gp Flashcards
1
Q
PCHR=
A
personal child health record (red book)
2
Q
baby checked when after birth?
A
72h
8 week
9 month
3
Q
what is checked with mum in the 8 week baby check
A
- wound
- blood test
- mental healt/ well ebing
- breastfeeding
- contraception
- discharge/period
4
Q
what is checked with baby in 8 week baby check
A
- eye refleces
- heart and breathing rate
- pulse , heart murmur etc
- physical check - testes, vagina, anus, skin, all over!
- hips dysplasia
- hearing
- size and weight
5
Q
when is heel prick test
what is it for
A
72 h after birth
checks for CF, Sickle cell
6
Q
PCV jab stands for
A
pneumococcal - prevents pneumonia
7
Q
RV jab stands for
A
rotavirus
8
Q
5 in 1 jab contains
A
diphtheria hib (haemophilius influenzae type b) polio whooping cough tetanus hep B -if 6 in 1 jab
9
Q
do babies need one jab per condition?
A
no. lots need booster(S)
10
Q
socrates =
A
site onset charchter radiation associated symptoms ttime/duration exarbated/releiving factors severity
11
Q
msk examination penumonic
A
PRISMS pain rashes eg psoriasis immune stiffness malignancy swelling
12
Q
TENS machine =
A
transcutaneous electrical nerve stimulation
for chronic pain
13
Q
analgesic ladder
- for what pain
- adjuvant =
A
- cancer pain , pain relief
- adjuvant = additional non-opioid drug eg antidepressant, steroid injections
14
Q
analgesic ladder stage 1
A
non-opioid analgesics (NSAIDs) +/- adjuvant
15
Q
anlagesic ladder stage 2
A
weak/mild opioid (codeine, tramadol, nefrapam)
+/- adjuvant +/- NSAIDs
16
Q
analgesic ladder stage 3
A
strong opioids (morphine, oxycodone, piritrimide, fentanyl) \+/-NSAIDs +/- adjuvant
17
Q
analgesic stage 4
A
inteventional treatment eg nerve blocking/ epidural
+/- NSAIDs +/ adjuvant
18
Q
long term effects of opioid prescribing
A
tolerance (need higher dose)
dependance (withdrawal)
respiratory depression – shallow, ineffective breathing –> respiraotry acidosis
19
Q
treatment for respiratory depression
A
naloxone (= opioid antagonist)
20
Q
NSAIDs adverse effects
A
GI bleeding
kidney function decline
indigestion
risk of MI/ stroke (except aspririn)
21
Q
diabetes diagnosis
A
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
22
Q
what is a fasting glucose
A
only water for 8 h
23
Q
what is glucose tolerance test
A
sugar level 2 hours after drinking a sugary drink with 75 g of sugar
24
Q
diabetes symptoms
A
polyuria polydipsia overweight /risk factors weight loss fatigue ketosis infections - recurrent poor wound healing
25
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
26
races high risk of diabetes
south asian
chinese
af-carib
black af
27
how often review diabetics
annually
28
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
29
how is contracpetive pill relevant to CV risk
increased risk of thromboembolism
30
what is slowed movements / thinking a symptom of?
depression
31
PHQ 9
depression test
looks at symptoms and asks how frequently you have felt them in last 2 weeks
32
GAD 7
anxiety test
looks at symptoms and asks how frequently you have felt them in last 2 weeks
33
gender epidemiology of depression and suicide
m > f suicide
| f > m depression (greater reporting)
34
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)
35
investigation of patient with chronic diarrhoea
| inc when (how long) it becomes chronic
4w+
stool analysis
sigmoidoscopy/colonoscopy + biopsy
radioscopy
36
IBS management
diet : lots of fluid, less fibre (unless IBS-C), less fizzy, less alc, less carbohydrate
physical activity
antidepressants, antispasmodics , loperamide (Imodium)
37
IBD management
```
suppressants
iron (for anaemia)
stress management
weight loss
diet: more soluble fibre, less alc/caffeine
painkillers
biologics
surgery
```
38
coeliac management
gluten free diet
39
inflam vs non-inflam degen MSK pain
inflam = worsen after rest, better with use. stiff in morning. good NSAID response
40
DMARD
stands for
action
example
disease modifying anti-rheumatic drug
decrease joint damage and increase function by blocking immune system inflam cytokine
methotrexate, sulfasalazine
41
biological treatments
stop chemicals activating your immune system
TNF alpha blockers -- infliximab = monoclonal antibody
B cell inhibitor - rituximab
42
RA tx
```
first line (of pharm) = DMARD
second line= bbiologics (expensive)
steroids
anti-inflam
anlagesia
non-pharmacolog (lifetsyle, physio etc)
surgery (eg synovectomy/ prosethis)
```
43
LUTS most common cause (organism)
| and then which following that
e.coli
then staph aureus
44
why does pregnancy cuase UTIs
urine retention/stasis so bacteria grow better (no mechanical flushing)
similar to obstructive causes
45
pregnancy and incontinence
birth trauma weakens the pelvic floor muscles so can cause stress incontinence (cough/strain)
46
why do catheters cause UTIs
introduce pathogens when inserted
easy for bacteria to grow up/along them
47
how do STIs cause UTIs
urethra near vagina
48
UTIs affect men or women more?
women -- shorter urethra
49
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
50
IPSS
international prostate symptoms score
how frequently have you experiecnced LUTS in last month
51
bladder diary
tracks fluid intake and outflow (urination)
52
DRE
digital rectal exam
finger in rectum - feel prostate for abnormalities
53
BPH feels like what on DRE
enlarged but smooth
54
prostate cancer feels like what on DRE
enlarged and nodular , irregular and asymmetrical
55
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
56
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
57
turp
transurethral resection of prostate
58
cystoplasty
increase bladder size
59
prostatectomy
remove entire prostate
60
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
61
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
62
non-breast symptoms to be looking out for with breast cancer
weight loss, fever, lethargy, gland swelling, pain elsewhere
63
family history of what increases your breast cancer risk
breast cancer
| ovarian cancer
64
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
65
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
66
secondary breast lump assessment
to see if lump benign
non-inasive: mammogram, ultrasound, MRI
invasive: biopsy (guided by ultrasound, sterotactic (xray), MRI)
67
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
68
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
69
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
70
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
71
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
```
72
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
73
3 examples of anticonvulsant
carbamazepine
sodium valproate
lamotrigine
levetiracetam
74
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
75
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
76
which anti convulsant risks baby in pregnancy
sodium valporate
77
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
```
78
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
79
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
80
asthma investigations
- historu
- spirometry
- peak flow
- exhaled nitric oxide (FeNO)
- challenge test
- allergy test
81
is blue salbutamol inhaler a reliever or preventer inhaler
reliever
82
what do preventer inhalers contain
steroid
83
what time of day is asthma worse
night/ early morning
