GP deck Flashcards
1
Q
Standard charge prescription
A
£7.85
2
Q
Free drugs for:
A
Over 60, under 18.Pregnant +12mCertain diseasesCancerRenal dialysis
3
Q
Prepayment prescriptions
A
£104(good for 15+ a year)
4
Q
Calgary-cambridge guide
A
1.Initiate.2.Gather.3.Examine.4. Options5. Explain + plan.6. Close
5
Q
Health promotion cycle
A
PrecontemplationPreparationAction–> MaintenanceReplapseback to beginning.
6
Q
Alcohol units/week
A
Men 21Women 14
7
Q
How many QOFs?
A
17 conditions.
8
Q
% of consultations that are multimorbidity
A
72%
9
Q
How many patients physically disabled?
A
10%
10
Q
Commonest cause of disability
A
arthritis.
11
Q
Intermediate care services funded by
A
Health AND social services
12
Q
Intermediate care examples
A
Rapid resonse- prevent admissions.Earlier discharge to community rehab teams.Short term community beds in NH and CH
13
Q
Self certificates
A
7 daysSickness or incapacity
14
Q
Medical certificates
A
After 7 days (self certificate).Unable to do job(hospitals can provide them).
15
Q
Med3- Fitness to work
A
RecommendationEmployer not obliged to follow.
16
Q
How long can Med3 forms be back dated?
A
3 months.
17
Q
£ statutory sick pay
A
£68.20/week
18
Q
Whos entitled to statutory sick pay?
A
16-65 year olds who have paid sufficient NI
19
Q
How long can you get statutory sick pay?
A
up to 28 weeks (7 months).
20
Q
Employment and support allowance
A
If sick for more than 13 weeks the department of work and pensions will assess you. with a Work capability assessment.
21
Q
Work capability assessment levels
A
- Return to work.2. Capacity to regain work.3. Limited capacity due to long-term issue.4. Unable to work.
22
Q
Attendance allowance
A
not means testedmoney goes to the disabled person (not carers allowance)>65 years oldCare and supervision.
23
Q
How much is attendance allowance?
A
£4025 MAX per year (depending on day and night care)
24
Q
Disability living allowance
A
Under 65Supervision and decreased mobilityTerminally ill
25
How much is DLA??
£6838/year
26
If a disabled person can only do low paying work:
Disabled person's tax credit.
27
Helps people find jobs
Access to work scheme
28
Carer's allowance
If they spend more than 35h and the disabled person gets attendance allowance, DLA or PIP
29
Personal independence pay
16-64 year olds. NEW claimants.Fluctuating conditions.Paid according to ability not condition.
30
How much can you get with PIP?
Up to £6998
31
Independent living fun age
16-65
32
Blue badge scheme
cars
33
Income support
Low incomeState pension only.
34
Who can help inform you of benefits?
Welfare benefits advice serviceCitizens advise bureauBenefits enquiry line
35
Safe haven
NH or RHVulnerable if left alone (i.e. carer in hospital).
36
Rehab
up to 6 weeks.
37
Resettlement
up to 2 weeks.
38
4 prevention parks of the national service framework for coronary heart disease
decrease risk factors and inequalities.decrease smokingidentify those at risk and treatIdentify the already ill and treat
39
Framingham data
CVS risk to do with SES and geography(not seen as that great anymore)
40
Qrisk2 involves
agesexpostcodesmokefamily historyAFBPRheumatoidCholesterolBMI
41
When to give statin+antihypertensive
If >20% in next 10 years.
42
LE with smoking
10 years less
43
Nicotine replacement increases quitting by:
200%
44
Buproprion other name
Zyban
45
Buproprion class of drug
Antidepressant
46
Buproprion CI
epilepsybipolareating disordersbreast feeding
47
Buproprion SE
dry mouth, sleep disturbance
48
How to take buproprion
For 8 weeks.Stop smoking on day 8.
49
Varenicline other name
Champix
50
Champix other name
Varenicline
51
Diagnosing hypertension 1st visit
BP>140/90 do second reading.Second reading also >140/90 send for ABPM/home monitoring2nd reading not high- do 3rd and record lowest.
52
ABPM
2 readings an hour.14 hours a dayTake averageAWAKE
53
Home monitoring
2x a day 1 min apartOnce in the morning, once in the evening.4 days.Take average.
54
Diagnosing hypertension from ABPM/home monitoring
>135/85 average
55
Who do you start antihypertensives on immediately?
>180/110
56
Target blood pressure <80
140/90
57
Target blood pressure >80
150/90
58
Lifestyle advise for high BP
Stop smoking.Increase exerciseDecrease saltDecrease alcohol.
59
Treat regardless
160/100 (or 150/95 on home)
60
Treat if +>20% risk of heart disease
140/90 (135/85)
61
Treat if +end stage organ damage
140/90 (135/85)
62
Ace inhibitors
Ramipril
63
ACE II inhibitor
Candesartan
64
Betablocker
Atenolol
65
Calcium channel blocker
Amlodipine
66
Thiazide like diuretic
Indapamide
67
If >55 or black BP:
(c) Amlodipine (+ ramipril)
68
If <55
(a) Ramipril (Candesartan if doesn't work)
69
Triple antihypertensive treatment
ACECalcium channel blockerDiuretic(Ramipril+amlodipine+indapamide)
70
Diabetogenic
B blocker and Diuretic
71
Ramipril+Candesartan (ACE+ACE2I)
No-no
72
When start statin
>20% CVD risk.Everyone over 70>40y and diabetesBP>160/100
73
SE of betablockers
FatigueInsomniaCold hands and feetDecreased heart rate
74
SE of ACE inhibitors
Funny tasteAngio-oedemaCough
75
Testing for ACE inhibitors
yearly U+E
76
CI for ACE inhibitors
PregnancyRenovascular disease
77
CI for Betablockers
AsthmaDyslipidaemiaPeripheral vascular diseaseHeart block
78
SE of calcium channel blockers
ConstipationOedmeaFlushingHeadache
79
CI for calcium channel blockers
MIHF
80
SE of thiazide like diuretics
GoutHypoKHypo NASexual dysfunctionimpaired glucose tolerance
81
CI of thiazide likes
gouturinary incontinencedyslipidaemia
82
SE of statins
GI upsetMyopathyLiver damageAlopecia
83
When to suspect familial hyperlipidaemia
cholesterol >7.5mmol
84
Simvastatin dose
40mg ON
85
Driving restrictions
Unstable cannot driveCan't drive 4 weeks post MI2 months after stroke.
86
amiodarone and lungs
pneumonitisinterstitial fibrosis
87
Cocaine and lungs
pneumothorax
88
Chest pain relieved leaning forward
pericarditis
89
Tearing mid scapular pain
aortic disection
90
Inspiratory pain in chest
PEPleuritisMusculoskeletal
91
Post operative SOB
AtelectasisBronchopneumoniaPEPneumothorax
92
Ix for SOB
FBC (Hb)CXR if more than 3 weeks.PEFRSpirometry
93
Spirometry COPD
FEV1<70%
94
Spirometry asthma
>15% increase in FEV1 after salbutamol400mg by MDI and spacer
95
Women cancers
BreastBowelLung
96
Men cancers
ProstateLungBowel
97
Overall cancers
BreastlungLarge bowelProstate
98
How many breast cancers picked up on screening?
33%
99
Who gets screened for breast cancer?
50-70 yearsEvery 3 years.
100
Red flags for breast cancer
Lump persists through period.FixedPost menopausalNipple changes/bleedingUnilateral eczematous skin change.
101
Colorectal cancer who gets screened?
60-69every 2 yearshome faecal occult bloodif positive--> colonoscopy
102
Red flags colorectal cancer
Change in bowel habit longer than 6 weeks.Weight lossAbdo painRectal bleedingAnaemia (<10 women)
103
Urgent CXR
Haemoptysis
104
Red flags lung cancer
Unexplained/persistent coughLymphadenopathyChest painDysnoeaClubbingHoarsenessWeight loss
105
Recurrent haemoptysis
17% risk of cancer.
106
Consider PSA if
enlarge prostate symptoms.symptoms of local spreasx of metastasis
107
Postpone PSA if
1m after UTI1w after PR exam
108
High PSA for 50-60year olds
>3.0
109
High PSA for 60-70 yr
>4.0
110
High PSA for 80+
>5.0
111
Emergency contraception brand names
LevonelleEllaoneCoil
112
Emergency contraception drug names
LevonorgestrelUlipristal acetateCoil
113
Levonorgesterel
Levonelle72 hours.13-60 year olds.1st 24h- 95% effective.2nd-48h- 85% 3rd- 58%
114
Levonelle dose
1.5mg once
115
Protection after Levonelle
7 days barrier7 days COCP2 days POP
116
Ellaone works by:
Selective progesterone receptor modulator
117
Ellaone
120h. after.
118
Dose for ellaone
30mg once
119
Ellaone contraindicated
Breast feeding (postpone for 36h)
120
SE of levonelle
bleeding
121
SE of ellaone
abdo painnauseableeding
122
IUD- coil for emergency contraception
120hours.
123
Risks with coil as emergency
Heavier bleedingPIDNeed a check up in 6 weeks.
124
How does ella one work?
delays ovulation
125
How does the emergency coil work?
Prevents fertilization.
126
Mental state exam
AppearanceMoodSpeechThoughts (interference, passivity)Perception (hallucinations, illusions)Cognition- (orientation, MSE)Insight
127
Chronic depressions
>2 years.
128
Self questionairre for depressions
PHQ-9
129
Relationship difficulties group
RELATE
130
Bereavement group
CRUSE
131
Counselling for depression
sleep hygieneproblem solving therapyCBTMindfullness based therapy
132
Online CBT
Beating the blues
133
LIFT psychology
CBT
134
SSRI
Citalopram
135
SE of Citalopram
SSRI:Dry mouthSleep disturbanceHeadacheSweatingNauseaWeakness
136
SNRI
Venlafaxine
137
TCA
Lofepramine
138
MAOI
MoclobemidePhenezine
139
Can't use MAOI with:
SSRI
140
Can't use with SSRI
St.Johns wartMAOI
141
Can't use st.johns wart with
OCPWarfarinSSRIanticonvulsantsciclosporindigoxin
142
SSRI discontinuation syndrome
from >8weeks useHeadache, nauseaParaesthesiaDizzinessAnxiety.
143
Domestic abuse age
>16 years
144
What percentage of women in GP surgeries report abuse?
40%
145
RF for domestic abuse
YoungPoorSeparated
146
Consequences of domestic abuseq
Chronic painInfectionsNeurologyIBS/GIheart diseasegynae problemssuicidesubstance misuseLBW babies.
147
Advocacy interventions
12-60h
148
Options for domestic abuse women
refugeesantenatal clinicscriminal justicesocial supportpsychological interventsions
149
CBT for domestic abuse
30m-16+hours.Decreases PTSDIncreases self esteemForegiveness therapy
150
IRIS
Identification and referral to safety
151
Diarrhoea more than 2 weeks
unlikely to be infection
152
Blood in stool
CancerIBDCampylobacter, E.coli, Shigella
153
Diarrhoea and aches
Campylobacter
154
Stool culture if:
Diarrhoea for >3 daysBeen abroad>2 in same house>2 ate same place
155
Tests IBD
CRP/ESR/ plasma viscosity
156
2 weeks colon referral
>60 yearsDiarrhoea>6 weeks.
157
Loperamine/imodium
4mg bolus then 2 mg after each loose stool (max 16g)not for kids
158
Loperamide action
Opioid receptor agonist.
159
Heartburn symptoms
Retrosternal painWaves15-60mins after mealBending/lying down makes it worse as does alcohol/smoke
160
pain on swalling
odynophagia
161
Drugs causing GORD
TCAAnti-cholinergicsAnti-psychotics
162
Drugs causing heart burn
antibioticsNSAIDSsteroidsIronNitratesBisphosphonatesCalciumTheophylline
163
Gaviscon dose
10ml after meal (safe in preggers)
164
Omeprazole dose
20mg PO ODthen up to 40mg
165
SE of omeprazole
GI disturbanceD+NconstipationFlatulence
166
Ranitidine dose
150mg PO BP
167
Treatment of heartburn
PPI for 1 monththen H2RA for 1 monthThen refer
168
Oesophageal pH monitoring
pH<4 for 5% of the time
169
H pylori stool sample
have to be PPI free for 2 weeks.
170
BP cuff
>2/3 of arm circumference>1/2 of arm length.
171
Pulsus paradoxus
should only be 5mmhg
172
Slow/repetitive cuff inflation
Venous congestion
173
Inaccurate BP readings
Cardiac dysrythmiasARVenous congestionValve replacement.
174
korotkoff signs
1. systolic (faint, tapping)2. sounds soften, swishing, auscultatory gap of 10-15mm3. return of sharp, crisp sound4. muffling5. all sounds disappear- DIASTOLIC
175
for BP how far do you go over before you start?
30mmhg
176
Increased gap in BP
HypertensionAortic regurg
177
Decreased gap in BP
Pulsus paradoxusCardiac temponade
178
Aura before migrane
5-60mins
179
Cluster headache
behind eye
180
Migranes DONT start after
50years
181
Antiemetics for migrane
Metaclopramide
182
Triptans
5HT1 agnoists50mg Po
183
SE of triptans
Feeling of painHeavinessTightnessNauseaDrowsinessDizziness
184
Triptans CI
anginaIHD
185
1st line prophylaxis migrane
propanolol
186
Drugs for migranes
PropanololAmitriptylineSodium valproateTopiramatepizotifenBotox A injections.
187
Proven migrane drug
topiramate
188
Sodium valproate side effects
nauseatremordizziness
189
pizotifen SE
weight gainsedation
190
If >15 headaches a month (8 migranes)
IM Botox A every 12 weeks.
191
Straight leg raise
normal if >45% each legabnormal: disc prolapse
192
Red flags for back pain
<20yearsnight painsteroidsHIVCauda equina symptoms
193
Consider MRI for back if:
CancerInfection/fractureCauda equinaAS
194
Sore throat usually lasts
1 week
195
Cold usually lasts
1.5 weeks
196
Rhinosinusitis usually lasts
2.5 weeks
197
Cough usually lasts
3 weeks.
198
Rash with cough
GuttateInfectious mononucleousisScarlet fever
199
EBV tests
LFTSFBCMonospot blood test
200
Centor criteria
ExudateTender lymph nodesAbsence of a coughFever
201
>3 centor criteria
B haem 60% likely- give Abx
202
Quinsy
much more likely if unwell with tonsillitis
203
tonsillectomy
>5episodes of tonsillitis in 1 year
204
Avoid contact sports in
infectious mononucleosis
205
Cause of flu:
orthomyxovirus
206
Epidemic
>200/100,000 in a week
207
Flu incubation
2 days
208
Strains of flu in humans
H1N1, H2N2, H3N2
209
Oseltamavir
Tamiflu
210
Tamiflu
Oseltamavir
211
Dose tamiflu
75mg BD 5 days.
212
Relenza
Zanamivir
213
Zanamivir
Relenza
214
Dose relenza
inhale 5mg BD 5 days.
215
When to use antivirals in flu?
Epidemics
216
Antivirals in flu efficacy
Reduce illness by 1 days if started <24h
217
IM flu injection SE
Guillain barreEgg allergy
218
Referred ear pain
Dental abscess CN5TonsillitisCarcinoma base of tongue CN9Ramsey-Hunt CN7Laryngiocarcinoma- vagus
219
causes of otitis media
s.pneumoniah.influenzam.catarrhalis.
220
RF for otitis media
passive smokingformula milkcraniofacial syndromes
221
Rx for otitis media
Para and Ibuif needed: amoxicillin or erythromycin 5 days.
222
Abx in otitis media if:
under 3 mhad for >3 daysbilateral in <2s
223
Repeated acute otitis in adults may indicate
nasopharyngeal cancer
224
>10 days ear discharge??
Mastoiditis.
225
Causes of otitis externa
staphcandidaeczemaswimmingcotton budstrauma
226
Rx for otitis EXTERNA
olive oil dropsanalgesiaAminoglycaside+steroid drops
227
Uncomplicated UTI
3 days trimethoprim 200mg BD3 days nitrofurantoin 50mg QDS
228
UTI in pregnancy treatment
7 day trimethoprim 200mg BD (not 1st tri)7 day nitrofurantoin 100mg BD (not 3rd tri)
229
Pyelonephritis treatment
7 days Ciprofloxacin 500mg BD
230
Chlamydia treatment
Azithromycin 1g once.Doxycycline 100mg BD for 5 days.
231
Chlamydia in pregnancy
Erythromycin.
232
If you suspect angina
Rapid access chest pain clinicexcercise ECGAngiography (might miss micro)Radio-isotope scanCT angioEcho
233
Diabetes diagnosis
Random glucose >11.1Fasting glucose >7.0
234
Oral glucose tolerance test
Fast overnight75mg of glucose in morning2 hr later >11.1mmol=diabetes
235
B12 treatment
1mg hydroxycobalamin IM injection 5-6 doses in 2 weeks then 1 mg every 3 months.
236
Iron treatment
Supplements and then 3 months after to build stores.
237
Exacerbation of COPD
30mg Pred
238
Chronic heart failure
ACEI (A)Add B blocker (B)Seek specialist
239
Trismums
unable to open mouth
240
Treatment strep throat
(Penicillin V) 500mg every 6 hours, however if allergic you would prescribe oral CLARITHROMYCIN 250-500 mg every 12 hours for 10 day
241
Warning drug and sore throat
A patient taking DMARDs, Carbimazole or on Chemotherapy - arrange an urgent FBC and seek advice. Could be drug induced agranulocytosis.
242
Opiates in urine
24h
243
Methadone in urine
48h
244
Cocaine in urine
24-48h
245
Buprenorphine
Buprenorphine is a newer medication then methadone. It is less sedating then methadone and is safer in overdose. However it is contraindicated in pregnancy.
246
Methadone
Oral methadone mixture 1mg/ml is the preparation of choice for opiate users.
247
Flu vaccine
over 65nursing homesdoctorschronic illnessesprenantcarers
248
Migrane sx
Lasts 4-7 hoursThrobbing/bangingUnilateral or bilateral.Nausea/vomitingLight sensitivity.
249
Cocp
99% effective
250
Cocp works by
1. suppress ovulation
2. Cervical mucus thickens
3. Endometrium hostile to implantation
4. Tubal motility
251
Benefits of cocp
Reduced cancer- endo, ovarian, colon
Reduced cysts and fibroids
Decrease pelvic infection
Betters anaemia
252
Ukmec
Cat 1: unrestricted
Cat 2: benefit outweighs
Cat 3 risk outweighs
Cat 4: no no
253
Risks with cocp
```
Vte (15 per 100,000 woman years)
Ischemic stroke
Mi
Breast cancer risk goes after 10 years of stopping
Gall stones
Benign/malignant liver tumour
Cervical cancer
```
254
No cocp for
```
Current vte/thrombosis
Stroke
Pro thrombotic problems
160/95
Over 35y >15sigs
Migraine
Af
Heart disease
Liver disease
Breast cancer
6 weeks post partum
```
255
Type of oestrogen in cocp
Ethinyl estradiol Ee
256
Drug interactions of cocp
Anticonvulsants
Rifampicin
HIV drugs
St. John's wart
257
No pop for:
Breast cancer
258
Failure rate of pop
1 to 4 per 100 women years
259
Disadvantages of pop
Strict window
Bleeding
Less effective
260
Progesterone in cerazette
Desogestrel
261
How to take pop
Everyday no break
3h window
Extra contraception for 2 days if missed 1
262
Depo provera
Im injection
| Medroxy progesterone acetate
263
Advantages of depoprovera
No bleeding in 60%
Treats menorrhagia
Reduced epilepsy and sickle cell crisis
264
Disadvantages of depoprovera
9m delay in fertility
Bone mineral density
0.1-1.0 per 100 women years
265
Implant
Nexplanon
266
Drug in nexplanon
Etonorgestrel
267
Nexplanon lasts
3 years
268
Failure rate nexplanon
0.1 per 100 woman years
269
Advantages nexplanon
Effective
| No concerns of bones or return of fertility
270
Disadvantages nexplanon
Bleeding
Surgical
Expensive
271
Failure rate iud
Less than 2 in 100 w y
272
Ius failure rate
Less than 1 per 100 w y
273
Disadvantages of ius it'd
```
Painful insert
Anaphylaxis
Expulsion
Pelvic infection
Perforation
Ectopic pregnancy
```
274
More than one emergency contraceptive in same period
Not 2 ella one
| But can use 2 levonelle
275
Latest time you can use emergency copper
Shortest cycle
Minus 14 (earliest date of ovulation)
Plus 5
276
Spermicide
Nonoxynol9
277
Cocp before 3 weeks postpartum
Risk of thrombosis
| Wait until baby is over 6 months if breast feeding
278
Ius/iud post partum
4 weeks
