General practice

Question 1

Name 3 health professionals who look after children until the age of 10.

Answer 1

community midwife: pregnancy and few weeks after birth

community health visitor: until the age of 5

school nurse: 5 to 10. does the hearing vision test.

Question 2

Name 3 things recorded in the Personal Child Health Record or the red book.

Answer 2

Height
Weight

Vaccinations

Question 3

What are the main concerns to look for in a NIPE screening programme for newborns or infants?

Answer 3

Congenital Heart Disease
Developmental Dysplasia of the Hip (DDH)

Congenital cataracts
Undescended testes

Question 4

What are the common sites for osteoarthritis?

Answer 4

Weight bearing joints

Knees and hip and spine

Question 5

Give two articular features of osteoarthritis.

Answer 5

1. loss of cartilage

2. formation of new bone

Question 6

What is the typical presentation of osteoarthritis?

Answer 6

> 45yo
pain and stiffness in weight bearing joints

stiffness in the morning/after rest lasting no longer than 30 mins
pain and stiffness worse with movement and exercise

Question 7

What are the red flag symptoms for a musculoskeletal condition?

Answer 7

back pain < 25yo
worsening back pain >55yo

Hx of cancer
steroid use
HIV positive
weight loss
structural deformities
night pain and sweats
saddle anaesthesia

Question 8

Give examples of non-pharmacological management of osteoarthritis.

Answer 8

weight loss
walking aids

exercise and physiotherapy
electrotherapy- transcutaneous electrical nerve stimulation (esp back pain)
appropriate footwear

Question 9

Give examples of pharmacological management of osteoarthritis.

Answer 9

topical capsaicin
paracetamol

NSAIDs (with PPI)
intra-articular corticosteroid injections

Question 10

Describe the analgesic ladder.

Answer 10

Mild pain: non-opioids: NSAIDs, aspirin, paracetamol
Moderate pain: mild opioids: codeine (constipation), dihrydrocodeine

Severe pain: strong opioids: morphine, tramadol, pethidine, diamorphine, fentanyl

Question 11

What are the side effects of opioids?

Answer 11

nausea, vomiting, constipation, drowsiness, respiratory depression, hypotension, addiction and itching

Question 12

What is a characteristic side effect of tramadol?

Answer 12

Serotonin syndrome

Question 13

What are the side effects of NSAIDs?

Answer 13

stroke, high blood pressure, tinnitus, peptic ulcer, indigestion

Question 14

What are the possible side effects of paracetamol?

Answer 14

Nausea, loss of appetite, leucopenia, low blood pressure, diarrhoea.

Question 15

How do you treat morphine overdose?

Answer 15

IV naloxone

Question 16

How do you treat paracetamol overdose?

Answer 16

IV N-acetylcysteine

Question 17

What tool would you use to assess a patient’s risk of developing cardiovascular disease in the next 10 years?

Answer 17

QRISK3

Question 18

What does the Dipeptidyl peptidase 4 inhibitor, pioglitazone, increase the risk of?

Answer 18

heart failure, bladder cancer, bone fracture

Question 19

What does a diabetic review involve?

Answer 19

Blood glucose test- HbA1c
Blood pressure check

Cholesterol check
Eye screening
Foot and leg exam
Renal function test
Advice on diet
Emotional and psychological support
Free flu jab
Sexual health concerns

Question 20

Name some complications of diabetes.

Answer 20

Neuropathy
Nephropathy

Retinopathy
Cardiovascular disease
Foot damage and gangrene
Hearing impairment
Skin conditions
Depression

Question 21

Give 3 causes of MI.

Answer 21

1. coronary atherosclerosis
2. coronary thrombus
3. reduced blood flow to heart due to shock or haemorrhage

Question 22

What are the side effects of corticosteroids?

Answer 22

immunosuppression
loss of bone density
mood
weight gain
hypertension
diabetes mellitus

Question 23

What would you expect to see on an X-ray of a joint with rheumatoid arthritis?

Answer 23

osteophyte formation

Question 24

Give 3 examples of DMARDs.

Answer 24

Methotrexate
Sulfasalazine
Azathioprine

Question 25

Why should sulfasalazine not be given to men?

Answer 25

reduces sperm count causing subfertility

Question 26

What signs and symptoms should a patient on myelosuppressants (chemo, azathioprine) look out for?

Answer 26

sore throat, fever, unexplained bruising or bleeding

Question 27

Define chronic kidney disease.

Answer 27

The presence of kidney damage (albuminuria) or decreased kidney function (glomerular filtration rate < 60 ml/minute per 1.73 m^2) for 3 months or more, irrespective of clinical diagnosis.

Question 28

What are the risk factors for CKD?

Answer 28

``` proteinuria CVD AKI hypertension diabetes mellitus smoking African, afro-Caribbean, Asian family origin chronic use of NSAIDs ```

Question 29

Describe the stages of CKD.

Answer 29

Stage 1: normal: >90 Stage 2: mild impairment: 60-89 Stage 3a: moderate impairment: 45-60 Stage 3b: moderate impairment: 30-45 Stage 4: severe impairment: 15-30 Stage 5: end-stage renal disease/established renal failure: <15 or on dialysis

Question 30

What does renal replacement therapy include?

Answer 30

haemodialysis, peritoneal dialysis, chronic ambulatory peritoneal dialysis, renal transplantation

Question 31

Give 3 benefits and 3 risks of transplantation.

Answer 31

Benefits: improved quality of life, no need for dialysis, reversal of anaemia and renal bone disease Risks: immediate operative complications (infection, pain, pneumonia, DVT), immediate graft failure, arterial or venous thrombosis in the transplant, side effects of immunosuppressive drugs.

Question 32

What are the contra-indications to peritoneal dialysis?

Answer 32

Abdominal adhesions, stoma, obesity, intestinal disease, respiratory disease, hernias.

Question 33

What does haemodialysis involve?

Answer 33

Blood is drawn from an arteriovenous fistula and circulated through a dialyser before being returned to the body.

Question 34

What does peritoneal dialysis involve?

Answer 34

A dialysate is infused into the peritoneal cavity and the blood flowing through the peritoneal capillaries acts as the blood source.

Question 35

What are the risks of breast cancer screening?

Answer 35

overtreatment unnecessary distress missed diagnosis x-ray radiation exposure during mammogram

Question 36

Who is offered breast cancer screening?

Answer 36

Women aged 50 to 71 who are registered with a GP, every 3 years

Question 37

What happens if someone has an abnormal breast screening result?

Answer 37

more mammograms, breast examination, ultrasonography, biopsy

Question 38

Give 5 symptoms of breast cancer.

Answer 38

``` breast lump nipple colour change nipple discharge (might be bloody) axillary lumps breast pain ```

Question 39

Give 5 risk factors of breast cancer.

Answer 39

``` Personal or family history of breast cancer BRCA-1 or BRCA-2 gene or TP53 mutation increased age obesity after menopause Increased exposure to oestrogen ```

Question 40

What are the complications of breast cancer treatment?

Answer 40

arm mobility, lymphoedema, menopausal symptoms, neutropenic sepsis

Question 41

What are the criteria for the genetic screening of BRCA?

Answer 41

More than 2 relatives who have had breast cancer before 50 relative who has developed breast cancer in both breasts male family history of breast cancer eastern European heritage jewish

Question 42

What is the pharmacological treatment of depression?

Answer 42

fluoxetine (SSRI) | marplan (MAOi)