Primary Care

Question 1

What are some examples of focal neurological deficits and the arteries that the symptoms may be caused by? (8)

Answer 1

• Facial weakness (MCA)
• Unilateral weakness of upper and or lower limb (MCA/ACA)
• Unilateral sensory loss of upper and or lower limb (MCA/ACA)
• Speech problems (MDA dominant hemisphere)
• Visual defects (PCA, occipital lobe)
• Disorders of perception (PCA, parietal lobe)
• Disorders of balance (posterior circulation)
• Coordination disorders (posterior circulation)

Question 2

What are some common stroke mimics? (7)

Answer 2

• Hypoglycaemia
• Labyrinthine disorders
• Migrainous aura
o Typical (visual symptoms)
o Atypical (motor weakness ‘hemiplegic migraine’, sensory symptoms, dysphasia, other).
• Mass lesions (subdural haematoma, cerebral abscess, tumours)
• Postictal weakness (also known as Todd’s paralysis)
• Simple partial seizures
• Functional hemiparesis

Question 3

How are TIAs assessed for severity and therefore treatment plan? Desricbe it.

Answer 3

ABCDsquared:

This is based on chance of having stroke in next 7 days:

A – age: 60 or older (1 point)
B – BP: 140/90 mmHg or greater (1 point)
C – clinical features: unilateral weakness (2 points), speech disturbances without weakness (1 point)
D – duration: 60 mins or longer (2 points), 10-59 mins (1 point)
D – diabetes

High risk: Seen within 24 hours
•	ABCD score of 4 or more 
•	More than one TIA in one week 
•	TIA whilst on an anticoagulant 
Low risk: Seen within 7 days
•	Score of less than 3 and no other symptoms 

Treatment: 
•	Start statin
•	Antiplatelet drug – clopidogrel or aspirin
•	Treat BP if raised 
•	No driving until seen by specialist

Question 4

What is the difference between primary care and general practice?

Answer 4

Primary care is the first point of contact for health care and therefore is often the GP.
Emergency ambulance and ED can also be considered primary care as is the first point of contact for some people with new or reoccurring health problems

Question 5

What does the term expert medical generalism entail?

Answer 5

• GPs proved provision of health care to all patients on the list with any health care need
• Focus on the person and not the disease(s)
• Broad variety of knowledge needed – focus on breadth not depth
• Long term relationship with patients

Question 6

What is the QOF ? Describe it.

Answer 6

quality and outcomes framework.

• Since 2004 meeting targets is associated with additional income for GPs
• This income reflects the resources required to achieve these targets
• Big areas focused on in the QOF are AF, DM, hypertension, CVD-PP, blood pressure

Question 7

Who are responsible for the disease registers in UK?

Answer 7

GPs

Question 8

What are the issues with evidence based medicine/

Answer 8

Not targetted to population:
Comorbidities not accounted for
Age and ethnicity sometimes not accounted for