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phase 2a mine > gp > Flashcards

gp Flashcards

1
Q

PCHR=

A

personal child health record (red book)

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2
Q

baby checked when after birth?

A

72h
8 week
9 month

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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
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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
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5
Q

when is heel prick test

what is it for

A

72 h after birth

checks for CF, Sickle cell

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6
Q

PCV jab stands for

A

pneumococcal - prevents pneumonia

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7
Q

RV jab stands for

A

rotavirus

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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
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9
Q

do babies need one jab per condition?

A

no. lots need booster(S)

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10
Q

socrates =

A 
site
onset
charchter
radiation
associated symptoms
ttime/duration
exarbated/releiving factors
severity
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11
Q

msk examination penumonic

A 
PRISMS
pain
rashes eg psoriasis
immune 
stiffness
malignancy 
swelling
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12
Q

TENS machine =

A

transcutaneous electrical nerve stimulation

for chronic pain

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13
Q

analgesic ladder

  • for what pain
  • adjuvant =
A
  • cancer pain , pain relief

- adjuvant = additional non-opioid drug eg antidepressant, steroid injections

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14
Q

analgesic ladder stage 1

A

non-opioid analgesics (NSAIDs) +/- adjuvant

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15
Q

anlagesic ladder stage 2

A

weak/mild opioid (codeine, tramadol, nefrapam)

+/- adjuvant +/- NSAIDs

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16
Q

analgesic ladder stage 3

A 
strong opioids (morphine, oxycodone, piritrimide, fentanyl)  
\+/-NSAIDs +/- adjuvant
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17
Q

analgesic stage 4

A

inteventional treatment eg nerve blocking/ epidural

+/- NSAIDs +/ adjuvant

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18
Q

long term effects of opioid prescribing

A

tolerance (need higher dose)
dependance (withdrawal)
respiratory depression – shallow, ineffective breathing –> respiraotry acidosis

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19
Q

treatment for respiratory depression

A

naloxone (= opioid antagonist)

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20
Q

NSAIDs adverse effects

A

GI bleeding
kidney function decline
indigestion
risk of MI/ stroke (except aspririn)

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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

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22
Q

what is a fasting glucose

A

only water for 8 h

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23
Q

what is glucose tolerance test

A

sugar level 2 hours after drinking a sugary drink with 75 g of sugar

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24
Q

diabetes symptoms

A 
polyuria
polydipsia
overweight /risk factors
weight loss
fatigue
ketosis
infections - recurrent
poor wound healing
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25
Q

pre diabetes diagnosis

A

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

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26
Q

races high risk of diabetes

A

south asian
chinese
af-carib
black af

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27
Q

how often review diabetics

A

annually

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28
Q

what happens at diabetic review

A

height/weight/ BMI
BP
blood glucose control (med ) and blood levels
discuss issues
discuss liefstyle factors
compication look out - feet, perippheral pulses

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29
Q

how is contracpetive pill relevant to CV risk

A

increased risk of thromboembolism

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30
Q

what is slowed movements / thinking a symptom of?

A

depression

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31
Q

PHQ 9

A

depression test

looks at symptoms and asks how frequently you have felt them in last 2 weeks

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32
Q

GAD 7

A

anxiety test

looks at symptoms and asks how frequently you have felt them in last 2 weeks

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33
Q

gender epidemiology of depression and suicide

A

m > f suicide

f > m depression (greater reporting)

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34
Q

pharmacological management of depression

A

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
Q

investigation of patient with chronic diarrhoea

inc when (how long) it becomes chronic

A

4w+
stool analysis
sigmoidoscopy/colonoscopy + biopsy
radioscopy

36
Q

IBS management

A

diet : lots of fluid, less fibre (unless IBS-C), less fizzy, less alc, less carbohydrate

physical activity

antidepressants, antispasmodics , loperamide (Imodium)

37
Q

IBD management

A 
suppressants
iron (for anaemia)
stress management
weight loss
diet: more soluble fibre, less alc/caffeine
painkillers
biologics
surgery
38
Q

coeliac management

A

gluten free diet

39
Q

inflam vs non-inflam degen MSK pain

A

inflam = worsen after rest, better with use. stiff in morning. good NSAID response

40
Q

DMARD
stands for
action
example

A

disease modifying anti-rheumatic drug

decrease joint damage and increase function by blocking immune system inflam cytokine

methotrexate, sulfasalazine

41
Q

biological treatments

A

stop chemicals activating your immune system

TNF alpha blockers – infliximab = monoclonal antibody

B cell inhibitor - rituximab

42
Q

RA tx

A 
first line (of pharm) = DMARD
second line= bbiologics (expensive)
steroids
anti-inflam
anlagesia
non-pharmacolog (lifetsyle, physio etc)
surgery (eg synovectomy/ prosethis)
43
Q

LUTS most common cause (organism)

and then which following that

A

e.coli

then staph aureus

44
Q

why does pregnancy cuase UTIs

A

urine retention/stasis so bacteria grow better (no mechanical flushing)

similar to obstructive causes

45
Q

pregnancy and incontinence

A

birth trauma weakens the pelvic floor muscles so can cause stress incontinence (cough/strain)

46
Q

why do catheters cause UTIs

A

introduce pathogens when inserted

easy for bacteria to grow up/along them

47
Q

how do STIs cause UTIs

A

urethra near vagina

48
Q

UTIs affect men or women more?

A

women – shorter urethra

49
Q

name 3 defense mechanisms against UTIs

A

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
Q

IPSS

A

international prostate symptoms score

how frequently have you experiecnced LUTS in last month

51
Q

bladder diary

A

tracks fluid intake and outflow (urination)

52
Q

DRE

A

digital rectal exam

finger in rectum - feel prostate for abnormalities

53
Q

BPH feels like what on DRE

A

enlarged but smooth

54
Q

prostate cancer feels like what on DRE

A

enlarged and nodular , irregular and asymmetrical

55
Q

PSA

A

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
Q

BPH management

pharmacological

A

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
Q

turp

A

transurethral resection of prostate

58
Q

cystoplasty

A

increase bladder size

59
Q

prostatectomy

A

remove entire prostate

60
Q

BPH management

non pharmacological

A

control fluid intake (less in evening, less fizzy/alc/caffeine)

bladder emptying - regular, bladder drill/training / pads

catheters

surgery

  • TURP
  • prostatectomy
  • cystoplasty
61
Q

NHS screening for breast cancer

  • how
  • when
  • pros, cons
A
  • 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
Q

non-breast symptoms to be looking out for with breast cancer

A

weight loss, fever, lethargy, gland swelling, pain elsewhere

63
Q

family history of what increases your breast cancer risk

A

breast cancer

ovarian cancer

64
Q

parts of history to look out for for breast cancer

A

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
Q

refer breast cancer in 2w when

A

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
Q

secondary breast lump assessment

A

to see if lump benign

non-inasive: mammogram, ultrasound, MRI
invasive: biopsy (guided by ultrasound, sterotactic (xray), MRI)

67
Q

breast cancer surgical options

A

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
Q

non surgical breast cancer treatment

A

radiotherapy (Session)
chemotherapy
hormone therapy

these are often given + surgery (pre/post op)

targeted therapy = medicines that reduce cancer growth/spread

69
Q

increased genetic risk of breast cancer

  • baseline risk
  • family history
  • genes

dont need to know percentges, just gist

A

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
Q

how does breast cancer predictive genetic testing work

A

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
Q

beyond breast cancer (non obv things)

A 
early menopause
may have excess lymph after surgery that needs draining
body image issues
in some cases, less fertile
lower libido
72
Q

epilepsy diagnosis

A

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
Q

3 examples of anticonvulsant

A

carbamazepine
sodium valproate
lamotrigine
levetiracetam

74
Q

anticonvulsant issues

A

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
Q

epilepsy treatment (that is not anticonvulsant)

A

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
Q

which anti convulsant risks baby in pregnancy

A

sodium valporate

77
Q

asthma related deaths signs

A 
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
Q

asthma related death risk factors

A

Uncontrolled asthma/ noncompliance with treatment plan
Previous severe attacks/hospitalization/ previous requirement on ventilator
Poor lung function
Inadequate patient education

79
Q

what is discussed at asthma annual review

A
  • 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
Q

asthma investigations

A
  • historu
  • spirometry
  • peak flow
  • exhaled nitric oxide (FeNO)
  • challenge test
  • allergy test
81
Q

is blue salbutamol inhaler a reliever or preventer inhaler

A

reliever

82
Q

what do preventer inhalers contain

A

steroid

83
Q

what time of day is asthma worse

A

night/ early morning

phase 2a mine (38 decks)

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