Primary care II Flashcards
screening for delirium in GP
4AT
Autism spectrum disorders
- social interaction
- presence of restrictive and repetitive behaviour
- communication issues
scarlet fever
- starts with cold symptoms
- strep pyogenes - group A
- rash spares palms and soles
- blanching
- management: oral penicillin V for 10 days
- notifiable illness
fever refractory to antipyretic
- Kawasaki
- paracetamol doesnt reduce pyrexia
- GIVE aspirin
where does measles start
behind the ears
rash started on face
slapped cheek- fifth
human parvovirus (PV) B19
management of BV
PO metronidazole for 7 days
- white smelly discharge- fishy
- no itchy
stress incontinence management- learn this
- PFMT for 3 months
- surgery
- duloxetine
endometrial cancer
- nun - no pregnancy
- high BMI
- late menopause
- early menarche
missed pills rule
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.
contacts can cause
bacterial keratitis- refer to eye casualty
- painful movement
most likely diagnosis
thrombosed haemorrhoids
- can only excise if started <3 days ago
- conservative treatment: lidocaine ointment, ice pack, increase fibre
treatment of anal fissure
topical GTN
omeprazole for a month
then test for H.pylori
then refer to gastro
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?
Until one or two semen samples show that the procedure has been effective?
whooping cough treatment
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.
leprosy example
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.
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.
vibrio cholerae
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?
streptococcus pneumonia associated with herpes labialis
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?
stop medication- medication overuse headache
reversal of suxamethonium(ACHr antagonist causing paralysis during surgery)
suzamethonium works by blocking the action of ACH at NMJ junction
neostigamine- cholinesterase inhibitor - increasing ACH conc in NMJ
extradural (epi) vs subdural
Pharmacological treatment for status
1) Full dose of benzodiazepine (5 mins)
2) Full 2nd dose of “ (0-15 mins)
3) Consider IV thiamine if alcohol use
4) 2nd line anti-epileptic if still in seizure (15-45) e.g. phenytoin, levetiracetam
5) 45+ = thiopentone/anaesthesia (will need ventilating)
