GP Flashcards
What is the STaRT back tool used for
Risk stratification of modifiable risk factors for assessing risk of chronicity/disability of back pain (biopsychosocial approach).
After how long do sciatica symptoms usually settle by
4-6 weeks
At what vertebral level does the cauda equina start
L1
Features of cauda equina syndrome
Urinary/fecal retention/incontinence Saddle anaesthesia Reduced anal tone Bilateral leg pain Bilateral leg weakness Erectile dysfunction Loss of reflexes
What are the 3 main types of spinal infection
Discitis
Vertebral osteomyelitis
Spinal epidural abscess
What is spondylolysis
Vertebral fracture - stress fracture of pars interarticularis which are common in sports, hyperextension movements, lumbar
What is spondylolithiasis
Vertebra slips - nerve root sx, step deformity, height loss, kyphosis
In palliative care what can be used to help loss of appetite
Prednisolone or Dexamethasone
In palliative care what can be used to help with respiratory secretions
Hyoscine hydrobromide
In palliative care what can be used to help with bowel colic
Hyoscine butylbromide Hyoscine hydrobromide Loperamide hydrochloride Hyoscine Glygopyronium bromide
In palliative care what can be used to help with capillary bleeding
Tranexamic acid
Vit K if liver disease related
In palliative care what can be used to help with SOB
Morphine
Diazepam
Dexamethasone
In palliative care what can be used to help with muscle spasm
Baclofen
In palliative care what can be used to help with nausea and vomiting
Metoclopramide
Cyclizine
In palliative care what can be used to help with restlessness/confusion
Haloperidol
In palliative care what can be used to help with insomnia
Temazepam
In palliative care what can be used to help with hiccups
Metoclopramide
What is an advanced statement
Preferences/wishes/values/beliefs for future care so if cant decide or communicate at any point. Where you want to be cared for, day-to-day preferences, religious beliefs, practical concerns e.g. pet care. Not legally binding but anyone caring for you must take it into account.
What is an advanced decision
Living will/Advanced directive
Legal document to refuse treatments in the future. Only valid if >18, have capacity, clear on which treatments to refuse and under which circumstances, signed by you (and a witness if refusing life-sustaining treatment), no pressure involved, not said/done anything to contradict it since.
What does CPR include
Chest compressions
Shocks
Ventilation
Medication
What are the 2 types of lasting power of attorney
A) Health and welfare
B) Finance and property
If handing over a palliative/end of life patient, what additional information is important to mention
Understanding of prognosis The care plan Preferred place of care Advanced decisions Advanced statements Lasting power of attorney DNACRP
Steps involved in the confirmation of a death
Check local minimum timeframe
Wash hands
Confirm patient identity
Inspect for signs of life - response to verbal stimulus, respiration
Pressure on fingernail to check response to pain
Pupils - fixed and dilated
Carotid pulse for 2 minutes
Listen for heart sounds for 2 minutes
Listen to lungs for 3 minutes
Wash hands again
Document findings
Document time of death as when you have confirmed it
Document whether or not they have a pacemaker if they want to be cremated
Which vitamin is Thiamine
B1
Which vitamin is Co-balamin
B12
What type of anaemia can Metformin cause
Macrocytic - B12 deficiency
What is the minimum blood sugar that is safe to drive
5
If you’ve had a hypo whilst driving when can you set off again
Once blood sugars have been normal for 45 minutes
Describe the NICE weighted 7 point checklist for suspected melanoma
Major features (2 points each) = change in size, irregular shape, irregular colour. Minor features (1 point each) = largest diameter 7mm or more, inflammation, oozing, change in sensation Refer under 2ww if 7 point checklist score of 3 or more.
What does SPIKES stand for
Setting Perception Invitation Knowledge Emotions Strategy and summary
What follow up bloods do you do after starting someone on a statin
Cholesterol at 3 months
Cholesterol and LFTs at 12 months
How do you calculate BMI
Weight in Kg divided by height in metres squared
Normal BMI
18.5-25
Obese BMI
30
On average how long does it take the body to clear one unit of alcohol
1 hour
How does herpes simplex encephalitis present
Focal neurological signs
Focal seizures
Decreased level of consciousness
Diagnostic criteria for Kawasaki disease
Fever for >5 days plus 4 of; Bilateral conjunctival injection Change in mucous membranes Change in extremities Polymorphous rash Cervical lymphadenopathy
Organism associated with epiglottitis
Haemophilus influenza B
Presentation of epiglottitis
2-4 year old Short history of fever Irritability SOB Dysphonia Dysphagia Drooling Sat forward, tripod position
Fraser criteria
For <16 year olds wanting contraception;
Understand advice
Won’t tell parents
Likely to continue even without contraception
Physical/mental health likely to suffer without contraception
In best interests without parental consent
Contraindications to NSAIDs
Active GI ulcer or bleed
Hx of bleed/perforation related to NSAID use
2 or more episodes of recurrent GI haemorrhage or ulceration
Hypersensitivity/allergy
Asthma
Sever liver or renal impairment
What is the risk associated with NSAIDs + SSRI
Gastric ulcer/bleed
What electrolyte imbalances can cause confusion
Hyponatraemia
Uraemia
Hyper or hypocalcaemia
B12 deficiency
Medications that can cause hyponatraemia
ACEi
PPIs
Antidepressants
Diuretics
Differentials for diarrhea
Infectious gastroenteritis - norovirus, campylobacter, C.diff Medication side effects Anxiety IBD IBS Hyperthyroidism Coeliac Diverticulosis
In gastroenteritis, after how many days would you expect the diarrhoea and vomiting to settle
Vomiting should settle first after 1-2 days
Diarrhea should settle after 3-4 days
Do you have to report food poisoning to public health england
Yes
After D+V when can you return to school/work
48 hours after the symptoms stopped
What medication can be used for bowel spasm in IBS
Hyoscine hydrobromide (Buscopan)
What medication can be used to ease vertigo
Prochlorperazine
Common side effects of opiates
Constipation
Nausea
Vomiting
Itch
Peripheral causes of vertigo
BPPV Labyrinthitis Vestibular neuritis Menieres disease Herpes zoster oticus/Ramsay Hunt
Central causes of vertigo
Stroke
SOL
Migraine
MS
BPPV;
A) maneuver to diagnose
B) maneuver to treat
A) Dix-hallpike
B) Epley
How to tell if a COPD exacerbation is mild, moderate or severe
Mild - controlled by increasing usual meds
Moderate - needs systemic steroids or antibiotics
Severe - needs admission
Goal oxygen saturation for COPD patients
88-92%
Diagnostic criteria for ADHD
6+ symptoms of inattentiveness and 6+ symptoms of hyperactivity and impulsiveness. Symptoms continuous for at least 6 months, symptoms started before the age of 12, symptoms in 2 different settings (home and school), causing difficulty with their social/academics/occupation.
