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Year 4 > GP > Flashcards

GP Flashcards

1
Q

What percentage of people consult their GP at least once a year?

A

75%

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2
Q

What is the average number of GP consultations per registered patient?

A

6 (double the rate of the previous decade)

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3
Q

What groups of people consult their GP more frequently?

A
  • Older people
  • Children
  • Females
  • Socially deprived areas
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4
Q

What explains the gender differences in GP consultation rates?

A

The higher consultation rates in women of reproductive years

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5
Q

Describe the ‘illness iceberg’

A

This refers to the observation that the majority of symptoms experienced by the population are never presented to the doctor

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6
Q

Define ‘illness behaviour’

A

‘The manner in which people differentially perceive, evaluate and respond to symptoms

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7
Q

Define a ‘lay referral’

A

People discussing their symptoms with other people, such as family members, close friends or people who are known to have had similar health problems

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8
Q

Describe the 5 possible triggers for consulting

A
  1. Interpersonal crisis
  2. Perceived interference with work activities
  3. Perceived interference with social/leisure activities
  4. Sanctioning by others who insist help be sought (lay referral)
  5. Symptoms persist beyond arbitrary time limit set by individual
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9
Q

Describe the WHO definition of health promotion

A

‘The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.’

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10
Q

The most effective health promotion initiatives…

A

operate at a population level and involve public health measures

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11
Q

List 3 reasons why GPs are well placed to carry out health promotion

A
  1. Most people are registered with a GP
  2. Most patients consult at least every 3 years, allowing for opportunistic health promotion
  3. GPs can link health promotion advice to a specific presenting complaint
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12
Q

Define primary disease prevention

A

Preventing disease

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13
Q

Define secondary disease prevention

A

Slowing the progression and avoiding complications of existing disease

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14
Q

Define tertiary disease prevention

A

Minimising the ill-health and disability caused by existing disease

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15
Q

Define ‘screening’

A

‘the presumptive identification of unrecognised disease or defects by means of tests, examinations or other procedures.’

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16
Q

Describe some negative effects of screening

A
  • Unnecessary anxiety
  • Identifying false positive results
  • Unnecessary investigations and treatments
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17
Q

Describe the standard criteria used for assessing a screening programme

A
  • Condition screened for should be an important one
  • There should be an acceptable treatment for patients with the disease
  • The facilities for diagnosis and treatment should be available
  • There should be a recognised latent or early symptomatic stage
  • There should be a suitable test which has few false positives and false negatives
  • The test should be acceptable to the population
  • The cost, including diagnosis and subsequent treatment, should be affordable
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18
Q

Who is offered a cervical smear and how often?

A

Women aged 25-64
Those aged 25-49 are called every 3 years
Those aged 50-64 are called every 5 years

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19
Q

For women aged 35-64, participation in a screening programme reduces the risk of endocervical cancer by ??% and the risk of advanced cancer by ??%?

A

60-80%

90%

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20
Q

The rates of uptake of the cervical smear test is lowest in what groups?

A
  • Young women
  • Women over 50
  • Women from ethnic minority groups
  • Women from areas of social deprivation
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21
Q

List some reasons for non-attendance of cervical smear tests

A
  • Inconvenience
  • Fear of cancer
  • Apathy
  • Concerns about the procedure
  • Mistaken beliefs e.g. only women with many sexual partners get cervical cancer, lesbians and women who aren’t sexually active don’t need to get smears
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22
Q

Describe the Guthrie (NBS) test

A

Newborn blood spot test, which involves taking a small amount of blood using a heel-prick when a baby is about 5 days old, usually carried out by community midwives.

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23
Q

What conditions does the Guthrie test test for?

A
  • Cystic fibrosis
  • Congenital hypothyroidism
  • Sickle cell disease
  • Other inherited metabolic disease
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24
Q

Define ‘surveillance’

A

‘A system of ongoing health checks to detect abnormality/disease in a previously health individual’ or ‘a system of ongoing health checks to detect complications and monitor the progression of a patient with existing disease’.

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25
Q

Describe Child Health Surveillance

A

A series of observations, measurements and screening tests at specified ages to monitor growth and development, and to detect psychological and medical problems.

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26
Q

Who is Child Health Surveillance carried out by?

A

Health visitors in GP practices or GPs

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27
Q

What is a health visitor?

A

A nurse with higher training who has a statutory duty to provide advice, support and surveillance for all pre-school children

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28
Q

Describe the goals of the Child Health Programme

A
  • Identify and treat physical problems and developmental delays as early as possible
  • Minimise disability and impairment by early and effective intervention
  • Provide support an resources for children with identified conditions
  • Offer health information to promote physical and mental health and well being
  • Identify and support vulnerable children and their families
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29
Q

Describe the specific activities involved in the Child Health programme

A
  • 6-week check screening for specific medical problems
  • Measurement of height and weight to detect and prevent failure-to-thrive and obesity
  • Assessment of motor skills and speech to minimise the impact of developmental delay
  • Screening for vision and hearing
  • Immunisations
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30
Q

What medical problems does the 6 week check screen for?

A
  • Congenital cataracts
  • Heart murmurs
  • Congenital hip dislocations
  • Testicular abnormalities
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31
Q

Describe the elements of ante-natal care

A
  • Taking regular measurements of the developing foetus to detect intra-uterine growth retardation
  • Taking regular measurements from the mother to detect pre-eclampsia and other pregnancy-related conditions
  • Screening (for chromosomal abnormalities and neural tube defects)
  • Immunisation of the pregnant woman against influenza
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32
Q

Describe the ‘locus of control’ belief

A

The degree to which people believe they have control over their own lives and healthcare.

People who believe they can influence their destinies have ‘internal’ locus and those who believe they have little control have ‘external’ locus.

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33
Q

Describe the ‘health belief model’, and the 6 factors it depends on

A

This belief attempts to explain and predict health-related behaviours and suggests that uptake of health promotion depends on 6 factors:

  1. Perceived susceptibility (opinions of chances of getting a condition)
  2. Perceived severity (opinion of seriousness and consequences of the conditions)
  3. Perceived benefits (belief in the efficacy of the advised action to reduce risk or seriousness)
  4. Perceived barriers (opinions of the tangible and psychological cost of the advised action)
  5. Cues to action (strategies to activate ‘readiness’)
  6. Self-efficacy (confidence in one’s ability to take action)
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34
Q

List the 4 factors thought to influence perceived susceptibility to a disease/condition

A
  1. Self-evident personal differences between individuals (including hereditary)
  2. The social environment (including wealth an occupation)
  3. The physical environment
  4. Luck
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35
Q

List the strategies of motivational interviewing

A
  • Avoid medical labelling
  • Avoid giving advice
  • Invite the patient to define his/her problems
  • Invite the patient to describe the pros and cons of their behaviour
  • Empathise with the difficulty of change
  • Allow the patient to view the decision as theirs to make
  • Invite the patient to come back and discuss progress
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36
Q

Describe the Stages of Change cycle

A
  1. Pre-contemplation: not recognising the need for change/not actively considering change
  2. Contemplation: recognising problem and is considering factors for and against change
  3. Preparation: planning and commitment to change
  4. Action: has already initiated change
  5. Maintenance: adjusting to change and is practising new skills and behaviours to maintain change
  6. Relapse: relapse from change OR 6. Abandoned risky behaviour
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37
Q

What technique can a GP use if they do not have time to complete a full motivational interview session?

A

Brief intervention

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38
Q

List some of the benefits of continuity of GP care

A
  • Better patient satisfaction
  • Better trust
  • Better quality of management
  • Reduced prescriptions
  • Reduced hospital admissions
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39
Q

What is the golden minute?

A

Allowing the patient to speak uninterrupted for the first minute of the consultation

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40
Q

Define safety netting

A

Making a contingency plan incase things don’t go according to plan - should include signs to watch for, timeframes and how to seek help

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41
Q

Describe the ‘inductive method’ of diagnosis

A

Linear, sequential process whereby a diagnosis is made following the symptomatic and indiscriminate gathering of standard medical information (history, examination and investigation).

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42
Q

Describe the ‘Hypothetic-deductive’ method of diagnosis

A

This model involves gathering information from a patient, formulating a hypothesis and then gathering further selective information which can help prove or refute this hypothesis.

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43
Q

Describe the ‘Heneghan et al’ method of diagnosis

A

A refined and more complex version of the hypothetic-deductive model, including stages:

  1. Initiation of the diagnosis
    - Spot diagnosis: the unconscious recognition of a non-verbal pattern (e.g. shingles)
    - Self-labelling: the patient tells the GP what they think is the problem
    - Presenting complaint
    - Pattern recognition trigger: immediate diagnosis from the history (e.g. appendicitis)
  2. Refinement
    - Restricted rule outs: depends on knowing the common, non-serious and rarer, more serious causes of a presentation (e.g. headache - migraine vs meningitis)
    - Stepwise refinement: refining anatomical location or pathological processes
    - Probabilistic reasoning: deciding the likelihood of a condition based on the doctors knowledge of incidence/prevalence of the disease
    - Pattern recognition fit: comparison with previous cases
    - Clinical prediction rule: using formal validated scores (e.g. Well’s score for DVT)
  3. Defining the final diagnosis (unnecessary if diagnosis is clear)
    - Known diagnosis
    - Further tests ordered
    - Test of treatment
    - Test of time
    - No label applied
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44
Q

Describe red flag symptoms

A

Specific symptoms or signs which may be volunteered by the patient or elicited by the door to rule out a serious condition. A red flag usually triggers a more detailed examination, investigation or referral to hospital.

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45
Q

Define prevalence

A

The proportion of a population with the condition

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46
Q

Define sensitivity

A

The chance that the test is positive in those with the disease (true positive): (true positive)/(true positive + false negative)

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47
Q

Define specificity

A

The chance that the test is negative in those without the disease (true negative): (true negative)/(false positive + true negative)

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48
Q

Define positive predictive value

A

The chance that a patient with a positive test result actually has the condition (true positive)/(true positive + false negative)

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49
Q

Define negative predictive value

A

The chance that a patient with a negative test result does not actually have the condition (true negative)/(true negative + false negative)

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50
Q

Positive and negative predictive value are affected by disease prevalence (T/F)

A

True - as prevalence increases, PPV increases and NPV decreases

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51
Q

Define a diagnostic label

A

A working diagnosis that functions as a basis for decisions

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52
Q

About ??% of problems presenting in GP have no diagnostic label

A

50%

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53
Q

List the 5 central ethos of GP

A
  1. Continuity of care
  2. Comprehensiveness
  3. Complexity
  4. Coordination
  5. Context
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54
Q

Define absolute risk

A

The chance of getting a disease

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55
Q

Define relative risk

A

The chance of getting a disease in one situation compared with another (e.g. smoker vs non-smoker)

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56
Q

Define number needed to treat

A

The number of patients who need to be treated in order to prevent one additional adverse outcome.

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57
Q

On average, GPs issue a prescription in about ??% of consultation?

A

66%

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58
Q

What percentage of hospital admissions are associated with adverse drug reactions?

A

6.5%

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59
Q

Define evidence based medicine

A

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

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60
Q

List the hierarchy of evidence

A
  1. Systematic review - review of all published and unpublished research on a particular question
  2. Meta-analysis - secondary analysis of pooled data from a number of studies
  3. RTC - participants randomly allocated to ‘treatment’ or ‘no treatment’ and followed up
  4. Cohort study - 2 groups are selected for their exposure/non-exposure to a factor and followed up
  5. Case-control study - patients with a condition are matched with controls and data is collected retrospectively to look for exposure to factors
  6. Case report - detailed description of a particular case
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61
Q

Define chronic condition

A

Diseases of long duration for which there is no cure, and which generally progress slowly, impact on a person’s life and which require ongoing care and support

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62
Q

Define long-term condition

A

A broader term which includes chronic conditions, as well as permanent conditions such as learning disability, symptom complexes or sensory impairment

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63
Q

Define co-morbidity

A

A disease which is additional to the main disease

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64
Q

Chronic disease accounts for ??% of death worldwide, and ??% of death in the UK

A

60%

85%

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65
Q

In Scotland, 1 in ? people over 16 have a long-term condition

A

4

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66
Q

Patients living in deprived areas are more than ??x as likely to have a long term condition than those in affluent areas

A

2x

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67
Q

List the top 10 commonest chronic conditions in the UK

A
  1. Hypertension
  2. Depression
  3. Diabetes
  4. Asthma
  5. CHD
  6. COPD
  7. CVA
  8. Dementia
  9. Epilepsy
  10. PAD
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68
Q

??% of British adults are obese, and ??% are overweight or obese

A

25%

61%

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69
Q

Chronic disease accounts for ??% of GP consultations

A

80%

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70
Q

List the situations where it is possible to divulge patient information without their consent

A
  • If a patient continues to drive although you are aware they have a reason not to, you should inform the DVLA
  • The patient may cause serious physical or psychological harms to themselves or others, including children
  • Serious communicable diseases (e.g. HIV) when patients are knowingly putting others at risk
  • Patient is unfit to work and continuing to do so puts others at risk
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71
Q

List some causes of dyspepsia

A
  • GORD
  • Peptic Ulcer Disease
  • Non-ulcer dyspepsia
  • Hiatus hernia
  • Barrett’s oesophagus
  • Gastric cancer
  • Oesophageal cancer
  • Drugs e.g. NSAIDs, calcium antagonists, nitrates, theophylline, bisphosphonates, anti-platelet drugs
  • Alcohol
  • Smoking
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72
Q

List the features in a history which may make you suspect a patient has dyspepsia?

A
  • Epigastric pain (often post-prandial, may wake patient at night), nausea, vomiting, distention, burning, heartburn
  • Previous dyspepsia/GORD
  • NSAID/calcium antagonists/theophylline/bisphosphonates/anti-platelet use
  • Alcohol
  • Smoking
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73
Q

List the red flag symptoms for dyspepsia

A
  • Weight loss
  • Dysphagia
  • Persistant vomiting
  • Haematemesis
  • Melena
  • Gastric mass
  • Iron deficiency anaemia
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74
Q

List the typical examination findings for a patient presenting with dyspepsia

A

Often normal

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75
Q

What investigations would you order in a patient presenting with dyspepsia

A
  • FBC, ferritin
  • H. Pylori stool antigen test
  • Consider endoscopy
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76
Q

What are the indications for an endoscopy in a patient with dyspepsia?

A
  • Red flags present (urgent endoscopy)
  • H.Pylori test negative and no response to medication
  • > 55 with persistent or recurrent dyspepsia (routine referral)
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77
Q

How would you manage a patient presenting with dyspepsia (no red flags)?

A
  1. Stop precipitating drugs
  2. Reduce alcohol/smoking
  3. Trial Alginates/PPIs/H2RA
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78
Q

Define normal bowel habit

A

3 movements per day to 3 movements per week

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79
Q

Define diarrhoea

A

> 3 loose stools per day

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80
Q

Most common cause of acute diarrhoea

A

Infection

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81
Q

What other symptoms would someone with infective diarrhoea have?

A

Fever
Vomiting
Blood in the stool

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82
Q

Describe the causes of infective diarrhoea

A
  1. Rotavirus - common in children. Presents with severe watery diarrhoea, vomiting, fever and abdominal pain for about a week
  2. Norovirus - affects all ages. Presents with watery diarrhoea, vomiting, fever and abdominal pain. Very contagious
  3. C.Diff - common in hospital patients
  4. Food poisoning - affects all ages. Symptoms occur within hours to days of ingesting affected foods.
  5. Traveller’s Diarrhoea - common in patients returning from abroad and is mainly caused by ingestion of contaminated food or water
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83
Q

List 4 drugs which commonly cause diarrhoea

A
  1. Antibiotics
  2. Metformin
  3. Ferrous sulphate
  4. Laxatives
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84
Q

When would investigations be indicated in a patient with acute diarrhoea?

A
  • Person is systemically unwell, needs hospital admission and/or antibiotics
  • Blood or pus present in the stool
  • Patient has recently had antibiotics or been in hospital
  • Patient has been travelling and a parasitic infection is suspected
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85
Q

How would you manage a patient with acute diarrhoea?

A

If patient is not at risk of dehydration: drink plenty and rest

At risk of dehydration: admit to hospital

Consider antibiotics if culture indicates. Consider contacting local health protection unit.

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86
Q

List 7 causes of chronic diarrhoea

A
  • Coeliac disease
  • IBD
  • Diverticulitis
  • Chronic infection
  • Anxiety
  • ‘Overflow’ diarrhoea - leakage around impacted faeces
  • Colonic carcinoma
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87
Q

What features in a patients history would make you suspect that they had Coeliac disease?

A
  • Weight loss
  • Diarrhoea
  • Fatigue
  • Association with gluten
  • Family history of autoimmune disease
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88
Q

How would you manage a patient with suspected coeliac disease?

A
  1. Check TTG
  2. Refer for endoscopy
  3. Support dietary changes
    Consider screening 1st degree relatives
89
Q

What features in a patients history would make you suspect that they had IBD?

A
  • Young adult
  • Diarrhoea
  • Cramping abdominal pain
  • Bloody stool
  • Generally unwell
  • Weight loss
90
Q

What features in a patients history would make you suspect that they had Diverticulitis?

A
  • Older adults
  • Abdominal cramps
  • Bloating
  • Diarrhoea
91
Q

What features in a patients history would make you suspect that they had chronic infective diarrhoea?

A
  • Diarrhoea
  • History of acute infection
  • Weight loss
  • Fatigue
92
Q

What features in a patients history would make you suspect that they had anxiety-related diarrhoea?

A
  • Diarrhoea
  • Anxiety disorder
  • Symptoms situational
93
Q

What features in a patients history would make you suspect that they had overflow diarrhoea?

A
  • History of constipation

- Risk factors for constipation

94
Q

What features in a patients history would make you suspect that they had colonic carcinoma?

A
  • Middle-aged/older adult
  • Abdominal pain
  • Weight loss
  • Blood in stools
  • Tenesmus
95
Q

How would you manage a patient with suspected IBD in GP?

A
  1. CRP
  2. Fecal calprotectin
  3. Refer to GI
96
Q

How would you manage a patient with suspected diverticulitis?

A
  1. Analgesia

2. Consider referral to GI

97
Q

How would you manage a patient with suspected chronic infective diarrhoea?

A
  1. Stool culture and sensitivities

2. Refer for endoscopy

98
Q

How would you manage a patient with suspected anxiety-related diarrhoea?

A
  1. Active listening

2. Management of anxiety

99
Q

How would you manage a patient with suspected overflow diarrhoea?

A
  1. PR exam

2. Laxatives

100
Q

How would you manage a patient with suspected colonic carcinoma?

A
  1. Urgent cancer referral
101
Q

What are the red flag symptoms associated with diarrhoea?

A
  • Middle-aged/older
  • Weight loss
  • Blood in stools
  • Tenesmus
102
Q

Clinical features of male urinary problems

A

Storage symptoms:

  • Urgency
  • Nocturia
  • Daytime urinary frequency
  • Urinary incontinence

Voiding symptoms:

  • Hesitancy
  • Weak flow
  • Incomplete emptying
  • Terminal dribbling

Post-micturition symptoms

  • Dribbling
  • Sense of incomplete emptying
103
Q

Causes of storage urinary symptoms in men

A
  • BPH
  • Prostate/bladder cancer
  • Drugs e.g. tricyclic antidepressants, antihistamines
  • Diabetic autonomic neuropathy
  • Urethral stricture
104
Q

Causes of voiding urinary symptoms in men

A
  • BPH
  • Neurological conditions
  • UTI
  • Bladder stones
  • Bladder/prostate cancer
  • Pelvic surgery
  • Urethral injury
  • Alcohol
  • Caffeine
  • Drugs e.g. alpha-blockers, sympathomimetics, anti-muscarinics, opioids, anaesthetics
105
Q

Red flag symptoms in a male with urinary symptoms

A
  • Weight loss >3kg
  • Haematuria
  • Hard/irregular prostate gland
  • Lower back pain
  • Bone pain
  • Raised PSA
106
Q

What examinations would you do on a man presenting with urinary symptoms (and what are you looking for)?

A
  • Temperature
  • Pulse
  • Abdominal examination (distended bladder, suprapubic dullness)
  • Genital examination (urethral discharge)
  • Rectal examination (prostate size, consistency, tenderness, regularity)
107
Q

What investigations would you consider in a man presenting with urinary symptoms?

A
  • Urinalysis
  • MSU (if urinalysis positive)
  • U&Es
  • FBC (anaemia)
  • PSA
  • Urinary Frequency volume chart
  • IPSS
108
Q

What would you do if you were worried about cancer in a man with urinary symptoms?

A

Urgent referral to urology

109
Q

What lifestyle advice would you give to a man with urinary symptoms?

A
  • Don’t restrict fluids excessively
  • Avoid constipation
  • Maintain a healthy weight
  • Limit alcohol, fizzy drinks and caffeine
  • Signpost to bladder foundation website
110
Q

Management plan for a man presenting with voiding symptoms

A

1) Active surveillance

2) Conservative management
- Pelvic floor exercises
- Lifestyle modification

3) Medication
- Tamulosin (moderate-severe symptoms)
- Finasteride (enlarged prostate and high progression risk)
- Tamulosin + Finasteride (severe symptoms and prostate enlargment)
- Consider adding oxybutin

111
Q

When is oxybutin contra-indicated

A

Frail, elderly men

112
Q

Management plan for a man presenting with an overactive bladder

A

1) Lifestyle advice
2) Referral for bladder training

3) Medication
- Oxybutin
- Mirabegron if oxybutn CI

113
Q

Management plan for a man presenting with stress incontinence

A

1) Incontinence aids e.g. pad

2) Refer to continence service and/or urology to find cause

114
Q

Management plan for a man presenting with acute urinary retention for the FIRST TIME

A
  • Urgent referral for catheterisation (urology/community nurse)
115
Q

Management plan for a man presenting with recurrent urinary retention

A

1) Limit fluid intake in afternoon/evening

2) Medication
- Diuretics e.g. furosemide
- Desmopressin

116
Q

Which vitamin should be avoided in pregnancy?

A

Vitamin A - can be teratogenic

117
Q

Which tests would you order if a patient complained of feeling ‘tired all the time’?

A
  • FBC
  • U&Es
  • LFTs
  • Random blood glucose
  • TFTs
  • ESR
118
Q

Contra-indications for using HbA1c in the diagnosis of diabetes?

A
  • Pregnancy
  • Acute pancreatitis
  • Chronic renal failure
119
Q

How would you manage a child presenting with ear pain, a bulging eardrum and systemic pyrexia?

A

Oral amoxicillin

120
Q

You see a 65 yo man who has just been diagnosed with Type 2 Diabetes. You seem him to discuss his results and confirm the diagnosis. His BMI is 31. He reports that he has lost 1 stone over the last 2 months.
What is the best next step?

A
  • Urgent referral for upper abdominal imaging - T2DM whilst unintentionally losing weight is pancreatic cancer until proven otherwise
121
Q

How would you differentiate between otitis media with perforation and otitis externa?

A
  • Otitis media: pain relieved with perforation of the ear drum
  • Otitis externa: ongoing pain
122
Q

How would you manage a patient with otitis externa?

A

Topical drops/spray e.g. otomize

Patient must keep ears dry

123
Q

What tests would you do if you suspected a woman (age 45+) was going through the menopause?

A
  • No further tests needed - clinical diagnosis
124
Q

Which medications require patients to follow ‘sick day rules’?

A

DAMN:

  • Diuretics
  • ACE inhibitors
  • Metformin
  • NSAIDS e.g. diclofenac
125
Q

What conditions are routinely screened for in Scotland

A
  • Colorectal cancer (all men and women 50-74 every 2 years, using FOB)
  • Cervical cancer (women 25-64 every 3 years, using cervical smear)
  • Abdominal aortic aneurysm (men age 65)
  • Diabetic retinopathy in diabetics (annually in over 12s)

(NOT prostate cancer)

126
Q

How would you manage a child you suspected had meningococcal septicaemia?

A

Call an ambulance

Give immediate injection of IM benzylpenicillin

127
Q

Causes of a raised PSA

A
  • Urinary tract infection
  • Ejaculation/sexual intercourse
  • DRE
  • Vigorous exercise
128
Q

Side effects of thiazide diuretics

A
  • Impotence
  • Rash
  • Precipitation of latent diabetes
  • Hyperuricaemia
  • Hypokalemia
  • Alkalosis
129
Q

Side effects of ACE inhibitors

A
  • Cough

- Renal dysfunction

130
Q

Side effects of calcium antaognists

A
  • Headaches
  • Flushing
  • Ankle swelling
  • Tachycardia
131
Q

Side effects of beta blockers

A
  • Wheeze
  • Cold peripheries
  • Lassitude
  • Exercise intolerance
  • Bad dreams
  • Impotence
  • Heart block
  • Diabetes
132
Q

Which medications must you stop when using clarithromycin?

133
Q

Clinical features of atopic eczema

A
  • Common - affects 1 in 5 people
  • Usually presents in childhood and persist into adulthood
  • History of asthma and allergic rhinitis
  • Itchy, scaly, dry rash in elbow/knee flexures with thickened skin
134
Q

Clinical features of venous/varicose eczema

A
  • Bilateral itchy, red, scaly rash on lower legs

- History of other venous disease

135
Q

Clinical features of contact eczema

A
  • Itchy, swollen eryhtmetous rash with distinct border,
  • May be associated blisters/vesicles
  • History of exposure
136
Q

Management plan for a patient with eczema

A

1) Emollients
2) Topical corticosteroids
3) Topical tarcolimus

137
Q

Clinical features of psoriasis

A
  • Usually presents in early adulthood
  • Plaque rash on extensor aspects of elbows and knees
  • May be scalp and nail involvement
138
Q

Management plan for a patient with psoriasis

A

1) Calcitriol
2) Corticosteroids
3) NBUVB therapy and referral to dermatology
4) Ciclosporin/methotrexate/acitretin
5) Biologics

139
Q

Clinical features of shingles

A
  • History of chickenpox
  • Mainly presents in older adults
  • Pain/itching followed by papules and vesicles in a single dermatome distribution
140
Q

Management plan for a patient with shingles

A

1) Aciclovir 7 days PO within 72 hours of rash onset

141
Q

Clinical features of pityriasis rosea

A
  • Single Herald patch followed by slightly itchy oval macules/plquaes affecting trunk in ‘christmas tree’ distribution
142
Q

Management plan for a patient with pityriasis rosea

A

No treatment required

143
Q

Clinical features of tinea infection

A
  • Clear bordered red rash in single or multiple small, scaly erythematous annular patches on
    groin (cruiris), foot (pedis), nails (unguium) or body (corps)
144
Q

Management plan for a patient with tinea infection

A

1) Clotrimzaole cream
2) Terbinafine

Investigate for type 2 DM in patients with persistent fungal infections

145
Q

Clinical features of urticaria

A
  • Appears as acute rash in children or chronic form in adults
  • Transient raised red oedematous lesions (wheals)
146
Q

Management plan for a patient with urticaria

A

No treatment required

147
Q

Clinical features of otitis media

A
  • Ear pain
  • Tenderness
  • Bulging tympanic membrane
148
Q

Management of a child with acute otitis media

A

1) Analgesia

2) Amoxicillin 5 days PO

149
Q

What antibiotic should you use in children with a penicillin allergy?

A

Clarithromycin

150
Q

Clinical features of tonsillitis

A
  • Sore throat
  • Otalgia
  • Headache
  • Malaise
  • Pyrexia
  • Enlarged tonsils
  • Tonsillar exudate
  • Inflamed pharyngeal mucosa
  • Fetor
  • Enlarged and tender cervical lymph nodes
151
Q

Management of a child with tonsillitis

A

1) Analgesia

2) Phenoxymethylpenicillin 10 days PO

152
Q

Features of the Centor criteria

A

1) Absence of cough
2) Tonsillar exudate
3) Fever
4) Tender anterior cervical adenoapthy
+1 point for each positive finding

0-2: no antibiotic or throat culture needed
3-4: antibiotic

Modified mentor criteria incorporates the patient’s age: <15 = 1 point, >44 = -1point

153
Q

Clinical features of pharyngitis

A
  • Sore throat
  • Dysphagia
  • Malaise
  • Erythematous pharyngeal and tonsillar mucosa
154
Q

Management of a child with pharyngitis

A

1) Analgesia

2) Phenoxymethylpenicillin 10 days PO

155
Q

Clinical features of croup

A
  • Usually <2
  • Characteristic inspiratory stridor
  • Barking cough
  • Hoarse voice
  • Fever
  • Dyspnoea
  • Symptoms worse at night
  • Child unsettled

Usually worse in 24-48 hours, but can last to 7 days

156
Q

Management of a child with croup

A

1) Prednisolone/dexamethasone PO single dose

157
Q

Clinical features of pneumonia in a child

A
  • Fever
  • Tachypnoea
  • Cough
  • Laboured breathing
  • Vomiting
  • Chest pain
  • Abdominal pain
  • Decreased activity
  • Loss of appetite
  • Cyanosis
158
Q

Most common cause of bacterial pneumonia in children

A

Strep pneumoniae

159
Q

Management of pneumonia in a child

A

1) Analgesia

2) Amoxicillin

160
Q

Clinical features of Whooping cough/Pertussis

A
  • Runny nose
  • Red-watery eyes
  • Sore throat
  • Mild fever
  • Followed by repeated coughing bouts lasting a few minutes
  • Symptoms worse at night
  • Thick yellow sputum
  • Symptoms last 2-3 months
161
Q

Management of a child with pertussis

A

1) Analgesia

2) Erythromycin

162
Q

Clinical features of UTI in a child

A
  • Fever
  • Vomiting
  • Lethargy
  • Irritability
  • Poor feeding
  • Failure to thrive
  • Change in normal toilet habits
  • Unpleasant smelling urine
  • Cloudy urine
163
Q

Management of a child with a UTI

A

1) Trimethoprim 3 days PO

164
Q

Clinical features of meningitis

A
  • Fever
  • Cold peripheries
  • Vomiting
  • Confusion
  • Tachypnoea
  • Muscle/joint pain
  • Non-blanching rash
  • Headache
  • Stiff neck
  • Photophobia
  • Sleepiness
165
Q

Management of a child with suspected meningococcal meningitis

A

1) IM or IV benzylpenicillin

2) Cefotaxime

166
Q

Clinical features of chickenpox

A
  • Develops 14-21 days after exposure
  • Intensely itchy rash mainly on face and trunk
  • Macular lesions –> papular or vesicular lesions –> become pustular –> scab over
167
Q

Management of chickenpox

A

No treatment required

168
Q

Clinical features of Hand, Foot and Mouth disease

A
  • 1-2 day prodrome: sore throat, pyrexia, dysphagia, poor appetite, malaise
  • Mouth lesions (1-2 days after fever) - vesicles seen in oral cavity, buccal mucosa and sides of tongue
  • Papular, vesicular rash with surrounding erythema on hands and feet (sometimes buttocks)
  • Symptoms last 7-10 days
169
Q

Management of Hand, Foot and Mouth disease

A

No treatment required

170
Q

Clinical features of Scarlet fever

A
  • Common in 2-8 year olds
  • High fever
  • Headache
  • Malaise
  • Nausea/vomiting
  • Blanching maculopapular rash initialyl on torso then spreading to rest of body
  • Enlarged red tonsils covered in white exudate
  • Furred tongue with enlarged papillae (‘strawberry tongue;)
171
Q

Management of scarlet fever

A

1) Analgesia + phenoxymethylpenicillin 10 days PO

172
Q

Clinical features of impetigo

A
  • Multiple golden, crusty lesions (merciless, vesicles or papillose) on face or extremities
173
Q

Management of impetigo

A

1) Flucloxacillin 7 days

174
Q

Clinical features of Fifth disease/slapped cheek

A
  • Common in school-aged children
  • 4 day prodrome: mild fever, sore throat, coryza, headache and nausea
  • Maculopapular rash on cheeks –> mauclopapular rash on extremities and trunk
175
Q

Management of fifth disease/slapped cheek

A

No treatment required

176
Q

Clinical features of cradle cap/infantile seborrhoea dermatitis

A
  • 1-2 weeks old

- Acute erythematous, coarse, yellow scaling of scalp (or nappy areas, face, chest, back and limb flexures)

177
Q

Management of infantile seborrhoea dermatitis

A

1) No treatment

2) Olive oil or Capasal shampoo

178
Q

Which vaccinations are given at 8 weeks old?

A
  • Diptheria, tetanus, pertussis, polio, Haemophilus influenzae B, hepatitis B (6-in-1) in the thigh
  • Pneumococcal (PCV) in the thigh
  • Meningococcal B (MenB) in the left thigh
  • Rotavirus gastroenteritis (rotavirus) by mouth
179
Q

Which vaccinations are given at 12 weeks old?

A
  • Diptheria, tetanus, pertussis, polio, haemophilus infleunza B, hepatitis B (6-in-1, round 2) in the thigh
  • Rotavirus gastroenteritis (Rotavirus) by mouth
180
Q

Which vaccinations are given at 16 weeks old?

A
  • Diptheria, tetanus, pertussis, polio, hameophilus influenza B, hepatitis B (6-in-1, round 3) in the thigh
  • Pneumococcal (PCV, round 2) in the thigh
  • Meningitis B (MenB) in the left thigh
181
Q

Which vaccinations are given at one year old?

A
  • Haemophilus influenza B and meningitis C in the upper arm/thigh
  • Pneumococcal (round 3) in the upper arm/thigh
  • Measles, mumps and rubella (MMR) in the upper arm/thigh
182
Q

Vaccination routine for the 6-in-1 vaccine

A
  1. 8 weeks old
  2. 12 weeks old
  3. 16 weeks old
183
Q

What diseases does the 6-in-1 vaccine protect against?

A
  1. Diptheria
  2. Tetanus
  3. Polio
  4. Pertussis
  5. Haemophilus influenza B
  6. Hepatitis B
184
Q

Vaccination routine for Pneumococcal

A
  1. 8 weeks old
  2. 16 weeks old
  3. 1 year old
185
Q

Vaccination routine for the Meningitis B vaccine

A
  1. 8 weeks old

2. 16 weeks old

186
Q

Vaccination routine for the rotavirus vaccine

A
  1. 8 weeks old

2. 12 weeks old

187
Q

Abdominal aortic aneurysm screening routine

A
  • Men aged 65, offered once using ultrasound of the abdomen
188
Q

Cervical screening routine

A
  • Women aged 25-64, offered every 3 (25-49) or 5 (50-64) years depending on age using cervical smear
189
Q

Breast screening routine

A
  • Women aged 50-70, offered every 3 years using mammogram (women over 70 can self-refer)
190
Q

Bowel screening programme

A
  • Men and women aged 50-74, offered every 2 years using faecal immunochemical test
191
Q

Diabetic retinopathy screening routine

A
  • Diabetics over the age of 12, offered every year
192
Q

Pregnancy screening routine

A

Pregnant women at various stages of pregnancy

  • number of blood tests throughout
  • 2 ultrasound scans (11-14 weeks, and 18-21 weeks - looking for main health conditions affecting brain, spinal cord, bowel, kidneys, limbs and heart)
193
Q

Newborn screening routine

A

All new born babies within the first few weeks of life

  • Hearing test
  • Bloodspot test - PKU, CF, sickle cell disease, congenital hypothyroidism, galactosemia, biotinidase deficiency, congenital adrenal hyperplasia, tyrosinemia
  • Physical examination - congenital heart disease
194
Q

Signs that a child with a feverish illness is low risk

A
  • Normal skin colour
  • Responds normally to social cues
  • Content/smiling
  • Stays awake or awakens quickly
  • Strong normal cry/not crying
  • Normal respiratory rate and effort
  • Normal skin and eyes
  • Moist mucous membranes
195
Q

Signs that an under 5 with a feverish illness is intermediate risk

A
  • Pallor
  • Not responding normally to social cues
  • Not smiling
  • Wakes only with prolonged stimulation
  • Decreased activity
  • Nasal flaring
  • Tachypnoea - >50bpm in <1 year, >40bpm in >1 year
  • Oxygen sats <96% on room air
  • Crackles head on chest
  • Tachycardia - >160bpm in <1 year, >150bpm in 1-2 year, >140bpm in 2-5)
  • Capillary refill time >3 seconds
  • Dry mucous membranes
  • Poor feeding
  • Reduced urine output
  • Age 3-6 months with a fever over 39
  • Fever for >4 days
  • Rigors
  • Swelling of a limb/joint
  • Non-weight bearing limb or not using an extremity
196
Q

Signs that an under 5 with a feverish illness is high risk

A
  • Pale/mottled/ashen/blue
  • No response to social cues
  • Appears ill
  • Does not wake when roused or if roused, does not stay awake
  • Weak, high-pitched or continuous cry
  • Grunting
  • Tachypnoea >60bpm
  • Moderate or severe chest in-drawing
  • Reduced skin turgor
  • Age <3 months with a temperature >38
  • Non-blanching rash
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal neurological signs
  • Focal seizures
197
Q

How would you manage a patient who wears contact lenses presenting with an acute red eye?

A

Refer urgently to ophthalmology to exclude coral ulcer

198
Q

How would you manage a patient with a high-velocity injury presenting with acute red eye?

A

Refer immediately to the emergency eye service for imaging of the orbit to check for an intra-ocular foreign body

199
Q

How would you manage a patient with chemical eye injury and an acute red eye?

A

Immediately irrigate the eye with 0.9% saline, and arrange urgent transfer for ophthalmology assessment

200
Q

Indications of a serious and potentially sigh-threatening cause of a patient with an acute red eye

A
  • Reduced visual acuity
  • Deep pain within the eye
  • Unilateral red eye
  • Contact lens use
  • Photophobia –> acute uveitis, corneal ulcer, contact-lens-related or foreign body
  • High-velocity injuries or injuries involving glass
  • Chemical eye injury
  • Ciliary injection –> corneal ulcer, contact-lens-related, corneal foreign body and anterior uveitis
  • Fluorescein staining –> corneal ulcer, abrasion
  • Unequal or misshapen pupils, or abnormal pupillary reaction –> acute glaucoma, anterior uveitis
  • Pain on pupillary constriction
  • Conjunctivitis in a baby <1 month old
201
Q

Define traveller’s diarrhoea

A
  • At least 3 loose to watery stools in 24 hours with or without one or more of abdominal cramps, fever, nausea, vomiting or blood in the stool.
202
Q

Most common cause of traveller’s diarrhoea

203
Q

Clinical features of E. Coli poisoning

A
  • Incubation: 12-48 hours
  • Common amongst travellers
  • Watery stools
  • Abdominal cramps and nausea
204
Q

Clinical features of Giardiasis

A
  • Incubation: >7 days

- Prolonged, non-bloody diarrhoea

205
Q

Clinical features of cholera

A
  • Profuse, watery diarrhoea
  • Severe dehydration resulting in weight loss
  • Not common amongst travellers
206
Q

Clinical features of Shigella

A

Incubation: 48-72 hours

  • Bloody diarrhoea
  • Vomiting and abdominal pain
207
Q

Clinical features of S.Aureus food poisoning

A
  • Severe vomiting

- Short incubation period (1-6 hours)

208
Q

Clinical features of Campylobacter poisoning

A
  • Incubation: 48-72 hours
  • Flu-like prodrome
  • Crampy abdominal pains, fever and diarrhoea (may be bloody)
  • May mimic appendicitis
  • Can lead to Guillain-Barre syndrome
209
Q

Clinical features of Bacillus cereus

A
  • Incubation 1-6 hours
  • Rice: vomiting within 6 hours
  • Other: diarrhoea after 6 hours
210
Q

Clinical features of amoebiasis

A
  • Incubation: >7 days
  • Gradual onset bloody diarrhoea, abdominal pain and tenderness
  • Symptoms last several weeks
211
Q

Differentials for right hypochondriac abdominal pain

A
  • Gallstones
  • Cholangitis
  • Hepatitis
  • Liver abscess
  • Cardiac disease
  • Respiratory disease
212
Q

Differentials for epigastric pain

A
  • Eosphagitis
  • GORD
  • Peptic ulcer
  • Perforated ulcer
  • Pancreatitis
213
Q

Differentials for left hypochondriac abdominal pain

A
  • Splenic abscess
  • Acute splenomegaly
  • Spleen rupture
214
Q

Differentials for right or left lumbar abdominal pain

A
  • Ureteric colic

- Pyelonephritis

215
Q

Differentials for umbilical abdominal pain

A
  • Appendicitis (early)
  • Mesenteric adenitis
  • Meckel’s diverticulitis
  • Lymphoma
216
Q

Differentials for right iliac fossa abdominal pain

A
  • Appendicitis
  • Crohn’s disease
  • Caecum obstruction
  • Ovarian cyst
  • Ectopic pregnancy
  • Hernia
217
Q

Differentials for hypogastric abdominal pain

A
  • Testicular torsion
  • Urinary retention
  • Cystitis
  • Placental abruption
218
Q

Differentials for left iliac fossa abdominal pain

A
  • Diverticulitis
  • Ulcerative colitis
  • Constipation
  • Ovarian cyst
  • Hernia

Year 4 (11 decks)

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