GP

Question 1

methods for assessing temperature in a child

Answer 1

Less than 4weeks of age - electronic thermometer in the axilla.
Aged 4weeks to 5years of age - electronic thermometer or a chemical dot thermometer in the axilla, or an infra-red tympanic thermometer.

Question 2

red flag symptoms in a child

Answer 2

appearance: pale, mottled, blue
activity: appears ill to professional, does not rouse, high pitched weak or continuous cry
respiratory: grunting, severe chest in-drawing, RR>60
circulation: reduced skin turgor
other: meningitis signs, temperature >38 in under 3 months

Question 3

causes of visual impairment

Answer 3

Elderly – Macular degeneration, glaucoma.

Younger – Diabetic retinopathy, uveitis, inherited retinal disease, retinovascular disease

Question 4

Fraser Guideline requirements

Answer 4

Understand
Parental knowledge can't be persuaded
Sex will occur anyway 
Suffer the physical + mental consequences 
It is in her best interests

Question 5

differential diagnosis for anxiety

Answer 5

• Situational Anxiety Disorder
• Hyperthyroidism
• Menopause
• GAD
• Acute coronary syndrome
• Panic disorder
• PTSD

Question 6

screening tools for depression, anxiety and substance misuse

Answer 6

depression: PHQ9, Geriatric depression scale, edingburgh postnatal depression scale, hospital anxiety and depression scale
anxiety: generalised anxiety disorder 7, hamilton anxiety rating scale. HADS

substance misuse: FAST, DAST, CAGE, AUDIT

Question 7

Questions to ask as part of a sexual history

Answer 7

Everyone
Last time you had sex, what type of sex was it, who was it with, how many partners, was it protected,

Vagina: pain, discharge, contraception, bleeding, cervical smear, last menstrual period, obstetric history

Penis: discharge, pain or swelling, urinary symptoms

Question 8

tests that are part of a confusion screen

Answer 8

TFTs, haemetinics (vitamins), FBC, MSU, radiology, cognitive assessment

Question 9

what is polypharmacy and what are the disadvantages of it

Answer 9

Polypharmacy: use of 4 or more types of medication
• Pill burden: storing, organising
• Compliance
• Interactions
• Side effects
• Costs
• Lack of understanding of all the medication
• Therapeutic cascade: taking medication to treat side effect of other drugs

Question 10

what is STOPP/Start and what are its aims

Answer 10

screening tool of older person’s medication and screening tool to alert doctors to right treatment

improve medication appropriateness
prevent adverse drug events
reduce drug costs

Question 11

step wise antihypertensive management

Answer 11

step 1
white or under 55: ACE inhibitors or angiotensin receptor blockers
black or over 55: calcium channel blockers

step 2: A + C

step 3: A + C + thiazide like diuretic

step 4: further diuretic, alpha blocker, beta blocker +/- specialist advice

Question 12

example of ACE inhibitors and common side effects and contraindications

Answer 12

ramipril, captopril, enalapril, lisinopril

SE: dry cough, rash, nausea and vomiting, diarrhoea, headache

CI: pregnancy, asthma, chronic cough, allergy, renal stenosis/kidney disease

Question 13

example of angiotensin receptor blockers, side effects and contraindications

Answer 13

candesartan, losartan

SE: headache, nausea, diarrhoea, dizziness, back pain

CI: pregnancy, renal stenosis, allergy

Question 14

examples of alpha 1 receptor blockers side effects and contraindications

Answer 14

(also reduce cholesterol)
Doxazosin, Terazosin

SE: hypotension

Question 15

examples of beta blockers, side effects and contraindications

Answer 15

bisoprolol atenolol labetolol

SE: bradycardia, fatigue, hypotension, decreased libido, impotence, bronchoconstriction

CI: obstructive lung disease, peripheral vascular disease

Question 16

examples of calcium channel blockers, side effects and contraindications

Answer 16

amlodipine, verapimil

SE: flushing, headache, dizziness, palpitations, peripheral oedema

CI: congestive heart failure, heart block, ventricular tachycardia

Question 17

examples of diuretics, side effects and contraindications

Answer 17

loop diuretics: furesomide
thiazide diuretics (distal nephron): indapamide
potassium sparing diuretics: spironolactone

SE: hypokalaemia, hyponatraemia, hypovolaemia, hypotension, increased gout + pancreatitis risk and metabolic alkalosis

SE PSD: hyperkalalaemia, metabolic acidosis, gynaecomastia

Question 18

components of the fever pain score

Answer 18

predicts likelihood of strep pharyngitis

fever in .past 24hrs
absence of cough/coryza
onset = 3 days
purulent tonsils 
severe tonsil inflammation

2 - 3: consider delayed antibiotics
4 - 5: consider antibiotics