Capsule GP Flashcards
Which three of the following medications are used in the prophylaxis of migraine headaches?
Amitriptyline
Propranolol
Topiramate
most appropriate test if high cholesterol suspected
fasting lipid glucose
Total cholesterol: 9.5 mmol/l Triglycerides: normal HDL: low LDL: high Which further blood tests are indicated here?
renal and liver function
thyroid function
fasting blood glucose
All Jade’s other test results are normal and the clinical diagnosis of Familial hypercholesterolaemia is made. Her GP refers her to a specialist to confirm the diagnosis of Type IIa Familial Hypercholesterolaemia. What is the specialist likely to recommend?
lipid lowering medication e.g. statin
lifestyle: Smoking cessation, diet modification, physical exercise and alcohol consumption decrease
Causes of secondary hypercholesterolaemia include (
uncontrolled diabetes mellitus, obesity, excess alcohol consumption, untreated hypothyroidism and some medications, for example, thiazide diuretics and ciclosporin.
MMR vaccine
- live attenuated
- first dose given at 12 months (A booster dose is given at three years four months old or soon after.)
- safe for egg allergy
Which of these statements are true when it comes to the UKMEC guidelines for prescribing contraception? Choose two options.
A 36 year old woman who smokes 40 cigarettes a day can be given the combined oral contraceptive pill (COCP) safely
A 22 year old woman who has been breastfeeding since delivery 4 weeks ago, can consider starting the combined oral contraceptive pill (COCP)
Having varicose veins is not a contra-indication on using the combined oral contraceptive pill (COCP) or the progesterone only pill (POP)
Patients with compensated cirrhosis without complications can consider having the combined oral contraceptive pill (COCP) or the progesterone only pill (POP))
The UKMEC guidelines are used to determine the risks and benefit in prescribing or giving hormonal and intrauterine contraception in women. The UKMEC guidelines give a category score of 1 to 4 for different types of contraception and whether or not to use them in patients with certain medical conditions e.g. hypertension, smoking etc. These guidelines can be updated and changed on a regular basis, therefore it is always best to check the guidelines when prescribing contraception.
The scores indicate the following:
UKMEC Definition of category
Category 1 – A condition for which there is no restriction for the use of the method
Category 2 – A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3 – A condition where the theoretical or proven risks usually outweigh the advantages of using the method. The provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the
method is not usually recommended unless other more appropriate methods are not available or not acceptable
Category 4 – A condition which represents an unacceptable health risk if the method is used
Women who are 35 years of age or older and who smoke 15 or more cigarettes a day have category 4 for combined oral contraceptive pill (COCP).
Women who are breastfeeding for 0 to 6 weeks postpartum have category 4 for COCP.
Having varicose veins is given category 1 for both the COCP and progesterone only pill (POP). Also having mild cirrhosis without complications is also given category 1 for both the COCP and the POP.
As his GP, what conservative measures would be appropriate to advise this patient to do whilst trying to quit smoking? Choose three options.
Write a list of reasons why you want to stop
Set a date for stopping and stop completely – this is usually the best way as patients who cut down their smoking usually smoke more per cigarette.
Tell everyone that you are giving up smoking so that they are aware
Get rid of ashtrays, lighters and cigarettes
Be prepared for smoke withdrawal symptoms
Anticipate a cough
Be positive and take each day as it comes
Bupropion is sometimes prescribed in patients to assist them in giving up smoking. Which of the statements below are true? Choose three options.
Bupropion should be started while the person is still smoking, and they should be advised to stop smoking 7–14 days after initiating the medication.
The dose of bupropion is 150 mg once a day for 6 days, increasing to 150 mg twice a day for a total of 7–9 weeks. A lower dose should be used in the elderly, patients who have mild to moderate liver impairment and renal impairment where GFR is less than 50 mL/min.
Contraindications to prescribing bupropion include current seizures, a history of seizure, a central nervous system tumour, severe hepatic cirrhosis and if there is a history of bipolar disorder, anorexia nervosa or bulimina.
which of the following 2 are correct
A one-off blood pressure reading of 140/90mmHg requires treatment with anti-hypertensives
Isolated systolic hypertension is not associated with increased risk of coronary artery disease
The target blood pressure for diabetic patients with target organ damage (e.g. nephropathy) is <130/80mmHg
Antihypertensive drug treatment should be initiated in patients with sustained clinic systolic blood pressure ≥ 160 mmHg or sustained clinic diastolic blood pressure ≥ 100 mmHg
The use of beta-blockers is absolutely contraindicated in heart failure
The target blood pressure for diabetic patients with target organ damage (e.g. nephropathy) is <130/80mmHg
Antihypertensive drug treatment should be initiated in patients with sustained clinic systolic blood pressure ≥ 160 mmHg or sustained clinic diastolic blood pressure ≥ 100 mmHg
what is required for diagnosis of dementia
CT scan
Acute confusional state: if treating the underlying cause and environmental modification not working then ………………….. sometimes used
haloperidol
You are called to review an 82-year-old male on the geriatric ward who was admitted 7-days previously with community-acquired pneumonia (CAP). He has a past medical history of type 2 diabetes mellitus and Parkinson’s disease. Upon arriving, the patient is clearly confused and is trying to physically attack ward staff and other patients. Non-pharmacological attempts to calm the patient fail and the decision is taken to use pharmacological therapy.
Which of the following would be most appropriate for this patient?
lorazapem
Typical antipsychotics should be avoided in delirious patients with a background of Parkinson’s disease
A 38-year-old man presents with shortness of breath and wheezy episodes. His symptoms started 1 year ago. His shortness of breath was more marked in the evening and early morning. He also stated that his symptom worsens on dust exposure and in the winter season. He has no significant past medical and drug history of note. Two of his family members has a history of asthma. He is a non-smoker and social drinker.
On examination, there were widespread rhonchi present on both lungs upon auscultation of the chest.
What would be his expected spirometric findings?
FEV1-significantly reduced, FVC- normal, FEV1/FVC- reduced with >12% post-bronchodilator improvement is the correct option. In the given context, the patient’s symptoms, significant diurnal variation, dust and seasonal aggravation, positive family history and examination findings point towards the diagnosis of bronchial asthma. Bronchial asthma is an obstructive airway disease with post-bronchodilator reversibility. Pulmonary function tests can be used to determine whether a respiratory disease is obstructive or restrictive. The table below summarises the main findings and gives some example conditions.
A 48-year-old woman with a history of asthma presents to the emergency department with shortness of breath, cough, with some specs of brown sputum. The only recent change in her life is moving into her new flat. Chest x-ray appears normal but blood tests later reveal an elevated IgE and IgM to A.fumigatus and so a diagnosis of allergic bronchopulmonary aspergillosis is made.
Which of the following would be considered a major feature seen in this condition?
A 48-year-old woman with a history of asthma presents to the emergency department with shortness of breath, cough, with some specs of brown sputum. The only recent change in her life is moving into her new flat. Chest x-ray appears normal but blood tests later reveal an elevated IgE and IgM to A.fumigatus and so a diagnosis of allergic bronchopulmonary aspergillosis is made.
Which of the following would be considered a major feature seen in this condition?
Eosinophilia is a feature of allergic bronchopulmonary aspergillosis
A 60-year-old man is being investigated for chronic breathlessness. After a respiratory review, he is sent for a high-resolution CT scan to assess for any interstitial lung disease. Upper zone fibrosis is noted on the CT report.
Which of the following is the most likely diagnosis?
Coal workers’ pneumoconiosis typically causes upper zone fibrosis
An obese 49-year-old male presents after experiencing 4 episodes of haemoptysis over the last two weeks. He has a 30 pack year smoking history. On examination the patient has purple striae on his abdomen and there is reduced air entry in the right lung. A chest radiograph shows a well defined opacity in the right middle zone. Lung cancer is strongly suspected.
Baseline ACTH is 246 ng/L (normal <80 ng/L) and cortisol is 800 mmol/L (normal 450-700 mmol/L) measured at 9am. The cortisol is not suppressed with high dose dexamethasone.Blood tests reveal:
small cell lung cancer
Paraneoplastic manifestations of small cell lung cancer are produced by their ectopic production of ACTH and ADH. The ACTH production produces a cushing’s syndrome. The ADH production leads to a dilutional hyponatraemia.
A 72-year-old female patient, with a past history of chronic kidney disease (CKD) and type 2 diabetes mellitus, presents to her general practitioner for the results of her annual urinary albumin:creatinine ratio (ACR) test. Her previous results have all been below 3mn/mmol, but on this occasion, it is reported as 4.7mg/mmol. The patient also has the following blood results:
What is the most important change which should be made in her management plan, in response to this finding?
Commence an ACE inhibitor is correct as this should be done In all patients with a clinically raised ACR (>3mg/mmol) and co-existent diabetes mellitus.
What is the most appropriate contraception option for someone recently diagnosed with breast cancee?
copper intrauterine device
Current breast cancer is a contraindication for all hormonal contraceptives options (UKMEC 4), including the Depo-Provera.
Therefore, the copper intrauterine device is the only appropriate contraception out of the options given.
A 43-year-old woman comes for review. A few months ago she developed redness around her nose and cheeks. This is worse after drinking alcohol. She is concerned as one of her work colleagues asked her if she had a drink problem despite her drinking 10 units per week
acne rosacea
Rosacea features:
- nose, cheeks and forehead
- flushing, erythema, telangiectasia → papules and pustules
describe this ECG
The heart rhythm is regular, but no P waves are seen, the T waves are peaked and there is a tachycardia. This ECG is seen in hyperkalaemia.
The next change is a widening of the QRS complex, followed by ventricular arrhythmias which are often fatal.
A 74-year-old male presents to hospital with breathlessness. He does not think that he has passed urine for 24 hours.
type of renal failure
chronic renal failure
The low haemoglobin and more significantly low serum calcium and elevated serum phosphate would suggest that he has had significant renal impairment GFR <30mls/min for several months.
