1
Q
What percentage of people consult their GP at least once a year?
A
75%
2
Q
What is the average number of GP consultations per registered patient?
A
6 (double the rate of the previous decade)
3
Q
What groups of people consult their GP more frequently?
A
- Older people
- Children
- Females
- Socially deprived areas
4
Q
What explains the gender differences in GP consultation rates?
A
The higher consultation rates in women of reproductive years
5
Q
Describe the ‘illness iceberg’
A
This refers to the observation that the majority of symptoms experienced by the population are never presented to the doctor
6
Q
Define ‘illness behaviour’
A
‘The manner in which people differentially perceive, evaluate and respond to symptoms
7
Q
Define a ‘lay referral’
A
People discussing their symptoms with other people, such as family members, close friends or people who are known to have had similar health problems
8
Q
Describe the 5 possible triggers for consulting
A
- Interpersonal crisis
- Perceived interference with work activities
- Perceived interference with social/leisure activities
- Sanctioning by others who insist help be sought (lay referral)
- Symptoms persist beyond arbitrary time limit set by individual
9
Q
Describe the WHO definition of health promotion
A
‘The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.’
10
Q
The most effective health promotion initiatives…
A
operate at a population level and involve public health measures
11
Q
List 3 reasons why GPs are well placed to carry out health promotion
A
- Most people are registered with a GP
- Most patients consult at least every 3 years, allowing for opportunistic health promotion
- GPs can link health promotion advice to a specific presenting complaint
12
Q
Define primary disease prevention
A
Preventing disease
13
Q
Define secondary disease prevention
A
Slowing the progression and avoiding complications of existing disease
14
Q
Define tertiary disease prevention
A
Minimising the ill-health and disability caused by existing disease
15
Q
Define ‘screening’
A
‘the presumptive identification of unrecognised disease or defects by means of tests, examinations or other procedures.’
16
Q
Describe some negative effects of screening
A
- Unnecessary anxiety
- Identifying false positive results
- Unnecessary investigations and treatments
17
Q
Describe the standard criteria used for assessing a screening programme
A
- Condition screened for should be an important one
- There should be an acceptable treatment for patients with the disease
- The facilities for diagnosis and treatment should be available
- There should be a recognised latent or early symptomatic stage
- There should be a suitable test which has few false positives and false negatives
- The test should be acceptable to the population
- The cost, including diagnosis and subsequent treatment, should be affordable
18
Q
Who is offered a cervical smear and how often?
A
Women aged 25-64
Those aged 25-49 are called every 3 years
Those aged 50-64 are called every 5 years
19
Q
For women aged 35-64, participation in a screening programme reduces the risk of endocervical cancer by ??% and the risk of advanced cancer by ??%?
A
60-80%
90%
20
Q
The rates of uptake of the cervical smear test is lowest in what groups?
A
- Young women
- Women over 50
- Women from ethnic minority groups
- Women from areas of social deprivation
21
Q
List some reasons for non-attendance of cervical smear tests
A
- Inconvenience
- Fear of cancer
- Apathy
- Concerns about the procedure
- Mistaken beliefs e.g. only women with many sexual partners get cervical cancer, lesbians and women who aren’t sexually active don’t need to get smears
22
Q
Describe the Guthrie (NBS) test
A
Newborn blood spot test, which involves taking a small amount of blood using a heel-prick when a baby is about 5 days old, usually carried out by community midwives.
23
Q
What conditions does the Guthrie test test for?
A
- Cystic fibrosis
- Congenital hypothyroidism
- Sickle cell disease
- Other inherited metabolic disease
24
Q
Define ‘surveillance’
A
‘A system of ongoing health checks to detect abnormality/disease in a previously health individual’ or ‘a system of ongoing health checks to detect complications and monitor the progression of a patient with existing disease’.
25
Describe Child Health Surveillance
A series of observations, measurements and screening tests at specified ages to monitor growth and development, and to detect psychological and medical problems.
26
Who is Child Health Surveillance carried out by?
Health visitors in GP practices or GPs
27
What is a health visitor?
A nurse with higher training who has a statutory duty to provide advice, support and surveillance for all pre-school children
28
Describe the goals of the Child Health Programme
- Identify and treat physical problems and developmental delays as early as possible
- Minimise disability and impairment by early and effective intervention
- Provide support an resources for children with identified conditions
- Offer health information to promote physical and mental health and well being
- Identify and support vulnerable children and their families
29
Describe the specific activities involved in the Child Health programme
- 6-week check screening for specific medical problems
- Measurement of height and weight to detect and prevent failure-to-thrive and obesity
- Assessment of motor skills and speech to minimise the impact of developmental delay
- Screening for vision and hearing
- Immunisations
30
What medical problems does the 6 week check screen for?
- Congenital cataracts
- Heart murmurs
- Congenital hip dislocations
- Testicular abnormalities
31
Describe the elements of ante-natal care
- Taking regular measurements of the developing foetus to detect intra-uterine growth retardation
- Taking regular measurements from the mother to detect pre-eclampsia and other pregnancy-related conditions
- Screening (for chromosomal abnormalities and neural tube defects)
- Immunisation of the pregnant woman against influenza
32
Describe the 'locus of control' belief
The degree to which people believe they have control over their own lives and healthcare.
People who believe they can influence their destinies have 'internal' locus and those who believe they have little control have 'external' locus.
33
Describe the 'health belief model', and the 6 factors it depends on
This belief attempts to explain and predict health-related behaviours and suggests that uptake of health promotion depends on 6 factors:
1. Perceived susceptibility (opinions of chances of getting a condition)
2. Perceived severity (opinion of seriousness and consequences of the conditions)
3. Perceived benefits (belief in the efficacy of the advised action to reduce risk or seriousness)
4. Perceived barriers (opinions of the tangible and psychological cost of the advised action)
5. Cues to action (strategies to activate 'readiness')
6. Self-efficacy (confidence in one's ability to take action)
34
List the 4 factors thought to influence perceived susceptibility to a disease/condition
1. Self-evident personal differences between individuals (including hereditary)
2. The social environment (including wealth an occupation)
3. The physical environment
4. Luck
35
List the strategies of motivational interviewing
- Avoid medical labelling
- Avoid giving advice
- Invite the patient to define his/her problems
- Invite the patient to describe the pros and cons of their behaviour
- Empathise with the difficulty of change
- Allow the patient to view the decision as theirs to make
- Invite the patient to come back and discuss progress
36
Describe the Stages of Change cycle
1. Pre-contemplation: not recognising the need for change/not actively considering change
2. Contemplation: recognising problem and is considering factors for and against change
3. Preparation: planning and commitment to change
4. Action: has already initiated change
5. Maintenance: adjusting to change and is practising new skills and behaviours to maintain change
6. Relapse: relapse from change OR 6. Abandoned risky behaviour
37
What technique can a GP use if they do not have time to complete a full motivational interview session?
Brief intervention
38
List some of the benefits of continuity of GP care
- Better patient satisfaction
- Better trust
- Better quality of management
- Reduced prescriptions
- Reduced hospital admissions
39
What is the golden minute?
Allowing the patient to speak uninterrupted for the first minute of the consultation
40
Define safety netting
Making a contingency plan incase things don't go according to plan - should include signs to watch for, timeframes and how to seek help
41
Describe the 'inductive method' of diagnosis
Linear, sequential process whereby a diagnosis is made following the symptomatic and indiscriminate gathering of standard medical information (history, examination and investigation).
42
Describe the 'Hypothetic-deductive' method of diagnosis
This model involves gathering information from a patient, formulating a hypothesis and then gathering further selective information which can help prove or refute this hypothesis.
43
Describe the 'Heneghan et al' method of diagnosis
A refined and more complex version of the hypothetic-deductive model, including stages:
1. Initiation of the diagnosis
- Spot diagnosis: the unconscious recognition of a non-verbal pattern (e.g. shingles)
- Self-labelling: the patient tells the GP what they think is the problem
- Presenting complaint
- Pattern recognition trigger: immediate diagnosis from the history (e.g. appendicitis)
2. Refinement
- Restricted rule outs: depends on knowing the common, non-serious and rarer, more serious causes of a presentation (e.g. headache - migraine vs meningitis)
- Stepwise refinement: refining anatomical location or pathological processes
- Probabilistic reasoning: deciding the likelihood of a condition based on the doctors knowledge of incidence/prevalence of the disease
- Pattern recognition fit: comparison with previous cases
- Clinical prediction rule: using formal validated scores (e.g. Well's score for DVT)
3. Defining the final diagnosis (unnecessary if diagnosis is clear)
- Known diagnosis
- Further tests ordered
- Test of treatment
- Test of time
- No label applied
44
Describe red flag symptoms
Specific symptoms or signs which may be volunteered by the patient or elicited by the door to rule out a serious condition. A red flag usually triggers a more detailed examination, investigation or referral to hospital.
45
Define prevalence
The proportion of a population with the condition
46
Define sensitivity
The chance that the test is positive in those with the disease (true positive): (true positive)/(true positive + false negative)
47
Define specificity
The chance that the test is negative in those without the disease (true negative): (true negative)/(false positive + true negative)
48
Define positive predictive value
The chance that a patient with a positive test result actually has the condition (true positive)/(true positive + false negative)
49
Define negative predictive value
The chance that a patient with a negative test result does not actually have the condition (true negative)/(true negative + false negative)
50
Positive and negative predictive value are affected by disease prevalence (T/F)
True - as prevalence increases, PPV increases and NPV decreases
51
Define a diagnostic label
A working diagnosis that functions as a basis for decisions
52
About ??% of problems presenting in GP have no diagnostic label
50%
53
List the 5 central ethos of GP
1. Continuity of care
2. Comprehensiveness
3. Complexity
4. Coordination
5. Context
54
Define absolute risk
The chance of getting a disease
55
Define relative risk
The chance of getting a disease in one situation compared with another (e.g. smoker vs non-smoker)
56
Define number needed to treat
The number of patients who need to be treated in order to prevent one additional adverse outcome.
57
On average, GPs issue a prescription in about ??% of consultation?
66%
58
What percentage of hospital admissions are associated with adverse drug reactions?
6.5%
59
Define evidence based medicine
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.
60
List the hierarchy of evidence
1. Systematic review - review of all published and unpublished research on a particular question
2. Meta-analysis - secondary analysis of pooled data from a number of studies
3. RTC - participants randomly allocated to 'treatment' or 'no treatment' and followed up
4. Cohort study - 2 groups are selected for their exposure/non-exposure to a factor and followed up
5. Case-control study - patients with a condition are matched with controls and data is collected retrospectively to look for exposure to factors
6. Case report - detailed description of a particular case
61
Define chronic condition
Diseases of long duration for which there is no cure, and which generally progress slowly, impact on a person's life and which require ongoing care and support
62
Define long-term condition
A broader term which includes chronic conditions, as well as permanent conditions such as learning disability, symptom complexes or sensory impairment
63
Define co-morbidity
A disease which is additional to the main disease
64
Chronic disease accounts for ??% of death worldwide, and ??% of death in the UK
60%
| 85%
65
In Scotland, 1 in ? people over 16 have a long-term condition
4
66
Patients living in deprived areas are more than ??x as likely to have a long term condition than those in affluent areas
2x
67
List the top 10 commonest chronic conditions in the UK
1. Hypertension
2. Depression
3. Diabetes
4. Asthma
5. CHD
6. COPD
7. CVA
8. Dementia
9. Epilepsy
10. PAD
68
??% of British adults are obese, and ??% are overweight or obese
25%
| 61%
69
Chronic disease accounts for ??% of GP consultations
80%
70
List the situations where it is possible to divulge patient information without their consent
- If a patient continues to drive although you are aware they have a reason not to, you should inform the DVLA
- The patient may cause serious physical or psychological harms to themselves or others, including children
- Serious communicable diseases (e.g. HIV) when patients are knowingly putting others at risk
- Patient is unfit to work and continuing to do so puts others at risk
71
List some causes of dyspepsia
- GORD
- Peptic Ulcer Disease
- Non-ulcer dyspepsia
- Hiatus hernia
- Barrett's oesophagus
- Gastric cancer
- Oesophageal cancer
- Drugs e.g. NSAIDs, calcium antagonists, nitrates, theophylline, bisphosphonates, anti-platelet drugs
- Alcohol
- Smoking
72
List the features in a history which may make you suspect a patient has dyspepsia?
- Epigastric pain (often post-prandial, may wake patient at night), nausea, vomiting, distention, burning, heartburn
- Previous dyspepsia/GORD
- NSAID/calcium antagonists/theophylline/bisphosphonates/anti-platelet use
- Alcohol
- Smoking
73
List the red flag symptoms for dyspepsia
- Weight loss
- Dysphagia
- Persistant vomiting
- Haematemesis
- Melena
- Gastric mass
- Iron deficiency anaemia
74
List the typical examination findings for a patient presenting with dyspepsia
Often normal
75
What investigations would you order in a patient presenting with dyspepsia
- FBC, ferritin
- H. Pylori stool antigen test
- Consider endoscopy
76
What are the indications for an endoscopy in a patient with dyspepsia?
- Red flags present (urgent endoscopy)
- H.Pylori test negative and no response to medication
- >55 with persistent or recurrent dyspepsia (routine referral)
77
How would you manage a patient presenting with dyspepsia (no red flags)?
1. Stop precipitating drugs
2. Reduce alcohol/smoking
3. Trial Alginates/PPIs/H2RA
78
Define normal bowel habit
3 movements per day to 3 movements per week
79
Define diarrhoea
>3 loose stools per day
80
Most common cause of acute diarrhoea
Infection
81
What other symptoms would someone with infective diarrhoea have?
Fever
Vomiting
Blood in the stool
82
Describe the causes of infective diarrhoea
1. Rotavirus - common in children. Presents with severe watery diarrhoea, vomiting, fever and abdominal pain for about a week
2. Norovirus - affects all ages. Presents with watery diarrhoea, vomiting, fever and abdominal pain. Very contagious
3. C.Diff - common in hospital patients
4. Food poisoning - affects all ages. Symptoms occur within hours to days of ingesting affected foods.
5. Traveller's Diarrhoea - common in patients returning from abroad and is mainly caused by ingestion of contaminated food or water
83
List 4 drugs which commonly cause diarrhoea
1. Antibiotics
2. Metformin
3. Ferrous sulphate
4. Laxatives
84
When would investigations be indicated in a patient with acute diarrhoea?
- Person is systemically unwell, needs hospital admission and/or antibiotics
- Blood or pus present in the stool
- Patient has recently had antibiotics or been in hospital
- Patient has been travelling and a parasitic infection is suspected
85
How would you manage a patient with acute diarrhoea?
If patient is not at risk of dehydration: drink plenty and rest
At risk of dehydration: admit to hospital
Consider antibiotics if culture indicates. Consider contacting local health protection unit.
86
List 7 causes of chronic diarrhoea
- Coeliac disease
- IBD
- Diverticulitis
- Chronic infection
- Anxiety
- 'Overflow' diarrhoea - leakage around impacted faeces
- Colonic carcinoma
87
What features in a patients history would make you suspect that they had Coeliac disease?
- Weight loss
- Diarrhoea
- Fatigue
- Association with gluten
- Family history of autoimmune disease
88
How would you manage a patient with suspected coeliac disease?
1. Check TTG
2. Refer for endoscopy
3. Support dietary changes
Consider screening 1st degree relatives
89
What features in a patients history would make you suspect that they had IBD?
- Young adult
- Diarrhoea
- Cramping abdominal pain
- Bloody stool
- Generally unwell
- Weight loss
90
What features in a patients history would make you suspect that they had Diverticulitis?
- Older adults
- Abdominal cramps
- Bloating
- Diarrhoea
91
What features in a patients history would make you suspect that they had chronic infective diarrhoea?
- Diarrhoea
- History of acute infection
- Weight loss
- Fatigue
92
What features in a patients history would make you suspect that they had anxiety-related diarrhoea?
- Diarrhoea
- Anxiety disorder
- Symptoms situational
93
What features in a patients history would make you suspect that they had overflow diarrhoea?
- History of constipation
| - Risk factors for constipation
94
What features in a patients history would make you suspect that they had colonic carcinoma?
- Middle-aged/older adult
- Abdominal pain
- Weight loss
- Blood in stools
- Tenesmus
95
How would you manage a patient with suspected IBD in GP?
1. CRP
2. Fecal calprotectin
3. Refer to GI
96
How would you manage a patient with suspected diverticulitis?
1. Analgesia
| 2. Consider referral to GI
97
How would you manage a patient with suspected chronic infective diarrhoea?
1. Stool culture and sensitivities
| 2. Refer for endoscopy
98
How would you manage a patient with suspected anxiety-related diarrhoea?
1. Active listening
| 2. Management of anxiety
99
How would you manage a patient with suspected overflow diarrhoea?
1. PR exam
| 2. Laxatives
100
How would you manage a patient with suspected colonic carcinoma?
1. Urgent cancer referral
101
What are the red flag symptoms associated with diarrhoea?
- Middle-aged/older
- Weight loss
- Blood in stools
- Tenesmus
102
Clinical features of male urinary problems
Storage symptoms:
- Urgency
- Nocturia
- Daytime urinary frequency
- Urinary incontinence
Voiding symptoms:
- Hesitancy
- Weak flow
- Incomplete emptying
- Terminal dribbling
Post-micturition symptoms
- Dribbling
- Sense of incomplete emptying
103
Causes of storage urinary symptoms in men
- BPH
- Prostate/bladder cancer
- Drugs e.g. tricyclic antidepressants, antihistamines
- Diabetic autonomic neuropathy
- Urethral stricture
104
Causes of voiding urinary symptoms in men
- BPH
- Neurological conditions
- UTI
- Bladder stones
- Bladder/prostate cancer
- Pelvic surgery
- Urethral injury
- Alcohol
- Caffeine
- Drugs e.g. alpha-blockers, sympathomimetics, anti-muscarinics, opioids, anaesthetics
105
Red flag symptoms in a male with urinary symptoms
- Weight loss >3kg
- Haematuria
- Hard/irregular prostate gland
- Lower back pain
- Bone pain
- Raised PSA
106
What examinations would you do on a man presenting with urinary symptoms (and what are you looking for)?
- Temperature
- Pulse
- Abdominal examination (distended bladder, suprapubic dullness)
- Genital examination (urethral discharge)
- Rectal examination (prostate size, consistency, tenderness, regularity)
107
What investigations would you consider in a man presenting with urinary symptoms?
- Urinalysis
- MSU (if urinalysis positive)
- U&Es
- FBC (anaemia)
- PSA
- Urinary Frequency volume chart
- IPSS
108
What would you do if you were worried about cancer in a man with urinary symptoms?
Urgent referral to urology
109
What lifestyle advice would you give to a man with urinary symptoms?
- Don't restrict fluids excessively
- Avoid constipation
- Maintain a healthy weight
- Limit alcohol, fizzy drinks and caffeine
- Signpost to bladder foundation website
110
Management plan for a man presenting with voiding symptoms
1) Active surveillance
2) Conservative management
- Pelvic floor exercises
- Lifestyle modification
3) Medication
- Tamulosin (moderate-severe symptoms)
- Finasteride (enlarged prostate and high progression risk)
- Tamulosin + Finasteride (severe symptoms and prostate enlargment)
- Consider adding oxybutin
111
When is oxybutin contra-indicated
Frail, elderly men
112
Management plan for a man presenting with an overactive bladder
1) Lifestyle advice
2) Referral for bladder training
3) Medication
- Oxybutin
- Mirabegron if oxybutn CI
113
Management plan for a man presenting with stress incontinence
1) Incontinence aids e.g. pad
| 2) Refer to continence service and/or urology to find cause
114
Management plan for a man presenting with acute urinary retention for the FIRST TIME
- Urgent referral for catheterisation (urology/community nurse)
115
Management plan for a man presenting with recurrent urinary retention
1) Limit fluid intake in afternoon/evening
2) Medication
- Diuretics e.g. furosemide
- Desmopressin
116
Which vitamin should be avoided in pregnancy?
Vitamin A - can be teratogenic
117
Which tests would you order if a patient complained of feeling 'tired all the time'?
- FBC
- U&Es
- LFTs
- Random blood glucose
- TFTs
- ESR
118
Contra-indications for using HbA1c in the diagnosis of diabetes?
- Pregnancy
- Acute pancreatitis
- Chronic renal failure
119
How would you manage a child presenting with ear pain, a bulging eardrum and systemic pyrexia?
Oral amoxicillin
120
You see a 65 yo man who has just been diagnosed with Type 2 Diabetes. You seem him to discuss his results and confirm the diagnosis. His BMI is 31. He reports that he has lost 1 stone over the last 2 months.
What is the best next step?
- Urgent referral for upper abdominal imaging - T2DM whilst unintentionally losing weight is pancreatic cancer until proven otherwise
121
How would you differentiate between otitis media with perforation and otitis externa?
- Otitis media: pain relieved with perforation of the ear drum
- Otitis externa: ongoing pain
122
How would you manage a patient with otitis externa?
Topical drops/spray e.g. otomize
Patient must keep ears dry
123
What tests would you do if you suspected a woman (age 45+) was going through the menopause?
- No further tests needed - clinical diagnosis
124
Which medications require patients to follow 'sick day rules'?
DAMN:
- Diuretics
- ACE inhibitors
- Metformin
- NSAIDS e.g. diclofenac
125
What conditions are routinely screened for in Scotland
- Colorectal cancer (all men and women 50-74 every 2 years, using FOB)
- Cervical cancer (women 25-64 every 3 years, using cervical smear)
- Abdominal aortic aneurysm (men age 65)
- Diabetic retinopathy in diabetics (annually in over 12s)
(NOT prostate cancer)
126
How would you manage a child you suspected had meningococcal septicaemia?
Call an ambulance
| Give immediate injection of IM benzylpenicillin
127
Causes of a raised PSA
- Urinary tract infection
- Ejaculation/sexual intercourse
- DRE
- Vigorous exercise
128
Side effects of thiazide diuretics
- Impotence
- Rash
- Precipitation of latent diabetes
- Hyperuricaemia
- Hypokalemia
- Alkalosis
129
Side effects of ACE inhibitors
- Cough
| - Renal dysfunction
130
Side effects of calcium antaognists
- Headaches
- Flushing
- Ankle swelling
- Tachycardia
131
Side effects of beta blockers
- Wheeze
- Cold peripheries
- Lassitude
- Exercise intolerance
- Bad dreams
- Impotence
- Heart block
- Diabetes
132
Which medications must you stop when using clarithromycin?
Statins
133
Clinical features of atopic eczema
- Common - affects 1 in 5 people
- Usually presents in childhood and persist into adulthood
- History of asthma and allergic rhinitis
- Itchy, scaly, dry rash in elbow/knee flexures with thickened skin
134
Clinical features of venous/varicose eczema
- Bilateral itchy, red, scaly rash on lower legs
| - History of other venous disease
135
Clinical features of contact eczema
- Itchy, swollen eryhtmetous rash with distinct border,
- May be associated blisters/vesicles
- History of exposure
136
Management plan for a patient with eczema
1) Emollients
2) Topical corticosteroids
3) Topical tarcolimus
137
Clinical features of psoriasis
- Usually presents in early adulthood
- Plaque rash on extensor aspects of elbows and knees
- May be scalp and nail involvement
138
Management plan for a patient with psoriasis
1) Calcitriol
2) Corticosteroids
3) NBUVB therapy and referral to dermatology
4) Ciclosporin/methotrexate/acitretin
5) Biologics
139
Clinical features of shingles
- History of chickenpox
- Mainly presents in older adults
- Pain/itching followed by papules and vesicles in a single dermatome distribution
140
Management plan for a patient with shingles
1) Aciclovir 7 days PO within 72 hours of rash onset
141
Clinical features of pityriasis rosea
- Single Herald patch followed by slightly itchy oval macules/plquaes affecting trunk in 'christmas tree' distribution
142
Management plan for a patient with pityriasis rosea
No treatment required
143
Clinical features of tinea infection
- Clear bordered red rash in single or multiple small, scaly erythematous annular patches on
groin (cruiris), foot (pedis), nails (unguium) or body (corps)
144
Management plan for a patient with tinea infection
1) Clotrimzaole cream
2) Terbinafine
Investigate for type 2 DM in patients with persistent fungal infections
145
Clinical features of urticaria
- Appears as acute rash in children or chronic form in adults
- Transient raised red oedematous lesions (wheals)
146
Management plan for a patient with urticaria
No treatment required
147
Clinical features of otitis media
- Ear pain
- Tenderness
- Bulging tympanic membrane
148
Management of a child with acute otitis media
1) Analgesia
| 2) Amoxicillin 5 days PO
149
What antibiotic should you use in children with a penicillin allergy?
Clarithromycin
150
Clinical features of tonsillitis
- Sore throat
- Otalgia
- Headache
- Malaise
- Pyrexia
- Enlarged tonsils
- Tonsillar exudate
- Inflamed pharyngeal mucosa
- Fetor
- Enlarged and tender cervical lymph nodes
151
Management of a child with tonsillitis
1) Analgesia
| 2) Phenoxymethylpenicillin 10 days PO
152
Features of the Centor criteria
1) Absence of cough
2) Tonsillar exudate
3) Fever
4) Tender anterior cervical adenoapthy
+1 point for each positive finding
0-2: no antibiotic or throat culture needed
3-4: antibiotic
Modified mentor criteria incorporates the patient's age: <15 = 1 point, >44 = -1point
153
Clinical features of pharyngitis
- Sore throat
- Dysphagia
- Malaise
- Erythematous pharyngeal and tonsillar mucosa
154
Management of a child with pharyngitis
1) Analgesia
| 2) Phenoxymethylpenicillin 10 days PO
155
Clinical features of croup
- Usually <2
- Characteristic inspiratory stridor
- Barking cough
- Hoarse voice
- Fever
- Dyspnoea
- Symptoms worse at night
- Child unsettled
Usually worse in 24-48 hours, but can last to 7 days
156
Management of a child with croup
1) Prednisolone/dexamethasone PO single dose
157
Clinical features of pneumonia in a child
- Fever
- Tachypnoea
- Cough
- Laboured breathing
- Vomiting
- Chest pain
- Abdominal pain
- Decreased activity
- Loss of appetite
- Cyanosis
158
Most common cause of bacterial pneumonia in children
Strep pneumoniae
159
Management of pneumonia in a child
1) Analgesia
| 2) Amoxicillin
160
Clinical features of Whooping cough/Pertussis
- Runny nose
- Red-watery eyes
- Sore throat
- Mild fever
- Followed by repeated coughing bouts lasting a few minutes
- Symptoms worse at night
- Thick yellow sputum
- Symptoms last 2-3 months
161
Management of a child with pertussis
1) Analgesia
| 2) Erythromycin
162
Clinical features of UTI in a child
- Fever
- Vomiting
- Lethargy
- Irritability
- Poor feeding
- Failure to thrive
- Change in normal toilet habits
- Unpleasant smelling urine
- Cloudy urine
163
Management of a child with a UTI
1) Trimethoprim 3 days PO
164
Clinical features of meningitis
- Fever
- Cold peripheries
- Vomiting
- Confusion
- Tachypnoea
- Muscle/joint pain
- Non-blanching rash
- Headache
- Stiff neck
- Photophobia
- Sleepiness
165
Management of a child with suspected meningococcal meningitis
1) IM or IV benzylpenicillin
| 2) Cefotaxime
166
Clinical features of chickenpox
- Develops 14-21 days after exposure
- Intensely itchy rash mainly on face and trunk
- Macular lesions --> papular or vesicular lesions --> become pustular --> scab over
167
Management of chickenpox
No treatment required
168
Clinical features of Hand, Foot and Mouth disease
- 1-2 day prodrome: sore throat, pyrexia, dysphagia, poor appetite, malaise
- Mouth lesions (1-2 days after fever) - vesicles seen in oral cavity, buccal mucosa and sides of tongue
- Papular, vesicular rash with surrounding erythema on hands and feet (sometimes buttocks)
- Symptoms last 7-10 days
169
Management of Hand, Foot and Mouth disease
No treatment required
170
Clinical features of Scarlet fever
- Common in 2-8 year olds
- High fever
- Headache
- Malaise
- Nausea/vomiting
- Blanching maculopapular rash initialyl on torso then spreading to rest of body
- Enlarged red tonsils covered in white exudate
- Furred tongue with enlarged papillae ('strawberry tongue;)
171
Management of scarlet fever
1) Analgesia + phenoxymethylpenicillin 10 days PO
172
Clinical features of impetigo
- Multiple golden, crusty lesions (merciless, vesicles or papillose) on face or extremities
173
Management of impetigo
1) Flucloxacillin 7 days
174
Clinical features of Fifth disease/slapped cheek
- Common in school-aged children
- 4 day prodrome: mild fever, sore throat, coryza, headache and nausea
- Maculopapular rash on cheeks --> mauclopapular rash on extremities and trunk
175
Management of fifth disease/slapped cheek
No treatment required
176
Clinical features of cradle cap/infantile seborrhoea dermatitis
- 1-2 weeks old
| - Acute erythematous, coarse, yellow scaling of scalp (or nappy areas, face, chest, back and limb flexures)
177
Management of infantile seborrhoea dermatitis
1) No treatment
| 2) Olive oil or Capasal shampoo
178
Which vaccinations are given at 8 weeks old?
- Diptheria, tetanus, pertussis, polio, Haemophilus influenzae B, hepatitis B (6-in-1) in the thigh
- Pneumococcal (PCV) in the thigh
- Meningococcal B (MenB) in the left thigh
- Rotavirus gastroenteritis (rotavirus) by mouth
179
Which vaccinations are given at 12 weeks old?
- Diptheria, tetanus, pertussis, polio, haemophilus infleunza B, hepatitis B (6-in-1, round 2) in the thigh
- Rotavirus gastroenteritis (Rotavirus) by mouth
180
Which vaccinations are given at 16 weeks old?
- Diptheria, tetanus, pertussis, polio, hameophilus influenza B, hepatitis B (6-in-1, round 3) in the thigh
- Pneumococcal (PCV, round 2) in the thigh
- Meningitis B (MenB) in the left thigh
181
Which vaccinations are given at one year old?
- Haemophilus influenza B and meningitis C in the upper arm/thigh
- Pneumococcal (round 3) in the upper arm/thigh
- Measles, mumps and rubella (MMR) in the upper arm/thigh
182
Vaccination routine for the 6-in-1 vaccine
1. 8 weeks old
2. 12 weeks old
3. 16 weeks old
183
What diseases does the 6-in-1 vaccine protect against?
1. Diptheria
2. Tetanus
3. Polio
4. Pertussis
5. Haemophilus influenza B
6. Hepatitis B
184
Vaccination routine for Pneumococcal
1. 8 weeks old
2. 16 weeks old
3. 1 year old
185
Vaccination routine for the Meningitis B vaccine
1. 8 weeks old
| 2. 16 weeks old
186
Vaccination routine for the rotavirus vaccine
1. 8 weeks old
| 2. 12 weeks old
187
Abdominal aortic aneurysm screening routine
- Men aged 65, offered once using ultrasound of the abdomen
188
Cervical screening routine
- Women aged 25-64, offered every 3 (25-49) or 5 (50-64) years depending on age using cervical smear
189
Breast screening routine
- Women aged 50-70, offered every 3 years using mammogram (women over 70 can self-refer)
190
Bowel screening programme
- Men and women aged 50-74, offered every 2 years using faecal immunochemical test
191
Diabetic retinopathy screening routine
- Diabetics over the age of 12, offered every year
192
Pregnancy screening routine
Pregnant women at various stages of pregnancy
- number of blood tests throughout
- 2 ultrasound scans (11-14 weeks, and 18-21 weeks - looking for main health conditions affecting brain, spinal cord, bowel, kidneys, limbs and heart)
193
Newborn screening routine
All new born babies within the first few weeks of life
- Hearing test
- Bloodspot test - PKU, CF, sickle cell disease, congenital hypothyroidism, galactosemia, biotinidase deficiency, congenital adrenal hyperplasia, tyrosinemia
- Physical examination - congenital heart disease
194
Signs that a child with a feverish illness is low risk
- Normal skin colour
- Responds normally to social cues
- Content/smiling
- Stays awake or awakens quickly
- Strong normal cry/not crying
- Normal respiratory rate and effort
- Normal skin and eyes
- Moist mucous membranes
195
Signs that an under 5 with a feverish illness is intermediate risk
- Pallor
- Not responding normally to social cues
- Not smiling
- Wakes only with prolonged stimulation
- Decreased activity
- Nasal flaring
- Tachypnoea - >50bpm in <1 year, >40bpm in >1 year
- Oxygen sats <96% on room air
- Crackles head on chest
- Tachycardia - >160bpm in <1 year, >150bpm in 1-2 year, >140bpm in 2-5)
- Capillary refill time >3 seconds
- Dry mucous membranes
- Poor feeding
- Reduced urine output
- Age 3-6 months with a fever over 39
- Fever for >4 days
- Rigors
- Swelling of a limb/joint
- Non-weight bearing limb or not using an extremity
196
Signs that an under 5 with a feverish illness is high risk
- Pale/mottled/ashen/blue
- No response to social cues
- Appears ill
- Does not wake when roused or if roused, does not stay awake
- Weak, high-pitched or continuous cry
- Grunting
- Tachypnoea >60bpm
- Moderate or severe chest in-drawing
- Reduced skin turgor
- Age <3 months with a temperature >38
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
197
How would you manage a patient who wears contact lenses presenting with an acute red eye?
Refer urgently to ophthalmology to exclude coral ulcer
198
How would you manage a patient with a high-velocity injury presenting with acute red eye?
Refer immediately to the emergency eye service for imaging of the orbit to check for an intra-ocular foreign body
199
How would you manage a patient with chemical eye injury and an acute red eye?
Immediately irrigate the eye with 0.9% saline, and arrange urgent transfer for ophthalmology assessment
200
Indications of a serious and potentially sigh-threatening cause of a patient with an acute red eye
- Reduced visual acuity
- Deep pain within the eye
- Unilateral red eye
- Contact lens use
- Photophobia --> acute uveitis, corneal ulcer, contact-lens-related or foreign body
- High-velocity injuries or injuries involving glass
- Chemical eye injury
- Ciliary injection --> corneal ulcer, contact-lens-related, corneal foreign body and anterior uveitis
- Fluorescein staining --> corneal ulcer, abrasion
- Unequal or misshapen pupils, or abnormal pupillary reaction --> acute glaucoma, anterior uveitis
- Pain on pupillary constriction
- Conjunctivitis in a baby <1 month old
201
Define traveller's diarrhoea
- At least 3 loose to watery stools in 24 hours with or without one or more of abdominal cramps, fever, nausea, vomiting or blood in the stool.
202
Most common cause of traveller's diarrhoea
E. Coli
203
Clinical features of E. Coli poisoning
- Incubation: 12-48 hours
- Common amongst travellers
- Watery stools
- Abdominal cramps and nausea
204
Clinical features of Giardiasis
- Incubation: >7 days
| - Prolonged, non-bloody diarrhoea
205
Clinical features of cholera
- Profuse, watery diarrhoea
- Severe dehydration resulting in weight loss
- Not common amongst travellers
206
Clinical features of Shigella
Incubation: 48-72 hours
- Bloody diarrhoea
- Vomiting and abdominal pain
207
Clinical features of S.Aureus food poisoning
- Severe vomiting
| - Short incubation period (1-6 hours)
208
Clinical features of Campylobacter poisoning
- Incubation: 48-72 hours
- Flu-like prodrome
- Crampy abdominal pains, fever and diarrhoea (may be bloody)
- May mimic appendicitis
- Can lead to Guillain-Barre syndrome
209
Clinical features of Bacillus cereus
- Incubation 1-6 hours
- Rice: vomiting within 6 hours
- Other: diarrhoea after 6 hours
210
Clinical features of amoebiasis
- Incubation: >7 days
- Gradual onset bloody diarrhoea, abdominal pain and tenderness
- Symptoms last several weeks
211
Differentials for right hypochondriac abdominal pain
- Gallstones
- Cholangitis
- Hepatitis
- Liver abscess
- Cardiac disease
- Respiratory disease
212
Differentials for epigastric pain
- Eosphagitis
- GORD
- Peptic ulcer
- Perforated ulcer
- Pancreatitis
213
Differentials for left hypochondriac abdominal pain
- Splenic abscess
- Acute splenomegaly
- Spleen rupture
214
Differentials for right or left lumbar abdominal pain
- Ureteric colic
| - Pyelonephritis
215
Differentials for umbilical abdominal pain
- Appendicitis (early)
- Mesenteric adenitis
- Meckel's diverticulitis
- Lymphoma
216
Differentials for right iliac fossa abdominal pain
- Appendicitis
- Crohn's disease
- Caecum obstruction
- Ovarian cyst
- Ectopic pregnancy
- Hernia
217
Differentials for hypogastric abdominal pain
- Testicular torsion
- Urinary retention
- Cystitis
- Placental abruption
218
Differentials for left iliac fossa abdominal pain
- Diverticulitis
- Ulcerative colitis
- Constipation
- Ovarian cyst
- Hernia
Year 4
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