GP Handbook Flashcards
In the context of preventative health, what is SNAP?
Smoking, nutrition, alcohol and physical activity
Describe the tactics you might employ to help a person quit smoking
- Quit plan
- Quit date
- Reasons to quit
- Trigger avoidance (places, people, circumstances)
- Distract, discuss, delay, drink water, deep breaths
- Diet
- Medication (nicotine replacement therapy > 8/52, champix/varenicline [blocks partial nicotinic agonist, care in renal failure], bupropion [CI - seizures, SSRIs, pregnancy])
What are the guidelines for regular physical activity in adults?
- 2.5 hours mod-intensity per week (brisk walk) OR
- 1.5 hours high-intensity per week (run)
- More for children
How often should adults have their lipid levels monitored?
- 5-yearly
- 2-yearly if >45 and moderate CVS risk
- 1-yearly if high risk
Which patients fit into the category 1 (low risk) group for bowel cancer screening. How should they be managed?
- No personal or family history of bowel cancer OR
- One FDR/SDR > 55 with bowel cancer
- FOBT 2-yearly from 50
- Flexible sigmoidoscopy 5-yearly
Which patients fit into the category 2 (medium risk) group for bowel cancer screening. How should they be managed?
- One FDR
- Two FDR or an FDR + SDR with bowel cancer at any age
- Colonoscopy 5-yearly from 50 or 10 years earlier than familial diagnosis
- Flexible sigmoidoscopy + barium enema/CT colonography if above contraindicated
- FOBT in intervening years
Which patients fit into the category 3 (very high risk) group for bowel cancer screening? How should they be managed?
- Three or more FDRs or FDR/SDRs on the same side of the family with bowel cancer
- Two or more FDR/SDRs on the same side of the family with any:
- Multiple bowel cancers in the one person
- Bowel cancer before 50 y/o
- HNPCC-related cancers - endometrial/ovarian/stomach/SI/renal/biliary/brain
- One FDR/SDR with multiple adenomas (?FAP)
- Genetic mutation with high susceptibility in family member
- Referral to genetic counsellor
- FAP
- Flexible sigmoidoscopy yearly/2-yearly from 12-15 until polyposis, then prophylactic surgery
- HNPCC
- Colonoscopy 2-yearly from 25 or 5y earlier than familial diagnosis
How often should the asymptomatic population be screened for diabetes?
- 3-yearly over 40 (fasting BGLs)
- OGTT if borderline
How often should the asymptomatic female population undergo mammography? At what age?
- 2-yearly from 50-74
Describe the symptoms of depression using an acronym
- S - sleep problems
- A - appetite or weight change
- D - dysphoria or bad mood
- F - fatigue
- A - agitation/psychomotor retardation
- C - concentration problems
- E - esteem problems
- S - suicidal thoughts
What are the criteria for anorexia nervosa?
- Weight < 85% predicted for height gender and ethnicity OR BMI < 17.5
- Fear of weight gain even when underweight - dieting, vomiting or excessive exercise
- Feeling fat when objectively thin
- Amenorrhoea (except OCP)
What are the criteria for bulimia nervosa?
- Regular binge eating episodes
- Preoccupation with weight
- Regular actions to offset binges - starvation, vomiting, laxatives, excessive exercise
- Weight in normal or overweight range
What are the criteria for diagnosis of schizophrenia?
- 2+ of for a significant portion of 1 month
- delusions
- hallucinations
- disorganised speech
- disorganised behaviour or catatonia
- negative symptoms
- Socio-occupational dysfunction
- Continuous disturbance for 6+ months
What are the likely side-effects of first-gen antipsychotics?
- Extrapyramidal movement disorders
- Dystonia, akathisia, parkisonism, tardive dyskinesia
- Anticholinergic effects
- Hyperprolactinaemia
- Hyperglycaemia
- Sedation
- Weight gain
What preventative and screening measures should be undertaken with patients on second-gen antipsychotics?
- Metabolic syndrome more likely
- Diet and exercise advice
- BMI
- BP
- BGL
- Lipids
- Medication review
Describe a basic risk assessment of a patient thought to be at risk of violence
- Risk of harm to self/others: thoughts/plans/means/EtOH
- Level of problem with functioning: socio-occupational
- Level of support available
- History of treatment response:
- Attitude to and engagement with treatment
When can lactational amenorrhoea be suitable as a contraceptive measure?
- Up to 6 months post-partum if 100% breastfeeding
When can medical termination of pregnancy be performed? Surgical?
- Medical <9/40
- Surgical vacuum aspiration <12/40
- Surgical dilation and curettage >12/40
What are the absolute contraindications to the combined oral contraceptive pill?
- Hyperthrombotic states
- Pregnancy
- <2 weeks post-partum
- Acute liver disease
- Polycythaemia
- Hx of thromboembolic disease or thrombophilia
- Cerebrovascular disease, coronary artery disease
- Focal migraines with aura
- Previous oestrogen dependent tumour
What are the relative contraindications to use of the combined oral contraceptive pill?
- CV risk factors
- Hypertension
- High BMI
- Smoking
- Diabetes
- Age > 35 and CVD risk factors
- Thrombotic states
- Long term immobilisation
- Liver disease
- 4 weeks pre and 2 weeks post-surgery
What are the absolute contraindications to use of an IUD?
- Pregnancy
- Previous ectopic pregnancy
- Active PID
- Undiagnosed uterine bleeding
What are the relative contraindications to use of an IUD?
- Anaemia
- Immunocompromise (PID risk)
- Impaired clotting mechanisms
- Valvular heart disease
- Very large or very small uterus
Describe the principles of a first antenatal visit in GP
- Confirm pregnancy
- Consider dating scan
- Screening tests
- FBE
- Group and antibodies
- Rubella, HBV/HCV, HIV, syphilis
- Pap smear
- Urine MCS
- General advice: diet, smoking/EtOH, exercise, weight
What should a routine post-natal check involve?
- History
- General health
- Bonding of baby and mother, family. Coping?
- Screen for postnatal depression (K10)
- Breast or bottle feeding
- Contraception, menstruation and sex
- Double check rubella status
- Continence
- Examination
- Mother - BP, breast (if pain), CS wound, pelvic examination, Pap test (if due)
- Baby - full check as for neonate
Describe a systematic baby check
- History: med/obs, mode of birth, ?resuscitation, medications, feeding, urine/faeces output
- Examination
- General: colour, rashes, alertness, posture, activity, tone
- Growth” charts
- Head/face/neck: shape, size, fontanelles, sutures, red reflex, palate, nose and ear position/size
- Clavicles/arm/hands: length, proportion, symmetry, digits
- Chest: shape, symmetry, heart sounds/rate, pulses, RR
- Abdo: size, shape, umbilical appearance, HSmegaly
- GU: genitalia, testes, anal patency
- Hips/legs/feet: Ortolani/Barlow, symmetry, digits
- Back: spinal alignment
- Neuro: posture, behaviour, tone, cry, reflexes
What are some developmental red flags at 6-8 weeks?
- Asymmetrical Moro
- Head lag
- No visual fixation/following
- No startle or quieting to sound
- No responsive smiling
What are some red-flag developmental signs at 8 months?
- Persistent primitive reflexes
- Not weight bearing on legs
- Not reaching out for toys
- Not fixing on small objects
- Not vocalising
What are some red-flag developmental signs at 10 months?
- Unable to sit unsupported
What are some red-flag developmental signs at 1 year?
- Showing a hand preference
- Not responding to own name
What are some red-flag developmental signs at 18 months?
- Not walking
- No pincer grip
What are some red-flag developmental signs at 3 years?
- Inaccurate use of spoon
- Not speaking in sentences
- Unable to understand simple commands
- Not interacting with other children
What immunisations should a child get at birth?
HepB
What immunisations should a child get at 2, 4 and 6 months?
- HepB
- DTPa
- HiB
- IPV
- Pneumococcal 13v
- Rotavirus
What immunisations should a child get at 12 months?
- HiB
- MMR
- Menigococcus
What immunisations should a child get at 18 months?
- MMR
What immunisations should a child get at 4 years?
- DTP
- IPV
What immunisations should a child get at 10-15 years?
- HepB
- Varicella
- HPV
- DTP
