GP Week

Question 1

What routine blood investigations would you do when a patient presents symptoms of alzheimer’s?

Answer 1

FBC - anaemia, vasculitis?

TFTs - Hypo?

Bone profile - Hyper Ca2+?

U&Es - kidney dysfunction?

LFTs

• alcoholic?
• Encephalopathy?

Glucose
- diabetic?

Vit B12
- mimic dementia

Lipid profile
- vascular dementia

Question 2

List some differentials for alzheimer’s disease:

Answer 2

Delirium **

Depression **

Vascular dementia

Dementia with lewy bodies

Frontal - temporal dementia

Vit B12 deficiency

Hypothyroidism

Question 3

What medications may aggravate or contribute to presenting symptoms of alzheimer’s?

Answer 3

Anticholinergics

Benzodiazepines

Antipsychotics

Question 4

What plans can be made to keep a patient with suspected alzheimer’s safe at home during the follow up period?

Answer 4

Package of care
- social team visits

Personal care > 65 years
(<65 years costs)

Friends and neighbours

Pharmacy service

Social care

District nurses

Appropriate alarm
- smoker detectors etc

Question 5

On the MMSE, what score identifies cognitive impairment?

Answer 5

<23

Question 6

What fields does the MMSE cover?

Answer 6

Orientation

Registration

Attention and calculation

Recall

Language

Question 7

What is your management when dementia is suspected?

Answer 7

> 65 years old: referral to memory clinic

<65 years: referral to neurology

Question 8

What investigation is used to diagnosis alzheimer’s?

Answer 8

CT

Question 9

What are the risk factors for alzheimer’s?

Answer 9

Smoking

excess alcohol

Head injury

High cholesterol

Low physcial activity

Apolipoprotein E - sporadic risk factor

Question 10

What are the main symptoms of alzheimer’s?

Answer 10

Cognitive

• problems carrying out: Activities of daily living (ADLS)
• money handling, paying bills etc

Non - Cognitive symptoms: 
- behavioural 
- psychological 
(BPSD)
- agitation 
- wandering 
- jealousy 
- aggression 
- delusions 
- information sharing

Question 11

Name the treatment for mild to moderate alzheimer’s and name the side effects:

Answer 11

Acetylcholinesterase inhibitors:

• Donepezile
• Rivastigamine
• Galantamine

Side effects:

• syncope
• bradycardia
• G.I upset

Condratications:
- Cardiac conduction abnormalities

**need ECG before

Question 12

Name some drugs given for moderate - to severe alzheimer’s:

Answer 12

NMDA receptor antagonist
- memantine

Side effects:

• constipation
• hypertension
• dizziness

Contraindications:
- renal impairment

Question 13

List some ways to gain further information regarding families if there was concern:

Answer 13

Health care system

Educational system

Question 14

What is it essential healthcare providers do in the setting of suspected child neglect?

Answer 14

Act and refer the early signs of abuse

Keep accurate records

Listen to the views of child

Review the concerns when situation is not improving

Sharing information appropriately without delay

Challenge others who appear not to be taking action `

Question 15

Where are notifications of concern referred too?

Answer 15

Social Work Services

Question 16

How long do you have to submit the documentation of a NOC?

Answer 16

48 hours

Question 17

Name the types of abuse that are recognised:

Answer 17

Abuse is a form of maltreatment of a child. this can be by inflicting harm or failing to act to prevent harm.

• Physical abuse
• Sexual abuse
• Emotional Abuse/ Psychological abuse
• Neglect

Question 18

Define Child Protection

Answer 18

When a child requires protection from child abuse or neglect.
It does not require for there to be abuse or neglect actually taken place, but if a risk has been identified to be likely to happen.

Question 19

Name some causes of erectile dysfunction:

Answer 19

Psychosexual Arousal

CVS/ Diabetes

Genitourinary

• penis abnormalities
• prostate

Gondo-pituitary axis

Question 20

What can erectile dysfunction eb sign of in an otherwise asymptomatic patient?

Answer 20

CVD

*you would therefore test for
- glucose
- LFTs
- FBC
- Blood pressure
etc

Question 21

Name some common drugs that can cause ED:

Answer 21

SSRI
Tricyclics

Beta blockers 
Verapamil 
Digoxin 
Amiodarone 
Diuretics

Cimetidine

Alcohol

Hormone therapies

Question 22

Compare and contrast the psychogenic and organic causes of ED:

Answer 22

psychogenic:
- younger
- sudden onset
- decreased libido
- spontaneous erections
- Major life events
- relationship changes
- previous psychological history

Organic:

• Older age
• gradual onset
• normal libido
• Loss of nocturnal erections
• previous medical history - CVD

Question 23

What drugs can be used for ED and how do they work?

Answer 23

Sildenafil

Phosphodiesterase inhibitors
- increases cGMP - leading to increase in NO production = increases smooth muscle relaxation

Question 24

When is sildenafil contraindicated:

Answer 24

Patients using nitrates

Unstable heart disease

Hypotension

Unstable angina

Recent stroke

Question 25

Common side effects of viagra:

Answer 25

Back pain
Dyspepsia
facial flushing
migraine

care with:

• beta blockers
• grape fruit
• alpha blockers
• nitrates

Question 26

What the second line if viagra fails?

Answer 26

Specialist clinical
- prostaglandin E1 analogue

MUSE
- in the uthera

VED
- vacuum erection device

Question 27

What is the 3rd line treatment for ED?

Answer 27

Prosthetic surgery

Question 28

Define Phimosis

Answer 28

Foreskin is too tight around the end of the penis