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Year 4 Family and Children ANNA > GP > Flashcards

GP Flashcards

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1
Q

What are the signs / symptoms of cauda equina syndrome?

A
  1. Bilateral sciatica
  2. Severe or progressive bilateral neurological deficit of the legs
  3. Difficulty initiating micturition or impaired sensation of urinary flow, with later retention and overflow
  4. Loss of sensation of rectal fullness and later faecal incontinence
  5. Saddle anaesthesia or paraesthesia
  6. Laxity of the anal sphincter
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2
Q

What are the symptoms of a spinal fracture?

A
  1. Sudden onset, severe pain, relieved by lying down.
  2. History of trauma (this may be minor in those with osteoporosis)
  3. Structural spinal deformity
  4. Point tenderness over a vertebral body
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3
Q

What are 4 serious differentials you must rule out when considering back pain?

A
  1. Cauda Equina
  2. Spinal fracture
  3. Cancer (cord compression)
  4. Infection
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4
Q

What is the difference between spondylosis, spondylitis, spondylysis, and spondylolesthesis?

A

SPONDY = spine

SpondyLOSIS = degenerative

SpondyLITIS = Inflammatory, this can be due to anything that results in inflammation.

SpondyloLYSIS = “break down” of a bone typically a stress fracture of the Pars Interarticularis, classically seen as a Scottie dog fracture on an X-ray.

SpondyloLESTHESIS = (to slip) – Slippage of a vertebrae body (not disc) typically due to a Pars Interarticularis fracture, but can also happen in degenerative conditions. This can cause nerve root compression.

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5
Q

What is the “rescue dose” of morphine for breakthrough pain?

A

Between 1 /10th and 1 /6th of the regular 24 hour dose (take every 2-4 hours unless severe / last days)

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6
Q

Name a drug that reduces respiratory secretions

A

Glycopyrronium Bromide

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7
Q

What question should be asked when considering if a patient should be put on the paliative care register?

A

“Would I be surprised if this patient died in the next 6-12 months?”

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8
Q

Which 2 vitamins should be replaced with alcohol withdrawal?

A

Thiamine (= B1) and Folic Acid

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9
Q

What are the symptoms of alcohol withdrawal?

A
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10
Q

What are some side effects of metformin?

A
  1. Abdominal pain
  2. Anorexia
  3. Diarrhoea (usually transient)
  4. Nausea
  5. Taste disturbances
  6. Vomiting

A rarer side effect could be decreased B12 absorption

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11
Q

Which 2 diabetic medications can cause hypoglycaemia?

A
  1. Insulin
  2. Sulphonylureas → such as gliclazide
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12
Q

What are the features described in the NICE 7 point checklist for suspected melanoma?

A

Major features of the lesions (scoring 2 points each):

  1. change in size
  2. irregular shape
  3. irregular colour.

Minor features of the lesions (scoring 1 point each):

  1. largest diameter 7 mm or more
  2. inflammation
  3. oozing
  4. change in sensation
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13
Q

What is the QRISK 3?

A

The QRISK®3 algorithm calculates a person’s risk of developing a heart attack or stroke over the next 10 years.

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14
Q

How do you work out the exact no of units in alcoholic drinks?

How much ethanol in 1 unit? How long does it take to process it?

A

strength (ABV) x volume (ml) ÷ 1,000 = units

8g in one unit, takes 1 hour

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15
Q

What is the difference between HDL and LDL?

A

HDL is known as “good cholesterol” It carries cholesterol away, from the blood vessel wall, back to the liver. The higher it is the more cholesterol comes off the blood vessels.

LDL on the other hand goes the other way, from the liver to the blood vessels to cause atheromatous plaques.

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16
Q

What score on QRISK3 would prompt the prescribing of a statin?

A

Over 10% risk of stroke / heart attack in next 10 years.

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17
Q

What 2 medications could alter the gut pH / flora and cause c.diff infection?

A
  1. antibiotics
  2. PPIs
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18
Q

What are the Fraser guidelines?

A

GP can give contraception advice under 16 if:

  1. The young person understands the practitioner’s advice.
  2. The young person cannot be persuaded to inform their parents, or will not allow the practitioner to inform the parents, that contraceptive advice has been sought.
  3. The young person is likely to begin or to continue having intercourse with or without contraceptive treatment.
  4. Unless he or she receives contraceptive advice or treatment, the young person’s physical or mental health (or both) are likely to suffer.
  5. The young person’s best interest requires the practitioner to give contraceptive advice or treatment (or both) without parental consent.
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19
Q

What is a Patient Group Direction (PGD)?

A

PGDs provide a legal framework that allows some registered health professionals to supply and/or administer a specified medicine(s) to a pre defined group of patients, without them having to see a prescriber.

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20
Q

What is the main mechanism of action of the morning after pill, levonogestrel?

A

the most likely and accepted mechanism is delay of ovulation.

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21
Q

What are the methods of emergency contraception?

A
  1. “Morning after pill” levonogestrel - within 3 days (72h)
  2. EllaOne (Ulipristal acetate) - within 5 days (120h)
  3. Copper coil - 5 days (120h) and long acting method
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22
Q

What are the symptoms of an upper GI bleed?

A
  1. melaena
  2. haematemesis
  3. coffee ground vomit
  4. presyncope/syncope
  5. severe abdominal pain if = perforation.
23
Q

What is the difference in presentation between an MI, pancreatitis and gastric ulcers?

A
24
Q

What is the spot diagnosis?

severe dull pain, epigastrium or LUQ radiating through to back and/or L shoulder. History of excess alcohol or gallstones.

A

Pancreatitis

25
Q

What are the self-remedies for constipation?

A
  1. Physical Activity
  2. Fruit
  3. Fibre
  4. Fluids
26
Q

What manoeuvres

  1. Diagnose benign paroxysmal positional vertigo?
  2. Treat it?
A
  1. The Dix-Hallpike manoeuvre
  2. The Epley manoeuvre
27
Q

How do you check for postural hypotension?

A

Check BP lying then after standing at intervals of 1, 3 and 5 minutes. Ask about symptoms

28
Q

When would you consider hospitalisation in a COPD exacerbation?

A
  1. Severe breathlessness, rapid onset of symptoms, acute confusion, cyanosis, worsening peripheral oedema, or impaired consciousness.
  2. The person is unable to cope or lives alone.
  3. A reduction in activities of daily living, is confined to bed, or is on long-term oxygen therapy (LTOT).
  4. Significant comorbidity.
  5. Low oxygen saturation (less than 90%) on pulse oximetry.
29
Q

What are the most common CAP causing organisms in COPD?

A

Haemophilus influenzae (most common cause)

Streptococcus pneumoniae

Moraxella catarrhalis

30
Q

what is the pathway of adding medications in COPD?

A
31
Q

What is the stepwise approach to asthma medications?

A

ß2 agonists:

  1. Short acting (SABA) e.g. salbutamol, terbutaline
  2. Long acting (LABA) e.g. salmeterol, eformoterol

Muscarinic antagonists / “antimuscarinics”

  1. ipratropium (SAMA)
  2. tiotropium (LAMA)
32
Q

What should be done when a mistake has been made (according to the GMC duty of candour)

A
  1. tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong
  2. apologise to the patient (or, where appropriate, the patient’s advocate, carer or family)
  3. offer an appropriate remedy or support to put matters right (if possible)
  4. explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened.
33
Q

What is the difference between a Living Will and Advanced directive?

A

Living Will = about what I do want e.g. to die at home. Not legally binding

Advanced directive = what I do not want in specific situations e.g. if I get a chest infection I don’t want abx. Legally binding

34
Q

What kind of monitoring does a patient on ramipril need?

A
  1. BP monitoring
  2. Kidney bloods
35
Q

What are the 4 key pillars of medical ethics?

A
  1. Autonomy
  2. Beneficence
  3. Non-maleficence
  4. Justice
36
Q

Why is metformin decreased if eGFR is dropping?

A

There is an increased risk of lactic acidosis if metformin given with renal impairment. NICE recommend that medication be stopped if sudden deterioration in renal function, and avoid if eGFR less than 30mL/minute/1.732

37
Q

What features of headache are red flags for serious cause?

A
  1. new or sudden onset headache
    1. especially in over 50s
  2. progressive / persistant headache that has changed dramatically
  3. associated features:
    1. papilloedema
    2. photophobia
    3. fever
    4. impaired consciousness
    5. dizziness
    6. atypical aura
    7. vomiting
  4. Contact with people with similar symptoms
  5. precipitating factors
  6. comorbidity
    1. immunosuppression
    2. malignancy
  7. pregnancy
38
Q

Which examinations might be pertinent to a headache history?

A
  1. Blood pressure
  2. HR
  3. CN
  4. Fundoscopy
  5. Palpate temporal arteries
39
Q

What are the social characteristics of increased suicide risk?

A
  1. male
  2. living alone
  3. <30 years
  4. >advanced age
40
Q

What are the factors in the history for increased risk of suicide?

A
  1. prior attempt
  2. fh of suicide
  3. hx of substance / alcohol abuse
  4. recently started on antidepressants
41
Q

what are the clinical features for increased suicide risk?

A
  1. hopelessness
  2. psychosis
  3. anxiety / agitation / panic attacks
  4. concurrent physical illness
  5. severe depression
42
Q

What is the (S)HARK questionnaire?

A

S - SAFE - do you feel safe to go home today?

H - HUMILIATION -Within the last year, have you been humiliated or emotionally abused in other ways by your partner or your ex-partner?

A - AFRAID - Within the last year, have you been afraid of your partner or ex-partner?

R - RAPE - Within the last year, have you been raped or forced to have any kind of sexual activity by your partner or ex-partner?

K - KICK - Within the last year, have you been kicked, hit, slapped or otherwise physically hurt by your partner or ex-partner?

43
Q

what is SENCO?

A

Special Educational Needs Coordinator

44
Q

what should be present to diagnose ADHD apart from the symptoms?

A

To be diagnosed with ADHD, a child must also have:

  1. 6 or more symptoms of inattentiveness, or 6 or more symptoms of hyperactivity and impulsiveness.
  2. been displaying symptoms continuously for at least 6 months
  3. started to show symptoms before the age of 12
  4. been showing symptoms in at least 2 different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or to parental control
  5. symptoms that make their lives considerably more difficult on a social, academic or occupational level
  6. symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition
45
Q

what are the 2 categories of symptoms in ADHD?

A
  1. Inattentiveness
  2. Hyperactivity + Impulsiveness
46
Q

What kind of signs of innattentiveness might be present in ADHD?

A
  1. having a short attention span and being easily distracted
  2. making careless mistakes – for example, in schoolwork
  3. appearing forgetful or losing things
  4. being unable to stick to tasks that are tedious or time-consuming
  5. appearing to be unable to listen to or carry out instructions
  6. constantly changing activity or task
  7. having difficulty organising tasks
47
Q

What are the main signs of hyperactivity and impulsiveness in adhd?

A

The main signs of hyperactivity and impulsiveness are:

  1. being unable to sit still, especially in calm or quiet surroundings
  2. constantly fidgeting
  3. being unable to concentrate on tasks
  4. excessive physical movement
  5. excessive talking
  6. being unable to wait their turn
  7. acting without thinking
  8. interrupting conversations
  9. little or no sense of danger
48
Q

What are the four key steps to follow to help you to identify and respond appropriately to possible abuse and/or neglect?

A
  1. Be Alert (know what signs to look for)
  2. Question behaviours (ask if you have any doubts)
  3. Ask for help (you do not have to deal with it alone)
  4. Refer (there are specialists in safeguarding who can help you and should be informed if you have concerns)
49
Q

what is the 1st line medical treatment for ADHD?

A

Methylphenidate

50
Q

What is the questionairre used for alcoholism?

A
  1. C - Have you ever felt you should cut down on your drinking?
  2. A - Have people annoyed you by criticizing your drinking?
  3. G - Have you ever felt bad or guilty about your drinking?
  4. E - Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)

score of 2+ suggests problematic drinking

51
Q

What questions should you ask alcoholics to assertain:

  • dependance
  • tolerance
  • impact
A

“If you stop drinking, do you…get the shakes/sweat a lot/feel sick/notice any physical changes?”

“Do you have to drink more than you used to, to get the same effects?” (tolerance)

“ever been involved with police as a result of drinking? Sent to hospital? lost friends over it?”

52
Q

What should you warn alcoholics about?

A

If you stop suddenly you could be at risk of delerium tremens:

  • confusion
  • shaking
  • fever
  • seizures
  • this can be very dangerous
53
Q
A

Year 4 Family and Children ANNA (23 decks)

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