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Phase 3a > GP & PH > Flashcards

GP & PH Flashcards

1
Q

In what patients is QRISK2 not used/ Contrindicated

A

Those who have had a CV event
Type 1 diabetes
CKD

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2
Q

Which patient groups are will QRISK2 underestimate CVE risk

A 
HIV
Recent stop smokers
Mental health problems
Antipsychotics (change blood profile)
Autoimmune disorders
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3
Q

What is the blood results you would see in acute pancreatitis

A

Raised amylase

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4
Q

List common causes for raised amylase

A

Acute pancreatitis
Gallstones
Alcohol
Scorpion bites

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5
Q

List some differentials for a recurrent cough with mucus and first line investigations

A

URT: Post nasal drip - recent illness, allergies?
LRT: infection, SOB, fever.

First line investigations: temperature, vitals, look in nose - any redness/ swelling that suggests allergies
Chest exam - can you hear anything in lungs suggesting infection
Bloods - infection screen (FBC, CRP)

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6
Q

What is the management of seasonal allergic rhinitis

A

Mild-moderate
1.Advice on avoiding allergens
2.PRN nasal antihistamine or oral non-sedating antihistamine citirizine
Moderate-severe (or above has failed)
1.Regular nasal steroid during periods of exposure (nb, maximal affects after 2 weeks, so need to keep going with it). Nasal drops if obstruction.
2.Combined therapy - antihistamine & steroid
Fluticasone and azelastine
(nasal spray longterm, nasal steroid drops during exposure to allergen, may need to be on these long term if its a house dustmite allergy)

+advice on allergen avoidance

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7
Q

What is the management of post-nasal drip

A

If the cause is allergic rhinitis - as per management for this - nasal spray antihistamine or steroid.

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8
Q

What is the difference between bronchiolitis and viral induced wheeze, what questions in a history would differentiate thess

A

Bronciolitis - usually <2 years. Corzyal symptoms, active illness. Acute wheeze. Fine crackles.
Viral induced wheeze - usually >2 years, post infections (recent illness but not active - failure of lungs to settle down after viral illness). Gradual wheeze. No fine crackles.

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9
Q

List some of the differential symptoms between bronchiolitis and viral induced wheeze

A 
Age
Corzyal symptoms present
Are the currently sick
Acute or gradual onset 
Fine crackles on auscultation
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10
Q

What is the management of POTTS

A

Beta blocker for tachycardia - bisoprolol

Steroid for hypotension - fludorcortisone

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11
Q

Which beta blocker is beta-1 selective

Which beta blocker is not beta-1 or beta-2 selective

A

Bisoprolol, atenolol

Propanalol - beta 1 and 2

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12
Q

What is the management of constipation in children in general practice

A

1.Lactulose (2.5 - 20 mL, depending on age) twice a day. NB adult lowest dose is 15 mL
May take up to 48 hours to act
Stool softener
2.Refer for stronger laxitives - movicol
3.Disimpaction movicol regime

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13
Q

List the different types of laxatives that can be used in children and adults

A

Osmotic: increase water in the bowel ‘stool softeners’ - Lactulose (sugar not absorbed in small bowel), Macrogol (Movicol),

Bowel stimulants: Sodium picosulfate,
Bisacodyl, Senna

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14
Q

What assessment do you need to do in children with constipation
What red flags need to be ruled out?

A

Ask about diet, especially milk
When did they pass their first stool >48 hrs?
Check lower limb reflexes
Is it associated with any foods - coaeliacs / allergies
Think about CF - Pale stools, persistent wet cough

Red flags - 1)absent/ reduced lower limb reflexes - any signs of cord compression 2) delayed meconium passage 3) persistent wet cough (CF)

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15
Q

What is the blood sugar range in a non diabetic - fasting, and non-fasting

A

Fasting <5.5

Non-fasting <7.8

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16
Q

What are diagnostic blood sugars for diabetes, fasting and non-fasting

A

Fasting >7

Non-fasting >11.1

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17
Q

What criteria is used to diagnose familial hypercholesterolaemia

A

Simon Broome criteria

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18
Q

What reduction in LDL do you look for after 3 months of being on a statin

A

40% reduction

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19
Q

What are the indications for prescribing a statin in non-FHC

A

QRISK2 >10%

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20
Q

What are the indications for prescribing a statin in FHC

A

Everyone with FHC should be on lipid-modifying therapy unless it is contraindicated. But, different statin used for primary (atorvostatin) vs secondary prevention.
CI: active hepatic disease, pregnancy

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21
Q

What is the recommended cholesterol range in UK

A

5 mmol/L and below

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22
Q

How is familial hypercholesterolaemia diagnosed

What is the chance of inheriting it from a parent with confirmed diagnosis

A

Blood test - look at cholesterol level
Refer to specialist for gene testing to confirm
50/50 chance of getting it in a first degree relative

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23
Q

What dietary advice would you give somebody with familial hypercholestrolaemia

A

Lower intake of high cholesterol foods: fats, diary, meats

Replace with vegetables, pulses, nuts - Mediterranean diet

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24
Q

What bloods should be done before starting someone on a statin

A 
Full lipid profile 
Creatinine Kinase
LFTs
U&amp;E 
HbA1c
TFT (hypo can cause dyslipidaemia)
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25
Q

What target HDL reduction would you want in someone with familial hypercholesterolaemia

A

50%

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26
Q

What are some of the common side effects of statins

A

muscle and joint pain
nosebleeds
sore throat
a runny or blocked nose (non-allergic rhinitis)
headache
feeling sick
problems with the digestive system, such as constipation, diarrhoea, indigestion or flatulence
increased blood sugar level (hyperglycaemia)
an increased risk of diabetes

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27
Q

What is the mechanism of action of statins

A

Statins act by competitively inhibiting HMG-CoA reductase, the first and key rate-limiting enzyme of the cholesterol biosynthetic pathway.
They block the metabolism of lipids to cholesterol.

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28
Q

You have a patient who is newly diagnosed with hypertension after home ambulatory BP monitoring. What investigations do you want to do to confirm/ rule out end organ damage,

A 
ECG - LV hypertrophy 
U&amp;E - kidney function 
FBC - polycythaemia 
LFT - for baseline
Lipid profile 
HbA1c - diabetes
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29
Q

What are the treatment options for menopause for somebody with a uterus

A 
1. HRT:
Coil (mirena) + oestrogen patch 
Combined (progesterone + oestrogen) HRT
Cyclical - bleed
Continuous - no bleed
2.SSRI, Clonidine (both are vasoconstrictors)
Mood symptoms: HRT/ CBT
Anxiety: CBT
Decreased libido: HRT/ testosterone gel
Muscular symptoms: HRT 
Vasomotor symptoms: SSRI/ clonidine
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30
Q

What do you have to consider in a patient who has a uterus when prescribing HRT

A

Prescribing combined HRT with progesterone to protect the endometrium

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31
Q

What HRT can you offer to someone for menopausal symptoms who has no uterus

A

Oestrogen only HRT - do not need to worry about endometrial protection via progesterone

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32
Q

What are the contraindications for HRT

A 
Active breast cancer
Active or recent CVD (angina, MI)
Current VTE or thrombophlebitis
or Hx of recurrent VTE
Undiagnosed vaginal bleeding (?Endo Ca)
Untreated endometrial hyperplasia
Liver disease, abnormal LFTs
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33
Q

In a patient with a BMI >30, what HRT would you offer for menopausal symptoms

A

Transdermal patch, because they are at higher risk of VTE, patch lowers any increased risk from oestrogen

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34
Q

What assessment should you do before starting someone on HRT

A

CVD risk assessment (bc CI in active CVD)
Check CI / BMI
Discuss risks with Breast Ca, smoking, VTE, ovarian Ca

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35
Q

What tests would you do to confirm if someone has gone through menopause

A

FSH - will be high if no longer ovulating

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36
Q

When should H Pylori be suspected and investigation

A

Complaint of epigastric pain

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37
Q

How is H pylori investigated

A

Stool sample

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38
Q

How are H Pylori sensitivies taken

A

Gastric biopsy

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39
Q

What are common side effects of PPIs, how can these be managed

A

Rebound hyperacidity - tapering withdrawal of PPI

Hypomagnesemia - bc of reduced Mg absorption in gut

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40
Q

What differentials should you consider in someone presenting with burning chest pain after eating, and at night

A 
GORD
Barratts oesophagus 
Oesophagitis
Malignancy 
Systemic sclerosis
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41
Q

What red flags should you ask about in someone presenting with burning chest pain that is related to eating (gastric chest pain)

A 
1.dyphagia + ANY ALARM sign or persistent symptoms 
Anaemia (unexplained)
Loss of weight 
Anorexia
Recent onset 
Melena, haematemasis
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42
Q

What red flag should you ask in anyone presenting with epigastric pain (dyspepsia)

A

If they have any difficulty swallowing

+ ALARM signs

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43
Q

What is the management of GORD

A 
1.Lifestyle changes - alcohol, caffeine
OTC antacids (Mg trisilicate) - review at 4 weeks
2.PPI or H2 blocker for 4 weeks
3. Endoscopy (hernia)
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44
Q

List some differentials for gastric chest pain

A

GORD
Hiatus hernia
Oesophagitis
Malignancy - oesophageal

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45
Q

What diet & lifestyle advice would you give to someone with GORD as first line management

A

Weight loss, smoking cessation, small, regular meals, reduce hot drinks, alcohol, citrus fruits, caffeine, chocolate
Avoid eating <3 hrs before bed

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46
Q

List some differentials for epigastric pain (dyspepsia)

A 
Duodenal/ gastric ulcers
Duodenitis
Gastric malignancy
Gastritis
Oesophagitis / GORD
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47
Q

What is the management of dyspepsia (epigastric pain)

A

1.Over 55 years OR dyphagia + ANY ALARM sign or persistent symptoms - urgent referral
2. Lifestyle / drug modifications (NSAIDs, Alcohol).
OTC antacids
3. H Pylori
4. PPIs/ H2
5. Referral - endoscopy

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48
Q

What is the monitoring time on bisphosphonates

A

6 months

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49
Q

What is the management of osteoarthritis

A

Exercises
Movement/ mobilse joint
Pain relief

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50
Q

What is the management of osteoperosis

A

Bisphosphonates - inhibit osteoclasts
Calcium and vitamin D
Monitor bloods every 6 months

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51
Q

What are the different levels of PVD

A

Asymptomatic
Intermittent claudication
Ischamic rest pain
Critical ischamia - ulceration/ gangrene

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52
Q

What examination should you do on someone with PVD

A 
Feel for foot pulses
Temperature 
Colour 
Sensation 
6Ps
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53
Q

List some causes of venous insufficiency

A 
blood clots.
varicose veins.
obesity.
pregnancy.
smoking.
cancer.
muscle weakness, leg injury, or trauma.
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54
Q

What are the most common areas for atherosclerosis in PVD

A

Buttocks
Calves
Penis
Coronaries

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55
Q

What is the protocol for GTN spray and chest pain

A

x2 sprays under the tongue, if not gone after 15 minutes call for an ambulance

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56
Q

What is included in a postnatal check for the baby

A 
Eyes - red reflex, fix and follow
Hearing - startle to noise? 
Palate - tongue tie/ cleft palate 
Head control- should have by 6 weeks 
Palmar creases - DS
Heart - murmurs
Chest - vesicular breathing
Hips 
Testes
Femoral pulses 
Anus
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57
Q

What are your differentials for a patient complaining of being ‘dizzy’

A

Brain - any focal neurology, balance
Heart - arrhythmia, valve (age), HTN, palpitations
ENT - labrynthitis, nausea, fever, recent illness
Medication - any new meds?

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58
Q

What is the criteria for referral with raised PSA

A

> 3 on 2 separate occasions
20 immediate referral
Double PSA if on alpha blocker
If have UTI, repeat as this can raise it

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59
Q

What can raise a PSA level

A

UTI

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60
Q

List some red flag features of critical ischemia

A

Pain at rest at night - alleviated by hanging leg over bed

Pale, cold, pulseless, paraesthesia

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61
Q

What is the management of sleep apnea

A

cPAP

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62
Q

What are some common symptoms of sleep apnea

A

Headache
Hypertension
Bc, heart is having to work harder and brain underperfused

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63
Q

Outline the different antidepressants

A

SSRIs

SNRI - mirtazepine, trazadone, venlafaxine

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64
Q

What are the side effects of mirtazepine

A

Drowsiness

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65
Q

What are the side effects of trazadone

A

Weight gain

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66
Q

In what groups would you treat an asymptomatic UTI

A

Pregnancy
Children
<3 months <3 years?
Men <65 years

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67
Q

What should you always check in a patient presenting with memory loss/ confusion who is elderly

A

Medication review - any medicines that could cause this

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68
Q

What are screening bloods for memory loss

A

FBC - Haematinics
Calcium
Folic acid

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69
Q

Outline the management of gout

A

Allopurinol - preventer

Colchicine - for acute episode

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70
Q

What blood test do you need to do before starting someone on antifungals

A

LFTs

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71
Q

What do you prescribe for folliculitis

A

Doxycycline

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72
Q

How would you assess a testicular lump

A

Smooth/ hard
Can you get all the way around it
It is tethered
is it in testes or epidydimis

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73
Q

List some differentials for testicular lumps

A 
Epidydimal cyst 
Hydrocele
Varocele
Spermatocele 
Orchitis
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74
Q

Give some differentials for light headedness

A

Anaemia
Valves - cardio
Postural hypotension

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75
Q

What should you look for when examing a child with undescended testes

A

Can you pull the testes down if they are not in the scrotum

If no, need to refer to paeds surgeons

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76
Q

How would you assess the stability of a joint in someone with ?osteoarthritis

A

Ask if the joint has given way on them

Have they had any trips/ falls bc of joint

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77
Q

What red flag should you ask about in an osteoarthritis hsitory

A

Does the pain wake you up at night - this may be a sign of malignancy - its also an indication for surgical referral
OA pain may stop them going to sleep but shouldnt wake up with pain
Functional assessment - ADL - also indication for referral if cant carry out activities of daily living

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78
Q

What should you assess in an OA history

A

Pain

Functional assessment - can they walk, can they do ADL - this will affect referral

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79
Q

What is the community management of OA, when would you refer

A

Conservative - exercise, activity, muscle strength, occupational therapy, walking aids, weight loss, footwear

Pharmacological - pain relief. Paracetamol, NSAID (caution - gastro protection), dermal patches (bupronorphine), intra-atricular steroid injections.

Surgical management (referral).

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80
Q

What would you look for on examination of OA joint

A

ROM - compare joints
Pain - compare joints
Bony swelling
Tender

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81
Q

What are the main differences in rheumatoid and OA on presentation

A

Joints involved - symmetrical vs non-symm
Soft tissue involvement - hot, swollen RA
Bony swelling - OA
Extra-articular involvement - RA
Weight baring joint - OA
Pattern of pain - worse at night/ waking - RA
Improves with joint movement - RA
Joint stability - gives way - OA

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82
Q

List some activities of daily living that you should ask about in an OA history

A 
Walking
Can they get up and down stairs 
Shopping
Eating
Bathing
Dressing
Toileting (being able to get on and off the toilet)
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83
Q

In a patient who presents with anaemia & melena, what non-cancer causes of bleeding should you look for on examination

A

Haemorrhoids
Anal fissure
Anything external around anus that could be causing bleed

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84
Q

List some red flags for bowel cancer

A 
Recent change in bowel habit - constipation or diarrhoea 
Melena, haematemsis 
Unexplained anaemia 
Weight loss
Lethargy
Fatigue 
Age >60 years (may be 55 years)
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85
Q

List some differentials for recent change in bowel habit

A 
IBD
IBS - ask about at night symptoms 
Diverticulosis (age - >60 years)
Coeliacs - any recent dietary changes
Malignancy 
Infection - recent travel
Biliary disease
Liver disease - decompensated
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86
Q

What is the management for genital herpes

A

Acyclovir
5 day course, if get more lesions 5 days more
If no new lesions, stop

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87
Q

What is pica and what is it sign of

A

Craving cold things, like ice, of no nutritional value

Sign of iron deficiency anaemia

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88
Q

What causes should you consider in someone with iron deficiency anaemia

A

Dietary - poor intake (supplements)

Bleeding - most likely in gut

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89
Q

How many virus can under 5s have per year

A

up to 13

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90
Q

What conditions need to be met for somebody to have ‘capacity’

A

They understand information about the decision
They can remember (retain) the information
They can use the information to make a decision (can they weigh up the consequences of the decision)
They can communicate their decision

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91
Q

What is the next step is someone doesnt have capacity

A

You should make a ‘best interests’ decision

Should involve family, carers, mental capacity advocate

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92
Q

How cab you determine if somebody qualifies for deprivation of liberty safeguards assessment

A

Are they free to leave
Are they under continuous observation or control
Do they lack capacity to consent
Are they confined to a restricted place for a non-negligible period of time

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93
Q

When should DOLS be considered

A

Someone who lacks capacity who has they liberty deprived for a period of time
Eg. someone who has a head injury who is admitted for investigations - not DOLS - this is not a ‘period of time’ it is part of routine investigations
Someone who is kept in a particular area and cannot leave, and they cannot consent (eg in a nursing home) for a long period time should have DOLS

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94
Q

What is required for DOLS

A

Must be necessary and in patients best interest

Harm prevention via DOL must be proportional to that harm

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95
Q

What is a typical UTI in an adult

A 
Non pregnant female 
No systemic features 
No loin pain/ renal angle tenderness
E coli 
Not recurrent
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96
Q

What is a typical UTI in a child 3months - 16 years

A 
Not systemically unwell
Responds to abx
E coli 
Passing urine 
No abdominal mass
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97
Q

What assessment should you do on all adults with LUTS

A

Pyelonephritis assessment
Sepsis assessment
Men - Prostate
Sexual health/ infections assessment

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98
Q

What inheritance pattern is haemochromatosis

A

Recessive

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99
Q

What inheritance pattern is wilsons disese

A

Recessive

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100
Q

What inheritance pattern is Huntingtons

A

Dominant

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101
Q

List some of the symptoms of haemochromatosis

A

arthralgia
Hepathomegaly
Liver signs and symptoms
More common in men than women - menstrual blood loss is protective

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102
Q

What is the composition of bone

A

Inorganic bone mineral (hydroxylapatite) and organic bone matrix (collagen and ground substance)

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103
Q

What is the clinical cut off for hypertension

A

135/85 - 24 hours ambulatory, or 1 week of home readings

140/90 in clinic

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104
Q

What is the HTN treatment goal for someone 1) without diabetes, 2) with diabetes, 3) >80 years

A
  1. <140/90
  2. 130/80
  3. 150/90
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105
Q

What secondary preventation medications should all post MI patients be on

A

Duel antiplatelet therapy - Aspirin, clopidogrel
Statin
Beta-blocker
ACE inhibitor

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106
Q

What are some common side effects of ACE inhibitors

A 
BEK 
BP - hypotension
Electrolytes - hyperkalaemia 
Kidney - acute renal failure 
Cough
Rash
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107
Q

List an urinary anticholinergic and alpha blocker

A

Oxybutynin - anticholinergic

Tamsulosin - alpha blocker

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108
Q

What is the difference between chronotrope and inotrope

A

chronotrope increases HR

inotrope increases contractility

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109
Q

Which beta receptors are predominantly in the heart

A

Beta 1 - bisoprolol

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110
Q

What is the action of ACE inhibitors and S/Es, when are the contraindicated

A

Peripheral vasodilator
S/E: BEK
C/I: women of child bearing age. pregnancy, sometimes pre-existing renal disease, if causing HTN

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111
Q

What is the action of CCB and S/E, when are the contraindicated

A

Peripheral vasoconstriction by L type calcium channel inhibition. Two types - act peripherally or centrall.
Peripheral: flushing, headaches, oedema, palpitations
Central: bradycardia, worsening HF
C/I in heart failure

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112
Q

What are the different types of diuretics and their side effects

A

Loop - furosemide, bumetadine
Thiadize - bendroflumethazide, indapamind (erectile dysfunction)
K sparing - aldosterone
SE: The ‘E’s: empty, electrolytes, erection
Electrolytes - hyper/hypokalaemia, hyponatraemia, hypomg, hypocalacaemia.

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113
Q

What is the management of heart failure

A 
Diuretics - treat congestion 
ACE inhibitor plus BB 
\+Spironolactone 
\+Digoxin 
\+Vasodilator - nitrates and hydralazine

Sacubitril + ARB can be used to prevent MIs in those with HF

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114
Q

What is the pharmacological management of angina

A 
Primary prevention:
antiplatelets and statin for CVD risk 
Secondary prevention:
1st line: BB or CCB (+gtn)
2nd line: add on vasodilator - ivabridine, nicorondil
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115
Q

What is the management of Acute coronary syndromes

A

ST elevation:
Antiplatelets - aspirin 300 mg loading, then ticagralor 180 mg
Pain relief - morphine
Oxygen, nitrates
Anticoagulate - AF risk
Beta blockers - rate stabaliser
>12 hrs - refer for PCI, if no PCI consider thrombolysis

Non ST elevation:
Antiplatelets- aspirin 300 mg
Analgesia - morphine
Nitrates - GTN
Measure troponin - if low conservative strategy
Raised - anticoagulate, second antiplatelet, IV nitrate, BB

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116
Q

What symptoms differentiate stable angina, unstable angina and MI

A

Stable angina - predictable, exertional, non persistent
Unstable angina (NSTEMI) - unpredictable, rest pain, non-persistent
ACS (STEMI) - unpredictable, rest pain, persistent

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117
Q

What is the triad of angina

A

Chest pain
Brought on by exersion
Alleviated by rest

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118
Q

What is the primary prevention of angina

A 
Diet - lower low density fat intake, fruits vegetables
Exercise
Manage HTN 
Lipids - statin 
Diabetes management 
Smoking/ alcohol
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119
Q

What is the management of acute heart failure

A 
Oxygen 
Pain relief 
Diuretics - furosemide
GTN spray 
?IV nitrate infusion 
NOT BB OR VASODILATORS
120
Q

what eGFR do you need in someone starting an ace inhibitor

A

60

121
Q

What are the issues relating to polypharmacy when managing patients with chronic disease

A 
Adverse drug reactions
Drug interactions
Medication non-adherence
Medication errors
Functional status
Cognitive impairment 
Falls
Urinary incontinence
Nutrition
122
Q

What is the definition of polypharmacy

A

The use of multiple concurrent medications by one individual.
Can be appropriate or inappropriate.

123
Q

What are the risk factors for polypharmacy

A 
Multiple co-morbidities
Multiple prescribers
Cognitive impairment 
Learning difficulties 
Disability
Over the counter medications
Poor doctor communication
124
Q

What are some of the changes that happen in the elderly that change what drugs we use

A

Decreased water, more fat, affects drug distribution
GI changes in absorption
Changes in hepatic metabolism
Changes in renal excretion

125
Q

How can ADR from be prevented

A

Regular medication review
Be vigilant for new symptoms
De-prescribe unnecessary drugs

126
Q

What is the prognosis of heart failure

A

25% die in first year of diagnosis
After this 10-15% more die each year
Not curable, only treatable - treatment aimed at symptoms

127
Q

What are the different classes of heart failure

A

Class I - No limitation on activity. Can do ordinary activity. ADL.
Class II - slight limitation. Comfortable at rest but ordinary (ADLs) activity results in some fatigue.
Class III - marked limitation. Less than ordinary activity results in fatigue/ breathlessness.
Class IV- unable to carry out physical activity without discomfort. Breathless at rest.

128
Q

What support is available in the community for patients with HF

A 
Specialist HF nurses
GP/ home visits
Palliative care 
Patient support groups - run by BHF
Physiotherapy
129
Q

List some examples of primary prevention of CVD

A

Identifying modifiable risk factors in individuals and addressing them
Lipids, diabetes, obesity, poor diet, low exercise, smoking, HTN
NHS health check - use of Q risk on everyone over 40 years - opportunity to intervene with modifiable risk factors
Statin in anyone with Q risk >10% (starting dose 20 mg)
Smoking ban outdoors
Ban on smoking advertising/ marketing
CHD information on cigarette packets

130
Q

List some examples of secondary prevention of CVD

A 
Post MI / stroke management 
MI:
Duel antiplatelet therapy 
Statin
ACE
BB 
Stroke and TIA:
Antiplatelts: 2 weeks aspirin
Then switch to clopidogrel (use duel if sig stenosed cranial stenosis or MI)
Modifiable RF management: 
Statin, HTN, HF, DM, AF, menopause
131
Q

From what ages is the NHS health check run

How often should people have an NHS health check

A

40-74

Every 5 years

132
Q

What is the definition of primary, secondary and tertiary prevention

A

Primary - prevent disease from occuring
Secondary - identify latent stage of disease and stop it progressing.
Tertiary - treating the symptoms of an established disease.

133
Q

What are the pros and cons of population vs high risk prevention strategies

A

Population - less time consuming to develop as they target everyone. Ethical issues of targeting and including those who dont benefit.
High risk - more time consuming to develop and target. More cost effective as targeting specifically those at risk.

134
Q

What healthy diet advice should you give a patient as primary or secondary prevetion

A

Eat at least five portions of fruit and vegetables (from a variety of sources) per day and two portions of oily fish per week.
Reduce intake of saturated fats.
Keep salt intake low — salt should not be added at the table, and processed foods should be kept to a minimum.

135
Q

What is the treatment goal of statin therapy

A

Reduce low density lipids by 40% within 3 months

136
Q 
List the common side effects of:
ACE inhibitors (+ARBs)
CCBs
Diuretics
Beta Blockers 
Amioderone
A

ACE inhibitors: Hypotension, Hyperkalaemia, renal failure, rash, cough (ARBs similar)
CCB: Oedema, flushing, palpitations, headache, (verapamil - bradycardia, worsening HF)
Diuretics: 3 E’s - erection, electrolytes, empty
Beta blockers: headaches, cool peripheries, nightmares. difficulties sleeping, palpitations
Amioderone: Thyroid - hyper, photosensitvity, grey coloured skin, abnormal LFTs, pneumonitis, optic neuropathy

137
Q

what duration is long QT

A

Females 470

Males 450

138
Q

What are the categories of assessment in NICE traffic light table for fever under 5s

A

Colour. Pallor - blue, mottled.
Activity. Reduced activity, difficult to rouse - unrousable
Breathing. Tachypnic, flaring, reduced o2, crackles - grunting, recessions, RR >60
Circulation. tachy, CRT, dry mucous membranes, reduced urine, poor feeding - reduced skin turgor
Other. Any meningococcal signs, kawasaki signs, signs of shock, focal neurology. Bulging fontanelle, rash.

139
Q

What are the features in the FeverPAIN score

And Centor criteria

A 
Fever >38 during previous 24 hours
Purulent tonsils
Attend rapidly (within 3 days of symptoms)
Inflammed tonsils (severly)
No cough/ coryza 
4-5 likely strep
Centor
Fever >38
Tender lymphadenopathy 
Exudate
No cough 
4/4 - likely to be strep
140
Q

List some of the paediatric notifiable disease

A 
Diphtheria
Mumps
Polio
Acute encephalitis and meningitis
Meningococcal septicaemia
Scarlet fever
Rubella
Measles
Pertussis (whooping cough)
Tetanus
141
Q

Who should you report notifiable diseases to

A

Local Council - local health protection team who then pass onto PHE

142
Q

What investigations should be done in GP for any child <5 scoring amber

A

Urinalysis - clean catch dipstick (except <3 months)
Do not prescribe antibiotics without a source.
Throat infection - consider Rapid GAS antigen test and throat swab and abx
If suspect pneumonia - need to either refer to paediatrics (if red flags) or if amber or green treat with abx as viral and bacterial cant be dissociated. Treat with amoxicillin, second line co-amoxiclav, or macrolide erythromycin, clarithromycin, azithromycin.

143
Q

When should you admin a child with suspected pneumonia to hospital

A

Falling O2 sats <92%

Signs of respiratory distress

144
Q

When would you admit a child with suspected bronchiolitis

A

Inadequate feeding
Respiratory distress
Hypoxia

145
Q

How do you test for chlamydia in males and females

A

Females - vulvovaginal swab - NAAT

Males - first void urine - NAAT

146
Q

How do you test for gonorrhea in males and females

A

Females - vulvovaginal or endocervical swab - NAAT

Males - urethral swab - NAAT

147
Q

List the most common types of contraception from most effective to least effective

A 
1. Hormonal Intra-uterine/ surgery/ IUD
Mirena coil 99.9, Vasectomy 99.9, IUD, 99.2
2.Hormonal surgical methods 
Depot/ implant - 97
3.Hormonal - oral 
COCP, POP - 92, COCP better than POP
4.Barrier / natural methods 
Condoms 85, Femidoms 80, caps 70-80, Natural 75.
148
Q

What is the mechanism of action for the common methods of contraception

A

IUS - prevents implantation (may inhibit ovulation for some)
IUD - prevent implantation and sperm entering uterus
Depot and implant - prevent implantation, may inhibit ovulation for some
COCP - inhibits ovulation and prevents implantation
POP - inhibits implantation (inhibits ovulation for some)
Condoms etc - barrier
Natural - timing of cycle

149
Q

What is the advice to give on missed pills

A

CoC - if 2 (20 mcg) or 3 (35 mcg) plus missed in 7 days and UPSI - emergency contraceptive
PoP - if >3 hrs or >12 hrs (cerezette) missed - take pill asap and continue, barrier methods for 2 days. If UPSI already taken place - emergency contraception.
Depot - if 12 week depot and it is 12 weeks and 5 days and UPSI - emergency contraception

150
Q

What are the absolute contraindications to the use of the COCP

A

Migraine with aura
Migraine without aura + CVD risk factors (eg HTN, smoking)
Status migrainosis

151
Q

What are the contraindication to the COCP

A

VTE risk >1, eg smoking, BMI >30, >35 years, past VTE
Arterial risk, same as VTE, plus valve or heart disease, DN
Liver disease
Cancer - breast, active or past
Enzyme inhibiting drugs - eg antibiotics
Pregnancy - cholestasis

152
Q

What are the contraindication to the PoP

A 
New migraine symptoms whilst on POP or new focal neurology
Breast cancer 
Undiagnosed vaginal bleeding 
Trophoblastic disease
SLE 
Liver disease
Enzyme inhibitors
153
Q

What are the associated risks of the COCP

A

Increased stroke risk
Increased breast and cervical Ca risk
Increased VTE risk
Mood changes - risk of depression

154
Q

What cancers is the COCP protective against

A

Endometrial, ovarian, bowel

155
Q

List some of the common side effects of the COCP

A

Oestrogen - nausea, breast tenderness, weight gain, bloating, vaginal discharge
Progesterone - mood swings, decreased libido
Breakthrough bleeding

156
Q

List some of the common side effects of the POP

A

Menstrual irregularities
Higher failure rate than COCP
Higher risk of ectopic than COCP
Depression, acne, reduced libido

157
Q

What are some of the contraindications to the depot

A

Osteoperosis RFs

NB, lowest risk of ectopic, also takes a while for menstrual regularity - 10 months

158
Q

What are some of the contraindications to the implant

A

High BMI

159
Q

What are the contraindications to the mirena coil

A

Emergency contraception
Hx of ectopic pregnancies
Undiagnosed vaginal bleeding/ pelvic pain

160
Q

What are some of the risk factors for teenage pregnancy

A 
Deprivation 
Poverty 
Low education 
Mental health problems
Homeless
Involved with crime
161
Q

What are some of the public health implications of teenage pregnancy

A

Low birth weight babies
Increased mortality
Reduced breastfeeding
More likely for child to be victim of an accident
Children likely to live in poverty
Children likely to lack housing and health problems associates
Child likely to have mental health problems

162
Q

What initiatives may help with reducing teenage pregnancy

A

Sex and relationship education

Engaging with parents on sex and relationship education

163
Q

What is gillick competency - CAPACITY

A 
It is a principle used to determine a child's capacity to consent. If the child is deemed to be gillick competent they can make healthcare decisions independent to their parents. Its a term used in medical law. 
PRN/SA 
Must show that they understand the:
Purpose of the treatment
The nature of the treatment 
The risks and benefits
The success of the treatment 
Availability of other options.
164
Q

What are the rules around sexual activity under the age of 13

A

Those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be acted on, regardless of the results of the Gillick test.

165
Q

When does a child have the right to make decisions about their own healthcare

A

<16 years - if deemed gillick competent. No lower age but if involves sexual activity, <13 child cannot consent and cannot use gillick.
16 years - in medical law
18 years - same rights as adult

166
Q

What are fraser guidelines - CONSENT TO CONTRACEPTIVE TREATMENT

A

Guidelines used to determine if a child can consent to contraception advice and treatment under the age of 16 years
UPSSI: Must:
Understand the nature of the treatment
Cannot Persuade to tell parents
will continue having or start having Sex regardless
their mental or physical health will Suffer
it is deemed to be overall in their best Interests

167
Q

What tool is used in general practice to screen for dementia, what does it test

A

Six item cognitive test
Screens orientation, STM, recall, attention, language
0-7 normal, 8-9 consider referral, 10+ significant cognitive impairment

168
Q

What score on a MOCA is normal

A

26 and above

169
Q

List some of the causes to investigate in someone with memory problems

A 
Anaemia (B12, folate deficiencies) 
Hypothyroid
Head trauma
Psychological - stress
SOL 
Menopause 
Alcohol B1 deficiency
170
Q

What medications can be used for alzheimers

A

Acetylcholinesterase inhibitors: Rivastigmine, Donepezil

NMDA antagonists: Memantine

171
Q

What is the prognosis of alzheimers

A

7 years

172
Q

What are the features of fronto-temporal dementia

A
  • Executive impairment
  • Behavioural / Personality change
  • Disinhibition (Lack of restraint)
  • Hyperorality (Insertion of inappropriate objectis in mouth)
  • Stereotyped behaviour
  • Emotional unconcern
  • Preserved episodic memory and spatial orientation until later stages
173
Q

What is the presentation of alzheimers disease

A
  • Insidious onset
  • Persistent, progressive and global cognitive impairment
  • Amnesia
  • Anosognosia (Lack of insight into the problems)
  • Impairment in learning and recall of recently learned information
174
Q

What are the features of vascular dementia

A 
•	Sudden onset
•	Stepwise deterioration 
•	Evidence of arteriopathy; eg:
o	Raised BP 
o	Previous strokes
175
Q

What are the features of lewy body dementia

A
  • Fluctuating cognitive impairment
  • Detailed visual hallucinations
  • Parkinsonism
  • REM sleep behaviour disorder
176
Q

What types of services and types of community care exist for dementia suffers and their families

A

Social worker - either via social services or old age community mental health. Support with finances and access to funding/ local support schemes.
Dementia nurses
Occupational therapist
Physiotherapy
Dietitians
Third sector support - eg Alzheimers society, age UK. Day activities, exercise, music, quizzes.

177
Q

What is meant by mental capacity

A

Capacity is the ability to use and understand information to make and communicate a decision

178
Q

What is the mental capacity act

A

The legal framework that allows healthcare professionals to treat a patient who lack capacity to consent.

179
Q

What criteria need to be met to have capacity

A

1) Does the patient have a disease of brain or mind that affects capacity?
2)Do they understand information about the decision
Can they retain the information
Can they weight up the consequences of the decision
Can they communicate the decision
If no to any of the four criteria dont have capacity.

180
Q

What is DOLs

A

Deprivation of Liberty safeguards
Use it when patient lacks capacity and there is potential deprivation of liberty. Assess this by considering:
1) Are they free to leave
2)Are they subject to continuous monitoring observation
3)Do they have capacity to consent to their care
4)Is the person confined to a restricted place for a non-negotiable period of time.
If so, need to apply for a DOLs

181
Q

What is a mental capacity advocate

A

Somebody who is instructed to represent the patient who is independent.

182
Q

Explain the concept of need, demand and supply

A

Need - ability to benefit from an intervention
Demand – what people ask for
Supply – what is provided

183
Q

What are the different definitions of Need

A 
Sociological definitions:
Felt need
Expressed need
Normative need
Comparative need
184
Q

What are the different public health approaches to need

A

Epidemiological
Comparative
Corporate

185
Q

Explain the epidemiological approach to health needs assessment, and some limitations

A

Assesses need based on:
Incidence and prevalence data
Services available and services provided
Evidence base
Quality of services
Limitations: depends on data and statistics that may not be available, or quality is mixed
Does not include felt need of those affected

186
Q

Explain the comparative approach to health needs assessment, and limitations

A

Compares services received by two populations
Can compare health outcomes, utilisation of a service, provision, health status
Limitations: Relies on data that may not be available
Does not tell you about level that a service or intervention may need to be aimed at, as it only compares two given populations

187
Q

Explain the corporate approach to health needs assessment, give some limitations

A

Stakeholder approach
Involves patients, experts, politicians, commissioners. providers
Limitations: may be difficult to distinguish between need and demand
Groups may have vested interests
May be influenced by political agendas

188
Q

Give some examples of health interventions that can be categorised into need, demand, supply

A

vaccinations
contraception
IVF
screening programmes

189
Q

What is a health needs assessment

A

It is a systematic method to review the health issues facing a population with the view to identify priorities and funding allocation that will improve health and inequalities.

190
Q

What is the health belief model,

gives some pros and cons

A

SCAB
Believe they are susceptible
Believe there are serious consequences
Believe that action can reduce their susceptibility
Believe that the benefits of taking action outweight the risks
Lims: Does not consider emotional impacts on behaviour
Does not explain relapse
Does not consider past habits or behaviour
Cant move backwards in model

191
Q

What is the Theory of planned behaviour,

give some limitations

A

3 factors influence intention which influences behaviour
Attitude - what do I think I should do
Subjective norms - what do others think i should do
Perceived behavioural control - i think i can do this
Intent - I intend to do this
Limitations: doesnt explain gap between intention and behaviour
Does not consider emotions
Cant move backwards through model

192
Q

What is the transtheoretical model,

give some limitations

A

Precontemplation - not going to give up
Contemplation - considering it
Preparation - getting ready for it
Action - doing it
Maintenance - keeping at it
Lims: doesnt explain how some people skip steps
Doesnt consider past habits, cultural beliefs or values

193
Q

What is nudge theory

A

When the environment makes the best option easiest, eg healthy food at a checkout

194
Q

What is motivation interviewing

A

Counselling approach to initiating behaviour change through addressing ambivalence

195
Q

What are social norms, how does this theory explain health behaviours

A

Individual behaviour is best predicted by their perception of group norms. (what attitudes and behaviours of the group are most common)
Usually there is a discrepancy between perceived norm and the actual norm.

196
Q

What are some of the current limitation in models of behaviour change

A 
Dont consider personality traits 
Dont consider past behaviour and habits 
Often fail to explain relapse 
Autonomic influences on behaviour
What predicts maintenance of a behaviour
197
Q

How can financial incentives be used to influence health behaviour

A

Food vouchers for breast feeding

198
Q

What are cues to action

A

Can be internal or external
External - brief advice from a GP
Internal - i dont like how smoking is making me feel anymore

199
Q

Define malnutrition

A 
Refers to a persons excess, deficiencies or imbalances in energy intake and or nutrients. 
Includes malnurishment (underweight) and being overweight.
200
Q

What are clinical features of being undernourished

A

Short (stunting), wasting, underweight

201
Q

List some of the early influences on feeding behaviour

A

Maternal diet and taste preference development
Role of breastfeeding for taste preference and bodyweight regulation
Parenting practices
Age of introduction of solid food, types of food exposed to during the weaning period

202
Q

List some of the early influences on feeding behaviour

A

Maternal diet and taste preference development - flavour exposure. Amniotic fluid is influenced by mothers diet.
Role of breastfeeding for taste preference and bodyweight regulation
Parenting practices - long meal times, lack of variety, authoritarian style, associating enjoyment/ reward with eating, relaxed vs stressful
Age of introduction of solid food, types of food exposed to during the weaning period

203
Q

What is the composition of clostrum

A

Low fat

High protein

204
Q

When are the most sensitive years for developing flavour and food preferences

A

First 2 years

Taste preferences developed in this time can last 10 years

205
Q

What are the advantages of breast feeding on the development of eatings behaviours

A

Exposure to maternal flavour, variety of taste preferences.

206
Q

What features of parental feeding practices can foster healthy infant feeding behaviours

A

Enjoyable meal times, food is used as incentive and reward
Short meal time
Relaxed style - not authoritarian

207
Q

What is an eating disorder vs disordered eating

A

Eating disorder is persistent behavioural and thought patterns associated with food that causes distress, disability and significant physical harms.
Disordered eating is inconsistent and unpredictable eating patterns that do not cause significant distress or harm.

208
Q

What are some of the problems associated with dieting

A

Risk factor for the development of eating disorders (bulimia, anorexia)
Dieting results in a loss of lean body mass, not just fat mass
Dieting slows metabolic rate and energy expenditure Chronic dieting may disrupt ‘normal’ appetite responses and increase subjective sensations of hunger

209
Q

What are some of the physiological responses to dieting

A 
Long-term weight loss is challenging – interventions typically demonstrate weight loss, plateau then weight regain 
Weight cycling (from repeated diet-relapse) often leads to ‘overshoot’ and may accelerate weight gain
Non-obese dieters are at increased risk of fat overshooting compared to obese dieters
210
Q

Why is dieting so difficult for some people

A

unresponsive to internal cues that signal satiety (when overconsuming) and hunger (when dieting)
vulnerable to external cues that signal availability of palatable food

211
Q

What makes a successful dieter

A

Being flexible and not rigid

212
Q

What is restraint theory

A

Theory that explains how dieters may become unresponsive to internal cues and be prone to overeating.

  1. People have an internal cue for hunger and satiety - these regulate eating and over eating.
  2. Restrained dieters consciously lower their minimum hunger response in order to reduce consumption. This creates greater disparity between hunger and satiety. Combined with a cognitive diet boundary of what is acceptable for them to eat, this can lead to overconsumption when the cognitive boundary is passed.
  3. This is called dis inhibition - can be triggered by large meals/ portion sizes, stress, emotions, alcohol.
213
Q

What is goal conflict theory

A

Explains unsuccessful dieting through the incompatibility of two goals. Weight loss and enjoyment of food. The dieter is motivated to lose weight but also to enjoy food. In the context of overwhelming environmental cues this inhibits the motivation to lose weight and leads to over consumption.

214
Q

What are restrained eaters prone to which makes dieting unsuccesful

A

Disinibition

215
Q

What types of environmental food cues have been linked to over eating

A

Portion sizes

Highly satiating foods

216
Q

What types of environmental food cues have been linked to over eating

A

Portion sizes
Highly satiating foods
Availability of food

217
Q

When do confidence intervals tell you if results are significant

A

If CI does not cross the 1 odds or risk ratio line

Results that cross the line are not significant

218
Q

What are some of the reasons for lack of causation in association

A

Bias
Chance
Confounders

219
Q

What is bias, give an example

A

Systematic error in the method or design of an experiment that could impact the results
Eg selection bias, information bias

220
Q

What is a confounder, give an example

A

An unstudied factor/ variable that influences the relationship of the studied IV and DV.

221
Q

What is the prevention paradox

A

It is a preventative measure that brings about benefit to the overall population but little benefit to the participating individuals.

222
Q

Give an example of the prevention paradox

A

Statins
NNT
40 to treat to save 1 life

223
Q

What is the difference between association and causation

A

Association - a RF and outcome are linked

Causation - exposure to RF lead to x outcome

224
Q

How can causation be identified

A

RCT
Cohort studies- sometimes
Always need a control group

225
Q

What is relative risk

What is absolute risk

A

Relative risk is the risk (percentage) of a health event (disease etc) relative to another (control group)
Absolute risk is the risk (percentage change) of a health event in comparison to everyone who could have had it (population).

226
Q

What does a 0,75 risk reduction mean

A

It means there is a 25% reduction in the chance of getting x health outcome in comparison to the control group.

227
Q

What is the difference between a population targeted prevention measure vs a high risk targeted prevention measure

A

Population targeted aims to reduce disease burden by improving the health of everyone in the population - the whole risk factor curve shifts.
high risk approach seeks to identify individuals above a chosen cut-off and treat them

228
Q

What are the different types of experimental design in epidemiology

A

Observational:
Cohort (direction of enquiry always forward)
Case control (direction of enquiry is backwards)
Cross-sectional (two groups, one time point, no control)

229
Q

What does evaluation of a health service mean

A

Evaluation is the assessment of whether a service achieves its objectives

230
Q

Describe a basic framework for evaluation of health services

based on structure, process and outcome

A

Structure - evaluate what is there
Process- evaluate what is done
Outcome - health outcomes. 5 D’s

231
Q

Provide a classification of health outcome measures

A

5 Ds

Disease, dissatisfaction, death, disability, discomfort

232
Q

Outline quantitative and qualitative methods for evaluation

A

Qualitative - focus groups, observation, interviews, questionnaires
Quantitative - mortality and morbidity statistics, number of serious incidents, rating scale based questionnaires, surveys, routinely collected data

233
Q

Provide a basic approach for evaluation appropriate to the health service being evaluated

A

Define what the service is (What it includes)
What are the aims / objectives of the service? Are they stated and are they appropriate?
Framework: Structure, Process, Outcome +/-Dimensions of quality
Methodology to be used - qualitative / quantitative / mixed methods
Results, Conclusions and Recommendations

234
Q

Donabedian’s “structure, process, outcome” is a useful
framework to use when carrying out evaluation of health
services. Explain what is meant by “structure”

A

Structure - what is there. Buildings, people who are employed.
Process - what is done. How many patients seen etc.
Outcome - health outcomes. 5 Ds - disability, disease, death, dissatisfaction, discomfort

235
Q

When assessing the quality of health services, Maxwell’s classification lists six dimensions. List the six dimensions.

A

3 E’s and 3 A’s
Effective - does what it is intended to do
Efficient - maximum output for input
Equity - is it fair
Accessible - cost, where is it available, waiting times
Acceptable - how acceptable it is
Appropriate - underuse, misuse, overuse

236
Q

Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations.
Explain why it may be difficult to attribute a health outcome to the service provided.

A

Difficult to attribute cause and effect between a service and health outcome.
May be time lag for the performance of service to be realised.
Issues with data quality - incomplete
Lack of data sources
Large data sets required

237
Q

Provide a classification for the determinants of health

A

Genes, environment, lifestyle, health care

238
Q

What is horizontal equity

What is vertical equity

A

Equal treatment for equal need, eg everyone with pneumonia should have same treatment
Unequal treatment for unequal need, eg treatment of cold should be less than pneumonia

239
Q

Give some examples of different forms of health equity

A

Equal spending for equal need
Equal access for equal need
Equal utilisation for equal need
Equal health care outcomes for equal need

240
Q

Describe the three domains of Public Health practice

A

Health Promotion
Health protection
Improving services

241
Q

Describe interventions that improve public health

A

Individual targeted - statins, behaviour change
Community targeted - screening, social prescribing
Population targeted - minimum unit pricing, sugar tax

242
Q

What approach should be taken to assessing health inequalities

A

Identify inequality - i.e. who is getting less than who

Then assess if its equitable - is it fair. Inequalities need to be fair. Equality and equity not always equal.

243
Q

How is equity usually defined in healthcare systems

A

Equal access for equal need

But measurement is usually about utilisation, health status or supply

244
Q

What are the three domains of public health, list some examples for each domain

A

Health promotion - prevent disease, promote health, reduce inequalities
Inequalities, education, housing, employment, lifestyle, family/ community
Health protection - control spread of disease/ hazards
Emergency response, Infectious diseases
Improving services - quality, safe, treatment
Audit, evaluation, clinical governance, service planning, effectiveness, efficiency

245
Q

Explain the difference between secondary and tertiary

prevention.

A

Secondary prevention aims to identify the early stage of a disease and stop it progressing. Tertiary prevention aims to treat the symptoms of an established disease.

246
Q

Explain the difference between horizontal and vertical equity in relation to health care.

A

Horizontal equity related to equal access for equal need, eg all with pneumonia should have equal access to health care. Verticle equity related to unequal access for unequal need.

247
Q

Explain the difference between public health interventions delivered at the population (ecological) and individual levels, using one example for each to illustrate your answer.

A

Individual - behaviour change interventions, eg smoking cessation, statin prescribing
Community - screening programmes, health promotion - eg diabetes educational programmes, social prescribing
Population - smoking ban outdoors, minimum unit pricing, ban on tobacco advertising, vaccinations

248
Q

What levels can public health interventions be made

A

Individual
Community
Population

249
Q

What are the 3 main health behaviours

A

Health behaviours
Illness behaviours
Sick role behaviour

250
Q

What are the 3 main health behaviours

A

Health behaviour: behaviour aimed at preventing disease - eating healthily
Illness behaviours - behaviour aimed to seek remedy - going to the doctor
Sick role behaviour - any behaviour aimed at getting better - taking prescribed medicines

251
Q

List some health damaging behaviours

A

Smoking, alcohol & substance abuse, risky sexual behaviour, sun exposure, driving without a seatbelt

252
Q

List some health promoting behaviours

A

Healthy eating, exercise, attending health checks, medication compliance, vaccinations

253
Q

Explain some of the reasons people engage in health damaging behaviours

A 
Unrealistic optimisim 
This is shaped by:
Health beliefs
Situational rationality 
Cultural reasons
Socioeconomic reasons
Stress
Age
254
Q

What is essential in order to start behaviour change with a patient

A

Establishing the patients perception of their risk

255
Q

What are perceptions of risk influenced by

A
  1. Lack of personal experience with problem
  2. Belief that preventable by personal action
  3. Belief that if not happened by now, its not likely to
  4. Belief that problem infrequent
256
Q

What can doctors do to support behaviour change

A 
Work with your patient’s priorities
Aim for easy changes over time
Set and record goals
Plan explicit coping strategies
Review progress regularly (this really matters)
257
Q

Why is behaviour change important in medicine

A

Important from both an individual and population perspective
Overwhelming evidence that changing people’s health behaviour can have an impact on some of the largest causes of mortality and morbidity
Interventions to change behaviour may offer a relatively simple solution to reducing disease

258
Q

Describe the differential diagnosis of an adult presenting with cough

A 
1.Airway disease:
Asthma 
COPD/ bronchiecstasis 
2.Tumour 
3.Infection - pneumonia, viral, TB
4.Other: GORD, post nasal drip
259
Q

What are the differential diagnosis of cough in children

A
  1. Airways: Asthma / VIW,
  2. Infection: Viral - bronchiecstasis, VIW, croup, Bacterial - pneumonia, whooping cough
  3. Bronchiecstasis (recurrent bronchitis)
  4. Non-respiratory: CF, CHD, Immunocompromised, enzyme deficiencies
260
Q

What are the differential diagnosis of cough in children

A
  1. Airways: Asthma / VIW,
  2. Infection: Viral - bronchiecstasis, VIW, croup, Bacterial - pneumonia, whooping cough
  3. Vaccine pathogens - Haemophilus Influenzae, whooping cough
  4. Bronchiecstasis (recurrent bronchitis)
  5. Foreign body
  6. Non-respiratory: CF, CHD, Immunocompromised, enzyme deficiencies
261
Q

What is the management of COPD

A

1st line: stop smoking and exercise/ physio.
This aims to prevent decline from COPD, eg breathlessness, muscle wasting, immobility, depression etc.
2nd line: Only after 1st line optimised: pharmacological therapy
-Bronchodilators: SABA, LABA, anticholinergics, alone or combination therapy
+ / - oxygen therapy
-Inhaled steroids: add on or combination - must be considered at risk of pneumonia (not a desired management)
-Oral steroids if very unwell
-Antibiotics if signs of infection
-NIV - if all of above is not workin

262
Q

What is the management of COPD

A

1st line: stop smoking and exercise/ physio.
This aims to prevent decline from COPD, eg breathlessness, muscle wasting, immobility, depression etc.
2nd line: Only after 1st line optimised: pharmacological therapy
-Bronchodilators: SABA, LABA, anticholinergics, alone or combination therapy
+ / - oxygen therapy
-Inhaled steroids: add on or combination - must be considered at risk of pneumonia (not a desired management)
-Oral steroids if very unwell
-Antibiotics if signs of infection
-NIV - if all of above is not working

263
Q

When should you consider admitting a patient with COPD to hospital

A 
	Marked increase in intensity of symptoms
	Severe underlying COPD
	Onset of new physical signs 
	Failure of an exacerbation to respond to initial medical management
	Presence of serious comorbidities
	Frequent exacerbations
	Older age
	Insufficient home support
264
Q

What are the risk factors for COPD

A

Smoking

Occupational exposure - dust exposure, coal mining, crop sraying

265
Q

What is COPD
How is it different to asthma
Why are steroids not first line treatment

A

Irreversible airway obstruction (damage) + parenchymal lung damage
The inflammatory response for COPD is CD8 medicated, asthma is CD4. CD4 is pro-inflammatory and may be dampened by steroids, CD8 is more damage pathway that is not steroid mediated.
Asthma is reversible airway obstruction.

266
Q

What investigations are diagnostic for COPD

A

Spirometry

267
Q

Describe the risk factors for TB

A 
HIV
Diabetes
Immunocompromised
Chronic disease
Substance misuse
Malnutrition 
Contact 
Geography - living in TB endemic area
268
Q

How would you consider protecting your practice population from contracting TB?

A

Administrative/ managerial controls: have policy in place to detect, act, refer, follow pts with suspected TB
Enviromental controls: opening windows, good ventilation
Personal respiratory protection: use in combination with above in high risk settings, eg isolation room, sputum collection, bronoscopy

269
Q

How would you consider protecting your practice population from contracting TB?

A

Administrative/ managerial controls: have policy in place to detect, act, refer, follow pts with suspected TB
Enviromental controls: opening windows, good ventilation
Personal respiratory protection: use in combination with above in high risk settings, eg isolation room, sputum collection, broncoscopy

270
Q

What health issues may need to be considered in patients newly arrived in the UK?

A 
Immunisations
Illness Specific to Country of Origin
Injuries from war and travelling
No previous health surveillance / Immunisations
Malnutrition
Torture and Sexual Abuse 
Infectious disease
Untreated Chronic Disease / Congenital Problems
271
Q

What is the definition of a refugee

A

A person granted asylum and refugee status. Usually means leave to remain for 5 years then reapply.

272
Q

What is the definition of indefinite leave to remain

A

When a person is granted full refugee status and Given permanent residence in the UK

273
Q

What are asylum seekers entitled to

A

Are entitled to money- currently £35 pounds per week
Are entitled to housing- no choice dispersal
Are entitled to free NHS care
If under 18, have the services of a social services key worker and can go to school
Are NOT allowed to work and are not entitled to any other form of benefit.

274
Q

What are failed asylum seekers entitled to

A

Are NOT entitled to any money
Are NOT housed
Are NOT entitled to full NHS care (only emergency care)
Reliant on charities

275
Q

What are some of the barriers for asylum seekers to access health care

A 
Lack of knowledge of where to get help
Lack of understanding how NHS works
Language / Culture / Communication
Frequent dispersal by Home office
Not homogenous group
276
Q

What mental health problems might someone newly arriving to the UK have

A 
PTSD 
Depression: Medication/Counselling
Sleep Disturbance
Psychosis
Self Harm
Presenting as physical symptoms
277
Q

What might the social circumstances be of someone who has recently arrived in the UK

A 
Separation from family
Hostility
Racism
Poverty
Poor housing
Unemployment
Detention
278
Q

What is important when working with victims of torture

A 
Time
Empathy
Good Communication -with interpreters
Continuity
Trust
Practical Support
279
Q

What is the definition of FGM

A

All procedures involving partial or total removal of female external genitalia or other injury to the female organs for non-medical reasons. It involves damaging and removing normal, healthy female genital tissue, and hence interferes with the natural function of girls’ and women’s bodies…”

280
Q

What are some of the reasons for FGM

A

It will bring status and respect
Preserves a girl’s chastity/ virginity
Part of being a woman
It’s a rite of passage
Upholds family honour
Cleanses and purifies the girl
Fulfils a perceived religious requirement
Gives the girl and her family a sense of belonging to the community
It gives a girl social acceptance, especially for marriage

281
Q

What is the inverse care law

A

The inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served.

282
Q

Why might socially excluded groups find it difficult to access care ?

A

Difficulties with access to health care
due to opening times, appointment procedures location and perceived or actual discrimination.
Lack of integration between mainstream primary care services and other agencies housing, social services , criminal justice system and voluntary sector.
Other things on their mind
People do not prioritise their health when there are more immediate survival issues.
May not know where to find help.

283
Q

What are the levels for maslows hierarchy of needs

A 
Physiological 
Safety 
Love 
Self-esteem 
Self-actualisation (lack of prejudice)
284
Q

List some of the causes of homelessness

A 
Relationship Breakdown
Domestic abuse
Disputes with parents
Poverty
Housing supply and affordability
Unemployment or insecure employment
285
Q

List some of the health problems faced by homeless adults

A 
78%  have a physical health condition
Serious mental illnesses – schizophrenia as well as depression and personality disorders
Addictions/substance misuse
Infectious diseases including TB and hepatitis.
Injuries following violence, rape
Sexual health, smears, contraception
Poor condition of feet and teeth
Poor nutrition
286
Q

List some of the health conditions of travellers

A

Gypsy/Traveller children are 1.5-2 x more likely to die in their 1st year of life.
3 x more anxiety problems reported by women.
Miscarriage rates 2.5 x higher
4 x more Chronic Bronchitis
2.5 x more Asthma
3 x more smoking
3 x more suspected angina

287
Q

What are some of the barriers for travellers seeking heathcare

A

Reluctance of GPs to register Gypsies and Travellers, and to visit sites.
Poor reading and writing skills. Many are illiterate.
Communication difficulties
Frequent movement/transient sites
Mistrust of professionals

288
Q

What are some of the health problems for LGBT

A

Depression
Suicide and self harm
Drugs and addiction problems
Sexually transmitted infections

289
Q

What are some of the barriers for LGBT accessing healthcare

A

Stigma/prejudice
Discomfort/fear of disclosing LGBTQ status due to real or perceived Homophobia
Previous negative experiences

290
Q

What is the definition of transgender

A

Someone whose gender identity differs from their birth sex.

291
Q

define gender identity
sex characteristics
sex orientation

A

Gender identity is the experienced sense of ones own gender.
Sex characteristics are the internal and external sex characteristics associated with being male or female you were both with. Some people have both.
Sex orientation is to do with who you are attracted to.

292
Q

What is the definition of transgender

How is this different from transexual

A

Someone whose gender identity differs from their birth sex.
transsexual is someone who identifies with the opposite sex, and usually refers to someone who would be willing, or who has gone through a sex change.

293
Q

What are some of the social and psychological risk factors for problem drinking

A

Drinking within the family
Childhood problem behaviour relating to impulse control
Early use of alcohol nicotine and drugs
Poor coping responses to life events
Depression as a cause not a result of problem drinking

294
Q

What are the most common causes of death from alcohol

A

Accidents and violence
Malignancies
Cerebrovascular disease
Coronary heart disease

295
Q

List some of the common eye conditions leading to sight loss

A 
Cataracts 
Age-related Macular Degeneration (AMD)
Glaucoma
Retinitis Pigmentosa
Hemianopia
Diabetic Retinopathy
296
Q

What benefits are there some someone registered as visually impaired

A 
Disability Living Allowance (DLA) or Personal Independence Payment (PIP) – a tax-free benefit to help with any costs relating to your disability or illness
a reduction in the TV licence fee
a tax allowance
reduced fees on public transport
parking concessions
297
Q

What ways can somebody who is visually impaired be accommodated in GP communications

A

Large font
Braille
Voice activated email
Phone calls

Phase 3a (9 decks)

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