GP Flashcards
What are the types of continuity?
Relational
- relationship
Longitudinal
- length of time
Informative
- record keeping
Why continuity important?
Patient satisfactions
Adherence to medical advice/ medication
Lower use of secondary care
Lower death rates
What are the factors in the grief cycle?
Denial
Bargaining
Anger
Depression
Acceptance
When should patients take their BP medication?
At night
What is typical angina pain?
Onset during exercise
Chest pain with radiation to jaw
Relieved by GTN
Typical is 3/3 of these
Atypical is only 2/3
What investigations do you want to do into someone presenting with chest pain that you suspect is angina, and when would you refer etc?
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
What advice should be given regarding GTN spray use:
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
What are the mainstays of treatment for CVD?
Heart related: Aspirin
Non - heart related: Clopidogrel
When should diabetics be offered statins?
Type I:
- > 10 years of disease
- > 40 years old
- Established nephropathy
- other CVDs
Type II:
- >10% QRISK
What age group should be offered statins regardless of lipid level?
> 85 years old
What is the biggest predictor sign of PVD?
Cool limb
What do you do if you have a patient with suspected DVT/ PE but you are unable to get a scan that day?
Take blood for D-dimer.
Give LMWH
Get scan when possible.
- D-dimer can be analysed later as well
What advice can be given out regarding flying and DVT/ P.E risk?
Low risk:
- hydration
- flight stockings
Medium risk:
same + Aspirin
High risk:
same + LMWH
What is the definition of a chronic cough and list some of the most common examples seen in GP:
> 8 weeks
Asthma
Reflux
ACE inhibitors
What are the red flags of a cough?
Dyspnoea Haemoptysis Hoarse voice Weight loss Fever Dysphagia Chest pain
What investigations should be done into someone with a chronic cough?
All patients with a chronic cough should be referred for:
- CXR
- Spirometry
When are you going to suspect COPD?
Exertional breathlessness
Chronic cough
Regular sputum production
Frequent chest infections in winter
When is oxygen therapy suggested in COPD?
FEV1 < 30
Polycythemia
Oxygen stats <92%
Given when Pa<7.3 or Pa7.3 - 8 \+ Polycythaemia or cor-pulmonale
When should you refer COPD to secondary care?
Symptoms worse than what is suggested by spirometry
<40 years old (suggest alpha 1- Antitrypsin deficiency)
Haemoptysis
Rapid decline in disease/ pulmonary hypertension
What medications can be used to help neuropathic pain?
Amitriptyline
Gabapentin
Pregablin
Duloxetine
Under what situations would you check TFTs?
Symptoms of thyroid disease
Type I diabetes
New onset AF
Unexplained anxiety
Depression
+ in children:
- lack of growth
- unexplained misbehaviour
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):
All thyrotoxicosis/ hyperthyroidism patients are referred to secondary care.
Hypothyroidism are treated in practice
Bloods
- FBC
- LFTs
When should levothyroxine be taken?
30 minutes before breakfast or tea/coffee
What important measure should be taken in pregnant women with hypothyroidism?
Increase levothyroxine as soon as they know they are pregnant.
- not to wait till Obs appointment.
20-30% increase is needed.
At what level should doctors intervene with a overweight patient?
BMI >91st centile
What specific things do you want to ask a patient who presents with feeling tired all the time:
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?
What investigations would one consider in a patient presenting with feeling tired all the time?
Bloods: - FBC + blood smear - U&Es - Glucose testing - TFTs - CRP/ ESR \+/- - Vitamin D - LFTs - Viral screens
Orifices:
- urine dip (glucose)
**consider mental health
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:
Colorectal carcinoma
Ovarian pathologies in women
- weight loss
- change in bowel habit
- PR bleeding
- Mass felt
- Anaemia
- Family history of rectal/ ovarian cancer
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:
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
When should stool samples be sent when someone presents with diarrhea to GP?
Systemically unwell patient Blood/ pus present in mucus Immunosuppressed patient Recent traveling Recent hospitalisation/ antibiotic use
Public health hazard
- diarrhea in food handler
Which diarrhoea illnesses are notifiable diseases?
Infectious bloody diarrhoea
Cholera
E.Coli 0157
Food handlers
When should you refer someone for suspected colorectal cancer?
> 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
What are some disadvantages of bowel prep for a colonoscopy?
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
Which group of people can often have right sided pain in diverticular disease?
Asian individuals
Which patients need admitted with suspected diverticulitis:
Signs and symptoms of:
- sepsis
- Intra Abdominal mass
- Peritonitis
- Fistula
- Intestinal obstruction
What is the first line antibiotic for diverticulitis being treated in GP?
- Co-amoxiclav
or if allergic to penicillin:
- Trimethoprim
- Metronidazole
List some common medications that can trigger migraines:
SSRIs
Opioids
Oral contraceptive
Nasal decongestants
What is a good differentiator between a migraine aura and an epileptic aura?
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
What is first line treatment for migraine?
Aspirin 900mg \+ Triptans - if the headache has started! \+ Metoclopramide or Prochlorperazine
List some causes of red eye which require same day referral:
Corneal ulcers/ keratitis
Anterior uveitis
Corneal foreign body with metal
Scleritis
Acute angle glaucoma
Hyperacute bacterial conjunctivitis
Chemical injury
When should you refer when someone comes in with depression?
Suicide risk
Psychotic features
Severe depression which has failed to respond to 2 lots of antipsychotic medication
How long should you wait before considering switching antidepressant?
6-8 weeks
What is a common symptom/ occurance with people who have panic attacks?
Frequent present to A&E with cardio or gastrointestinal symptoms
Which other condition is often seen with panic disorders?
2/3rd will have agorophobia
What is the calculation for working out units of alcohol drunk?
Volume of drink (ml) x % of alcohol/ 1000
i.e. 250ml glass of wine at 13%
= 3.25
How much does 1unit of alcohol equate to in mass?
1 unit = 8g of pure alcohol
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?
Spread eveningly over >3 or more days.
people who binge the amount over 1-2 days are at same increased risk of death
List 2 useful screening tools to identify excessive alcohol use in GP practice:
FAST Questionnaire
AUDIT -C Questionnaire
List some drugs which can be used to help maintain abstence from alcohol:
Acamprosate
- reduces cravings. it is a weak MNDA antagonist
Naltrexone
Disulfiram
- acetyl dehydrogenase inhibitor
Following on from an acute exacerbation of COPD, what should be prescribed following their discharge?
Oral antibiotics
- amoxicillin or clarithromycin
Prednisolone
