GP Flashcards
What are the types of continuity?
Relational
- relationship
Longitudinal
- length of time
Informative
- record keeping
Why continuity important?
Patient satisfactions
Adherence to medical advice/ medication
Lower use of secondary care
Lower death rates
What are the factors in the grief cycle?
Denial
Bargaining
Anger
Depression
Acceptance
When should patients take their BP medication?
At night
What is typical angina pain?
Onset during exercise
Chest pain with radiation to jaw
Relieved by GTN
Typical is 3/3 of these
Atypical is only 2/3
What investigations do you want to do into someone presenting with chest pain that you suspect is angina, and when would you refer etc?
Bloods:
- FBC
- U&Es
- Cholesterol
- TFTS
- Diabetic screen
ECG
- q waves
- T-wave abnormalities
- changes to ST
Refer for CT angiogram if:
- atypical chest pain
- ECG changes with no angina history
If typical:
- start anti-angina medication
- refer for non- invasive testing
What advice should be given regarding GTN spray use:
Carry it at all times
If you need to use - stop and use.
Up to max 2 doses, if no relief phone 999
*if this occurs take aspirin
What are the mainstays of treatment for CVD?
Heart related: Aspirin
Non - heart related: Clopidogrel
When should diabetics be offered statins?
Type I:
- > 10 years of disease
- > 40 years old
- Established nephropathy
- other CVDs
Type II:
- >10% QRISK
What age group should be offered statins regardless of lipid level?
> 85 years old
What is the biggest predictor sign of PVD?
Cool limb
What do you do if you have a patient with suspected DVT/ PE but you are unable to get a scan that day?
Take blood for D-dimer.
Give LMWH
Get scan when possible.
- D-dimer can be analysed later as well
What advice can be given out regarding flying and DVT/ P.E risk?
Low risk:
- hydration
- flight stockings
Medium risk:
same + Aspirin
High risk:
same + LMWH
What is the definition of a chronic cough and list some of the most common examples seen in GP:
> 8 weeks
Asthma
Reflux
ACE inhibitors
What are the red flags of a cough?
Dyspnoea Haemoptysis Hoarse voice Weight loss Fever Dysphagia Chest pain
What investigations should be done into someone with a chronic cough?
All patients with a chronic cough should be referred for:
- CXR
- Spirometry
When are you going to suspect COPD?
Exertional breathlessness
Chronic cough
Regular sputum production
Frequent chest infections in winter
When is oxygen therapy suggested in COPD?
FEV1 < 30
Polycythemia
Oxygen stats <92%
Given when Pa<7.3 or Pa7.3 - 8 \+ Polycythaemia or cor-pulmonale
When should you refer COPD to secondary care?
Symptoms worse than what is suggested by spirometry
<40 years old (suggest alpha 1- Antitrypsin deficiency)
Haemoptysis
Rapid decline in disease/ pulmonary hypertension
What medications can be used to help neuropathic pain?
Amitriptyline
Gabapentin
Pregablin
Duloxetine
Under what situations would you check TFTs?
Symptoms of thyroid disease
Type I diabetes
New onset AF
Unexplained anxiety
Depression
+ in children:
- lack of growth
- unexplained misbehaviour
With regard to thyroid disease, which patients are referred onto secondary care and which are not. Additionally before referring what useful bloods can be done (thinking about potential treatments):
All thyrotoxicosis/ hyperthyroidism patients are referred to secondary care.
Hypothyroidism are treated in practice
Bloods
- FBC
- LFTs
When should levothyroxine be taken?
30 minutes before breakfast or tea/coffee
What important measure should be taken in pregnant women with hypothyroidism?
Increase levothyroxine as soon as they know they are pregnant.
- not to wait till Obs appointment.
20-30% increase is needed.
