism Lymphoma Diabetes mellitus HIV infection Drugs: opiates, statins, ACE-inhibitors, chloroquine

Answer 40

Lichen planus Lichen simplex Dermatitis herpetiformis Atopic dermatitis (eczema) Venous eczema Asteatotic eczema Scabies Urticaria Psoriasis

Answer 41

Communications Patient Care including Nutrition / Hydration Values and Behaviour

Answer 42

Relevant screening tests for organic disease based on body system (therapeutic investigations have very little effect on patients) Clinicians worry about knowledge gaps but studies show they are more likely to make errors by discounting differentials too early Good management is a compassionate explanation of the situation Some patients welcome syndrome based descriptors because they validate their experience Some will also desire a detailed explanation of how their body may be dysfunctional Management techniques: self-management support, CBT and pharmacotherapy

Answer 43

bloods: DM, thyroid, alchoho, B12/folate neuro imaging may need same day neuro referral

Answer 44

Appearance Behaviour – Speech, Affect, Movement Thought – Content, Form Cognition – Orientation and perception Inisght – Awareness of illness

Answer 45

Mononeuropathies result in a localised sensory disturbance in the area supplied by the damaged nerve

Answer 46

Radiculopathy occurs due to nerve root damage and results in sensory disturbances in the affect dermatomes

Answer 47

Peripheral neuropathy typically causes symmetrical sensory deficits in a “glove and stocking”

Answer 48

DM shingles-post herpatic neuralgia B12 deficiwncy alchol AI-RA, SLE lyme disease syohilis HIV toxins heriditary - charcot-marie tooth

Answer 49

Thalamic lesions result in contralateral sensory loss. The most common cause of a thalamic lesion is a stroke.

Answer 50

Spinal cord damage results in sensory loss both at and below the level of involvement, in a dermatomal pattern, due to the impact of injury on the sensory tracts running through the cord.

Answer 51

motor lateral corticospinal veritcal corticospinal tract

Answer 52

sensory dorsal columns - deep touch, vibration, proprioception lateral spinothalamic - pain, temp ventral spinothalamic - light touch

Answer 53

Removal of equipment otherwise keeping the patient alive Stopping of medications Expediting their passing with medication Withholding further treatment Refusing to eat or drink Refusing to take medications

Answer 54

Written statement that sets down the preferences, wishes, beliefs and values regarding the future care of the patient. Aims to provide a guide to anyone who might have to make decisions in their best interest if they have lost the ability to make or communicate decisions. Can cover any aspect of their future health or social care: how they want any religious or spiritual beliefs to be reflected in their care where they would like to be cared for, for example at home or in a hospital, a nursing home, or a hospice how they like to do things, for example if they prefer a shower instead of a bath, or like to sleep with the light on practical issues, for example who will look after their dog if they become ill An advance statement is not legally binding, but anyone making decisions about their care must take it into account.

Answer 55

A decision a patient can make now to refuse a specific type of treatment at some time in the future. It lets the family, carers and health professionals know their wishes about refusing treatment if they're unable to make or communicate those decisions themselves. Treatments they’re deciding to refuse must all be named in the advance decision. It need to be clear about all the circumstances in which they want or don’t want to refuse this treatment.

Answer 56

With an advance decision the patient can refuse a treatment that could potentially keep them alive. In order to refuse life-sustaining treatment advance decisions need to be: written down signed by the patient signed by a witness

Answer 57

An advance decision is legally binding as long as it: complies with the Mental Capacity Act is valid applies to the situation An advance decision may only be considered valid if: they're aged 18 or over and had the capacity to make, understand and communicate their decision when they made it they specify clearly which treatments they wish to refuse they explain the circumstances in which they wish to refuse them it's signed by them (and by a witness if they want to refuse life-sustaining treatment) they have made the advance decision of their own accord, without any harassment by anyone else they have not said or done anything that would contradict the advance decision since they made it (for example, saying that they've changed their mind) If it's valid and applies to the situation, an advance decision gives their health and social care team clinical and legal instructions about their treatment choices. An advance decision will only be used if, at some time in the future, they're not able to make their own decisions about their treatment.

Answer 58

Gives another person the right to make decisions about the patients care and welfare They can appoint just 1 attorney, or more than 1 attorney, to act. A health and welfare LPA gives their attorney the power to make decisions about their daily routine (washing, dressing, eating), medical care, moving into a care home and life-sustaining medical treatment. It can only be used if they're unable to make their own decisions. If the patient made a decision to refuse future medical treatment (advance decision) in advance of losing their mental capacity, the attorney cannot override their decision unless the LPA was made later and specifies that they have the power to do so.

Answer 59

STOPP-this is a tool used too reduce the prescription of unnecessary drugs in the palliative patient

Answer 60

ready - can we talk about health and care expect - what do you know diagnosis matters - what is important actions - what we can do plan

Answer 61

think about future talk with family and friends record thoughts discuss planw with dr share this info

Answer 62

liver enzymes found in hepatocytes -> leak into blood stream when the liver is damaged / inflamed ALT + AST can be raised in conditions involving liver scarring (NAFLD and ARLD)

Answer 63

can be indicative of obstruction / cholestatic liver disease Alkaline Phosphatase is also involved in the bile duct and bones meaning its not just liver specific.

Answer 64

can indicate alcohol usage and NAFLD

Answer 65

endo: DM, diabetes insipidus, testosterone deficiency, menopause, thyroif, obesity cardiac: HF renal failure rheum: OA, SLE, PMR, IA infection: HIV, hep, EBV gastro: coeliac, IBD neuro: migraine, MS, narcoplepsy, insomnia psychogenic: fibromyalgia, stress, depression, anxiety, ME CFS haem: anaemia, polycythaemia malignancy