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Flashcards in GP ILAs and public health Deck (51):
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