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Clinical Years / Progress Test > GP > Flashcards

GP Flashcards

1
Q

causes of back pain broadly

A
  • mechanical
  • fracture
  • malignancy
  • infection
  • inflammatory/autoimmune
  • non back pain e..g pancreatitis, AAA, pyelonephritis, pneumonia
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2
Q

pathologies underlying mechanical back pain

A
  • bulging/herniated/degenerating disc
  • lumbar muscle strain
  • spine stenosis
  • facet joint disease
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3
Q

types of spinal fracture/bony disease

A

Spondylolysis - Pars Interarticularis fracture (stress fracture)
- not particularly painful or debilitating

spondylolisthesis – vertebral body slippage secondary to spondylolysis
- likely associated with nerve root symptoms

Vertebral Fracture e.g. wedge fractures in osteoporosis
- extreme tenderness over area

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4
Q

back pain in malignancy

A
  • secondaries from other cancer
  • myeloma
  • rarely primary tumours

especially suspect if thoracic, night pain, rest pain

cancers that are more likely to metastasise to bone are Kidney, Ovarian, Thyroid, Lung, Prostate, Testicular (only certain types), Myeloma, Breast

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5
Q

infectious causes of back pain

A

rare
- discitis
- osteomyelitis
- TB

any infective symptoms?
any immunosuppression or diabetes?

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6
Q

inflammatory/autoimmune causes of back pain

A
  • Inflammatory spondyloarthopathy e.g. Ankylosing Spondylitis
  • Connective tissue diseases
  • Reactive arthritis

PMH and morning stiffness are indicators

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7
Q

what conditions associated with back pain need to be identified/ruled out using red flags

A

cauda equina
spinal fracture
cancer
infection

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8
Q

red flags back pain

A
  • bilateral sciatica or neurological deficit
  • urinary retention, incontinence or difficulty
  • loss of sensation of rectal fullness –> incontinence
  • saddle anaesthesia or parasthesia
  • Sudden onset, severe pain, relieved by lying down
  • History of trauma (this may be minor in those with osteoporosis)
  • Structural spinal deformity
  • Point tenderness over a vertebral body
  • > 50 years old
  • gradual onset, unremitting pain disturbing sleep
  • worse straining
  • thoracic pain
  • unexplained weight loss
  • any past hx of cancer
  • Fever
  • Tuberculosis, or recent urinary tract infection
  • Diabetes
  • History of intravenous drug use
  • HIV infection, use of immunosuppressants, or the person is otherwise immunocompromised
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9
Q

palliative care medicines for
1. Anorexia
2. Hiccups
3. Pruritis
4. nausea

A

anorexia - dexamethasone

hiccups - metaclopromide

pruritus - cholestyramine

nausea - cyclizine

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10
Q

palliative care medicines for
1. Dyspnoea
2. Excessive respiratory secretions
3. Capillary bleeding

A

dyspnoea - morphine

secretions - hyoscine

capillary bleeding - tranexamic acid

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11
Q

palliative care medicines for
1. muscle spasms
2. insomnia
3. restlessness

A

spasms - baclofen

insomnia - diazepam/tenazepam

restlessness - haloperidol

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12
Q

what is disulfiram

A

causes an acute reaction when consumed with alcohol thus acting as a deterrent

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13
Q

what is acamprosate

A

reduces the desire to drink alcohol

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14
Q

what medications should people with alcohol dependence be taking

A

thiamine and folic acid tablets

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15
Q

common side effects of metformin

A

Abdominal pain
Anorexia
Diarrhoea (usually transient)
Nausea
Taste disturbances
Vomiting

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16
Q

group 1 license; when do diabetics on non-insulin medication need to inform DVLA

A

if
- two episodes of severe hypoglycaemia within the last 12 months
- any impaired awareness of hypoglycaemia
- a disabling hypo is experienced while driving
- if other medical conditions may contribute to ability to drive

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17
Q

what non-insulin medications are most likely to cause hypos

A

sulphonylurea or glinide tablets

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18
Q

insulin treated diabetes self monitoring for driving

A

test no more than 2 hours before start of journey
test every 2 hours of driving

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19
Q

group 2 vehicles DVLA diabetes

A

must notify DVLA but can drive if
- full hypo awareness
- no severe hypo in last 12 months
- regularly self monitoring even when not driving
-

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20
Q

NICE weighted 7 point checklist suspected melanoma

A

Major features of the lesions (scoring 2 points each):
change in size
irregular shape
irregular colour.

Minor features of the lesions (scoring 1 point each):
largest diameter 7 mm or more
inflammation
oozing
change in sensation

refer if 3 or more points of 2ww

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21
Q

how quickly should a GP send a 2ww referral off

A

within 24 hours of seeing the pt and making the referral decision

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22
Q

is cholesterol measured for asymptomatic patients

A

yes - everyone aged 40-74 can have a CVD risk check

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23
Q

what does a CVD risk check include

A

cholesterol
diet
physical activity
smoking
alcohol
ethnicity
family hx

24
Q

testing renal function on ACEi

A

before starting and after 2 weeks

regular testing thereafter

25
Q

what is QRISK

A

a tool, used in primary care, to calculate a patient’s risk of suffering a cardiac event, or a stroke, over the next 10 years as a percentage. It takes into account the patient’s age, cholesterol results, family history, ethnicity, blood pressure and other existing conditions.

26
Q

what is QRISK

A

a tool, used in primary care, to calculate a patient’s risk of suffering a cardiac event, or a stroke, over the next 10 years as a percentage. It takes into account the patient’s age, cholesterol results, family history, ethnicity, blood pressure and other existing conditions.

27
Q

what should be done if QRISK over 10%

A

have a discussion about health behaviour modification, support to make changes and the offer to re-assess their risk again after they have tried to change some behaviours. If behavioural intervention is ineffective or inappropriate, then statin treatment should be offered.

28
Q

statin recommendation if behaviour change doesn’t bring QRISK to <10%

A

20mg atorvastatin for the primary prevention of CVD

29
Q

exercise recommendations

A

strength exercises on 2 or more days week, and 150 minutes of moderate activity or 75 minutes of vigorous activity (or a combination of both) and to reduce time sitting.

30
Q

fever pain criteria sore throat

A

The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
o Fever over 38°C.
o Purulence (pharyngeal/tonsillar exudate).
o Attend rapidly (3 days or less)
o Severely Inflamed tonsils
o No cough or coryza

A score of 0 or 1 is associated with a 13% to 18% likelihood of isolating streptococcus. A score of 2 or 3 is associated with a 34% to 40% likelihood of isolating streptococcus. A score of 4 or 5 is associated with a 62% to 65% likelihood of isolating streptococcus.

31
Q

types of emergency contraception

A

Copper coil - most effective. up to 5 days

Levonorgestrel - EHC. Up to 72 hours

Ulipristal - EHC up to 5 days

32
Q

when would a pregnancy test be needed after emergency contraception

A

irregularity in her cycle and if her next period is light or more than 3 days late, she’d need a pregnancy test.

33
Q

swollen ankle/lower limb differentials

A

Gout
Septic arthritis
Cellulitis
Inflammatory arthritis
Osteoarthritis
Trauma
DVT

34
Q

melaena

A

black “tarry” sticky faeces due to upper GI bleeding; the black colour is due to haemoglobin being altered by digestive chemicals and intestinal bacteria.

35
Q

features of stomach upset caused by ferrous sulphate

A

stomach upset, cramps, dark grittiness of the stools and altered bowel habit, either towards constipation or diarrhoea

differentiating from upper GI bleed; stool are dark but gritty and pain is relieved by defection

36
Q

GP medications that can lead to hyponatraemia

A

ACE inhibitors, diuretics, anti-depressants, and proton pump inhibitors

37
Q

campylobacter
- what is it
- what treatment
- work/school
- public health?

A

Campylobacter are a group of bacteria that cause food poisoning, often due to eating undercooked meat

no treatment is usually required except good hydration during the illness

stay off until 48 hrs after last episode of diarrhoea

it is a notifiable disease to Public Health England

38
Q

ongoing diarrhoea differentials

A

hyperthyroidism

IBS

IBD

anxiety

coeliac disease

colorectal cancer

39
Q

investigations ongoing diarrhoea

A

TFTs
Faecal calprotectin - normal reduces likelihood of IBD
CRP + ESR
FBC
renal function - might put strain on kidneys
Tissue Trans-glutaminase antibodies - coeliac

40
Q

medication for spasms in IBS

A

buscopan ( hyoscine butylbromide)

41
Q

Clostridium Difficile
- what is it
- how does it occur
- treatment

A

most common cause of diarrhoea in hospitalised patients especially if they have received antibiotics and are elderly

bacteria which can be found in healthy people’s intestines but can cause diarrhoea when the normal gut and intestinal bacteria flora are compromised (e.g. due to antibiotics and other medications, including Proton pump inhibitors), which then lead to an overgrowth of C.difficile

in severe cases can cause pseudomembranous colitis

it is a notifiable disease

treated with other oral antibiotics, such as vancomycin/metronidazole and in the community there would need to be strict hygiene measures

42
Q

common side effects of opiates

A

constipation
itch
nausea and vomiting

43
Q

self management advice for constipation

A

increased consumption of fruit and vegetables
physical activity
hydration
feet on low stool when opening bowels

44
Q

systems to examine/enquire about for dizziness

A

cardio
resp
GI - could be bleed, dehydration etc
neurological
ENT

45
Q

symptomatic medications for vertigo

A

A vestibular sedative such as cyclizine, cinnarazine, or prochlorperazine
A vasodilator in the inner ear called Betahistine - review and stop if not helping

both should be limited courses

46
Q

what is in a rescue pack for COPD exacerbation

A

prednisolone
doxycycline

to be started if increased breathlessness or discoloured sputum

47
Q

when should a COPD exacerbation be hospitalised

A

Severe breathlessness.
Inability to cope at home (or living alone).
Poor or deteriorating general condition.
Acute confusion or impaired consciousness.
Cyanosis or reduced oxygen saturation esp <90%
Worsening peripheral oedema.
A new arrhythmia.

48
Q

common side effects of furosemide

A

mild gastro-intestinal disturbances

postural hypotension

electrolyte disturbances (including hyponatraemia, hypokalaemia, hypocalcaemia,
hypochloraemia, and hypomagnesaemia)

hypersensitivity reactions (including rash, photosensitivity, and pruritus)

49
Q

HARK questionnaire

A

screening tool for domestic abuse

H-humilation
A-afraid
R-rape
K- kick or other physical violence

1 point for each yes

sometimes S is added for is it safe to go home

50
Q

starting treatment for type 2 diabetes

A

if HbA1C confirmed >48 after two tests then first start with lifestyle changes for 3 months
- diet
- weight
- exercise
- address other factors such as smoking and alcohol
useful if pt can see HbA1C come down

if still diabetic then metformin is first line

51
Q

target HbA1C if on 2 medications

A

58 mmol/L

52
Q

target HbA1C if one 1 medication

A

48 mmol/L normally

53 if medication can cause hypos such as a sulphonylurea

53
Q

lower GI cancer 2WW criteria

A

-They are aged 40 and over with unexplained weight loss and abdominal pain or
-They are aged 50 and over with unexplained rectal bleeding or
-They are aged 60 and over with:
-Iron-deficiency anaemia or
-Changes in their bowel habit
-Tests show occult blood in their faeces

54
Q

statins blood tests/monitoring

A

blood tests before

Repeat blood tests would be required at 3 months for total cholesterol, HDL and non-HDL cholesterol, plus liver function tests at 3 months and 12 months - small risk atorvastatin can affect liver

55
Q

mechanism of action levonorgestrel

A

inhibiting or at least delaying ovulation by preventing follicular rupture

Clinical Years / Progress Test (24 decks)

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