GP Flashcards
1
Q
What things should be asked when investigating a possible malignant hypertension?
A
Any obvious symptoms indicating accelerating or malignant HTN- Headache, visual disturbances, seizures, nausea and vomitting, chest pain
2
Q
What things should be asked for when investigating kidney disease as a cause of hypertension?
A
Visable blood or frothy urine (indicative of proteinuria)
Lower limb swelling
Tenderness and pain in flank
Weight loss
3
Q
What should be asked when taking a history for hypertension?
A
- Family history
- Medications
- Menstrual cycle
- Any symptoms
4
Q
What clinical findings would indicate autosomal dominant polycystic kidney disease?
A
Enlarged palpable kidneys when balloting the kidneys
5
Q
What clinical findings would indicate renal artery stenosis?
A
Renal bruits heard when auscultating over the area of the renal arteries
6
Q
What clinical findings would indicate coarctation of the aorta?
A
Systolic murmer in the left infraclavicular region under the left scapula
7
Q
What clinical findings would indicate cushings syndrome?
A
Moon faces, abdominal purple striae and bruising
8
Q
What clinical findings would indicate hypothyroidism?
A
Brittle nails, dry skin and thin hair
9
Q
What clinical findings would indicate hyperthyroidism?
A
Fine tremor, palmar erythema and a neck goitre
10
Q
What clinic blood pressure indicates stage one hypertension?
A
> 140/90 mmHg
11
Q
What clinic blood pressure indicates stage two hypertension?
A
> 160/100 mmHg
12
Q
What clinic blood pressure indicates stage three hypertension?
A
180/120 mmHg
13
Q
What is ABPM?
A
Ambulatory blood pressure monitoring
14
Q
What is HBPM?
A
Home blood pressure monitoring
15
Q
What extra investigations should be given to someone with hypertension?
A
Urinalysis= for haematuria and proteinuria (Renal disease)
Urine albumin creatinine ratio (End organ damage)
ECG for cardiac arrhythmias
Blood U&E for renal impairment
HbA1c for diabetes
16
Q
What lifestyle changes can improve hypertension?
A
Improving diet with less salt Cut back on alcohol Have a healthy BMI Exercise regularly Cut down on caffeine Stop smoking
17
Q
What medications can be used for hypertension?
A
ACE inhibitors Angiotensin-2 receptor blockers (ARBs) Calcium channel blockers Diuretics Beta blockers Alpha blockers
18
Q
What are some risk factors for hypertension?
A
Obesity, high salt, caffeine, alcohol, low exercise, over 65, family history, black African or Caribbean descent, the pill etc.
19
Q
What things should be discussed/ checked during a postnatal check?
A
- Any pain
- Breastfeeding?
- Mental wellbeing
- Periods/discharge
- Contraception
- Check stitches
- Check BMI and BP
20
Q
What contraception can be used immediately after birth?
A
- Progesterone only pill
- Injection and implant
- Condoms
- IUD and IUS if inserted within 48 hrs of birth
- LAM
21
Q
What things may affect mothers contraception choice after birth?
A
- Whether she wants more children
- Breastfeeding
- Personal preference
22
Q
What is checked during an 8 week baby check?
A
- Babys head circumference
- Babys weight
- Babys heart and breathing
- Babys hips
- Babys spine
- Babys genitals
23
Q
What is the red book?
A
A personal record of a childs health
24
Q
When are the infanrix hexa vaccines administered?
A
8 weks
12 weeks
16 weeks
25
What is vaccinated against with the infanrix hexa vaccine?
- Diptheria
- Tetanus
- Pertussis
- Polio
- Haemophillius influenzae type b
- Hepatitis B
26
When is bexsero vaccine adminisered?
8 weeks
16 weeks
1 year
27
What is vaccinated against using the bexsero vaccine?
Meningococcal group B
28
What is vaccinated against using rotarix?
Rotavirus gastroenteritis
29
When is rotarix virus administered?
- 8 weeks
| - 12 weeks
30
What is vaccinated against using prevenar 13 vaccine?
Pneumococcal
31
When is prevenar 13 administered?
12 Weeks
| 1 year
32
What is vaccinated against using menitorix?
Hib
| Men C
33
What is vaccinated against using MMR?
Measles
Mumps
Rubella
34
When is MMR vaccine given?
1 year
| 3 years and 4 months
35
When is the HPV vaccine given?
Boys and Girls aged 12-13 years
36
What is vaccinated against using revaxis?
Tetanus, diptheria and polio
37
When is revaxis vaccine given?
14 years old
38
What is the PRISMS system for exploring key rheumatological symptoms?
- Pain
- Rashes, skin lesions and nail changes
- Immune
- Stiffness
- Malignancy
- Swelling and sweats
39
What questions should be asked when taking a history of rheumatological systems?
- Radiation of pain?
- Where is pain?
- When did it start?
- Characteristics of pain
- Associations
- Time course- morning vs evening pain?
- Severity of pain
- Rashes, skin lesions and nail changes
- Exacerbating or relieving factors?
40
What does GALS stand for?
Gait
Arms
Legs
Spine
41
What are the pharmacological steps of rheumatoid pain?
Step one= Non-opioid analgesics (paracetamol, NSAIDs)
Step 2= Mild opioids (Codeine, dihydrocodeine)
Step 3= Strong opioids (Morphine, Pethidine, Methadone, Tramadol etc)
42
List some non-pharmacological steps of managing rheumatoid pain?
- Heat/ice
- Massage therapy
- Physiotherapy
- Relaxation techniques
43
Briefly explain how NSAIDs work
NSAIDs targets Cyclooxygenase-2 (COX-2) enzymes and inhibit COX-mediated conversion of arachidonic acid to prostaglandins and thromboxanes which cause vasodilatation, oedema and pain. The overall effect if this is reduced hyperanalgesic and vasodilatory effects in acute inflammation
44
A patient complains of a severe, sharp, sudden pain in their big toe. What is a likely diagnosis?
Gout
45
A patient complains of stiffness in joints. Their are in pain and find mobility hard. The joint is hot to touch and the patient feels tired and unwell. The pain is often worse in the morning. What is it likely to be?
Rheumatoid arthritis
46
A patient complains of joint stiffness in one knee. It is an achy pain that is worse later in the day after activities. What is it likely to be?
Osteoarthritis
47
What are some possible symptoms of DMT2?
- Weight gain or loss
- Polyuria
- Weakness/fatigue
- Skin or other infections
- Blurred vision
- Abdominal pain
48
What checks can be done into the complications of diabetes?
- Weight gain/ loss= BMI
- Hypertension= BP monitoring
- Cholesterol monitoring
- Diabetic nephropathy= Urine albumin:creatinine ratio
- Diabetic retinopathy= Eye checks
- Foot ulceration= Foot clinic checks
49
What issues can happen to do with diabetic injection sites?
- Infection
- Lipohypertrophy
- Bruising
50
What is the first line treatment for DMT2?
Diet and exercise modifications
51
What is the second line treatment for DMT2?
Diet and exercise modifications
| Metformin
52
What is the third line treatment for DMT2?
Diet and exercise modifications
Metformin
SGLT2 inhibitors, glp analogues, Sulphylurea
53
List some common complications of diabetes
```
Retinopathy
Nephropathy
Hypertension
Diabetic foot ulceration
Numbness
```
54
List some primary preventative methods for DMT2
Population-based healthy lifestyle programmes
Exercise
Prevention of obesity
55
List some secondary preventative methods for DMT2
Screening of populations in NHS health checks and at risk groups
Early intervention
56
When is DMT2 screening performed?
- At NHS Health checks
- During pregnancy
- People at risk= First degree relative, obesity, certain ethnicities (African-Caribbean, Middle Eastern or South Asian)
57
What test is used for DMT2 screening?
IGT
- 6.0-6.4= pre diabetic
- 6.5 and over= Diabetic
58
List some thoracic differentials for chest pain?
MI (STEMI, NSTEMI)
Stable angina
Pericarditis
Thoracic aortic dissection
59
List some respiratory differentials for chest pain?
Pneumonia
Spontaneous pneumothorax
Pulmonary embolism
60
List some GI differentials for chest pain?
- GORD
- Oesophageal spasm
- Gallstones
61
List some MSK differentials for chest pain?
- Rib fracture
| - Muscle sprain/tear
62
What is the typical presentation for acute MI?
- Chest pain which is severe and constant. It may radiate to the left arm, jaw and chest
- Nausea, vomitting, dyspnoea, fatigue
- Distress and anxiety
63
How is a STEMI diagnosed on ECG?
- ST elevation, tall T waves, L bundle branch block, T wave inversion, Pathological Q waves follow
- After afew days the ST segment returns to normal
- After weeks, the T wave may return but the Q wave remains
64
How is a NSTEMI diagnosed?
Diagnosis is retrospective
- ST depression and T wave invesion
- Troponin I or T increased
- Myoglobin increased
65
Where should V1 chest lead be placed?
4th intercostal space at the right sternal edge
66
Where should V2 chest lead be placed?
4th intercostal space at the left sternal edge
67
Where should V3 chest lead be placed?
midway between the V2 and V4 electrodes
68
Where should V4 chest lead be placed?
5th intercostal space in the midclavicular line.
69
Where should V5 chest lead be placed?
Left anterior axillary line at the same horizontal level as V4
70
Where should V6 chest lead be placed?
Left mid-axillary line at the same horizontal level as V4 and V5
71
Where should the red limb lead be placed?
The ulnar styloid process of the right arm
72
Where should the yellow limb lead be placed?
The ulnar styloid process on the left arm
73
Where should the green limb lead be placed?
The medial or lateral malleolus of the left leg
74
Where should the black limb lead be placed?
The medial or lateral malleolus of the right leg
75
What blood tests would be done if a MI is suspected?
- FBC
- U&Es
- Troponin T
- Lipid profile
- Serum glucose
76
What tests are done if a MI is suspected?
12 lead ECG
Blood tests
CXR
77
What would be the immediate treatment for MI?
- Aspirin
- GTN sublingual for pain relief
- Oxygen if needed
- Morphine for pain relief
78
What are the risk factors for MI?
High age, male, history of premature CHD, Diabetes, menopause, smoking, obesity, sedentary lifestyle, hypertension, hyperlipidaemia
79
List the risk factors for suicide
```
Family history of suicide.
Family history of child maltreatment.
Previous suicide attempt(s)
History of mental disorders, particularly clinical depression.
History of alcohol and substance abuse.
Feelings of hopelessness.
Impulsive or aggressive tendencies
```
80
What are the classes of antidepressants?
SSRI
SNRI
TCA
MAOI
81
What are the common SSRIs?
Fluoxetine (first line)
Paroxetine (Better for anxiety)
Citalopram
82
What are the main side effects of SSRIs?
GI Irritation
Weird dreams/ Sleep disturbances
Can increase suicide risk in the first couple of weeks
83
What are the common SNRIs?
Venlafaxine
| Duloxetine
84
What are the main side effects of SNRIs?
Raised BP. Increased anxiety. GI upset.
85
What are the common tricyclic antidepressants?
Lofepramine (Most commonly used for depression)
| Amitriptyline (Used for nerve pain/ sleep problems at a lower dose)
86
What are the main side effect of lofepramine antidepressants?
Conduction disorders= TCA have a higher risk profile in overdose
87
What is the most common MAOI?
Phenelzine
88
What are the main side effects of MAOIs?
Acute prophyria
| Interact with alot of other medications and foods
89
List some common psychological therapies used to treat depression
- Mindfulness
- CBT
- Combined/ Group therapy
- Psychodynamic therapy
90
What is a mental state examination?
A structured tool and process that allows you to observe and assess a patient's current mental state
91
What food should be avoided in a patient with IBS?
- Fatty, spicy and processed food
- Excessive fruit
- Excessive tea or coffee
- Alcohol or fizzy drinks
92
What drugs can be used to treat IBS?
- Antispasmodic drugs e.g. mebeverine and peppermint oil
- Laxatives e.g. Mavicol
- Anti motility agents e.g. Loperamide
- Tricyclic antidepressants
93
What things are checked for during a rectal exam?
- External signs= Skin tags, haemorrhoids, fissure or fistula
- Prostate gland
- Rotate the finger and inspect for lumps etc
- Withdraw finger and inspect for blood or mucous
94
What causes IBS?
Dysfunction in the brain-gut axis resulting in a disorder of intestinal motility and/or visceral hypersensitivity
95
What are the common symptoms of IBS?
- Abdominal pain= Relieved by defecation
- Bloating
- Change in bowel habit; diarrhoea or constipation
- Urgency, mucous in stool, nausea
96
What are the risk factors for IBS?
- Female
- Previous severe and long diarrhoea
- Anxiety/ stress
97
List some differentials for IBS
- Coeliac disease
- Lactose intolerance
- IBD
- Colorectal cancer
- Appendicitis
- Infection
98
What are some self help methods for IBS?
- Dietary changes, low fodmap diet
- Food diary
- Exercise
- Water
- Probiotics
- Over the counter medications
99
What are the classic clinical features of OA?
Joint pain exacerbated by exercise.
Joint stiffness at rest (transient in morning)
Reduced functionality
Sometimes bony swellings in distal interphalangeal (Heberden’s) and proximal interphalangeal (Brouchards)
Sometimes warm
Can affect any joint, but is more often larger, weight bearing joints . Often starts as a single joint (generally progressing to involve more as time goes on). Not particularly symmetrical.
100
What are the classic clinical features of RA?
Symmetrical joint pain in the distal small joints. Symptoms worse in the morning and cold
Joints warm and tender. Red.
Systemic symptoms of lethargy, tiredness, fever, weight loss.
Limited movement and muscle wasting.
Morning stiffness (More than 30 mins)
Deformities; Ulnar deviation of fingers, swan neck and boutonniere
Can involve lungs, heart, eyes, kidneys etc.
101
What are the classic clinical features of gout?
Sudden pain, swelling and redness
| Typically in 1st MTP
102
What are the classic clinical features of septic arthritis?
Hot, (very) painful, red joint. Decreased range of movement. Localised swelling.
Can be systemically unwell (septicaemia)
103
What are the classic clinical features of psoriatic arthritis?
Asymmetrical oligoarthritis
Pain, swelling, stiffness. Reduced range of movement
Systemic symptoms such as lethargy
Most usually, the distal joints of fingers and toes, and lower back.
‘sausage’ fingers and toes. Pitted nails.
104
What are the classic clinical features of ank spon?
Back pain and stiffness. Worse with rest and in the morning/overnight (may wake during night due to pain in the back and buttock region)
Can improve with exercise. Takes >30mins for stiffness to improve in the morning
105
A patients test results come back showing
- Raised WCC
- Raised serum uric acid
- Rasied CRP and ESR
- Needle shaped crystals on joint aspiration
- No autoantibodies
What is it likely to be?
Gout
106
A patients test results come back showing
- Raised WCC
- Raised CRP, Raised ESR
- Bacteria in aspiration of joint
What is it likely to be?
Septic arthritis
107
A patients results come back showing
- Raised WCC
- Anaemia
- Raised CRP and ESR
- Crystals on aspiration
- Anti CCP and rheumatoid factor autoantibodies
What is it likely to be?
Rheumatoid arthritis
108
A patient with joint pain's results come back showing
- Raised CRP
- No autoantibodies
- No raised WCC
- No anaemia
What is it likely to be?
Osteoarthritis
109
What is the first line treatment of rheumatoid arthritis?
DMARDS= Sulfasalazine and methotrexate
110
A patient presents with fever, rigors, nausea and loin pain. On dipstick, she has haematuria and leukocytes. What is it likley to be?
Pyelonephritis
111
A patient presents with urinary frequency and haematuria. She has no leukocytes or nitrates on dipstick. What investigation should you send for?
CT (likely to be bladder stones)
112
A patient presents with frequency, dysuria, pain and haematuria. On dipstick, she also has leukocytes. She is young and not pregnant. How would you treat her?
Trimethoprim or nitrofurantoin (Likely to be a lower UTI)
113
An elderly gentleman presents with frequency, nocturia, post void dribbling and incontinence. How would you examine him?
Digital rectal exam
= Smooth, enlarged prostate would be PBH
= Hard irregular prostate would be prostate carcinoma
114
What are the two week wait symptoms for prostate cancer?
- Raised PSA
| - Hard, irregular prostate
115
What are the two week wait symptoms for lung cancer?
```
2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:
• cough
• fatigue
• shortness of breath
• chest pain
• weight loss
• appetite loss
```
116
What are the two week wait symptoms for oesophageal cancer?
```
Unexplained symptoms
• with dysphagia or
• aged 55 and over with weight loss and any of the following:
－ upper abdominal pain
－ reflux
－ dyspepsia.
```
117
What two classes of drugs can be prescribed for BPH?
- Alpha-1 antagonists e.g. tamsulosin
| - 5 alpha-reductase inhibitor e.g. Finasteride
118
What is the gold standard surgical repair of BPH?
Transurethral resection of prostate
119
What are the two week wait symptoms for colon cancer?
Unexplained
- Weight loss and abdominal pain
- Rectal bleeding
- Over 60 with iron deficiency anaemia or changes in bowel habit
- Tests show occult blood in their faeces
120
What are the main side effects of tamsulosin and how does it work?
Relaxes smooth muscle in bladder neck and prostate
| = Hypotension, erectile dysfunction
121
What are the main side effects of finasteride and how does it work?
It blocks the conversion of testosterone to DHT to prevent prostate enlargement
= Hot flushes, reduced libido, gynaecomastia
122
How long do episodes of syncope typically last?
Less than 30 seconds
123
How long do seizures typically last?
More than 30 seconds
124
What investigations may you perform to diagnose epilepsy?
- Electoencephalogram
- Brain imaging= MRI and CT
- ECG to rule out long QT syndrome
- Blood tests to rule out differentials
125
What is the first line treatment for generalised tonic-clonic seizures?
Sodium valproate
126
List some commom triggers of epileptic seizures
- Flashing lights
- Alcohol
- Tiredness
127
What are the risk factors for epilepsy?
- Family history
- Premature born babies
- Abnormal blood vessels
- Alzheimers or dementia
- Drugs and alcohol
- Stroke/ brain tumour/ trauma/ infection
128
What are the rules for driving with epilepsy?
If you have epilepsy you must stop driving and tell the DVLA. The license is taken away until the seizures are under control. If the seizure has caused you to lose consciousness, you will not be able to reapply until you have not had a seizure for at least a year
129
What is SUDEP
Sudden unexpected death in epilepsy
130
What is absence epilepsy?
Caesing activity, staring and pales. Typically in children
131
How would you test CNI?
Smell test
132
How would you test CNII?
Visual test, examine with light
133
How would you test CNIII, CNIV or CNVI?
- Examine pupillary reflex
| - Move eyes in H pattern
134
How would you test CNV?
Touch face at various areas for sensation
135
How would you test CNVII?
Identification of different tastes. Check the patient can smile and show teeth.
136
How would you test CNVIII?
Hearing test
137
How would you test CNIX?
Gag reflex and taste test
138
How would you test CNX?
Swallowing
139
How would you test CNXI?
Ask the patient to move his/her head against a mild resistance and shrug shoulders
140
How would you test CNXII?
Movement of tongue (Stick out)
141
List some symptoms of breast cancer
- Nipple discharge
- Lump
- Nipple inversion
- Erythema
- Dimpling
- Ulceration
- Weight loss, malaise
- Lymphadenopaty
142
What is the 2 week wait criteria for breast cancer?
- If aged 30 yrs and unexplained breast lump with/without pain
- Aged over 50 with any of the following symptoms in one nipple only; Discharge, retraction or other changes of concern
143
What is a mammogram?
Low-energy X-rays used to examine the breasts
144
What is a breast ultrasound?
High frequency sound waves to produce an image of the inside of the breasts, showing any lumps or abnormalities
145
What is a breast biopsy?
A sample of tissues is taken from the breast
146
When is a mammogram given?
To patients with symptoms that have been referred to the specialist breast unit
As part of the national screening program
147
When is breast screening performed?
Aged 50-71
148
What happens during breast screening?
Two X-rays are taken of each breast
149
What is BRCA2 associated with?
Breast cancer
150
Where is BRCA1?
Chromosome 17
151
Where is BRCA2?
Chromosome 13
