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
