GP Flashcards
would you normally give Abx in otitis media and why
no
- don’t tend to improve Sx
- have side effects
- Abx resistance
in what situation would you consider giving Abx in otitis media?
- bilateral in under 2 yr old
- w/ otorrhoea (discharge)
when would you prescribe Abx for sore throat?
3 or more centor criteria: -no cough -exudate -cervical lymphadenopathy -fever [young OR old]
Abx for otitis media
amoxicillin
abx for sinusitis
amoxicillin
tonsilitis Abx
penicillin V (phenoxymethylpenicillin) 10/7
LRTI Abx
amoxicillin
UTI Abx
trimethoprim /nitrofurantoin
define BNP
brain natriuretic peptide
secreted by ventricles in response to muscle stretch
indicates HF [also raised in AF, sepsis, PE, age]
Tx for white under 55 w/ HTN
ACE inhibitor
ramipril ?5mg
Treatment for african/ caribbean or >55 with HTN
CCB amlodipine
step 2 for HTN if 1st line doesnt control
combine ACE inhib with CCB
step 3 for HTN management if not controlled
add thiazide-like diuretic
contraindications/side effects of ace inhibitors
cause cough
teratogenic
renal artery stenosis
what monitoring do patients on ACE inhibitor need why
regular UandEs
renal artery stenosis
contraindication of beta blockers
asthma
why dont you prescribe iron and thyroxine
interact - iron stops thyroxine being absorbed
Tx of HTN in women of child bearing age
BB
HTN drugs contraindicated in patient with renal failure
ACE
ARB
risk of BB + thiazide diuretic
DM
can’t prescribe ACE/ARB with which diuretic and why
K-sparing
ACE and ARB reduce K excretion
leads to ^^K
common side effect of amlodipine
ankle oedema few weeks after starting
signs on CXR of heart failure
Alveolar oedema B lines Cardiomegaly Dilated pulmonary vessels Effusion
issues with polypharmacy
- interactions
- prescription cascade
- compliance
- ^s adverse effects [falls]
GP dementia screen
bloods (inc. syph)
urine
MMSE, AMTS
differentials for dementia
delirium subdural bleed (even wks after fall) alcohol depression deafness
define dementia
progressive decline in cognitive fn
management of alzheimers
donepazil/rivastigmine (ACh esterase inhib)
treat associated anxiety
average survival from Dx with Alzh
8-10 years
define Alzh
degenerative cerebral disease
describe deterioration in vascular dementia
stepwise
what are lewy bodies?
abnormal aggregates of protein that develop within cells
Sx of lewy body dementia
fluctuating cognition
parkinsonism
falls (drop attacks)
To have capacity to make a decision, someone must be able to:
- Understand the info
- Retain the info
- Use info as part of decision making process
- Communicate decision
what is deprivation of liberty safeguards (DOLS)
Aim to prevent unlawful detention of adults in hospitals/care setting who lack capacity to choose where they live/to consent to care& Tx
DOLS ensures that
- it is in the person’s best interests;
- they have representatives and rights of appeal
- the DOL is regularly reviewed and monitored
mental capacity
person’s ability to make own choices and decisions.
when deciding what’s in a patient’s best interests you must:
- 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
what are the 4 aspects of the planning cycle in the evaluation of healthcare
needs assessment
planning
implementation
evaluation
problems with evaluation of healthcare outcomes
cause and effect difficult to establish/multiple factors
no data
long time between intervention and outcome
data inaccuracy
explain what is meant by each component of Donabedian’s “structure, process, outcome” framework in evaluation of health services
structure - no. of beds, no. of surgeons
process - what is done? no. of operations
outcome - morbidity/mortality/patient satisfaction
List Maxwell’s six dimensions for assessing the quality of health services
Effectiveness Efficiency Equity Acceptability Accessibility Appropriateness
imms at 8 weeks
6 in 1 (dip, tet, whooping cough, polio, Hib, Hep B)
pneumococcal (PCV)
rotavirus
men B
imms at 12 weeks
6 in 1
rotavirus
16 week imms
6 in 1
pneumoccal
men B
1 year imms
hib
men B
men C
pneumococcal
MMR
what jab should children get between 2 and 7 years
annual influenza jab
3 yrs 4 months imms
MMR
4 in 1 pre-school booster (dip, tetanus, whooping cough, polio)
imms between age 12 and 14
12-13: HPV
14: 3 in 1 teenage booster (DTP), men ACWY
who do you inform in the instance of a suspected notifiable disease. Give an example of a notifiable disease.
proper officer of your local authority. Meningitis, TB, food poisoning/ gastroenteritis
reasons you should not vaccinate a child
serious adverse reaction to past imm
current active infection
parent does no consent
severe side effect of vaccination
anaphylaxis
mild side effects of vaccine
slight temp
localised redness and swelling
what can you give a child to reduce the mild side effects of imms
liquid paracetamol
management of anaphylaxis
adrenaline
white vaginal discharge with itching, cottage cheese-like consistency. Diagnosis
candida
normal vaginal discharge
white, beginning and end of menstrual cycle, stretchy mucous when ovulating, clear after heavy exercise.
brown/bloody usually normal
small amount of spotting could indicate
pregnancy
if during preg -> miscarriage
treatment for trichomoniasis
metronidazole
at what age do you change a woman from combined pill to progesterone only
> 40
what is meant by fraser competence
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
cloudy/yellow/green vaginal discharge. intermens bleeding, urinary incont, pelvic pain. Diagnosis?
gonorrhoea
grey/yellow vaginal discharge with fishy odour. Redness/swelling, itchy. Diagnosis?
bacterial vaginosis
define stroke
rapid onset
neurological deficit
due to infarct/haemorrhage of CN tissue
risk factors for stroke
HTN, DM, smokingm hyperlipidaemia, obesity, COCP, alcohol, polycythaemia, AF
primary prevention of stroke
exercise diet weight loss DM control smoking statins anticoag
secondary prevention of stroke
ABCDE! Antiaggregants [aspirin, clopidogrel] Anticoag [apixaban] BP meds Cessation of smoking Diet Exercise
stroke differentials [not ischaemic/haemorrhagic]
carotid/vertebral artery dissection SAH hypo/hyperglycaemia neoplasia enceph/meningitis migraine hypo/hypernatraemia hypertensive emergency TIA labrinthitis ossifans
immediate management of stroke. Ix and Tx
CT [EXCLUDE HAEMORRHAGE]
TPA within 4.5 hrs!
thrombectomy
aspirin 300mg within 24 hrs
after CT of stroke patient, why might you consider MRI
CT may not show infarct in 1st few hrs or >10 days
uncertain diagnosis
contraindications of TPA for stroke pateint
haemorrhage on CT severe HTN recent trauma/ surgery bleeding disorder aneurysm
complications of stroke/ post stroke
cerebral oedema haemorrhage aspiration pressure sores depression cog impairment
what investigation best confirms location of small stroke
MRI with diffusion weighted imaging on day 1
what are the downfalls of CT for stroke diagnosis over MRI
may not show signs early on
less sensitive than MRI [e.g. for small strokes]
less accurate for posterior infarct
20 year old with acute onset dizziness/ataxia and neck pain 3 days ago. Diagnosis?
dissection
20 year old with acute onset dizziness/ataxia and neck pain 3 days ago. What Ix to find cause?
CT or MRI angiography at day 1
which areas of the brain are affected by a posterior circulation infarct?
occipital lobe
brainstem
cerebellum
what usually causes a post circulation infarct
vertebral/ basilar arteries [circle of willis]
aortic valve replacement followed by left sided weakness. Pyrexia. Diagnosis?
endocarditis
aortic valve replacement followed by left sided weakness. Pyrexia. 1st Investigation?
blood cultures
what is the dukes criteria? and name some components
diagnostic criteria for endocarditis
e.g. cultures, echo changes, Hx of cardiac lesion/embolisation, fever
30 yr old, gradual onset slurred speech which resolves in 12 hrs, headache, nausea, photophobia. Had previous episode. Diagnosis?
migraine
which of the following Sx could be seen in a partial seizure? focal neuro deficit, hedache, nasea
only focal neuro deficit
how long would an episode of demyelination with neuro deficit take to resolve [compared with migraine]
MS - over 24 hrs, typically days
migraine - resolve <24hrs
what is amaurosis fugax
painless temporary vision loss in one or both eyes
80 yr old, previous TIA, 3 episodes of temporary vision loss. Smoker, HTN, AF. Differentials?
carotid/opthalmic artery stenosis
AF embolus
surgical management for carotid artery stenosis
carotid endarterectomy or stent
symtoms of giant cell arteritis
headache
visual loss
jaw claudication
scalp tenderness
Ix for GCA
ESR
temp art biopsy
70 year old man found on floor, drowsy, bit tongue, left sided weakness. Recovers fully in 12 hrs. Diagnosis?
epileptic seizure
Does TIA cause altered consciousness
no
tool used to decide whether to give warfarin for AF. list components
CHADSVASC. CHF HTN Age DM stroke vascular disease
how do you assess whether you can use an NG tube
aspirate, then test pH. If pH<4 or no aspirate, do CXR
differentials for depression
parkinsons dementia MS neoplasia hypothyroidism drug/alcohol abuse sleep disorder dysthymia bipolar schizophrenia PTSD/OCD
risk factors for depression
stress chronic medical condition alcoholism sleep disorder menopause drug withdrawal family member with depression abuse postpartum
what is the mental health act
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
in general practice, when would you admit someone under the mental health act
danger to self or others
describe section 2 of the mental health act. What’s it for, how long for, and by whom?
admission for assessment
up to 28 days
application by AMHP and 2 Dr.s
section 3 of the mental health act. What for, how long, and by whom?
admission for treatment
up to 6 months
AMHP and 2 Dr.s
section 4 of the mental health act. What for, how long for, who by?
emergency admission
up to 72 hrs
1 AMHP, 1 Dr
section 135 mental health act. what for?
forced entry to a property
section 136 mental health act. what for?
police can detain someone to a place of safety
community management of depression
CBT, talking therapy, lifestyle advice
SSRIs, SNRIs, NASSAs, TCAs, MAOI
screening tool for alcohol excess
CAGE questionaire: feel you need to Cut down? Annoyed when people question your drinking Guilt Eye opener
define domestic abuse
Controlling/ coercive/ threatening behaviour, Violence/ abuse.
16 or over.
Intimate partners/ family.
Regardless of gender or sexuality
examples of types of domestic abuse
psychological physical sexual financial emotional
3 ways that domestic abuse impacts on the health of the abused
trauma
somatic [headaches, GI, prem]
psych
what are the best indicators of domestic abuse in an A and E setting
reports unwitnessed
repeat attendence
delay in attendence
multiple minor injuries
what tool could you use to assess risk in domestic abuse cases
dash
What action would you take with a standard/medium risk domestic abuse patient
give contact details for domestic abuse services
What action would you take with a high risk domestic abuse patient
refer to MARAC (multi agency risk assessment conference) /IDVAS (independent domestic violence advocates) with or without consent
where in the disease course do primary secondary and tertiary prevention target?
primary - no disease
secondary - preclinical disease
tertiary - clinical
criteria for a screening program
Disease: Important, Preclinical phase, Natural history known
Test: Suitable, acceptable
Tx: effective, who to treat
facilities available
Inexpensive
Continuous
Sensitivity –
proportion of those with disease who are correctly identified by screening
Specificity –
proportion of those without disease who are
correctly excluded by screening
how do you calculate sensitivity of screening
true pos / (true pos + false neg)
how do you calculate specificity of screening
true neg/ (true neg + false pos)
Positive predictive value and how do you calculate?
the proportion of people with a positive test result who actually have the disease
true pos / (true pos + false pos)
Negative predictive value and how do you calculate
the proportion of people with a negative
test result who do not have the disease
true neg / (true neg + false neg)
why is there a length-time bias when looking at cancer survival in patients picked up by screening not?
Less aggressive cancers are more likely to be detected by screening rounds
describe a cohort study
take group of people without disease. half are exposed to an external factor, half aren’t. Looks at who got disease and didnt
describe a case-control study
looks at people with the disease an a control group without disease. Retrospective into whether they were exposed or not. Opposite way to cohort
describe a cross sectional study
like a census
looks at info from one point in time
prevalence etc
describe an ecological study
investigates risk and prevalence geographically
define odds ratio
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
define prevalence and incidence
prevalence - total number of cases at a given time
incidence - total number of new cases over a period out of total disease free population
define absolute risk vs relative risk
absolute = deaths/population relative = deaths in one group compared to another (smokers / non-smokers)
define bias
A systematic deviation from the true
estimation of the association between
exposure and outcome
criteria for causality
Strength of association
Dose-response
Consistency
Timing [outcome after exposure]
Reversibility
Biological plausibility
Investigators find a high level of correlation between levels of socioeconomic
deprivation and cardiovascular mortality across electoral wards in the UK. Type of study?
ecological
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
case-control
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?
cross-sectional
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
person years
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
B
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
E
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
E
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
C
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
define disability
physical, sensory or mental impairment which seriously affects daily activities
what is charles bonnet syndrome
visual hallucinations in a visually impaired person
risk factors for TB
immunosuppression e.g. HIV
country of origin with high prevalence e.g. sub-saharan africa
overcrowding/poverty
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?
narrowed repetoire
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?
withdrawal
State Two blood tests to screen for alcohol dependence and state how
each is affected.
GGT ^
RBC MCV ^
CDT (carbohydrate deficient transferrin) ^
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?
delirium tremens
describe 3 blood tests for suspected hyperthyroid and what result you’d expect
free T4 ^
TSH low
thyroid autoantibodies ^ [for graves]
3 medications for patient presenting with suspected hyperthyroid - sweating, ^HR, sore eyes, anxiety
carbimazole
propanolol
lubricating eye drops
at a followup for suspected hyperthyroid, patient lost his prescription and now feels worse - nausea, diarrhoea, palpitations. Diagnosis and action
thyroid storm/ crisis
admit as emergency
when do children get DTP jabs
2 months, 3 months, 4 months, 3 yrs 4 months, 14 yrs
MMR jabs when
1 yr
3yrs 4 months
pertussis jabs when
2 months, 3 months, 4 months, 3 yrs 4 months
AF management
cardioversion if life threatening
amiodarone [rhythm]
BB/CCB [rate]
apixaban/warfarin
Ix in HF
12 lead ECG Chest X-ray Bloods Urinalysis Peak Flow/Spirometry
verapamil + BB =
risk of complete heart block
key measure[/Ix] in diagnosis of COPD?
FEV1/FVC ratio
COPD Mx
stop smoking! lose weight yearly pneumococcal and flu vaccine pulmonary rehab bronchodilator SAMA, LABA, LAMA, ICS O2 oral pred ABX if sputum +ve
67 yr old - achy, itchy, restless legs, lost appetite, Hx of HTN
CKD
HF symptom alleviation
loop diuretic [furosemide]
mechanism that an ACEi might cause this cough
Bradykinin accumulation
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
Echocardiogram
