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Specialities > GP > Flashcards

GP Flashcards

1
Q

What are the types of continuity?

A

Relational
- relationship

Longitudinal
- length of time

Informative
- record keeping

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2
Q

Why continuity important?

A

Patient satisfactions

Adherence to medical advice/ medication

Lower use of secondary care

Lower death rates

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3
Q

What are the factors in the grief cycle?

A

Denial

Bargaining

Anger

Depression

Acceptance

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4
Q

When should patients take their BP medication?

A

At night

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5
Q

What is typical angina pain?

A

Onset during exercise
Chest pain with radiation to jaw
Relieved by GTN

Typical is 3/3 of these
Atypical is only 2/3

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6
Q

What investigations do you want to do into someone presenting with chest pain that you suspect is angina, and when would you refer etc?

A

Bloods:

  • FBC
  • U&Es
  • Cholesterol
  • TFTS
  • Diabetic screen

ECG

  • q waves
  • T-wave abnormalities
  • changes to ST

Refer for CT angiogram if:

  • atypical chest pain
  • ECG changes with no angina history

If typical:

  • start anti-angina medication
  • refer for non- invasive testing
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7
Q

What advice should be given regarding GTN spray use:

A

Carry it at all times
If you need to use - stop and use.
Up to max 2 doses, if no relief phone 999
*if this occurs take aspirin

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8
Q

What are the mainstays of treatment for CVD?

A

Heart related: Aspirin

Non - heart related: Clopidogrel

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9
Q

When should diabetics be offered statins?

A

Type I:

  • > 10 years of disease
  • > 40 years old
  • Established nephropathy
  • other CVDs

Type II:
- >10% QRISK

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10
Q

What age group should be offered statins regardless of lipid level?

A

> 85 years old

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11
Q

What is the biggest predictor sign of PVD?

A

Cool limb

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12
Q

What do you do if you have a patient with suspected DVT/ PE but you are unable to get a scan that day?

A

Take blood for D-dimer.
Give LMWH

Get scan when possible.
- D-dimer can be analysed later as well

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13
Q

What advice can be given out regarding flying and DVT/ P.E risk?

A

Low risk:

  • hydration
  • flight stockings

Medium risk:
same + Aspirin

High risk:
same + LMWH

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14
Q

What is the definition of a chronic cough and list some of the most common examples seen in GP:

A

> 8 weeks

Asthma
Reflux
ACE inhibitors

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15
Q

What are the red flags of a cough?

A 
Dyspnoea 
Haemoptysis 
Hoarse voice
Weight loss 
Fever 
Dysphagia 
Chest pain
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16
Q

What investigations should be done into someone with a chronic cough?

A

All patients with a chronic cough should be referred for:

  • CXR
  • Spirometry
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17
Q

When are you going to suspect COPD?

A

Exertional breathlessness
Chronic cough
Regular sputum production
Frequent chest infections in winter

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18
Q

When is oxygen therapy suggested in COPD?

A

FEV1 < 30
Polycythemia
Oxygen stats <92%

Given when Pa<7.3 
or 
Pa7.3 - 8 
\+ Polycythaemia 
or 
cor-pulmonale
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19
Q

When should you refer COPD to secondary care?

A

Symptoms worse than what is suggested by spirometry

<40 years old (suggest alpha 1- Antitrypsin deficiency)

Haemoptysis

Rapid decline in disease/ pulmonary hypertension

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20
Q

What medications can be used to help neuropathic pain?

A

Amitriptyline

Gabapentin

Pregablin

Duloxetine

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21
Q

Under what situations would you check TFTs?

A

Symptoms of thyroid disease

Type I diabetes

New onset AF

Unexplained anxiety

Depression

+ in children:

  • lack of growth
  • unexplained misbehaviour
22
Q

With regard to thyroid disease, which patients are referred onto secondary care and which are not. Additionally before referring what useful bloods can be done (thinking about potential treatments):

A

All thyrotoxicosis/ hyperthyroidism patients are referred to secondary care.

Hypothyroidism are treated in practice

Bloods

  • FBC
  • LFTs
23
Q

When should levothyroxine be taken?

A

30 minutes before breakfast or tea/coffee

24
Q

What important measure should be taken in pregnant women with hypothyroidism?

A

Increase levothyroxine as soon as they know they are pregnant.
- not to wait till Obs appointment.

20-30% increase is needed.

25
Q

At what level should doctors intervene with a overweight patient?

A

BMI >91st centile

26
Q

What specific things do you want to ask a patient who presents with feeling tired all the time:

A

Define exactly what is meant by tiredness:

  • breathless?
  • Mental exhausation?
  • at the end of the day or begining?

Duration of problem
- previous illness before it?

Previous levels of activity

Any other changes?

  • Apeptite
  • sleep loss
  • night sweats

Changes in medication

Polyuria?

27
Q

What investigations would one consider in a patient presenting with feeling tired all the time?

A 
Bloods: 
- FBC + blood smear 
- U&Es 
- Glucose testing 
- TFTs
- CRP/ ESR 
\+/- 
- Vitamin D 
- LFTs 
- Viral screens

Orifices:
- urine dip (glucose)

**consider mental health

28
Q

In patients >50 years old, what two major differential diagnosis should you be considering in patients presenting with IBS like symptoms?
and what are the general red flags for IBS like symptoms:

A

Colorectal carcinoma

Ovarian pathologies in women

  • weight loss
  • change in bowel habit
  • PR bleeding
  • Mass felt
  • Anaemia
  • Family history of rectal/ ovarian cancer
29
Q

IBS can overlap with many of the symptoms of IBD. Before referring for colonoscopy - what test should be done to help decide if they should go:

A

Faceal calprotectin
- should be done to help exclude those to go to colonoscopy

*note if anyone has red flags then they should be referred regardless

30
Q

When should stool samples be sent when someone presents with diarrhea to GP?

A 
Systemically unwell patient 
Blood/ pus present in mucus 
Immunosuppressed patient 
Recent traveling 
Recent hospitalisation/ antibiotic use

Public health hazard
- diarrhea in food handler

31
Q

Which diarrhoea illnesses are notifiable diseases?

A

Infectious bloody diarrhoea

Cholera

E.Coli 0157

Food handlers

32
Q

When should you refer someone for suspected colorectal cancer?

A

> 40 years old with unexplained weight loss/ abdominal pain

> 50 years old with unexplained PR bleeding

> 60 years old with Iron deficiency anaemia or change in bowel habit

33
Q

What are some disadvantages of bowel prep for a colonoscopy?

A

Bowel prep can decompensate some patients with:

  • heart failure
  • CKD
  • Diuretics
  • Induce hypokalemia (especially those on lithium)

Reduce absorption of certain drugs
- especially anti-epileptics

Bowel prep may need to be done in hospital

34
Q

Which group of people can often have right sided pain in diverticular disease?

A

Asian individuals

35
Q

Which patients need admitted with suspected diverticulitis:

A

Signs and symptoms of:

  • sepsis
  • Intra Abdominal mass
  • Peritonitis
  • Fistula
  • Intestinal obstruction
36
Q

What is the first line antibiotic for diverticulitis being treated in GP?

A
  • Co-amoxiclav

or if allergic to penicillin:

  • Trimethoprim
  • Metronidazole
37
Q

List some common medications that can trigger migraines:

A

SSRIs
Opioids
Oral contraceptive
Nasal decongestants

38
Q

What is a good differentiator between a migraine aura and an epileptic aura?

A

In migraines you get negative symptoms, you tend to loose something.

  • vision disappears
  • loss of sensory information

Whereas in epileptic you get positive symptoms - tend to gain something i.e.

  • visual input
  • new smells
  • new sounsd
39
Q

What is first line treatment for migraine?

A 
Aspirin 900mg 
\+
Triptans - if the headache has started! 
\+ 
Metoclopramide or Prochlorperazine
40
Q

List some causes of red eye which require same day referral:

A

Corneal ulcers/ keratitis

Anterior uveitis

Corneal foreign body with metal

Scleritis

Acute angle glaucoma

Hyperacute bacterial conjunctivitis

Chemical injury

41
Q

When should you refer when someone comes in with depression?

A

Suicide risk
Psychotic features
Severe depression which has failed to respond to 2 lots of antipsychotic medication

42
Q

How long should you wait before considering switching antidepressant?

A

6-8 weeks

43
Q

What is a common symptom/ occurance with people who have panic attacks?

A

Frequent present to A&E with cardio or gastrointestinal symptoms

44
Q

Which other condition is often seen with panic disorders?

A

2/3rd will have agorophobia

45
Q

What is the calculation for working out units of alcohol drunk?

A

Volume of drink (ml) x % of alcohol/ 1000

i.e. 250ml glass of wine at 13%
= 3.25

46
Q

How much does 1unit of alcohol equate to in mass?

A

1 unit = 8g of pure alcohol

47
Q

The low risk advice for alcohol is no more than 14 units a week for both males and females. How should people be advised to consume alcohol throughout the week in order to maintain a safe level of consumption?

A

Spread eveningly over >3 or more days.

people who binge the amount over 1-2 days are at same increased risk of death

48
Q

List 2 useful screening tools to identify excessive alcohol use in GP practice:

A

FAST Questionnaire

AUDIT -C Questionnaire

49
Q

List some drugs which can be used to help maintain abstence from alcohol:

A

Acamprosate
- reduces cravings. it is a weak MNDA antagonist

Naltrexone

Disulfiram
- acetyl dehydrogenase inhibitor

50
Q

Following on from an acute exacerbation of COPD, what should be prescribed following their discharge?

A

Oral antibiotics
- amoxicillin or clarithromycin

Prednisolone

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