GP Flashcards
You want to start a patient on a statin. What should be measured?
Lipid levels
LFTs
CK if complains of muscle pains
Why measure lipid levels if you are going to start a statin on the basis of qrisk2 score anyway?
Very high (>7.5 with FHx or >9.0) levels should be referred to a specialist
A patient has familial hypercholestraemia. What treatment should be used?
Ezetamibe
When should vit D levels be checked?
High risk patients
S+S or low vit D or calcium
If vit D levels very low
Oral colecalciferol
Followed by prescribed adcal / calcichew / invita D3 dependant on calcium intake
If Vit D levels are a little low (30-50nmmol/l) what should be done?
Purchase own adcal / calcichew / invita D3 dependant on calcium intake
What should be offered for borderline vit D levels (50-75nmol/l)?
Advice
- sun
- oily fish/eggs/fortified cereal /milk
What is the GP management algorithm?
R - reach a shared understanding (reassurance) A - advice P - prescription R - referral I - investigations O - observations and follow up P - prevention
If an adult female patient complains of >2 uti signs and symptoms
Check for vaginal discharge type symptoms
Give antibiotics - 90% will be culture +ve as more than 2 symptoms
If an adult female under 65 presents with 1 or 2 uti symptoms what shoud be the following management?
Check if urine is cloudy
If cloudy dipstick
N+L or N - give ABX
L - send for culture and consider delayed ABX prescription
Neither - unlikely uti - consider other diagnosis
What management should be considered in a patient with uti symptoms who is over 65?
What if asymptomatic but dipstick +ve?
Culture and ABX
If asymptomatic do not treat or culture - asymptomatic bacteruria common
What should be done in a patient with an indwelling urinary catheter who presents systemically unwell?
Rule out other infection sources
Send for culture
Start ABX and change catheter
Which special cases should get a urine culture?
Symptomatic Pregnant Suspected pyelonephritis All men Previous failed treatment/no response Recurrent UTIs
What should be considered if a urine culture returns sterile pyuria?
Chlamydia trachomatis
TB
Renal pathology
Other non-culturable organisms
A urine culture returns with epithelial cells and mixed growth. What do these indicate? Significance?
Perineal contamination
Reduced culture significance
What is more accurate for detecting urinary red cells, dipstick or microscopy?
Dipstick
Cells going to microscopy may lyse
What scoring system can help determine if a sore throat is bacterial or viral? Components? Cut offs and tx
Centor score
+1 fever, exudate, cervical lymphadenopathy, no cough, 3-14,
-1 >45
3 give 2-3 day delayed prescription of abx and culture
When should abx always be given for tonsillitis irrespective of centor score?
Systemically unwell
Valvular heart disease
Quincy
When should you have a low threshold for antibiotics in tonsillitis irrespective of centor score?
Immunocompromised
Rheumatic fever
No abx treatments of tonsillits?
Paracetamol
Nsaids
Lozenges
Warm salt wash
Complications of tonsillitis?
Quincy Middle ear infection Sleep apnea Rheumatic fever Scarlet fever
Signs of quincy
Trismus Voice change Uvula deviation Unilateral throat or ear pain Salivation and dribbling
Terms for flat lesions 1cm
patch
Terms for raised lesions 2cm
plaque
Terms for fluid filled leisions 1cm
bulla
Terms for puss filled lesions
Pustule
Abcess
Terms for broken skin with loss of:
Epidermis
Dermis
Crack in epi and dermis
Epidermis - erosion
Dermis - ulcer
Crack - fissure
