Revision lectures Flashcards
What are the 5 Rs of fluid prescribing?
Resucuitation - 10ml/kg over 15 mins (repeat x4, halve if elderly/cardiac problems)
Routine maintenance
Replacement of ongoing losses
Redistribution
Reassessment
Why do you give glucose in fluids?
to prevent ketosis, not for nutritional purposes
How should you approach fluid prescribing?
Clinical assessment of patient
- history and notes review
- notes for intra-op blood loss, fluid balance and post-op plan
- examination and assessment of dehydration
- look for EWS red flags
- do relevant investigations
Management
Reassessment
Signs of hypervolaemia?
oedema, raised JVP, bi-basal crackles, S3 heart sounds, ascites
Signs of hypovolaemia?
dry mucous membranes, low skin turgor, cool peripheries, cap refill > 2 secs
altered consciousness, pallor, tachycardia, tachypnoea, hypotension
NG and drains - increased loss
Surgical site examination
Why might patients show hypokalaemia on bloods post op?
drain loss and NG tube loss of K+
What should you do after prescribing fluids to any patient?
document
reassess
if more than 3 days NBM, consider TPM
obtain senior support early if complex case
Which factors effect the accuracy of HbA1c?
haemoglobinopathies - thalassemia , sickle cell
haemolytic anaemia
splenectomy
haemoldialysis / blood transfusion
CKD
HIV
pregnancy
being a child
Major complications of diabetes?
Macrovascular
- Cerebrovascular
- Peripheral vascular
- Cardiovascular
Microvascular
- Retinopathy
- Nephropathy
- Neuropathy (Autonomic or peripheral)
Main side effects for:
metformin?
sulfonylurea?
metformin:
GI upset, lactic acidosis
sulfonylurea:
hypos - falls and affects driving
What is required for diagnosis of diabetes?
WHO criteria
Fasting plasma glucose > 7
Random glucose > 11.1
If asymptomatic then requires 2 readings
How could you explain AF to a patient in a GP setting?
rather than contracting properly, the chambers at the top of your heart quiver (demonstrate with hands)
blood not being pumped as effectively - explains palpitations / dizzy sensation
actually quite common, one of the most common rhythm abnormalities- more common as you get older
Sometimes it’s not triggered by anything in particular but there are risk factors for it - high blood pressure can increase your risk (causes structural change to heart over many years)
How would you explain AF mx to a patient in GP?
There are two main things :
One is the heart Rhythm - low dose of bisoprolol - once daily oral tablet - risk of bradycardia and hypotension
One is risk of stroke - we reduce that by putting you on a blood thinner - DOAC like apixiban - risk of nausea and bleeding
can cardiovert if young and new onset - refer to hospital specialists
How would you safety net for AF in GP?
Face arms speech 999
Feel very SOB then call for help
Side effects - bleeding risk
Beta blockers lower your BP so if you feel faint or dizzy then you need to come back
What statin should you prescribe to reduce cardiovascular risk?
How would you explain?
Adverse effects?
atorvastatin 20mg OD or 80mg OD if secondary
fat in your blood called cholesterol
if you have too much it can get deposited in the blood vessels in your body
can increase risk of heart attacks, stroke and PAD
this medication stops you from making too much cholesterol, take it once at night
AE: muscle pain, hyperglycaemia, headache, GI upset
Risks of smoking?
mouth / throat / lung cancer
coronary artery disease
heart attack
stroke
peripheral vascular disease
cerebrovascular disease
COPD which incorporates bronchitis and emphysema
pneumonia
erectile dysfunction
risk to family of second hand smoke
what vision and fine motor milestones should be present when a child is aged:
6-8 weeks?
4-6 months?
7 months?
10 months?
16-18 months?
following moving object or face by turning their head
palmar grasp
transfer toys from one hand to another
mature pincer grip
makes marks with crayons
what social, emotional and behavioural milestones should be present when a child is aged:
6-8 weeks?
6-8 months?
10-12 months?
18 months?
18-24 months?
2 years?
smiles responsively
puts food in mouth
waves bye,plays peek-a-boo,drinks from a cup with 2 hands
holds a spoon and gets food safely to the mouth
symbolic play
toilet training
what gross motor milestones should be present when a child is:
newborn?
6-8 weeks?
6-8 months?
10 months?
12 months?
2-2.5 years?
Symmetrical and flexed posture, marked head lag on pulling up
Raises head to 45 degrees when lying prone
Sitting
Standing
Starting to try to walk
Walks steadily,runs and jumps
what hearing, speech and language milestones should be present when a child is aged:
newborn?
3-4 months?
7 months?
12 months?
18 months?
2 years?
startles to loud noises
vocalise alone or when spoken to
turns to soft sound out of sight, polysyllabic babble
2/3 words other than ‘dada’ and ‘mama’,understand their name
6-10 words,can point to body parts when asked
join 2 or more words to make simple phrases
What is the functional constipation mx in a toddler?
manage acute causes - e.g. stress
increase fibre and fluid intake
then macrogol e.g. movicol
toilet training - reward going to the toilet
What percentage of people with PMR get GCA?
25% - give 18 months of prednisolone
- monitor Hba1c and osteoporosis risk (FRAX then DEXA scan)
GCA can cause irreversible blindness
- start very high dose steroids eg 60mg pred if visual sxs and refer to hospital
how should you manage insomnia in a GP setting?
Non-pharmacological management:
sleep hygiene
- Don’t use phone last thing at night
- Create a restful bedroom environment, only use bedroom for sleep, sex and getting dressed
- Avoid stimulants after lunch
- Alcohol does not improve sleep quality
- Regular exposure to natural light
- Regular exercise throughout the day
- Limit naps
- Light meal before bed
Avoid medication as they’re addictive, promote sleep hygiene and reassure patient it can work
What factors increase risk of suicide?
Feeling of hopelessness
PMHx self harm
Evidence of planning e.g. note
Precautions to prevent rescue
Being male
Physical health problems
Low socioeconomic status
High risk employment (farmer, vet) / unemployment
Bereavement
Changes in relationship
Abusive relationships
Social isolation
Access to means
Offensive stool and malabsorption in child =
coeliac!!!
Single test to rule out IBD =
faecal calprotectin
What is tinea capitis? Mx?
scalp ringworm , causes scarring alopecia
Mx:
oral antifungals: terbinafine for Trichophyton tonsurans
topical ketoconazole shampoo should be given for the first two weeks to reduce transmission
What is tinea corporis? Mx?
ringworm
oral fluconazole
What is tinea pedis? Mx?
athletes foot
itchy, peeling skin between the toes
topical terbinafine / miconazole
General features of fungal rash?
well demarcated
itchy
erythematous
lifestyle advice for fungal infection?
keep area dry
don’t share towels, clothes or shoes
wear loose clothes
What is cradle cap? Mx?
Seborrhoeic dermatitis on scalp in babies
reassurance that it doesn’t affect the baby and usually resolves within a few weeks
massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo
if severe/persistent topical imidazole cream
Mx of thrush?
avoid irritant soaps, douching and tight clothes
oral fluconazole
clotrimazole intravaginal pessary if oral contraindicated
What Fever pain score suggests need for abx?
1 - no abx
2-3 - delayed
4-5 - give abx
What are the components of Fever-Pain score?
Fever in last 24 hrs
Pus on tonsils
Attends rapidly (within 3 days)
Inflamed tonsils
No cough / coryza
