week 1

Question 1

what is a fit note for?

Answer 1

• free of charge
• statement for fitness to work advising either
  a) not fit for work
  b) you may be fit for work taking account certain pieces of advice

Question 2

when does a fit note need to be issued

Answer 2

when an individual has been off work for more than 7 days

Question 3

can altered hours be stated as a request for a patient issued with a fit note

Answer 3

yes

Question 4

palliative management of anorexia

Answer 4

dexamethasone

Question 5

palliative management of pruritus

Answer 5

cholestyramine

Question 6

palliative trx muscle spasms

Answer 6

baclofen

Question 7

palliative trx insomnia

Answer 7

temazepam

Question 8

palliative trx hiccups

Answer 8

metoclopramide

Question 9

palliative trx dyspnoea

Answer 9

morphine

Question 10

palliative trx restlessness

Answer 10

haloperidol

Question 11

palliative trx excessive resp secretions

Answer 11

hyoscine hydrobramide

Question 12

palliative trx capillary bleeding

Answer 12

tranexamic acid

Question 13

4 basic principles of end of life care

Answer 13

• autonomy
• beneficience
• non maleficence
• justice

Question 14

time definition of end of life

Answer 14

person likely to die within next 12 months

Question 15

1st line management of delirium tremens

Answer 15

oral lorazepam

Question 16

presentation of delerium tremens

Answer 16

tachycardia, HTN, pyrexia

Question 17

when does delerium tremens occur

Answer 17

1-2 days following cessation of alcohol

Question 18

other signs of alcohol withdrawal

Answer 18

• n+v
• headache
• tremors
• extreme sweating
• hallucinations
• agitation/anxiety

Question 19

during what period is alcohol withdrawal symptoms worst

Answer 19

first 48 hours

Question 20

peak incidence of alcohol withdrawal seizures

Answer 20

36 hours

Question 21

peak incidence of delirium tremens

Answer 21

48-72 hours

Question 22

symptoms of delirium tremens

Answer 22

• seizures
• hallucinations
• coarse tremor
• confusion
• fever
• tachycardia

Question 23

cause of wernicke’s encephalopathy

Answer 23

thiamine deficiency

Question 24

offer thiamine to…. (4)

Answer 24

• those at high risk of wernickes encephalopathy
• are malnourished
• decompensated liver disease
• in acute withdrawal

Question 25

2 supplementations during alcohol withdrawal

Answer 25

thiamine + folic acid

Question 26

why is folic acid required in alcohol withdrawal

Answer 26

alcohol affects the bodys ability to absorb folate

Question 27

where is alcohol detoxification carried out

Answer 27

undertaken by specialist community alcohol services - in patient, or - close supervision at home

Question 28

treatment for alcohol withdrawal

Answer 28

benzodiazepine regimen: chloorodiazepoxide

Question 29

therapy for alcohol dependancy (4)

Answer 29

- self help groups: AA - 12 step facilitation therapy - CBT - family therapy

Question 30

4 medications for alcohol dependancy

Answer 30

- acamprosate - disulfiram - naltrexone - nalmefene

Question 31

mechanism of acamprostate and how long advised course

Answer 31

- weak NDMA antagonist | - 6 months course

Question 32

promotes abstinence if you are concerned you may have a relapse

Answer 32

Disulfiram

Question 33

mechanism of disulfiram

Answer 33

prevents you drinking by causing an unpleasant reaction when you do drink - nausea - chest pain - vomiting - dizziness

Question 34

what must you warn patients about when starting disulfiram

Answer 34

May have reaction to other alcohol containing things such as perfume, mouthwash, aftershave

Question 35

blocks opioid receptos

Answer 35

- Naltrexone | - Nalmefene

Question 36

lower back pain red flags (6)

Answer 36

- age <20 - age >50 - hx previous malignancy - night pain - hx trauma - weight loss - fever

Question 37

gradual onset of unilateral/bilateral pain with numbness, weakness; worse on walking. - pain resolves sitting down - diagnosed by MRI

Answer 37

spinal stenosis

Question 38

causes of spinal stenosis (3)

Answer 38

- tumour - disc prolapse - degenerative changes

Question 39

Management of disc herniation/prolapse

Answer 39

- NSAIDs - PPI protection - exercise programme - manual therapy - epidural injections of local anaesthesia + steroids

Question 40

what tool do GPs use as a prognostic questionnaire to help identify modifiable risk factors for back pain

Answer 40

STarT tool

Question 41

presentation of lumbar muscle sprain/strain

Answer 41

- muscle spasms on movement - lasting < 30 minutes - aggravated by movement - usually lasts 2-4 weeks

Question 42

- saddle anaesthesia - urinary/faecal incontinence - bilateral sciatics

Answer 42

cauda equina

Question 43

spinal cord compression presentation

Answer 43

- gradual onset - aching night pain - localised spinal tenderness - worse with coughing/straining

Question 44

infection e.g. spinal epidural abscess

Answer 44

- fever - TB - recent UTI - HIV infection/immunosuppressed

Question 45

causes of lumbar spinal stenosis

Answer 45

- tumour - disc prolapse - degen changes

Question 46

easier to walk uphill than downhill

Answer 46

lumbar spinal stenosis

Question 47

management of lumbar spinal stenosis

Answer 47

- laminectomy

Question 48

common side effects of Metformin

Answer 48

- Abdo pain - anorexia - diarrhoea - nausea - taste disturbances - vomiting

Question 49

rarer side effect of metformin

Answer 49

decreased B12 absorption