primary care Flashcards
(81 cards)
Can you make a new diagnosis of IBS (irritable bowel syndrome) in someone over the age of 50 years?
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
What is the commonest cause of food poisoning in the UK?
Campylobacter - and its most common in the summer
When taking a history for diarrhoea, what diagnoses might blood in the stool indicate?
Infective- campylobacter, E.coli, shigella.
Inflammatory- IBD.
Neoplastic - bowel cancer.
A patient presents with diarrhoea alongside crampy abdominal pain which is relieved on defecation. What diagnosis may this suggest?
Irritable bowel syndrome (IBS)
When can people who have had gastroenteritis return to work or school?
They should not return to work or school until 48 hours after the diarrhoea has stopped
If a patient has diarrhoea, what medications should they stop taking until the diarrhoea has resolved and why?
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.
Should patients with acute diarrhoea be advised to take Loperamide (Imodium)?
Consider loperamide if it is important to stop the diarrhoea (e.g. before a long journey), but otherwise it should be avoided.
What type of drug is loperamide?
It is an opioid that does not cross the BBB, but increases colonic transit time
Which specific circumstances should loperamide definitely not be used to treat diarrhoea?
In children and in anyone with bloody diarrhoea, as it may increase their risk of complications
Which arm should you use to measure a patient’s blood pressure?
Unless there are good reasons for not doing so (such as patient discomfort), you should use the patient’s right arm
What are the ALARMs symptoms (red flag symptoms) that warrant immediate endoscopy?
Anaemia (iron deficiency) Loss of weight Anorexia Recent onset/ progressive symptoms Melaena / haematemesis Swallowing difficulty
What drugs/ medications can cause heartburn symptoms?
Antibiotics e.g. tetracyclines, NSAIDs, corticosteroids, iron compounds, nitrates, bisphosphonates, calcium preparations, calcium channel antagonists and theophylline.
What is the typical eradication therapy for H. Pylori?
A PPI such as omeprazole and 2 antibiotics e.g. amoxicillin and clarithromycin.
Patients can complete self-certificates for time off work due to illness, how does this work and for how long does it last?
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.
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
bacterial endocarditis
murmur
fever
at higher risk due to injecting steroids
dysuria and nocturia 3 days
no fever
no loin pain
progesterone implant
diagnosis and treatment
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
management for pyelonephritis
fever + loin pain + urinary symptoms
ciprofloxacin
co-amoxiclav
treatment for bacterial vaginosis
metronidazole
persistent dysuria and nocturia
no fever, no loin pain
on trimethoprim but no better - resistant
MSU: high WCC, no RBCs no growth on culture
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
investigation for chlamydia
women: vaginal swab for NAAT (nucleic acid amplification test)
men: urine sample for NAAT
chlamydia management
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
UTI management in pregnancy
nitrofurantoin in first or second trimester
trimethoprim in third trimester
returning from abroad
watery diarrhoea
blood in stool
most appropriate investigation?
what bacteria are likely?
stool sample - look for ova and parasites (if been abroad) - giardia (abroad), campylobacter (chicken esp)
IBD investigation
sygmoidoscopy
