1
Q
What is Carers Allowance?
A
Carers do not have to be related or live with the person
Must be over 16 years old, and spend at least 35 hours per week caring for person
Ill or disabled person must be in receipt of either Attendance Allowance or Disability Living Allowance
Must be living in England, Scotland or Wales for at last 2 of the last 3 years prior to applying
2
Q
What is Carers Credit?
A
Can be applied for if Carers Allowance not met
Must be over 16 years old but be under state pension age and spend at least 20 hours per week caring for a person
3
Q
What is Statutory Maternity Pay?
A
Payable for up to 39 weeks
Required to have been employed by same employer continuously for at least 26 weeks into the 15th week before baby due
4
Q
What is WHO Greatest Burden of Disease due to YLD?
A
Ischaemic Heart Disease
5
Q
What International GP exchange programmes are available?
A
Family Medicine 360 - Beyond Europe
Hippokrates - Europe
6
Q
Principles of adult learning theory?
A
- Learner should be active contributor, closely relate to understanding and solving real life problems
- Learners current knowledge and previous experience are critical and need to be built upon
- Learners given opportunity and support, self-assessment and feedback
- Opportunities to reflect on their practice
- Use of role models by medical educators has impact
7
Q
What are working time regulations?
A
Worker Entitled to uninterrupted break of 20 minutes when daily working more than 6 hours
8
Q
What are the GMS 1 + 3 Forms?
A
GMS1 - Register Patients on a permanent bases
GMS3 - Temporary Resident Form, Used to register patients temporarily for up to 3 months
9
Q
Define referral criteria for increased breast cancer risk? (6)
A
- One 1st degree female relative with breast cancer <40 years old
- One 1st degree male relative with breast cancer of any age
- One 1st degree relative with bilateral breast cancer where first primary diagnosed <50 years old
- Two 1st degree relatives or one 1st and one 2nd degree relative with breast cancer at any age
- One 1st degree or 2nd degree relative with breast cancer at any age plus one 1st or 2nd degree relative with ovarian cancer at any age (one 1st degree needed)
- Three 1st or 2nd degree relatives on same side of family with breast cancer at any age
10
Q
Define referral criteria for increased breast cancer risk - when to seek further advice?
A
Bilateral breast cancer
Male breast cancer
Ovarian cancer
Jewish Ancestry
Sarcoma in relative <45 years old
Glioma or childhood adrenal cortical carcinoma
Complicated patterns of multiple cancers at young age
Paternal history of breast cancer (2 or more relative on father’s side)
11
Q
When is orlistat indicated to prescribe?
A
After dietary, exercise and behavioural approaches have been started
Adults - BMI >28 with associated risk factors or BMI >30
Children - Over aged 12 only in specialist settings
12
Q
What is the definition of delayed puberty?
A
Absence of any breast development or secondary characteristics by age of 13
Presence of normal development but primary amenorrhoea by age 15
13
Q
What is general exercise advice to give to patients?
A
a minimum of 150 minutes of moderate intensity per week (increased breathing and able to talk)
or at least 75 minutes of vigorous intensity per week (breathing fast and difficulty talking), or a combination of both.
14
Q
What is RIDDOR reporting system? And what are the 8 types of conditions it affects?
A
Puts duties on employers, the self-employed and people in control of work premises to report certain serious workplace accidents, occupational diseases and specified dangerous occurrences (near misses)
For an occupational disease to be reportable it must be one of the eight types of condition, and it must be likely that it was caused or made worse by the person’s current work:
Carpal tunnel syndrome
Cramp of the hand or forearm
Occupational dermatitis
Hand arm vibration syndrome
Occupational asthma
Tendonitis or tenosynovitis
Occupational cancer
Exposure to a biological agent
15
Q
National Screening Programmes - AAA - who is it offered to?
A
Men 65 years old, single USS scan
Not offered to people who have already been treated for AAA
16
Q
National Screening Programmes - AAA - what is the test?
A
Abdominal US
If not visualised - repeat scan
17
Q
National Screening Programmes - AAA - interpretation of results?
A
No aneurysm (<3.0cm) - no further scans
Small AAA (3.0-4.4cm) - surveillance, repeat scan in 12 months
Medium AAA (4.5-5.4cm) - surveillance, repeat scan 3 months
Large AAA (>5.5cm) - referred to vascular surgery within 2 weeks
Inform DVLA if >6cm (licence revoked if >6.5cm)
18
Q
National Screening Programme - Bowel Cancer - Who is it offered to?
A
Age - 50 -74 years
Every 2 years
If does not respond - reminder letter in 4-6 weeks, if no response after 3 months - GP received electronic notification, re-invited at next recall
19
Q
National Screening Programme - Bowel Cancer - what is the test?
A
FIT Test - threshold >120 micrograms of Hb/g of faeces
20
Q
National Screening Programme - Bowel Cancer - Outcome of FIT test?
A
Normal - routine recall every 2 years up to 75
Abnormal FIT - assessed by specialist nurse and offered colonoscopy or imaging if unsuitable for colonoscopy
Spoilt Kit - sent repeat test kit
21
Q
National Screening Programme - Bowel Cancer - management of colonoscopy results?
A
No abnormalities - returned to routine recall
Low Risk Adenoma (1 or 2 small <1cm) - returned to routine recall
Intermediate Risk Adenoma (3 or 4 adenomas or at least 1 adenoma >1cm) or high risk adenoma (5 or more, 3 or more with at least 1 >1cm) - colonoscopic surveillance
22
Q
National Screening Programme - Breast Cancer - who is it offered to?
A
Age 50 - 70 years old (up to 71st birthday)
Can be called up to 3 years after 50th birthday
Recall 3 yearly
23
Q
National Screening Programme - Breast Cancer - what is the test?
A
Routine mammography screening
24
Q
National Screening Programme - Breast Cancer - outcome of results?
A
Normal - routine recall
Further tests needed - urgent appointment
25
National Screening Programme - Cervical Cancer - Who is it offered to? How does recall work?
Age - 25 - 64 years old
- At 24.5 years - 1st invite, completed by 25th birthday
- At 25-64 - recall every 5 years
- Negative hrHPV and no recent hrHPV positive - now recalled every 5 years
- People >65 years old - recent abnormal cytology, not had since 50 and request one
26
National Screening Programme - Cervical Cancer - Process of testing?
Primary HPV Testing
- Identify high-risk HPV
Liquid based cytology - if hrHPV found
Colposcopy
27
National Screening Programme - Cervical Cancer - how to take smear test?
Speculum exam, take a sample from whole of transformation zone
- If 2 cervices, take sample from each cervix
- If cannot be visulaised refer for colposcopy
- If cervical stenosis refer for colposcopy clinic for consideration of cervical dilatation
28
National Screening Programme - Cervical Cancer - what to do if bleeding during sample taking?
- If no suspicion of malignancy - assess amount and causes. Send sample - advised may be inadequate
- If repeated bleeding or post coital bleeding then consider gynae referral
- If cervix bleeds and clinical suspicion of malignancy - do not take sample, refer 2ww
29
National Screening Programme - Cervical Cancer - when to delay smear?
Menstruating
<12 weeks post-partum
<12 weeks after termination of pregnancy/miscarriage
Pregnant
Pelvic infection/vaginal discharge
30
National Screening Programme - Cervical Cancer - management of negative hrHPV? Management of positive hrHPV?
Negative for high-risk HPV are classified as negative unless and returned to routine recall:
- Test of Cure pathway
- Untreated CIN1 pathway
- Follow up for incompletely excised CGIN, SMILE or cervical cancer
People who test positive for hrHPV should have cytology test performed
31
National Screening Programme - Cervical Cancer - Types of cytology results?
Negative - no abnormality detected
Abnormal
- Borderline changes in squamous or endocervical cells
- Low-grade dyskaryosis
- Moderate high-grade dyskaryosis
- Severe high-grade dyskaryosis
- Invasive squamous cell carcinoma
- Glandular neoplasia
Inadequate
- Taken but cervix not fully visualised
- Taken in inappropriate manner (wrong sample device)
- Insufficient cells
- Obscuring element (lube, blood, inflammation)
Incorrectly labelled
32
National Screening Programme - Cervical Cancer - managing of hrHPV positive and negative cytology?
HrHPV positive and negative cytology - repeat HPV test at 12 months
- If negative - routine recall
- If positive at 12 months - repeat in further 12 months
- If positive at 24 months - referred to colposcopy
33
National Screening Programme - Cervical Cancer - managing inadequate results?
Inadequate - repeat within 3 months
2 consecutive inadequate cytology results - refer to colposcopy
- If colposcopy normal - hfHPV test 12 months and if negative, routine recall
- If colposcopy inadequate - repeat screening test and colposcopy examination in 12 months - if normal and negative routine recall
34
National Screening Programme - Cervical Cancer - managing of abnormal cytology results? Referral urgencies?
Inadequate - repeat smear, routine colposcopy if 2x inadequate
Borderline - HPV testing - routine colposcopy (6 weeks) if high risk
Low-Grade - HPV testing - routine colposcopy (6 weeks) if high risk
High-Grade or suspected cancer - Urgent Colposcopy (2 weeks)
35
National Screening Programme - Cervical Cancer - what happens at colposcopy?
Observe cervix for CIN/cancer
Apply acetic acid to cervix - abnormal areas turn white
Iodine solution, pre-cancerous do not stain
Biopsy
36
National Screening Programme - Cervical Cancer - special circumstances - CIN?
Test of cure cervical sample 6 months after treatment
Negative hrHPV - repeat cytology 3 years, then routine recall
Positive hrHPV - refer colposcopy
37
National Screening Programme - Cervical Cancer - special circumstances - hysterectomy?
Subtotal hysterectomy - continue
Total hysterectomy - not required
38
National Screening Programme - Cervical Cancer - special circumstances - immunosuppressed?
Kidney Failure with dialysis - Offer at diagnosis if not up to date
Organ Transplant - Offer within a year before transplant
HIV positive - At diagnosis and annually thereafter (colposcopy at diagnosis)
Cytotoxic Drugs - Offer if screening history incomplete
39
National Screening Programme - Chlamydia - when to offer?
Under 25 years old
Sexual partners with proven or suspected chlamydia infection
Sexual active women under 25, annually or more frequently if changed partner
All people with concerns about sexual exposure - if <2 weeks, then repeat after 2 weeks of exposure
People <25 treated for chlamydia in previous 3 months
People with 2 or more sexual partners in previous 12 months
All women seek TOP
All people attending GUM clinics
40
National Screening Programme - Chlamydia - tests for men and women?
Women - VVS or endocervical swab (alt first-catch urine)
Men - first-catch urine (alt urethral swab)
41
Gynaecomastia - aetiology?
Enlargement of male glandular breast tissue, due to imbalance between male oestogen-testosterone ratio from relative oestrogen excess or testosterone deficiency
Prevalence 35-65% in males aged 50-69 years
42
Gynaecomastia - Causes?
- Physiological - Newborn, pubertal, senility
- Benign - Idiopathic, familial, obesity
- Drugs, illicit drug use, anabolic steroid use
spironolactone (most common drug cause), cimetidine, digoxin, cannabis, finasteride, GnRH agonists e.g. goserelin, buserelin, oestrogens, anabolic steroids, tricyclics, isoniazid, calcium channel blockers, heroin, methyldopa
- Endocrine - Hyperthyroidism, primary hypogonadism (Klinefelters, Kallmanns), secondary hypogonadism, hyperprolactinaemia
- Liver - cirrhosis, malabsoprtion
- Urological - Testicular tumour, haemochromatosis, CKD
43
Gynaecomastia.- when are investigations not required?
Newborns or adolescents with physiological gynaecomastia
Older males with senile gynaecomastia
Males with fatty or drug-related gynaecomastia
44
Gynaecomastia - when to investigate?
Rapid breast enlargement
Recent gynaecomastia in lean males aged >20
Persistent painful gynaecomastia
Eccentric hard masses
Adolescents with:
- Massive gynaecomastia
- Persistent >18 months duration
45
Gynaecomastia - what investigations?
9am testosterone
- If abnormal - LH/FSH/SHBG/prolactin/oestradiol/albumin
LFT, U&E, TFT
AFP, B-HCG
- If raised - testicular USS
46
Gynaecomastia - when to refer urgently?
Male >50 with unilateral subareolar mass +/- nipple discharge +/- skin changes
Bloody nipple discharge
Unilateral ulceration of the nipple
47
Gynaecomastia - routine referral?
Unilateral lump with increased risk (FHx, Klinefelters)
No obvious physiological/drug cause
>6 months with normal bloods
48
Gynaecomastia - management of physiological?
Physiological gynaecomastia - reassure and healthy body weight advice, most resolved within 3 years
49
Osteoporosis - definition?
Low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture
Bone mineral density (BMD) of 2.5 standard deviations below the mean peak mass (average of young healthy adults) as measured by dual-energy X-ray absorptiometry (DXA) applied to the femoral neck and reported as a T-score.
50
Osteoporosis - definition of osteoporotic and fragility fracture?
Osteoporotic fracture is a fragility fracture occurring as a consequence of osteoporosis
Fragility fracture is defined as a fracture following a fall from standing height or less, although vertebral fractures may occur spontaneously, or as a result of routine activities e.g. bending or lifting.
51
Osteoporosis - risk factors affecting bone strength - reduce BMD?
- Endocrine - DM, Hyperthyroid, hyperparathyroid
- GI - Crohn's, UC, Coeliac, Pancreatitis - chronic
- CKD
- Cirrhosis
- COPD
- Menopause
- Immobility
- BMI <18.5
52
Osteoporosis - risk factors affecting bone strength - do not reduce BMD?
Age
Smoking
Alcohol (3 or more units daily)
Previous Fragility Fractures
RA
Oral corticosteroids
Prental history of hip fracture
Drugs - SSRI, PPI, Carbamazepine (unsure re BMD)
53
Osteoporosis - when to consider risk assessment?
All women 65 and over and all men aged 75 and over
All women <65 and men <75 who have any risk factor
54
Osteoporosis - when to consider risk assessment - what are the risk factors?
- Previous osteoporotic fragility fracture
- Current use or frequent recent use of oral corticosteroids
- Hx of falls.
- FHx of hip fracture
- BMI <18.5 kg/m2
- Smoking
- Alcohol >14 units
- Secondary cause of osteoporosis, including:
1. Hypogonadism in either sex, inc untreated premature menopause (menopause before 40 years of age), aromatase inhibitors (such as exemastane) or GnRH agonists (such as goserelin).
2. Endocrine conditions (DM, Cushing's disease, hyperthyroidism, hyperparathyroidism, and hyperprolactinaemia.
3. Malabsorption (IBD, coeliac disease, and chronic pancreatitis)
4. RA (plus inflammatory arthropathies)
5. Multiple myeloma and haemoglobinopathies
6. COPD
7. Chronic liver failure.
8. CKD
9. Immobility
55
Osteoporosis - when not to consider risk assessment?
Aged <50 unless:
- Current or frequent use of oral corticosteroids
- Untreated premature menopause
- Previous fragility fracture
56
Osteoporosis - when to consider risk assessment in <40 years old?
- Current of recent use of high-dose oral corticosteroids (equivalent to >7.5mg prednisolone daily for 3 months or more)
- Previous major osteoporotic fracture
- History of multiple fragility fractures
57
Osteoporosis - how to assess fragility fracture risk?
Exclude non osteoporotic causes (metastases, myeloma, osteomalacia, Paget's disease)
Exclude secondary causes (endocrine, rheumatology, GI, liver, CKD, COPD)
Offer DEXA scan
58
Osteoporosis - when to offer DXA scan without calculating fragility fracture risk?
>50 with history of fragility fracture
<40 who have major risk factor for fragility fracture (depending on NMD score - refer to specialist)
Note can consider drug treatment without DXA for people with vertebral fracture
59
Osteoporosis - how to investigate people with risk factors?
Calculate 10-year fragility fracture risk (Q-fracture, FRAX)
DXA for high risk (>10%/red zone) or close if RF underestimate
Assess Vitamin D and calcium
60
Osteoporosis - when to offer oral bisphosphonates prior to DXA?
If on glucocorticoid therapy and:
- Prior fragility fracture
- Women >70
- Post menopausal women and men >50 taking high dose steroids (7.5 mg or more of prednisolone daily or equivalent over 3 months) or exceeding intervention threshold
61
Osteoporosis - management - how to manage high risk for fragility fracture (on Q-fracture)?
DXA
If < -2.5 - bone-sparing drug treatment
(If > -2.5 - treat/modify RF and cause - repeat within 2 years)
62
Osteoporosis - management - how to manage intermediate risk for fragility fracture (on Q-fracture)?
Lifestyle advice
Follow up within 5 years
63
Osteoporosis - management - how to manage low risk for fragility fracture (on Q-fracture)?
Lifestyle
Follow up within 5 years
64
Osteoporosis - management - when to consider referring for consideration of parenteral treatment?
Very high risk if:
- Recent vertebral fracture within 2 years
- Two or more vertebral fractures
- BMD T-Score < -3.5
- High dose oral steroids (7.5 mg or more of prednisolone daily or equivalent over 3 months)
- High imminent risk of re-fracture
65
Osteoporosis - management - drug treatment for high risk patients?
Oral bisphosphonate to:
- Postmenopausal women and men >50 if osteoporosis (T-score <-2.5)
Alendrenate 70mg once weekly (or risedronate 35mg once weekly - first line
- If unsuitable ibandronate 150mg once monthly
- if not tolerated or contraindicated -specialist referral
ONLY RISEDRONATE LISCENCED IN MEN
If calcium adequate - 400 units of vitamin D
If calcium inadequate - 400 units Vit D + 1000mg calcium daily (800 units + 1000mg housebound/care home)
66
Osteoporosis - management - lifestyle advice?
Regular exercise
Balanced diet
Stop smoking
Reduce alcohol
67
Osteoporosis - management - follow up after starting bone sparing treatment?
3-4 months - check tolerance, SE
12 months - check tolerance
5 years
- If high risk - continue 10 years (>70 at start of bisphosphonates, previous hip/vertebral fracture, one or more fragility fracture during 1st 5 years)
- Arrange DXA and consider continuing for another 5 years if < -2.5, pausing treatment for 1.5-3 years if >-2.5
68
Osteoporosis - management - follow up - when to reassess?
Re-fracture occurs
Risk Factor changes
69
Osteoporosis - management - what to do if osteoporotic fracture on bone-sparing treatment?
Check adherence, exclude secondary causes
Consider referral to specialist
70
Osteoporosis - management - follow up for intermediate risk?
Reassess after minimum 2 years
71
Bisphosphonates - when not to prescribe?
- Hypocalcaemia, PTH dysfunction, low vitamin D (should be treated prior to bisphosphonates)
- CKD (alendronate CrCl <35, risedronate CrCl <30)
- Unable to stand or sit upright for >30 mins - oesophageal issues (stricture, achalasia)
- Pregnant or breastfeeding women
Caution dysphagia, gastritis, duodenitis, ulceration, major GI bleed, Barrett's oesophagus
72
Bisphosphonates - side effects?
GI - nausea, dyspepsia, mild gastritis, abdominal pain (1st month)
Bone, joint, muscle pain
Oesophagitis, oesophageal ulcers/strictures/erosions
Osteonecrosis of jaw/auditory canal
Atypical stress fractures
73
Bisphosphonates - advice to person?
Only to be taken on empty stomach, swallow whole, water >200mls, upright for >30 min
Alendronate - at least 30 mins before first food or drink
Risendronate - >30 mins pre first food/drink or at least 2 hours before or after lunch/dinner
Dental check up before starting and annually - tell dentist
74
Sick Day Rules - Type 1 Diabetes?
Insulin - do not stop
BM frequently - every 1-2 hours including through the night
consider checking blood or urine ketone levels regularly
Normal meal pattern. If appetite is reduced meals could be replaced with carbohydrate-containing drinks (such as milk, milkshakes, fruit juices, and sugary drinks)
Aim to drink at least 3 L of fluid (5 pints)
75
Sick Day Rules - Type 2 Diabetes?
Temporarily stop some OHA during an acute illness, medication may be restarted once the person is feeling better and eating and drinking for 24-48 hours
Metformin: stop treatment if there is a risk of dehydration, to reduce the risk of lactic acidosis
Sulfonylureas: may increase the risk of hypoglycaemia
SGLT-2 inhibitors: check for ketones and stop treatment if acutely unwell and/or at risk of dehydration, due to the risk of euglycaemic DKA
GLP-1 receptor agonists: stop treatment if there is a risk of dehydration, to reduce the risk of AKI
Insulin, do not stop treatment, monitor blood glucose more frequently as necessary
76
Management of undescended testes - If suspected disorder of sexual development and/or bilateral impalpable undescended testes are identified at birth?
Refer urgently to consultant paediatrician for review within 24 hours
If disorder of sexual development excluded and testes not palpable in scrotum by 4-5 month - refer paediatric urology seen by 6 months
77
Management of undescended testes - bilateral impalpable undescended testes at 6-8 weeks?
Urgent referral to senior paediatrician seen within 48 hours
78
Management of undescended testes - if one or both testes palpable but not located in scrotum?
Birth - reexamine 6-8 weeks, if normal nil further
6-8 weeks - reexamine 4-5 months
4-5 months- if testis remain undescended, referral to paediatric urology to be seen by 6 months
If one or both retractile - annual follow up until after puberty (risk of ascending testis)
79
Monitoring requirements for statin as initiation and monitoring?
LFTs at baseline, 3 months and 12 months
80
Monitoring requirements for ACEi as initiation and monitoring?
U&E prior to treatment
U&E after increasing dose 1-2 weeks
U&E at least annually
81
Monitoring requirements for amiodarone as initiation and monitoring?
Prior to treatment - TFT, LFT, U&E, CXR
TFT, LFT every 6 months
82
Monitoring requirements for methotrexate as initiation and monitoring?
FBC, LFT, U&E
FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised
Thereafter patients should be monitored every 2-3 months
83
Monitoring requirements for azathioprine as initiation and monitoring?
FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months
84
Monitoring requirements for lithium as initiation and monitoring?
TFT, U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT, U&E every 6 months
85
Monitoring requirements for sodium valproate as initiation and monitoring?
LFT, FBC before treatment
LFT 'periodically' during first 6 months
86
Monitoring requirements for glitazones as initiation and monitoring?
LFT before treatment
LFT 'regularly' during treatment
87
What drugs need to be prescribed by brand name?
- Modified release calcium channel blockers
- Antiepileptics
- Ciclosporin and tacrolimus
- Mesalazine
- Lithium
- Aminophylline and theophylline
- Methylphenidate
- CFC-free formulations of beclometasone
- Dry powder inhaler devices
88
When is OA diagnosed clinically?
If > 45 years and activity-related joint pain and has either:
- no morning joint-related stiffness or
- morning stiffness that lasts no longer than 30 minute
89
Definition and management of pompholyx?
Small, itchy blisters on the palms, fingers, soles, or toes.
Management
- affected areas clean and dry
- avoid triggers, such as allergens and irritants
- topical corticosteroids and/or emollients
90
How many doses of DTaP vaccine given in childhood?
When would a booster be given?
5 doses
Booster:
- Travelling to areas where medical attention not accessible
- If tetanus prone injury likely to occur and last dose >10 years ago
91
Risks of chickenpox infection in pregnancy?
Risk of congenital varicella syndrome
- low birth weight
- neurological abnormalities
- eye lesions
- skeletal anomalies
- skin scarring
- limb hypoplasia
92
Management of chickenpox in pregnancy?
Oral aciclovir for pregnant women present <24 hours of the onset of the rash and if >20 weeks' gestation
Use of aciclovir before 20 weeks should also be considered
Intravenous aciclovir should be administered to all pregnant women with severe chickenpox
Refer to a fetal medicine specialist, at 16–20 weeks or 5 weeks after infection, for discussion and detailed ultrasound examination
93
When to give VZIG in chickenpox in pregnancy?
Used in PEP when antivirals contraindicated or not tolerated
Effective given up to 10 days after contact (non immune woman)
No benefit once developed chickenpox
VZIG has no benefit once a woman has developed chickenpox
94
What is raised Ca125 most associated with? What else is it raised in?
Non-specific, more likely associated with epithelial tumours
Raised in other tumours, diabetes, CCF and liver disease.
95
How is RMI calculated for ovarian cancer?
USS x Ca125 x Menopausal Status
96
What asthmatic patients are at increased risk with NSAIDs?
Females
Middle age
Severe asthma
Nasal polyps
Nasal congestion
Profuse rhinorrhoea
97
When to refer CKD to nephrologist?
5-year risk of needing RRT >5% ( 4-variable Kidney Failure Risk Equation)
ACR >70 mg/mmol or more
ACR >30 mg/mmol + haematuria
Drop in eGFR of >25% and a change in eGFR category within 12 months
Drop in eGFR >15 ml/min/1.73 m2 or more per year
Poorly controlled hypertension (use of at least 4 meds), known or suspected genetic cause, suspected RAS
98
Mechanism of action of prostaglandin analogues (latanoprost, bimatoprost)?
Increase uveoscleral outflow
99
Mechanism of topical eye drop beta blockers, alpha-agonist and carbonic anhydrase inhibitor?
Reduce aqueous humour production
100
Monitoring requirements in ADHD medications?
HR and BP before, after dose change and 6 monthly
Height 6 monthly (children)
Weight 3 monthly (children <10), 6 monthly for adults
101
How long is Mirena coil licensed in contraception?
8 years
102
Management of vasomotor symptoms in Menopause?
HRT (unless contraindicated)
Menopausal specific CBT
Other options - Do not routinely offer SSRIs, SNRIs or clonidine as first-line treatment for vasomotor symptoms alone
103
Risk Factors for Ovarian Cancer?
Protective Factors?
FHx
Nulliparity or having first child at more than 35-years-old
Late age of menopause
White race
Protective features:
- Oral COCP
- Multiple pregnancies and breastfeeding - fewer ovulatory cycles
104
Complications of Coeliac Disease?
Vitamin D deficiency
Osteoporosis
Iron deficiency
Ulcerative jejunitis
Intestinal lymphoma.
105
Contraindications of testosterone therapy?
Breast cancer in males
History of liver tumours
Hypercalcaemia
Prostate cancer
106
Most common malaria causative organism in Africa and South Asia?
Plasmodium falciparum >90% of malaria imported to the UK from Africa
Plasmodium vivax is responsible for the majority of cases of malaria imported from South East Asia
107
C peptide level in MODY? And management?
C peptide level normal (reduced in T1DM and undetectable after 3-5 years)
Treated with sulphonylureas (gliclazide)
108
Describe Still's Murmur?
Most common innocent murmurs, kids 3-6 but sometimes persisting in adolescence
Auscultated over the left lower sternal border and apex. Systolic murmur, described as ‘musical’ or ‘crescendo-decrescendo’
Heard best with the patient supine and is quieter on standing
109
Questionnaires for OSA? Scoring for Epworth?
STOP-Bang questionnaire is an eight-item tool (snoring, sleepiness, apnoeas, hypertension, obesity, neck circumference, age, and sex)
- Sensitive but not specific
Epworth score is a self-administered eight-item tool assesses the likelihood of daytime sleepiness in a variety of common situations
- Normal - up to 10
- 11-12 indicates mildly excessive daytime sleepiness.
110
Risk factors for chronic open angle glaucoma?
Type 2 diabetes, hypertension and CVD
111
Severity assessment for COPD on spirometry?
FEV1 > 80% stage 1 or mild COPD
FEV1 50–79% stage 2 or moderate COPD
FEV1 30–49% stage 3 or severe COPD
FEV1 < 30% stage 4 or very severe COPD
112
How long to wait until starting SSRI after fluoxetine?
4-7 days
113
What conditions pre-dispose children to chronic spontaneous urticaria?
Nutritional deficiency (iron and vitamin D)
Coeliac disease, Thyroid disease, SLE
114
What causes highest reduction in all cause mortality post MI?
Exercise-only rehabilitation
115
Management of family of patient diagnosed with HOCM?
Ix of families diagnosed with HOCM requires referral to cardiologist
116
Management of typical UTI in children <6m?
USS Renal Tract within 6 weeks
If over 6 months and responded to Abx within 48 hours - none needed
117
Drug advice for desmopressin in childhood nocturnal enuresis?
Fluid restrict 1 hour before and 8 hours after for childhood nocturnal enuresis
118
What are the common child topical anaesthetics for blood taking?
EMLA (lidocaine 2.5% and prilocaine 2.5%)
Ametop (tetracaine)
119
Optimal emollients for patients?
Ointment - most effective for dry skin, last longer but hard to apply and messy
Creams and Lotions - better for red, inflamed areas of skin
120
Poor prognostic factors for alopecia acreta?
Childhood onset
Extensive or chronic alopecia
Involvement of scalp margins
Presence of autoimmune disease
121
When would Industrial Disablement Benefit be claimed for occupational deafness?
SSHL >50dB in each ear
Average of losses at 1, 2 and 3 kHz
Owing to case of at least one ear to occupational noise
122
When can you apply for Motability Scheme? Other features?
Every three years, or Wheelchair Accessible Vehicle every 5 years
Can apply for a car as a passenger
Possible to nominate up to 3 other people to drive on their behalf
Parents can apply on behalf of children >3 years old
123
How to calculate NNT?
Absolute Risk Reduction = Absolute Risk of Events in Treatment Group - Absolute Risk of Events in Control Group
1/ARR
124
SE of topical eye prostaglandin analogues?
Darkening, thickening and lengthening of eyelashes, increase brown pigment in iris
125
Causes of thrombocytosis?
IDA
Bacterial Infection
Inflammatory Conditions
Trauma
Cancer
Acute bleeding
126
What dose equivalent is 10mcg topical oestrogen 1 year supply?
1 tablet of oral standard HRT
127
Iron profile bloods in IDA?
Low iron + ferritin + transferrin saturation
High TIBC
128
Blood monitoring in testosterone therapy?
Testosterone + Haematocrit levels annually (3-monthly haematocrit in 1st year of treatment)
129
Management of cluster headaches - acute and prophylaxis?
Acute Treatment
- Oxygen
- SC or nasal sumatriptans
Prophylaxis
- Verapamil
129
What is plantar fasciitis associated with?
HLA-B27 (AS, Psoriatic Arthritis, Reactive Arthritis)
130
Classifying headaches by frequency?
Episodic = Frequency <15 per month
Chronic = Frequency >15 per month, for more than 3 months
131
Management of hiccups in palliative care?
Non pharmacological - Sip ice water, breathing in paper bag, interrupt normal breathing, drink from opposite side of cup, rub soft palate with swab
Pharmacological - Peppermint water, Antacid, Metoclopramide, PPI, Dexamethasone
132
What % have cancer in all cancer referrals + positive FIT tests?
3% of suspected cancer referrals have cancer
7% of positive FIT (PPV) have cancer
133
Management of recurrent UTI?
Refer in Men <65 to urology
Defined as 2 or more UTIs in 6m or 3 or more in 12m
134
LTOT Criteria?
PaO2 <7.3
PaO2 <8 with associated peripheral oedema, pulmonary hypertension, secondary polycythemia or nocturnal hypoxaemia or O2 <92% on RA
135
MRC Dyspnoea Scale?
0 = Not troubled by breathless except on strenuous exercise
1 = Short of breath when hurrying on a level or when walking up a slight hill
2 = Walks slower than most people on the level, stops after a mile or so, or stops after 15 min walking at own pace
3 = Stops for breath after walking 100 yards, or after a few minutes on level ground
4 = Too breathless to leave the house, or breathless when dressing/undressing
136
Is artificial colouring advised to be avoided in ADHD?
Not routinely
If adamant there is a link - refer to dietician
137
Diagnostic Criteria of Obesity Hypoventilation Syndrome? (3)
BMI >30
Raised PaCO2
Breathing abnormal during sleep (obs apnoeas and hypoapnoeas +/- hypoventilation)
138
What abx should you avoid alkylosing agents in? Why?
Nitrofurantoin
Affects urinary pH
139
Most common cause of adult dyspepsia?
Functional dyspepsia
140
When to test for HIV if suspected?
At presentation
+
45 days after exposure
4th gen testing
141
What renal manifestation is MODY associated with?
Renal cysts
142
How to manage suspected TIA if presents <7 days and >7days?
Presents within 7 days - 300 mg aspirin immediately and assessed within 24 hours by a specialist
If presents over 7 days - refer to TIA clinic within 7 days
143
Management of APS in pregnancy?
Aspirin 75mg od and LMWH from positive test to at least 34 weeks gestation
144
Principles of Access to Health Records Act 1990?
Qualified right of access to a deceased individuals health records where person seeking access has interest in the estate of deceased
Unless dead individual specifically requested confidentiality while alive, any person who has claim/interest has right to access
145
Principles of Access to Medical Reports Act 1988?
Allows patients to see medical reports for employment or insurance purposes, can see before supplied or for up to 6 months after
146
Principles of Data Protection Act 1998?
Governs access to health records of living people. Right to apply for access to health records irrespective of when they were compiled
147
Principles of Freedom of Information Act 2000?
general right of public access to all types of recorded information held by public authorities. Must be made within 20 working days
148
Temperature values for infants and what risk category does that put them in?
<3 months any temp >38.0 - high (red) risk
3-6 months temp >39 - intermediate risk
>6 months - height of temp alone not used for risk
149
Definition criteria of LD?
IQ <70
Significant impairment of social and adaptive function
Onset in childhood
150
How long can COCP be continued for (age)?
Up until 50 (unless other CIs)
151
What are some homeopathic treatments for N&V in pregnancy?
ginger, acupuncture and acupressure can be tried
152
When can you consider stopping AEDs in seizures?
seizure-free for 2 years, individualised assessment determines risk of seizure recurrence by an epilepsy specialist
153
POP Missed Pill Rules - What denotes missed pill for desogestrel, drospirenone and other POPs?
If desogestrel - missed if >12 hours late from when should have been taken (>36h after last pill)
If drospirenone - missed if >24 hours late from when should have been taken (>48 hours after last pill)
Other POPs - missed if >3 hours from when last should have been taken (>27 hours after last pill)
154
POP Missed Pill Rules - If Missed Dose of POP - General Measures?
Take a pill ASAP (only one if more than one missed)
- For drospirenone, the HFI (placebo pills) should be omitted if any of the last 7 active pills missed.
Take the next pill at the normal time.
Avoid sexual intercourse or use a barrier method of contraception (such as condoms) for 7 days if taking drospirenone, or 2 days for all other POPs.
155
POP Missed Pill Rules - For Drosperidone when to use EC?
Any active pill missed and UPSI from time first pill missed until correct pill-taking resumed for 7 days
Pill missed on days 1–7 of packet and UPSI during the hormone-free interview (HFI) or week 1.
156
POP Missed Pill Rules - For Desogeestrel and other POPs when to use EC?
UPSI from time first pill missed until correct pill-taking had resumed for 48 hours.
157
Management of nasolacrimal duct obstruction?
Occurs in 5% of infants, usually no need for treatment and resolves spontaneously
Refer if fails to clear by 12 months
Treatment is by probing the duct
158
How long can IUD be in place if inserted after 40 years old?
IUD when the woman is 50 or older, can remain in situ until one year after the last menstrual period (LMP)
If a woman is under 50, the IUD can remain in situ for two years after the LMP
159
When do you not use lipid risk assessment scoring system for high risk patients?
Patients with type 1 diabetes who:
- are aged more than 40 years
- have had diabetes for more than 10 years or have established nephropathy
- have other CVD risk factors.
Patients with chronic kidney disease stage 3 or beyond.
Patients with familial hypercholesterolaemia.
160
What is the Delphi Method?
Method for achieving convergence of opinion concerning real-world knowledge solicited from experts
161
When to start varenciline in smoking cessation?
Start while still smoking
Stop smoking 7-14 days after start varenicline
Course 12 weeks total
162
What is foetal varicella syndrome?
1% if <20 weeks gestation, reduced with gestational age - none following 28 weeks
Skin scarring, microphthalmia, limb hypoplasia, microcephaly, learning disabilities
163
Management of chickenpox exposure in pregnancy?
If clear history of past chickenpox, shingles or 2x doses of vaccine - immunity assumed
If doubt about mother previously having chickenpox - blood for maternal varicella antibodies (IgG)
If Abs then immune
If not - d/w specialist for need for prophylaxis
Choice - aciclovir at day 7 - 14 after exposure
164
Management of chickenpox infection in pregnancy?
If develops chickenpox in pregnancy - specialist advice
Tx Oral aciclovir if pregnant women >20 weeks and present within 24 hours (considered with caution with aciclovir <20 weeks)
165
What tumour markers are raised in Non seminomous germ cell testicular tumour?
AFP
Beta-HCG
166
When do patients automatically qualify for blue badge?
Receiving the Higher Rate of the Mobility Component of the Disability Living Allowance
Receiving a Personal Independence Payment for being unable to walk further than 50 metres (a score of 8 points or more under the ‘moving around’ activity of the mobility component)
Registered blind (severely sight impaired)
Receiving a War Pensioner’s Mobility Supplement
Has received a lump sum benefit within tariff levels 1-8 of the Armed Forces and Reserve Forces (Compensation) Scheme and has been certified as having a permanent and substantial disability which causes inability to walk or very considerable difficulty in walking.
167
BNF Symbols - AWMSG?
AWMSG - All Wales Medicines Strategy Group
168
BNF symbols - BAN?
British Approved Name
169
BNF Symbols - P?
Pharmacy Only Medicine
170
BNF Symbols - PoM
Prescription only medication
171
BNF Symbols - upside down triangle?
Limited experience of use of product, MHRA requests all suspected ADRs reported
172
Contraindications for disulfiram?
Cardiac failure
Coronary artery disease
History of CVA
Hypertension
Psychosis
Suicide risk.
173
Contraindications for acamprosate?
Severe hepatic impairment
Renal impairment (avoid if creatinine is > 120 micromol/l) Pregnancy
174
Contraindications for bupropion?
History of seizures or of eating disorders
Bipolar disorder
Pregnancy
175
Risk of sudden withdrawal of PD meds?
NMS
176
Minimum visual acuity for Group 1 Licences?
VA >6/12 with both eyes open or in the only eye if monocular - do not drive and inform DVLA if not
177
Physical Activity for children recommended?
60 minutes moderate exercise daily
178
What is Honey and Mumford Questionnaire for learning styles?
Define preferred learning styles. 4 types - Activist, Reflectors, Theorists, Pragmatists
179
What is Belbin Inventory?
Team roles in relation to behaviour, contribution and interrelation. 9 types of personality
180
What is Calgary Cambridge Obs Guide?
Guide medical interview, 5 tasks - initiating session, gathering information, building relationships, giving information and closing the session
181
What is Johari Window?
used to assess and improve self-awareness, group dynamics
182
What is Myers Briggs Type Indicator?
- 16 personality types, completed by trained administrator
183
What medications form part of Advisory Committee on Borderline Substances (ACBS)?
Nutritional supplements for malnourished
Specialist foods (e.g. gluten free foods for patients with coeliac disease or dermatitis herpetiformis, low protein foods for patients with phenylketonuria and specialist infant formulas for bottle-fed babies with reflux, lactose intolerance or milk protein allergy)
Artificial saliva for patients with dry mouth following radiotherapy or as a result of sicca syndrome
Camouflage make up for people with disfiguring skin conditions
Sunscreen for people with photodermatoses
Body washes for patients with dermatitis or eczema
184
Where is drug resistant TB most common?
South Asia
185
What is Dianette Licensed for? What is VTE risk?
Dianette (ethinylestradiol and cyproterone acetate) is licensed for:
- severe acne in women refractory to prolonged oral antibacterial therapy
- moderately severe hirsuitism
VTE risk of Dianette is around 1.5-2.0 times that of standard COCPs
186
What AD is highest risk of discontinuation symptoms?
Paroextine
187
What are benefits of breastfeeding for adults and children?
Benefits of breastfeeding for the mother include:
- Reduce risk of breast and ovarian cancer
- Helps bonding
- Lowers long-term risk T2DM
Benefits of breastfeeding for the baby include:
- Reduced incidence of infections – gastroenteritis, pneumonia and otitis media
- Reduced incidence of obesity and diabetes in later life
- Increased IQ
- Reduced risk of developing asthma and eczema
- Reduced risk of SIDS
188
When to refer to paediatrics - if not holding object placed in hand?
5 months
189
When to refer to paediatrics - unable to reach for object?
6 months
190
When to refer to paediatrics - unable to sit unsupported?
12 months
191
When to refer to paediatrics - unable to walk (boys and girls)
18 months - boys
2 years - girls
192
When to refer to paediatrics - unable to point at object to share interest?
2 years
193
When to refer to paediatrics - unable to run?
2.5 years
194
Management of Bells Palsy - what medication and when?
Presents <72h of onset of symptoms
Prednisolone 50mg OD for 10d or 60mg daily for 5 days then reduced daily by 10mg (10 days total)
195
Management of postnatal hypertension (breastfeeding)?
Enalapril (1st line)
Black African or Caribbean family origin - nifedipine (1st line)
196
When is mefloquine contra-indicated?
Psychiatric disorders (can cause hallucinations and psychosis)
197
Condition most linked with oral allergy syndrome?
Hayfever / Rhinitis
198
Treatment of Acne - useful in darker skin with antipigment property?
Azelaic Acid
199
organism and treatment of Lyme disease?
Borellia burgdorferi
Treat with 21d doxycycline/amoxicillin or 17d azithromycin
200
Gout - when to check rate after acute attack?
check urate 2 weeks after acute attack
201
PTSD - psychological therapies management?
Trauma-focused CBT if presents >1 months after event
EMDR 1-3 months if preference, all adults 3+ months after trauma (non combat)
Supported computerised CBT if >3m after and prefer to face to face
202
What are the live vaccines? (8)
Live influenza vaccine (Fluenz Tetra)
MMR vaccine (Priorix, MMRVaxPro)
Rotavirus vaccine (Rotarix)*
Shingles vaccine (Zostavax)
BCG vaccine
Oral typhoid vaccine (Ty21a)
Varicella vaccine (Varilrix, Varilvax)
Yellow Fever vaccine
203
Vaccines to avoid if anaphylaxis to egg? (4)
●● Influenza (see chapter 19)
●● Tick-borne encephalitis (Chapter 31)
●● Yellow fever (Chapter 35)
●● Hepatitis A (Chapter 17)
204
Pathology, diagnosis and management of meralgia paraethetica?
Compression of the lateral cutaneous nerve as it passes under the inguinal ligament
Burning or stinging sensation over the anterolateral aspect of the thigh
Diagnosis - absence of motor signs and exclude pelvic and intra-abdominal pathology
Conservative management is usually sufficient
205
When and how long to wait to do PSA test?
Acute UTI or within 6 weeks
Ejaculated or vigorous exercise (cycling) in previous 48 hours.
Urological intervention such as prostate biopsy in previous 6 weeks.
206
When to restart hormonal contraception after two EC tablets?
Ulipristal Acetate - wait 5 days
Levonorgestrel - immediately
207
Pre op HbA1c target for elective surgery?
Pre op HbA1c = target <69
208
Scoring system for frailty?
Frailty diagnosis - PRISMA, score of > 3 frailty
209
Blood monitoring in isotretinoin?
Isotretonoin - LFT, Lipids before, 1 month and every 3 months
210
Signs in vertigo - peripheral cause?
Head Impulse Test - Abnormal, corrective saccade to midline with head
Nystagmus - Unilateral, horizontal
Test of skew - no deviation
211
Signs in vertigo - central cause?
Head Impulse Test - Normal
Nystagmus - Horizontal and direction changing, vertical and torsional
Test of Skew - Skew Deviation present
212
Who guides management of ID in migrants? Which organisation?
United Kingdom Health Security Agency (UKHSA) - guidance on managing infectious diseases in all migrants (migrant health guide)
213
SE of imiquimod cream?
Imiquimod cream - SE - flu like symptoms, usually mild and Tx with paracetamol
214
What is syringomelia and symptoms it can present?
Damage spinothalamic system
Loss of temperature and pain sensation
Preservation of vibration sense and proprioception (dissociated sensory loss)
Neuropathic shoulder joints (Charcot’s joints) can be a consequence
215
Malaria prophylaxis with mefloquine
Start 2-3 weeks before travel into an endemic area and continued for four weeks after leaving
216
First Convusions - risk of subsequent seizures? When it is more common?
Risk of a second seizure within the first year is 30%, <10% after 2 years without a seizure
Second seizures 3x more common underlying MH problem. Patients with a structural brain disorder (e.g., brain injury, stroke, tumour)increased risk
217
What age is it legal requirement to have age on prescription?
legal requirement for children under the age of 12 that their age is specified on the prescription
218
Management of whooping cough?
Infants <6m - admitted
Notifiable disease
Oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) if the onset of the cough is within the previous 21 days
Household contacts should be offered antibiotic prophylaxis
School exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
219
Inheritance of Familial Hypercholesterolaemia?
Familial hypercholesterolaemia is an autosomal dominant
220
Management of guttate psoriasis?
Guttate psoriasis >10% of the BSA - urgently dermatology referral for phototherapy
If <10% BSA - reassurance, self-resolve in 3-4 months
221
How often to check HbA1c in stable T2DM patients?
HbA1c should be checked 6 monthly in this stable patient with type 2 diabetes mellitus (T2DM)
222
Parametric tests in stats?
Student's t-test - paired or unpaired*
Pearson's product-moment coefficient - correlation
paired data refers to data obtained from a single group of patients, e.g. Measurement before and after an intervention. Unpaired data comes from two different groups of patients
223
Non parametric tests in stats and when to use?
Mann-Whitney U test - compares ordinal, interval, or ratio scales of unpaired data
Wilcoxon signed-rank test- compares two sets of observations on a single sample, e.g. a 'before' and 'after' test on the same population following an intervention
Chi-squared test - used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions
Spearman, Kendall rank - correlation
224
Management of genital warts?
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
225
When to start oral bisphosphonates in osteoporosis prior to DEXA?
Postmenopausal women, men age ≥50, who are treated with oral glucocorticoids for ≥7.5 mg/day prednisolone or the next 3 months - start bisphosphonates at the same time
226
Mitochondral inheritance patterns?
Mitochondrial inheritance has the following characteristics:
- Inheritance is only via the maternal line
- none of the children of an affected male will inherit the disease
- all of the children of an affected female will inherit the disease
227
Dose of benzylpenicillin in meningococcal septicaemia and ages?
IM Benzypenillin
<1y - 300mg
1-10 years old - 600mg
>10 - 1200mg
228
How to calculate likelihood ratio, both positive and negative results?
+ LR = sensitivity / (1 - specificity)
- LR = (1 - sensitivity) / specificity.
229
Genetic Conditions - Patau Syndrome (Trisomy 13)?
Microcephaly, small eyes
Cleft palate
Polydactyl
Skin Lesions
230
Genetic Conditions - Edward's Syndrome (Trisomy 18)?
Low set ears
Rockerbottom Feet
Overlapping fingers
231
Genetic Conditions - Noonan Syndrome?
Webbed Neck
Short Stature
Pectus Excavatum
Pulmonary Stenosis
231
Genetic Conditions - Pierre Robin Syndrome?
Microganthima
Posterior Displacement of tongue
Cleft Palate
232
Genetic Conditions - fragile X syndrome?
Learning disability
Long face
Large ears
Macrocephaly
Macroorchidism
233
Genetic Conditions - Williams Syndrome?
Short stature
Learning difficulties, friendly
Supravalvular AS
233
Genetic Conditions - Prader Willi Syndrome?
Obesity
Hypotonia
Hypogonadism
233
Genetic Conditions - Cri du Chat? (chromosome 5p deletion syndrome)
Characteristic cry due to laryngeal / neuro problems
Feeding difficulties, learning disability
Poor weight gain
Hypertelorism
Microcephaly
234
Emergency Contraception - Levonorgestrel - Mode of Action and when can it be used?
Acts both to stop ovulation and inhibit implantation
Taken ASAP - efficacy decreases with time,
must be taken <72 hours of UPSI
Unlicensed after this time
235
Emergency Contraception - Levonorgestrel - Dose and when to double dose?
Single dose 1.5mg
Doubled (3mg) - BMI >26 or weight >70kg, taking enzyme-inducing drugs (although a copper IUD preferred)
Vomiting 1% - if vomiting <3 hours - dose repeated
Can be used more than once in a menstrual cycle if clinically indicated
236
Emergency Contraception - Ulipristal Acetate - mode of action?
Selective progesterone receptor modulator (EllaOne)
Mode of action is thought to be inhibition of ovulation
237
Emergency Contraception - Ulipristal Acetate - dosing, when can it be taken? And when is it cautioned?
Dose - 30mg taken ASAP, <120 hours after UPSI
Pill, patch or ring should be started, or restarted, 5 days after having ulipristal with barrier methods
Caution - patients with severe asthma
Ulipristal can be used more than once in the same cycle
Delay breastfeeding 1 week (no such restrictions on the use of levonorgestrel)
238
Emergency Contraception - IUD (Copper Coil) - when can it be used?
Most effective form of EC
Must be inserted < 5 days of UPSI, or if a woman presents after more than 5 days then <5 days after the likely ovulation date
May inhibit fertilisation or implantation
May be left in-situ to provide long-term contraception. If the client wishes for the IUD to be removed it should be at least kept in until the next period
239
What visual acuity is deemed blind (severely visually impaired)?
registered as severely sight impaired with a visual acuity less than 3/60
AKT Flashcards
flashcards
Decks in class (37)
# Cards
-
Last Minute . com146
-
DVLA Advice63
-
Statistics86
-
Organisation and Management152
-
Developmental Milestones44
-
School Exclusion Illnesses11
-
Immunisation Programme44
-
2-Week Cancer Pathways34
-
Questions I Got Wrong243
-
Learning Points from Questions96
-
Notifiable Diseases5
-
BP & Diabetes Targets9
-
CYP450 DRUGS5
-
DRUGS IN PREGNANCY AND BREASTFEEDING3
-
Haematology273
-
Cardiovascular516
-
Endocrine454
-
ENT313
-
Gastrointestinal 1402
-
Gastrointestinal 2513
-
Infectious Diseases335
-
MSK370
-
Neurology 1250
-
Neurology 2242
-
Ophthalmology & Skin353
-
Psychiatry345
-
Reproductive System 1232
-
Reproductive System 2280
-
Respiratory411
-
Urinary System368
-
Gynaecology357
-
Fertility72
-
Antenatal Obstetrics399
-
Postnatal Obstetrics75
-
Contraception Drugs212
-
General Paediatrics424
-
General Paediatrics 2530
