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COMP 2 > GP deck > Flashcards

GP deck Flashcards

1
Q

Standard charge prescription

A

£7.85

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2
Q

Free drugs for:

A

Over 60, under 18.Pregnant +12mCertain diseasesCancerRenal dialysis

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3
Q

Prepayment prescriptions

A

£104(good for 15+ a year)

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4
Q

Calgary-cambridge guide

A

1.Initiate.2.Gather.3.Examine.4. Options5. Explain + plan.6. Close

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5
Q

Health promotion cycle

A

PrecontemplationPreparationAction–> MaintenanceReplapseback to beginning.

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6
Q

Alcohol units/week

A

Men 21Women 14

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7
Q

How many QOFs?

A

17 conditions.

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8
Q

% of consultations that are multimorbidity

A

72%

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9
Q

How many patients physically disabled?

A

10%

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10
Q

Commonest cause of disability

A

arthritis.

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11
Q

Intermediate care services funded by

A

Health AND social services

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12
Q

Intermediate care examples

A

Rapid resonse- prevent admissions.Earlier discharge to community rehab teams.Short term community beds in NH and CH

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13
Q

Self certificates

A

7 daysSickness or incapacity

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14
Q

Medical certificates

A

After 7 days (self certificate).Unable to do job(hospitals can provide them).

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15
Q

Med3- Fitness to work

A

RecommendationEmployer not obliged to follow.

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16
Q

How long can Med3 forms be back dated?

A

3 months.

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17
Q

£ statutory sick pay

A

£68.20/week

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18
Q

Whos entitled to statutory sick pay?

A

16-65 year olds who have paid sufficient NI

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19
Q

How long can you get statutory sick pay?

A

up to 28 weeks (7 months).

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20
Q

Employment and support allowance

A

If sick for more than 13 weeks the department of work and pensions will assess you. with a Work capability assessment.

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21
Q

Work capability assessment levels

A
  1. Return to work.2. Capacity to regain work.3. Limited capacity due to long-term issue.4. Unable to work.
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22
Q

Attendance allowance

A

not means testedmoney goes to the disabled person (not carers allowance)>65 years oldCare and supervision.

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23
Q

How much is attendance allowance?

A

£4025 MAX per year (depending on day and night care)

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24
Q

Disability living allowance

A

Under 65Supervision and decreased mobilityTerminally ill

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25
Q

How much is DLA??

A

£6838/year

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26
Q

If a disabled person can only do low paying work:

A

Disabled person’s tax credit.

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27
Q

Helps people find jobs

A

Access to work scheme

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28
Q

Carer’s allowance

A

If they spend more than 35h and the disabled person gets attendance allowance, DLA or PIP

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29
Q

Personal independence pay

A

16-64 year olds. NEW claimants.Fluctuating conditions.Paid according to ability not condition.

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30
Q

How much can you get with PIP?

A

Up to £6998

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31
Q

Independent living fun age

A

16-65

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32
Q

Blue badge scheme

A

cars

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33
Q

Income support

A

Low incomeState pension only.

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34
Q

Who can help inform you of benefits?

A

Welfare benefits advice serviceCitizens advise bureauBenefits enquiry line

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35
Q

Safe haven

A

NH or RHVulnerable if left alone (i.e. carer in hospital).

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36
Q

Rehab

A

up to 6 weeks.

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37
Q

Resettlement

A

up to 2 weeks.

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38
Q

4 prevention parks of the national service framework for coronary heart disease

A

decrease risk factors and inequalities.decrease smokingidentify those at risk and treatIdentify the already ill and treat

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39
Q

Framingham data

A

CVS risk to do with SES and geography(not seen as that great anymore)

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40
Q

Qrisk2 involves

A

agesexpostcodesmokefamily historyAFBPRheumatoidCholesterolBMI

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41
Q

When to give statin+antihypertensive

A

If >20% in next 10 years.

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42
Q

LE with smoking

A

10 years less

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43
Q

Nicotine replacement increases quitting by:

A

200%

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44
Q

Buproprion other name

A

Zyban

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45
Q

Buproprion class of drug

A

Antidepressant

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46
Q

Buproprion CI

A

epilepsybipolareating disordersbreast feeding

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47
Q

Buproprion SE

A

dry mouth, sleep disturbance

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48
Q

How to take buproprion

A

For 8 weeks.Stop smoking on day 8.

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49
Q

Varenicline other name

A

Champix

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50
Q

Champix other name

A

Varenicline

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51
Q

Diagnosing hypertension 1st visit

A

BP>140/90 do second reading.Second reading also >140/90 send for ABPM/home monitoring2nd reading not high- do 3rd and record lowest.

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52
Q

ABPM

A

2 readings an hour.14 hours a dayTake averageAWAKE

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53
Q

Home monitoring

A

2x a day 1 min apartOnce in the morning, once in the evening.4 days.Take average.

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54
Q

Diagnosing hypertension from ABPM/home monitoring

A

> 135/85 average

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55
Q

Who do you start antihypertensives on immediately?

A

> 180/110

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56
Q

Target blood pressure <80

A

140/90

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57
Q

Target blood pressure >80

A

150/90

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58
Q

Lifestyle advise for high BP

A

Stop smoking.Increase exerciseDecrease saltDecrease alcohol.

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59
Q

Treat regardless

A

160/100 (or 150/95 on home)

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60
Q

Treat if +>20% risk of heart disease

A

140/90 (135/85)

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61
Q

Treat if +end stage organ damage

A

140/90 (135/85)

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62
Q

Ace inhibitors

A

Ramipril

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63
Q

ACE II inhibitor

A

Candesartan

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64
Q

Betablocker

A

Atenolol

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65
Q

Calcium channel blocker

A

Amlodipine

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66
Q

Thiazide like diuretic

A

Indapamide

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67
Q

If >55 or black BP:

A

(c) Amlodipine (+ ramipril)

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68
Q

If <55

A

(a) Ramipril (Candesartan if doesn’t work)

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69
Q

Triple antihypertensive treatment

A

ACECalcium channel blockerDiuretic(Ramipril+amlodipine+indapamide)

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70
Q

Diabetogenic

A

B blocker and Diuretic

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71
Q

Ramipril+Candesartan (ACE+ACE2I)

A

No-no

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72
Q

When start statin

A

> 20% CVD risk.Everyone over 70>40y and diabetesBP>160/100

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73
Q

SE of betablockers

A

FatigueInsomniaCold hands and feetDecreased heart rate

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74
Q

SE of ACE inhibitors

A

Funny tasteAngio-oedemaCough

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75
Q

Testing for ACE inhibitors

A

yearly U+E

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76
Q

CI for ACE inhibitors

A

PregnancyRenovascular disease

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77
Q

CI for Betablockers

A

AsthmaDyslipidaemiaPeripheral vascular diseaseHeart block

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78
Q

SE of calcium channel blockers

A

ConstipationOedmeaFlushingHeadache

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79
Q

CI for calcium channel blockers

A

MIHF

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80
Q

SE of thiazide like diuretics

A

GoutHypoKHypo NASexual dysfunctionimpaired glucose tolerance

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81
Q

CI of thiazide likes

A

gouturinary incontinencedyslipidaemia

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82
Q

SE of statins

A

GI upsetMyopathyLiver damageAlopecia

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83
Q

When to suspect familial hyperlipidaemia

A

cholesterol >7.5mmol

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84
Q

Simvastatin dose

A

40mg ON

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85
Q

Driving restrictions

A

Unstable cannot driveCan’t drive 4 weeks post MI2 months after stroke.

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86
Q

amiodarone and lungs

A

pneumonitisinterstitial fibrosis

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87
Q

Cocaine and lungs

A

pneumothorax

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88
Q

Chest pain relieved leaning forward

A

pericarditis

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89
Q

Tearing mid scapular pain

A

aortic disection

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90
Q

Inspiratory pain in chest

A

PEPleuritisMusculoskeletal

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91
Q

Post operative SOB

A

AtelectasisBronchopneumoniaPEPneumothorax

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92
Q

Ix for SOB

A

FBC (Hb)CXR if more than 3 weeks.PEFRSpirometry

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93
Q

Spirometry COPD

A

FEV1<70%

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94
Q

Spirometry asthma

A

> 15% increase in FEV1 after salbutamol400mg by MDI and spacer

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95
Q

Women cancers

A

BreastBowelLung

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96
Q

Men cancers

A

ProstateLungBowel

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97
Q

Overall cancers

A

BreastlungLarge bowelProstate

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98
Q

How many breast cancers picked up on screening?

A

33%

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99
Q

Who gets screened for breast cancer?

A

50-70 yearsEvery 3 years.

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100
Q

Red flags for breast cancer

A

Lump persists through period.FixedPost menopausalNipple changes/bleedingUnilateral eczematous skin change.

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101
Q

Colorectal cancer who gets screened?

A

60-69every 2 yearshome faecal occult bloodif positive–> colonoscopy

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102
Q

Red flags colorectal cancer

A

Change in bowel habit longer than 6 weeks.Weight lossAbdo painRectal bleedingAnaemia (<10 women)

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103
Q

Urgent CXR

A

Haemoptysis

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104
Q

Red flags lung cancer

A

Unexplained/persistent coughLymphadenopathyChest painDysnoeaClubbingHoarsenessWeight loss

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105
Q

Recurrent haemoptysis

A

17% risk of cancer.

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106
Q

Consider PSA if

A

enlarge prostate symptoms.symptoms of local spreasx of metastasis

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107
Q

Postpone PSA if

A

1m after UTI1w after PR exam

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108
Q

High PSA for 50-60year olds

A

> 3.0

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109
Q

High PSA for 60-70 yr

A

> 4.0

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110
Q

High PSA for 80+

A

> 5.0

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111
Q

Emergency contraception brand names

A

LevonelleEllaoneCoil

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112
Q

Emergency contraception drug names

A

LevonorgestrelUlipristal acetateCoil

113
Q

Levonorgesterel

A

Levonelle72 hours.13-60 year olds.1st 24h- 95% effective.2nd-48h- 85% 3rd- 58%

114
Q

Levonelle dose

A

1.5mg once

115
Q

Protection after Levonelle

A

7 days barrier7 days COCP2 days POP

116
Q

Ellaone works by:

A

Selective progesterone receptor modulator

117
Q

Ellaone

A

120h. after.

118
Q

Dose for ellaone

A

30mg once

119
Q

Ellaone contraindicated

A

Breast feeding (postpone for 36h)

120
Q

SE of levonelle

A

bleeding

121
Q

SE of ellaone

A

abdo painnauseableeding

122
Q

IUD- coil for emergency contraception

A

120hours.

123
Q

Risks with coil as emergency

A

Heavier bleedingPIDNeed a check up in 6 weeks.

124
Q

How does ella one work?

A

delays ovulation

125
Q

How does the emergency coil work?

A

Prevents fertilization.

126
Q

Mental state exam

A

AppearanceMoodSpeechThoughts (interference, passivity)Perception (hallucinations, illusions)Cognition- (orientation, MSE)Insight

127
Q

Chronic depressions

A

> 2 years.

128
Q

Self questionairre for depressions

A

PHQ-9

129
Q

Relationship difficulties group

A

RELATE

130
Q

Bereavement group

A

CRUSE

131
Q

Counselling for depression

A

sleep hygieneproblem solving therapyCBTMindfullness based therapy

132
Q

Online CBT

A

Beating the blues

133
Q

LIFT psychology

A

CBT

134
Q

SSRI

A

Citalopram

135
Q

SE of Citalopram

A

SSRI:Dry mouthSleep disturbanceHeadacheSweatingNauseaWeakness

136
Q

SNRI

A

Venlafaxine

137
Q

TCA

A

Lofepramine

138
Q

MAOI

A

MoclobemidePhenezine

139
Q

Can’t use MAOI with:

A

SSRI

140
Q

Can’t use with SSRI

A

St.Johns wartMAOI

141
Q

Can’t use st.johns wart with

A

OCPWarfarinSSRIanticonvulsantsciclosporindigoxin

142
Q

SSRI discontinuation syndrome

A

from >8weeks useHeadache, nauseaParaesthesiaDizzinessAnxiety.

143
Q

Domestic abuse age

A

> 16 years

144
Q

What percentage of women in GP surgeries report abuse?

A

40%

145
Q

RF for domestic abuse

A

YoungPoorSeparated

146
Q

Consequences of domestic abuseq

A

Chronic painInfectionsNeurologyIBS/GIheart diseasegynae problemssuicidesubstance misuseLBW babies.

147
Q

Advocacy interventions

A

12-60h

148
Q

Options for domestic abuse women

A

refugeesantenatal clinicscriminal justicesocial supportpsychological interventsions

149
Q

CBT for domestic abuse

A

30m-16+hours.Decreases PTSDIncreases self esteemForegiveness therapy

150
Q

IRIS

A

Identification and referral to safety

151
Q

Diarrhoea more than 2 weeks

A

unlikely to be infection

152
Q

Blood in stool

A

CancerIBDCampylobacter, E.coli, Shigella

153
Q

Diarrhoea and aches

A

Campylobacter

154
Q

Stool culture if:

A

Diarrhoea for >3 daysBeen abroad>2 in same house>2 ate same place

155
Q

Tests IBD

A

CRP/ESR/ plasma viscosity

156
Q

2 weeks colon referral

A

> 60 yearsDiarrhoea>6 weeks.

157
Q

Loperamine/imodium

A

4mg bolus then 2 mg after each loose stool (max 16g)not for kids

158
Q

Loperamide action

A

Opioid receptor agonist.

159
Q

Heartburn symptoms

A

Retrosternal painWaves15-60mins after mealBending/lying down makes it worse as does alcohol/smoke

160
Q

pain on swalling

A

odynophagia

161
Q

Drugs causing GORD

A

TCAAnti-cholinergicsAnti-psychotics

162
Q

Drugs causing heart burn

A

antibioticsNSAIDSsteroidsIronNitratesBisphosphonatesCalciumTheophylline

163
Q

Gaviscon dose

A

10ml after meal (safe in preggers)

164
Q

Omeprazole dose

A

20mg PO ODthen up to 40mg

165
Q

SE of omeprazole

A

GI disturbanceD+NconstipationFlatulence

166
Q

Ranitidine dose

A

150mg PO BP

167
Q

Treatment of heartburn

A

PPI for 1 monththen H2RA for 1 monthThen refer

168
Q

Oesophageal pH monitoring

A

pH<4 for 5% of the time

169
Q

H pylori stool sample

A

have to be PPI free for 2 weeks.

170
Q

BP cuff

A

> 2/3 of arm circumference>1/2 of arm length.

171
Q

Pulsus paradoxus

A

should only be 5mmhg

172
Q

Slow/repetitive cuff inflation

A

Venous congestion

173
Q

Inaccurate BP readings

A

Cardiac dysrythmiasARVenous congestionValve replacement.

174
Q

korotkoff signs

A
  1. systolic (faint, tapping)2. sounds soften, swishing, auscultatory gap of 10-15mm3. return of sharp, crisp sound4. muffling5. all sounds disappear- DIASTOLIC
175
Q

for BP how far do you go over before you start?

A

30mmhg

176
Q

Increased gap in BP

A

HypertensionAortic regurg

177
Q

Decreased gap in BP

A

Pulsus paradoxusCardiac temponade

178
Q

Aura before migrane

A

5-60mins

179
Q

Cluster headache

A

behind eye

180
Q

Migranes DONT start after

A

50years

181
Q

Antiemetics for migrane

A

Metaclopramide

182
Q

Triptans

A

5HT1 agnoists50mg Po

183
Q

SE of triptans

A

Feeling of painHeavinessTightnessNauseaDrowsinessDizziness

184
Q

Triptans CI

A

anginaIHD

185
Q

1st line prophylaxis migrane

A

propanolol

186
Q

Drugs for migranes

A

PropanololAmitriptylineSodium valproateTopiramatepizotifenBotox A injections.

187
Q

Proven migrane drug

A

topiramate

188
Q

Sodium valproate side effects

A

nauseatremordizziness

189
Q

pizotifen SE

A

weight gainsedation

190
Q

If >15 headaches a month (8 migranes)

A

IM Botox A every 12 weeks.

191
Q

Straight leg raise

A

normal if >45% each legabnormal: disc prolapse

192
Q

Red flags for back pain

A

<20yearsnight painsteroidsHIVCauda equina symptoms

193
Q

Consider MRI for back if:

A

CancerInfection/fractureCauda equinaAS

194
Q

Sore throat usually lasts

A

1 week

195
Q

Cold usually lasts

A

1.5 weeks

196
Q

Rhinosinusitis usually lasts

A

2.5 weeks

197
Q

Cough usually lasts

A

3 weeks.

198
Q

Rash with cough

A

GuttateInfectious mononucleousisScarlet fever

199
Q

EBV tests

A

LFTSFBCMonospot blood test

200
Q

Centor criteria

A

ExudateTender lymph nodesAbsence of a coughFever

201
Q

> 3 centor criteria

A

B haem 60% likely- give Abx

202
Q

Quinsy

A

much more likely if unwell with tonsillitis

203
Q

tonsillectomy

A

> 5episodes of tonsillitis in 1 year

204
Q

Avoid contact sports in

A

infectious mononucleosis

205
Q

Cause of flu:

A

orthomyxovirus

206
Q

Epidemic

A

> 200/100,000 in a week

207
Q

Flu incubation

A

2 days

208
Q

Strains of flu in humans

A

H1N1, H2N2, H3N2

209
Q

Oseltamavir

A

Tamiflu

210
Q

Tamiflu

A

Oseltamavir

211
Q

Dose tamiflu

A

75mg BD 5 days.

212
Q

Relenza

A

Zanamivir

213
Q

Zanamivir

A

Relenza

214
Q

Dose relenza

A

inhale 5mg BD 5 days.

215
Q

When to use antivirals in flu?

A

Epidemics

216
Q

Antivirals in flu efficacy

A

Reduce illness by 1 days if started <24h

217
Q

IM flu injection SE

A

Guillain barreEgg allergy

218
Q

Referred ear pain

A

Dental abscess CN5TonsillitisCarcinoma base of tongue CN9Ramsey-Hunt CN7Laryngiocarcinoma- vagus

219
Q

causes of otitis media

A

s.pneumoniah.influenzam.catarrhalis.

220
Q

RF for otitis media

A

passive smokingformula milkcraniofacial syndromes

221
Q

Rx for otitis media

A

Para and Ibuif needed: amoxicillin or erythromycin 5 days.

222
Q

Abx in otitis media if:

A

under 3 mhad for >3 daysbilateral in <2s

223
Q

Repeated acute otitis in adults may indicate

A

nasopharyngeal cancer

224
Q

> 10 days ear discharge??

A

Mastoiditis.

225
Q

Causes of otitis externa

A

staphcandidaeczemaswimmingcotton budstrauma

226
Q

Rx for otitis EXTERNA

A

olive oil dropsanalgesiaAminoglycaside+steroid drops

227
Q

Uncomplicated UTI

A

3 days trimethoprim 200mg BD3 days nitrofurantoin 50mg QDS

228
Q

UTI in pregnancy treatment

A

7 day trimethoprim 200mg BD (not 1st tri)7 day nitrofurantoin 100mg BD (not 3rd tri)

229
Q

Pyelonephritis treatment

A

7 days Ciprofloxacin 500mg BD

230
Q

Chlamydia treatment

A

Azithromycin 1g once.Doxycycline 100mg BD for 5 days.

231
Q

Chlamydia in pregnancy

A

Erythromycin.

232
Q

If you suspect angina

A

Rapid access chest pain clinicexcercise ECGAngiography (might miss micro)Radio-isotope scanCT angioEcho

233
Q

Diabetes diagnosis

A

Random glucose >11.1Fasting glucose >7.0

234
Q

Oral glucose tolerance test

A

Fast overnight75mg of glucose in morning2 hr later >11.1mmol=diabetes

235
Q

B12 treatment

A

1mg hydroxycobalamin IM injection 5-6 doses in 2 weeks then 1 mg every 3 months.

236
Q

Iron treatment

A

Supplements and then 3 months after to build stores.

237
Q

Exacerbation of COPD

A

30mg Pred

238
Q

Chronic heart failure

A

ACEI (A)Add B blocker (B)Seek specialist

239
Q

Trismums

A

unable to open mouth

240
Q

Treatment strep throat

A

(Penicillin V) 500mg every 6 hours, however if allergic you would prescribe oral CLARITHROMYCIN 250-500 mg every 12 hours for 10 day

241
Q

Warning drug and sore throat

A

A patient taking DMARDs, Carbimazole or on Chemotherapy - arrange an urgent FBC and seek advice. Could be drug induced agranulocytosis.

242
Q

Opiates in urine

A

24h

243
Q

Methadone in urine

A

48h

244
Q

Cocaine in urine

A

24-48h

245
Q

Buprenorphine

A

Buprenorphine is a newer medication then methadone. It is less sedating then methadone and is safer in overdose. However it is contraindicated in pregnancy.

246
Q

Methadone

A

Oral methadone mixture 1mg/ml is the preparation of choice for opiate users.

247
Q

Flu vaccine

A

over 65nursing homesdoctorschronic illnessesprenantcarers

248
Q

Migrane sx

A

Lasts 4-7 hoursThrobbing/bangingUnilateral or bilateral.Nausea/vomitingLight sensitivity.

249
Q

Cocp

A

99% effective

250
Q

Cocp works by

A
  1. suppress ovulation
  2. Cervical mucus thickens
  3. Endometrium hostile to implantation
  4. Tubal motility
251
Q

Benefits of cocp

A

Reduced cancer- endo, ovarian, colon
Reduced cysts and fibroids
Decrease pelvic infection
Betters anaemia

252
Q

Ukmec

A

Cat 1: unrestricted
Cat 2: benefit outweighs
Cat 3 risk outweighs
Cat 4: no no

253
Q

Risks with cocp

A 
Vte (15 per 100,000 woman years)
Ischemic stroke
Mi
Breast cancer risk goes after 10 years of stopping
Gall stones
Benign/malignant liver tumour
Cervical cancer
254
Q

No cocp for

A 
Current vte/thrombosis
Stroke
Pro thrombotic problems 
160/95
Over 35y >15sigs
Migraine
Af
Heart disease
Liver disease
Breast cancer
6 weeks post partum
255
Q

Type of oestrogen in cocp

A

Ethinyl estradiol Ee

256
Q

Drug interactions of cocp

A

Anticonvulsants
Rifampicin
HIV drugs
St. John’s wart

257
Q

No pop for:

A

Breast cancer

258
Q

Failure rate of pop

A

1 to 4 per 100 women years

259
Q

Disadvantages of pop

A

Strict window
Bleeding
Less effective

260
Q

Progesterone in cerazette

A

Desogestrel

261
Q

How to take pop

A

Everyday no break
3h window
Extra contraception for 2 days if missed 1

262
Q

Depo provera

A

Im injection

Medroxy progesterone acetate

263
Q

Advantages of depoprovera

A

No bleeding in 60%
Treats menorrhagia
Reduced epilepsy and sickle cell crisis

264
Q

Disadvantages of depoprovera

A

9m delay in fertility
Bone mineral density
0.1-1.0 per 100 women years

265
Q

Implant

A

Nexplanon

266
Q

Drug in nexplanon

A

Etonorgestrel

267
Q

Nexplanon lasts

A

3 years

268
Q

Failure rate nexplanon

A

0.1 per 100 woman years

269
Q

Advantages nexplanon

A

Effective

No concerns of bones or return of fertility

270
Q

Disadvantages nexplanon

A

Bleeding
Surgical
Expensive

271
Q

Failure rate iud

A

Less than 2 in 100 w y

272
Q

Ius failure rate

A

Less than 1 per 100 w y

273
Q

Disadvantages of ius it’d

A 
Painful insert
Anaphylaxis
Expulsion
Pelvic infection
Perforation
Ectopic pregnancy
274
Q

More than one emergency contraceptive in same period

A

Not 2 ella one

But can use 2 levonelle

275
Q

Latest time you can use emergency copper

A

Shortest cycle
Minus 14 (earliest date of ovulation)
Plus 5

276
Q

Spermicide

A

Nonoxynol9

277
Q

Cocp before 3 weeks postpartum

A

Risk of thrombosis

Wait until baby is over 6 months if breast feeding

278
Q

Ius/iud post partum

A

4 weeks

COMP 2 (3 decks)

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