ILAs Flashcards
What topics need to be covered in a sexual hx
symptoms menstrual hx gynae hx obstetric hx sexual hx social hx
what specifically needs to be explored in the symptomatic hx
Vaginal discharge: itchy/offensive – different to normal?
Dysuria / frequency
Vulval itching/soreness
Genital skin changes
Abdominal pain – SOCRATES is useful here
Pain during or after intercourse – dyspareunia
Systemic symptoms (which may be related) Have you noticed any rashes elsewhere on your body?”“Do you have any pain in your joints?” – reactive arthritis (e.g. chlamydia)“Have you had any pain in your eyes?” – iritis / anterior uveitis
what specifically needs to be explored in the menstrual hx
Last menstrual period (LMP) – was it normal or was it spotting( could be pregnant) Regularity – monthly / unpredictable Length of cycle Dysmenorrhoea Post-coital bleeding Intermenstrual bleeding
what specifically needs to be explored in the menstrual hx
Cervical screening (previously smear) – dates / results Treatment – previous gynaecological treatment – e.g. loop excision of transitional zone (LETZ)“
what specifically needs to be explored in the obstetric hx
Contraception – type of contraception / length of use / any issues / previous contraception
Current pregnancy?
what ph is normal discharge
<4.5
could be thrush
pathological discharge
Associated with blood, odour, pruritus, ulcers and soreness • Colour • Ordour • Pain • Bleeding
Prescribing contraception to U16 - Fraser Guidelines
UPSSI
understand
Parents (cant be persuaded to tell their parents)
Sex (will continue have intercourse regards)
Suffer (likely to suffer mentally or physically if does not receive)
Interest (in her best interests)
Dementia screening in primary care
1 - Mini mental screening examination. Normal >27/30 2 - Bloods: dementia screen - FBC - Thyroid - U&E - Glucose - LFTs + Ca 3. Do MSU if there is delirium 4. Some memory drugs can cause prolonged QT so do ECG
Memory clinic will do head CT
Refer to memory clinic
Pathophysiology of Alzheimer’s
Degeneration of the cerebral cortex with cortical atrophy, neurofibrillary tangles, amyloid plaque formation and reduction in acetylcholine production from the affected neurones
Rx Alzheimer’s
Acetlycholinesterase inhibitors: donepezil, galantamine
Assessing mental capacity (4)
The ability to make a decision, only that decision at that time
Understand
Retain
Weigh up
Communicate decision
deprivation of liberty / capacity
- assume have capacity
- given all information & steps to help
- allowed to make unwise decision
- act with their best interests
- least restrictive option
Dementia is a triad of problems:
memory loss, decline in some other aspect of cognition and difficulties of daily living.
Describe the differential diagnosis of a patient presenting with cough (a comprehensive history) Remember occupation
Asthma
• Diurnal variation, Other signs of atopy (rhinnitis, eczema), Reversible, No signs of viral infection
GORD
• Relationship to food, central burning pain
Chronic bronchitis
• Smoking, Dysponea, Hx of smoking, Sputm production
ACEinhibitor adverse effect
• Dry cough (tickling/scratching sensation)
Pneumonia
• Fever, malaise, cough (sputum production), chest pain
Bordetella pertussis infection (whopping cough, ask about vaccinations)
Malignancy
TB
• Cough (Weight loss, blood, fatigue)
Viral infection
• Clear chest, pale green sptum, course of serveral weeks
