gp Flashcards
PCHR=
personal child health record (red book)
baby checked when after birth?
72h
8 week
9 month
what is checked with mum in the 8 week baby check
- wound
- blood test
- mental healt/ well ebing
- breastfeeding
- contraception
- discharge/period
what is checked with baby in 8 week baby check
- eye refleces
- heart and breathing rate
- pulse , heart murmur etc
- physical check - testes, vagina, anus, skin, all over!
- hips dysplasia
- hearing
- size and weight
when is heel prick test
what is it for
72 h after birth
checks for CF, Sickle cell
PCV jab stands for
pneumococcal - prevents pneumonia
RV jab stands for
rotavirus
5 in 1 jab contains
diphtheria hib (haemophilius influenzae type b) polio whooping cough tetanus hep B -if 6 in 1 jab
do babies need one jab per condition?
no. lots need booster(S)
socrates =
site onset charchter radiation associated symptoms ttime/duration exarbated/releiving factors severity
msk examination penumonic
PRISMS pain rashes eg psoriasis immune stiffness malignancy swelling
TENS machine =
transcutaneous electrical nerve stimulation
for chronic pain
analgesic ladder
- for what pain
- adjuvant =
- cancer pain , pain relief
- adjuvant = additional non-opioid drug eg antidepressant, steroid injections
analgesic ladder stage 1
non-opioid analgesics (NSAIDs) +/- adjuvant
anlagesic ladder stage 2
weak/mild opioid (codeine, tramadol, nefrapam)
+/- adjuvant +/- NSAIDs
analgesic ladder stage 3
strong opioids (morphine, oxycodone, piritrimide, fentanyl) \+/-NSAIDs +/- adjuvant
analgesic stage 4
inteventional treatment eg nerve blocking/ epidural
+/- NSAIDs +/ adjuvant
long term effects of opioid prescribing
tolerance (need higher dose)
dependance (withdrawal)
respiratory depression – shallow, ineffective breathing –> respiraotry acidosis
treatment for respiratory depression
naloxone (= opioid antagonist)
NSAIDs adverse effects
GI bleeding
kidney function decline
indigestion
risk of MI/ stroke (except aspririn)
diabetes diagnosis
fasting glucose >7mmol/L
random glucose >11.1 mmoml/L
glucose tolerance test >11.1 mmol
hba1c >6.5% normal aka 48+mmol/mol
symtpoms + one of those
or no symptoms + 2
what is a fasting glucose
only water for 8 h
what is glucose tolerance test
sugar level 2 hours after drinking a sugary drink with 75 g of sugar
diabetes symptoms
polyuria polydipsia overweight /risk factors weight loss fatigue ketosis infections - recurrent poor wound healing
pre diabetes diagnosis
fasting glucose 5.6-7
random glucose 7.8-11.1
glucose tolerance test 7.8 -11.1
hba1c 6-6.4% aka 42-48
races high risk of diabetes
south asian
chinese
af-carib
black af
how often review diabetics
annually
what happens at diabetic review
height/weight/ BMI
BP
blood glucose control (med ) and blood levels
discuss issues
discuss liefstyle factors
compication look out - feet, perippheral pulses
how is contracpetive pill relevant to CV risk
increased risk of thromboembolism
what is slowed movements / thinking a symptom of?
depression
PHQ 9
depression test
looks at symptoms and asks how frequently you have felt them in last 2 weeks
GAD 7
anxiety test
looks at symptoms and asks how frequently you have felt them in last 2 weeks
gender epidemiology of depression and suicide
m > f suicide
f > m depression (greater reporting)
pharmacological management of depression
mood stabilisers (lithium, antiepileptics)
antidepressants
SSRI (selective serotonin reuptake inhibitors - reuptake into presynapse inhibited)
- setaline, fluxatine, citalopram
selective noradrenaline reuptake inhibitors (SNRI)
- venlafaxine, dulaxaline
TCA (tricyclic adrenaline)
- amytipiltine, metazapine
MAOI (monoamine oxidase inhibitors)
investigation of patient with chronic diarrhoea
inc when (how long) it becomes chronic
4w+
stool analysis
sigmoidoscopy/colonoscopy + biopsy
radioscopy
IBS management
diet : lots of fluid, less fibre (unless IBS-C), less fizzy, less alc, less carbohydrate
physical activity
antidepressants, antispasmodics , loperamide (Imodium)
IBD management
suppressants iron (for anaemia) stress management weight loss diet: more soluble fibre, less alc/caffeine painkillers biologics surgery
coeliac management
gluten free diet
inflam vs non-inflam degen MSK pain
inflam = worsen after rest, better with use. stiff in morning. good NSAID response
DMARD
stands for
action
example
disease modifying anti-rheumatic drug
decrease joint damage and increase function by blocking immune system inflam cytokine
methotrexate, sulfasalazine
biological treatments
stop chemicals activating your immune system
TNF alpha blockers – infliximab = monoclonal antibody
B cell inhibitor - rituximab
RA tx
first line (of pharm) = DMARD second line= bbiologics (expensive) steroids anti-inflam anlagesia non-pharmacolog (lifetsyle, physio etc) surgery (eg synovectomy/ prosethis)
LUTS most common cause (organism)
and then which following that
e.coli
then staph aureus
why does pregnancy cuase UTIs
urine retention/stasis so bacteria grow better (no mechanical flushing)
similar to obstructive causes
pregnancy and incontinence
birth trauma weakens the pelvic floor muscles so can cause stress incontinence (cough/strain)
why do catheters cause UTIs
introduce pathogens when inserted
easy for bacteria to grow up/along them
how do STIs cause UTIs
urethra near vagina
UTIs affect men or women more?
women – shorter urethra
name 3 defense mechanisms against UTIs
1 acidic urine
2 urine mechanically flushes out
3 urine contains competitive inhibitors for attachement sites
4 IgA in mucosa
5 mucosa secretes 6 cytokines/chemokines
7 prostate contains zinc which is bactericidla
IPSS
international prostate symptoms score
how frequently have you experiecnced LUTS in last month
bladder diary
tracks fluid intake and outflow (urination)
DRE
digital rectal exam
finger in rectum - feel prostate for abnormalities
BPH feels like what on DRE
enlarged but smooth
prostate cancer feels like what on DRE
enlarged and nodular , irregular and asymmetrical
PSA
prostate specidic antigen
= protein produced by prostate gland
prostate cancer,
but not always :BPH, UTI, prostatitis, urinary catheter, exercise, ejaculations etc
if positive, followed with biopsy
BPH management
pharmacological
weight loss, exercise
alpha blocker (increases venous outflow, relax prostate and bladder base) - quicker but only symptom control rather than reducing prostate volume - tamulosin, doxazoisn
5alpha reductase inhibitors (less test–> dihydrotest, so shrink prostate)
– finasteride
combination of them two
anticholinergics (stop parasympathetic detrusor stimulation so relaxes it)
PDE5 inhibitor - relax prostate neck
Hormone replacement therapy
- Orchiectomy = remove testical
- LHRH antagonist – Overload pituitary gland so LH stops being produced (transient flare up of cancer)
- Antiandrogens – Block testosterone at testes receptor level
Diuretics- Speed up urine production so more done in day and less in night
Desmopressins- Slow urine production down → less produced at night
turp
transurethral resection of prostate
cystoplasty
increase bladder size
prostatectomy
remove entire prostate
BPH management
non pharmacological
control fluid intake (less in evening, less fizzy/alc/caffeine)
bladder emptying - regular, bladder drill/training / pads
catheters
surgery
- TURP
- prostatectomy
- cystoplasty
NHS screening for breast cancer
- how
- when
- pros, cons
- mammograms (low dose x ray) to each breast
- 50-71y invite but can have after if patients opts
- every 3 yrs
pros: spots cancers well. the earlier found, the smaller it is so better prognosis, less likely to need surgery/chemo
cons: picks up cancers that would never cause symptoms (unnecessary treatment/worry)
small amount of radiation, false neg/pos
non-breast symptoms to be looking out for with breast cancer
weight loss, fever, lethargy, gland swelling, pain elsewhere
family history of what increases your breast cancer risk
breast cancer
ovarian cancer
parts of history to look out for for breast cancer
age of menarche/menopause
parity - age + breastfed?
radiation exposure
oestrogen/HRT
as well as prev cancer, breast trauma, surgical, medical history, family history, smoking, drinking, exercise, overweight, physical examination
refer breast cancer in 2w when
refer (suspected cancer)
- 30+, unexplained breast lump without pain
- 50+, nipple discharge/ retraction/ changes (one nip)
consider if
- unexplained axilla lump
- suspicious skin changes
non urgent referral if
- <30 with unexplained lump +/- pain
secondary breast lump assessment
to see if lump benign
non-inasive: mammogram, ultrasound, MRI
invasive: biopsy (guided by ultrasound, sterotactic (xray), MRI)
breast cancer surgical options
Conserving = lump removed - lumpectomy
Mastectomy = whole breast removed
quadrant ectomy = 1 quarter removed
Reconstructive = recreate a breast
Lymph node surgery/clearance , if cancer has spread, it will spread here first
non surgical breast cancer treatment
radiotherapy (Session)
chemotherapy
hormone therapy
these are often given + surgery (pre/post op)
targeted therapy = medicines that reduce cancer growth/spread
increased genetic risk of breast cancer
- baseline risk
- family history
- genes
dont need to know percentges, just gist
baseline risk = 12.5%
relative with breast/ovarian cancer …. 17-30%
BRCA1 (60-90%) BRCA2. (45-85%) f= increase risk of breast /ovarian m= increase risk of breast/ prostate higher risk of young breast cancer, further breast cancers 50% chance of passing on
TP53, CHEK2 and others increase risk
how does breast cancer predictive genetic testing work
blood test relative with cancer - do they have a gene
if yes, blood test patient without cancer - do they have same gene
if yes, regular MRI screening (Rather than mammogram)
need genetic counselling
beyond breast cancer (non obv things)
early menopause may have excess lymph after surgery that needs draining body image issues in some cases, less fertile lower libido
epilepsy diagnosis
2 or more unprovoked seizures 24h+ apart
symptoms enough. may be supported by:
- EEG electroencephalogram - unusual electrical activity recorded with electrodes during/ not during seizure
- MRI/CT/PET to see cause / rule out alternatives (hippocampus also looked at)
- neural exam - see what areas are affected and how
- bloods - rule out other causes and discover comorbidities
3 examples of anticonvulsant
carbamazepine
sodium valproate
lamotrigine
levetiracetam
anticonvulsant issues
start on low dose and gradually increase (too high dose - drunk-like symptoms)
side effects- reduce qol. can be life threatening
need monitoring
interactions - eg reduce effectiveness of combined pill
need to stop gradually. sudden stopping/ dose skip can induce seizure
epilepsy treatment (that is not anticonvulsant)
surgery
- remove causing part
- implant electrical device to control them (vagal nerve / deep brain stimulation)
diet
- ketogenic : high in fat, low in carbs/protein. used mainly for kids due to adult risk of diabetes/CV disease
avoid triggers
which anti convulsant risks baby in pregnancy
sodium valporate
asthma related deaths signs
Symptoms worsen - constantly tight etc Inhaler not helping Peak expiratory flow drop Too breathless to speak Pulse racing agitates/ restless Cyanosis - blue lips/nails
asthma related death risk factors
Uncontrolled asthma/ noncompliance with treatment plan
Previous severe attacks/hospitalization/ previous requirement on ventilator
Poor lung function
Inadequate patient education
what is discussed at asthma annual review
- symptoms (change, affect on life)
- medicine (s/e, concordance, correct use)
- travel (extra precautions - more drugs, easily accessible)
- pregnancy, fam planning (symptoms may get worse, need to control well, extra measure for labour)
- monitor progression (tests)
- support available (groups etc - work, hobbies, mental health)
personal action plan made
asthma investigations
- historu
- spirometry
- peak flow
- exhaled nitric oxide (FeNO)
- challenge test
- allergy test
is blue salbutamol inhaler a reliever or preventer inhaler
reliever
what do preventer inhalers contain
steroid
what time of day is asthma worse
night/ early morning
