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Flashcards in GP ILAs and public health Deck (132):
1

Describe the management of hypertension with regards to the drug ladder

Step one: ACE inhibitor or ARB (Use CCB if over 55 or Afro-Caribbean)
Step 2: ACE-i/ARB and CCB
Step 3: Add thiazide diuretic
Step 4: Add spironolactone

2

Describe the management of hypertension IGNORING the drug ladder

Lifestyle (lower weight, exercise, diet, relaxation, alcohol, caffeine, salt, smoking)
Statins

3

What should be completed within 2 weeks of starting or changing dose of an ACE-i?

U+E

4

Describe stage 1 and stage 2 hypertension, and how treatment guidelines differ between them

Stage 1 = BP>140/90
Treat if under 80 years and one of target organ damage, CVR disease, renal disease or diabetes.

Stage 2 = >160/100
Treat all

5

What investigations should be completed before referring a patient for heart failure?

BNP
Echocardiogram

6

What is the management of CCF?

Lifestyle (exercise, smoking, depression, alcohol, sexual activity, air travel, flu vaccinations)
Diuretics
CCBs
Amiodarone
Anticoagulant and Aspirin

7

What are the two types of heart failure?

HFPEF (heart failure with preserved ejection fraction)
HFREF (heart failure with reduced ejection fraction)

8

What are the different types of diuretic?
Give an example for each

Thiazide diuretics (Bendroflumethiazide)
Loop diuretics (Furosemide)
K sparing diuretics (Spironolactone)

9

Why is Bumetanide better than Furosemide orally for CCF?

Bumetanide is absorbed better in odematous bowel and has a lower volume of distribution so is more concentrated.

Furosemide is very potent IV

10

What is the prognosis of heart failure?

Poor - 60% survive 18 months
Especially poor if requires hospitalisation

11

What are DAFNE and DESMOND?

DAFNE - dose adjustment for normal eating. T1DM patients learn to inject correct amount of insulin for the meal they are eating

DESMOND - T2DM teaching - Diabetes Education and Self Management for Ongoing and Newly Diagnosed diabetics

12

What are the four levels of prevention?

Primary
Secondary
Tertiary
Quaternary (Population level eg. Government legislation)

13

Against what disease are babies immunised on day 1?

TB

14

Against what diseases are babies immunised at 8 weeks?
What injection includes most of these?

Diphtheria
Tetanus
Pertussis
Polio
H influenza
Hepatitis B
(ALL OF ABOVE IN Infanrix VACCINE)

PCV (pneumococcal conjugate vaccine)
Rotavirus
Meningitis B

15

Against what diseases are babies immunised at 12 weeks?
What injection includes most of these?

Diphtheria
Tetanus
Pertussis
Polio
H influenxa
Hepatitis B
(ALL OF ABOVE IN Infanrix VACCINE)

Rotavirus

16

Against what diseases are babies immunised at 16 weeks?
What injection includes most of these?

Diphtheria
Tetanus
Pertussis
Polio
H influenxa
Hepatitis B
(ALL OF ABOVE IN Infanrix VACCINE)

PCV (Pneumococcal conjugate vaccine)
Meningitis B

17

Against what diseases are babies immunised at 12 months?

H influenza
Meningitis C
MMR
PCV (pneumococcal conjugate vaccine)
Meningitis B

18

Against what diseases are babies immunised at 3 years and 4 months?

Diphtheria
Tetanus
Pertussis
Polio
MMR booster

19

Against what virus are 13 year old females vaccinated against?

Human Papiloma Virus (types 16 and 18)
Reduces risk of cervical cancer

20

Name 5 notifiable diseases

Anthrax
Diphtheria
Food poisoning
Legionnaire's
Leprosy
Malaria
Measles
Mumps
Plague
Rabies
Rubella
Scarlet fever
Tetanus
TB
Pertussis
Yellow fever

21

What coloured system is used when dealing with an unwell child?

Traffic light system:
Green - low risk (all normal)

Amber - intermediate risk (pallor, sleepy, tachypnoea, chest crackles, low sats, tachycardia, poor feeding, fever and swelling)

RED - HIGH RISK (Blue/mottled skin, very sleepy, weak voice, tachypnoea > 60, chest indrawing, grunting, reduced skin turgor, fever, seizures, neurological signs)

22

What service to GPs refer an unwell child to?

Single point of access

23

Describe safety netting

Advice given to patients about signs of deterioration and actions to be taken if those signs are seen.

24

How is normal vaginal discharge described?

Clear or white, thick and sticky

25

What is the likely causative condition/organism:

White, thick (like cottage cheese) vaginal discharge. Site is itchy.

Thrush (Candiditis)

26

What is the likely causative condition/organism:

White/grey, thin and watery vaginal discharge. Fishy smell.

Bacterial vaginosis

27

What is the likely causative condition/organism:

Green/yellow, frothy and thick vaginal discharge. Site is itchy and painful

Trichomoniasis

28

What is the likely causative condition/organism:

Thick green/yellow vaginal discharge. Urination is painful

Gonorrhoea

29

Describe Fraser competence and how it is assessed

Used to define whether a child (U16) has capacity to request contraception without informing parents.
Consider:
-Does the child understnd the advice?
-Will the child be convinced into telling their parents/letting you tell their parents?
-Will the child partake in unprotected sex without the contraceptive?
-Will the child's physical or mental health suffer without the contraceptive?

If you are satisfied, treat and maintain confidentiality.

30

Describe how a contraceptive implant works, how effective they are and how long they last for

Long acting, 100% effective, last up to 3 years.
Progesterone in the implant enters the bloodstream and stops ovulation, prevents implantation and thickens cervical mucus.

31

Describe inter-uterine devices, how they work, how effective they are and how long they last for

Long acting, 99% effective, lasts 5-10 years.
Copper coil, the copper destroys sperm and the presence of the coil prevents implantation.

32

Describe inter-uterine systems, how they work, how effective they are and how long they last for

Long acting, 99% effective, last 3-5 years
Progesterone in the device is released into the uterine system and thickens cervical mucus. Also the presence of the system prevents implantation.

33

Describe DEPO injection contraceptives, how they work, how effective they are and how long they last for

Long acting, less than 99% effective, last 12 weeks
Progesterone depo that slowly releases into the bloodstream. This thickens cervical mucus, prevents implantation and stops ovulation.

34

Name 7 short acting contraceptives

Combined OCP
Progesterone only pill (mini-pill)
Patch
Ring
Condom
Diaphragm
Cap

35

What are the legally important age boundaries regarding teenage sex

Child under 13 cannot consent to sex therefore it is rape whether the child attempts to consent or not

Child under 16 is underage for sex but can legally give consent (mutually agreed teenage sex is legal unless abusive or exploitative)

Confidentiality can be broken in a case of safeguarding or child welfare

36

What tools might you use to screen for dementia?
What are the common questions featured?

MMSE
GP-COG
6-CIT (cognitive impairment test)
AMT (abbreviated mental test)

-Draw a clock
-Name the current year/month/date/season
-Recall words or an address
-Name your present location, objects or people

37

What community care services are available to dementia patients?

Admiral nurses
OTs
Dietitians
Laundry
Carers
Meals on wheels
Benefits

38

What is a COP3 form used for?

Declaring a person to be lacking capacity

39

What needs assessing when assessing mental capacity?

Whether a patient can:
-Understand the information
-Remember the information
-Consider the information
-Communicate a decision

40

What is a DOLS?

Deprivation of liberty safeguards - these ensure a patient is not inappropriately restricted if denied liberty in their best interests

41

What three aspects apply to best interests?

Health
Finance
Social care

42

What is an IMCA?

Independent Mental Capacity Advocate
-a legal safeguard for people lacking mental capacity in the absence of family or a friend

43

What are some advantages of giving mental health patients a diagnosis/label?

Professional communication
Treatment plan
Reassurance - it's an illness, not madness
Patient's personal research

44

What are some disadvantages of giving mental health patients a diagnosis/label?

Can be used or viewed by others as an excuse
Socially avoided once open about diagnosis
Can never be taken back once it has been said
One size does not fit all

45

What is an AMHP?

An approves mental health professional (not a doctor)

46

What screening tools might a GP use for a depressed patient?

HAD scale (Hospital Anxiety and Depression)
BDI-2 (Beck Depression Inventory-2)
PHQ (Patient Health Questionnaire)

47

What are the risk factors for TB?

Extremes of age
IV drug use
Homelessness or cramped, damp housing
Infected relatives
Immunosuppression
Being in a TB prevalent county

48

In what countries is TB prevalent?

Nigeria
Pakistan
South Africa
Bangladesh

49

When protecting a population from an infectious disease what four aspects should you consider?
Give an example relevant to TB.

Medical - Vaccinations
Administrative - Risk assess the area, have an equipped laboratory on hand
Environmental - Try to remove contaminated air
Equipment - Use PPE when in high risk areas

50

What health issues do new UK immigrants face?

Lack of immunisations
Latent infections
Undiagnosed conditions
Poor housing and economic depression
Emotional trauma from journey and reason for emigration

51

What issues can occur when a language barrier exists between clinician and patient?

Poor history leads to incorrect diagnosis and prescription errors
Patient unable to engage with posters or other services available to them
Additional time requirement for consultation
Confidentiality should the interpreter be family
Distrust arising from low satisfaction with healthcare

52

What five categories do sexual problems fall into?

Drive
Desire/Libido
Excitation
Orgasm
Resolution

53

In what situations is a genital examination necessary following a sexual history?

If a pain disorder is described
If you suspect co-morbid conditions
If topical agents are to be prescribed
If patient is concerned about their anatomy

54

In a sexual context, why might you investigate BM and lipids?

For diabetes or CVD causing reduced sensation or bloodflow issues

55

If you suspect a sexual desire disorder, what investigations would be appropriate?

Sex hormones, Prolactin, TSH, FBC

56

Describe hypoactive sexual desire disorder

Lack or loss of sexual desire not secondary to any other sexual difficulties.
This has no effect on enjoyment or orgasm, only initiation

57

What can causes hypoactive sexual desire disorder?

Obesity, CVD, Diabetes, Anaemia, Androgen deficiency, hyperprolactinaemia hypogonadism, antidepressants, oophrectomy, orchidetomy, psychological, hypothyroid, addison's, OCP, HRT, Beta-blockers

58

How is hypoactive sexual desire disorder treated?

Testosterone/oestrogen replacement
Psychological therapy
Sexual growth programme (to overcome negative beliefs)

59

Describe erectile disorder

Difficulty developing or maintaining an erection suitable for satisfactory intercourse

60

What can cause erectile dysfunction?

CVD, Diabetes, Neurological disease, Androgen deficiency, Hyperprolactinaemia, Prostate surgery, antihypertensives, SSRIs, Pain, Age, Veno-occlusive disorder, depression, substance abuse, negative life experences

61

What is the treatment for erectile disorder?

Medication (Sildenafil or Alprostadil)
Penis ring with/without vacuum device
Kegel exercises

62

Describe female sexual interest/arousal disorder

Lack of sexual interest or arousal causing reduced sexual activity, erotic thoughts/fantasies, initiation or response to partner's initiation of sex, and pleasure during sex.

This often presents as vaginal dryness first

63

What can cause female sexual interest/arousal disorder?

CVD, Diabetes, Neurological disease, Oestrogen deficiency, Antidepressants, Breastfeeding, Depression, Anxiety, Eating disorders, Previous abuse

64

How is female sexual interest/arousal disorder treated?

Couples psychosexual therapy
Sexual growth programme
Lubricant, vibrator or Eros system for improved excitation

65

Describe female orgasmic disorder

Absence of or marked delay in reaching orgasm. Reduced sensations if orgasm does occur

66

What can cause female orgasmic disorder

CVD, Diabetes, Neurological disorder, Renal or Hepatic conditions, Oestrogen or androgen deficiency, Hypothyroidism, Pelvic floor weakness, Aeging, SSRIs, Depression, Anxiety, Substance abuse, Previous sexual abuse

67

How is female orgasmic disorder treated?

Psychotherapy (change attitudes towards sex)
Depression treatment review
Personal sex growth programme
Kegel exercises

68

Describe rapid ejaculation

Inability to control ejaculation sufficiently for enjoyment of both partners

69

What causes rapid ejaculation?

Genetics, Penile hypersensitivity, prostatitis, ED, anxiety, learned experiences, lack of experience, environment

70

How is rapid ejaculation treated?

Topical anaesthetics
Dapoxetine (SSRIs)
Couples psychotherapy
Stop/Start technique
Kegel exercises

71

Describe delayed ejaculation

Marked delay or failure of ejaculation

72

Describe the causes of delayed ejaculation

Congential, Trauma, Age, DM, Spinal cord injuries, Depression, SSRIs, Thiazides, Alpha-blockers, low testosterone, Poor arousal, Fear

73

What can delayed ejaculation sometimes be confused with?

Retrograde ejaculation

74

What is the treatment for delayed ejaculation?

Individual therapy
Couples therapy
Kegel exercises
Superstimulation (vibrators or 'spicy' lube)

75

Describe vaginismus

Spasm of pelvic floor muscles surrounding vagina, closing the vaginal opening. This makes penetration painful or impossible

76

What can cause vaginismus?

Thrush, Anticipation (of pain), FGM, Congenital abnormality, Religion/Culture, Fear of pregnancy, Previous abuse/unpleasant experience

77

What is the treatment of vaginismus?

Treat the cause
Individual psychosexual therapy
Integrated CBT
Examination (With therapy beforehand)
Behaviours - self exploration, relaxation, kegel exercises)

78

Describe dyspareunia

Pain during intercourse not secondary to another sexual dysfunction

79

What causes dyspareunia?

Infection, Injury, Irritation, Hypersensativity, Herpes, Allergies, Circumcision, Menopause, Radiotherapy, Penis size, Endometriosis, Pelvic tumours, IBS, Constipation, Adhesions, Previous painful experience

80

What is the treatment for dyspareunia?

Examination
Steroid cream
Testosterone replacement
Couples therapy/Personal sexual growth programme

81

What is your 'sex assigned at birth'?

Male or female, based on external genetalia

82

What is your gender identity?

Intrinsic sense of being male/female/alternative

83

What is your gender role/expression?

Personality, appearance and behaviour

84

What abnormality causes Kleinfelter's?
Describe the symptoms

XXY Trisomy
Usually male at birth but have gynacomastia and late puberty

85

Describe the symptoms of congenital adrenal hyperplasia

Usually assigned female at birth, but experience gonadomegaly and reduced breast tissue

86

Describe gender dysphoria

Distress due to in-congruence between gender identity and sex assigned at birth

87

What are FtM and MtF used for?

Describing transgender people:
FtM - Female to Male
MtF - Male to Female

88

Define paraphilia

Arousal from non usually sexual objects/stimulation.
Often causes relationship problems and distress. Mostly affects males.

89

Define Fetishistic Transvestism

Conditioned response paraphilia (fetish) due to the act of cross dressing

NB: Not related to gender dysphoria

90

Define necrophilia

Sexual arousal through contact with dead bodies

ILLEGAL

91

Define coprophilia

Sexual arousal through contact with faeces

92

Define zoophilia

Sexual arousal through contact with animals

ILLEGAL

93

Define exhibitionism

Sexual arousal through exposing genitals to unconsenting victims

94

Define sex additction

Compulsive engagement in sexual behaviours
Causes issues in relationships

95

Describe a sloth error

Not bothering to check results/information for accuracy
Incomplete evaluation
Inadequate documentation
--> Poor standards

96

Describe a loss of perspective error

Unshakeable focus on one diagnosis, unable to step back and see the bigger picture.
Overlooking warning signs

97

Describe a communication error

Unclear instructions/plans
Not listening to others

98

Describe a poor team working error

Team members working independently
Poor direction
Under/Over-utilisation of individuals

99

Describe a playing the odds error

Always ignoring the rare event

100

Describe a bravado error

Working beyond your competence

101

Describe an ignorance error

Lack of knowledge, consciously or unconsciously

102

Describe a mis-triage error

Under/Overestimating the seriousness of a situation

103

Describe a lack of skill error

Lacking the required skill, practice or teaching

104

Describe a system error

Environmental, technological or organisational failures
Inadequate safeguards

105

If a wound is black, what is going on?

Necrosis

106

If a wound is yellow/brown, what is going on?

Slough production - remove this

107

If a wound is red, what is going on? (Not bleeding)

Granulation - leave this on!

108

If a wound is pink, what is going on?

Epithelialising - leave this on!

109

Describe hydrogel

An intra-site gel that rehydrates dry wounds (SEAWEED)
Cover this with a secondary dressing

110

Describe alginate dressings

Highly absorbant dressings for high-exudate wounds

111

Describe hydrocolloid dressings

Good for necrotic or sloughly wounds - low to moderate exudate

112

Name and describe the 4 stages of wound healing

Vascular response - bleeding and serous fluid cleanse the wound, then clot forms into a fibrin mesh and a scab
Inflammatory response - Vasodilation and attraction of WBCs (Neut - bactericidal, Mac - Phagocytosis, Lymph - delayed response)
Proliferation - Fibroblasts secrete collagen and glycosaminoglycans. Granulation, epithelialisation and contraction of wound take place
Maturation - Collagen production halts, wound strength progressively improves

113

Describe a Keloid scar

A wide, raised, flat-topped scar that occurs when the 4 stages of wound healing occur in the wrong order

114

Describe wound healing by primary intention

Achieved if little or no tissue loss - wound edges directly opposed to each other, giving a neat linear scar

115

Describe wound healing by secondary intention

Where wound edges are not opposable (eg blunt trauma or ulcers). Granulation causes a broader scar

116

Describe wound healing by tertiary intention

Wound is purposely left open (due to infection or foreign body) for cleaning, debriding and observation.
Requires surgical suturing or a skin graft

117

What can be described as domestic abuse?

Abuse (Physical, Psychological, Sexual, Financial, Emotional) of a person ages 16+

Events "unwitnessed by anyone else" are highly suspicious

118

Regarding domestic abuse, define standard, medium and high risk

Standard - Serious harm unlikely
Medium - Signs are present but serious harm currently unlikely
HIGH - Imminent risk of serious harm, break confidentiality and act (Refer to DA/MARAC)

119

What screening tool is used to screen for domestic abuse?

DASH tool

120

Define allostasis

Stability through change
Physiological systems rapidly adjust to environmental stressors (eg standing up, infections, learning)

121

Define allostatic load

The health impairments caused by allostasis gone wrong (eg hypertention, AI disorders, dementia)

122

What is the difference between equality and equity?

Equality is where all people receive the same, equity is where all people receive what they require to get to the same place

123

What is horizontal and vertical equity?

Horizontal = equal treatment for equal need (eg all pneumonia patients get the same treatment)

Vertical = Unequal treatment for unequal need (eg cough and pneumonia treated differently)

124

What four points form a circle for public health needs evaluations

Needs assessment
Planning
Intervention
Evaluation

125

How much ethanol is in one unit of alcohol?

8 grams

126

How many units are cleared in 1 hour?

15g = 1.9 units.
It is metabolised indirectly to water and CO2

127

What are the four key concepts of the health belief model?

Perceived susceptibility (to a condition)
Perceived severity (of said condition's symptoms)
Perceived barriers (actions to reduce susceptibility)
Perceived benefits (outweighing costs of said actions)

128

What are the key points of planned behaviour?

Behaviours are preceded by Intentions, which are subject to three conditions:
Attitudes
Subjective norm
Perceived behaviour control

129

What are the key points of the stages of change model?

Pre-Contemplation (not thinking about it)
Contemplation (thinking about it)
Preparation (Getting ready)
Action
Maintenance (keeping it up)

It is possible to relapse backwards

130

What six words are Maxwell's dimensions of quality?

Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity

131

What five categories feature in Maslow's hierarchy of needs?

Self-actualisation
Esteem
Belonging
Safety
Physiological

132

What is the prevention paradox?

A measure that brings great benefit to a population often brings little to individuals