GP Flashcards
how often is breast screening?
every 3 years
In what age range is bowel screening offered?
54-74 years
How often is bowel screening done?
every 2 years
what are 4 screening tests in pregnancy?
Hep B, HIV and syphilis screen
Down’s, pataus and edwards screen - combined/quadruple test
sickle cell/thallsaemia test
20 week anomaly scan
diabetic eye screen - if have diabetes
what are 3 new born screening tests?
NIPE
hearing test
blood spot heel prick test
when do you offer Abx in acute bronchitis?
if CRP >20 offer delayed prescription
if CRP >100 offer ABx now
what is the first line abx in acute bronchitis?
doxycycline
not in preggos or children - Amoxacillin
what is a Meibomian cyst?
internal infection of meibomian glands in eyelid causing lump - like what dan had - hot compress and analgesia should go away on own
what is the management for gingivostomatitis (ulcers) in HSV?
oral acyclovir and chlorohexadine mouth wash
what is the management for genital herpes?
acyclovir
what is the management of herpes in pregnancy?
elective c-section if primary genital infection >28 weeks
which herpes virus is most commonly responsible for herpes encephalitis?
HSV-1
How often do diabetics get their HbA1c measured?
every 3-6 months
what is the name of the darkening skin on neck axilla and groin seen in insulin resistance?
acanthosis nigricans
what medication can be added to patients on metformin with an existing CVD or QRisk >10%?
SGLT-2 inhibitor - dapagliflozin
what is the MOA of metformin?
increases insulin sensitivity and decreases glucose production - a biguanide
what are 2 side effects of metformin?
GI symptoms
Lactic acidosis - secondary to AKI
NOT hypos NOT weight gain
what is the MOA of SGLT-2 inhibitors?
prevent sodium glucose co-transporter 2 protein from reabsorbing glucose in proximal tubules allowing for greater excretion
what are 8 side effects of SGLT-2 inhibitors?
Glycosuria
Increased urinary output and frequency
UTIs + genital infections
weight loss
DKA
Lower limb amputation
Fourniers gangrene
Hypoglycaemia
what are 4 side effects of pioglitazone?
weight gain
heart failure
increased risk bone fractures
small increase risk bladder cancer
what are 2 side effects of sulfonylureas?
weight gain
hypoglycaemia
what is a rapid acting insulin and how long does it work for?
Novorapid - works after 10 mins for 4 hours
what is a short acting insulin and how long does it work for?
Actrapid - works after 30 mins for 8 hours
what is an intermediate acting insulin and how long does it work for?
Humulin I - works after 1 hour for 16 hours
what is a long acting insulin and how long does it work for?
Levemir and lantus - works after 1 hour for 24 hours
what is the 1st line antihypertensive in T2Dm?
acei
what are 4 signs of PE? (CXR and ECG)
Fleischner sign = dilated central pulmonary vessel. Westermark sign (collapse of vasculature distal to PE) Hampton’s hump - wedge-shaped infarct
ECG features - sinus tachycardia and/or ST depression.
what is the management of pericarditis?
NSAIDs
what is the MOA of N-acetylcysteine?
Replenishes body stores of glutathione preventing hepatocyte damage.
what is the moa of methotrexate?
competitively inhibits dihydrofolate reductase
what is the chronic management for ACS?
Block An ACS
Beta Blocker + ACEi + Aspirin + Clopidogrel + Statin
what is the MOA of aspirin?
Cox-1 inhibitor
what is the MOA of clopidogrel?
P2Y12 inhibitor
what is severe asthma in adults?
PEF 33–50% best or predicted
RR ≥25/min
HR ≥110/min
inability to complete sentences
what is life threatening asthma in adults?
PEF <33% best or predicted
SpO2 <92%
PaO2 <8 kPa
‘normal’ PaCO2 (4.6–6.0 kPa)
altered conscious level
exhaustion
arrhythmia
hypotension
cyanosis
silent chest
poor respiratory effort
what is chronic suppurative ottitis media?
otitis media >2 weeks with recurrent ear discharge
what risk score is used for pressure ulcers?
Waterlow score
what is the name of the sign where muscle twitching is elicited in the face by tapping in front of the ear which is indicative of hypocalcaemia?
Chvostek sign
what is examination finding in otitis media with effusions?
grey tympanic membrane
fluid level
loss of cone of light reflex
AKA glue ear
what is examination findings in suppurative otitis media?
mucopurulent discharging ear
where does the VZV lay dormant?
dorsal root or cranial nerve ganglia
what are 3 risk factors for shingles?
increased age
HIV
Immunocompromised
What are the most commonly affected dermatomes in shingles?
T1-L2
what is the presentation of shingles?
prodromal period of burning pain over dermatome for 2-3 days, headache, fever, lethargy
rash - erythematous, macular rash over affected dermatome, becomes vesicular, well demarcated to dermatome
what is the management of shingles?
Infectious for 5-7 days - until vesicles have crusted
1 - Paracetamol and nsaid analgesia
2 - Neuropathic agents
3 - Oral corticosteroids - if pain is severe and not responding
Aciclovir/famiciclovir/valaciclovir within 72h unless patient <50 years and mild rash, mild pain and no risk factors
what is one of the benefits of prescribing antivirals in shingles?
reduces incidence of post-herpetic neuralgia
what are 3 complications of shingles?
Post-herpetic neuralgia - most common
HZ ophthalmicus - affecting occular division of TJN
HZ oticus - ramsay hunt syndrome
what kind of vaccine is the chickenpox vaccine?
live attenuated
when are people given the ‘shingle vaccine’?
aged 70-79
live attenuated - contraindicated in immunosuppression
give SC
what deaths are alway referred to the coroner?
Sudden on unexpected death, or within 24h of hospital admission
Unnatural causes - accidents, suicides, violence, trauma
Unclear/disputed cause
Death shortly after/during medical procedures
Death related to neglect or self-neglect
death in custody/state detention
occupational or industrial diseases
what is the role of the medical examiner?
independently review clinical record of deceased and discuss circumstances of death with certifying doctor
communicate with family to explain cause of death and address concerns
referral to coroners
what is 1a on the death certificate?
disease of condition leading directly to death
what is 1b/c/d on the death certificate?
other disease or condition leading to 1a/1b/1c
what is part 2 on the death certificate?
other significant conditions contributing to death but not relating to disease or condition causing it
when can frailty of old age be used as a cause of death?
Patient is >80
personally cared for patient over long time - several months
Observed gradual decline in general health and functioning
Not aware of any identifiable disease or injury that contributed to death
Certain no reason the death should be reported to the coroner
