m i n o r i l l n e s s e s

Question 1

describe how the dx of a UTI is made

Answer 1

MSU sample for MCS

or CSU for MCS if they have a catheter

Question 2

management of UTI

Answer 2

trimethoprim
nitrofurantoin
amoxicillin

Question 3

what are the sx of UTI

Answer 3

dysuria 
frequency 
urgency 
foul smelling urine 
malaise/fever

Question 4

what are three ddx for chest infections in the community

Answer 4

acute bronchitis
COVID
HAP

Question 5

what are three ddx for chest infections in the community

Answer 5

acute bronchitis
COVID
HAP

Question 6

describe the causative viruses for acute bronchitis

Answer 6

rhinovirus
enterovirus
influenza A and B
coronavirus

Question 7

describe the management of acute bronchitis

Answer 7

usually mild and self limiting illness

advice on adequate fluid intake,

paracetamol and ibuprofen for sx relief,

OTC cough medicines

stop smoking

seek help if sx do not improve 3-4 weeks or become systemically unwell

amoxicillin if systemically unwell

Question 8

for CAP, speed of recovery after starting abx (1 week, 4 weeks, 6 week, 3 months, 6 months)

Answer 8

1 week — fever should have resolved.

4 weeks — chest pain and sputum production should have substantially reduced.

6 weeks — cough and breathlessness should have substantially reduced.

3 months — most symptoms should have resolved but fatigue might still be present.

6 months — symptoms should have fully resolved.

Question 9

additional care for pt with CAP

Answer 9

stop smoking

offer person written infromation on pneumonia - NHS

Question 10

COVID 19 viral pneumonia may be more likely if pt presents with

Answer 10

1. Presents with a history of typical COVID‑19 symptoms for about a week.
2. Has severe muscle pain (myalgia).
3. Has loss of sense of smell (anosmia).
4. Is breathless but has no pleuritic pain.
5. Has a history of exposure to known or suspected COVID‑19, such as a household or workplace contact.

Question 11

an immediate antibiotic prescribing in URTI approach may be considered for:

Answer 11

children younger than 2 years with bilateral acute otitis media

children with otorrhoea who have acute otitis media

patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are presen

Question 12

what is the centor criteria for URTI

Answer 12

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

Question 13

how long should respiratory tract infections last

Answer 13

acute otitis media: 4 days
acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
common cold: 1 1/2 weeks
acute rhinosinusitis: 2 1/2 weeks
acute cough/acute bronchitis: 3 weeks

Question 14

describe the management of candidiasis

Answer 14

antivirals = miconazole

Question 15

presentation of candidiasis

Answer 15

widespread infection (such as oesophageal candidiasis, characterized by difficulty or pain on swallowing, or retrosternal pain).

Question 16

what are the side effects of a stoke/TIA

Answer 16

mobility problems
sensory problems
continence problems
pain
fatigue
problems with swallowing
sexual dysfunction

Question 17

management of suspected acute stroke

Answer 17

1. Arrange immediate emergency admission to an acute stroke facility for anyone with suspected acute stroke or emergent transient ischaemic attack (TIA).
2. Do not start anticoagulation (for example in people with atrial fibrillation) or antiplatelet treatment in people following ischaemic stroke until intracerebral haemorrhage has been excluded by brain imaging
3. give supplemental oxygen if sats are reduced

Question 18

management of suspected TIA

Answer 18

1. Offer aspirin 300 mg immediately with PPI
2. refer pt to specialist assessment to be seen withinn 24 hrs
   3

Question 19

hypercholesteremia what investigations are needed

Answer 19

ck - can be associated with lipid lowering therapy

liver function tests - non alcoholic fatty liver disease

renal function - egfr - ckd and use of lipid loerinf drugs

HbA1c = DM

TFT = hypothyroidism

Question 20

QRISK3

Answer 20

likelihood of cardiovascular event in next 10 years

heart attack or stroke

Question 21

primary prevention dose of statins vs secondary dose

Answer 21

20mg = primary
80mg = secondary

Question 22

management of high cholesterol

Answer 22

start atorvastatin 80 mg
repeat lipids in 3 months time= 40 percent reduction in non HDL cholesterol = check compliance and increase or change med

check lfts at 3 to 12 months - nafld

check ck for unexplained muscle sx

Question 23

lx required in high cholesterol

Answer 23

total cholesterol
HDL
LDL
QRISK

Question 24

annual review of high cholesterol

Answer 24

compliance
side effects
lifestyle advice/ address risk factors
check non-fasting hdl cholesterol

Question 25

hypercholestoremia management

aim

Answer 25

aim of treatment is to achieve a greater than 50% reduction in baseline low-density lipoprotein (LDL) cholesterol levels.

Question 26

associated sx of headache

Answer 26

aura; nausea and vomiting; motion sensitivity; photophobia and/or phonophobia (may suggest migraine).

Question 27

types of headache

Answer 27

migrane

cluster headache

tension headache

medication overuse headache

GCA, TIA, STROKE

Question 28

aura sx

Answer 28

Visual symptoms such as zigzag lines, flickering lights, and/or scotoma (visual aura is the most common type of aura).

Sensory symptoms such as numbness or pins and needles of the hand, arm, and/or face.

Speech and/or language disturbance such as aphasia.

Question 29

ipsilateral associations of cluster headache

Answer 29

Conjunctival injection and/or lacrimation.
Nasal congestion and/or rhinorrhoea.
Eyelid swelling.
Forehead and facial sweating.
Forehead and facial flushing.

Question 30

tension type head is

Answer 30

bilateral

Question 31

management of migraines

Answer 31

1. self care advice = pt information on nhs website, diary to help with triggers, ensure women with migrate with auras stop COCP
2. offer simple analgesia = ibuprofen, aspirin, paracetamol
3. triptan - sumatriptan
4. antiemetic if nausea and vomiting

follow up in 2-8 weeks

Question 32

anaphylaxis signs and sx

Answer 32

angioodema
urticaria
difficulty breathing

Question 33

anaphylaxis management

Answer 33

A-E

give oxygen, monitor pt

Remove trigger if possible

IM adrenaline/ epipen 1 to 1000 = anterolateral aspect o middle third of thigh repeat after 5 mins if not working

consider inhaled salbutamol

Question 34

following MI/ PCI = driving advice and work

Answer 34

Off work for 4-6 weeks
Can return to driving after 1 week
Only need to notify DVLA if driving for work

Question 35

heart failure classification

Answer 35

NYHA

Class 1  no symptoms or limitation of activity
Class 2  mild symptoms, slight limitation of activity, ordinary activity causes symptoms
Class 3  moderate symptoms, less than ordinary activity causes symptoms
Class 4  severe symptoms, symptoms present at rest

Question 36

HF management

Answer 36

Medications that improve prognosis:
Beta blockers
ACE inhibitors
Spironolactone
Hydralazine
Medications that improve symptoms:
Loop diuretics
Thiazide diuretics
Secondary prevention
Aspirin
Statins