GP Flashcards
1
Q
Whats ages do health workers work with?
A
0-5
2
Q
Give 3 roles of the health visitor
A
- ) Ante-natal and post-natal support
- ) Support parents
- ) Advice on feeding
- ) Support special needs
- ) Advise on behavioural management techniques
- ) Advice on reducing risks and accidents
- ) Information on local services
- ) Safeguarding
3
Q
What is the red book/PCHR?
A
Personal child health record
4
Q
Give 3 purposes of a 6-8 week baby check
A
- ) Detect congenital heart disease
- ) Developmental dysplasia of hip
- ) Congenital cataract
- ) Undescended testes
- ) Hernias
5
Q
Give 3 things children are vaccinated against at 8 weeks
A
- ) Diphtheria
- ) Tetanus
- ) Pertussis (DTP)
- ) Polio
- ) H. influenzae
- ) Hep B
- ) Pneumococcal
- ) Meningococcal group B
- ) Rotavirus gastroenteritis
6
Q
Give 3 things children are vaccinated against at 12 weeks
A
- ) DTP
- ) Polio
- ) Hib
- ) Hep B
- ) Pneumococcal
- ) Men B
7
Q
Give 3 things children are vaccinated against at 16 weeks
A
- ) DTP
- ) Polio
- ) Hib
- ) Hep B
- ) Pneumoccocal
- ) Men B
8
Q
Give 3 things children are vaccinated against at 12 months
A
- ) Hib
- ) Men C
- ) Pneumococcal
- ) MMR
- ) Men B
9
Q
What are girls aged 12-13 given a vaccination of?
A
Human papillomavirus (HPV)
10
Q
What is the aim of vaccination?
A
To produce a rapid protective immune response upon re-exposure to that pathogen
11
Q
Give the steps of the pathogenesis of vaccination with T cells (6)
A
1) Macrophages ingest attacker/fragments
2) Travel to lymph nodes
3) Use class II MHC molecules to present antigens
4) Helper T cell receptors recognise antigens
5) Helper T cell receptors bind and trigger helper T cells to proliferate
6) Eventually some of helper T cells become memory cells
12
Q
Give the steps of the pathogenesis of vaccination with B cells (4)
A
1) B cell receptors recognise attacker/fragment of attacker from APC
2) B cell triggered
3) Proliferates and makes plasma cells to make lots of the same antibody
4) Some B cells become memory cells
13
Q
Give the 3 types of vaccine
A
- ) Inactivated
- ) Attenuated
- ) Live vaccines
14
Q
Give 3 differential diagnoses for a cough
A
- ) Asthma
- ) Acute respiratory infection
- ) GORD
- ) Seasonal allergic rhinitis
- ) Post infectious cough
- ) Pertussis
- ) Pneumonia
- ) Head cold
- ) TB
- ) Inhaled foreign body
- ) Bronchiolitis
15
Q
Give 3 differential diagnoses for SOB
A
- ) Asthma
- ) Severe anaemia
- ) Pneumothorax
- ) Pulmonary oedema
- ) COPD
- ) Arrhythmia
- ) Lower respiratory tract infection
- ) Panic attacks
- ) Metabolic acidosis
- ) PE
16
Q
Give 2 measurements a spirometry shows
A
- ) Amount of air you breathe out in 1 second
- ) Total amount of air in lungs
17
Q
What is a peak flow test?
A
How fast you can blow air out of your lungs in one breath
18
Q
Give 2 tests for breast cancer
A
- ) Mammogram
- ) US
- ) Core biopsy
- ) Fine needle aspiration
19
Q
Give 3 presenting symptoms of breast cancer
A
- ) Breast lump
- ) Nipple change
- ) Nipple discharge
- ) Bloodstained discharge from nipple
- ) Skin contour changes
- ) Axillary lumps
- ) Breast pain/mastalgia
- ) Symptoms of metastatic disease
20
Q
What are we looking for in a breast inspection?
A
- ) Variations in breast size and contour
- ) Inverted nipple? Uni/bilateral?
- ) Any oedema?
- ) Redness/retraction of skin
- ) Dimpling of skin (orange peel)
21
Q
How do we palpate a breast in examination?
A
- ) Flat hand of 2,3,4th fingers
- ) Circle outwards from nipple
- ) Increase axillary tail and axilla
- ) Light, medium then deep pressure
- ) Assess mobility of lump (attached to skin/tissue?)
- ) Both breasts
22
Q
When should we urgently refer to a breast clinic and see within 2 weeks?
A
- ) Suspicious breast lump
- ) Persistent/unexplained lump in axilla
- ) Unilateral nipple discharge, retraction, ulceration, distortion, eczema resistant to topical steroids, changes of concern
- ) Skin changes including nodules, ulceration, peau d’orange, dimpling
- ) Unilateral non cyclical breast pain persisting beyond one menstrual cycle
- ) Men >50 with subareolar lump
23
Q
Give 3 systemic symptoms of breast cancer
A
- ) Weight loss
- ) Fever
- ) Lethargy
- ) Pain elsewhere
- ) Gland swelling
24
Q
Give 2 medications we need to ask about in breast cancer investigations
A
- ) HRT
- ) Oral contraceptive pill
25
What does BRCA stand for?
Breast cancer gene
26
What does BRCA do when it functions normally?
Acts to repair cell damage to keep breast, ovarian and other cells growing normally - TUMOUR SUPPRESSORS
27
What are BRCAs considered, as they are associated with a high risk of developing breast cancer?
High penetrance
28
What other mutations (not BRCAs) are linked to a higher breast cancer risk?
SNPs, single nucleotide polymorphisms
29
Men with an abnormal what have a higher risk of breast cancer?
BRCA2
30
Give 2 risk reducing surgeries for breast cancer
- ) Mastectomy
| - ) Oophorectomy
31
What does an oophorectomy lead to?
Early menopause
32
Give an advantage of having a genetic test for BRCA
- ) Positive - take steps to manage risk
| - ) Less stress and anxiety from not knowing
33
Give a disadvantage of having a genetic test for BRCA
- ) Results sometimes inconclusive
| - ) Positive result can cause permanent anxiety
34
Is BRCA autosomal dominant or recessive?
Dominant
35
Give 3 ways we manage our risk of breast cancer
- ) Regularly examine breasts
- ) Screening
- ) Lifestyle changes
- ) Medication
- ) Risk-reducing surgery
36
What is the AMONA management for an acute MI?
```
Ambulance
Morphine
Oxygen
Nitrates
Aspirin
```
37
Give 3 differential diagnoses for chest pain
- ) Heartburn
- ) Indigestion
- ) Chest sprain/strain
- ) Anxiety/panic attack
- ) Chest infection/pneumonia
- ) Shingles
38
What are the 9 areas of the abdomen?
- ) L hypochondriac
- ) Epigastric
- ) R hypochondriac
- ) L lumbar
- ) Umbilical
- ) R lumbar
- ) L iliac fossa
- ) Suprapubic
- ) R iliac fossa
39
Give 4 things we look for in an abdominal examination
- ) Scars
- ) Ascites
- ) Masses
- ) Pulsation
- ) Cullen's sign (bruising around umbilicus)
- ) Grey-Turner's sign (bruising in flanks)
- ) Abdominal distension
- ) Striae
- ) Caput medusae
- ) Stomas
40
What are we assessing for on abdominal palpation?
- ) Tenderness
- ) Rebound tenderness (peritonitis)
- ) Guarding
- ) Masses
41
What are the steps of an abdominal examination? (9)
1) Observation
2) Light palpation
3) Deep palpation
4) Liver
5) Gallbladder (not usually palpable)
6) Spleen (not usually palpable)
7) Kidneys
8) Aorta
9) Bladder (empty not palpable)
42
What is Murphy's sign?
- ) Place hand in R costal margin mid-clavicular line
- ) Patient takes deep breath
- ) Sudden stop in inspiration due to pain
- ) Positive if no discomfort in same location on left
43
What does liver tenderness suggest?
Hepatitis
44
What can a pulsatile enlarged liver be caused by?
Tricuspid regurgitation
45
What does an outward movement on aorta examination indicate?
Expansile, suggestive of AAA
46
What should we suspect if there is acute diarrhoea?
Gastoenteritis
47
Give 3 risk factors for diarrhoea
- ) Travel
- ) Insect bites
- ) Contact with dirty water
- ) Contact with D&V
- ) Diet change
48
What do we ask about diarrhoea?
- ) Consistency
- ) Mucous
- ) Blood
- ) Urgency
49
Give 3 infectious causes of diarrhoea
- ) Campylobacter
- ) E. coli
- ) Norovirus
- ) Rotavirus
- ) Malaria
- ) Giardiasis
50
Give 3 non-infectious causes of diarrhoea
- ) IBD
- ) IBS
- ) Anxiety
- ) Allergy/intolerance
- ) Chronic pancreatitis
- ) Diverticular disease
- ) Bowel cancer
- ) Surgery
51
Give 3 medications that can cause diarrhoea
- ) Laxatives
- ) Antacids
- ) Long term antibiotics
- ) Chemo drugs
- ) NSAIDs
- ) SSRIs
52
What 2 main tests do we do in a patient with chronic diarrhoea?
Blood work and stool tests
53
Give 3 things a patient should not have when having a PSA test
-) Active urine infection
-) Produced semen (ejaculated) in previous 48hrs
-) Exercised heavily in previous 48hrs
-) Prostate biopsy in last 6 weeks
-) DRE in previous week
CIs that can produce a high PSA
54
How does the definition of a normal PSA result change?
Increases as you get older
55
How do we do a prostate biopsy?
US guided, 12 or more small cores of prostate tissue examined
56
Give 3 treatment options for prostate cancer
- ) Watchful waiting (no DRE, more palliative)
- ) Active surveillance (DREs and prostate biopsies)
- ) Radical prostatectomy
- ) Hormone therapy (castration, androgen deprivation)
- ) Radical radiotherapy
57
Give 2 risks of a radical prostatectomy
- ) Urinary incontinence
- ) ED
- ) Incomplete resection of tumour
58
Give the 4 main treatment options for an enlarged prostate gland
- ) Lifestyle changes
- ) Medication
- ) Catheters
- ) Surgery
59
Give 3 lifestyle changes for an enlarged prostate gland
- ) Fewer fizzy drinks, alcohol, caffeine, artificial sweeteners
- ) Drink less in evening
- ) Remember to empty bladder
- ) More fruit and fibre
- ) Pads/sheath
- ) Bladder training
- ) Exercises
60
Give 3 medications for an enlarged prostate gland
- ) Alpha blockers
- ) Anticholinergics
- ) 5-alpha reductase inhibitors
- ) Diuretics
- ) Desmopressins
61
How do alpha blockers work, and give an example (enlarged prostate gland)
- ) Relax muscle in prostate gland and base of bladder
| - ) Tamsulosin and alfuzosin
62
Give an example of a 5-alpha reductase inhibitor
Finasteride, dutasteride
63
When should we give diuretics and desmopressins in an enlarged prostate gland?
Diuretics speed up urine production - daytime
| Desmopressins slow down urine production - nighttime
64
Give 3 surgical options for an enlarged prostate gland
- ) Transurethral resection of prostate
- ) Open prostatectomy
- ) Cystoplasty
- ) Botulinum toxin
- ) Implanted sacral nerve root stimulation
- ) Urinary diversion
65
How does the patient lie in a DRE?
On their side with their knees up to their abdomen
66
What are we assessing in a prostate exam?
- ) Size
- ) Consistency (smooth, nodules, masses)
- ) Tenderness
- ) Fluctuations
67
What do we assess if a testicular mass is found?
- ) Size and shape
- ) Regularity
- ) Consistency
- ) Discomfort
- ) Fixed/separate to testicle
- ) Transilumination
68
What is the problem with PSA testing?
Lots of false negatives and positives
69
Give 3 reasons for not organ donating
- ) Lack of knowledge about need
- ) Don't know how to register
- ) Uncertainty about faith's position
- ) Religiously permissible?
- ) Issue of trust in allocation procedures
- ) Perceived lack of relevance for own community
- ) Language barriers
70
Give 3 ways we manage stage 5 CKD
- ) Transplant
- ) Dialysis
- ) Palliative care
71
Which ethnicities have a higher incidence of CKD?
Black and South Asian
72
Give 4 roles of the kidney dialysis cannot replace
- ) Continuous removal of waste products and excess fluid
- ) Production of EPO
- ) Conversion of vitamin D into active compound
- ) Excretion of some drugs
- ) Control of BP
73
How long does renal impairment have to persist to be considered chronic?
3 months
74
Give an example of a nephrotoxin
- ) NSAIDs
- ) Aminoglycosides
- ) IV radiocontrast agents
75
How does high cholesterol cause CKD?
Build up of fatty despots in blood vessels supplying kidneys
76
How is proteinuria assessed? (2)
- ) PCR (protein:creatinine ratio)
| - ) ACR (albumin:creatinine radio)
77
Give 4 things to plan in palliative care
- ) Preferred place of death (and carer willingness and availability)
- ) Making will/living will
- ) Power of attorney
- ) DNAR status
- ) Involving faith leaders
- ) Contact details for health care professionals out of ours
- ) Planning a funeral
78
What should we immunise against before beginning dialysis?
Hep B
79
What artery do we attach a new kidney to?
Internal iliac artery
80
Give 3 risks of a kidney transplant
- ) Rejection
- ) SEs of steroids
- ) Skin cancers
- ) Solid tumours
- ) Lymphoma
- ) High risk pregnancy
81
Give the 2 main types of dialysis
Haemodialysis, peritoneal dialysis
82
Give 3 tests we should do in CKD
- ) BP
- ) U&Es, FBCs, HbA1C, lipid, ACR, PCR, alkaline phosphate, Ca, PTH, vitamin D
- ) EPO (chronic anaemia with normal iron levels)
- ) DEXA
83
Give 2 types of inflammatory arthritis
- ) RA
- ) Spondyloarthritis
- ) Crystal arthritis
84
What does FBC show in RA?
Normochromic, normocytic anaemia and thrombocytosis
85
What is rheumatoid factor?
An auto-antibody directed against the Fc region of an Ig, form immune complexes and active the complement system
86
Give 3 auto-antibodies that can be tested for in RA
- ) Anti CCP
- ) ANA
- ) DsDNA
- ) ENA
- ) RF
87
What do DMARDs do?
Treat symptoms and slow down the progression of the disease
88
Give 3 DMARDs
- ) Gold injections
- ) Hydroxychloroquine
- ) Leflunomide
- ) Methotrexate
- ) Sulfasalazine
89
Give 3 treatment options for RA
- ) DMARDs
- ) Biological therapies (type of DMARD)
- ) Immunosuppression with corticosteroids
- ) NSAIDs before DMARDs
90
Give 3 side effects of methotrexate
- ) Nausea
- ) Loss of appetite
- ) Sore mouth
- ) Diarrhoea
- ) Headaches
- ) Hair loss
- ) Pancytopenia
- ) Leucopenia
- ) Thrombocytopenia
- ) Megaloblastic anaemia
91
Give 3 parts of the body DMARDs can effect
- ) Blood count
- ) Liver
- ) Kidneys
- ) Eyes
- ) Lungs
92
What is DAS28 and what does it include? (4)
Measure of disease activity
- ) Number of swollen joints
- ) Number of tender joints
- ) ESR/CRP
- ) Patient gives global assessment of health 1-10
93
What must be given to someone who is taking methotrexate?
Folic acid tablets
94
Give 3 cardinal features on exam for a diagnosis of rheumatoid disease
- ) >3 joints affected
- ) Tenderness on palpation
- ) Synovitis of affected areas
- ) Positive squeeze test across MCPJs
95
Give 3 things we should ask when taking a MSK history
- ) Current symptoms
- ) Evolution of problem
- ) Involvement of other systems
- ) Systemic symptoms
- ) FHx
- ) History of other autoimmune disease
- ) Impact on patient's life
- ) Other joints than presenting joint
96
What does SOCRATES stand for?
```
Site
Onset
Character (dull, stabbing)
Radiation
Associations
Time course
Exacerbating/relieving factors
Severity
```
97
How do we assess joints to differentiate between RA and OA?
- ) Stiffness - OA less stiff
- ) Pain with use - OA more pain, less pain with rest
- ) Number of joints
- ) Symmetry - OA asymmetric
- ) Acute
- ) Tenderness/redness - RA
98
Give 3 differential diagnoses of mono-articular inflammation
- ) OA
- ) Gout (v. acute)
- ) Pseudogout
- ) Septic arthritis
99
Give 2 differential diagnoses of poly-articular inflammation
- ) RA
- ) Viral infections
- ) Spondyloarthropathies
100
What do we stop in the treatment for RA when the patient has an infection?
DMARDs
101
Give 2 examples of an anti-TNF drug
- ) Infliximab
| - ) Rituximab
102
How do we monitor the treatment of RA?
Shared care protocol
- ) Hospital appt with consultant every 6-12 months
- ) Blood tests every 3 months (hospital nurse/GP)
- ) Contact as necessary by phone with rheumatology nurses
103
What do the routine 3 monthly blood tests for DMARDs include? (3)
- ) FBC
- ) U&E
- ) LFTs
- ) Possible BP and urine test
- ) Eyesight test with hydroxychloroquine
104
Give 3 things uncontrolled chronic pain can cause
- ) Anxiety and emotional distress
- ) Undermines wellbeing
- ) Interferes with functional capacity
- ) Stops one from fulfilling family, social, vocational roles
105
Give 3 feeling a patient way have when in pain
- ) Tense
- ) Easily angered and hostile
- ) Hopeless, depression
- ) Difficulties with sleeping
106
What do we use to assess ADL?
Katz ADL
107
Give 4 things the Katz ADL looks at
- ) Bathing
- ) Dressing
- ) Toileting
- ) Tranferring
- ) Continence
- ) Feeding
108
Give 3 distinct types of behaviours of how people first cope with pain
- ) Trying to beat it
- ) Boom and bust
- ) Complete avoidance
109
Give 3 pharmacological managements of osteoarthritis
- ) Oral analgesics
- ) Topical NSAIDs
- ) NSAIDs and highly selective COX2 inhibitors
- ) Intra-articular injection of corticosteroids
110
Give 3 non-pharmacological managements of osteoarthritis
- ) Exercise and manual therapy
- ) Weight loss
- ) Transcutaneous electrical nerve stimulation
- ) Aids/devices
111
Give the 3 steps of the analgesic ladder
- ) Non opioid +/- adjuvant
- ) Weak opioid +/- non-opioid, +/- adjuvant
- ) Strong opioid +/- non-opioid, +/- adjuvant
112
Give 2 examples of analgesia adjuvants
- ) Antidepressants
- ) Anti-seizure
- ) Muscle relaxants
- ) Sedatives
- ) Anti-anxiety
- ) Botulinum toxin
113
Give an example of a non-opioid analgesia
- ) Aspirin
- ) Paracetamol
- ) NSAID
- ) Nafopam
114
Give an example of a weak opioid
- ) Codeine
- ) Dihydrocodeine
- ) Tramadol
115
Give an example of a strong opioid
- ) Morphine
- ) Fentanyl
- ) Oxycodone
- ) Dimorphine
116
What 3 things do we look at in a knee examination?
- ) Gait
- ) Anterior inspection
- ) Posterior inspection
117
What 3 things do we feel in a knee examination?
- ) Palpitation with leg straight and relaxed
- ) Joint effusion assessment
- ) Palpation with knee bent to 90 degrees
118
What 2 types of movement do we do in a knee examination?
Active and passive
119
Give 2 other tests we do in a knee examination
- ) Ligament tests
| - ) Meniscal damage
120
Give 4 things in a pain toolkit
- ) Acceptance
- ) Support team
- ) Pacing
- ) Prioritising
- ) Setting goals/action plans
- ) Be patient
- ) Relaxation
- ) Stretching and exercise
- ) Setback plan
121
Give 4 main treatments for breast cancer?
- ) Surgery
- ) Radiotherapy
- ) Chemotherapy
- ) Hormone therapy
- ) Biological therapy (targeted therapy)
122
Give 2 hormone therapies used in breast cancer treatment
- ) Tamoxifen
- ) Aromatase inhibitors (after menopause)
- ) Ovarian ablation or suppression
123
What biological therapy do we give for breast cancer treatment?
Trastuzumab for HER-2 positive cancers
124
What does HER-2 stand for?
Human epidermal growth factor receptor 2
