Primary care II

Question 1

screening for delirium in GP

Answer 1

4AT

Question 2

Autism spectrum disorders

Answer 2

• social interaction
• presence of restrictive and repetitive behaviour
• communication issues

Question 3

scarlet fever

Answer 3

• starts with cold symptoms
• strep pyogenes - group A
• rash spares palms and soles
  
  • blanching
• management: oral penicillin V for 10 days
  
  • notifiable illness

Question 4

fever refractory to antipyretic

Answer 4

• Kawasaki
• paracetamol doesnt reduce pyrexia
• GIVE aspirin

Question 5

where does measles start

Answer 5

behind the ears

Question 6

rash started on face

Answer 6

slapped cheek- fifth

human parvovirus (PV) B19

Question 7

management of BV

Answer 7

PO metronidazole for 7 days

• white smelly discharge- fishy
• no itchy

Question 8

stress incontinence management- learn this

Answer 8

• PFMT for 3 months
• surgery
• duloxetine

Question 9

endometrial cancer

Answer 9

• nun - no pregnancy
• high BMI
• late menopause
• early menarche

Question 10

missed pills rule

Answer 10

What if I have missed 1 pill?

If you have missed 1 pill anywhere in the pack or started a new pack 1 day late, you’re still protected against pregnancy.

You should:

• take the last pill you missed now, even if this means taking 2 pills in 1 day
• carry on taking the rest of the pack as normal
• take your 7-day pill-free break as normal, or if you’re on an everyday (ED) pill, take your dummy (inactive) pills

You do not need to use extra contraception.

What if I have missed 2 or more pills?

If you have missed 2 or more pills anywhere in the pack or started a new pack 2 or more days late (48 hours or more), your protection against pregnancy may be affected.

You should:

• take the last pill you missed now, even if this means taking 2 pills in 1 day
• leave any earlier missed pills
• carry on taking the rest of the pack as normal
• use extra contraception, such as condoms, for the next 7 days

When you come to the end of your pill pack, after missing 2 or more pills:

• if there are 7 or more pills left in the pack after the last missed pill – finish the pack, take your 7-day pill-free break as normal, or take your inactive pills before you start your next pack
• if there are less than 7 pills left in the pack after the missed pill – finish the pack and start a new pack the next day; this means missing out the pill-free break or not taking your inactive pills

You may also need emergency contraception if you have missed 2 or more pills in the first week of a pack and had unprotected sex in the previous 7 days.

Question 11

contacts can cause

Answer 11

bacterial keratitis- refer to eye casualty

• painful movement

Question 12

most likely diagnosis

Answer 12

thrombosed haemorrhoids

• can only excise if started <3 days ago
• conservative treatment: lidocaine ointment, ice pack, increase fibre

Question 13

treatment of anal fissure

Answer 13

topical GTN

Question 14

A 52-year-old lady presents to her GP with epigastric pain especially at night-tme. She has to sleep almost sitting upright else the pain will keep her up. This has been present for about 3 weeks. She has tried taking paracetamol but this has not helped. She has a history of type 2 diabetes mellitus for which she takes metformin, asthma for which she uses PRN salbutamol and eczema for which she uses emollients. She has not lost any weight. O/E NAD no abdominal masses

management

Answer 14

omeprazole for a month

then test for H.pylori

then refer to gastro

Question 15

A 47-year-old male comes into the GP surgery to discuss the advantages and disadvantages of a vasectomy. He wants to know how long after the procedure he must use contraception for.

How do you answer?

a) Vasectomy is effective immediately
b) 2 weeks after the procedure
c) 4 weeks afer the procedure
d) 12 weeks afer the procedure
e) Until one or two semen samples show that the procedure has been effective?

Answer 15

Until one or two semen samples show that the procedure has been effective?

Question 16

whooping cough treatment

Answer 16

pertussis

clarithromycin- doesnt reduce length of illness, reduces length of inactivity

example presentation: 3-week history of coryzal symptoms which have progressed significantly in the last two days. She is now experiencing severe fits of coughing, that are worse at night and occur with frequent vomiting afterward.

Question 17

leprosy example

Answer 17

A 60 year old male presents to his GP with widespread hypopigmented insensate plaques on his skin. He is unable to extend the fourth and fifth digits on his right hand, and has a right-sided foot drop. On examination, a thickened peroneal nerve is felt around the fibular head.

Question 18

A 27-year-old man has just come back from Bangladesh where he has been working with a charity to help with some recent flooding. He says in the last 24 hours he has been having large amounts of diarrhoea. He describes it as rice water looking and has also been vomiting.

Answer 18

vibrio cholerae

Question 19

A 46-year-old woman presents to the General Practice after a five day history of high fever, sharp chest pain worse on inspiration and a productive cough. She has also developed a cluster of blisters on her lower lip that have been causing her discomfort.

On examination she has increased vocal resonance and bronchial breathing in the right lower lung zone.

Which is the most likely causative organism?

Answer 19

streptococcus pneumonia associated with herpes labialis

Question 20

A 36 year old female with a history of depression presents with a three month history of headaches. She takes TDS co-codamol and PRN ibuprofen, and gets headaches almost every day. She has a history of anxiety, and is otherwise fit and well. Neurological examination findings are normal.

What is the most appropriate management of this patient?

Answer 20

stop medication- medication overuse headache

Question 21

reversal of suxamethonium(ACHr antagonist causing paralysis during surgery)

Answer 21

suzamethonium works by blocking the action of ACH at NMJ junction

neostigamine- cholinesterase inhibitor - increasing ACH conc in NMJ

Question 22

extradural (epi) vs subdural

Answer 22

Question 23

Pharmacological treatment for status

Answer 23

1) Full dose of benzodiazepine (5 mins)
2) Full 2^nd dose of “ (0-15 mins)
3) Consider IV thiamine if alcohol use
4) 2^nd line anti-epileptic if still in seizure (15-45) e.g. phenytoin, levetiracetam
5) 45+ = thiopentone/anaesthesia (will need ventilating)