Primary care Flashcards
medication for weight loss
orlistat -→ energy wastage→ poo out fat
liraglutide →appetite suppression
pharmacological interventions for people with alcohol dependence or disease caused by alcohol
e.g. acamprosate
(disulfiram used less regulary now)
serious consequenc of alcohol
Wernickes →Korakoffs
A 34-year-old woman has just given birth 24 hours ago. She states she is not planning on having any more children in the immediate future and would like to start a long-term contraceptive. She has a past medical history of heavy menstrual bleeding and is planning to exclusively breastfeed.
What is the most appropriate contraception for this patient?
The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks
but due to history of heavy bleeding- IUS
A 21-year-old woman at 34 weeks gestation telephones her GP for advice. Her pregnancy is progressing well but she is keen to explore which contraceptive options are available to her following childbirth. After an extended discussion, her preferred option would be the contraceptive implant. The patient has no underlying medical conditions and does not plan to breastfeed.
From what timepoint could this patient commence on this treatment?
A contraceptive implant can be safely inserted any time after childbirth
A 32-year-old female requests emergency contraception. She had unprotected sexual intercourse 28 hours ago and is not using any regular contraception. She has a diagnosis of obesity, severe asthma and uterine fibroids with distortion of the uterine cavity.
Levonorgestrel (double standard dose)51%
within 72hours
double dose due to obesity
A 41-year-old female called this morning to request emergency contraception. She had unprotected sexual intercourse 48 hours before calling and is not using any regular contraception. Currently, she is breastfeeding. There is no medical history of note and she weighs 55 kg. She declined an intrauterine device and you prescribed an emergency hormonal contraception however she calls during your afternoon clinic to say she vomited one hour after taking this.
Levonorgestrel (standard dose)
Vomiting occurs in around 1% of patients who take levonorgestrel. If vomiting occurs within 3 hours then the dose should be repeated.
A 29-year-old female requests emergency contraception. She had unprotected sexual intercourse 7 days ago. Her LMP was 16 days ago, her cycle is usually 30 days. She was using condoms intermittently for contraception and takes no regular medications.
The copper intrauterine device can be used as emergency contraception if it is inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date.
A 32-year-old woman is reviewed at 3 days post-partum on the postnatal ward. She had an uncomplicated, elective lower-segment caesarean section. This was her first child and she is keen to exclusively breastfeed. Her lochia is normal and she is mobilising to the bathroom independently. She is to be discharged later that day and is keen to start contraception immediately. At different points in time before her pregnancy, she reports using the combined oral contraceptive pill and an intrauterine device, both of which suited her.
What should she be offered?
Postpartum women (breastfeeding and non-breastfeeding) can start the progestogen-only pill at any time postpartum
A 32-year-old woman is reviewed at 3 days post-partum on the postnatal ward. She had an uncomplicated, elective lower-segment caesarean section. This was her first child and she is keen to exclusively breastfeed. Her lochia is normal and she is mobilising to the bathroom independently. She is to be discharged later that day and is keen to start contraception immediately. At different points in time before her pregnancy, she reports using the combined oral contraceptive pill and an intrauterine device, both of which suited her.
What should she be offered?
Postpartum women (breastfeeding and non-breastfeeding) can start the progestogen-only pill at any time postpartum
A 24-year-old woman presents to the clinic for family planning. She requests a form of contraception that will not interfere with sexual intercourse and is reversible upon stopping.
She currently experiences heavy, painful, and irregular periods, but is otherwise fit and well. It is suggested she starts the combined oral contraceptive pill (COCP) as there are no contraindications and it might help her symptoms.
What additional health benefits might this medication provide?
benefits
- lighter and less painful periods
- protective against ovarian and endometrial cancer
negatives
- increased risk of breast and cervical cancer
describe elevated solid lesions
<1cm
papule
>1cm
nodule
>2cm
plaque
describe flat lesions
<1cm
macule
>1cm
patch
describe fluid filled lesion
<1cm
Vesicle
>1cm
Bulla
describe pus filled blister
<1cm
pustule
>1cm
abscess
hypersensitivity reaction (just learn)
Type 1- allergy
Type 2- haemolytic reaction
Type 3- SLE
Type 4- contact dermatitis
A 19-year-old with a few papules and pustules with some erythema mainly on the forehead and cheeks. He has tried a few over-the-counter creams with no success.
opical adapalene (topical retinoid) with benzoyl peroxide
A 32-year-old female reports that she is still experiencing facial acne despite continuing to use the benzoyl peroxide cream prescribed by her GP. She is in the process of weaning off her baby from breast milk. She would like to try an oral tablet.
Erythromycin is safe in breastfeeding, unlike tetracyclines or retinoids, and is, therefore, the most appropriate choice as the baby is still partly breastfeeding. Antibiotics can be used for up to 3 months for acne. They should be co-prescribed with benzoyl peroxide, which she is using.
A 77-year-old man presents to his GP with a painful rash around his ear. He first noticed pain in his left ear 3 days ago and is now also complaining of vertigo and tinnitus. On examination, you note a vesicular rash around his left ear.
Given the most likely diagnosis, what is the most appropriate treatment for this patient?
Treatment of Ramsay Hunt syndrome consists of oral aciclovir and corticosteroids
Treatment of Ramsay Hunt syndrome consists of oral aciclovir and corticosteroids
Otosclerosis may be precipiated by pregnancy in those who are genetically predisposed
audiograms
Audiograms are usually the first-line investigation that is performed when a patient complains of hearing difficulties. They are relatively easy to interpret as long as some simple rules are followed:
- anything above the 20dB line is essentially normal (marked in green on the audiogram below)
- in sensorineural hearing loss both air and bone conduction are impaired
- in conductive hearing loss only air conduction is impaired
- in mixed hearing loss both air and bone conduction are impaired, with air conduction often being ‘worse’ than bone
the combined pill increases your risk of which cancers
breast
cervical
the combined pill decreases your risk of which cancers
endometrial
ovarian
management of COPD
Make sure patient has correct inhalation technique. Nebulised treatment should be considered for patients with distressing or disabling breathlessness
- Initial treatment: SABA or SAMA
- Step up treatment for patient without asthmatic features or features suggesting steroid responsiveness: LABA and a LAMA (discontinue SAMA if LAMA given)
- SABA continued throughout all stages of treatment
- Patients on LAMA and LABA who have severe exacerbations or at least 2 moderate exacerbations, consider addition of ICS INHALER (TRIPLE THERAPY)
- Step up treatment for patient with asthmatic features or features suggesting steroid responsiveness
- LABA and ICS
- Patients on LABA and ICS who have severe exacerbations or at least 2 moderate exacerbations, consider addition of LAMA
Iron deficiency anaemia vs anaemia of chronic disease
A 65-year-old woman attended the GP 4 days ago feeling lethargic and tired for the past 3 months. Her only past medical history is rheumatoid arthritis for which she takes paracetamol as required for pain. She is a non-smoker, does not drink alcohol, and retired 10 years ago from her job working in a factory producing ceramic paints. Bloods show:
Anaemia of chronic disease
Ferritin is low in iron deficiency anaemia but high or normal in anaemia of chronic disease
cause of normocytic anaemia
look at reticulocyte count
- high- haemolytic
- haemolysis
- blood loss
- low - non-haemolytic
- marrow hypoplasia
Hearing Disability is defined as:
- Normal hearing is defined to be 20dB or better.
- Mild hearing loss is between 21-40dB.
- Moderate hearing loss is between 41-70dB.
- Severe hearing loss is considered to be 71-90dB.
- Profound hearing loss is worse than 90dB.
which ear
- In the left ear, the light reflex should be positioned at approximately 7 o’clock to 8 o’clock.
which ear
- In the right ear, the light reflex should be positioned at approximately 4 o’clock to 5 o’clock.
arterial supply of the nose includes
ophthalmic artery- posterior nose bleeds (ethmoidal arteries)
maxillary artery- most common source of bleeding
sensory supply of the tongue
nervous supply to the tongue
- Anterior 2/3
- Sensation- trigeminal (V3)
- Taste- facial
- Posterior 1/3
- Sensation and tase- glossopharyngeal
malignant causes of thyroid nodules
papillary- most common - good prognosis
follicular- good prognosis
medullary- produce calcitonin
anaplastic- bad prognosis
A 12 year old boy suffers from episodes of rhinorrhoea, nasal blockage and recurrent sneezing. This is worse during the summer and also became more frequent after his family adopted a dog. He has a past medical history of childhood eczema and asthma. On examination, the nasal mucosae appear generally inflamed but no abnormalities are visualised. What is the pathophysiology that underpins the most likely diagnosis?
type I sensitivity reaction
Causes of secondary hyperparathyroidism
- Vitamin D deficiency
-
Loss of extracellular calcium
- Pancreatitis
- Rhabdomyolysis
- Hungry bone syndrome
- Calcium malabsorption
-
Abnormal parathyroid hormone activity
- Chronic kidney disease
- Pseudohypoparathyroidism
- Inadequate calcium intake
