Common GP conditions Flashcards
hard, raised, nodular skin lesion which may be ulcerated or keratinising. Mostly on head and neck
Squamous cell carcinoma
Ulcerated centre with raised edges. Pearly or waxy nodules. Telanietctatic area around lesion.
Basal cell carcinoma
Differential for a keratinising skin lesion
Keratocanthoma
Referral checklist for suspected malignant melanoma - 2 week wait.
Weighted 7-point checklist.
2 points for:
Change in size, irregular shape, irregular colour.
1 point for:
Diameter over 0.7cm, inflammation, oozing and change in sensation.
Most common type of prostate cancers
Adenocarcinomas (glandular cells)
Most common place for prostate cancer met
Bone causing fragility and bone pain.
Risk factors for prostate cancer
Age (over 50)
Black ethnicity.
FHx
Obesity and weight,
Tool for risk stratification of localized prostate cancer
Gleason score (includes PSA) and TNM clinical staging.
Signs and symptoms of prostate cancer
lower urinary tract symptoms e.g. freuqency, urgency, hesitancy, dribbling or poor stream. Lower back or bone pain. Lethargy. Erectile dysfunction. Haematuria. Weight loss and anorexia.
Investigations for prostate cancer
DRE - hard and nodular.
Raised PSA levels.
Transrectal US and biopsy.
Management of prostate cancer
dependent on advance stage of cancer.
radical = prostatectomy, radiotherapy.
Adjuvant horomne therapy.
Criteria for antibiotics in sore throats
Centor:
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenitis
- History of fever (over 38°C)
- Absence of cough
4 AKI causing drugs
Diuretics
ACE inhibitor
NSAIDs
Metformin
What to consider when prescribing a drug
NO TEARS Need of medication. Open questions on adherence. Tests and monitoring Evidence and guidelines for use of medication Adverse effects Risk reduction/prevention Simplification and switches
What is a medication review?
Structure examination of patient’s medicines with the aim of reaching a mutual agreement on the treatment plan while optimising the impact of medicines, minimising side effects and reducing waste.
- USE STOPP-START toolkit for medicines review!!
Old people and prescribing
- Age related organ damage = adverse effects more likely.
- Multiple co-morbidities = more drugs = more interactions or contraindications.
- USE STOPP-START toolkit for medicines review!!
Poor renal function and medications
Reduced renal excretion can lead to toxicity.
Sensitivity to drug if elimination is impaired.
More side effects
Not as effective.
Local and systemic causes of an itch
Local = eczema, folliculitis, ringworm/tinea, insect bite. Systemic = liver disease, CKD, polycythaemia rubra vera (after hot bath), lymphoma.
beta blocker which increases QT interval
Sotalol, can cause ventricular arrhythmia.
3 reasons to deprescribe
Patient choice
Risk outweighs benefit
Not relevant.
Age of mental capacity act
16
The Mental Capacity Act’s 5 main principles.
- Assumed to have capacity unless established otherwise.
- Duty to support patients to make decisions and provide appropriate help in making decision.
- Able to make unwise or eccentric decisions.
- If lack capacity any action must be done in best interests of patients,
- Least restrictive intervention.
Deprivation of liberty safeguards
Care-homes and hospitals are allowed to lawfully detain a patient OVER THE AGE OF 18 who lacks capacity if the action is in the best interests of the patient and to protect them from harm.
Need supervisory, local authority to approve.
Can not be done if advanced directive states refusal of treatment wanting to be give.
Lasting Power of Attorney decision is against DOLS.
Got no family or friends and lack capacity who turns up to best interest meeting?
Independent Mental Capacity Advocate.
