GP Flashcards
How would you work out BMI?
Weight (kg) / height (m)2
What is considered a healthy BMI?
18.5 - 24.9
What investgiations should be done on an idividual that presents to the GP practice with hypertension?
- ABPM 24 hours
- Ophthalmology
- ## CV risk assessment
What risk score would you use to stratify the risk of an individual with AF having a stroke?
List all of the criteria
CHADS(2)VASc
CHD Hypertension Age (>75) Diabetes Stroke / TIA / VTE Vascular disease Age 65-74 Sex
> 1 consider anticoagulants
What risk score would you use to stratify the risk of an individual that has had a TIA having a stroke?
What score is classed as a high risk?
ABCD2
Age BP Clinical symptoms Diabetes Duration of symptoms
Out of 7
> 6 = high risk of having a stroke within the next 2 - 7 days
What are the differences when biopsying a patients rectum with UC and Chrons?
UC = goblet cell depeletion, crypt abscess, superficial inflammation, psuedopolyps
Chrons = granuloma, transmural involvement, skip lesions, cobblestoning appearance
What is the difference in treatment for chrons and UC?
UC = 5 ASA first (sulfasalazine). Surgery needs to take out the whole of the colon otherwise symptoms will return.
Chrons = steroids first. STOP SMOKING, may add on 5 ASA / methotrexate if its bad. Surgery is to take out the skip lesions.
What is the QRIsk 2 score and what is it used for?
To work out your risk of a heart attack or stroke within 10 years
Smoking Diabetes CKD AF Rheumatoid arthritis Angina / heart attack
What should your BP be to diagnose hypertension?
140-160/90-99
List 2 SE of ace inhibitors
Cause vasodilation and therefore reduce the peripheral vascular resistance (block AC enzyme, therefore prevent production of aldosterone that therefore reduces salt and water retention) and prevent brakdykinin breakdown - vasodilator.
- Dry cough - bradykinin
- postural hyptertension due to water depletion
- do NOT prescribe NSAID, thiazide like diuretic and ACEi - can result in renal failure.
Give 6 signs of heart failure
- Peripheral oedema
- S3 (third heart sound)
- Pleual effusion
- HEPATOMEGALY (back flow of blood)
list 6 symptoms of heart failure
- Paroxysmal nocturnal dyspnoea
- Fatigue
- Breahtlessness
- Pink frothy sputum with cough
What staging system is used to classify heart disease?
New york heart association
What are the 5 signs seen on an Xray of someone with heart failure?
Alevolar oedema (bat wing opacities) BKerly B lines Cardiomegally Dilated upper vessels Effusion (pleural)
What tests would you do for someone with suspected heart failure?
NT-proBNP (lowered in obesity and those already on medications)
CXR
fbc
ecg - CAUSATIVE PROBLEM
What are the rules with heart failure and the DVLA?
Private car users - dont need to know
LGV drivers are disqualified
What drugs should you give in heart failure?
- ACEi
- Diuretic
- Beta blockers - may be used first line instead of ACEi in the elderly due to postural hypotension that they can cause.
DO NOT TAKE CALCIUM CHANNEL BLOCKERS (accept amlodipine)
Give 4 lifestyle factors that you may need to make if you have heart failure?
- Reduce salt intake
- Increase exercise
- Reduce alcohol
- Stop smoking
- Avoid stress
Name one tertiary prevention for people with heart failure
- Cardiac rehab groups
List 3 reasons for reduced uptake of immunisations
- No access to vaccinations in developing countries
- Lack of trust in vaccine (MMR concerns)
- Herd immunity thoughts
- Time constraints
List 3 reasons for uptake of immunisations
- Know people that have had the vaccine - safe
- Parents want to prevent child becoming ill
- Trust in healthcare professional
How do you report notifiabe diseases to PHE?
- Verbally within 24 hours - urgent
- Written within 3 days
List 3 mental examinations useful for screening dementia in GP
- MMSE
- GPCPOG
- 6 CIT
What propositions does the mental capacity act include?
Adults are assumed to have capacity unless proven otherwise
Individuals must be given all available support before it is concluded that they cannot make decisions for themselves
People must retain the right to make what may be seen as eccentric and unwise decisions
Anything done for a person without capacity must be in their best interests and should restrict their rights and basic freedoms as little as possible
What are the three things that determine whether a person is deprived of their liberty?
- under continuous supervision and control
- not free to leave
- person lacks capacity to consent to this
What can you use to treat gonorrohoea / chlamydia?
Ceftriaxone and azithromycin
can be used to treat both and treats resistant strains too
What are the fraser competencies?
that the girl (although under the age of 16 years of age) will understand his advice;
that he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice;
that she is very likely to continue having sexual intercourse with or without contraceptive treatment;
that unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer;
that her best interests require him to give her contraceptive advice, treatment or both without the parental consent.”
What is the treatment for TB?
RIPE
6 months RI
2 months PE
What are the symptoms of tb?
Pneumonia
BLOODY SPUTUM
Fever, malaise, weight loss
Pleural effusion
How do you test for TB (microbiology)?
- Ziehl Nelson
- Lowstein Jensen
Name 3 at risk groups of TB
- iMMUNOCOMPROMISED
- homeless
- Children
- Those living in damp, confined spaces
What is the vaccine for TB?
BCG
