GP Handbook

Question 1

In the context of preventative health, what is SNAP?

Answer 1

Smoking, nutrition, alcohol and physical activity

Question 2

Describe the tactics you might employ to help a person quit smoking

Answer 2

• Quit plan
• Quit date
• Reasons to quit
• Trigger avoidance (places, people, circumstances)
• Distract, discuss, delay, drink water, deep breaths
• Diet
• Medication (nicotine replacement therapy > 8/52, champix/varenicline [blocks partial nicotinic agonist, care in renal failure], bupropion [CI - seizures, SSRIs, pregnancy])

Question 3

What are the guidelines for regular physical activity in adults?

Answer 3

• 2.5 hours mod-intensity per week (brisk walk) OR
• 1.5 hours high-intensity per week (run)
• More for children

Question 4

How often should adults have their lipid levels monitored?

Answer 4

• 5-yearly
• 2-yearly if >45 and moderate CVS risk
• 1-yearly if high risk

Question 5

Which patients fit into the category 1 (low risk) group for bowel cancer screening. How should they be managed?

Answer 5

• No personal or family history of bowel cancer OR
• One FDR/SDR > 55 with bowel cancer
• FOBT 2-yearly from 50
• Flexible sigmoidoscopy 5-yearly

Question 6

Which patients fit into the category 2 (medium risk) group for bowel cancer screening. How should they be managed?

Answer 6

• One FDR
• Two FDR or an FDR + SDR with bowel cancer at any age
• Colonoscopy 5-yearly from 50 or 10 years earlier than familial diagnosis
  
  • Flexible sigmoidoscopy + barium enema/CT colonography if above contraindicated
• FOBT in intervening years

Question 7

Which patients fit into the category 3 (very high risk) group for bowel cancer screening? How should they be managed?

Answer 7

• Three or more FDRs or FDR/SDRs on the same side of the family with bowel cancer
• Two or more FDR/SDRs on the same side of the family with any:
  
  • Multiple bowel cancers in the one person
  • Bowel cancer before 50 y/o
  • HNPCC-related cancers - endometrial/ovarian/stomach/SI/renal/biliary/brain
• One FDR/SDR with multiple adenomas (?FAP)
• Genetic mutation with high susceptibility in family member
• Referral to genetic counsellor
• FAP
  
  • Flexible sigmoidoscopy yearly/2-yearly from 12-15 until polyposis, then prophylactic surgery
• HNPCC
  
  • Colonoscopy 2-yearly from 25 or 5y earlier than familial diagnosis

Question 8

How often should the asymptomatic population be screened for diabetes?

Answer 8

• 3-yearly over 40 (fasting BGLs)
• OGTT if borderline

Question 9

How often should the asymptomatic female population undergo mammography? At what age?

Answer 9

• 2-yearly from 50-74

Question 10

Describe the symptoms of depression using an acronym

Answer 10

• S - sleep problems
• A - appetite or weight change
• D - dysphoria or bad mood
• F - fatigue
• A - agitation/psychomotor retardation
• C - concentration problems
• E - esteem problems
• S - suicidal thoughts

Question 11

What are the criteria for anorexia nervosa?

Answer 11

• Weight < 85% predicted for height gender and ethnicity OR BMI < 17.5
• Fear of weight gain even when underweight - dieting, vomiting or excessive exercise
• Feeling fat when objectively thin
• Amenorrhoea (except OCP)

Question 12

What are the criteria for bulimia nervosa?

Answer 12

• Regular binge eating episodes
• Preoccupation with weight
• Regular actions to offset binges - starvation, vomiting, laxatives, excessive exercise
• Weight in normal or overweight range

Question 13

What are the criteria for diagnosis of schizophrenia?

Answer 13

• 2+ of for a significant portion of 1 month
  
  • delusions
  • hallucinations
  • disorganised speech
  • disorganised behaviour or catatonia
  • negative symptoms
• Socio-occupational dysfunction
• Continuous disturbance for 6+ months

Question 14

What are the likely side-effects of first-gen antipsychotics?

Answer 14

• Extrapyramidal movement disorders
  
  • Dystonia, akathisia, parkisonism, tardive dyskinesia
• Anticholinergic effects
• Hyperprolactinaemia
• Hyperglycaemia
• Sedation
• Weight gain

Question 15

What preventative and screening measures should be undertaken with patients on second-gen antipsychotics?

Answer 15

• Metabolic syndrome more likely
  
  • Diet and exercise advice
  • BMI
  • BP
  • BGL
  • Lipids
  • Medication review

Question 16

Describe a basic risk assessment of a patient thought to be at risk of violence

Answer 16

• Risk of harm to self/others: thoughts/plans/means/EtOH
• Level of problem with functioning: socio-occupational
• Level of support available
• History of treatment response:
• Attitude to and engagement with treatment

Question 17

When can lactational amenorrhoea be suitable as a contraceptive measure?

Answer 17

• Up to 6 months post-partum if 100% breastfeeding

Question 18

When can medical termination of pregnancy be performed? Surgical?

Answer 18

• Medical <9/40
• Surgical vacuum aspiration <12/40
• Surgical dilation and curettage >12/40

Question 19

What are the absolute contraindications to the combined oral contraceptive pill?

Answer 19

• Hyperthrombotic states
  
  • Pregnancy
  • <2 weeks post-partum
  • Acute liver disease
  • Polycythaemia
  • Hx of thromboembolic disease or thrombophilia
• Cerebrovascular disease, coronary artery disease
• Focal migraines with aura
• Previous oestrogen dependent tumour

Question 20

What are the relative contraindications to use of the combined oral contraceptive pill?

Answer 20

• CV risk factors
  
  • Hypertension
  • High BMI
  • Smoking
  • Diabetes
  • Age > 35 and CVD risk factors
• Thrombotic states
  
  • Long term immobilisation
  • Liver disease
  • 4 weeks pre and 2 weeks post-surgery

Question 21

What are the absolute contraindications to use of an IUD?

Answer 21

• Pregnancy
• Previous ectopic pregnancy
• Active PID
• Undiagnosed uterine bleeding

Question 22

What are the relative contraindications to use of an IUD?

Answer 22

• Anaemia
• Immunocompromise (PID risk)
• Impaired clotting mechanisms
• Valvular heart disease
• Very large or very small uterus

Question 23

Describe the principles of a first antenatal visit in GP

Answer 23

• Confirm pregnancy
• Consider dating scan
• Screening tests
  
  • FBE
  • Group and antibodies
  • Rubella, HBV/HCV, HIV, syphilis
  • Pap smear
  • Urine MCS
• General advice: diet, smoking/EtOH, exercise, weight

Question 24

What should a routine post-natal check involve?

Answer 24

• History
  
  • General health
  • Bonding of baby and mother, family. Coping?
  • Screen for postnatal depression (K10)
  • Breast or bottle feeding
  • Contraception, menstruation and sex
  • Double check rubella status
  • Continence
• Examination
  
  • Mother - BP, breast (if pain), CS wound, pelvic examination, Pap test (if due)
  • Baby - full check as for neonate

Question 25

Describe a systematic baby check

Answer 25

* History: med/obs, mode of birth, ?resuscitation, medications, feeding, urine/faeces output * Examination * General: colour, rashes, alertness, posture, activity, tone * Growth" charts * Head/face/neck: shape, size, fontanelles, sutures, red reflex, palate, nose and ear position/size * Clavicles/arm/hands: length, proportion, symmetry, digits * Chest: shape, symmetry, heart sounds/rate, pulses, RR * Abdo: size, shape, umbilical appearance, HSmegaly * GU: genitalia, testes, anal patency * Hips/legs/feet: Ortolani/Barlow, symmetry, digits * Back: spinal alignment * Neuro: posture, behaviour, tone, cry, reflexes

Question 26

What are some developmental red flags at 6-8 weeks?

Answer 26

* Asymmetrical Moro * Head lag * No visual fixation/following * No startle or quieting to sound * No responsive smiling

Question 27

What are some red-flag developmental signs at 8 months?

Answer 27

* Persistent primitive reflexes * Not weight bearing on legs * Not reaching out for toys * Not fixing on small objects * Not vocalising

Question 28

What are some red-flag developmental signs at 10 months?

Answer 28

* Unable to sit unsupported

Question 29

What are some red-flag developmental signs at 1 year?

Answer 29

* Showing a hand preference * Not responding to own name

Question 30

What are some red-flag developmental signs at 18 months?

Answer 30

* Not walking * No pincer grip

Question 31

What are some red-flag developmental signs at 3 years?

Answer 31

* Inaccurate use of spoon * Not speaking in sentences * Unable to understand simple commands * Not interacting with other children

Question 32

What immunisations should a child get at birth?

Answer 32

HepB

Question 33

What immunisations should a child get at 2, 4 and 6 months?

Answer 33

* HepB * DTPa * HiB * IPV * Pneumococcal 13v * Rotavirus

Question 34

What immunisations should a child get at 12 months?

Answer 34

* HiB * MMR * Menigococcus

Question 35

What immunisations should a child get at 18 months?

Answer 35

* MMR

Question 36

What immunisations should a child get at 4 years?

Answer 36

* DTP * IPV

Question 37

What immunisations should a child get at 10-15 years?

Answer 37

* HepB * Varicella * HPV * DTP