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Phase 2a Medicine - Riona > GP > Flashcards

Flashcards in GP Deck (124)
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1
Q

Whats ages do health workers work with?

A

0-5

2
Q

Give 3 roles of the health visitor

A
  • ) Ante-natal and post-natal support
  • ) Support parents
  • ) Advice on feeding
  • ) Support special needs
  • ) Advise on behavioural management techniques
  • ) Advice on reducing risks and accidents
  • ) Information on local services
  • ) Safeguarding
3
Q

What is the red book/PCHR?

A

Personal child health record

4
Q

Give 3 purposes of a 6-8 week baby check

A
  • ) Detect congenital heart disease
  • ) Developmental dysplasia of hip
  • ) Congenital cataract
  • ) Undescended testes
  • ) Hernias
5
Q

Give 3 things children are vaccinated against at 8 weeks

A
  • ) Diphtheria
  • ) Tetanus
  • ) Pertussis (DTP)
  • ) Polio
  • ) H. influenzae
  • ) Hep B
  • ) Pneumococcal
  • ) Meningococcal group B
  • ) Rotavirus gastroenteritis
6
Q

Give 3 things children are vaccinated against at 12 weeks

A
  • ) DTP
  • ) Polio
  • ) Hib
  • ) Hep B
  • ) Pneumococcal
  • ) Men B
7
Q

Give 3 things children are vaccinated against at 16 weeks

A
  • ) DTP
  • ) Polio
  • ) Hib
  • ) Hep B
  • ) Pneumoccocal
  • ) Men B
8
Q

Give 3 things children are vaccinated against at 12 months

A
  • ) Hib
  • ) Men C
  • ) Pneumococcal
  • ) MMR
  • ) Men B
9
Q

What are girls aged 12-13 given a vaccination of?

A

Human papillomavirus (HPV)

10
Q

What is the aim of vaccination?

A

To produce a rapid protective immune response upon re-exposure to that pathogen

11
Q

Give the steps of the pathogenesis of vaccination with T cells (6)

A

1) Macrophages ingest attacker/fragments
2) Travel to lymph nodes
3) Use class II MHC molecules to present antigens
4) Helper T cell receptors recognise antigens
5) Helper T cell receptors bind and trigger helper T cells to proliferate
6) Eventually some of helper T cells become memory cells

12
Q

Give the steps of the pathogenesis of vaccination with B cells (4)

A

1) B cell receptors recognise attacker/fragment of attacker from APC
2) B cell triggered
3) Proliferates and makes plasma cells to make lots of the same antibody
4) Some B cells become memory cells

13
Q

Give the 3 types of vaccine

A
  • ) Inactivated
  • ) Attenuated
  • ) Live vaccines
14
Q

Give 3 differential diagnoses for a cough

A
  • ) Asthma
  • ) Acute respiratory infection
  • ) GORD
  • ) Seasonal allergic rhinitis
  • ) Post infectious cough
  • ) Pertussis
  • ) Pneumonia
  • ) Head cold
  • ) TB
  • ) Inhaled foreign body
  • ) Bronchiolitis
15
Q

Give 3 differential diagnoses for SOB

A
  • ) Asthma
  • ) Severe anaemia
  • ) Pneumothorax
  • ) Pulmonary oedema
  • ) COPD
  • ) Arrhythmia
  • ) Lower respiratory tract infection
  • ) Panic attacks
  • ) Metabolic acidosis
  • ) PE
16
Q

Give 2 measurements a spirometry shows

A
  • ) Amount of air you breathe out in 1 second

- ) Total amount of air in lungs

17
Q

What is a peak flow test?

A

How fast you can blow air out of your lungs in one breath

18
Q

Give 2 tests for breast cancer

A
  • ) Mammogram
  • ) US
  • ) Core biopsy
  • ) Fine needle aspiration
19
Q

Give 3 presenting symptoms of breast cancer

A
  • ) Breast lump
  • ) Nipple change
  • ) Nipple discharge
  • ) Bloodstained discharge from nipple
  • ) Skin contour changes
  • ) Axillary lumps
  • ) Breast pain/mastalgia
  • ) Symptoms of metastatic disease
20
Q

What are we looking for in a breast inspection?

A
  • ) Variations in breast size and contour
  • ) Inverted nipple? Uni/bilateral?
  • ) Any oedema?
  • ) Redness/retraction of skin
  • ) Dimpling of skin (orange peel)
21
Q

How do we palpate a breast in examination?

A
  • ) Flat hand of 2,3,4th fingers
  • ) Circle outwards from nipple
  • ) Increase axillary tail and axilla
  • ) Light, medium then deep pressure
  • ) Assess mobility of lump (attached to skin/tissue?)
  • ) Both breasts
22
Q

When should we urgently refer to a breast clinic and see within 2 weeks?

A
  • ) Suspicious breast lump
  • ) Persistent/unexplained lump in axilla
  • ) Unilateral nipple discharge, retraction, ulceration, distortion, eczema resistant to topical steroids, changes of concern
  • ) Skin changes including nodules, ulceration, peau d’orange, dimpling
  • ) Unilateral non cyclical breast pain persisting beyond one menstrual cycle
  • ) Men >50 with subareolar lump
23
Q

Give 3 systemic symptoms of breast cancer

A
  • ) Weight loss
  • ) Fever
  • ) Lethargy
  • ) Pain elsewhere
  • ) Gland swelling
24
Q

Give 2 medications we need to ask about in breast cancer investigations

A
  • ) HRT

- ) Oral contraceptive pill

25
Q

What does BRCA stand for?

A

Breast cancer gene

26
Q

What does BRCA do when it functions normally?

A

Acts to repair cell damage to keep breast, ovarian and other cells growing normally - TUMOUR SUPPRESSORS

27
Q

What are BRCAs considered, as they are associated with a high risk of developing breast cancer?

A

High penetrance

28
Q

What other mutations (not BRCAs) are linked to a higher breast cancer risk?

A

SNPs, single nucleotide polymorphisms

29
Q

Men with an abnormal what have a higher risk of breast cancer?

A

BRCA2

30
Q

Give 2 risk reducing surgeries for breast cancer

A
  • ) Mastectomy

- ) Oophorectomy

31
Q

What does an oophorectomy lead to?

A

Early menopause

32
Q

Give an advantage of having a genetic test for BRCA

A
  • ) Positive - take steps to manage risk

- ) Less stress and anxiety from not knowing

33
Q

Give a disadvantage of having a genetic test for BRCA

A
  • ) Results sometimes inconclusive

- ) Positive result can cause permanent anxiety

34
Q

Is BRCA autosomal dominant or recessive?

A

Dominant

35
Q

Give 3 ways we manage our risk of breast cancer

A
  • ) Regularly examine breasts
  • ) Screening
  • ) Lifestyle changes
  • ) Medication
  • ) Risk-reducing surgery
36
Q

What is the AMONA management for an acute MI?

A
Ambulance
Morphine
Oxygen
Nitrates
Aspirin
37
Q

Give 3 differential diagnoses for chest pain

A
  • ) Heartburn
  • ) Indigestion
  • ) Chest sprain/strain
  • ) Anxiety/panic attack
  • ) Chest infection/pneumonia
  • ) Shingles
38
Q

What are the 9 areas of the abdomen?

A
  • ) L hypochondriac
  • ) Epigastric
  • ) R hypochondriac
  • ) L lumbar
  • ) Umbilical
  • ) R lumbar
  • ) L iliac fossa
  • ) Suprapubic
  • ) R iliac fossa
39
Q

Give 4 things we look for in an abdominal examination

A
  • ) Scars
  • ) Ascites
  • ) Masses
  • ) Pulsation
  • ) Cullen’s sign (bruising around umbilicus)
  • ) Grey-Turner’s sign (bruising in flanks)
  • ) Abdominal distension
  • ) Striae
  • ) Caput medusae
  • ) Stomas
40
Q

What are we assessing for on abdominal palpation?

A
  • ) Tenderness
  • ) Rebound tenderness (peritonitis)
  • ) Guarding
  • ) Masses
41
Q

What are the steps of an abdominal examination? (9)

A

1) Observation
2) Light palpation
3) Deep palpation
4) Liver
5) Gallbladder (not usually palpable)
6) Spleen (not usually palpable)
7) Kidneys
8) Aorta
9) Bladder (empty not palpable)

42
Q

What is Murphy’s sign?

A
  • ) Place hand in R costal margin mid-clavicular line
  • ) Patient takes deep breath
  • ) Sudden stop in inspiration due to pain
  • ) Positive if no discomfort in same location on left
43
Q

What does liver tenderness suggest?

A

Hepatitis

44
Q

What can a pulsatile enlarged liver be caused by?

A

Tricuspid regurgitation

45
Q

What does an outward movement on aorta examination indicate?

A

Expansile, suggestive of AAA

46
Q

What should we suspect if there is acute diarrhoea?

A

Gastoenteritis

47
Q

Give 3 risk factors for diarrhoea

A
  • ) Travel
  • ) Insect bites
  • ) Contact with dirty water
  • ) Contact with D&V
  • ) Diet change
48
Q

What do we ask about diarrhoea?

A
  • ) Consistency
  • ) Mucous
  • ) Blood
  • ) Urgency
49
Q

Give 3 infectious causes of diarrhoea

A
  • ) Campylobacter
  • ) E. coli
  • ) Norovirus
  • ) Rotavirus
  • ) Malaria
  • ) Giardiasis
50
Q

Give 3 non-infectious causes of diarrhoea

A
  • ) IBD
  • ) IBS
  • ) Anxiety
  • ) Allergy/intolerance
  • ) Chronic pancreatitis
  • ) Diverticular disease
  • ) Bowel cancer
  • ) Surgery
51
Q

Give 3 medications that can cause diarrhoea

A
  • ) Laxatives
  • ) Antacids
  • ) Long term antibiotics
  • ) Chemo drugs
  • ) NSAIDs
  • ) SSRIs
52
Q

What 2 main tests do we do in a patient with chronic diarrhoea?

A

Blood work and stool tests

53
Q

Give 3 things a patient should not have when having a PSA test

A

-) Active urine infection
-) Produced semen (ejaculated) in previous 48hrs
-) Exercised heavily in previous 48hrs
-) Prostate biopsy in last 6 weeks
-) DRE in previous week
CIs that can produce a high PSA

54
Q

How does the definition of a normal PSA result change?

A

Increases as you get older

55
Q

How do we do a prostate biopsy?

A

US guided, 12 or more small cores of prostate tissue examined

56
Q

Give 3 treatment options for prostate cancer

A
  • ) Watchful waiting (no DRE, more palliative)
  • ) Active surveillance (DREs and prostate biopsies)
  • ) Radical prostatectomy
  • ) Hormone therapy (castration, androgen deprivation)
  • ) Radical radiotherapy
57
Q

Give 2 risks of a radical prostatectomy

A
  • ) Urinary incontinence
  • ) ED
  • ) Incomplete resection of tumour
58
Q

Give the 4 main treatment options for an enlarged prostate gland

A
  • ) Lifestyle changes
  • ) Medication
  • ) Catheters
  • ) Surgery
59
Q

Give 3 lifestyle changes for an enlarged prostate gland

A
  • ) Fewer fizzy drinks, alcohol, caffeine, artificial sweeteners
  • ) Drink less in evening
  • ) Remember to empty bladder
  • ) More fruit and fibre
  • ) Pads/sheath
  • ) Bladder training
  • ) Exercises
60
Q

Give 3 medications for an enlarged prostate gland

A
  • ) Alpha blockers
  • ) Anticholinergics
  • ) 5-alpha reductase inhibitors
  • ) Diuretics
  • ) Desmopressins
61
Q

How do alpha blockers work, and give an example (enlarged prostate gland)

A
  • ) Relax muscle in prostate gland and base of bladder

- ) Tamsulosin and alfuzosin

62
Q

Give an example of a 5-alpha reductase inhibitor

A

Finasteride, dutasteride

63
Q

When should we give diuretics and desmopressins in an enlarged prostate gland?

A

Diuretics speed up urine production - daytime

Desmopressins slow down urine production - nighttime

64
Q

Give 3 surgical options for an enlarged prostate gland

A
  • ) Transurethral resection of prostate
  • ) Open prostatectomy
  • ) Cystoplasty
  • ) Botulinum toxin
  • ) Implanted sacral nerve root stimulation
  • ) Urinary diversion
65
Q

How does the patient lie in a DRE?

A

On their side with their knees up to their abdomen

66
Q

What are we assessing in a prostate exam?

A
  • ) Size
  • ) Consistency (smooth, nodules, masses)
  • ) Tenderness
  • ) Fluctuations
67
Q

What do we assess if a testicular mass is found?

A
  • ) Size and shape
  • ) Regularity
  • ) Consistency
  • ) Discomfort
  • ) Fixed/separate to testicle
  • ) Transilumination
68
Q

What is the problem with PSA testing?

A

Lots of false negatives and positives

69
Q

Give 3 reasons for not organ donating

A
  • ) Lack of knowledge about need
  • ) Don’t know how to register
  • ) Uncertainty about faith’s position
  • ) Religiously permissible?
  • ) Issue of trust in allocation procedures
  • ) Perceived lack of relevance for own community
  • ) Language barriers
70
Q

Give 3 ways we manage stage 5 CKD

A
  • ) Transplant
  • ) Dialysis
  • ) Palliative care
71
Q

Which ethnicities have a higher incidence of CKD?

A

Black and South Asian

72
Q

Give 4 roles of the kidney dialysis cannot replace

A
  • ) Continuous removal of waste products and excess fluid
  • ) Production of EPO
  • ) Conversion of vitamin D into active compound
  • ) Excretion of some drugs
  • ) Control of BP
73
Q

How long does renal impairment have to persist to be considered chronic?

A

3 months

74
Q

Give an example of a nephrotoxin

A
  • ) NSAIDs
  • ) Aminoglycosides
  • ) IV radiocontrast agents
75
Q

How does high cholesterol cause CKD?

A

Build up of fatty despots in blood vessels supplying kidneys

76
Q

How is proteinuria assessed? (2)

A
  • ) PCR (protein:creatinine ratio)

- ) ACR (albumin:creatinine radio)

77
Q

Give 4 things to plan in palliative care

A
  • ) Preferred place of death (and carer willingness and availability)
  • ) Making will/living will
  • ) Power of attorney
  • ) DNAR status
  • ) Involving faith leaders
  • ) Contact details for health care professionals out of ours
  • ) Planning a funeral
78
Q

What should we immunise against before beginning dialysis?

A

Hep B

79
Q

What artery do we attach a new kidney to?

A

Internal iliac artery

80
Q

Give 3 risks of a kidney transplant

A
  • ) Rejection
  • ) SEs of steroids
  • ) Skin cancers
  • ) Solid tumours
  • ) Lymphoma
  • ) High risk pregnancy
81
Q

Give the 2 main types of dialysis

A

Haemodialysis, peritoneal dialysis

82
Q

Give 3 tests we should do in CKD

A
  • ) BP
  • ) U&Es, FBCs, HbA1C, lipid, ACR, PCR, alkaline phosphate, Ca, PTH, vitamin D
  • ) EPO (chronic anaemia with normal iron levels)
  • ) DEXA
83
Q

Give 2 types of inflammatory arthritis

A
  • ) RA
  • ) Spondyloarthritis
  • ) Crystal arthritis
84
Q

What does FBC show in RA?

A

Normochromic, normocytic anaemia and thrombocytosis

85
Q

What is rheumatoid factor?

A

An auto-antibody directed against the Fc region of an Ig, form immune complexes and active the complement system

86
Q

Give 3 auto-antibodies that can be tested for in RA

A
  • ) Anti CCP
  • ) ANA
  • ) DsDNA
  • ) ENA
  • ) RF
87
Q

What do DMARDs do?

A

Treat symptoms and slow down the progression of the disease

88
Q

Give 3 DMARDs

A
  • ) Gold injections
  • ) Hydroxychloroquine
  • ) Leflunomide
  • ) Methotrexate
  • ) Sulfasalazine
89
Q

Give 3 treatment options for RA

A
  • ) DMARDs
  • ) Biological therapies (type of DMARD)
  • ) Immunosuppression with corticosteroids
  • ) NSAIDs before DMARDs
90
Q

Give 3 side effects of methotrexate

A
  • ) Nausea
  • ) Loss of appetite
  • ) Sore mouth
  • ) Diarrhoea
  • ) Headaches
  • ) Hair loss
  • ) Pancytopenia
  • ) Leucopenia
  • ) Thrombocytopenia
  • ) Megaloblastic anaemia
91
Q

Give 3 parts of the body DMARDs can effect

A
  • ) Blood count
  • ) Liver
  • ) Kidneys
  • ) Eyes
  • ) Lungs
92
Q

What is DAS28 and what does it include? (4)

A

Measure of disease activity

  • ) Number of swollen joints
  • ) Number of tender joints
  • ) ESR/CRP
  • ) Patient gives global assessment of health 1-10
93
Q

What must be given to someone who is taking methotrexate?

A

Folic acid tablets

94
Q

Give 3 cardinal features on exam for a diagnosis of rheumatoid disease

A
  • ) >3 joints affected
  • ) Tenderness on palpation
  • ) Synovitis of affected areas
  • ) Positive squeeze test across MCPJs
95
Q

Give 3 things we should ask when taking a MSK history

A
  • ) Current symptoms
  • ) Evolution of problem
  • ) Involvement of other systems
  • ) Systemic symptoms
  • ) FHx
  • ) History of other autoimmune disease
  • ) Impact on patient’s life
  • ) Other joints than presenting joint
96
Q

What does SOCRATES stand for?

A
Site
Onset
Character (dull, stabbing)
Radiation
Associations
Time course
Exacerbating/relieving factors
Severity
97
Q

How do we assess joints to differentiate between RA and OA?

A
  • ) Stiffness - OA less stiff
  • ) Pain with use - OA more pain, less pain with rest
  • ) Number of joints
  • ) Symmetry - OA asymmetric
  • ) Acute
  • ) Tenderness/redness - RA
98
Q

Give 3 differential diagnoses of mono-articular inflammation

A
  • ) OA
  • ) Gout (v. acute)
  • ) Pseudogout
  • ) Septic arthritis
99
Q

Give 2 differential diagnoses of poly-articular inflammation

A
  • ) RA
  • ) Viral infections
  • ) Spondyloarthropathies
100
Q

What do we stop in the treatment for RA when the patient has an infection?

A

DMARDs

101
Q

Give 2 examples of an anti-TNF drug

A
  • ) Infliximab

- ) Rituximab

102
Q

How do we monitor the treatment of RA?

A

Shared care protocol

  • ) Hospital appt with consultant every 6-12 months
  • ) Blood tests every 3 months (hospital nurse/GP)
  • ) Contact as necessary by phone with rheumatology nurses
103
Q

What do the routine 3 monthly blood tests for DMARDs include? (3)

A
  • ) FBC
  • ) U&E
  • ) LFTs
  • ) Possible BP and urine test
  • ) Eyesight test with hydroxychloroquine
104
Q

Give 3 things uncontrolled chronic pain can cause

A
  • ) Anxiety and emotional distress
  • ) Undermines wellbeing
  • ) Interferes with functional capacity
  • ) Stops one from fulfilling family, social, vocational roles
105
Q

Give 3 feeling a patient way have when in pain

A
  • ) Tense
  • ) Easily angered and hostile
  • ) Hopeless, depression
  • ) Difficulties with sleeping
106
Q

What do we use to assess ADL?

A

Katz ADL

107
Q

Give 4 things the Katz ADL looks at

A
  • ) Bathing
  • ) Dressing
  • ) Toileting
  • ) Tranferring
  • ) Continence
  • ) Feeding
108
Q

Give 3 distinct types of behaviours of how people first cope with pain

A
  • ) Trying to beat it
  • ) Boom and bust
  • ) Complete avoidance
109
Q

Give 3 pharmacological managements of osteoarthritis

A
  • ) Oral analgesics
  • ) Topical NSAIDs
  • ) NSAIDs and highly selective COX2 inhibitors
  • ) Intra-articular injection of corticosteroids
110
Q

Give 3 non-pharmacological managements of osteoarthritis

A
  • ) Exercise and manual therapy
  • ) Weight loss
  • ) Transcutaneous electrical nerve stimulation
  • ) Aids/devices
111
Q

Give the 3 steps of the analgesic ladder

A
  • ) Non opioid +/- adjuvant
  • ) Weak opioid +/- non-opioid, +/- adjuvant
  • ) Strong opioid +/- non-opioid, +/- adjuvant
112
Q

Give 2 examples of analgesia adjuvants

A
  • ) Antidepressants
  • ) Anti-seizure
  • ) Muscle relaxants
  • ) Sedatives
  • ) Anti-anxiety
  • ) Botulinum toxin
113
Q

Give an example of a non-opioid analgesia

A
  • ) Aspirin
  • ) Paracetamol
  • ) NSAID
  • ) Nafopam
114
Q

Give an example of a weak opioid

A
  • ) Codeine
  • ) Dihydrocodeine
  • ) Tramadol
115
Q

Give an example of a strong opioid

A
  • ) Morphine
  • ) Fentanyl
  • ) Oxycodone
  • ) Dimorphine
116
Q

What 3 things do we look at in a knee examination?

A
  • ) Gait
  • ) Anterior inspection
  • ) Posterior inspection
117
Q

What 3 things do we feel in a knee examination?

A
  • ) Palpitation with leg straight and relaxed
  • ) Joint effusion assessment
  • ) Palpation with knee bent to 90 degrees
118
Q

What 2 types of movement do we do in a knee examination?

A

Active and passive

119
Q

Give 2 other tests we do in a knee examination

A
  • ) Ligament tests

- ) Meniscal damage

120
Q

Give 4 things in a pain toolkit

A
  • ) Acceptance
  • ) Support team
  • ) Pacing
  • ) Prioritising
  • ) Setting goals/action plans
  • ) Be patient
  • ) Relaxation
  • ) Stretching and exercise
  • ) Setback plan
121
Q

Give 4 main treatments for breast cancer?

A
  • ) Surgery
  • ) Radiotherapy
  • ) Chemotherapy
  • ) Hormone therapy
  • ) Biological therapy (targeted therapy)
122
Q

Give 2 hormone therapies used in breast cancer treatment

A
  • ) Tamoxifen
  • ) Aromatase inhibitors (after menopause)
  • ) Ovarian ablation or suppression
123
Q

What biological therapy do we give for breast cancer treatment?

A

Trastuzumab for HER-2 positive cancers

124
Q

What does HER-2 stand for?

A

Human epidermal growth factor receptor 2