Week 2

Question 1

Seborrheic Keratoses

Answer 1

Benign epidermal skin lesions seen in older people

Features: large variation in colour, ‘stuck-on’ appearance, keratotic plugs may be seen on the surface

Reassurance about the benign nature.
Options for removal include curettage, cryotherapy and shave biopsy

Question 2

Weighted 7 point checklist (for pigmented lesions) - urgent referral if 3 or more

Answer 2

Major features (2 points each):
Change in size
Irregular shape
Irregular colour

Minor features (1 point each):
Largest diameter 7 mm or more
Inflammation
Oozing 
Change in sensation

Question 3

2ww referral

Answer 3

Referral must be made within 24 hours

Question 4

Prevention of CV disease

Answer 4

All patients between 40-60 can have a CV risk check on the NHS. This is likely to be extended to 74.

Question 5

Physical Activity recommendations

Answer 5

Break up long periods of sitting

Strength exercises on 2 or more days a week plus mix of moderate / intense aerobic exercise - total of 150 minutes

Question 6

Conditions associated with CV disease

Answer 6

HIV
Renal disease
Gout
Erectile dysfunction

Question 7

Risk

Answer 7

Absolute risk: the risk of developing a condition over a period of time

Relative risk: used to compare the risk in two different cohorts of people (e.g. those given medication vs those not)

Question 8

QRISK score

Answer 8

Used in primary care to calculate a patient’s risk of suffering a cardiac event / stroke over the next 10 years as a %.

Current recommendation is 20 mg artorvastatin who’s QRISK score is > 10%

Question 9

Reasons for not being up to date with vaccinations…

Answer 9

Fear about damage from vaccination or allergies
Possible safeguarding issues
Not feeling that their child is at risk
Not knowing about the vaccination / not being invited
Concern that the vaccination may overload / weaken baby’s immune system
Not liking to see their child in pain during the injection

Question 10

‘Traffic Light System’

Answer 10

Helps with assessment of a child with fever which helps assess risk and whether the child needs immediate treatment / assessment in hospital and how urgently

Question 11

Bacterial meningitis

Answer 11

Neck stiffness, bulging fontanelle, decreased LOC, convulsive status epilepticus

Question 12

Meningococcal disease

Answer 12

Non-blanching rash, particularly with one or more of:
an ill-looking child
lesions larger than 2mm in diameter
cap refill >/ 3 s
neck stiffness

Question 13

Epiglottitis

Answer 13

Rapidly progressive cellulitis of epiglottis and adjacent structures - potential to cause abrupt and complete airway obstruction (don’t examine throat unless facilities for immediate intubation / tracheostomy available)

Caused by Haemophilus influenza type B (reduced incidence since Hib vaccine)

Features: rapid onset, high fever, generally unwell, stridor, drooling of saliva

Question 14

FeverPAIN

Answer 14

Alternative to CENTOR

Fever in last 24 h
Purulence
Attend rapidly under 3d
Severely inflamed tonsils
No cough or coryza 

0 - 1 = no antibiotic, 2-3 = 3 day back up abx, > 4 = immediate abx if severe or 48hr short back up prescription

Question 15

Personal Child Health Record (the red book)

Answer 15

Given out to patient’s at the time of birth
Record health and development - growth, growth charts, vaccinations
The parent keeps the record