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3A GH > GP > Flashcards

GP Flashcards

1
Q

would you normally give Abx in otitis media and why

A

no

  • don’t tend to improve Sx
  • have side effects
  • Abx resistance
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2
Q

in what situation would you consider giving Abx in otitis media?

A
  • bilateral in under 2 yr old

- w/ otorrhoea (discharge)

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3
Q

when would you prescribe Abx for sore throat?

A 
3 or more centor criteria:
-no cough
-exudate
-cervical lymphadenopathy
-fever
[young OR old]
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4
Q

Abx for otitis media

A

amoxicillin

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5
Q

abx for sinusitis

A

amoxicillin

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6
Q

tonsilitis Abx

A

penicillin V (phenoxymethylpenicillin) 10/7

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7
Q

LRTI Abx

A

amoxicillin

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8
Q

UTI Abx

A

trimethoprim /nitrofurantoin

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9
Q

define BNP

A

brain natriuretic peptide
secreted by ventricles in response to muscle stretch
indicates HF [also raised in AF, sepsis, PE, age]

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10
Q

Tx for white under 55 w/ HTN

A

ACE inhibitor

ramipril ?5mg

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11
Q

Treatment for african/ caribbean or >55 with HTN

A

CCB amlodipine

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12
Q

step 2 for HTN if 1st line doesnt control

A

combine ACE inhib with CCB

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13
Q

step 3 for HTN management if not controlled

A

add thiazide-like diuretic

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14
Q

contraindications/side effects of ace inhibitors

A

cause cough
teratogenic
renal artery stenosis

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15
Q

what monitoring do patients on ACE inhibitor need why

A

regular UandEs

renal artery stenosis

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16
Q

contraindication of beta blockers

A

asthma

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17
Q

why dont you prescribe iron and thyroxine

A

interact - iron stops thyroxine being absorbed

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18
Q

Tx of HTN in women of child bearing age

A

BB

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19
Q

HTN drugs contraindicated in patient with renal failure

A

ACE

ARB

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20
Q

risk of BB + thiazide diuretic

A

DM

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21
Q

can’t prescribe ACE/ARB with which diuretic and why

A

K-sparing
ACE and ARB reduce K excretion
leads to ^^K

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22
Q

common side effect of amlodipine

A

ankle oedema few weeks after starting

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23
Q

signs on CXR of heart failure

A 
Alveolar oedema
B lines
Cardiomegaly
Dilated pulmonary vessels
Effusion
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24
Q

issues with polypharmacy

A
  • interactions
  • prescription cascade
  • compliance
  • ^s adverse effects [falls]
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25
Q

GP dementia screen

A

bloods (inc. syph)
urine
MMSE, AMTS

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26
Q

differentials for dementia

A 
delirium
subdural bleed (even wks after fall)
alcohol
depression
deafness
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27
Q

define dementia

A

progressive decline in cognitive fn

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28
Q

management of alzheimers

A

donepazil/rivastigmine (ACh esterase inhib)

treat associated anxiety

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29
Q

average survival from Dx with Alzh

A

8-10 years

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30
Q

define Alzh

A

degenerative cerebral disease

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31
Q

describe deterioration in vascular dementia

A

stepwise

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32
Q

what are lewy bodies?

A

abnormal aggregates of protein that develop within cells

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33
Q

Sx of lewy body dementia

A

fluctuating cognition
parkinsonism
falls (drop attacks)

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34
Q

To have capacity to make a decision, someone must be able to:

A
  1. Understand the info
  2. Retain the info
  3. Use info as part of decision making process
  4. Communicate decision
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35
Q

what is deprivation of liberty safeguards (DOLS)

A

Aim to prevent unlawful detention of adults in hospitals/care setting who lack capacity to choose where they live/to consent to care& Tx

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36
Q

DOLS ensures that

A
  • it is in the person’s best interests;
  • they have representatives and rights of appeal
  • the DOL is regularly reviewed and monitored
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37
Q

mental capacity

A

person’s ability to make own choices and decisions.

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38
Q

when deciding what’s in a patient’s best interests you must:

A
  • Involve person in decision as much as poss. find out their views/wishes (inc. before they lost capacity)
  • Respect their culture/religion
  • Talk to family/ friends/care staff
  • limit restrictions. e.g. take outside w/support
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39
Q

what are the 4 aspects of the planning cycle in the evaluation of healthcare

A

needs assessment
planning
implementation
evaluation

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40
Q

problems with evaluation of healthcare outcomes

A

cause and effect difficult to establish/multiple factors
no data
long time between intervention and outcome
data inaccuracy

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41
Q

explain what is meant by each component of Donabedian’s “structure, process, outcome” framework in evaluation of health services

A

structure - no. of beds, no. of surgeons
process - what is done? no. of operations
outcome - morbidity/mortality/patient satisfaction

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42
Q

List Maxwell’s six dimensions for assessing the quality of health services

A 
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
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43
Q

imms at 8 weeks

A

6 in 1 (dip, tet, whooping cough, polio, Hib, Hep B)

pneumococcal (PCV)

rotavirus

men B

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44
Q

imms at 12 weeks

A

6 in 1

rotavirus

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45
Q

16 week imms

A

6 in 1

pneumoccal

men B

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46
Q

1 year imms

A

hib

men B

men C

pneumococcal

MMR

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47
Q

what jab should children get between 2 and 7 years

A

annual influenza jab

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48
Q

3 yrs 4 months imms

A

MMR

4 in 1 pre-school booster (dip, tetanus, whooping cough, polio)

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49
Q

imms between age 12 and 14

A

12-13: HPV

14: 3 in 1 teenage booster (DTP), men ACWY

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50
Q

who do you inform in the instance of a suspected notifiable disease. Give an example of a notifiable disease.

A

proper officer of your local authority. Meningitis, TB, food poisoning/ gastroenteritis

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51
Q

reasons you should not vaccinate a child

A

serious adverse reaction to past imm
current active infection
parent does no consent

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52
Q

severe side effect of vaccination

A

anaphylaxis

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53
Q

mild side effects of vaccine

A

slight temp

localised redness and swelling

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54
Q

what can you give a child to reduce the mild side effects of imms

A

liquid paracetamol

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55
Q

management of anaphylaxis

A

adrenaline

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56
Q

white vaginal discharge with itching, cottage cheese-like consistency. Diagnosis

A

candida

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57
Q

normal vaginal discharge

A

white, beginning and end of menstrual cycle, stretchy mucous when ovulating, clear after heavy exercise.
brown/bloody usually normal

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58
Q

small amount of spotting could indicate

A

pregnancy

if during preg -> miscarriage

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59
Q

treatment for trichomoniasis

A

metronidazole

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60
Q

at what age do you change a woman from combined pill to progesterone only

A

> 40

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61
Q

what is meant by fraser competence

A

describes under 16yr old who is considered to be of sufficient age and understanding to be competent to receive contraceptive advice without parental knowledge or consent

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62
Q

cloudy/yellow/green vaginal discharge. intermens bleeding, urinary incont, pelvic pain. Diagnosis?

A

gonorrhoea

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63
Q

grey/yellow vaginal discharge with fishy odour. Redness/swelling, itchy. Diagnosis?

A

bacterial vaginosis

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64
Q

define stroke

A

rapid onset
neurological deficit
due to infarct/haemorrhage of CN tissue

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65
Q

risk factors for stroke

A

HTN, DM, smokingm hyperlipidaemia, obesity, COCP, alcohol, polycythaemia, AF

66
Q

primary prevention of stroke

A 
exercise
diet
weight loss
DM control
smoking
statins
anticoag
67
Q

secondary prevention of stroke

A 
ABCDE!
Antiaggregants [aspirin, clopidogrel]
Anticoag [apixaban]
BP meds
Cessation of smoking
Diet
Exercise
68
Q

stroke differentials [not ischaemic/haemorrhagic]

A 
carotid/vertebral artery dissection
SAH
hypo/hyperglycaemia
neoplasia
enceph/meningitis
migraine
hypo/hypernatraemia
hypertensive emergency
TIA
labrinthitis ossifans
69
Q

immediate management of stroke. Ix and Tx

A

CT [EXCLUDE HAEMORRHAGE]
TPA within 4.5 hrs!
thrombectomy
aspirin 300mg within 24 hrs

70
Q

after CT of stroke patient, why might you consider MRI

A

CT may not show infarct in 1st few hrs or >10 days

uncertain diagnosis

71
Q

contraindications of TPA for stroke pateint

A 
haemorrhage on CT
severe HTN
recent trauma/ surgery
bleeding disorder
aneurysm
72
Q

complications of stroke/ post stroke

A 
cerebral oedema
haemorrhage
aspiration
pressure sores
depression
cog impairment
73
Q

what investigation best confirms location of small stroke

A

MRI with diffusion weighted imaging on day 1

74
Q

what are the downfalls of CT for stroke diagnosis over MRI

A

may not show signs early on
less sensitive than MRI [e.g. for small strokes]
less accurate for posterior infarct

75
Q

20 year old with acute onset dizziness/ataxia and neck pain 3 days ago. Diagnosis?

A

dissection

76
Q

20 year old with acute onset dizziness/ataxia and neck pain 3 days ago. What Ix to find cause?

A

CT or MRI angiography at day 1

77
Q

which areas of the brain are affected by a posterior circulation infarct?

A

occipital lobe
brainstem
cerebellum

78
Q

what usually causes a post circulation infarct

A

vertebral/ basilar arteries [circle of willis]

79
Q

aortic valve replacement followed by left sided weakness. Pyrexia. Diagnosis?

A

endocarditis

80
Q

aortic valve replacement followed by left sided weakness. Pyrexia. 1st Investigation?

A

blood cultures

81
Q

what is the dukes criteria? and name some components

A

diagnostic criteria for endocarditis

e.g. cultures, echo changes, Hx of cardiac lesion/embolisation, fever

82
Q

30 yr old, gradual onset slurred speech which resolves in 12 hrs, headache, nausea, photophobia. Had previous episode. Diagnosis?

A

migraine

83
Q

which of the following Sx could be seen in a partial seizure? focal neuro deficit, hedache, nasea

A

only focal neuro deficit

84
Q

how long would an episode of demyelination with neuro deficit take to resolve [compared with migraine]

A

MS - over 24 hrs, typically days

migraine - resolve <24hrs

85
Q

what is amaurosis fugax

A

painless temporary vision loss in one or both eyes

86
Q

80 yr old, previous TIA, 3 episodes of temporary vision loss. Smoker, HTN, AF. Differentials?

A

carotid/opthalmic artery stenosis

AF embolus

87
Q

surgical management for carotid artery stenosis

A

carotid endarterectomy or stent

88
Q

symtoms of giant cell arteritis

A

headache
visual loss
jaw claudication
scalp tenderness

89
Q

Ix for GCA

A

ESR

temp art biopsy

90
Q

70 year old man found on floor, drowsy, bit tongue, left sided weakness. Recovers fully in 12 hrs. Diagnosis?

A

epileptic seizure

91
Q

Does TIA cause altered consciousness

A

no

92
Q

tool used to decide whether to give warfarin for AF. list components

A 
CHADSVASC.
CHF
HTN
Age
DM
stroke
vascular disease
93
Q

how do you assess whether you can use an NG tube

A

aspirate, then test pH. If pH<4 or no aspirate, do CXR

94
Q

differentials for depression

A 
parkinsons
dementia
MS
neoplasia
hypothyroidism
drug/alcohol abuse
sleep disorder
dysthymia
bipolar
schizophrenia
PTSD/OCD
95
Q

risk factors for depression

A 
stress
chronic medical condition
alcoholism
sleep disorder
menopause
drug withdrawal
family member with depression
abuse
postpartum
96
Q

what is the mental health act

A

the law which sets out when a patient can be admitted/detained/treated in hospital against their wishes. Agreed they have mental disorder that requires hosp

97
Q

in general practice, when would you admit someone under the mental health act

A

danger to self or others

98
Q

describe section 2 of the mental health act. What’s it for, how long for, and by whom?

A

admission for assessment
up to 28 days
application by AMHP and 2 Dr.s

99
Q

section 3 of the mental health act. What for, how long, and by whom?

A

admission for treatment
up to 6 months
AMHP and 2 Dr.s

100
Q

section 4 of the mental health act. What for, how long for, who by?

A

emergency admission
up to 72 hrs
1 AMHP, 1 Dr

101
Q

section 135 mental health act. what for?

A

forced entry to a property

102
Q

section 136 mental health act. what for?

A

police can detain someone to a place of safety

103
Q

community management of depression

A

CBT, talking therapy, lifestyle advice

SSRIs, SNRIs, NASSAs, TCAs, MAOI

104
Q

screening tool for alcohol excess

A 
CAGE questionaire:
feel you need to Cut down?
Annoyed when people question your drinking
Guilt
Eye opener
105
Q

define domestic abuse

A

Controlling/ coercive/ threatening behaviour, Violence/ abuse.
16 or over.
Intimate partners/ family.
Regardless of gender or sexuality

106
Q

examples of types of domestic abuse

A 
psychological
physical
sexual
financial
emotional
107
Q

3 ways that domestic abuse impacts on the health of the abused

A

trauma
somatic [headaches, GI, prem]
psych

108
Q

what are the best indicators of domestic abuse in an A and E setting

A

reports unwitnessed
repeat attendence
delay in attendence
multiple minor injuries

109
Q

what tool could you use to assess risk in domestic abuse cases

A

dash

110
Q

What action would you take with a standard/medium risk domestic abuse patient

A

give contact details for domestic abuse services

111
Q

What action would you take with a high risk domestic abuse patient

A

refer to MARAC (multi agency risk assessment conference) /IDVAS (independent domestic violence advocates) with or without consent

112
Q

where in the disease course do primary secondary and tertiary prevention target?

A

primary - no disease
secondary - preclinical disease
tertiary - clinical

113
Q

criteria for a screening program

A

Disease: Important, Preclinical phase, Natural history known

Test: Suitable, acceptable

Tx: effective, who to treat

facilities available
Inexpensive
Continuous

114
Q

Sensitivity –

A

proportion of those with disease who are correctly identified by screening

115
Q

Specificity –

A

proportion of those without disease who are

correctly excluded by screening

116
Q

how do you calculate sensitivity of screening

A

true pos / (true pos + false neg)

117
Q

how do you calculate specificity of screening

A

true neg/ (true neg + false pos)

118
Q

Positive predictive value and how do you calculate?

A

the proportion of people with a positive test result who actually have the disease
true pos / (true pos + false pos)

119
Q

Negative predictive value and how do you calculate

A

the proportion of people with a negative
test result who do not have the disease
true neg / (true neg + false neg)

120
Q

why is there a length-time bias when looking at cancer survival in patients picked up by screening not?

A

Less aggressive cancers are more likely to be detected by screening rounds

121
Q

describe a cohort study

A

take group of people without disease. half are exposed to an external factor, half aren’t. Looks at who got disease and didnt

122
Q

describe a case-control study

A

looks at people with the disease an a control group without disease. Retrospective into whether they were exposed or not. Opposite way to cohort

123
Q

describe a cross sectional study

A

like a census
looks at info from one point in time
prevalence etc

124
Q

describe an ecological study

A

investigates risk and prevalence geographically

125
Q

define odds ratio

A

the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure

126
Q

define prevalence and incidence

A

prevalence - total number of cases at a given time

incidence - total number of new cases over a period out of total disease free population

127
Q

define absolute risk vs relative risk

A 
absolute = deaths/population
relative = deaths in one group compared to another (smokers / non-smokers)
128
Q

define bias

A

A systematic deviation from the true
estimation of the association between
exposure and outcome

129
Q

criteria for causality

A

Strength of association

Dose-response

Consistency

Timing [outcome after exposure]

Reversibility

Biological plausibility

130
Q

Investigators find a high level of correlation between levels of socioeconomic
deprivation and cardiovascular mortality across electoral wards in the UK. Type of study?

A

ecological

131
Q

Researchers set out to examine the association between alcohol consumption and stroke. They identify all new patients admitted with stroke and compare
their alcohol consumption with patients admitted for elective surgery. Type of study

A

case-control

132
Q

General practitioners set up a study to estimate the prevalence of depression within their registered population. They decide to start with a random sample of adults aged 45-74 years. Type of study?

A

cross-sectional

133
Q 
In a randomised controlled trial, the time at risk was determined from entry to the study to various end points.
F. Person-years
G. Prevalence
H. Absolute risk reduction
I. Relative risk
J. Number needed to treat
A

person years

134
Q 
For patients with meningococcal meningitis, the risk of dying has been estimated to vary from 5-10%.
A. Attributable risk
B. Case-fatality rate
C. Cumulative incidence
D. Incidence rate
E. Odds ratio
A

B

135
Q 
In a case-control study of recent alcohol consumption and road traffic accidents, the measure of association was substantially greater than 1 and indicates that there is a positive association between exposure and outcome.
A. Attributable risk
B. Case-fatality rate
C. Cumulative incidence
D. Incidence rate
E. Odds ratio
A

E

136
Q

Researchers set out to examine the hypothesis that stress causes HTN using hypertensive and normotensive individuals in a case control
study. The study design is however criticised because of concerns regarding the temporal sequence of events.
A. Bias
B. Chance
C. Confounding
D. Specificity
E. Reverse causality

A

E

137
Q 
A study reports an association between coffee consumption and cancer. However, subsequent studies find that there is a clear association between smoking and coffee consumption.
A. Bias
B. Chance
C. Confounding
D. Specificity
E. Reverse causality
A

C

138
Q 
An association between postmenopausal oestrogen use and endometrial cancer was reported in some studies. However, it was subsequently argued that this might be due to increased diagnostic attention received by women with uterine bleeding after oestrogen exposure.
A. Bias
B. Chance
C. Confounding
D. Specificity
E. Reverse causality
A

A

139
Q

define disability

A

physical, sensory or mental impairment which seriously affects daily activities

140
Q

what is charles bonnet syndrome

A

visual hallucinations in a visually impaired person

141
Q

risk factors for TB

A

immunosuppression e.g. HIV

country of origin with high prevalence e.g. sub-saharan africa

overcrowding/poverty

142
Q

alcohol dependence patient tells GP he used to drink beer wine and spirits. He now only drinks wine every day. Which dependence symptom is he describing?

A

narrowed repetoire

143
Q

alcohol dependence patient tell you “I need to have a drink first thing in the morning to stop the shakes”. Which dependence symptom is he describing?

A

withdrawal

144
Q

State Two blood tests to screen for alcohol dependence and state how
each is affected.

A

GGT ^
RBC MCV ^
CDT (carbohydrate deficient transferrin) ^

145
Q

Three days after his last drink, an alcohol dependent patient presents with agitation, tremors
and dilated pupils. Also visual hallucinations of little spiders. What is the diagnosis?

A

delirium tremens

146
Q

describe 3 blood tests for suspected hyperthyroid and what result you’d expect

A

free T4 ^
TSH low
thyroid autoantibodies ^ [for graves]

147
Q

3 medications for patient presenting with suspected hyperthyroid - sweating, ^HR, sore eyes, anxiety

A

carbimazole
propanolol
lubricating eye drops

148
Q

at a followup for suspected hyperthyroid, patient lost his prescription and now feels worse - nausea, diarrhoea, palpitations. Diagnosis and action

A

thyroid storm/ crisis

admit as emergency

149
Q

when do children get DTP jabs

A

2 months, 3 months, 4 months, 3 yrs 4 months, 14 yrs

150
Q

MMR jabs when

A

1 yr

3yrs 4 months

151
Q

pertussis jabs when

A

2 months, 3 months, 4 months, 3 yrs 4 months

152
Q

AF management

A

cardioversion if life threatening
amiodarone [rhythm]
BB/CCB [rate]
apixaban/warfarin

153
Q

Ix in HF

A 
12 lead ECG
Chest X-ray
Bloods 
Urinalysis
Peak Flow/Spirometry
154
Q

verapamil + BB =

A

risk of complete heart block

155
Q

key measure[/Ix] in diagnosis of COPD?

A

FEV1/FVC ratio

156
Q

COPD Mx

A 
stop smoking! lose weight
yearly pneumococcal and flu vaccine
pulmonary rehab
bronchodilator
SAMA, LABA, LAMA, ICS
O2
oral pred
ABX if sputum +ve
157
Q

67 yr old - achy, itchy, restless legs, lost appetite, Hx of HTN

A

CKD

158
Q

HF symptom alleviation

A

loop diuretic [furosemide]

159
Q

mechanism that an ACEi might cause this cough

A

Bradykinin accumulation

160
Q 
What investigation is helpful to diagnose heart failure in a patient with a history of MI?
A. BNP
B. ECG
C. Echocardiogram
D. FBC
E. U+E
A

Echocardiogram

3A GH (8 decks)

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