GP Flashcards
What is a FOBT kit used for?
To detect for bowel cancer
What is a colonic polyp?
A benign tumour off the colon
What is a suppository?
A tablet up the back passage as a treatment
What is a colonoscopy?
A camera up the back passage
How does CT scanning work?
Using X-rays
What is a metastases?
A cancer which has spread
What are haemorrhoids?
The blowing up of veins near/in the back passage
What does an MRI scan locate in the body?
Water molecules
What percentage of people are affected by bowel cancer?
5%
At what age is bowel cancer screening offered?
55+
What is bowel scope screening?
Screening using a camera on a thin tube
When is bowel scope screening offered?
At age 55
What does bowel scope screening look for?
Benign polyps
What is the risk of bowel cancer screening?
Severe bleeding
How common is a normal result for bowel cancer screening?
95%
What is done if a polyp is found to be cancerous?
Another colonoscopy and a referral
When is the home screening test provided?
Between 60-74 years
How often is the home bowel screening test sent?
Every 2 years once past 60
What does the home testing kit for bowel cancer test for?
Blood in the faeces
What is required for the bowel cancer home screening?
2 samples of faeces on 3 occasions
What is an unclear result on the home testing kit for bowel cancer?
A small amount of blood in the sample
What is an abnormal result in the home bowel cancer screening?
A fair amount of blood in the sample. The patient will be invited for a colonoscopy
What are the 4 types of bowel cancer?
Small bowel, colon (large bowel), rectal (back passage) and anal (bowel opening)
What is a digital rectal examination (DRE)?
A finger up the back passage to feel for abnormalities
What is a colonoscopy?
A camera up the back passage to examine for abnormalities
What does a 3D colonography do?
Produces a 3D image of the large bowel and rectum
What is relapse?
The reoccurrence of cancer
Name 5 symptoms of bowel cancer
- Bleeding from back passage/blood in faeces
- A persistent and unexplained change in bowel habits
- Unexplained weight loss
- Extreme tiredness
- A pain/lump in the abdomen
What does PC stand for?
Present complaint
What does HPC stand for?
History of presenting complaint
What does PMHx stand for?
Past medical history
What does DHx stand for?
Drug history
What does FHx stand for?
Family history
What does SHx stand for?
Social history
What is osteoarthritis due to?
Wear and tear
What is a long term condition?
Can’t be cured at present but can be controlled by medication and other therapies
Give 5 examples of long term conditions
- Diabetes
- Heart disease
- Arthritis
- Hypertension
- COPD
How many people are living with a long term condition in England?
15 million
Where are long term conditions more prevalent?
In the over 60’s and in more deprived groups
What is multimorbidity?
The presence of two or more chronic medical conditions in an individual
What are the most common pair of conditions (multi morbidity)?
A cardio metabolic condition and osteoarthritis
What is polypharmacy?
The concurrent use of multiple medications by a patient (widely regarded as 5 or more)
What are some issues with polypharmacy?
Adverse drug interactions, prescription cascades, medication compliance, higher costs
What is the purpose of medication reviews?
Improves medication compliance, allows a joint approach between professional and patient
What does SOBOE stand for?
Shortness of breath on exertion
What is an underweight BMI?
Less than 18.5
What is a healthy BMI?
18.5 to 24.9
What is an overweight BMI?
25 to 29.9
What is an obese BMI?
30 or more
What is the maximum amount of units of alcohol you should consume per week?
Around 14 units
What is a coronary angiography?
X-ray and dye
What are some conditions which fall under cardiovascular disease?
Coronary heart disease, stroke, peripheral arterial disease, aortic disease (aneurysm)
What is a multidisciplinary approach?
Drawing multiple team members from multiple disciplines
What are the types of cardiac chest pain?
Ischaemic and non-ischaemic
What is the definition of ischaemic?
Restriction of blood flow
What is a bypass?
Adding a vein from elsewhere around the blockage
What are modifiable risks?
Physical activity, smoking, diet, saturated/trans fats, obesity and hypertension
What are some examples of primary prevention?
Changing exercise, diet, smoking habits, and lowering BMI into a healthy range
What are some examples of secondary prevention?
The use of statins, anti-hypertensive therapies ad controlled blood glucose
What are some non-modifiable factors?
Family history and being diabetic
What are the physiological effects of nicotine?
Activation of nicotinic ACh receptors in the brain, causing dopamine release in the NAcc (nucleus accumbens)
What are the two different types of smoking cessation?
Nicotine replacement therapy (NRT) (e.g. patches, gums, nasal spray, microtab, inhaler) and non-nicotine pharmacotherapy (e.g. champix and zyban)
What are the stages of the transtheoretical model?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance/relapse
What is the patient approach (3 A’s)?
Ask, advise, assist
What does spirometry do?
Measures the rate of air flow and estimates lung capacity
What do lung volume tests do?
Measure how much air the lungs can hold
What do lung diffusion capacity tests do?
Assess how well oxygen gets into the blood from the air inspired
What does pulse oximetry do?
Estimates oxygen levels in the blood
What do arterial blood gases do?
Directly tests the level of gases, such as oxygen and carbon dioxide in the blood
What do fractional exhaled nitric oxide tests do?
Measure how much nitric oxide is in the air is exhaled. The patient will initially inhale the nitric oxide
Name 3 progressive lung diseases
- Emphysema
- Chronic bronchitis
- Refractory asthma
What is the aetiology of COPD?
Smoking, air pollution, occupational exposure
What is the physiology of COPD?
- Increased airway resistance due to decreased elastic recoil
- Fibrotic changes
- Luminal obstruction of airways by mucus secretion
What are some symptoms of COPD?
- Daily cough and mucus production
- Shortness of breath
- Wheezing
- Chest tightness
- Frequent respiratory infections
- Lack of energy
What is the management of COPD?
- Dependent of FEV1
- Corticosteroids
- Bronchodilators
- Nebulisers
What is self-management?
Encouraged by a care plan, shared decision making and patient partnership. Promotes confidence and understanding to patient’s long-term conditions
What is patient partnership?
Patient collaboration. Encourages patients to be more involved in care and self-management
What is a care plan?
A document about management aims made by a patient and a professional. Ensures that patient’s needs are regularly reviewed, care is patient centred and encourages self-management
What does patient centred mean?
Care adapted for an individual patient
What is shared decision making?
The sharing of ideas on how to manage care. identifies how aware patient is to their conditions and their motivation to manage it. Opportunity to clarify any issues with professional and set goals
What is a ‘standard’ blood pressure?
140/80
What is the health-illness continuem?
A common concept of health as a continuous spectrum ranging from optimal wellness at one end to illness cumulating in death at the other end
What is the WHO definition of health?
A state of complete physical, mental and social well-being and not merely the absence of disease
What is the definition of physical health?
Essential to the complete health of an individual, a state of well-being in which the individual is able to perform daily activities without problems
What is social well-being?
A person’s ability to establish and maintain healthy relationships, as well as socialise and interact with others
What is mental health?
A person’s condition with regard to their psychological and emotional well-being
What is ill-health?
A condition of inferior health in which some disease or impairment of function is present but is usually not as serious in terms of curtailing activity as an illness
What is a NHS health check?
At age 40-74, every 5 years, designed to spot early signs of stroke, kidney disease, heart disease, type II diabetes or dementia
What is the most obvious symptom of dementia?
Memory loss
Name a less common symptom of dementia
Restlessness
What is tested in cognitive assessments?
- Short/long term memory
- Concentration and attention span
- Language and communication skills
- Orientation
What causes Alzheimer’s?
Deposits of amyloid proteins (plaques) and tau proteins which form tangles
What happens to neurotransmitters in Alzheimer’s?
Decreases
What are the levels of acetylcholine like in patients with Alzheimer’s?
Low
Where in the brain tends to be affected in Alzheimer’s and what happens at this point?
This hippocampus, it is responsible for laying down new memories
What causes vascular dementia?
Reduced blood flow to the brain
What happens when there is a reduced blood flow in the brain?
Nerve cells are deprived of oxygen and nutrients, so a decline in function and death
What can cause a reduced blood flow in the brain?
- Small vessel disease
- Stroke
- TIAs
What are Lewy bodies?
Small clumps of alpha-synuclein protein that can develop inside brain cells
What do Lewy bodies do?
Damage the way cells work and communicate with each other in the brain
What causes frontotemporal dementia?
Abnormal clumping of proteins in the frontal and temporal lobes in the brain. This damages nerve cells, causing brain cells to die
What is the mental capacity act?
Protects and empower people who may lack the metal capacity to make their own decisions about their care and treatment
What is the 2 stage test of the MCA?
- Does the person have an impairment of their brain/mind?
- Does this mean they are unable to make a specific decision when needed?
What is power of attorney?
A legal document which allows someone to make decisions for you, or act on your behalf, if you no longer can or don’t want to
What is the most common symptom of dementia?
Memory loss
What are the point of cognitive assessments?
They may show whether there is memory difficulty
What do cognitive assessments test?
Short & long term memory, concentration & attention span, language & communication skill and orientation
What is aetiology?
Cause or set of causes for a disease or condition
What happens to the amount of neurotransmitters in patients with Alzheimer’s?
- Decrease in neurotransmitters travelling between brain cells
- Levels of acetylcholine are low
What is Epidemiology?
Study of how often diseases occur in different groups of people
Give 8 ways to prevent cerebrovascular disease
- Beta blockers
- Lifestyle factors
- Aspirin
- Carotid enterectomy
- Lipid management
- Stents
- Anticoagulants
- Antithrombotic treatment
What kind of prevention are beta blockers?
Primary
What kind of prevention is lifestyle factors?
Primary and secondary
What kind of prevention is aspirin in cerebrovascular disease?
Primary and secondary
What kind of prevention is a carotid enterectomy?
Secondary
What kind of prevention is lipid management?
Primary
What kind of prevention is a stent?
Secondary
What kind of prevention is anticoagulants?
Primary and secondary
What kind of prevention is antithrombotic treatment?
Secondary
What is the most common type of cerebral disease?
Stroke
In what demographics are strokes most common?
- Males
- Over 65
- FHx of stroke
Give 6 factors which increase the risk of cerebrovascular disease
- Hypertension
- Smoking
- Obesity
- Poor diet/lack of exercise
- Diabetes
- High blood cholesterol
What does atherosclerosis do in blood vessels?
Causes blockages
Name 7 signs of a stroke
- Hemiplegia
- Hemiparesis
- Confusion
- Difficulty communicating
- Loss of half of vision
- Loss of balance
- Loss of consciousness
What is cerebrovascular attack?
TIA/stroke
What is a cerebrovascular disease?
Narrowing of arteries
What does the ABCD2 score assess?
Risk of a stroke within the next 7 days
What does the Glasgow coma scale assess?
Level of consciousness
What is the most common form of eczema?
Atopic eczema
What does atopic eczema cause?
Skin becomes itchy, red, dry and cracked
In what age group is atopic eczema more prevalent?
Children
What kind of condition is atopic eczema?
Chronic condition
What are the two main treatment options for atopic eczema?
- Emollients (use as much as required)
- Topical corticosteroids (only use in regulated amounts)
Name 5 triggers for atopic eczema
- Irritants
- Environmental factors
- Food allergies
- Certain materials
- Hormonal changes
Why should soft cheese and pates be avoided in pregnancy?
To avoid listeria bacterial growth risk
Why should partially cooked eggs be avoided in pregnancy?
To avoid salmonella risk
Why should liver be avoided in pregnancy?
Too much vitamin A
Why should some fish be avoided in pregnancy?
Too much mercury
What supplements should be used in pregnancy?
10mg vitamin D and 400mg folic acid
What is aminocentesis?
A test offered to pregnant women as a diagnostic test for downs. Tissue sample is taken from uterus fluid surrounding the baby
What is chorionic villus sampling?
A test where a needle is used to take a tissue sample from the placenta. This is a diagnostic test that can be done at 11-14 weeks
What is chronic kidney disease?
A long term condition where the kidneys don’t work effectively as they should
What is EGFR?
Estimated glomerular filtration rate.
What is the EGFR altered by?
- Age
- Body mass
- Ethnicity
- Gender
What is looked at in a U&E blood test?
- Urea (created by liver - break down of proteins)
- Sodium ions (extracellular - should be high)
- Potassium ions (intracellular - should be low)
- Creatine (muscles - cleared by kidneys)
Give two examples of NSAIDs?
Ibuprofen and aspirin
