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Routine Problems Flashcards

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1
Q

A 37 year woman patient presents with night sweats, give 5 differentials to consider?

A

Infective causes
Menopause
Anxiety
Hyperthyroid
Diabetes
Medications
Malignancy

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2
Q

Name three drug groups that could cause night sweats?

A

Antidepressants
Hormonal medications
Diabetic medications which can cause hypoglycemia

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3
Q

A 37 year old female presents with night sweats, you can’t find any obvious causes in the history, name what initial investigations may you consider?

A

FBC
Thyroid function
HbA1c
Inflammatory markers/ U+E/ LFT

Consider TB/ HIV/ CXR etc if indicated

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4
Q

A 32year old gentleman presents with a wart on the inferior aspect of his R hemiscrotum - what is the suggested management?

A

Podophyllotoxin 0.5% solution (Condyline® or Warticon®) or 0.15% cream (Warticon®) - better if soft (non keratinised)

Imiquimod 5% cream (Aldara®) - either keratinised or non keratinised

(Apply for 3 days consecutive, then four days off - upto 4 weeks)
(Advise often 1-6 months active treatments, high failure and relapse rates, often multiple courses and treatments needed)

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5
Q

What is slapped cheek syndrome, how does it present/ how managed?

A

Parvovirus B19 infection

Classic red cheeks, can spread to rash on body
Usually preceded by viral unwell, coryzal, sore throat, temp, headache

Manage as viral illness
Avoid pregnant people (risk to mum/ baby)
Rash usually settles within 2 weeks

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6
Q

What are the milk options which can be prescribed in primary care for CMPA?

A

EHF (Extensively hydrolysed formula) - First line, 90% of children
(Aptamil Pepti 1/2, Nutramigen LGG 1/2, SMA Althera, Similac)

AAF (Amino acid formula) - only needed by 10%
(Neocate LCP, nutramigen puramino, SMA alfamino)

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7
Q

Name 3 bits of practical advice you should give mums when trialing new formula milk for CMPA?

A

Try a formula for a minimum of two weeks and avoid product switching
- It takes 2 to 6 weeks without allergen to improve symptoms

If infant is struggling to take, can try to titrate with current formula (but will take longer to improve)

Stools may change and have a green tinge

Formula generally should only be prescribed for up to one year, and up to the age of 2 (around 2/3 by this point)
Challenge with cows milk every 6 months to see if developed tolerance, start at bottom and move up the milk ladder

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8
Q

During a routine set of bloods a patient of yours had an isolated raised ALT (ALT = 68), what is the most appropriate next step?

A

1) Look for obvious cause (alcohol, drugs), if no obvious repeat in 4-6 weeks
2) If persistent - full liver bloods, autoimmune/ hepatitis screen, USS of liver, hba1c etc.

Note 1 in 5 of random population in primary care with have abnormal LFT’s, only small amount of those with have other pathology found

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9
Q

A 43 year old female presents with itching, soreness and a thick white discharge from the vagina, what is the most appropriate first line management?

A

OTC Canesten (Clotrimazole) or Duo (Clotrimazole and Fluconazole) mainly useful for vulval symptoms (treat for 2 weeks)

Fluconazole 150 mg oral capsule as a single dose first-line (CI in pregnancy and breast feeding)
- Clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated (adults only)

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10
Q

Whilst going through your bloods we see a raised ALP - how would you interpret this alongside a gamma GT?

A

High ALP + normal GGT - Most likely bone (Check ca, bone etc)
High ALP + high GGT - Most likely liver (do liver screen)

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11
Q

Isolated raised bilirubin with otherwise normal other LFT’s, what is the most likely diagnosis?

A

Gilberts syndrome
(Could also be due to hemolysis, worth checking FBC, reticulocytes etc)

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12
Q

A 43 year old female presents with itching, soreness and a thick white discharge from the vagina, she has had 14 days of canesten along with a single dose fluconzole but there is no resolution of symptoms? What is the most appropriate next step?

A

For induction, prescribe three doses of oral fluconazole 150 mg (to be taken every 72 hours) first-line.

If severe and recurrent, for maintenance, prescribe oral fluconazole 150 mg once a week for six months first-line.

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13
Q

What is the starting dose of sertraline, and how would you titrate up?

A

Start 50mg
Titrate up by 50mg at most every 1-2 weeks as needed
Max 200mg daily

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14
Q

You are stopping sertraline and starting citalopram for a young female patient, how should you cross taper?

A

Straight swap
When going between SSRI and SNRI or vice versa cross tapering is not necessary and direct switch.

(Although whenever cross tapering check the NICE CKS on swapping antidepressents)

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15
Q

A 72 year old man currently taking Clopidogrel and atorvastatin post CVA complains of dyspepsia. A trial of OTC Gaviscon has not helped, what is the most appropriate next step in management?

A

Add lansoprazole (15-30mg)

(Note omeprazole and esomeprazole are both CI with Clopidogrel)

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16
Q

What is the DVLA driving guidance post TIA/ multiple TIA/ stroke?

A

1) Don’t drive for 1 month following single TIA, don’t notify DVLA
2) People who have multiple TIAs must not drive for 3 months and must notify DVLA. Driving may resume after 3 months if there have been no further TIAs
3) After stroke:
- Don’t drive for 1 month
- If after 1 month no neurological deficit, can drive and not notify DVLA
- If neurological deficit, visual field defects, cognitive defects, impaired limb function need to notify DVLA and not drive

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17
Q

What is first line self care advice for varicose veins?

A

Weight loss
Light to moderate physical activity
Avoid prolonged sitting/ standing
Elevate legs as much as possible

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18
Q

When should varicose veins be referred to vascular surgeons for consideration of intervention?

A

Symptomatic despite conservative tx (Pain, swelling)
Venous ulceration
Lower limb venous eczema
Superficial vein thrombosis (localized red, hard and hot superficial vein)

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19
Q

Following lifestyle changes, what are the conservative options for management of varicose veins?

A

Compression stockings (once arterial disease excluded with ABPI)

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20
Q

What should you advise a patient before h.pylori testing?

A

No PPI in last 2 weeks
No ABx in last 4 weeks

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21
Q

When does retesting for h.pylori following initial eradication therapy take place?

A

Never routinely

If done, at least four (ideally 8) weeks after eradication therapy. Urea breath test first line but stool antigen test possible
(usually if poor compliance with eradication or if patient requests)

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22
Q

What is the standard triple therapy regime for h.pylori eradication?

A

PPI twice daily (Lansoprazole 30mg, Omeprazole 40mg, Esomeprazole 20mg)

Amoxicillin 1g BD
Clarithromycin 500mg BD (or metronidazole 400mg BD)

If pen allergic both clarithomycin and metroidazole

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23
Q

Your obese patient with deranged ALT that you sent off for USS + liver screen results are back. USS shows fatty liver with an otherwise unremarkable liver screen. What is the most appropriate next step?

A

Diagnose and code NAFLD
Fib4 or NAFLD score
Lifestyle advice, control CVD risk factors
Annual CVD risk assessment and QRISK
Repeat FIB4 every 5 years

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24
Q

A 21 year old female comes in asking to delay her period for two weeks as she is going on holiday? What are the considerations and prescription options?

A

1st Line: Norethisterone 5mg TDS (BNF says for up to 10 days but can push to 28)

2nd Line: Medroxyprogesterone 10mg TDS
- If clot risk (Overweight, smoker, over 35yrs etc)

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25
A 19y old wants to start the COCP, what are the 6 broad areas the consultation should cover?
1) Alternative contraception options? 2) Benefits 3) Risk assessment (VTE, BP etc.) 4) Side effects 5) How to take and missed pill rules 6) Follow up
26
You are risk assessing a young woman who wants to start the COCP, what questions do you ask to check there are no UKMEC contraindications?
BAP CHAVSS B- BMI >35 A- Age > 50 P- Post partum (up to 6 weeks if breast feeding) C- Cancer (breast) or FHx H- Hypertension (BP >14/90) A- migraine with Aura V- VTE + FHx S- Smoker over 35 S- Stroke or major CV risk factors
27
A 19 year old is starting the COCP for the first time, when will it be effective from?
If taken on: D1- Immediately Any other time - after 7 days of use
28
What are the options of administration regimes for COCP?
1) Take 21 days and then 7 day break 2) Tailored (Tricycling 3x21 active pills then 7 day break) or continuous NB: Tailored or continuous are supported by FSRH but are off license uses
29
What are the most common side effects to advise about with the COCP?
1) Breakthrough bleed (most common in first few months) 2) Temporary: Breast tenderness, headaches, nausea - usually settle in 3 months NB: Mood changes - minimal evidence, weight gain - no evidence
30
What vitamin D levels would be classed as a) deficient b) inadequate and c) sufficient?
a) Below 25 b) 25-50 c) Over 50 (serum 25[OH]D)
31
What treatment should be offered for deficient/ inadequate levels of vit D if rapid correct needed?
300,000 IU Given over 6-10 weeks as either daily or weekly doses (i.e. 50,000 once weekly for 6 weeks or 1000IU QDS for 10 weeks)
32
What treatment should be offered for deficient/ inadequate levels of vit D if no rapid correction is needed? Is this prescribed or OTC?
Vit D3 - 800-2000IU daily with no loading doses (Prescribed if osteoporosis/ malabsorbtion, all other patients should by OTC)
33
A patient presents asking about prevention of vitamin D deficiency, what should you advise RE supplimentation?
All adults over 65/ with RF (low sun exposure, darker skin, CKD, liver disease, obsese) to take: 400 IU daily year round All other UK adults to consider taking 400IU either just autum/ winter or year round (Both OTC)
34
When should antiviral treatment be considered in patients with shingles (indications/ timeframe)?
Aim to start within 72 hours of rash starting, consider up to 1 week Prescribe if no indications for referal if rash/ pain moderate or worse, any with non truncal involvement and any immunocompromise, age over 50
35
What dose/ length of aciclovir is used for shingles in a well patient who does not need referral?
800mg five times daily 7 days (if immunocompromise consider until 2 days after crusting of lesions, up to 10 days)
36
What are the pain managment options for a patient with shingles?
1) Paracetamol 2) + codiene/ NSAID 3) + Amitryptiline/ gabapentin/ pregabalin/ duloxetine (one of not in combination) 4) Can consider steroids along with antiviral
37
What blood tests should be done as part of a memory screen?
FBC/ U+E/ LFT Bone profile + calcium TFT's HbA1c B12 and folate
38
What is the quickest/ easiest cognitive assessment tool to use in GP?
6-item cognitive impairment test (Available on patient UK) 1) Year 2) Month 3) Give address 4) About what time (within one hour) 5) Count back from 20-1 6) Months of year in reverse 7) Repeat address Or GPCOG
39
A 57 year old patient presents with unexplained weight loss, give four examples of 2ww referral considerations that could be relevant?
WL > 50 + no rectal bleed > ?FIT test WL > 40 + abdo pain = 2ww WL > 40 + ever smoker = Urgent CXR (in 2wks) WL > 55 + upper abdo pain/ reflux = UGI 2ww
40
What are the indications for blood tests in determining menopause? (2)
Consider blood test to confirm if: - Age under 45 - Age over 45 with atypical symptoms - This includes if considering premature ovarian failure
41
What is the age cut off (and symptoms) for a purely clinical diagnosis of perimenopause/ menopause?
Over 45 Perimenopause — if the woman has vasomotor symptoms and irregular periods. Menopause — if the woman has not had a period for at least 12 months (and is not using hormonal contraception).
42
You suspect menopause in a 42 year old female - which blood test is most appropriate and how would the result be interpreted?
FSH FSRH states that a single elevated serum FSH level (more than 30 IU/L) suggests ovarian insufficiency (but not sterility) and to confirm this should be on two different blood tests 4-6 weeks apart
43
What OTC treatments are available for ear wax?
Sodium bicarbonate 5% (otex) - QDS (5 days initially) Olive oil or almond oil drops (Don't use if active infection)
44
Name 2 indications for referral to remove ear wax?
Causing hearing loss or other symptoms TM needs to be visualized or impression made of ear canal
45
Name 5 childhood conditions where exclusions for school/ nursery apply (and the relevant exclusions):
1) Chicken pox (5 days from onset and all blisters crusted over) 2) Resp infections (only if temperature and unwell) 3) D+V (48 hours after both have stopped) 4) Impetigo (until lesions crusted or 48 hours after starting antibiotics) 5) Scarlet fever (24hrs after Abx), Scabies (after 1st dose)
46
What are the exclusion criteria for: a) Measles, mumps or rubella b) Scarlet fever c) Scabies
a) Measles 4 days from rash onset, rubella 5 days from rash onset, mumps 5 days from swelling onset b) Scarlet fever (until 24hrs after starting antibiotic) c) Scabies - until had first treatment
47
What are the exclusion criteria for: a) New TB b) Whooping cough
a) TB - 2 weeks from starting antibiotics (not needed for non-pulmonary or latent) b) Whooping cough - 48 hours from starting ABx treatment
48
What are the exclusion criteria for hand, foot and mouth, glandular fever, conjunctivitis, MRSA and tonsilitis?
None
49
In addition to menstrual changes, name 5 symptoms of menopause to ask about?
Hot flushes and night sweats Sleep disturbance Vaginal dryness Urinary problems Joint or muscle pains Loss of libido Mood or cognitive changes
50
Name 5 contraindications to HRT?
History of breast Ca (or oestrogen dependant tumour) Undiagnosed PVB Uncontrolled HTN Aterial vascular disease Current or recurrent VTE Liver disease (with abnormal LFT's) Thromboembolic disorder
51
Counselling for HRT: What 5 key risks should be discussed?
Breast Ca: Small increased risk (less than lifestyle factors) VTE: Increased (mainly oestrogen), patches safer than tablets CVD: HRT may likely be cardio protective Stroke: Oral HRT small increase stroke risk, patches likely safer Ovarian Ca: Possibly slight increased risk
52
A 46y old woman wants to start HRT and asks about breast ca risks with her combined HRT - what do you advise?
Small increase risk of breast ca - This is smaller than increase from lifestyle factors - Slightly increased for for combined than oestrogen only - V.unlikely increased risk under 50yrs - so exposure from HRT is only counted after 50 yrs (therefore unlikely to affect risk for this pt)
53
What questions need to be asked to determine the type of HRT a patient needs? (3)
1) Uterus Y/N - if N then oestrogen only HRT (unless subtotal/ endometriosis) 2) Contraception needed (I.e. >50 and no period for 1 yr, <50 and no period for 2 years or <55 and menstruating) If Y: Oestrogen + IUS/ COCP/ sequential combined HRT < STOP AT 55 3) If N to both above, has she been amenorrhoeic for >1y? Y: Continuous HRT N: Sequential HRT
54
A patient 52 year old lady, started on combined HRT 2 months ago who has not had a period for 6 years presents with small amount of PVB, how do you manage?
Bleeding after starting continuous combined HRT is normal for up to 6 months, if persistent will need 2ww for PMB
55
What symptom questionnaire can be used to assess severity of menopausal symptoms?
Greene Climacteric Scale
56
Name: 1) Continuous combined HRT patch 2) Sequential combined HRT patch 3) A brand of oestrogen only patch and common doses 4) The best progesterone to combine with osteogren only patches and why
1) Evorel Conti / FemSeven Conti 2) Evorel Sequi / FemSeven Sequi 3) Evorel - 25/50/75/100mcg Estradot 25/37.5/50/75/100mcg 4) Micronized progesterone's - generally lower risks and also helps with sleep symptoms
57
Name 3 features which support a diagnosis of idopathic nocturnal leg cramps?
Sudden intense calf or foot pain mainly at night, lasting seconds to 10mins Disrupts sleep Residual tenderness in muscle Visible or palpable knotting or muscle tightening
58
Name 3 differentials of organic causes for patients presenting with leg cramps at night
Calf swelling/ varicose veins - VTE Pain on exercise/ pulse changes - Vascular cause (PVD) Muscle wasting/ fasiculations/ dystonia not relieved by stretch - neurological signs O/E - Peripheral neuropathy/ MND etc. Urge to move legs/ uncomfortable sensations and improve with activity - Restless legs syndrome
59
You suspect a patient may have restless legs syndrome, what blood test is most likely to be helpful?
FBC + Ferritin (commonly precipitated by IDA) Consider U+E/ TFT/ glucose/ B12+folate)
60
What drugs could be used first line for restless legs syndrome?
NICE CKS recommends (off licence): - Pramipexole/ ropinirole/ rotigotine OR - Pregabalin or gabapentin (minimum dose for symptoms) Can also consider weak opioid
61
You suspect your patient has idopathic leg cramps, bloods have come back normal, what medication options do you have (in addition to self care measures)?
Quninine 200-300mg daily - Trial for 4 weeks and if not benefit to stop - Review 3 monthly - Warm about signs thrombocytopenia (bruising, bleeding, petechiae)
62
How do you manage treatment failure in vaginal thrush?
Review risk factors Perform HVS for C+S Prescribe alternative route/ duration of tx (If severe syx fluconazole 150mg oral repeated D1 and D4)
63
Name 5 components of a fertility history
Children born/ previous pregnancy/ miscarriages Length of time trying to conceive/ frequency of intercourse Mechanism (ejaculation issues, dyspareunia) Previous contraception/ time since stopped Symptoms (STI/ PID/ endometriosis) Menstrual cycle details Lifestyle factors (Diet, exercise, smoking)
64
After what duration should you refer couples for infertility investigations + how long does it normally take couples to conceive?
84% couples naturally within 1 year, 92% within 2 years Begin investigations after 1 year of regular unprotected sex
65
What investigations should be done for a female as part of an infertility work up?
- Day 21 (or 7 days before end of cycle) progesterone - STI Screen Symptom dependant: -FSH + LH if irregular periods - Thyroid function - Prolactin
66
What are the indications for earlier fertility referral? (As opposed to waiting for 12 months of UPSI)
Women:- 36 or older (refer at 6 months) - Previous STI/ PID/ surgery - Reduced/ no periods Men: - Previous genital surgery/ STI/ pathology/ varicocele Either: Known reason for infertility (i.e. cancer tx)
67
A 71 year old man comes in struggling with erectile dysfunction - name 5 possible causes?
Cardiovascular disease (Screen for angina) Weight loss Smoking Alcohol Diabetes Drugs Psychogenic
68
How do you distinguish between psychogenic and organic causes of erectile dysfunction?
Psychogenic - Self stimulated/ waking erections no problem, sudden onset, psychological problems Organic: Gradual onset, normal ejaculation, normal libido, risk factors in history/ drugs
69
If no contraindications what is your first line prescription for a man struggling with erectile dysfunction?
Sildenafil 50mg (Can change to 25-100mg) One dose every 24 hours Taken one hour before sex
70
If a patient has not had benefit from first line erectile dysfunction treatment (assuming causative factors are being addressed) - what options do you have?
If sildenafil is ineffetive, try 4-8x at maximum dose - if still ineffective then trial alternative (Tadalafil, Vardenfail, Avanafil)
71
What investigations should be performed in a man presenting with erectile dysfunction?
HbA1c Morning testosterone PSA - older patients TFT
72
Name 3 indications to refer a patient presenting with new erectile dysfunction?
Endocrine abnormality High cardiovascular risk (where sexual activity unsafe) Younger patients Pelvic trauma/ structural abnormality Mental health service input needed
73
How do you distinguish between Androgenic Alopecia and Telogen Effluvium?
Androgenic alopecia: - Permanent, in pattern (temples/ bald patch), gradual onset often after menopause Telogen Effluvium - Generally temporary, generalised hair loss, sudden onset (usually a trigger - IDA, childbirth, crash diet, trauma, thyroid, stress)
74
What are the four main types of female hair loss/ thinning?
Androgenic alopecia - Generally older, 1/3 white women affected Alopecia areata - Generally teens to 30's, generally well demarcated, usually autoimmune or FHx Telogen Effluvium Diffuse hair loss, usually transient, 1/3 women post childbirth, or other triggers Anagen effluvium - Total hair loss (usually due to chemo, radiotherapy etc)
75
You suspect your 36 year old female patient has telogen effluvium - what would be the most common causes to consider?
Childbirth Trauma IDA Thyroid disease Crash dieting or weight loss Low zinc levels
76
A) 24 year old female patient presents TATT. What would be first line bloods? B) What additional bloods would be done if they were a 68 year old male?
A) FBC, Ferritin, U+E, LFT, HbA1c, Tissue TTG, B12 + folate B) Add bone profile and myeloma screen Could also consider HIV if high risk patient
77
How do you manage an asymptomatic finding of haematuria on a urine dipstick or +ve for RBC on uranalysis (>5 RBC)?
Check for and treat UTI if appropriate Repeat in 4-6 weeks If persistent NVH (non visible hematuria) refer: - Age over 50 urgent referral - Age over 60 if persistent and also dysuria or raised WCC on bloods then for 2ww
78
When should you refer a patient with fibroids for gynae assessment? Give 3 examples
Any suspicion of malignancy (2ww) Fibroids over 3cm Submucosal fibroids (on scan) Fertility issues Heavy bleeding not managed in primary care Compressive urinary or bowel symptoms
79
What advice should be given to a woman with fibroids who wants to start HRT in relation to her fibroids?
HRT may increase the size of fibroids and possibly cause symptoms If already symptomatic consider specialist advice before prescribing HRT
80
How do you manage heavy menstrual bleeding in a patient with fibroids?
If <3cm and no other red flags same as all menorrhagia - 1st line IUS 2nd line: - COCP - TXA/ NSAIDS - Cyclical progesterone (norethisterone if safe)
81
What age/ risk factors are key to note to diagnose fibroids?
Unlikely under 30 Most common in 40's By 35, over half of black women will have fibroids HTN/ alcohol/ diet are RF Exercise, increased parity protective
82
What are the most common presenting features of an ovarian cyst?
Most asymptomatic Dull pain in lower abdo If large: Swollen abdomen/ mass/ pressure effects Unusual to cause bleeding changes, only if pressure effects
83
Going through lab reports, an USS result for a 25y female shows a new ovarian cyst - when do you NOT need to do a Ca-125?
Do not need to do Ca-125 in premenopausal women with simple cysts Ca-125 generally unreliable in differentiating benign from malignant pre-menopause
84
Other than ovarian Ca, what other things can raise Ca-125? Name 5
- Diverticulitis, liver cirrhosis - Endometriosis, uterine fibroids, -- Menstruation, pregnancy, - Benign ovarian tumors -Other malignancies (pancreatic, bladder, breast, liver, lung)
85
What blood tests should be performed for women under 40 with complex ovarian cysts found on USS?
LDH, AFP, hCG - Under age 40 possibility of germ cell tumours
86
How should you manage a new finding on pelvic USS of a simple cyst in a 28 year old woman?
<50mm - No follow up 50-70mm - Yearly USS follow up - If persistent and symptomatic can consider surgery > 70mm - Refer to gynae either futher imaging or surgery COCP not helpful
87
What scoring system is used to calculate risk of maligancy for those with ovarian masses?
For POST menopausal women Risk of Malignancy Index (RMI) - Ca125/ menopausal status/ ultrasound score - RMI over 200 needs referral. Any other concerning features
88
What risk factors should be considered when assessing possiblity of ovarian malignancy? (Name 3)
- Infertility/ clomifene use/ nulliparous - Early menarche/ late menopause - HRT use - FHx/ BRACA - Smoking/ obesity Protective: Childbearing, breastfeeding, early menopause, COCP
89
What features would raise concern of ovarian malignancy and require 2ww?
New ascites Pelvic or abdominal mass
90
What features would raise concern of ovarian malignancy and require urgent primary care ix?
Ca-125 and pelvic USS Especially if 50 or over: - Persistent distension or bloating - Persistent feeling full or loss appetite - Persistent pelvic or abdominal pain - Persistent increased urgency or frequency (Weight loss, fatigue, change in bowel habit also)
91
What is the diagnostic criteria for ADHD?
Hyperactivity, impulsivity, and inattention - Resulting in significant psychological, social, and/or educational functional impairment Present over 6 months in at least two different settings
92
How should reflux/ dyspepsia initially be managed? (3)
Lifestyle factors/ triggers diary OTC relief can be used temporarily (but not long term) Treat - either: - 1 month PPI trial - H.pylori testing
93
What is the best way to initially test for H.pylori?
Stool antigen test (Can also use urea breath test) Ensure off PPI for at least 2 weeks
94
You trial a 4 week course of PPI for new dyspepsia, symptoms are ongoing. What is the next best step?
H.pylori testing (stop PPI for 2 weeks)
95
Your patient has ongoing dyspepsia despite 4 weeks of full dose PPI followed by h.pylori testing and eradication - what's the options for next steps? (3)
Trial H2 antagonist (ranitidine) Can consider (retesting for h.pylori) and if needed use second line h.pylori eradication regime If second line eradication failed / ongoing symptoms > refer for endoscopy
96
What are the options to manage a patient with gastroscopy proven GORD?
Consider: - Repeat 4 week course full dose PPI - 4 week course double dose PPI - Add ranitidine for 2 weeks at night
97
After 4 week trial of double dose PPI, your patient with gastroscopy proven GORD has recurrent dyspepsia - what should be advised for long term GORD treatment?
PPI used at lowest dose Use PPI as needed Can consider switching PPI's Can consider 8 week double dose course
98
What are the NICE 2ww guidelines for UGI cancer?
2ww for: * Any dysphagia * Aged 55 years and over with weight loss and any of the following: - Upper abdominal pain. - Reflux. - Dyspepsia.
99
When should patients with a new diagnosis of anginal symptoms be referred?
Urgent: - Pain at rest/ minimal exertion/ rapidly progressing etc All new angina: - Urgent (seen in 2 weeks) to rapid access chest pain clinic for Ix
100
Aside from drops, what is the main treatment for glaucoma?
360° selective laser trabeculoplasty (SLT)

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