GP ILAs and public health Flashcards
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1
Q
Describe the management of hypertension with regards to the drug ladder
A
Step one: ACE inhibitor or ARB (Use CCB if over 55 or Afro-Caribbean)
Step 2: ACE-i/ARB and CCB
Step 3: Add thiazide diuretic
Step 4: Add spironolactone
2
Q
Describe the management of hypertension IGNORING the drug ladder
A
Lifestyle (lower weight, exercise, diet, relaxation, alcohol, caffeine, salt, smoking)
Statins
3
Q
What should be completed within 2 weeks of starting or changing dose of an ACE-i?
A
U+E
4
Q
Describe stage 1 and stage 2 hypertension, and how treatment guidelines differ between them
A
Stage 1 = BP>140/90
Treat if under 80 years and one of target organ damage, CVR disease, renal disease or diabetes.
Stage 2 = >160/100
Treat all
5
Q
What investigations should be completed before referring a patient for heart failure?
A
BNP
Echocardiogram
6
Q
What is the management of CCF?
A
Lifestyle (exercise, smoking, depression, alcohol, sexual activity, air travel, flu vaccinations) Diuretics CCBs Amiodarone Anticoagulant and Aspirin
7
Q
What are the two types of heart failure?
A
HFPEF (heart failure with preserved ejection fraction)
HFREF (heart failure with reduced ejection fraction)
8
Q
What are the different types of diuretic?
Give an example for each
A
Thiazide diuretics (Bendroflumethiazide) Loop diuretics (Furosemide) K sparing diuretics (Spironolactone)
9
Q
Why is Bumetanide better than Furosemide orally for CCF?
A
Bumetanide is absorbed better in odematous bowel and has a lower volume of distribution so is more concentrated.
Furosemide is very potent IV
10
Q
What is the prognosis of heart failure?
A
Poor - 60% survive 18 months
Especially poor if requires hospitalisation
11
Q
What are DAFNE and DESMOND?
A
DAFNE - dose adjustment for normal eating. T1DM patients learn to inject correct amount of insulin for the meal they are eating
DESMOND - T2DM teaching - Diabetes Education and Self Management for Ongoing and Newly Diagnosed diabetics
12
Q
What are the four levels of prevention?
A
Primary
Secondary
Tertiary
Quaternary (Population level eg. Government legislation)
13
Q
Against what disease are babies immunised on day 1?
A
TB
14
Q
Against what diseases are babies immunised at 8 weeks?
What injection includes most of these?
A
Diphtheria Tetanus Pertussis Polio H influenza Hepatitis B (ALL OF ABOVE IN Infanrix VACCINE)
PCV (pneumococcal conjugate vaccine)
Rotavirus
Meningitis B
15
Q
Against what diseases are babies immunised at 12 weeks?
What injection includes most of these?
A
Diphtheria Tetanus Pertussis Polio H influenxa Hepatitis B (ALL OF ABOVE IN Infanrix VACCINE)
Rotavirus
16
Q
Against what diseases are babies immunised at 16 weeks?
What injection includes most of these?
A
Diphtheria Tetanus Pertussis Polio H influenxa Hepatitis B (ALL OF ABOVE IN Infanrix VACCINE)
PCV (Pneumococcal conjugate vaccine)
Meningitis B
17
Q
Against what diseases are babies immunised at 12 months?
A
H influenza Meningitis C MMR PCV (pneumococcal conjugate vaccine) Meningitis B
18
Q
Against what diseases are babies immunised at 3 years and 4 months?
A
Diphtheria Tetanus Pertussis Polio MMR booster
19
Q
Against what virus are 13 year old females vaccinated against?
A
Human Papiloma Virus (types 16 and 18)
Reduces risk of cervical cancer
20
Q
Name 5 notifiable diseases
A
Anthrax Diphtheria Food poisoning Legionnaire's Leprosy Malaria Measles Mumps Plague Rabies Rubella Scarlet fever Tetanus TB Pertussis Yellow fever
21
Q
What coloured system is used when dealing with an unwell child?
A
Traffic light system:
Green - low risk (all normal)
Amber - intermediate risk (pallor, sleepy, tachypnoea, chest crackles, low sats, tachycardia, poor feeding, fever and swelling)
RED - HIGH RISK (Blue/mottled skin, very sleepy, weak voice, tachypnoea > 60, chest indrawing, grunting, reduced skin turgor, fever, seizures, neurological signs)
22
Q
What service to GPs refer an unwell child to?
A
Single point of access
23
Q
Describe safety netting
A
Advice given to patients about signs of deterioration and actions to be taken if those signs are seen.
24
Q
How is normal vaginal discharge described?
A
Clear or white, thick and sticky
25
What is the likely causative condition/organism:
White, thick (like cottage cheese) vaginal discharge. Site is itchy.
Thrush (Candiditis)
26
What is the likely causative condition/organism:
White/grey, thin and watery vaginal discharge. Fishy smell.
Bacterial vaginosis
27
What is the likely causative condition/organism:
Green/yellow, frothy and thick vaginal discharge. Site is itchy and painful
Trichomoniasis
28
What is the likely causative condition/organism:
Thick green/yellow vaginal discharge. Urination is painful
Gonorrhoea
29
Describe Fraser competence and how it is assessed
Used to define whether a child (U16) has capacity to request contraception without informing parents.
Consider:
-Does the child understnd the advice?
-Will the child be convinced into telling their parents/letting you tell their parents?
-Will the child partake in unprotected sex without the contraceptive?
-Will the child's physical or mental health suffer without the contraceptive?
If you are satisfied, treat and maintain confidentiality.
30
Describe how a contraceptive implant works, how effective they are and how long they last for
Long acting, 100% effective, last up to 3 years.
Progesterone in the implant enters the bloodstream and stops ovulation, prevents implantation and thickens cervical mucus.
31
Describe inter-uterine devices, how they work, how effective they are and how long they last for
Long acting, 99% effective, lasts 5-10 years.
| Copper coil, the copper destroys sperm and the presence of the coil prevents implantation.
32
Describe inter-uterine systems, how they work, how effective they are and how long they last for
Long acting, 99% effective, last 3-5 years
Progesterone in the device is released into the uterine system and thickens cervical mucus. Also the presence of the system prevents implantation.
33
Describe DEPO injection contraceptives, how they work, how effective they are and how long they last for
Long acting, less than 99% effective, last 12 weeks
Progesterone depo that slowly releases into the bloodstream. This thickens cervical mucus, prevents implantation and stops ovulation.
34
Name 7 short acting contraceptives
```
Combined OCP
Progesterone only pill (mini-pill)
Patch
Ring
Condom
Diaphragm
Cap
```
35
What are the legally important age boundaries regarding teenage sex
Child under 13 cannot consent to sex therefore it is rape whether the child attempts to consent or not
Child under 16 is underage for sex but can legally give consent (mutually agreed teenage sex is legal unless abusive or exploitative)
Confidentiality can be broken in a case of safeguarding or child welfare
36
What tools might you use to screen for dementia?
| What are the common questions featured?
MMSE
GP-COG
6-CIT (cognitive impairment test)
AMT (abbreviated mental test)
- Draw a clock
- Name the current year/month/date/season
- Recall words or an address
- Name your present location, objects or people
37
What community care services are available to dementia patients?
```
Admiral nurses
OTs
Dietitians
Laundry
Carers
Meals on wheels
Benefits
```
38
What is a COP3 form used for?
Declaring a person to be lacking capacity
39
What needs assessing when assessing mental capacity?
Whether a patient can:
- Understand the information
- Remember the information
- Consider the information
- Communicate a decision
40
What is a DOLS?
Deprivation of liberty safeguards - these ensure a patient is not inappropriately restricted if denied liberty in their best interests
41
What three aspects apply to best interests?
Health
Finance
Social care
42
What is an IMCA?
Independent Mental Capacity Advocate
| -a legal safeguard for people lacking mental capacity in the absence of family or a friend
43
What are some advantages of giving mental health patients a diagnosis/label?
Professional communication
Treatment plan
Reassurance - it's an illness, not madness
Patient's personal research
44
What are some disadvantages of giving mental health patients a diagnosis/label?
Can be used or viewed by others as an excuse
Socially avoided once open about diagnosis
Can never be taken back once it has been said
One size does not fit all
45
What is an AMHP?
An approves mental health professional (not a doctor)
46
What screening tools might a GP use for a depressed patient?
HAD scale (Hospital Anxiety and Depression)
BDI-2 (Beck Depression Inventory-2)
PHQ (Patient Health Questionnaire)
47
What are the risk factors for TB?
```
Extremes of age
IV drug use
Homelessness or cramped, damp housing
Infected relatives
Immunosuppression
Being in a TB prevalent county
```
48
In what countries is TB prevalent?
Nigeria
Pakistan
South Africa
Bangladesh
49
When protecting a population from an infectious disease what four aspects should you consider?
Give an example relevant to TB.
Medical - Vaccinations
Administrative - Risk assess the area, have an equipped laboratory on hand
Environmental - Try to remove contaminated air
Equipment - Use PPE when in high risk areas
50
What health issues do new UK immigrants face?
```
Lack of immunisations
Latent infections
Undiagnosed conditions
Poor housing and economic depression
Emotional trauma from journey and reason for emigration
```
51
What issues can occur when a language barrier exists between clinician and patient?
Poor history leads to incorrect diagnosis and prescription errors
Patient unable to engage with posters or other services available to them
Additional time requirement for consultation
Confidentiality should the interpreter be family
Distrust arising from low satisfaction with healthcare
52
What five categories do sexual problems fall into?
```
Drive
Desire/Libido
Excitation
Orgasm
Resolution
```
53
In what situations is a genital examination necessary following a sexual history?
If a pain disorder is described
If you suspect co-morbid conditions
If topical agents are to be prescribed
If patient is concerned about their anatomy
54
In a sexual context, why might you investigate BM and lipids?
For diabetes or CVD causing reduced sensation or bloodflow issues
55
If you suspect a sexual desire disorder, what investigations would be appropriate?
Sex hormones, Prolactin, TSH, FBC
56
Describe hypoactive sexual desire disorder
Lack or loss of sexual desire not secondary to any other sexual difficulties.
This has no effect on enjoyment or orgasm, only initiation
57
What can causes hypoactive sexual desire disorder?
Obesity, CVD, Diabetes, Anaemia, Androgen deficiency, hyperprolactinaemia hypogonadism, antidepressants, oophrectomy, orchidetomy, psychological, hypothyroid, addison's, OCP, HRT, Beta-blockers
58
How is hypoactive sexual desire disorder treated?
Testosterone/oestrogen replacement
Psychological therapy
Sexual growth programme (to overcome negative beliefs)
59
Describe erectile disorder
Difficulty developing or maintaining an erection suitable for satisfactory intercourse
60
What can cause erectile dysfunction?
CVD, Diabetes, Neurological disease, Androgen deficiency, Hyperprolactinaemia, Prostate surgery, antihypertensives, SSRIs, Pain, Age, Veno-occlusive disorder, depression, substance abuse, negative life experences
61
What is the treatment for erectile disorder?
Medication (Sildenafil or Alprostadil)
Penis ring with/without vacuum device
Kegel exercises
62
Describe female sexual interest/arousal disorder
Lack of sexual interest or arousal causing reduced sexual activity, erotic thoughts/fantasies, initiation or response to partner's initiation of sex, and pleasure during sex.
This often presents as vaginal dryness first
63
What can cause female sexual interest/arousal disorder?
CVD, Diabetes, Neurological disease, Oestrogen deficiency, Antidepressants, Breastfeeding, Depression, Anxiety, Eating disorders, Previous abuse
64
How is female sexual interest/arousal disorder treated?
Couples psychosexual therapy
Sexual growth programme
Lubricant, vibrator or Eros system for improved excitation
65
Describe female orgasmic disorder
Absence of or marked delay in reaching orgasm. Reduced sensations if orgasm does occur
66
What can cause female orgasmic disorder
CVD, Diabetes, Neurological disorder, Renal or Hepatic conditions, Oestrogen or androgen deficiency, Hypothyroidism, Pelvic floor weakness, Aeging, SSRIs, Depression, Anxiety, Substance abuse, Previous sexual abuse
67
How is female orgasmic disorder treated?
Psychotherapy (change attitudes towards sex)
Depression treatment review
Personal sex growth programme
Kegel exercises
68
Describe rapid ejaculation
Inability to control ejaculation sufficiently for enjoyment of both partners
69
What causes rapid ejaculation?
Genetics, Penile hypersensitivity, prostatitis, ED, anxiety, learned experiences, lack of experience, environment
70
How is rapid ejaculation treated?
```
Topical anaesthetics
Dapoxetine (SSRIs)
Couples psychotherapy
Stop/Start technique
Kegel exercises
```
71
Describe delayed ejaculation
Marked delay or failure of ejaculation
72
Describe the causes of delayed ejaculation
Congential, Trauma, Age, DM, Spinal cord injuries, Depression, SSRIs, Thiazides, Alpha-blockers, low testosterone, Poor arousal, Fear
73
What can delayed ejaculation sometimes be confused with?
Retrograde ejaculation
74
What is the treatment for delayed ejaculation?
Individual therapy
Couples therapy
Kegel exercises
Superstimulation (vibrators or 'spicy' lube)
75
Describe vaginismus
Spasm of pelvic floor muscles surrounding vagina, closing the vaginal opening. This makes penetration painful or impossible
76
What can cause vaginismus?
Thrush, Anticipation (of pain), FGM, Congenital abnormality, Religion/Culture, Fear of pregnancy, Previous abuse/unpleasant experience
77
What is the treatment of vaginismus?
```
Treat the cause
Individual psychosexual therapy
Integrated CBT
Examination (With therapy beforehand)
Behaviours - self exploration, relaxation, kegel exercises)
```
78
Describe dyspareunia
Pain during intercourse not secondary to another sexual dysfunction
79
What causes dyspareunia?
Infection, Injury, Irritation, Hypersensativity, Herpes, Allergies, Circumcision, Menopause, Radiotherapy, Penis size, Endometriosis, Pelvic tumours, IBS, Constipation, Adhesions, Previous painful experience
80
What is the treatment for dyspareunia?
Examination
Steroid cream
Testosterone replacement
Couples therapy/Personal sexual growth programme
81
What is your 'sex assigned at birth'?
Male or female, based on external genetalia
82
What is your gender identity?
Intrinsic sense of being male/female/alternative
83
What is your gender role/expression?
Personality, appearance and behaviour
84
What abnormality causes Kleinfelter's?
| Describe the symptoms
XXY Trisomy
| Usually male at birth but have gynacomastia and late puberty
85
Describe the symptoms of congenital adrenal hyperplasia
Usually assigned female at birth, but experience gonadomegaly and reduced breast tissue
86
Describe gender dysphoria
Distress due to in-congruence between gender identity and sex assigned at birth
87
What are FtM and MtF used for?
Describing transgender people:
FtM - Female to Male
MtF - Male to Female
88
Define paraphilia
Arousal from non usually sexual objects/stimulation.
| Often causes relationship problems and distress. Mostly affects males.
89
Define Fetishistic Transvestism
Conditioned response paraphilia (fetish) due to the act of cross dressing
NB: Not related to gender dysphoria
90
Define necrophilia
Sexual arousal through contact with dead bodies
ILLEGAL
91
Define coprophilia
Sexual arousal through contact with faeces
92
Define zoophilia
Sexual arousal through contact with animals
ILLEGAL
93
Define exhibitionism
Sexual arousal through exposing genitals to unconsenting victims
94
Define sex additction
Compulsive engagement in sexual behaviours
| Causes issues in relationships
95
Describe a sloth error
Not bothering to check results/information for accuracy
Incomplete evaluation
Inadequate documentation
--> Poor standards
96
Describe a loss of perspective error
Unshakeable focus on one diagnosis, unable to step back and see the bigger picture.
Overlooking warning signs
97
Describe a communication error
Unclear instructions/plans
| Not listening to others
98
Describe a poor team working error
Team members working independently
Poor direction
Under/Over-utilisation of individuals
99
Describe a playing the odds error
Always ignoring the rare event
100
Describe a bravado error
Working beyond your competence
101
Describe an ignorance error
Lack of knowledge, consciously or unconsciously
102
Describe a mis-triage error
Under/Overestimating the seriousness of a situation
103
Describe a lack of skill error
Lacking the required skill, practice or teaching
104
Describe a system error
Environmental, technological or organisational failures
| Inadequate safeguards
105
If a wound is black, what is going on?
Necrosis
106
If a wound is yellow/brown, what is going on?
Slough production - remove this
107
If a wound is red, what is going on? (Not bleeding)
Granulation - leave this on!
108
If a wound is pink, what is going on?
Epithelialising - leave this on!
109
Describe hydrogel
An intra-site gel that rehydrates dry wounds (SEAWEED)
| Cover this with a secondary dressing
110
Describe alginate dressings
Highly absorbant dressings for high-exudate wounds
111
Describe hydrocolloid dressings
Good for necrotic or sloughly wounds - low to moderate exudate
112
Name and describe the 4 stages of wound healing
Vascular response - bleeding and serous fluid cleanse the wound, then clot forms into a fibrin mesh and a scab
Inflammatory response - Vasodilation and attraction of WBCs (Neut - bactericidal, Mac - Phagocytosis, Lymph - delayed response)
Proliferation - Fibroblasts secrete collagen and glycosaminoglycans. Granulation, epithelialisation and contraction of wound take place
Maturation - Collagen production halts, wound strength progressively improves
113
Describe a Keloid scar
A wide, raised, flat-topped scar that occurs when the 4 stages of wound healing occur in the wrong order
114
Describe wound healing by primary intention
Achieved if little or no tissue loss - wound edges directly opposed to each other, giving a neat linear scar
115
Describe wound healing by secondary intention
Where wound edges are not opposable (eg blunt trauma or ulcers). Granulation causes a broader scar
116
Describe wound healing by tertiary intention
Wound is purposely left open (due to infection or foreign body) for cleaning, debriding and observation.
Requires surgical suturing or a skin graft
117
What can be described as domestic abuse?
Abuse (Physical, Psychological, Sexual, Financial, Emotional) of a person ages 16+
Events "unwitnessed by anyone else" are highly suspicious
118
Regarding domestic abuse, define standard, medium and high risk
Standard - Serious harm unlikely
Medium - Signs are present but serious harm currently unlikely
HIGH - Imminent risk of serious harm, break confidentiality and act (Refer to DA/MARAC)
119
What screening tool is used to screen for domestic abuse?
DASH tool
120
Define allostasis
Stability through change
| Physiological systems rapidly adjust to environmental stressors (eg standing up, infections, learning)
121
Define allostatic load
The health impairments caused by allostasis gone wrong (eg hypertention, AI disorders, dementia)
122
What is the difference between equality and equity?
Equality is where all people receive the same, equity is where all people receive what they require to get to the same place
123
What is horizontal and vertical equity?
Horizontal = equal treatment for equal need (eg all pneumonia patients get the same treatment)
Vertical = Unequal treatment for unequal need (eg cough and pneumonia treated differently)
124
What four points form a circle for public health needs evaluations
Needs assessment
Planning
Intervention
Evaluation
125
How much ethanol is in one unit of alcohol?
8 grams
126
How many units are cleared in 1 hour?
15g = 1.9 units.
| It is metabolised indirectly to water and CO2
127
What are the four key concepts of the health belief model?
```
Perceived susceptibility (to a condition)
Perceived severity (of said condition's symptoms)
Perceived barriers (actions to reduce susceptibility)
Perceived benefits (outweighing costs of said actions)
```
128
What are the key points of planned behaviour?
Behaviours are preceded by Intentions, which are subject to three conditions:
Attitudes
Subjective norm
Perceived behaviour control
129
What are the key points of the stages of change model?
```
Pre-Contemplation (not thinking about it)
Contemplation (thinking about it)
Preparation (Getting ready)
Action
Maintenance (keeping it up)
```
It is possible to relapse backwards
130
What six words are Maxwell's dimensions of quality?
```
Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity
```
131
What five categories feature in Maslow's hierarchy of needs?
```
Self-actualisation
Esteem
Belonging
Safety
Physiological
```
132
What is the prevention paradox?
A measure that brings great benefit to a population often brings little to individuals
