Royston: Week 1/2 Flashcards
Codeine:
- MoA
- Why it causes constipation
- What 2 things must you tell the patient before they go on opiates?
- Give 2 laxatives to prescribe and give their MoA
- Laxative types (BOSS)
- Mu opioid receptors to reduce pain transmission
- Inhibit peristalsis
- Tolerance and addiction
- Senna (stimulant) and lactulose (osmotic)
- Bulkers (fibre, bran), Osmotic (lactulose), Softeners (sodium docusate) and Stimulants (senna)
UTI management
a) 1st line usually. Why? What else is it used for? CI?
b) 2nd line usually. CI?
c) 3rd line/pregnancy? If allergic -try…?
d) % of those with penicillin allergy that are ceph-allergic
a) Trimetho. Targets bladder. … pregnancy (folate antagonist - NTDs). Also used inPCP, travellers diarrhoea and otitis media (2nd lin)
b) Nitrofurantoin. Pregnancy
c) Amox. Cefalexin
d) 10%
QOF:
a) What is this?
b) What does it provide a measure of?
c) Give the three areas with examples
d) Total points available
a) Quality outcome framework - points based system for recording hitting targets in three key areas. Required for funding
b) Achievement/excellence of practice
c) Clinical (chronic diseases like CKD, CCF, HTN), Public health prevention (HTN, smoking 15+, obesity 18+, CVD) and public health additional (contraception, cervical screening)
d) 559
GP politics
a) Alma Ata agreement - explain
b) Funding
c) QOF for Royston verus CCG and national average
a) Agreed in 1978 - international (WHO, etc.) to pledge to better primary care. Updated this year.
b) Not NHS staff; contractors (99% funding from NHS); bid for contracts;
c) Above for both. Total achieved points 2016/17: 99.4% (555.64 out of 559 points)
Lumps and swellings
a) 5 aetiological groups - TONIC
b) O/E: 5S, 3Cs, 3Ts,
c) Distinguishing solid from fluid swelling? - good example
a) •Traumatic; •Other (degenerative, metabolic, parasitic, hormonal disorder; •Neoplastic (benign or malignant, primary or secondary); •Inflammatory (acute or chronic); •Congenital or acquired.
b) Site, size, shape, surface, surroundings
Colour, consistency, character (pulsatile?, bruit?)
Temperature, tenderness, trans-illumination
c) Trans-illuminate; hydrocele
Diagnosing lumps and swellings.
a) 3 common investigations
b) Neck lump - commonly what? - 4 causes.
c) Thyroid masses - possible features
d) Groin/scrotum - 3 differentials
e) Breast lumps - 4 differentials. Check for spread where?
f) Abdominal lumps: i) 4 organ enlargements, ii) Malignancy common. iii) In women. iv) Vascular.
a) Aspiration and MC&S for cyst, FNA for solid tumour, USS
b) Lymphadenopathy - acute/chronic infection or post-infection (reactive), malignancy (lymphoma, metastasis), cysts (e.g. sebaceous cyst), inflammatory diseases
c) Raise when swallow, goitre, eye disease, thyroid status, thyroglossal cyst (raised when tongue protrudes), retrosternal goitre (dull percussion of sternum)
d) Inguinal hernia, testicular tumour, hydrocele, epididymal cyst
e) Fibroadenoma, fibrocystic changes, breast malignancy, sebaceous cyst, abscess; axillary lymphadenopathy
f) i) Liver, spleen, kidneys, bladder, ii) Colorectal, iii) Pregnancy, iv) AAA - pulsatile?
Types of lump
a) Lipomas - site, symptoms
b) Sebaceous cyst - characteristic features?
c) Cutaneous abscess - common pathogen
d) Boils: i) 1 is called…?, ii) Multiple is called…?
e) Rheumatoid nodules - common where?
f) Spot diagnosis: single nodule on the lower leg; freely moving, firm consistency, 0.5-1.0 cm diameter. The overlying skin is tethered, causing it to dimple when pinched.
g) Common non-cancerous growth on face (e.g. eyebrow, eyelid or nose), neck or scalp
h) Malignant tumours - clinical signs
a) Fatty tissue, anywhere except palms/scalp; symptoms due to pressure effects
b) Characteristic punctum, intradermal so skin cannot be pulled over it, may be purulent. Excise
c) S. Aureus
d) Infected hair follicle = furuncle; multiple = carbuncle
e) Granulomas; common on elbow extensor surface
f) Dermatofibroma - common and benign skin tumour
g) Dermoid cyst
h) Fibrosarcoma, liposarcoma, leiomyosarcoma rhabdomyosarcoma - hard consistency, rapid growth (ABCD)
Headache.
a) Red flags: i) History (sOcrATES), ii) PMHx
b) 4 common primary
c) 1 common secondary. 5 serious secondary
d) i) Vital signs to assess. ii) Other important things to examine
e) Explain Cushing reflex
a) •New-onset severe headache or worse headache than normal •Sudden-onset (thunderclap) •Recent trauma/head injury •Signs of raised ICP - vomiting, visual changes, neurological deficit, seizures, reduced GCS, papilloedema, exacerbated by (early mornings, valsalva, lying down) •Consider serious causes such as carbon monoxide poisoning if household contacts have similar symptoms. •Current or previous malignancy
b) Migraine, tension, cluster, TGN
c) Medication overuse, IC bleed, IC tumour, GCA, meningitis, severe HTN
d) i) Temp (infection), BP (HTN, Cushing), HR (Cushing), RR (Cushing), ii) Neurology, carotid and temporal arteries. Note: diagnosis is clinical, but if severe pathology suspected, do CT/MRI
Persistent cough in paediatrics.
a) Important things to elicit about the cough
b) Important things to ask in history (after HPC)
c) Five causes of stridor (URT)
d) Three causes of wheeze (LRT)
a) Time course, associated with wheeze?
b) FHx of asthma/atopy, smokers at home, immunisations up to date
c) Inhaled foreign body, croup, tracheo/laryngomalacia, choanal atresia, anaphylaxis, tracheitis
d) Asthma, viral wheeze, bronchiolitis,
SOB in paediatrics.
a) Respiratory causes
b) Cardiac causes. Often SOB will present during ____.
c) Signs of increased WOB
a) Laryngomalacia/ tracheomalacia/ foreign body/ epiglottitis/ pneumonia/ asthma/ bronchiolitis
b) Myocardial dysfunction (pump failure): RHF causing inadequate delivery to lungs (hypoxemia; cyanotic CHD) or LHF causing inadequate delivery to body (pulmonary edema; acyanotic CHD); also severe anaemia causing high-output HF
c) Recessions (intercostal, suprasternal, costal margin), Paradoxical abdominal breathing, Accessory muscle use, Nasal flaring, Sternomastoid contraction, Forward posture
Adverse events.
a) AE
b) AR
c) SAE
d) SAR
e) SSAR
f) SUSAR
a) Any unfavourable and unintended signs, including abnormal laboratory results, symptoms or a disease associated with treatment
b) Adverse events but causally related to investigational medicinal product
c) Results in death, hospitalisation or prolongation of existing hospitalisation, persistent or significant disability/incapacity or a congenital anomaly or birth defect
d) As above, but must be causally related
e) Any SARs considered consistent with information available about an Investigational medicinal Product (IMP)
f) Any SARs suspected to be caused by an IMP, but which are not consistent with information about the IMP
Adverse event nomenclature.
a) AE
b) AR
c) SAE
d) SAR
e) SSAR
f) SUSAR
a) Any unfavourable and unintended signs, including abnormal laboratory results, symptoms or a disease associated with treatment
b) Adverse events but causally related to investigational medicinal product
c) Results in death, hospitalisation or prolongation of existing hospitalisation, persistent or significant disability/incapacity or a congenital anomaly or birth defect
d) As above, but must be causally related
e) Any SARs considered consistent with information available about an Investigational medicinal Product (IMP)
f) Any SARs suspected to be caused by an IMP, but which are not consistent with information about the IMP
Childhood rash.
a) Define: i) Macule, ii) Patch, iii) Papule, iv) Nodule, v) Vesicle, vi) Bullae vii) Pustule, viii) Petechiae, ix) Purpurae, x) Plaque
b) Common causes
c) Refer to paediatric flowchart
a) i) Flat, <1cm, ii) Flat, >1cm, iii) Raised, <1cm, iv) Raised, >1cm, v) Fluid filled, <1cm, vi) Fluid filled, >1cm, vii) Pus-filled, viii) Pin-point red/purple spot (non-blanching), ix) More extensive, non-blanching (indicate capillary leakage), x) Raised with flat top, often scaled.
Childhood rash.
a) Eczema - i) Most common type. ii) Usual presentation (according to age). iii) Management. iv) Severe infection - management
a) i) Atopic, ii) itching erythematous patches, papules and plaques with moist crusted erosions on the face, neck and upper trunk and also the elbows and knees,
iii) Avoid triggers, use emollients, topical steroids for flare-up (mild - hydrocortisone, moderate - beclametasone, severe - clobetasol), potency of steroid should match severity (mild on face/genitals). Other options: calcineurin inhibitors, systemic steroids or DMARDs, coal tar, phototherapy
Suicide risk assessment.
a) Define suicide
b) Risk factors: i) Comorbidities, ii) Occupation, iii) Demographics, iv) Other, v) Lack of …
c) Risk assessment - SAD PERSONS
a) a fatal act of self-harm initiated with the intention of ending one’s own life
b) i) Mental illness (depression, schizophrenia, bipolar, substance abuse), ii) Machine operators/construction workers, chemist/dentist etc. iii) Age 40-45, male, iv) Previous suicide attempt or self-harm, bereavement, v) Protective factors
c) S: Male sex
A: Age (<19 or >45 years)
D: Depression
P: Previous attempt
E: Excess alcohol or substance use
R: Rational thinking loss
S: Social supports lacking
O: Organized plan
N: No spouse
S: Sickness
