GP

Question 1

Way to report adverse drug reactions to meds?

Answer 1

Yellow Card scheme

It is run by the Medicines and Healthcare products Regulatory Agency (MHRA).

Question 1

The following should be reported (taken from the MHRA website) to the yellow card scheme?

Answer 1

• all suspected adverse drug reactions for new medicines (identified by the black triangle symbol) should be reported
• all suspected adverse drug reactions occurring in children, even if a medicine
  has been used off-label
• all serious* suspected adverse drug reactions for established vaccines and
  medicines, including unlicensed medicines, herbal remedies, and medicines used off-label

*reactions which are fatal, life-threatening, disabling or incapacitating, result in or
prolong hospitalisation, or medically significant are considered serious.

Question 2

Info about the yellow card scheme?

Answer 2

Yellow Cards are found at the back of the BNF or reports can be completed online (www.yellowcard.gov.uk)

any suspected reactions (not just confirmed) should be reported

patients can report adverse events

Yellow Cards are sent to the MHRA who in collate and assess the information. In turn the MHRA may consult with the Commission on Human Medicines (CHM), an independent scientific advisory body on medicines safety

Question 3

A large number of criteria must apply before a national screening programme is considered. For example:

Answer 3

There must be a test available which picks up a disease or condition before symptoms develop.

This test must be reasonably accurate. It should not be positive for too many people who do NOT have the condition and it must not miss many people who DO have the condition.

The test must be reasonably simple to perform and acceptable to the people having the test.

The benefits of the screening test must be greater than any potential harm or risks it could cause.

The cost of the test, across the whole population, must not be more than the benefits it gives.

There must be a treatment at the early stage of the condition or disease which will make a difference to the outcome. There is no point in screening for something if it cannot be successfully treated.

The condition being screened for must have a significant impact on health and well-being.

There must be an organised, efficient plan for what happens if the test is positive.

Question 4

Screening programmes in UK?

Answer 4

Abdominal Aortic Aneurysm Screening Programme for men the year they turn 65.

Bowel Cancer Screening Programme every 2 years for people between the ages of 54 and 74 (shortly to become aged 50 to 74); people can choose to continue past the age of 74 by requesting the test every 2 years.

Breast Screening Programme every 3 years for women between the ages of 50 and 70; women can choose to continue past the age of 70 by requesting the test every 3 years.

Cervical Screening Programme every 3 years for women between the ages of 24.5 and 50 and then every 5 years for women between the ages of 51 and 64.

Diabetic Eye Screening Programme every year for people with diabetes.

Fetal Anomaly Screening Programme offered in the first trimester of pregnancy to all pregnant women.

Infectious Diseases in Pregnancy Screening Programme to all pregnant women.

Newborn and Infant Physical Examination Screening Programme to all newborn babies.

Newborn Blood Spot Screening Programme to all newborn babies.

Newborn Hearing Screening Programme to all newborn babies.

Sickle Cell and Thalassaemia Screening Programme to all pregnant women.

Question 5

AAA screening?

Answer 5

single abdo USS too all men 65yrs and over

Question 6

Bowel ca screening?

Answer 6

FIT= every 2 years for people between the ages of 54 and 74 (shortly to become aged 50 to 74); people can choose to continue past the age of 74 by requesting the test every 2 years.

Question 7

Breast ca screening?

Answer 7

every 3 years for women between the ages of 50 and 70; women can choose to continue past the age of 70 by requesting the test every 3 years.

Question 8

Cervical ca screening?

Answer 8

every 3 years for women between the ages of 25 and 50 and then every 5 years for women between the ages of 51 and 64

Question 9

Diabetic eye screening?

Answer 9

every yr for pt with diabetes

Question 10

Fetal anomaly screening?

Answer 10

Screening for 11 physical conditions as part of the 20-week scan is offered to all pregnant women and takes place between 18⁺⁰ and 20⁺⁶ weeks of pregnancy.

Question 11

Infectious Diseases in Pregnancy Screening Programme?

Answer 11

A blood test should be offered as early as possible in pregnancy to ensure timely referral and management of care.

HIV
hepatitis B
syphilis

Question 12

Newborn and Infant Physical Examination Screening Programme?

Answer 12

within 72hrs of birth and 6 to 8 weeks

Question 13

Newborn Blood Spot Screening Programme?

Answer 13

normally when 5d old

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)

Question 14

Newborn Hearing Screening Programme?

Answer 14

ideally within the first 4 to 5 weeks after they are born, up until 3m of age

automated otoacoustic emission (AOAE) test. Some babies also need a second test, the automated auditory brainstem response (AABR) test.

Question 15

Sickle Cell and Thalassaemia Screening Programme?

Answer 15

All pregnant women are offered screening for thalassaemia.

All biological fathers are offered screening if the pregnant woman is a genetic carrier for sickle cell disease or thalassaemia.

Question 16

Primary prevention?

Answer 16

(Before Disease Occurs)

Goal: Prevent the onset of disease or injury.

Methods: Health education, vaccination, lifestyle modifications (e.g., exercise, healthy diet, avoiding smoking), environmental safety measures.

Example: Vaccination against measles, wearing seat belts, promoting hand hygiene.

Question 17

Secondary prevention?

Answer 17

(Early Detection and Intervention)

Goal: Detect and treat diseases in their early stages to prevent progression.

Methods: Screening programs, regular check-ups, early medical interventions.

Example: Mammograms for breast cancer, blood pressure screenings, Pap smears for cervical cancer.

Question 18

Tertiary prevention?

Answer 18

(Managing and Reducing Impact of Disease)

Goal: Reduce complications and improve quality of life for those with existing diseases.

Methods: Rehabilitation, medical treatment, support groups, chronic disease management.

Example: Physical therapy for stroke patients, insulin therapy for diabetes, cardiac rehabilitation after a heart attack.

Question 19

Hyperthermia/Hyperpyrexia?

Answer 19

describes an excessive elevation of body temperature above the average normal temperature.

Question 20

Hyperthermia/Hyperpyrexia causes?

Answer 20

It may be caused by the vast majority of agents which precipitate a pyrexia of unknown origin, however, relatively common causes include:

excessive sun exposure

bacterial septicaemia

viral infection e.g. infectious mononucleosis

rarer= syndrome of malignant hyperpyrexia and thyrotoxic crisis.

Question 21

Rare examples of hyperthermia causes?

Answer 21

syndrome of malignant hyperpyrexia and thyrotoxic crisis.

Question 22

Hyperthermia temp?

Answer 22

37.5–38.3 °C

Question 23

Chronic rhinosinusitis?

Answer 23

affects up to 1 in 10 people. It is generally defined as an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer.

Question 24

Chronic rhinosinusitis predisposing factors?

Answer 24

atopy: hay fever, asthma nasal obstruction e.g. Septal deviation or nasal polyps recent local infection e.g. Rhinitis or dental extraction swimming/diving smoking

Question 25

Chronic rhinosinusitis features?

Answer 25

facial pain: typically frontal pressure pain which is worse on bending forward nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection nasal obstruction: e.g. 'mouth breathing' post-nasal drip: may produce chronic cough

Question 26

Management of recurrent or chronic sinusitis?

Answer 26

avoid allergen intranasal corticosteroids nasal irrigation with saline solution

Question 27

Red flags in chronic rhinosinusitis?

Answer 27

unilateral symptoms persistent symptoms despite compliance with 3 months of treatment epistaxis

Question 28

Chronic sinusitis vs chronic rhinosinusitis?

Answer 28

same thing

Question 29

Mesenteric adenitis?

Answer 29

inflamed lymph nodes within the mesentery

Question 30

Mesenteric adenitis features?

Answer 30

an cause similar symptoms to appendicitis and can be difficult to distinguish between the two. It often follows a recent viral infection and needs no treatment

Question 31

Mesenteric adenitis Tx?

Answer 31

needs no Tx, it is self-limiting

Question 32

Mesenteric adenitis vs appendicitis?

Answer 32

Mesenteric adenitis is.... Pain starts in RIF Coryzal symptoms due to viral infection before hand no anorexia or vomiting like appendicitis Higher fever More normal CRP and WBC Self limiting in 24-48 hours

Question 33

idiopathic arthritis aka...

Answer 33

Juvenile idiopathic arthritis (JIA)

Question 34

BMI =?

Answer 34

BMI = weight (kg) / height (m) squared

Question 35

BMI ranges?

Answer 35

Underweight < 18.49 Normal 18.5 - 25 Overweight 25 - 30 Obese class 1 30 - 35 Obese class 2 35 - 40 Obese class 3 > 40

Question 36

Normal BMI?

Answer 36

Normal 18.5 - 25

Question 37

Underweight BMI?

Answer 37

Underweight < 18.49

Question 38

Overweight BMI?

Answer 38

Overweight 25 - 30

Question 39

The management of obesity consists of a step-wise approach, what is this?

Answer 39

conservative: diet, exercise medical= orlistat, liraglutide surgical

Question 40

Obesity Mx= orilistat MOA?

Answer 40

pancreatic lipase inhibitor

Question 41

Obesity Mx= orilistat adverse effects?

Answer 41

faecal urgency/incontinence and flatulence. A lower dose version is now available without prescription ('Alli')

Question 42

Obesity Mx= orilistat - when should it be used?

Answer 42

It should only be prescribed as part of an overall plan for managing obesity in adults who have: - BMI of 28 kg/m^2 or more with associated risk factors, or - BMI of 30 kg/m^2 or more - continued weight loss e.g. 5% at 3 months - orlistat is normally used for < 1 year

Question 43

Obesity Mx= Liraglutide MOA?

Answer 43

a glucagon-like peptide-1 (GLP-1) mimetic that is used in the management of type 2 diabetes mellitus (T2DM)

Question 44

Obesity Mx= Liraglutide how is it given?

Answer 44

given as a once daily subcutaneous injection when used in the management of T2DM it was noted to cause weight loss in a significant proportion leading to research interest in its use in obesity

Question 45

Obesity Mx= Liraglutide - criteria for use?

Answer 45

person has a BMI of at least 35 kg/m² prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)

Question 46

Obesity in children definition?

Answer 46

Defining obesity is more difficult in children than adults as body mass index (BMI) varies with age. BMI percentile charts are therefore needed to make an accurate assessment.

Question 47

Obesity in children- when to consider Mx?

Answer 47

consider tailored clinical intervention if BMI at 91st centile or above. consider assessing for comorbidities if BMI at 98th centile or above

Question 48

Obesity in children- most common cause?

Answer 48

most common cause of obesity in childhood is lifestyle factors. Other associations of obesity in children include: Asian children: four times more likely to be obese than white children female children taller children: children with obesity are often above the 50th percentile in height

Question 49

Cause of obesity in children?

Answer 49

growth hormone deficiency hypothyroidism Down's syndrome Cushing's syndrome Prader-Willi syndrome

Question 50

Consequences of obesity in children?

Answer 50

orthopaedic problems: slipped upper femoral epiphyses, Blount's disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains psychological consequences: poor self-esteem, bullying sleep apnoea benign intracranial hypertension long-term consequences: increased incidence of type 2 diabetes mellitus, hypertension and ischaemic heart disease

Question 51

When may bariatric surgery be used for obesity?

Answer 51

for many obese patients who fail to lose weight with lifestyle and drug interventions the risks and expense of long-term obesity outweigh those of surgery.

Question 52

Who should be referred for bariatric surgery?

Answer 52

it is complicated very obese patients (e.g. BMI 40-50 kg/m^2 etc) are referred early for bariatric surgery, particularly if they have other conditions that may be caused by it (e.g. type 2 diabetes mellitus, hypertension), rather than it being a 'last resort'

Question 53

Types of bariatric surgery?

Answer 53

Primarily restrictive operations Primarily malabsorptive operations Mixed operations

Question 54

Types of bariatric surgery= Primarily restrictive operations?

Answer 54

laparoscopic-adjustable gastric banding (LAGB)= it is normally the first-line intervention in patients with a BMI of 30-39kg/m^2; produces less weight loss than malabsorptive or mixed procedures but as it has fewer complications sleeve gastrectomy= stomach is reduced to about 15% of its original size intragastric balloon= the balloon can be left in the stomach for a maximum of 6 months

Question 55

Types of bariatric surgery= Primarily restrictive operations- laparoscopic-adjustable gastric banding (LAGB)?

Answer 55

it is normally the first-line intervention in patients with a BMI of 30-39kg/m^2 produces less weight loss than malabsorptive or mixed procedures but as it has fewer complications

Question 56

Types of bariatric surgery= Primarily restrictive operations- sleeve gastrectomy?

Answer 56

stomach is reduced to about 15% of its original size

Question 57

Types of bariatric surgery= Primarily restrictive operations- intragastric balloon?

Answer 57

the balloon can be left in the stomach for a maximum of 6 months

Question 58

Types of bariatric surgery= Primarily malabsorptive operations?

Answer 58

biliopancreatic diversion with duodenal switch usually reserved for very obese patients (e.g. BMI > 60 kg/m^2)

Question 59

Types of bariatric surgery= Mixed operations?

Answer 59

Roux-en-Y gastric bypass surgery is both restrictive and malabsorptive in action

Question 60

Absorption sites?

Answer 60

Duodenum = Metal ions + Folate (first) Jejunum = all vitamins except Ileum = B12 Large intestine = U&E (Na K water)

Question 61

Dehydration?

Answer 61

common presentation in the elderly and can present with nonspecific symptoms

Question 62

Dehydration- exam findings?

Answer 62

Examination findings have poor sensitivity and specificity. They include dry mucous membranes, loss of skin turgor, sunken eyes, and in severe dehydration tachycardia, hypotension and delirium.

Question 63

Varicose veins?

Answer 63

dilated, tortuous, superficial veins that occur secondary to incompetent venous valves, allowing blood to flow back, away from the heart Whilst extremely common, the vast majority of patients do not require any intervention.

Question 64

Varicose veins- why do they occur?

Answer 64

most commonly occur in the legs due to reflux in the great saphenous vein and small saphenous vein

Question 65

Varicose veins= RFs?

Answer 65

increasing age female gender pregnancy the uterus causes compression of the pelvic veins obesity

Question 66

Presentation of varicose veins?

Answer 66

For many patients, the cosmetic appearance may prompt presentation. However other patients may complain of symptoms: aching, throbbing itching some may present with Cx of varicose veins

Question 67

Cx of varicose veins?

Answer 67

a variety of skin changes may be seen bleeding superficial thrombophlebitis venous ulceration deep vein thrombosis

Question 68

Cx of varicose veins= skin changes?

Answer 68

varicose eczema (also known as venous stasis) haemosiderin deposition → hyperpigmentation lipodermatosclerosis → hard/tight skin atrophie blanche → hypopigmentation

Question 69

Cx of varicose veins= in Lipodermatosclerosis what is the hyperpigmentation due to?

Answer 69

secondary to haemosiderin deposition and the appearance of tight skin

Question 70

Ix for varicose veins?

Answer 70

venous duplex ultrasound: this will demonstrate retrograde venous flow

Question 71

Mx of varicose veins?

Answer 71

the majority of patients with varicose veins do not require surgery so just conservative treatments endothermal ablation: using either radiofrequency ablation or endovenous laser treatment foam sclerotherapy: irritant foam → inflammatory response → closure of the vein surgery: either ligation or stripping

Question 72

Mx of varicose veins- conservative Mx?

Answer 72

leg elevation weight loss regular exercise graduated compression stockings

Question 73

Mx of varicose veins- reasons for referral to secondary care include?

Answer 73

significant/troublesome lower limb symptoms e.g. pain, discomfort or swelling previous bleeding from varicose veins skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema) superficial thrombophlebitis an active or healed venous leg ulcer

Question 74

Assess hydration status of pt?

Answer 74

Hands= - Inspect the hands for relevant clinical signs - Assess and compare the temperature of the hands - Assess peripheral CTT - Assess skin turgor Pulses and blood pressure= - Palpate the patient’s radial pulse and assess rate/rhythm - Palpate the patient's brachial pulse and assess character - Measure the patient’s blood pressure Measure the patient's jugular venous pressure Face: - Inspect the eyes for signs relevant to the patient’s fluid status - Inspect the mouth for signs relevant to the patient’s fluid status Chest: - Calculate the patient’s respiratory rate - Assess central capillary refill time - Auscultate the patient’s heart sounds - Auscultate the patient's lungs Abdomen: - Position the patient lying flat on the bed, with their arms by their sides and legs uncrossed for abdominal inspection. - Inspect the patient’s abdomen for signs suggestive of hypervolaemia - Assess for shifting dullness if ascites is suspected Oedema: - Assess for sacral oedema - Assess for pedal oedema

Question 75

Viral exanthem?

Answer 75

an eruptive skin rash that is often related to a viral infection. Immunizations have decreased the number of cases of measles, mumps, rubella and chickenpox, but all viral skin infections require clinical care by a physician or other healthcare professional.