primary care Flashcards

(81 cards)

1
Q

Can you make a new diagnosis of IBS (irritable bowel syndrome) in someone over the age of 50 years?

A

You shouldn’t make this diagnosis without first excluding/ considering other causes such as bowel cancer or diverticulosis which are more common with advancing age

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2
Q

What is the commonest cause of food poisoning in the UK?

A

Campylobacter - and its most common in the summer

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3
Q

When taking a history for diarrhoea, what diagnoses might blood in the stool indicate?

A

Infective- campylobacter, E.coli, shigella.
Inflammatory- IBD.
Neoplastic - bowel cancer.

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4
Q

A patient presents with diarrhoea alongside crampy abdominal pain which is relieved on defecation. What diagnosis may this suggest?

A

Irritable bowel syndrome (IBS)

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5
Q

When can people who have had gastroenteritis return to work or school?

A

They should not return to work or school until 48 hours after the diarrhoea has stopped

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6
Q

If a patient has diarrhoea, what medications should they stop taking until the diarrhoea has resolved and why?

A

ACE inhibitors, NSAIDs and diuretics. If the patient continues to take these drugs whilst they have diarrhoea, they run the risk of developing an AKI.

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7
Q

Should patients with acute diarrhoea be advised to take Loperamide (Imodium)?

A

Consider loperamide if it is important to stop the diarrhoea (e.g. before a long journey), but otherwise it should be avoided.

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8
Q

What type of drug is loperamide?

A

It is an opioid that does not cross the BBB, but increases colonic transit time

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9
Q

Which specific circumstances should loperamide definitely not be used to treat diarrhoea?

A

In children and in anyone with bloody diarrhoea, as it may increase their risk of complications

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10
Q

Which arm should you use to measure a patient’s blood pressure?

A

Unless there are good reasons for not doing so (such as patient discomfort), you should use the patient’s right arm

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11
Q

What are the ALARMs symptoms (red flag symptoms) that warrant immediate endoscopy?

A
Anaemia (iron deficiency) 
Loss of weight
Anorexia 
Recent onset/ progressive symptoms 
Melaena / haematemesis 
Swallowing difficulty
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12
Q

What drugs/ medications can cause heartburn symptoms?

A

Antibiotics e.g. tetracyclines, NSAIDs, corticosteroids, iron compounds, nitrates, bisphosphonates, calcium preparations, calcium channel antagonists and theophylline.

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13
Q

What is the typical eradication therapy for H. Pylori?

A

A PPI such as omeprazole and 2 antibiotics e.g. amoxicillin and clarithromycin.

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14
Q

Patients can complete self-certificates for time off work due to illness, how does this work and for how long does it last?

A

The self certificate will cover the first 7 days off work due to sickness. They complete their own self certificate/ form which is available from their employer.

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15
Q

normally on methadone
not been to pick up methadone

feeling sweaty, shivery
headache, SOB, cough, clear colourless sputum
injection marks
fever
faint systolic murmur over left lower sternal edge

most likely diagnosis

A

bacterial endocarditis

murmur
fever
at higher risk due to injecting steroids

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16
Q

dysuria and nocturia 3 days
no fever
no loin pain
progesterone implant

diagnosis and treatment

A

diagnosis: uncomplicated UTI

management: nitrofurantoin
women: 3 days
men/complicated/ pregnancy: 7 days

(definitely not pregnant as on implant so can use nitrofurantoin)
increasing resistance to trimethoprim so nitrofurantoin used more

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17
Q

management for pyelonephritis

A

fever + loin pain + urinary symptoms
ciprofloxacin
co-amoxiclav

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18
Q

treatment for bacterial vaginosis

A

metronidazole

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19
Q

persistent dysuria and nocturia
no fever, no loin pain
on trimethoprim but no better - resistant
MSU: high WCC, no RBCs no growth on culture

A

persistant dysuria + resistant to abx = resistant UTI or chlamydia

sterile pyuria = chlamydia
(no growth on culture)

man with dysuria much more likely to have chlamydia

women more likely to have UTI

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20
Q

investigation for chlamydia

A

women: vaginal swab for NAAT (nucleic acid amplification test)
men: urine sample for NAAT

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21
Q

chlamydia management

A

azithromycin one off dose

or doxycycline 7 days

takes a week for treatment to be effective - condoms needed
don’t test negative till after 6 weeks

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22
Q

UTI management in pregnancy

A

nitrofurantoin in first or second trimester

trimethoprim in third trimester

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23
Q

returning from abroad
watery diarrhoea
blood in stool
most appropriate investigation?

what bacteria are likely?

A

stool sample - look for ova and parasites (if been abroad) - giardia (abroad), campylobacter (chicken esp)

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24
Q

IBD investigation

A

sygmoidoscopy

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25
diarrhoea with blood crampy abdo pain fever aches and pains which bacteria most likely causing this gastroenteritis?
campylobacter
26
campylobacter management
- off work/school for 48hr after end of diarrhoea - notifiable disease - to public health - macrolide abx (if extended symptoms)
27
first line management for HTN <55yrs
ACEi: ramipril
28
first line management for HTN >55yrs/ black ethnicity
calcium channel blocker: amlodipine
29
continuing management for HTN
A + C A + C + D (thiazide like diuretic) add B-blocker or a-blocker or alternative diuretic
30
what BP is aimed for in HTN
clinic BP < 140/90 (<150/90 if >80)
31
when to treat HTN
BP > 140/90 end organ damage type 2 diabetes type 1 diabetes >40
32
investigations
ABPM if clinic BP > 140/90 urine for protein, blood, glucose fasting blood for: - HBA1c - U&Es - eGFR - total/ HDL cholesterol ECG QRISK 2 - 10 yr risk of cardiovascular disease: if >10% then start medication
33
primary prevention for high cholesterol
statin - atorvastatin 20mg daily baseline LFTs, 3months, 1yr if LFTs rise > x3 then stop statins
34
side effects of statins
``` reversible myositis gastro-intestinal altered LFTs headache alopecia ```
35
causes for raised cholesterol
hypothyroidism | weight gain
36
``` long lasting (weeks) cough with intermittent white/yellow sputum breathless on exertion abx resistance afebrile most appropriate management? ```
CXR | to rule out lung cancer
37
lung cancer 2ww guidelines
request urgent CXR in those aged >40 with any 2 of: - cough - fatigue - SOB - chest pain - weight loss - appetite loss
38
bowel cancer investigation
faecal occult blood test colonoscopy CT
39
COPD
chronic bronchitis + emphysema mostly caused by smoking can be caused by genetic abnormality: alpha-1 antitrypsin
40
COPD management
1. STOP SMOKING 2. inhaler: - relievers: salbutamol or ipatropium - preventers: tiotropium, salmeterol 3. manage exacerbations: - corticosteroids - abx 4. long term O2 therapy: - cyanosis - <92% sats - cor-pulmonale - thrombocytosis
41
breathlessness at rest oedema hepatomegaly most likely diagnosis
heart failure
42
heart failure management
lifestyle: - weight loss - stop smoking - exercise secondary prevention: - aspirin 75mg - all patients - anti-hypertensives - statins pharmacological interventions: - reduced systolic function: ACEi + b-blocker + diuretic - preserved systolic: diuretics (indapamide) regular ECG monitoring
43
angina management
lifestyle: | - weight loss, smoking cessation,
44
what are some important points about medical certificates supplied by doctors for statements of fitness to work?
- free of charge - doctor does not personally have to see the patient - can be backdated - cannot be issued for >3 months
45
which patient groups are exempt from prescription charges?
<18 yrs >60 pregnant women diabetes, epilepsy, hypothyroidism, cancer Tx, renal dialysis
46
which contraceptive might be prescribed for a patient to help with acne?
COCP e.g. co-cyprindiol (Dianette)
47
which contraceptive method may lead to a delay in fertility
the injection (injectable contraceptives)
48
how to COCPs work?
inhibit ovulation
49
advantages of the COCP?
- regulates cycles and reduces pain and amount of bleeding - reduces symptomatic fibroids and benign breast disease - reduces risk of ovarian, colorectal and endometrial cancer
50
for COCP which pills in the packet are 'most important' not to miss
important not to miss any of the first 7 pills (stop ovulation from occurring)
51
what type of patients would the POP be suitable for rather than the COCP
- migraine with aura - smokers >35yrs - women breastfeeding
52
how are POPs taken
- taken within 3hrs of the same time everyday - taken daily without break - desogestrel POP can be taken within 12hrs of time its due - first line
53
how does POP work
prevents pregnancy by thickening cervical mucus | - desogestrel can also stop ovulation
54
types of injectable contraceptives and how long they last
- most common: depo- provera - every 13 weeks - noristat - every 8 wks - saying press - 13 wks (administered by patient)
55
side effects of injectable contraceptives
- effective at reducing heavy or painful menstrual bleeding - can cause amenorrhoea or regular bleeding - unscheduled bleeding or return to fertility can last for up to a yr on stopping - risk of osteoporosis - weight gain
56
how long do progesterone implants last
3 yrs
57
how long do copper and mirena coils last
copper: 5-10 yrs mirena: 5 yrs
58
what investigations should you do if the threads of a coil are not palpable or visible
pelvic USS to assess position
59
if a lady becomes pregnant with a coil in situ, what does this increase the risk of?
ectopic pregnancy
60
what does the copper coil and mirena IUS do to bleeding
copper coil: menorrhagia (increased) | mirena: lighter bleeding, amenorrhoea
61
outline the options for emergency contraception
levonelle: up to 3 days after UPSI Ella one: up to 5 days copper coil: up to 5 days
62
what are the key points to remember about the levonorgestrel pill for emergency contraception
- taken up to 3 days after UPSI - one off dose 1.5mg - double dose if >70kg (BMI>26) - can start contraception straight away so protected after 7 days for COCP or 2 days for POP
63
is emergency contraception effective after ovulation has taken place?
no
64
key points about ulipristal acetate (ellaOne) for emergency contraception?
- can be taken up to 5 days after UPSI - protected after your next period if on contraception - can't be taken if on progesterone or severe asthma - more effective than levonelle
65
what if a patient vomits after taking an emergency contraceptive pill?
if vomit within 2hrs (3 for ellaOne) of taking pill, repeat dose with anti-emetic
66
what is the most effective emergency contraceptive
the copper IUD
67
what are the key points about the copper IUD for emergency contraception
- up to 5 days after UPSI - protected as soon as fitted - makes periods heavier - must screen for STDs at insertion
68
what are some non-/modifiable risk factors for CVD?
``` non-modifiable: - FHx - age - male - ethnicity modifiable: - smoking - high BMI - HTN - high cholesterol - diabetes - physical inactivity ```
69
what tool is used to calculate cardiovascular risk
QRISK3
70
pharmacotherapies for people who want to quit smoking
- nicotine (Patches, vapes, injections) - bupropion - varenicline e-cigarettes
71
blood pressure: clinic BP and ABPM/HBPM
- clinic BP >140/90 repeated - if they differ, repeat 3rd time. the lower of the last two taken as clinic BP - ABPM - to confirm diagnosis (14 measurements) - HBPM: alternative (7days)
72
how do NICE define the stages of HTN
stage 1: clinic BP>140/90 ABPM> 135/85 stage 2: clinic BP >160/100 ABPM> 150/95 severe: clinic BP> 180 or > /110 malignant: >180/110 + organ damage
73
when should drug treatment be considered for HTN
- immediately (before ABPM) if clinic BP >180/110 - all stage 2 HTN - stage 1 HTN if elevated risk (e.g. QRISK3>10%, diabetes, end organ damage)
74
recommended treating HTN to a clinic BP of what?
<140/90 (or 150/90 in those aged >80)
75
In the stepwise treatment of HTN, how long after starting a treatment should you wait until you reassess BP?
BP reassessed after 4-6 wks before considering progressing to next stage
76
What is the stepwise treatment regimen for HTN?
``` <55. >55/ black A. C A + C A+ C + D add B-blocker, a-blocker, or different D ``` A: ACEi (ramipril) C: calcium channel blocker (amlodipine) D: thiazide like diuretic (indapamide)
77
what antihypertensive should you used in a patient with T2DM?
ACEi
78
A patient is unable to tolerate their ACE inhibitor (due to cough), what antihypertensive should you consider instead?
An angiotensin II receptor blocker (ARB) e.g. Lorsartan
79
What is the first-line recommended primary prevention drug treatment for high cholesterol? (Include the dosage in your answer)- note I am asking about DRUG treatment but always remember to give lifestyle advice
atorvastatin 20mg
80
40yrs 2nd episode left sided back pain radiating to back of left knee for past 5 weeks paracetamol/ibuprofen not helping otherwise well straight leg raise improved normal power, reflexes, sensation, no foot drop management option for GP to offer?
refer for physiotherapy
81
``` 82yrs increasing SOB few months fatigue after walking non smoker amlodipine for HTN sertraline for depression ibuprofen for osteoarthritis pale but not clubbed or cyanosed 152/76 vesticular and symmetrical breathing ``` most likely cause?
anaemia