Psych & Sore Throat

Question 1

Is there evidence that sore throats a result of a bacterial cause are more severe than viral ones or that the duration of the illness is significantly different in either case.

Answer 1

No

Question 2

How does fever relate to pharyngitis and tonsillitis?

Answer 2

Common

Question 3

How does sore throat relate to dehydration?

Answer 3

Can be caused by reduced fluid intake and also cause dehydration.

Question 4

At what point is reduced fluid intake an issue in infants and children?

Answer 4

Down by 50%

Question 5

What is the FeverPain/Centor score used to assess?

Answer 5

Likelihood fo Group A Streptococcus

Question 6

What are the components of the FeverPain score?

Answer 6

Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

Question 7

What are the components of the Centor score?

Answer 7

Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough

Question 8

What are the cut off scores for FeverPain/Centor?

Answer 8

4-5

Question 9

5 common (non-step) causes of common sore throat

Answer 9

The common cold 
Influenza — 
Pharyngoconjunctival fever — 
Acute herpetic pharyngitis 
Infectious mononucleosis (glandular fever) ).

Question 10

3 Rare but serious causes of sore throat?

Answer 10

Kawasaki
Epiglottitis
Measles

Question 11

antibiotics for streptococcal sore throat decrease symptom duration by…?

Answer 11

Less than 1 day

Question 12

For people not in a vulnerable group, and without severe symptoms, or who have a FeverPAIN score of 2 or 3, what would you consider?

Answer 12

Delayed antibiotic prescribing

Question 13

What is the antibiotic of choice and allergy alternative for sore throat?

Answer 13

phenoxymethylpenicillin

Clarithromycin

Question 14

Self care for sore throat

Answer 14

Fluids
NSAIDS for fever and pain relief
Avoid hot drinks
Medicated lozenges can give a bit of relief

Question 15

How soon can kids return to school after sore throat?

Answer 15

Day after fever has resolved

Question 16

Safety net for sore throat

Answer 16

Symptoms have not improved after 3 or 4 days of antibiotic therapy
Pain does not improve after 3 days, and/or there is fever over 38.3°C
It becomes difficult to swallow saliva or liquids, if any difficulty in breathing develops, or if there is any one-sided neck or throat swelling

Question 17

Two core questions for depression?

Answer 17

During the last month have you often been bothered by feeling down, depressed, or hopeless?
Do you have little interest or pleasure in doing things?

Question 18

How long do at least one of the “core” symptoms of depression have to be present for?

Answer 18

most days, most of the time, for at least 2 weeks

Question 19

7 associated features of depression

Answer 19

Disturbed sleep (decreased or increased compared to usual).
Decreased or increased appetite and/or weight.
Fatigue/loss of energy.
Agitation or slowing of movements.
Poor concentration or indecisiveness.
Feelings of worthlessness or excessive or inappropriate guilt.
Suicidal thoughts or acts

Question 20

Are investigations routinely indicated for depression?

Answer 20

No

Question 21

5 Medical conditions that may present as depression?

Answer 21

Anxiety
Bipolar
Dementia
Parkinson's
Hypothyroidism

Question 22

4 questions to assess risk of suicide?

Answer 22

Do you have thoughts about death or suicide?
Do you feel that life is not worth living?
Have you made a previous suicide attempt?
Is there a family history of suicide?

Question 23

2 questions for suicide protective factors?

Answer 23

What keeps you from harming yourself?

Is there anything that would make life worth living?

Question 24

3 questions about plans for suicide?

Answer 24

Have you considered a method?
Do you have access to the materials?
Have you made any preparations (for example, written a note)?

Question 25

3 high risk groups for suicide

Answer 25

Young and middle-aged men. People in contact with the criminal justice system. Specific occupational groups, for example, doctors, nurses, veterinary workers, farmers, agricultural workers.

Question 26

MGMT for mild to moderate depression

Answer 26

Improved Access to Psychological Therapies CBT Avoid anti-depressants

Question 27

MGMT for mod-severe depression

Answer 27

Anti-depressant and high intensity psychological intervention

Question 28

Safety net for depression

Answer 28

To be vigilant for worsening depressive symptoms and suicidal ideas, particularly when starting and changing medications, and at times of increased personal stress. Advise them to seek help promptly if they are concerned.

Question 29

How long does it usually talk for symptoms to improve when starting antidepressants?

Answer 29

2-4 weeks

Question 30

What happens if I suddenly stop taking antidepressants?

Answer 30

restlessness, problems sleeping, unsteadiness, sweating, abdominal symptoms, altered sensations (for example electric shock sensations in the head), or altered feelings (irritability, anxiety, confusion).

Question 31

Are SSRIs addictive?

Answer 31

No, but you can get discontinuation symptoms

Question 32

When should you arrange a review for someone with depression?

Answer 32

Risk of suicide - 2 weeks | and under 30 - 1 week

Question 33

When should you suspect GAD?

Answer 33

a person who reports chronic, excessive worry which is not related to particular circumstances, and symptoms of physiological arousal

Question 34

What are the physiological symptoms of GAD?

Answer 34

Restlessness Insomnia Muscle tension

Question 35

In GAD the person experiences at least 3 of the following symptoms most of the time....

Answer 35

``` restlessness/nervousness, being easily fatigued, poor concentration, irritability, muscle tension , or sleep disturbance ```

Question 36

What meds can cause anxiety as a side effect?

Answer 36

salbutamol theophylline beta-blockers herbal medicines

Question 37

What 4 features might you find on physical examination of a pt with GAD?

Answer 37

Increased heart rate. Shortness of breath. Trembling. An exaggerated startle response.

Question 38

GAD MGMT step 1

Answer 38

Monitoring and information to assess social functioning

Question 39

GAD MGMT step 2 & 3

Answer 39

2 - CBT | 3 - intensive CBT and SSRI/SNRI

Question 40

Do you offer benzos to people with GAD?

Answer 40

No, except in particular crisis

Question 41

Safety net for GAD

Answer 41

Monitoring with further appointment and if symptoms get worse/suicidal if starting drug treatment

Question 42

Questions that form part of CAGE alcohol screen

Answer 42

Cut down Annoyed when people comment Guilty about drinking Eyeopener

Question 43

Symptoms of delirium tremens

Answer 43

confusion/delirium, generalised tonic-clonic seizures (this may be the first manifestation of alcohol withdrawal for some people), auditory, visual, or tactile hallucinations, hyperthermia subsequent to psychomotor agitation

Question 44

Symptoms of mild alcohol withdrawal

Answer 44

hypertension and tachycardia, anorexia, anxiety, emotional lability, insomnia, irritability, diaphoresis, headache, and fine tremor.

Question 45

Timescale of mild and moderate alcohol withdrawal

Answer 45

Onset in 4-6 hours | Peak at 24-36 hours

Question 46

Red Flag referral for alcohol treatment

Answer 46

acute withdrawal or at risk of developing | Wernicke encephalopathy

Question 47

MGMT of alcohol dependence and want to quit?

Answer 47

referral to specialist alcohol service

Question 48

Do piss heads need to inform DVLA?

Answer 48

yes

Question 49

MGMT options for problem drinking?

Answer 49

Advice Referral to specialist service if they want to quit Urgent admission if they are acutely withdrawing

Question 50

What medication is possible for problem drinkers and what group do you offer it to?

Answer 50

Thiamine for harmful/dependent drinkers at risk of malnourishment

Question 51

What questionnaire would you use to asses the level of someone's drinking?

Answer 51

AUDIT

Question 52

What do you offer to all problem drinkers?

Answer 52

Information about community support groups

Question 53

If a drinker wants specialist medication to stop drinking what do you tell them?

Answer 53

No, needs to be prescribed by specialist service

Question 54

Low tech advice for drinkers

Answer 54

Cut down alcohol but DON’T stop suddenly Recognizing and avoiding high risk situations for drinking Recognizing personal cues for drinking (for example stress and being alone). Drinking a soft drink for every alcoholic drink, and eating before drinking. Trying alternative activities to drinking (coping strategies) Keeping a drinking diary Avoid pub after work Avoid joining in buying rounds

Question 55

Symptoms of Wernicke's encephalopathy

Answer 55

confusion, ataxia, ophthalmoplegia, nystagmus

Question 56

Risk assessment aspects in problem drinking

Answer 56

``` MOOD • Children at home • Domestic violence • Driving • Occupation ```

Question 57

Safety net for problem drinking

Answer 57

o Ask patient to return if they find themselves struggling or they need more support o Ask patient to return if they have symptoms of withdrawal (shaking, sweat,tremor) o Direct them to Crisis Team Helpline or Samaritans out of hours.