GP Block

Question 1

OSA scale to measure

Answer 1

Epworth sleepiness scale

Question 2

Epworth Scale and example questions

Answer 2

Measure OSA
chance of falling asleep when doing things like sitting at cinema, talking to someone, lying down, in traffic

Question 3

skin lesion describing

Answer 3

A- asymmetry
B- borders, well defined, ill defined
C- colour, how many colours, change in colour
D- diameter
E- evolution, how has it changed, when did it first appear
also mention- bleeding, itching, pus, weeping, any others?

Question 4

triggers of migraines

Answer 4

drop in estrogen before period, anxiety, stress, tiredness, caffeine, skipping meals, dehydration, bright lights,

advise to keep diary for at least 8 weeks to spot triggers

Question 5

treatment for migraines

Answer 5

pain relief- pcm, ibuprofen, triptans such as sumitriptan (zolmitriptan can be given nasally), diclofenac
nausea- metoclopramide or prochlorperazine
prevention- propanolol, amitriptyline 2nd line
watch out for MOH

Question 6

sumitriptan side effects

Answer 6

dizziness, drowsiness, nausea, vomiting,

Question 7

Causes of change in bowel habit

Answer 7

coeliac disease
IBD
IBS
malignancy

Question 8

challenges for pt with chronic pain

Answer 8

mental health
financial strain
not being able to work
isolated by limited social life
misunderstood
change in role

Question 9

CBT for pain principles

Answer 9

aims to tackle the feelings caused by the pain such as fear, anger, depression, anxiety
does not reduce pain and unlikely to reduce catastrophising
increases quality of life

Question 10

causes of constipation

Answer 10

hypercalcaemia
hypothyroidism
diabetes (dehydration)
spinal chord lesion
stricture
colon or ovarian cancer
parkinson’s disease
Ehlers-Danlos

Question 11

symptoms of hiatus hernia

Answer 11

food stuck sensation
dysphagia
acid reflux
regurgitation
odynophagia
haematemesis

Question 12

risk factors for hiatus hernia

Answer 12

obesity
increased age
increased intra-abdominal pressure (chronic cough, pulmonary disease, strenuous exercise, ascites, multiparity)
anti-reflux procedure
other hernia
male

Question 13

dysphagia definition

Answer 13

difficulty swallowing

Question 14

odynophagia definition

Answer 14

painful swallowing

Question 15

migraine questions for history

Answer 15

triggers
aura (visual, somatic, smells)
when does aura occur
is it prolonged
nausea and vomiting
decreased functioning
light / noise sensitivity
unilateral

Question 16

risk factors for migraine

Answer 16

female
obesity
stressful life events
medication overuse
sleep disorders

Question 17

symptoms of a PE

Answer 17

cough
chest pain
SOB
fatigue
palpitations
calf swelling
fever
hameoptysis

Question 18

risk factors for PE

Answer 18

pregnancy and 6 weeks postpartum
oestrogen only hrt
active cancer
immobilisation
previous DVT or PE
smoking
cocp
family hx

Question 19

investigate and manage PE

Answer 19

LMWH dose adjusted to weight
weigh pt
d-dimer
CTPA or VQ mismatch scan if contraindicated
ECG
U&E for contrast and baseline
ABG
CXR
lower leg venous ultrasound

Question 20

GP test for memory

Answer 20

6-CIT

Question 21

joint issues sx to ask

Answer 21

injury
swelling
bruising
locking
giving way

Question 22

muscle relaxants

Answer 22

benzodiazepines
baclofen
methocarbamol

Question 23

hiatus hernia investigation and management

Answer 23

PPI

refer to upper GI surgeons
CXR
upper GI fluoroscopy with contract

Question 24

Restless legs sx

Answer 24

urge to move legs
itching, crawling feeling over legs
occurs in evening and at night
received by movement, stretching or massage

Question 25

risk factors for restless legs syndrome

Answer 25

alcohol, caffeine, iron deficiency, pregnancy, fhx, female, medications (antidepressants, sedating antihistamines, antipsychotics) age, obesity, DM, Parkinson's, MS, PN

Question 26

Investigations for Restless Legs

Answer 26

Clinical diagnosis Iron studies

Question 27

Management for restless legs

Answer 27

good sleep hygiene reduce alcohol and caffeine stop smoking moderate regular exercise stretching limb heat relaxation exercises distraction at times of rest (games or reading) massaging limbs frequent or daily sx- pregabalin or gabapentin, opioids, benzos

Question 28

Differentials for restless legs

Answer 28

Cramps arthritis peripheral neuropathy DVT Akathesia Intermittent claudication polyneuropathy

Question 29

Parkinson's triad

Answer 29

bradykinesia, rigidity, tremor

Question 30

Parkinson's sx

Answer 30

bradykinesia rigidity unilateral tremor mask-like face stooped posture hypophonias micrographia shuffling gate

Question 31

headache differentials- common

Answer 31

trigeminal neuralgia cluster migraine tension medication overuse otitis media acute sinusitis withdrawal menstrual dental cavities TMJ disorder concussion

Question 32

headache differentials- red flag

Answer 32

giant cell arteritis haematoma (epidural, subdural) malignancy stroke meningitis / encephalitis subarachnoid haemorrhage angle closure glaucoma CO poisoning idiopathic intracranial hypertension

Question 33

trigeminal neuralgia

Answer 33

severe pain along trigeminal nerve sharp, burning or shooting pain triggered by tooth brushing, eating, cold and touch RF- age and MS

Question 34

giant cell arteritis hx

Answer 34

pain triggered by contact with affected area tenderness over temporal area (temporal) headache jaw claudication over 50, female hx of vascular risk factors monocular vision loss (transient or permanent) fatigue, anorexia, wt loss, depression Polymyalgia Rheumatica carotid bruits, limb claudication

Question 35

cluster headache history

Answer 35

unilateral around eye watery eye and nose on ipsilateral side red eye 15-180 mins relapsing and remitting pattern start over 20 male, fhx, hx concussion, smoking and heavy drinking

Question 36

withdrawal headaches associated with

Answer 36

associated with: caffeine opioids htn antidepressants steroids antihistamines

Question 37

menstrual headache

Answer 37

episodic headache always associated with menses

Question 38

GCA management

Answer 38

if new visual loss- urgent ophthalmology assessment +/- iv steroids (100mg oral prednisone if not possible) refer with GCA pathway- appt in 3 days, 60mg oral pred bloods- FBC, CRP and ESR treat with steroids over 1-2 years and wean off slowly safety netting- a&e for visual changes, urgent attention for return of headache or jaw claudication)

Question 39

side effects of steroids

Answer 39

wt gain osteoporosis dyspepsia (PPI) muscle weakness skin thinning easy bruising immunosuppression adrenal suppression diabetes visual changes psychiatric disturbances no live vaccines until 3/12 after stopping antihtn and diabetes drugs work less well

Question 40

carbon monoxide poisoning sx

Answer 40

exposure to CO other household members (pets too) have similar sx flu-like sx morning headaches dizziness ataxia confusion n&v

Question 41

meningitis hx

Answer 41

HIV or immunocompromised triad of fever, headache, neck stiffness vomiting seizures photophobia rash altered mental state

Question 42

meningitis examination

Answer 42

brudzinski's sign (neck flexion causes knee flexion) KErnig's sign (back pain when hip flexed and Knee Extended above 90)

Question 43

subdural haematoma

Answer 43

associated with alcohol misuse, anti coags, frequent falls seizures altered mental state coma pupillary abnormalities

Question 44

idiopathic intracranial hypertension history

Answer 44

female, obese, 20-30 n&v headaches transient visual disturbances associated with medications ( steroids, isotretinoin, nitrofurantoin, tamoxifen, trimethoprim, tetracyclines)

Question 45

subarachnoid haemorrhage

Answer 45

thunderclap headache or sentinel (mild to severe) headache women aged 40-60

Question 46

epidural haematoma

Answer 46

blunt trauma to skull LOC followed by period of lucidity, then deteriorates headache vomiting lethargy

Question 47

IBS history

Answer 47

abdominal pain passing stool relieves pain change in bowel habit bloating normal abdominal exam mucus urgency of defecation pain after eating risk factors physical and sexual abuse PTSD age under 50 at onset female fhx

Question 48

IBS in women

Answer 48

backache fatigue insomnia dyspareunia fluctuating food sensitivities luteal phase- diarrhoea and stomach pain ovulation- bloating and constipation

Question 49

symptoms of hypothyroidism

Answer 49

weakness, fatigue and cold intolerance dry hair or hair loss, weight gain, depression, poor memory, constipation, muscle cramps, oligo/amenorrhoea

Question 50

symptoms of hyperthyroidism

Answer 50

palpitations, wt loss, excessively hot or sweaty, tremor, goitre, RF- female, family hx