GP

Question 1

Most common cause of viral gastroenteritis in children?

Answer 1

rotavirus

Question 2

What signs should raise suspicion of gastroenteritis having a bacterial cause?

Answer 2

blood in stool, or a fever of greater than 39 in adults of 38 in children under than three months

Question 3

What’s a normal ankle-brachial pressure?

Answer 3

normal is between 0.9 and 1.2. Values below 0.9 indictate arterial disease but values above 1.3 can do in the form of false neg results secondary to arterial calcification

Question 4

Mainstay of treatment for venous ulcers?

Answer 4

compression therapy, wound care and topical agents to control bacterial overgrowth

Question 5

conservative treatments of varicose veins?

Answer 5

leg elevation, weight loss, regular exercise, compression socks

Question 6

treatments for varicose veins?

Answer 6

endothermal ablation, foam sclerotherapy and surgery

Question 7

Who is eligible for liraglutide? (GLP1)

Answer 7

Initial BMI of 35 or more and nondiabetic hyperglycaemia and high risk of CVD

Question 8

who is eligible for tirepatide and semaglutide?

Answer 8

people with a bmi of at least 35 and at least one weight related comorbidity

Question 9

when should people be offered assessment for bariatric surgery?

Answer 9

if they have a bmi of more than 40, or between 35 and 39 with significant health problem that could be improved if they lost weight

Question 10

When should you consider prescribing antiviral for influenza?

Answer 10

if patient is an at risk group, there is circulating influenza nationally and the patient is able to start treatment within 48 hours

Question 10

First line for diarrhoea in IBS?

Answer 10

Loperamide (Immodium)

Question 11

First line for influenza?

Answer 11

oseltamivir

Question 12

What is reduced in secondary hypothyroidism?

Answer 12

thyrotropin releasing hormone which leads to a decreased stimulation of the thyroid and subsequent hypothyroidism

Question 13

first line investigations for hypothyroidism?

Answer 13

thyroid stimulating hormone and serum free T4 (thyroxine)

Question 14

starting dose of levo for normal patients and patients with cardiac disease/or that over 50?

Answer 14

cardiac disease/over 50 25mcg that should be uptitrated slowly, other patients 50-199mcg

Question 15

How should dose adjustments of levo be done for pregnant women?

Answer 15

women who get pregnant should have their dose increased by at least 25-50mcg

Question 16

what is a type 1 hiatus hernia?

Answer 16

a sliding one, most common, involves sliding movement of GEJ above the diaphragm

Question 17

what is a type II hiatus hernia?

Answer 17

paraesophageal - the GEJ stays in normal position but the stomach herniates through the hiatus beside it. Has increased risk of vovulus

Question 18

stereotypical presentation of hiatus hernia?

Answer 18

middle aged patient with symptoms of GORD, might get chest pain and resp symptoms if large

Question 19

first line investigation for hiatus hernia?

Answer 19

barium swallow, but gastroscopy is the gold standard as it allows direct visualisation

Question 20

non surgical hiatus hernia management?

Answer 20

lifestyle modifications, and proton pump inhibitors. H2 receptor antagonists may be considered if PPIs are not tolerated

Question 21

What is firstline surgical management for hiatus hernia?

Answer 21

laparoscopic fundoplication (Nissen fundoplication)

Question 22

grading of internal haemorrhoids?

Answer 22

grade I do not prolapse, grade II prolapse on defecation but reduce spontaneously, grade III can be manually reduced, grade IV cannot be reduced

Question 23

clinical features of haemorrhoids?

Answer 23

painless rectal bleeding, pruritus, pain not usually significant unless piles are thrombosed

Question 24

management of haemorrhoids?

Answer 24

soften stools with fibre and fluid, topical anesethics and steroids, rubber band ligation

Question 25

Patients with GORD symptoms, who should be referred for OGD?

Answer 25

age >55, symptoms > 4 weeks, dysphagia, symptoms despite treatment, relapsing symptoms, weight loss, excessive vomiting

Question 26

If there is an inadequate response to PPI in treatment of GORD what other medical management can be given?

Answer 26

H2 receptor antagonist therapy (ranitidine etc)

Question 27

What ambulatory blood pressure reatings count as stage 1 hypertension?

Answer 27

>135/85 to 150/95.

Question 28

when should stage 1 hypertension be treated?

Answer 28

if less than 80 and any of : target organ damage, established CVD, renal disease, diabetes

Question 29

Cause of unequal blood pressure readings from each arm?

Answer 29

aortic stenosis

Question 29

What are the potassium levels to determine which drug should be added as a step four antihypertensive agent?

Answer 29

if potassium is less than 4.5 add spiro, if potassium > 4.5 add an alpha or a beta blocker

Question 30

What are blood pressure targets to aim for in under 80 and over 80?

Answer 30

under 80 135/85, over 80 145/85

Question 31

what kind of drug is ipatropium bromide?

Answer 31

SAMA - short acting muscarinic antagonists

Question 32

What kind of drug is tiotropium?

Answer 32

long acting muscarinic antagonist

Question 33

If a patient is taking a SABA or SAMA and still getting symptoms but they have no asthmatic features what should be added?

Answer 33

a long acting beta 2 agonist and a long acting muscarinic antagonist

Question 34

What should be done before giving azithromycin prophylaxis to COPD patients?

Answer 34

liver function tests and an ECG to exclude QT prolongation as azithromycin can prolong QT interval

Question 35

Which COPD patients should be assessed for long term oxygen therapy?

Answer 35

FEVI less than 30% predicted, cyanosis, polycthaemia, peripheral oedema, raised JVP, oxygen sats less than or equal to 92% on room air

Question 36

Whereabouts do majority of anal fissures occur?

Answer 36

90% occur on posterior midline

Question 37

First line for chronic anal fissure? (>6 weeks)

Answer 37

topical glyceryl trinitrate, if topical GTN not effective then secondary care referral should be considered for surgery or botilinum toxin