GP

Question 1

What questionnaire’s or criteria can you use to assess a patient’s mood/depression?

Answer 1

• Patient health questionnaire 9
• Hospital anxiety and depression scale
• Beck depression inventory

Question 2

Benefits of breastfeeding

Answer 2

• Breast milk meets all of the baby’s nutritional needs
• Breast milk protects the baby from infections and diseases
• Breastfeeding provides health benefits for the mother (reducing risk of breast cancer, ovarian cancer, osteoporosis, obesity)
• Breast milk is available whenever the baby needs it
• Breastfeeding can build a stronger emotional bond between the mother and baby

(Giving nothing but breast milk is recommended for about the first 6 months of the baby’s life)

Question 3

3 things that newborn health screening programme does

Answer 3

• Immediate physical examination
• Newborn heel prick test - Cystic fibrosis, sickle cell disease, congenital hypothyroidism
• Cardiac examination

Question 4

3 things that childhood health screening programme does

Answer 4

Physical examination looking for:
- undescended testis, congenital heart disease, breathing, rashes

Checking the weight, head circumference

Assessment of organs - eyes, heart, lungs, abdomen, genitalia

Question 5

Signs and symptoms of anorexia nervosa

Answer 5

BMI <13 = high risk,, 13-15 (medium risk)
Rate of weight loss - more than 0.5kg per week
Pulse rate <40bpm
Bp <90/70
Blood test - basically deficient in most things (potassium, sodium, magnesium, phosphate, glucose, albumin)

Question 6

What investigations do you do for anorexia and which questionnaire do you use?

Answer 6

First line - FBC
Serum chemistry - metabolic alkalosis (in patient induced vomiting)

Questionnaire: SCOFF questionnaire

Can use the SCOFF questionnaire
Do you make yourself sick because you feel uncomfortably full?
Do you worry that you have lost control over how much you eat?
Have you recently lost more than (one stone) 14lb(6.35kg) in a 3 month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that food dominates your life?

Question 7

State 3-5 components of an annual diabetic review

Answer 7

• Blood pressure
• HbA1c
• Diabetic retinopathy
• BMI measurement
• Foot check (diabetic foot)

Question 8

What is the CHADSVASC and ORBIT score used for?

Answer 8

CHA2DS2-VASc score helps to estimate the risk of stroke in patients with AF

ORBIT score (outcomes registry for better informed treatment of AF)
- Helps to estimate the risk of major bleeding in patients with AF who are treated with anticoagulant therapy. (kind of seeing if benefit of anticoagulants outweigh the risk of bleeding while on anticoagulants)

Question 9

What is a stoma?

Answer 9

A stoma is a surgically made hole in the abdomen that allows body waste to be removed from the body directly through the end of the bowel into a collection bag.

Question 10

Some nephrotoxic drugs

Answer 10

Ace inhibitors
Cisplatin
Amphotericin B
Methotrexate
NSAIDS
Aminoglycosides - gentamicin

Question 11

5 types of renal replacement therapy

Answer 11

Haemodialysis
Peritoneal dialysis
Kidney transplant
Haemofiltration
Haemodiafiltration

Question 12

Indications for dialysis

Answer 12

• Presence of clinical features of uraemia
• Severe hyperkalemia
• Severe metabolic acidosis
• Severe renal failure (urea >30, creatinine >500)

Question 13

Pros and cons of haemodialysis and peritoneal dialysis

Answer 13

Pro - 3 days of dialysis per week
Cons
- Need to TRAVEL regularly for treatment as most sessions are carried out in dialysis clinic
- Need to avoid certain foods and fluid intake is restricted

Peritoneal dialysis
Pro - can be carried out at home
Cons
- Needs to be done everyday
- Catheter is left there permanently
- Risk of developing peritonitis
- Dialysis fluid used can cause malnutrition as it can reduce protein levels

Question 14

Continuous ambulatory peritoneal dialysis vs automated peritoneal dialysis

Answer 14

CAPD main advantage
- Equipment is portable

Disadvantage - need to spend at least 2 hours a day performing dialysis

APD main advantage
- Dialysis free in the day, allowing more freedom to engage in daily activities
- Improved quality of life

Disadvantage - A dialysis machine needs to be kept in the house which may be bulky and require regular maintenance - not practical for some people.

Question 15

Renal transplant pros and cons

Answer 15

Pros
- Can stop dialysis
- Improved quality of life with normal diet and activity

Cons
- Operative complications e.g Infection, DVT
- Side effect of immunosuppressive drugs
- Opportunistic infections
- Recurrence of original disease in the transplant

Question 16

2 situations where PSA testing is indicated

Answer 16

If symptoms suggest bladder outlet obstruction is due to a benign prostatic enlargement

If a man is concerned about prostate cancer

If the prostate feels abnormal on rectal examination

Question 17

Pros and Cons of PSA testing

Answer 17

Pro - early detection of prostate cancer

Cons
- False positives as PSA levels can be elevated for other reasons e.g. inflammation, BPH, increased age
- False negatives - A normal PSA level does not guarantee absence of cancer
- (Can’t tell the difference between slow and fast growing tumour - may lead to over treatment which may lead to unnecessary side effects)

Question 18

8 week immunisation (state 3 things kids are given vaccines for)

Answer 18

6 in 1

Diphtheria
Tetanus
Pertussis (Whooping cough)
Polio
Haemophilus influenzae type B
Hepatitis B

DPPTHH

rotavirus, pneumococcal vaccine

Question 19

Why should metformin be withheld if a patient is undergoing radiological investigation with IV contrast?

Answer 19

It can lead to lactic acidosis (has a mortality of 30-50%)

Metformin should be withheld 48 hours prior to and post contrast. Serum creatinine should be measured prior to starting metformin

Question 20

Mechanism of beta blockers

Answer 20

Beta-adrenoceptor blocking drugs (beta-blockers) block the beta-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, and liver. In this way they block the effects of the hormone adrenaline, causing the heart to beat more slowly and with less force, which lowers blood pressure. Beta blockers also help widen veins and arteries to improve blood flow, which is why they are used in ischaemic heart disease.

Question 21

Conditions where beta blockers are contraindicated

Answer 21

Asthma, hypotension, third degree heart block

Question 22

Side effects of alpha blockers

Answer 22

• Postural hypotension
• Retrograde ejaculation
• Headache, nausea, dizziness

Question 23

Why is folic acid given with methotrexate? When specifically must it be taken?

Answer 23

Folic acid is given to counteract the folate antagonist action of methotrexate (dihydrodrofolate reductase)

Folic acid is given at 5mg once weekly on any day as long as not the same day as methotrexate (it would reduce the effectiveness on methotrexate)