General Practice

Question 1

What are the differentials for back pain?

Answer 1

Mechanical - muscle sprain/strain
Fracture
Malignancy
Infection e/g, osteomyelitis

Question 2

What are the red flags for cauda equina syndrome?

Answer 2

Bilateral sciatica
Progressive bilateral neurological deficit of the legs
Impairment of urinary flow or bowel flow
Saddle anaesthesia

Question 3

What are the red flags for a spinal fracture?

Answer 3

Sudden onset severe pain
Pain relieved by lying down
History of trauma (may be minor in those with osteoporosis)
Point tenderness over vertebral body

Question 4

What are the red flags for back pain for cancer?

Answer 4

>50 years 
Gradual onset
Severe pain 
Pain worse at night
Pain worse when coughing or sneezing 
Thoracic back pain 
Radicular pain 
Weight loss
Past history of cancer

Question 5

What are the red flags for back pain and infection?

Answer 5

Fever
Tuberculosis - or recent UTI
Diabetes 
History of IVDU
HIV infection 
Immunocompromised

Question 6

What are the 2 vitamins which alcohol addicts may be short on and should be supplemented during withdrawal of alcohol?

Answer 6

Folic acid (vitamin B12) - as alcohol affects the body’s ability to absorb folate

Thiamine (B1) - low thiamine is often seen in alcoholics

Question 7

What condition is low thiamine related to?

Answer 7

Brain disorder

Wernicke-korsaoff syndrome (WKS)

Question 8

What medications should alcoholic be put on when helping with detoxification?

Give an example

Answer 8

Benzodiazepines

Example: chloradiazepoxide

Question 9

When would you need to inform the DVLA if you have diabetes?

Answer 9

If you have had 2 episodes of severe hypoglycaemia in the last 12 months
If you are unable to recognise when a hypoglycaemic episode starts
If you have experienced a disabling hypo while driving
If you have other medical conditions which could effect your ability to drive e.g, vision problems, circulation/sensation problems

Question 10

How would you advise a diabetic to manage their diabetes during Ramadan?

Answer 10

High risk patients (for hypoglycaemia) and those who have diabetic complications are advised not to fast

Patients taking sulphonylureas (e.g, glicazide) - should stop taking these as they have a side effect of hypoglycaemia

Question 11

What is the centor criteria?

Answer 11

Used to predict bacterial infection in patients with sore throat:

• presence of tonsillar exudate
• fever
• absence of cough
• cervical lymphadenopathy

Question 12

At what score on the centor criteria would you prescribe antibiotics?

Answer 12

If they were scoring a 3 or a 4 - this is suggestive of bacterial infection

Offer 2 day delayed prescription if wary

Question 13

What is the Fraser criteria

Answer 13

The guidelines for prescribing contraception in a girl under the age of 16

• they understand the advice
• they cannot be persuaded to inform their parents
• they are likely to have sexual intercourse with or without treatment
• unless they receive treatment/advice then their mental health may suffer

Question 14

What is the mode of action of the IUD (copper coil)?

Answer 14

Prevents fertilisation by causing decreased sperm motility and survival (possibly due to effect of copper ions)

Question 15

What is the most of action of the IUS (mirena)?

Answer 15

Progesterone based (levonorgestrel)

Levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

Question 16

How many days after insertion is the IUS effective?

Answer 16

7 days

Question 17

What is the effect of the IUS (mirena coil) on periods?

Answer 17

Initial frequent uterine bleeding and spotting

Later women typically have intermittent light menses with some women becoming amenorrhoeic

Question 18

What are the risks of implantation of the IUS and IUD?

Answer 18

Perforation - 2 per 1000 insertions
Ectopic pregnancy - as if they were to get pregnant it would be more likely be in the tubes
Infection - small increase in PID in first 20 days after insertion
Expulsion - risk is 1 in 20, more likely to occur in first 3 months

Question 19

What is the most of action of the combined oral contraceptive pill?

Answer 19

Inhibits ovulation by tricking your body into thinking it is pregnant already - hormones mimic pregnancy hormones

Question 20

What is the mode of action of the progesterone only pill?

Answer 20

Thickens cervical mucus

Question 21

What is the method of action of the implant?

Answer 21

Inhibits ovulation

Also thickens cervical mucus

Question 22

What are the absolute contraindications to starting the combined contraceptive pill?

Answer 22

> 35 years old and smoking >15 cigarettes a day
Migraine with aura
History of VTE or thrombogenic mutation e.g factor V Leiden
History of stroke or ischaemic heart disease
Breast feeding <6 weeks post-partum
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation

Question 23

How often is the depo injectable contraceptive given?

Answer 23

Every 3 months

Question 24

What is the mode of action of the depo injection for contraception?

Answer 24

Inhibits ovulation

Also causes cervical mucus thickening and endometrial thinning

Question 25

What are the adverse effects of the injection?

Answer 25

Irregular bleeding
Weight gain
May increase risk of osteoporosis
Not quickly reversible and fertility may return after a varying time (up to 12 months)

Question 26

What are the differential for a swollen ankle?

Answer 26

Cellulitis
Septic arthritis 
DVT
Inflammatory arthritis 
Gout 
Oedema 
Sprain/fracture

Question 27

Which medications can cause hyponatraemia?

Answer 27

ACE inhibitors 
Diuretics 
PPIs - omeprazole 
Antidepressants- SSRIs 
NSAIDs

Question 28

What is rescue pack for COPD?

Answer 28

Owned by patients with COPD
They are given to patients who are identified as being able to benefit from prompt use of steroids and/or antibiotics
Steroids are to be taken if the patient notices an increased SOB affecting activities of daily living
Antibiotics are to be taken during symptoms of chest infection - if they have more discoloured sputum

Question 29

What is the HARK questionnaire for domestic abuse?

Answer 29

H - Humiliation
A - Afraid
R - Rape
K - Kick