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Yr 4 General Practice > GP Student Handbook General Concepts > Flashcards

GP Student Handbook General Concepts Flashcards

1
Q

Average GP list size

A

5900

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2
Q

Ethos of GP

5 C’s

A 
Continuity of care
Comprehensive care
Complexity
Coordination of care
Context of health and illness (taking the patient-centred approach)
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3
Q

___ consult their GP at least once of year

A

3/4 consult their GP at least once of year

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4
Q

What is the illness iceberg?

A

Concept observed that the majority of symptoms experienced by the population are never presented to a doctor

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5
Q

What is illness behaviour?

A

The manner in which people differentially perceive, evaluate and respond to symptoms

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6
Q

Name the classic 5 triggers to consulting

A

Interpersonal crisis
Perceived interference with work activities
Perceived interference with social/leisure activities
Sanctioning by others who insist help be sought (lay referral)
Symptoms persist beyond arbitrary time limit set by individual

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7
Q

Example of primary, secondary and tertiary prevention intervention as part of health promotion

A

Primary: Immunisation, screening
Secondary: BP monitoring, glucose monitoring in diabetics
Tertiary: Minimising ill health and disability in existing illness e.g. orthopaedic interventions in RA

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8
Q

Negatives of screening

A

False positives
Anxiety
Prompting unnecessary treatments

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9
Q

Set up of cervical screening programme

A

Women aged 25-64 are eligible
25 to 49 every 3 years
50 to 64 every 5 years

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10
Q

What is the new name for Guthrie test?

A

Newborn Blood Spot (NBS)

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11
Q

Process of NBS?

A

Small amount of blood taken using heel prick at 5 days old
Done by community midwife at house
To detect: Congenital conditions e.g. CF, congenital hypothyroidism, sickle cell disease or inherited metabolic diseases

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12
Q

What specific activities are done as part of the Child Health Programme in child health surveillance?

A

The 6 week check- screen for medical problems (e.g. congenital cataracts, heath murmurs, congenital hip dislocation and testicular abnormalities) *3 Hs: Hearing, hips and heart
Measurement of height and weight (detects and prevents failure-to-thrive and obesity)
Assessment of motor skills and speech (minimises impact of developmental delay)
Immunisation
Screening of vision and hearing

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13
Q

Features of ante-natal care

A

Regularly measuring development of foetus to detect intra-uterine growth retardation
Monitor mother for pre-eclampsia
Screening for chromosomal abnormalities and neural tube defects
Primary prevention via immunisation of pregnantt women against influenza

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14
Q

What two models are used to understand lifestyle and risk?

A

The locus of control

The health belief model

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15
Q

What is the Locus of Control model?

A

Degree to which people believe they have control over their own lives
Internal locus: When people believe they can control their own destinies
External locus: Belief of having little control over fate, instead it is controlled by external influences

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16
Q

What is the Health Belief Model (HBM)?

A

Explains and predicts health-related behaviour using 6 main factors

  1. Perceived susceptibility
  2. Perceived severity
  3. Perceived benefits
  4. Perceived barriers
  5. Cues to action
  6. Self-efficacy
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17
Q

What are the 4 components of self susceptibility in the HBM?

A
  1. Self evident personal differences between individuals
  2. Social environment
  3. Physical environment
  4. Luck
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18
Q

Give strategies of motivational interviewing

A

Avoid advice giving
Avoid medical labelling
Invite patient to define the problem
Invite pt to describe pros and cons of problem
Empathise with difficulty to change
Invite patient to revisit to discuss progress
Invite pt to view decision as his or hers to make

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19
Q

What are the stages of the transtheoretical model of behaviour change?

A 
Precontemplation
Contemplation
Action
Maintenance
Relapse
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20
Q

What consultation model is the basis for own marking guide?

A

the 1996 Kurtz and Silverman

The Calgary-Cambridge Observation Guide to Consultation

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21
Q

Name 5 defining aspect of the GP consultation?

A 
The golden minute
The patients agenda (ICE)
Shared understanding
Safety netting 
Housekeeping
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22
Q

What does “housekeeping” mean in the gp consult context?

A

Looking after yourself between patients to ensure you are fit to consult

23
Q

Name 3 theoretical models of diagnosis?

A

The inductive method
The hypothetico-deductive model
Heneghan et al

24
Q

What is the inductive method of diagnosis?

A

This model refers to a linear, sequential process whereby a diagnosis is made following the systematic and indiscriminate gathering of standard information (presenting complaint, symptomatic inquiry, past medical history, family history, drug history, complete physical examination and appropriate investigations).

25
Q

What is the hypothetico-deductive model of diagnosis?

A

This model involves gathering information from a patient, formulating a hypothesis and then gathering further selected information which can help to prove or refute that hypothesis. Compared to the inductive model which is linear, it introduces the idea of circularity or FEEDBACK.

26
Q

What are the three stages of the Heneghan et al model of diagnosis?

A

Stages:

  1. Initiation of the diagnosis
  2. Refinement
  3. Defining the final diagnosis
27
Q

Stage 1 (Initiation of the diagnosis) of the Heneghan et al model of diagnosis, name 4 strategies that are involved?

A
  1. Spot diagnosis (a type of pattern recognition) = the unconscious recognition of a non-verbal pattern (e.g. chickenpox (visual) or stridor (auditory)).
  2. Self-labelling = the patient tells the GP what they think is the problem. Even when incorrect, this will initiate the
  3. Presenting complaint
  4. Pattern recognition trigger = immediate diagnosis from the history. E.g. feeling unwell, thirst and weight loss = diabetes.
28
Q

Stage 2 (Refinement) of the Heneghan et al model of diagnosis, name 5 strategies that are involved?

A
  1. Restricted rule-outs = depends on knowing the common, non-serious and rarer, more serious causes of a presentation. E.g. headache - common causes = migraine and tension headache. Rule-outs = subarachnoid haemorrhage and meningitis.
  2. Stepwise refinement = refining anatomical location or pathological processes.
  3. Probabilistic reasoning (see below).
  4. Pattern recognition = comparison with previous cases - relies on experience.
  5. Clinical prediction rules = using formal validated tools. E.g. Wells score for DVT.
29
Q

What can be done as part of Stage 3 (Defining the diagnosis) of the Heneghan et al model of diagnosis?

A

This is unnecessary if the diagnosis is clear. If not, the GP can:
 Order further tests
 Apply a test of treatment
 Apply a test of time
 Decide that no label should be applied (see below).

30
Q

Define sensitivity

A

The chance that the test if positive in those with disease. Looking at all those with disease i.e. true positive

31
Q

Define specificity

A

The chance that the test if negative in those without disease. Looking at those without disease i.e. true negative

32
Q

PPV in tests?

A

Positive predictive value

I.e. chance that a patient with a positive test has condition. Looking at everyone with positive result

33
Q

NPV in tests?

A

Negative predictive value

I.e. chance that a patient with a negative test hasn’t got condition. Looking at everyone with negative result

34
Q

Difference between sensitivity + specificity and PPV + NPV/

A

Sensitivity and specificity are characteristics of the test itself and are unaffected by prevalence

PPV and NPV are affected by the prevalence of the condition – as prevalence increases, PPV increases and NPV decreases. This means that the same test performed by a specialist will often have a higher PPV than when it is done in general practice

35
Q

Name 9 management strategies?

A
  1. Establishing the agenda: patient-centred approach and shared decision-making
  2. Communication: Explaining risk and discussing treatment options, giving advice and active listening
  3. Prescribing
  4. Use of time
  5. Safety netting
  6. Involve primary care team
  7. Referral to the voluntary sector / local groups / local resources
  8. Referral to secondary care
  9. Management outwith consult e.g. prescription signing, patient records review, results reviewing
36
Q

What is absolute risk?

A

Chance of getting disease

37
Q

What is relative risk?

A

The chance of getting the disease in one situation vs another

38
Q

What is NNT?

A

Number of patients who need to be treated to prevent one additional bad outcome

39
Q

Define EBM

A

Evidence-based medicine (EBM) is ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’

40
Q

What are the limitations of EBM that prevent all decisions being informed by high-grade evidence?

A

Lack of funding to a clinical problem
- The term ‘Cinderella disease’ has been applied to conditions which are important but do not readily attract funding.

Lack of research for the relevant group
- Elderly and those with co-morbities are often excluded from clinical trails –> Lack of data

Ethical barriers e.g. mental illness reduces capacity to consent to research

Rare diseases lack funding and statistal power

41
Q

Where are sources of evidence based guidelines?

A

The Scottish Intercollegiate Guideline Network (SIGN) www.sign.ac.uk was formed in 1993 to improve the quality of healthcare through the development and dissemination of national guidelines. A similar function is fulfilled in England and Wales by the National institute for Health and Clinical Excellence (NICE) http://www.nice.org.uk. Guidelines published by those two national bodies are adapted for local use. In NHS Lothian, local guidelines can be accessed via the Intranet.

42
Q

What are the 5 stages to applying EBM suggested by David Sackett ?

A
  1. Formulate the problem into an answerable question.
    It is usually more fruitful to focus on a specific question such as ‘should I prescribe an antibiotic for this sore throat?’; rather than ‘what is the best way to manage sore throats?’
  2. Track down the relevant information sources.
    Online resources and mobile devices have made this task much easier.
  3. Critically appraise the information,
    with regard to its validity and applicability.
  4. Apply the information with your patient
    – assess how the evidence applies to this patient
  5. Evaluate and reflect on the intervention.
43
Q

What are the feature of the metabolic syndrome?

A

Hypertension
Hyperglycaemia
Central obesity
Abnormal lipid profile

44
Q

Causes of inappropriate polypharmacy?

A

(i) there is no evidence-based indication;
(ii) the medicines fail to achieve the therapeutic objectives;
(iii) the drugs cause or put the patient at risk of unacceptable side effects.
iv) maintains illusion of recovery in palliative patients

45
Q

What are the changes in approach to treating those with multiple morbidity ?

A

(i) emphasises the need for patients to be fully involved in their own care;
(ii) argues for a team-based approach that is well coordinated;
(iii) recognises the importance of the role of carers and
(iv) flags up the potential role for technologies.

46
Q

3/4 have 3 leading causes of death?

A

Circulatory (CHD and stroke)
Cancer
Respiratory disease

47
Q

What is the illness trajectory for cancer?

A

Steady progression and a clear terminal phase

48
Q

What is the illness trajectory for organ failure e.g. COPD and heart failure?

A

Gradual decline punctuated with multiple exacerbations with partial recovery

49
Q

What is the illness trajectory for old age/ frailty / dementia?

A

Prolonged and gradual decline

50
Q

What are the two likely features of a “dying” diagnosis?

A

1 /+ progressive pathological processes (malignant or non-malignant) that has widespread organ impact, that is unaltered by max medical intervention

A progressive decline in QoL, that medical interventions cannot improve but is amenable to palliative treatments

51
Q

ACP

A

Anticipatory care plan

52
Q

ePCS

A

electronic palliative care summary

53
Q

Which injectable “just in case” medications would the gp prescribe to maintain good symptoms control in palliative patients at home?

A

Anxiolytics
Anti-emetics
Analgesia

For administration as necessary by a district nurse, the OOH tea, or care-home nurse

Yr 4 General Practice (9 decks)

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