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Random Bits Flashcards

1
Q

Treatment for tonsillitis

A

Phenoxymethylpenicillin for 10 days

Clarithromycin or erythromycin in penicillin allergy

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2
Q

Treatment of quinsy

A

IV antibiotics penicillin or metronidazole, can give steroids

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3
Q

Causes of ABRS

A

Strep pneumoniae
H influenzae
Staph aureus

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4
Q

Management of AVRS

A

Self limiting
Analgesics
Nasal irrigation
Intranasal steroids

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5
Q

Risk factors of candidiasis

A 
HIV
Xerostomia
Dentures
Malnutrition
Advanced malignancy
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6
Q

Management of candidiasis

A

Mild to moderate use of clotrimazole

Severe use fluconazole

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7
Q

What is strawberry cervix

A

Trichomoniasis - also has yellow green discharge

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8
Q

What is seen in BV

A

Positive whiff test
clue cells
pH <7.4
thick white discharge

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9
Q

Management of uncomplicated genital thrush

A

Intravaginal cream or pessary fluconazole

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10
Q

Initial presentation for headache

A 
Nausea and vomiting
Visual disturbance
Photophobia
Neck stiffness
Fever
Rash
Weight loss
Sleep disturbance
Temporal region tenderness
Neurological deficits
Contacts with similar symptoms
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11
Q

Features of migraine without aura

A 
5 attacks
Lasts 4-72 hours
Unilateral location
Pulsating
Nausea, vomiting, photophobia and phonophobia during
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12
Q

Migraine with aura features

A

Visual symptoms - zigzag lines
Sensory symptoms - pins and needles
Motor weakness

Aura spreads over 5 mins
Aura lasts 5-60 mins
Unilateral
Accompanied by headache

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13
Q

Management of migraine

A 
Headache diary
Avoid triggers
Ensure no COCP
Analgesia
Triptan e.g. sumatriptan
Anti-emetic e.g. metoclopramide

Arrange follow up 2-8 weeks

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14
Q

Preventative treatment for a migraine

A

Propranolol, amitryptiline

Not gabapentin

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15
Q

Tension type headache

A

Generalised pressure or tightness
Spread to neck
Pericranial tenderness
Exacerbating environmental factors

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16
Q

Cluster headache

A

Unilateral periorbital pain
Ipsilateral autonomic symptoms
Nasal congestion, rhinorrhoea, eyelid oedema
Pain sharp, pulsating, burning or pressure like
Brief attacks last less than 3 hours

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17
Q

Management of cluster headaches

A

Red flags refer
Verapamil preventative
Do not offer paracetamol, NSAIDs, opioids or triptans

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18
Q

Management of SAH

A

Enteral nimodipine
Tranexamic acid
Fluid therapy
Clipping/coiling

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19
Q

Investigations for syncope

A 
12 lead ECG
Refer to cardio in 24 hours if any abnormalities
Capillary blood glucose
Urinary pregnancy test
CT head if first fit or head injury, red flags
Routine bloods
Urinalysis
CXR
Echo
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20
Q

Management for sprains and strains

A 
Protection
Rest for first 48-72 hours
Ice - apply ice in damp towel 15-20 mins every 2-3 hours
Compression
Elevation

Paracetamol
NSAID

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21
Q

When is HPV vaccine offered?

A

11-14 years

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22
Q

When is pneumococcal offered?

A

65 years

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23
Q

When is shingles vaccine offered?

A

70 years single dose

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24
Q

What is incubation period of chickenpox?

A

1-3 weeks

Infectious 1-2 days before rash appears

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25
Q

Complications of chickenpox

A

Varicella pneumonia in smokers

Fetal varicella syndrome if pregnant, causes skin scarring, eye defects, microcephaly

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26
Q

Describe chickenpox rash

A

Small erythematous macules on scalp, face, trunk
Intensely itchy
Crusting within 5 days of onset

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27
Q

Treatment of chickenpox

A

Self limiting
Aciclovir if immunocompetent

Paracetamol for pain or fever
Calamine

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28
Q

What is shingles

A

Reactivation of varicella zoster from ganglion

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29
Q

RFs of shingles

A 
Increasing age
Immunocompromised
Co-morbidities
Female sex
Statin use
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30
Q

What are the complications of shingles?

A

Post herpetic neuralgia - chronic debilitating pain
Ramsay Hunt
CNS involvement

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31
Q

Describe shingles rash

A

Maculopapular rash, cluster of vesicles

Limited to dermatomal pattern

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32
Q

What is the management of shingles

A

Aciclovir

Admit to hospital if needed

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33
Q

What is Hutchinson’s sign

A

Rash on tip, side or root of nose - nasociliary nerve

Can cause eye inflammation and permanent corneal denervation

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34
Q

Presentation of EBV

A 
Low grade fever
Fatigue
Malaise
Sore throat
Tonsillar enlargement
Lymphadenopathy
Mild hepatomegaly and splenomegaly
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35
Q

What are the investigations

A

EBV serology if ill for at least 7 days
Monospot test in adults or immunocompromised

If second monospot negative consider CMV, HIV
Check LFTs

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36
Q

Management of EBV

A

Hospital admission if stridor, dehydration, splenic rupture

Paracetamol, ibuprofen relieve pain and fever

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37
Q

Management of scleritis

A

High dose steroids or antibiotics

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38
Q

Presentation of uveitis

A

Painful watery red eye

Cloudy view, irregular pupils

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39
Q

Management of acute angle glaucoma

A

Lie patient flat
Beta blocks
Pilocarpine

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40
Q

Causes of aphthous ulcers

A 
Genetics
Smoking
Iron, b12 deficiency
Luteal phase of menstrual cycle
Trauma
Anxiety
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41
Q

Malignancy considered instead of aphthous ulcers

A

Solitary ulcer or swelling of oral mucosa

Persists for more than 3 weeks

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42
Q

Signs of high risk serious illness in a child

A 
Pale, mottled, ashen, blue
No response to cues
Appears ill
Does not wake
High pitched cry
Grunting
Reduced skin turgor
Bulging fontanelle
Neck stiddness
Status epilepticus
Focal neurological signs or seizures
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43
Q

What is a stroke

A

Sudden onset of rapidly developing focal or global neurological disturbance lasts more than 24 hours

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44
Q

What is a TIA

A

Less than 24 hours of neurological dysfunction, caused by focal brain, spinal cord or retinal ischaemia
Without acute infarction

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45
Q

Causes of haemorrhagic stroke

A

Intracerebral haemorrhage e.g. aneurysm

SAH

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46
Q

Long term complications of stroke

A 
Motility issues
Sensory problems
Pain
Incontinence
Fatigue
Dysphagia
Skin problems
Sexual dysfunction
Cognitive
Financial
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47
Q

What is acute vestibular syndrome

A

Symptoms of stroke of posterior circulation
Vertigo, nystagmus, nausea and vomiting
New gait unsteadiness

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48
Q

Management of stroke

A

Stroke thombolysis

Do not start antiplatelet treatment until haemorrhagic stroke ruled out

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49
Q

Management of TIA

A

Aspirin 300mg stat
PPI
Urgent assessment within 24 hours

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50
Q

Bell’s palsy

A

Acute unilateral facial nerve weakness or paralysis with rapid onset

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51
Q

Complications of Bell’s

A

Eye injury
Corneal ulceration
Dry mouth
Intolerance to loud noises if stapedius affected

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52
Q

What does forehead sparing suggest in a facial palsy

A

Upper motor neurone lesion such as a stroke

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53
Q

Management of Bell’s

A

Prednisolone

Antiviral treatments alone not recommended

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54
Q

Causes of hypothalamic amenorrhoea

A

Functional disorders e.g. exercise, ED
Chronic conditions e.g. thyroid
Kallmann syndrome - x linked,failure of migration of GnRH cells

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55
Q

What are pituitary causes of amenorrhoea

A 
Prolactinomas
Pituitary tumours
Sheehan's
Destruction of pituitary gland
Post contraception
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56
Q

Ovarian causes of amenorrhoea

A

PCOS
Turner’s 45 XO
Premature ovarian failure

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57
Q

Genital tract abnormalities causing amenorrhoea

A

Ashermann’s adhesions
Imperforate hymen
Transverse vaginal septum
MRKH agenesis

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58
Q

What is average freq for cycle

A

28 days

>38 days infrequent

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59
Q

Av duration of period

A

5 days, >8 days prolonged

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60
Q

Av vol loss during menses

A

40ml

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61
Q

Differentials for HMB

A 
Pregnancy - miscarriage or ectopic
Endometrial or cervical polyps
Adenomyosis
Fibroids
Malignancy
Coagulopathy
Endometriosis
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62
Q

What are fibroids

A

Leiomyomas

Benign smooth muscle tumours arising from myometrium

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63
Q

RFs for fibroids

A 
Obesity
Early menarche
Increasing age
FH
AfroAmericans
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64
Q

Management of fibroids

A

Tranexamic or mefanamic acid
Hormonal contraception to control menorrhagia
Ulipristal can reduce size

Hysterectomy, myomectomy

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65
Q

What is endometriosis

A

Extrauterine implantation and growth of endometrial tissue

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66
Q

What is adenomyosis

A

Deposits of endometrial tissue in the myometrium of the uterus

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67
Q

Clinical features of endometriosis

A 
chronic pelvic pain
dysmenorrhoea
irregular periods
dyspareunia
infertility/sub
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68
Q

Investigations and management for endometriosis

A

Laparoscopy
USS, MRI
Pain management
Excision or ablation

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69
Q

Diagnosis and management of adenomyosis

A

Same symptoms as endometriosis
Symetrically enlarged tender uterus

Transvaginal US
Only curative is hysterectomy
NSAIDs, COCP, uterine artery embolisation

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70
Q

Pathogenesis of PCOS

A

Insulin resistance
Hyperinsulinaemia
Reduction in sex hormone binding globulin
LH higher than FSH so no surge and ovulation
Excess androgens

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71
Q

Features of PCOS

A 
Oligo/amenorrhoea
Infertility/sub-fertility
Acne, hirsutism
Obesity
Sleep apnoea
Anxiety/depression
Acanthosis nigricans
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72
Q

Risk of cancer in PCOS

A

Risk of endometrial
Endometrial hyperplasia can occur
Pts to have withdrawal bleed every 3-4 months and tv uss in any abnormal bleeding or absent bleeding

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73
Q

Management of PCOS

A 
COCP
Weight loss
Hair removal techniques
Topical ointments for acne
Smoking cessation, exclude other causes of infertility
Healthy lifestyle
74
Q

Complications of PCOS

A 
T2DM
Gestational diabetes
CVD
Sleep apnoea
Depression/anxiety
75
Q

Causes of post-coital bleeding

A 
Infection
Cervical ectropion
Polyps
Vaginal cancer
Cervical cancer
Trauma, abuse
Atrophic change
76
Q

Causes of IMB

A 
Pregnancy related
Spotting in ovulation
Adenosis, vaginitis
Infections, STIs, polyps
Fibroids, cancer, endometriosis
Tamoxifen, smear, missed COCP, drugs
77
Q

Types of HRT

A

Unopposed oestrogen or combination of oestrogen and prog
Given oral or transdermal
Topical HRT for vaginal dryness

78
Q

Risks of HRT

A

Combined has increased risk of breast cancer
Increased risk from ovarian cancer
Oral has increased risk of VTE

Risk of fragility fractures reduced

79
Q

contraception post menopause

A

hrt not contraception
Women under 50 fertile 2 years after last period
over 50 fertile 1 year after last period so still need contraception

80
Q

Premature ovarian insufficiency

A 
younger than 40
not on contraception
menopausal symptoms
no periods
elevated FSH
can be genetic or autoimmune
81
Q

Contraindications to HRT

A 
Current, past or suspected breast cancer
Oestrogen dependent cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Previous idiopathic or current VTE
Active or recent arterial thromboembolic disease
Active liver disease
Pregnancy
Thromophilic disorder
82
Q

Complications of HRT

A

Oestrogen causes fluid retention, bloating, breast tenderness
Leg cramps
PMS like symptoms
Vaginal bleeding problems

83
Q

What is croup

A

Upper respiratory viral illness leads to inflammation of larynx and airways below the glottis

84
Q

Causes of croup

A

parainfluenza
adenovirus
coronavirus
rhinovirus

85
Q

clinical features of croup

A

viral prodrome
coryzal symptoms of runny nose, dry cough
fever lasts 24-48 hrs
Sudden onset barking cough, stridor, resp distress

86
Q

Score to assess croup

A

Westley score

87
Q

Management of croup

A

Dexamethosone and anti-pyretics

88
Q

organic causes of constipation in children

A 
anorectal malformations
anal fissure
hirschsprung's
hypothyroid
coeliac
CF
Lead toxicity
89
Q

Red flag symptoms of constipation in kids

A 
Commence from birth
delay in passing meconium
ribbon stools
leg weakness
abdominal distention and vomiting
abnormal anus
limb deformity
90
Q

What is SCFE?

A

Slipped capital femoral epiphysis

Metaphysis displaces anteriorly and superiorly leading to slipped plate

91
Q

viral induced wheeze usually due to

A

rhinovirus

92
Q

what does a tense or sunken fontanelle mean

A

raised icp - hydrocephalus

dehydration

93
Q

what do you look for on newborn exam in eyes

A

erythema, discharge
position of eyes
red reflex

94
Q

When is red reflex absent

A

congenital cataracts
retinoblastoma
retinal detachment
vitreous haemorrhage

95
Q

what are the two tests on the hips

A

barlows and ortolani’s

adduct hips with pressure on knee with thumb for barlow

ortalani - flex hips and knees to 90

96
Q

what reflexes are present in a baby

A

rooting - brush cheek and turn

stepping - pretends to walk when touch flat surface

moro - drop back once or twice, extension of legs and head, arms jerk up

palmar grasp

sucking - sucks anything which touches roof of mouth

97
Q

scabies caused by

A

sarcoptes scabiei

98
Q

presentation of scabies

A

female burrows
leaves eggs in skin causes wavy silver lines
papules, nodules, pustules

99
Q

management of scabies

A

all contacts treated
premethrin dermal cream
hot washes
cream applied overnight head to toe, and then again one week later

100
Q

where is eczema common

A

On flexural or skin creases

101
Q

management of eczema

A

keep skin hydrated
emollients, moiturisers
tacrolimus if not controlled by maximal corticosteroids

102
Q

treatment of acne

A

keep face clear
blue light therapy

benzoyl peroxide
topical antibiotics e.g. erythromycin
topical retinoids e.g. tretinoin

103
Q

presentation of psoriasis

A

itchy, well demarcated circular pink elevated lesions
distributed symmetrically
fissuring in plaques

nail changes
pitting, onchyolysis

104
Q

management of psoariasis

A

topical therapies, corticosteroids and vitamin D analogues
phototherapy
biological therapies e.g. infliximab third line

105
Q

what is vitiligo

A

patchy loss of melanin

due to emotional stress, childbirth, skin trauma or exposure to chemicals

106
Q

causes of erythema multiforme

A

herpes simplex
mycoplasma pneumonia
fungal infections
penicillins

107
Q

causes of erythema nodosum

A

IBD
Strep infection, scarlet fever
Sarcoidosis, TB

108
Q

treatment of eczema herpeticum

A

painful itchy blistered rash complication of atopic dermatitis
treatment is antivirals

109
Q

management of urticaria

A

aggravating factors minimised
topical anti-pruritic agents e.g. calamine
H1 antihistamines e.g. certirizine

110
Q

presentation of SCC

A

Indurated nodular keratinising crusted tumour
non healing ulcer
small nodules

111
Q

presentation of BCC

A

slow growing, locally invasive, arises from hair follicles

indurated edge, ulcerated centre

112
Q

subtypes of malignant melanoma

A

superficial
nodular
lentigo
acral on hands, feet and nailbed

113
Q

changes of melanoma

A

ABCDE

Diameter >6mm

114
Q

cause of impetigo

A

bullous or non
staphlococcus aureus and strep pyogenes

due to poor hygiene
break in skin protective layers

115
Q

presentation of impetigo

A

tiny pustules evolve into honey coloured plaques if non bullous

in bullous rupture spontaneously, likely to occur on atopic eczema

116
Q

management of impetigo

A

stay off school, avoid sharing towels
no scratching
fusidic acid 3x day for one week
hydrogen peroxide cream if not unwell

refer if widespread, recurring, systemically unwell

117
Q

management of atopic dermatitis

A

avoid irritant
use of PPE
simple emollients
topical corticosteroids e.g. ciclosporin

118
Q

what is rosacea

A

chronic relapsing disease of facial skin, recurrent episodes of flushing
erythema, papules, telangiectasia

119
Q

causes of flushing in rosacea

A

heat, alcohol, caffeine, spicy foods, stress

120
Q

management of rosacea

A

reassurance
facial massage

topical metronidazole
oral abx e.g. doxycycline if severe papulopustular

laser treatment for telangiectasia

121
Q

different types of ringworm

A 
tinea corporis - trunk
cruris - groin and natal cleft
pedis - athlete's foot
manuum - infection of hand and scaling in palmar creases
capitis - scalp; patches of broken hair
unguium - nail yellowing
122
Q

presentation of ringworm

A 
itching, rash
hair loss
secondary infection with cellulitis or impetigo
webs of toes macerated
oncholysis
annular scaly plaques, raised edges
overlapping concentric circles
123
Q

management of ringworm

A 
keep skin cool
keep dry
do not scratch
do not share towels
cover feet
treatment with topical antifungal e.g. miconazole
124
Q

what is otitis externa

A

inflammation of outer ear; auricle, external auditory canal

125
Q

RFs for otitis externa

A

humidity
swimming
old age
obstruction e.g. wax

126
Q

causes of ear infections

A 
bacterial or fungal
staph aureus
p aerugonisa
fungal
herpes zoster rh
127
Q

presentation of otitis externa

A 
ear canal erythema
oedema, exudate
pain moving tragus
hearing loss, discharge
oedematous canal
128
Q

what is malignant otitis externa

A 
spreads into mastoid or temporal bones
due to p aeruginosa or s aureus
pain and headache
can have FN palsy
temp, vertigo, hearing loss
pain, oedema
129
Q

what is chronic otitis externa

A

lack of earwax
hypertrophic skin
pain on manipulation
constant itch in ear

130
Q

management of acute otitis externa

A

clean, syringe, dry swab

analgesia for symptomatic relief

131
Q

what is chronic suppurative otitis media

A

chronic inflammation
follows slowly resolving AOM
effusion of glue like fluid behind intact membrane

132
Q

presentation of acute otitis media

A

pain, children pull at ear, irritability, vomiting
high temp, pinna may be red
red bulging tympanic membrane with fluid behind

hearing loss, otalgia and fever in adults

133
Q

management of acute otitis media

A

rule out complications e.g. mastoiditis, FN

If abx needed 5-7 day course amoxicillin
erythromycin or clarithromycin in pregnant women

134
Q

presentation of suppurative otitis media

A

chronically draining ear > 2 weeks
history of AOM
hearing loss

135
Q

what is mastoiditis

A

suppurative infection from middle ear spreads to mastoid air cells
common in young children or immunocompromised

136
Q

common organisms in mastoiditis

A

strep pneumoniae
strep pyogenes
staph
h influenzae

137
Q

presentation of mastoiditis

A

intense otalgia
pain behind ear
external ear may protrude forwards
boggy tender mass behind ear

138
Q

management of mastoiditis

A

hospital referral
high dose cephalosporins IV
tympanostomy tube insertion
mastoidectomy

139
Q

what is otitis media with effusion and management

A 
glue ear, collection of fluid in middle ear
no inflammation
may be due to impaired eustachian tube dysfunction
hearing loss
aural discharge
loss of light reflex
crackling, popping
tinnitus

do tympanometry
audiometry

active observation should resolve in 6-12 weeks
if persist, hearing loss severe, tympanic membrane structurally abnormal then refer

140
Q

cause of BPPV

A

Loose calcium carbonate crystals

When head moves, otoconia move causing motion of fluid

141
Q

RFs of BPPV

A

head injury
recumbent position
ear surgery
inner ear pathology

142
Q

what is vestibular neuritis

A

vestibular neuropathy
due to reactivation of type 1 herpes simplex virus in vestibular ganglion

hearing not affected

143
Q

what is labyrinthitis

A

vestibular nerve and labyrinth affected
which contains peripheral sensory organs for balance and hearing

hearing loss, vertigo, nausea and vomiting

144
Q

what is meniere’s

A

disorder of inner ear due to change in fluid volume
vertigo, tinnitus, fluctuating hearing loss
sense of aural pressure

fluctuating episodic pattern

145
Q

management of meniere’s

A

reassure
keep medication accessible if sudden attacks
stop driving if vertigo when driving
cyclizine for vomiting
consider betahistine to reduce freq of attacks

146
Q

causes of vertigo

A 
inner ear, labyrinth, vestibular nerve
brainstem/cerebellum
BPPV
Vestibular neuronitis
Meniere's
Migraine, stroke, TIA
147
Q

management of chronic sinusitis

A 
admission if orbital or intracranial involvement
avoid allergic triggers
no smoking
good dental hygiene
saline solution and irrigation
intranasal corticosteroids - fluticasone
148
Q

removal of earwax

A

ear drops, sodium bicarbonate, olive oil
irrigation if symptoms persist
microsuction
do not use irrigation if increase risk of trauma or infection

149
Q

what is acoustic neuroma

A

tumour of vestibulocochlear CN 8 nerve
From schwann cells of nerve sheath
slow growing, benign, life threatening

unilateral or asymmetrical hearing loss or tinnitus progressive

as tumour spreads - facial pain or numbness

150
Q

management of acoustic neuroma

A

microsurgery

radiotherapy and observation

151
Q

what is a cholesteatoma

A

abnormal accumulation of squamous epithelium and keratinocytes in middle ear and mastoid air spaces

erodes into neighbouring structures

chronic negative middle ear pressure causes tympanic membrane to be retracted
forms pocket

progressive conductive hearing loss, as lesion grows get vertigo, headache, FN palsy

152
Q

complications of cholesteatoma

A 
recurrent ear infections
conductive hearing loss 
vertigo
sensorineural loss due to erosion into inner ear 
mastoiditis
153
Q

management of cholesteatoma

A

surgery removal

incision behind ear and auditory meatus

154
Q

what is otosclerosis

A

fixation of stapes footplate to oval window

impairs movement of stapes and transmission of sound into inner ear

155
Q

presentation and management of otosclerosis

A

progressive hearing loss and tinnitus
audiometry and CT

improve hearing loss through bilateral hearing aids
sodium fluoride and bisphosphonates
stapedectomy

156
Q

What is generalised anxiety disorder

A

syndrome of ongoing worrying, anxiety in an excessive and inappropriate manner

157
Q

symptoms of GAD

A

Nervousness, trembling, muscle tension, sweating

158
Q

RFs for GAD

A

female, FH, physical or emotional stress, hx of abuse of trauma, other anxiety disorder

159
Q

Management of GAD

A

Use of GAD 7 questionnaire assess severity
enquire about comorbidities and treat
discuss other stressors, help, active monitoring

Offer low intensity psychological interventions
non facilitated self help, guided self help, groups

High intensity CBT, drug treatments, SSRIs
If pregnant need high intensity interventions first

Refer to specialist if not improving, risk of self harm neglect or suicide risk

160
Q

who is at risk of suicide

A 
Male, under 30, living alone/single
Previous attempt
Substance abuse or alcohol abuse
Family history
Recent initiation of treatment
161
Q

what are the characteristics of acute stress reaction

A

intrusion - re-experiencing
avoidance - avoid expressing thoughts related to trigger
hyperarousal - reckless of arrogant behaviour
mood related - negative thoughts

162
Q

What are the kubler ross cycle stages of grief

A 
denial
anger
bargaining
depression
acceptance
163
Q

what is self harm

A

intentional act of self poisoning or self injury
expression of emotional distress
includes suicide attempts when there is no attempt

164
Q

what are risk factors for self harm

A 
age approx 16-24
socio economic disadvantages
stressful life events
bereavement by suicide
mental health, substance abuse
involvement in criminal justice system
165
Q

what are the complications of self harm

A

acute liver failure
scarring, tissue/tendon/nerve damage
repetitive
increase risk of suicide if male, repeatedly self harm
physical health problems, suicidal ideation

166
Q

what is the acute management following an act of self harm

A 
sensitive, compassion, minimise distress
examine for injuries
assess emotional and mental state
assess any increase in risk of suicide, any protective factors e.g. family to stay for
safeguarding concerns

consider toxbase, may need to go to A&E
if no A&E wound management, refer to mental health

ensure follow up in 48 hours, full assessment
prevent access to any means
support all involved

risk assessment, referral to CAMHS if appropriate
community mental health, individual care plan

167
Q

what does the PHQ9 tool cover

A 
little interest in things
feel low or hopeless
trouble falling asleep, staying asleep, sleep too much
tired/little energy
poor appetite, overeating
feel bad about self, let down
hard to concentrate
move or speak slow
suicidal ideation
168
Q

what is the management of depression

A 
assess suicide risk and risk factors
factors which may affect course of depression 
response to treatment in past
safeguarding concerns
manage comorbidities
SSRIs - continue for 6 months 
sleep hygiene, mindfulness
follow up 1-2 weeks after initial appt, then every 2-3 weeks for first 3 months if not at increase risk
169
Q

management of OCD

A 
Assess degree of issue
may have other mental health conditions
safeguarding, self harm, self neglect
psychological intervention
CBT, SSRI 
Refer to secondary care mental health
170
Q

what is anorexia nervosa vs bulimia nervosa

A

anorexia - restriction of intake to have low body weight, intense fear of gaining weight, denial of malnutrition
dry skin, hair loss, bradycardia, postural hypotension

bulimia - recurrent binge eating then restrictions
compensations - vomiting, purging, laxatives, exercise
weight is often in normal limits

171
Q

what is the SCOFF questionnaire

A 
Sick
Loss of Control
lost more than ONE stone in 3 months
too Fat
Food dominates life
172
Q

what interventions for drug misuse

A

substitution therapy e.g. maintenance or detox with methadone, buprenorphine
Goals - abstinence, reduction, maintenance, harm reduction, psychosocial interventions
brief interventions, motivational interviewing
CBT, groups, family groups

173
Q

What is the model of change

A 
cycle of
pre contemplation
contemplation
action
maintenance

hopefully leave cycle and in remission

174
Q

How to calculate units of alcohol

A

strength (abv) x vol / 1000 = units

175
Q

recommended alcohol consumption

A

no more than 14 units a week on regular basis

spread drinking over 3 or more days

176
Q

what is included in CAGE questionnaire

A

should you cut down on drinking
are people annoyed at your drinking
do you ever feel guilty
drinking in morning - eye opener

177
Q

what management is available for alcoholics

A

motivational interviewing, promote abstinence
psychological interventions
assisted alcohol withdrawal as inpatient or outpatient

178
Q

withdrawal symptoms of smoking cessation

A 
irritability
depression
restlessness
poor concentration
disturbed sleep
nicotine craving
179
Q

what are the parameters for BMI

A

<18.5 underweight
18.5-24.9 normal weight
25-29.9 overweight
>30 obese

180
Q

what is the time limit for emergency contraception

A

ulipristal acetate inhibits or delays ovulation via suppression of LH; up to 5 days after UPSI

CaIUD toxic effect on sperm and ova, inflammation prevents implantation within 5 days or within 5 days of the earliest estimated date of ovulation whichever latest

levonorgestrel - within 72 hours

181
Q

what are the anticipatory medicines in palliative care

A

analgesics - morphine for pain, breathlessness
anxiolytics sedatives e.g. midazolam for distress
anti-secretory - hyoscine butylbromide for secretions
Anti-emetics e.g. levomepromazine

GP (2 decks)

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