General Practise Learning objectives

Question 1

What preventative activities should be undertaken by GPs in patients of Middle age (45-49) e.g What screening questions to ask? (2 marks) what measurements/tests to be performed) (1.5 marks)

Screening

Also what are important tools risk calculator tools to be used in this age group?

e.g AUSDRISK/Absolute CV risk/ Osteoporosis

Answer 1

Preventative activities by age

Middle age (45-49)

Ask

1. SNAP screen - smoking every visit ; NAP at least every 2 years
2. Depression screen
3. Signs of skin cancer - any new or changing lesions?
4. Family Hx screening questionnaire

Measure

1. BMI (weight and height) + waist circumference
2. BP
3. Fasting lipids - every 5 years as part of CV assessment

PerformScreening

1. Cervical cancer screen - every 5 years from 25
2. Vaccination
3. Influenza vaccination - recommend for all; particularly for at risk
4. Pneumococcal - ATSI and chronic lung disease
5. DTPA - pregnant

Calculate

1. AUSDRISK - every 3 years from 40 for low risk or every 1 year for high risk
2. Absolute CV risk - every 2 years 45+
3. Osteoporosis risk factors - post-menopausal women and men >50

Question 2

What preventative activities should be conducted in middle age 50-64yr

(all the previous screening for 25-49)

Answer 2

Middle age 50-64y

• As above PLUS (45-49 yr)

Screening

• CRC - FOBT every 2 years from 50
• Breast cancer - mammogram every 2 years from 50
• Cervical cancer - every 5 years

Question 3

What are Elderly 65+ preventative activites needed to be conducted at GP?

As with all others, plus think, immunizations, af, falls prevention, Vision and hearing, dementia screening, Nutrition, nutrition in chronic diseases?

Answer 3

Elderly 65+

Immunisation

• Influenza - annually for all 65+ (PBS)
• Pneumococcal - one dose 65+ unless predisposing condition
• HZV - single dose 60+

SNAP

• Physical activity - 30 minutes moderate intensity on most if not all days
• Smoking & alcohol cessation

AF

• ECG everyone 65+

Falls prevention Screen

• All 65+ every 12 months

Moderate-high risk (past falls or risk factors) - every 6 months

3 questions

1. How many falls in the past 12 months?
2. Are you presenting following a fall?
3. Difficulty with walking or balance?

Any positive –> falls risk assessmnet

Falls risk assessment

• Hx (risk factors) -falls, balance, vision, mobility, medications, chronic disease, neurological disease
• Exam - postural BP & pulse, TUG test, visual acuity and fields, neurological, CV for for arrhythmia
• Tools - falls risk assessment tools

Management

1. Doctor - medication review (psychotropics, anticholinergics, sedatives, orthostatic hypotension)
2. Physio or exercise physiologist - refer for balance specific exercise program
3. OT home assessment - for those mod-high risk
4. Ophthalmologist or optometrist - cataracts or visual acuity/fields deficit
5. Podiatrist - walking and feet issues

Vision and hearing

• Snellen chart - if symptomatic or requested
• Hearing impairment screen - every 12 months by finger rub at 5cm + ask about hearing difficulty

Dementia

• Low risk - no benefit of screening
• Mod risk- Symptomatic, high CV risk, ATSI, family Hx, depression –> screen

How

• Ask - how is your memory?
• Cognitive assessment - GP assessment of cognition, MMSE, Kimberley Indigenous Cognitive Assessment tool

Prevention

• Physical activity by guidelines
• Social engagement
• Cognitive training
• Mediterranean diet
• Smoking cessation

Physical activity

• Screen - every 2 years

Recommendations

• 150 -300 minutes a week of moderate physical activity OR
• 75-150 minutes a week of vigorous

Nutrition

Screening and MxAll adult patients every 2 years

• Ask about - portion sizes of fruits and vegetables/day, sodium intake, saturated fat intake
• Advise to follow NHRMC dietary guidelines
• High risk patients every 6 monthsInclude
• Overweight/obese, high CV absolute risk, personal history of CVD, family Hx CVD (1o relative), type 2 DM

What

1. Lifestyle advice to reduce sat fat, sodium and increase fruit and veg intake
2. Provide information
3. Refer to dietician
4. Rough dietary guidelines

Vegetables - 5 serves

• Fruit - 2 serves
• Carbohydrates - 6 serves
• Dairy - 2.5
• Lean meat - 2.5

Question 4

What are Nutritional guides for prevention and managment chronic diseases such as 1) Cardiovascular (CVD reducing) 2) T2DM 3) CKD

Answer 4

Reducing CVD risk

• Fat - lower saturated and trans fats
• ≥ 2 serves of oily fish
• Lower salt
• Limit alcohol
• Reduce red meat

Type 2 DM

• Low fat
• Low GI CHOs - reduce simple sugars

CKD

• Varies with stage of disease
• Dietary restrictions
• Protein restricted diet
• Na+ restriction
• K+ restriction
• Fluid restriction - amount depends on GFR, oedema, hypertension
• Oral sodium bicarbonate to maintain HCO3-

Question 5

What is obesity? What is the epidemiology in Australia? Screening for obesity? Who is at high risk?

What are the classificaions of obesity, based on BMI, Waist circumference

What are the 5 As of Management of obesity ?

Answer 5

Obesity

Epidemiology

• Almost 2/3 Australians overweight
• 28% obese
• 25% children overweight or obese

Screening

• General population - BMI every 2 years
• High risk (ATSI, known CV disease, DM) - annually
• Known overweight - every 6 months

Management

• Ask - concerns about their weight
• Assess - BMI, waist circumference, diet, exercise, stage of change
• Advise - health benefits (CVD, DM etc.), change diet (2500kJ energy deficit), increase exercise (5x week 60 minutes of moderate intensity activity)
• Assist - set goals (achievable 5% loss initially –> significant benefits just from this), refer to dietician or exercise physiologist/program
• Arrange - follow-up in 2 weeks, bariatric surgery if BMI > 35 with comorbidities and unresponsive to lifestyle change

Question 6

Outline hx, motivational interviewing, bio/psycho/social+pharmacotherapy for SMOKING cessation:

8 Minute OSCE easily

Answer 6

Smoking cessation

• Intro
• History (ASK)HPC
• Smoking - type; quantify pack years; past attempts to quit; withdrawal symptoms
• Lung cancer screen - cough, sputum, blood, SOB, wheeze, hoarseness, weight loss
• CV screen - chest pain, palpitations, ankle swelling, orthopnoea, PND

PMHx

• Social*
• ICE
• SNAP - alcohol important
• Other drugs
• Home - marriage, kids etc.
• Occupation
• Family history

1. CV disease
2. Lung cancer

Motivational interview

Ask

• Above

Assess

• Stage of change - are you ready to quit?

Advise

• Risks - increased CV risk, increased cancer risk particularly lung and pancreatic cancer which are generally incurable, COPD/pneumonia etc., never too late to quit
• Benefits - much of the lung damage is reversible with time, minimise risks above, money, energy improve, fitness will improve
• SEs of quitting - weight gain, withdrawal

Assist

• Bio - pharmacotherapy (if >10/day)
• Psycho - offer Quitline, strategies (e.g. walk instead of smoke)
• Social (behavioural) - avoid cues to smoke, avoid situations that will tempt you, ask friends and family for support, alternatives (exercise)

Arrange

• Set a date - ask for a commitment
• Follow-up - appropriate time to check progress

Pharmacotherapy (assist)Nicotine replacement therapy

• Gum, patches

Varenicline (Champix)

• Works by reducing craving and withdrawal symptoms

Most effective

• 12 week therapy
• SEs - nausea, neuropsychiatric (depressive symptoms, agitation)

Buproprion

• Risks - seizures

Question 7

What is the australian childhood immunization schedule? Ages, Antigens, routes comments

Question 8

What are Qld Immunisations for adolescents and adults? e.g starting in school

Answer 8

Question 9

What are the current childhood vaccinations schedule in Australia? What are the ages and intervals? Which ones are live?

Answer 9

Question 10

What is the route these immunizations are taken - and at what ages?

What vaccines are inactivated? Purified compoonent? Synthetic? Live (most important)?

What is Vaccination catch up? What are the principles of catch up vaccinations?

What are live vaccines? Who cannot they be given too? What is Pre-vaccination assessment for live vaccines?

Answer 10

RouteMost given IM at 90 degrees

• <12 months - thigh (less fat)
• >12 months - deltoid

MMRV

• Given subcut - 45 degrees

Rotavirus - PO

Hep B at birth

• Babies get severe Hep B - develop chronic disease and cirrhosis

Healthcare workers

• dTpa - immunity proven
• Hep B - immunity proven
• MMRV - immunity proven
• Annual influenza

Vaccine types

• Inactivated - hepatitis A, polio, influenza, tetanus
• Purified component - acellular pertussis, polysaccharide vaccines
• Synthetic - conjugate (Hib, meningococcal C), recombinant (hepatitis B, HPV) vaccines
• Live - rotavirus, MMRV

Catch up

Welfare/child care benefits REQUIRE either

• Fully vaccinated children
• To be on a recognised catch up schedule

Catch up schedules

• Children <10 should be commenced on a catch up schedule covering the vaccines usually given throughout childhood
• Requires same amount of doses split up over a prolonged period >1 year
• Children >10 should be commenced on a catch up schedule but don’t require
• HiB
• Rotavirus
• Pneumococcal

Live vaccines

Virulence reduced greatly

• MMRV*
• Rotavirus*
• Also - YF, BCG, OPV (not routinely given in Australia)

Administration of more than one live vaccine

• Either give at the same time or 4 weeks apart (otherwise poor immune response)

Immunosuppression and household immunosuppressed contacts

• Cannot give live to immunosuppressed
• Can give to children with household contact immunosuppressed EXCEPT OPV (risk of paralysis) - all encouraged (only a very small risk of transmission of rotavirus –> benefit outweighs harm)
• Advise to keep away from immunosuppressed contact for a week or 2

Pre-vaccination assessment for live vaccines

• Are they immunosuppressed e.g. chemotherapy, steroid therapy? (small chance of causing actual disease)
• Are you pregnant? (possible teratogen)
• Have you had a vaccine recently? (cannot give 2 live vaccines within 4 weeks as interferes with immune response)
• Have you been given IgG recently? (reduces immune response to vaccine)

Question 11

What vaccines are lives? What is important about giving these vacinations?

What pre-vaccination assessment is avaliable to live vaccines?

What are absolute contraindications to vaccines?

What are FALSE contrainidications to vaccination?

Answer 11

Live Vaccines:

Virulence reduced greatly

Live vaccines

1. MMRV*
2. Rotavirus*
3. Also - YF, BCG, OPV (not routinely given in Australia)
4. Administration of more than one live vaccine
5. Either give at the same time or 4 weeks apart (otherwise poor immune response)

Immunosuppression and household immunosuppressed contacts

1. Cannot give live to immunosuppressed
2. Can give to children with household contact immunosuppressed EXCEPT OPV (risk of paralysis) - all encouraged (only a very small risk of transmission of rotavirus –> benefit outweighs harm)
3. Advise to keep away from immunosuppressed contact for a week or 2

Pre-vaccination assessment for live vaccines

1. Are they immunosuppressed e.g. chemotherapy, steroid therapy? (small chance of causing actual disease)
2. Are you pregnant? (possible teratogen)
3. Have you had a vaccine recently? (cannot give 2 live vaccines within 4 weeks as interferes with immune response)
4. Have you been given IgG recently? (reduces immune response to vaccine)

Question 12

What are common adverse effects of vaccination? 1) common 2) rare

What are signs and symptoms of measles? Ix?

Answer 12

Adverse effects

Common

1. Febrile illness
2. Pain/erythema/hematoma at injection site
3. Rash

Rare

1. Febrile convulsion
2. Anaphylactic shock - very rare
3. Intussusception - rotavirus

Measles

• Eliminated from Australia

Sx

• Fever
• 3 Cs - coryza, cough, conjunctivitis
• Rash - maculopapular on trunk
• Koplik’s spots - white on buccal mucosa

Complications

1. Pneumonia
2. Encephalitis
3. Thrombocytopenia

Ix

• IgM Abs
• PCR

PEP for contact with measles

• MMR if <72 hours
• Ig - if >72 hours ONLY if at risk of severe complications (pregnant, <12 months etc.)

Question 13

What are the main objectives of vaccination couenselling? What are common myths to dispel? What is herd immunity? What are the benefits of vacciniation?

Answer 13

Objectors

Dispelling myths

• No evidence of autism
• False paper that has since been retracted due to conflict of interest

Toxins

• All components are stringently tested over many years by the TGA
• Safety of vaccines is closely monitored
• All current components are safe
• Since anti-vax movement there has been outbreaks of fatal disease - pertussis and measles

Unnatural or weaken immune system

• Strengthen it
• Use body’s natural defence mechanism to combat infection
• No mercury in vaccines since 2000

Herd immunity

• If parent relying on herd immunity –> state that this requires 90% vaccine coverage, however, vaccines not 100% effective and some communities have lower rates hence your child is not covered

Give benefits

• Gives immunity to many potentially fatal diseases
• Serious adverse effects are extremely rare - much more likely to be affected actual disease
• Vaccinating everyone gives protection through herd immunity to vulnerable people in the community who cannot be immunised/immunosuppressed –> so also helping others

Question 14

Possible Vaccination OSCES!

Answer 14

Possible OSCEs!!!

Child with febrile convulsions from vaccine causing developmental delays with his brother who have not received any more vaccines

• Catch up program for brother - not a contraindication
• Catch-up vaccination for the kid with the febrile convulsion (not a CI as not anaphylactic)

Mother worried about toxins in vaccine (aluminium and thiouracil)

• Required for proper function of the vaccine
• Research shows they do not cause disease

Pregnant wants to get vaccinated

• Live contraindicated - theoretical risk to foetus
• All others ok

Pregnant come back in for postpartum check found not immune to varicella Can she get vaccinated if breastfeeding?

• YES (ASAP) - maternal Abs do not reduce response to own immunisation, even live vaccines
• 1 week post-partum developed chickenpox worried newborn will contract
• Should she be worried? Yes
• Supportive treatment for mother
• Can treat child - give VZV Ig to child prophylactically (particularly if premature)
• Child receives vaccine at normal age of 18 months - may not have an appropriate immune response earlier

Baby come for 4 month vaccines and mother tells you her mother is on chemotherapy

• Give the vaccines - can stay in house but keep grandma away from faeces (rotavirus)

Man has Sx of measles over 2 days and been in contact with case of measlesWhat public health measures do you put in place

• Notify authorities
• Must recall everyone who was present in the clinic when man presented and find out who was vaccinated –> vaccinate those who were not

Question 15

• What are the stages of change? (motivational intervieiwing)
• What are the 5 As of motivational interviewinig?
  
  • Outline an applied example stages of change
    
    • What are the benefits and strengths of these models for motivational interviewing
• How and when are these best applied in medical practise? (give 6 examples)

Answer 15

Stages of change

Pre-contemplation

• Advise of the dangers neutrally without imposing and rolling with resistance
• Encourage considering change

Contemplation

• Motivational interviewing including discussing pros and cons
• Build confidence and commitment

Preparation

• Negotiate a plan with CLEAR GOALS
• Build confidence

Action

• Positive reinforcement
• Discuss overcoming barriers and rewards

Maintenance

• Positive reinforcement
• Signs of relapse

Relapse

• Reinforce it as a learning experience
• Provide support
• Reassess stage

5 A’s

Ask

• Risk factors

Assess

• Level of use/vice
• Stage of change - intention and optimism

Advise

• Brief advice on level of use
• Motivational interviewing
• Written information

Assist

• Pharmacotherapies
• Self-monitoring

Arrange

• Refer - services, support groups, phone & counselling (Quitline)

Motivational interviewing

Relation to stages of change

• MI is a technique used to move patients through the stages of change through resolution of their ambivalence

Techniques

• What are your concerns with X?
• Elicit pros & cons of changing - elicit from patient to understand their ambivalence
• Contrast possible outcomes - what would a future be like if you didn’t stop X? what would a future be like if you did?

Stages of MI

Stage 1 = building motivation (OARS)

• Open ended questions
• Affirmations - compliment or show understanding
• Reflections - explore patients motivations by rewording their statements
• Summarising - ensure mutual understanding

Stage 2 = strengthening commitment (MI TECHNIQUES = PIGS)

• Pros vs cons - what would be the benefits of changing? What would be the cons?
• Importance ruler: 0-10 where 0 is not important and 10 is extremely important where would you be –> why not 0? What would help you move to 10?
• Goal setting
• Scenario of possible outcomes

Stage 3

• Negotiate a plan
• What changes are you thinking of making?

Spirit RULE

• Resist righting reflex
• Understand motivations
• Listen with empathy
• Empower patient

GRACE model

• Generate a gap
• Roll with resistance
• Avoid arguments
• Can do attitude
• Express empathy

Benefits/strengths

• Targets patient motivation to change
• Aim is not to tell them what to do
• You have to aspire to evoke motivation by developing repour with the patient then exploring the underlying motivators of their behaviour as well as the factors that prevent them from change –> its personal and patient centred

Decision balance

• Gives the opportunity for the patient to reflect on the potential outcomes of their behaviour
• Effective technique is to simplify –> if you go down this path what do you think the outcome will be? –> Now what about if you followed this path? –> how good could your life be?
• Gives opportunity to identify barriers and develop strategies on how to overcome them

Applications

• Substance addiction - smoking, drugs, alcohol etc.
• Lifestyle - exercise, diet
• Psychiatry - patterns of behaviours
• Gambling
• Proper use of medications - e.g. insulin

Question 16

What are the most common STIs in Australia?

What are the risks associated with STIs?

Who Should be screened? How are they screened?

What do you need to screen for in pregnancy?

Who are at higher risk for STIs? What and how frequent should they be screened?

Answer 16

Most common

• Chlamydia
• Gonorrhoea
• Hepatitis B
• Syphilis
• HIV

Risks

• Women with untreated chlamydia infection have a risk of innfertility

Screening: All sexually active people ≤29

• Chlamydia screen - PCR of urine sample or genital swab (first catch)

Pregnant

• Hep B, Hep C, HIV, syphilis

High risk

• Who - MSM, ATSI, high risk sexual behaviour, sex workers
• What - chlamydia, gonorrhoea + serology for HIV, syphilis

IVDU

• Screen for Hep C, Hep B and HIV

Question 17

What are genital warts? What is the prognosis? How are they treated?

Answer 17

Genital warts

Rx

• Spontaneous 9-12 months (most want removed)

Rx

• Cryotherapy
• Podophylin
• Imiquimod

Question 18

Herpes Clinical

1. Primary - flu like vesciles
2. Ulcers - from vesicles
3. Severe Knife like pain

Differential diagnosis:

Infection - Herpes Syphilis, donvanosis, LGV, Chancroid

1. Trauma -
2. Herpes
3. Syphilis mechanical/chemical
4. Allergic
5. Neoplastic
6. Secondary - Infestartions, lichren sclerosis

Diagnosis:

1) Clinical diagnosis
2) Swab for herpes PCR - if want to confirm

3)

Question 19

How do you write a standard RPS prescription?

What details are needed on the script: give example

Answer 19

Contact details at the top;

• personal prescriber number (where “1234567” is on the above sample);
• patient’s name and address;
• tick either PBS or RPBS boxes;
• tick the “Brand substitution box not permitted” box if necessary;
• drug name (generic name preferable) and strength;
• dosing amount and frequency;
• quantity of the medication and number of repeats (if applicable);
• signature and date

Question 20

Learning objectives - Know from GP outline

What preventive activites should be complete prior to prgnancy? (what age range)

What should be considered in preconception care?

Answer 20

• Every women of reproductive age should be considered for preconception care
• Inteventions should aim to identify and modify biochemical, behavioural and social risks to a women throughout pregnancy

Preconception care should include

1. Reproductive planning and effective use of contraception to prevent unplanned pregnancy
2. Reproductive history- Ask - any problems with previous pregnancies?(infant death, fetal loss, birth defects (NTD), Low birth weight, preterm/gestational diabetes
3. Medical history: Any conditions that could effect pregnancy - Chronic diseases such as- Diabetes, thyroid disease, hypertension, epilepsy, thrombophilia? Consider management is optimal for early pregnancy, given that early embryogenesis will occur prior to any consultation in pregnancy
4. Medication use - Review all current medication, OTC, vitamins
5. Family history/genetic history - genetic conditions in family e.g CF? Downs? Consanguity
6. Substance use history- Couensel about tobacco, alcohol and drug use in pregnancy
7. Vaccinations: Ascertain, Immunity to hepatitis B and rubella - routine serological testing - Recommended vaccinations- (red book) - MMR, Varicella (in those without a clear history of chickenpox or non-immune on testing, Influenza, DTPA (diptheria, tetanus, acelluar pertussis)

Specific Advice (SNAP)

1. Folic acid supplementation0.5mg per day of folic acid - at least one month prior to pregnancy and for the first three months after conception 5mg per day (patients at increased risk - e.g anticonvulsant therapy, pre pregnancy DM, BMI >30, previous NTD in child)
2. Iodine supplementation: 150ug each day
3. Healthy weight, nutrition and excecise: Discuss weight management, recommened moderate intensity excercise andasses risk of nutritional deficiencies (vegan, lactose intolerant and calicium, iron, vit d deficiency)
4. Psychosocial Health: Discuss perinatal mental health, including anxiety/depression. Other MH conditions psychosocial, or psychiatric isssues and treatments, use of medication. AND increased risk of excaerbation of mood disorders in pregnancy and post partum. Mental health screening should include a psychosocial assessment
5. Smoking, alcohol and illegal drug cessation:
6. Toxins: TORCH Infection: Toxoplasmosis. (other- e.g syphilis, varicella, mumps, parvovirus and HIV, listerosis), Rubella, Cytomegalovirus, Herpes simplex

General physical examination:

• Conduct a breast examination if it is due, Perform a CST before pregnancy, BMI, BP, oral cavity

Question 21

What are TORCH infections, and for each what should be avoided?

Answer 21

Question 22

Outline preconception Preventive interventions - e.g folate, iodine,

Answer 22

Question 23

What is the role of genetic couenselling and testing?

What is a screening tool to assist taking a family history?

Answer 23

In order to identify patients who may be at risk of a genetic disorder, a comprehensive family history must be taken from all patients, and this should be regularly updated. A family history should include f irst-degree and second-degree relatives on both sides of the family and ethnic background. Age of onset of disease and age of death should be recorded where available.

Question 24

What genetic conditions should be screened in GP (red book)

List the genetic conditions that can be screened at GP level?

Answer 24

Clinical genetic services provide testing, diagnosis, management and counselling for a wide range of genetic
conditions.

Reasons for referral include:

• diagnosis of a genetic condition
• family history of a genetic condition
• recurrence risk counselling (eg risk of recurrence in a future pregnancy)
• pregnancy counselling (eg preconception, consanguinity)
• prenatal screening and testing
• presymptomatic and predictive testing for adult-onset disorders (eg cancer)
• discussions surrounding genetic testing
• arranging of genetic testing.

Question 25

Conditions to be screened for in genetic testing/couenselling of patients in GP? e.g CF, Downs, Fragile X syndrome, Haemoglobinopathies and thalaseeaemias, Breast and colon cancer, Familial hypercholesterolaemia, Heridtary haemochromatsosis (HFE geen)

Answer 25

Question 26

What is the family history screening questionaire? * What does it assist in?

Answer 26

* can help identify individuals who may require more detailed assessment of their family history of cancer, heart disease or diabetes. * This tool can be used as part of the patient’s assessment at their first visit to a practice. If patients are uncertain about their family history, they can be asked to discuss the FHSQ with their relatives prior to completing the questionnaire. * For patients with low literacy, the FHSQ may need to be completed with the support of a healthcare professional. * A positive response to any question requires follow-up with a more detailed assessment of the family history. * As family history can change it is recommended that the FHSQ be repeated at least every three years.

Question 27

What is the criteria for diagnosis of familial hypercholestrolaemia? (DUTCH lipid clinic criteria) Components of criteria include: 1) Family history 2) Clinical hisotory 3) Physical examination (including LDL levels) 4) Startification (score) What is the modified UK Simon Broome criteria?

Answer 27

Modified UK Simon Broome criteria 1. Deoxyribonucleic acid (DNA) mutation 2. Tendon xanthomas in patient or first-degree or second-degree relative 3. Family history myocardial infarction (MI) \<50 years of age in second-degree relative or \<60 years of age in first-degree relative 4. Family history of cholesterol \>7.5 in first-degree or second-degree relative 5. Cholesterol \>7.5 (adult) or \>6.7 (aged \<16 years) 6. Low-density lipoprotein-cholesterol \>4.9 (adult) or \>4.0 (aged \<16 years) Definite: (5 or 6) + 1 Probable: (5 or 6) + 2 Possible familial hypercholesterolaemia: (5 or 6) + (3 or 4)

Question 28

What are Preventive activities in children and young people (0-19) according to red book? What should be done for each age? (assessment and preventive counselling and advice, health promotion, ) Age - Neonatal 2,4,6, 12 and 18 months and 3 years 3.5 years- 5 years - 6-13 years 14-19 years

Answer 28

Neonatal- What should be done? Assessment? Preventive counselling and advice 1) promote immunisation (austrlalian immunization handbook) 2) Assessment: 3) Preventive counselling and advice

Question 29

What are Preventive activities in children and young people (0-19) according to red book? What should be done for each age? (assessment and preventive counselling and advice, health promotion, ) --\> 2, 4, 6,12 and 18 months; and 3 years 1) Immunization 2) Assessment 3) Health promootion 4) Preventive counselling and advice

Answer 29

Question 30

What are Preventive activities in children and young people (0-19) according to red book? What should be done for each age? (assessment and preventive counselling and advice, health promotion, ) 3. 5 years to 5 years. 1) immunization 2) Assessment 3) Preventive counselling and advice

Answer 30

Question 31

What preventive activites need to be complete for child aged 6-13 years (as per redbook) 1) Assessment 2) Preventive and counselling and advice

Answer 31

Question 32

What preventive activites need to be complete for child aged 14-19 years (as per redbook) 1) Immunization 2) Assessment 3) Prventive counselling and advice

Answer 32

Question 33

Assessing developmental progress in children? What is a PEDs tool and how can it be useful for parents and GP?

Answer 33

Question 34

What are the "red flags" Early intevention referral guide? (for children 0-5 years)

Answer 34

Question 35

What preventive acitvities should be undertaken in middle age? (45-49) According to the GP red book: - How often should you oppurtunistically screen low irsk patients in this age group? 1) What should you ask about? 2) What should you measure? 3) What should you perform? 4) What should you calculate for these patients?

Answer 35

Ask about: SNAP, depression, skin cancer, preconception care, FHQ (family history) Meausre: Height, weight, BMI, WC, BP, fasting lipid Perform: HPV every 5years (CST), Mammography, 23 valent pneumococcal and infuelnza (ATSI), DTPA for pregnancy, genetic testing as part of preconception Calculate: Risk of diabetes using the (AUSDRISK), Review fracture risk factorrs for women\> 45years, absolute CV risk score.

Question 36

What are the preventive activites as for the red book for ages between 50-64 years of age? (red book) Ask, Measure, perform, calculate (AMPC)

Answer 36

Question 37

What are preventive activities in older age? (red book) (65 Plus) What are important considerations when seeing an older patient for preventive activities (e.g medications) ] What immunizations are recommended from 65?

Answer 37

Question 38

What are preventive activities in older age? (red book) (65 Plus) (physical activity) What benefits does it have in this age group (physical activity) What are the recommentations for older people? (sedentary and physical activity)

Answer 38

The following are Australia’s physical activity and sedentary behaviour guidelines for older people (www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#chba): Older people: 1. should do some form of physical activity, no matter what their age, weight, health problems or abilities 2. should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibilit 3. should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days 4. who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up to the recommended amount, type and frequency of activity 5. who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to. s.

Question 39

What are preventive activities in older age? (red book) (65 Plus) ( When and what should you do as part of a falls assessment? Who is at risk? (moderate) What are the three most important questions to ask a patient at this age to assess falls risk? What does a falls intervention/preventive screen entail? (e.g Hx, Physical exam, cognitive and functional impairments screen- GPCOG-, prescribe home excercisei increasing strength)

Answer 39

Question 40

When and what should you do as part of a falls assessment? Falls risk question continued answer (red book)

Answer 40

Ask: 1. Have you had two or more falls in the past 12 months? 2. Are you presenting following a fall? 3. Are you having difficulty with walking or balance? Comprehensive history should include: * If the answers to any of these are positive, complete a multifactorial risk assessment including obtaining relevant medical history, completing a physical examination, and performing cognitive and functional assessments * History should include: * –– detailed history of falls (eg how many falls?, at home or outdoors?, patient perception of causes, any fear of falling) * –– multiple medications, and specific medications (eg psychotropic medications) * –– impaired gait, balance and mobility * –– foot pain and deformities, and unsafe footwear * –– home hazards * –– bifocal or multifocal spectacle use * –– incontinence * –– recent discharge from hospital * –– chronic illness such as stroke, multiple sclerosis (MS), Parkinson’s disease, cognitive impairment/dementia * –– vitamin D deficiency/poor sun exposure if housebound or in a care facility Physical examination should include: –– impaired visual acuity, including cataracts –– reduced visual fields –– muscle weakness –– neurological impairment –– cardiac dysrhythmias –– postural hypotension –– six-metre walk, balance, sit-to-stand\* • Cognitive and functional impairments should include: –– dementia/cognitive impairment assessment (eg General Practitioner Assessment of Cognition [GPCOG]) –– activities of daily living and home assessment as appropriate (eg by occupational therapist) –– falls risk–assessment tools –– if unsteady, gait and mobility assessment by physiotherapist There are many fall risk–assessment tools. However, reports from researchers are variable, so no single tool can be recommended for implementation in all settings or for all subpopulations within each setting * Prescribe or refer for a home-based excercise program and or encourage participation in a community based program, particularly targetting balance and whihc may include strength and endurance * For specific excercises - refer to excercise physiologist * Needs to be done for atleast 2 hours per week * Regular review medication * Anticholinergic load should be reviewed * OT home review for home assessment * MDT- podiatry, phyi, optometrists * Investigate causes of dizziness

Question 41

What preventive measure need to be assessed for patients over 65 (Visual and hearing impairment) (Red Book)

Answer 41

Question 42

What preventive measure need to be assessed for patients over 65 (Dementia) (Red Book) How do you identify risks? (average, moderate risk) What should be done?

Question 43

Dementia: Preventive interventions? Case finding and confirmation: Ask? Symptom review? Hx? SMMSE? GPCOG? KICA? Physical examination?

Answer 43

Ask; Symptoms?

Question 44

What are early intervention and prevention techniques for dementia?

Answer 44

Question 45

Communicable diseases; What role does the GP play in prevention and management of communicable diseases? What is the ACIR and VIVAS? How is consent taken with vaccinations? (benefits/harms)

Answer 45

Question 46

What about vaccinations for special high risks groups (e.g Aplenia)

Answer 46

Question 47

Health inequity: What are the key equity issues and who is at risk? (what do they need to be aware of?) What can GPs do? - (what does evidence support?)

Answer 47

Question 48

Outline the main requirments from the national immunisation program/schedule: Birth? 6-8 weeks? 4 months? 6 months\>? Who? 12 months? 12- 18 months? 18 months? 18-24 months? 4 years? 10-15 years? (+/-) School based programs? Gp catch up?

Answer 48

Question 49

Immunisation schedule: 15-49 years Prgenant women? 50 years and over? 65 years and over?

Answer 49

Question 50

What vaccines are recommended but not funded in the National immunisation program? Soon After birth? Who ? What vaccine? What should all travellers, parents and carers (of \< 6 month olds), healthcare workers? What vaccines should all healthworkers have? MSM? IVDU?

Answer 50

Question 51

Sexually transmissible infections: What it the most common STI seen in GP? What is the worst complication of STIs? What STIs should you consider in ATSI populations? STI History? - Outline: What needs to be included? What is contact tracing? What are the names of services that can assist with this?

Answer 51

Question 52

Outline Sexual history: OSCE stop check list 2 pages

Answer 52

Question 53

What ages Should you SCREEN for STIS (in particular Chlamydia and other STIS) What is the risk of infertily in undiagnosed Chlamydia in women? What STIs should you screen for in high risk patients? Who are "high", risk? How often should MSM be screened? What for? When should you screen for hepatitis C? What should all pregnant women be screened for?

Answer 53

Question 54

Risk assessment: STIs - Identifying risks: Outline different level of "risks" associated with different populations? What should be done for each of these groups? (e.g low risk patients? Medium risk patients? High risk patients? Highest risk patients? How often should these be done in these individuals?

Answer 54

Question 55

What are the two major tests to detect sexually transmissible infections? What is the technique required for each? What is the prevalence of chlamydia? How should partners/ sexual partners be contacted and treated when they have had sex with a known STI positive individual?

Answer 55

Question 56

Prevention of chronic disease: What are the most important lifestyfle risk factors? What chronic diseases do they contribute mostly to in GP? What is the 5'As? (organises assessment and management of behavioural risk factors in primary health care) Where else can this be implemented??? (e.g Drugs and alcohol, all chronic disease risk factors- prevention)

Answer 56