Workshop learning

Question 1

Before PHQ9, what quick screening tool can we use and how is this done?

Answer 1

PHQ-2 - also known as the ‘two question screening test’

1. During the last month, have you often been bothered by feeling down, depressed or hopeless?
2. During the last month, have you often been bothered by having little interest or pleasure in doing things?

Answering yes to either of these questions is considered a positive answer warranting further assessment .

Question 2

What is a controlled drug?

Answer 2

A drug or other substance that is tightly controlled by the government because it may be abused or cause addiction

The control applies to the way the substance is made, used, handled, stored, and distributed.

Question 3

List 4 examples of controlled drugs which are legal in the UK

Answer 3

1. Benzodiazepines
2. Cocaine
3. Codeine
4. Morphine

Question 4

What 4 things must a prescription for a Controlled Drug be in order to be valid?

Answer 4

1. Indelible
2. Signed by the prescriber
3. Dateded
4. Prescriber’s address

?????

Question 5

In a prescripton, what can be said about writing the quantity?

Answer 5

MUST be written in both words and numbers

Question 6

What must be monitored for Warfarin?

Answer 6

INR (once stable monitor every 3 months)

Question 7

What must be monitored for Insulin?

Answer 7

Glucose and HbA1c

Question 8

Lithium monitoring?

Answer 8

1. Renal function
2. Tyroid function
3. Cardiac + ECG (in patients with CVD or RFs)
4. Body-weight/ BMI
5. U&Es
6. FBC

Question 9

Methotrexate monitoring?

Answer 9

1. FBC
2. Renal function
3. LFTs

Question 10

Azothioprine monitoring?

Answer 10

1. FBC
2. LFTs

Question 11

Toxicity a/w Azothioprine

Answer 11

Myelotoxicity - bone marrow suppression

Question 12

Amioderone monitoring?

Answer 12

1. Thyroid function
2. LFT’s
3. Serum K+
4. Chest x-ray

Question 13

Why chest x-rays in monitoring of Amiodarone?

Answer 13

a/w pulmonary fibrosis - not often used as first line

Question 14

Monitoring of corticosteroids

Answer 14

1. FBC
2. HbA1c

????

Question 15

Triad of reactive arthritis

‘can’t see, can’t pee, can’t climb a tree’

Answer 15

Urethritis, conjunctivitis, arthritis

Question 16

Diagnostic test for IBD?

Answer 16

Faecal calprotectin

Question 17

What is a FIT test?

Answer 17

faecal immunochemical test (FIT) - bowel cancer screening

Question 18

A patient presents to you with suspected hip OA

What patient-reported tool can help us assess severity and potential need for a THR

Answer 18

Oxford Hip Score

Question 19

A chronic smoker of 35 years requires a THR. What MUST we inform patient prior to booking the surgery

Answer 19

Health risks and surgical complications a/w smoking

Must NOT smoke upto 4 weeks before surgery

Question 20

Normal serum value for K+

Answer 20

3.5 - 5.5

Question 21

4 drugs which increase K+

Answer 21

1. NSAIDs
2. ACEi
3. ARBs
4. K+ sparing

Question 22

3 conditions causing increased K+

Answer 22

1. Congestive heart failure
2. DKA
3. Addisons

Question 23

Values for mild, moderate and sever hyperkalaemia

Answer 23

Mild: 5.5 - 5.9

Moderate: 5.9 - 6.5

Sever: > 6.5

Question 24

Any patient with a K+ > 6 requires what?

Answer 24

An ECG

Question 25

ECG changes in hyperkalaemia

Answer 25

1. ST elevation 2. Tall tented T waves

Question 26

Causes of low K+

Answer 26

1. CKD 2. Diarrhea 3. Loop diuretics - furosomide 4. Excessive alcohol 5. DKA

Question 27

Dosage of paracetamol for an adult?

Answer 27

0.5–1 g every 4–6 hours; maximum 4 g per day

Question 28

What OTC analgesic is contraindicated in \< 16y and WHY?

Answer 28

Asprin - risk of developing Reye's syndrome ## Footnote Rare but serious condition that causes swelling in the liver and brain. Most often affects children and teens recovering from a viral infection (ie. flu or chickenpox)

Question 29

What OTC pain medication should be avoided in a child or individual with chicken pox?

Answer 29

Ibuprofen or any NSAIDs - can stop the inflammation

Question 30

What assessment/ guidlines are used to assess competence in an under 16yo?

Answer 30

Fraser guidelines Gillick competence

Question 31

Why is Ovarian cancer often only diagnosed in late stage disease? What tumour marker in the blood can aid diagnosis?

Answer 31

Clinical features are non-specific ie. feeling constantly bloated, discomfort in tummy or pelvic area, increased need to pee etc... Test for Ca-125

Question 32

Explain the GOLD classification for COPD

Answer 32

Assesses severity of COPD to aid management plan - takes into account mMRC and CAT

Question 33

All Immunisations can be completed at any stage of life if an individual has missed their childood immunisations What is the exception to this?

Answer 33

HPV vaccine Must be given to girls at the age of **12-13** because the thymus is required to produce the desired response.

Question 34

List 4 pieces of lifestyle advice you can give to an individual with uncontrolled hypertension

Answer 34

1. Reduced alcohol consumption if they drink excessively 2. decrease consumption of coffee + caffeine-rich products 3. Keep dietary sodium intake low 4. Increase daily activity 5. Quit smoking if applicable

Question 35

What does the GP management algorithm RAPRIOP stand for?

Answer 35

R - reassurance A - advice P - prescription R - referral I - investigations O - observations and follow up P - prevention and health promotion

Question 36

What 4 things do we assess in a neuro exam of the musculoskeletal system?

Answer 36

Power, Tone, Sensation, Reflexes

Question 37

Two most common bacteria causing an URTI + treatment

Answer 37

Streptococcus pneumoniae (+) and haemophilus influenzae (-) 1st line treatment: Amoxicillan

Question 38

List 4 common s/e of antibiotics (hint GI symptoms)

Answer 38

1. nausea and vomiting 2. diarrhoea 3. thrust (esp if prone to thrush already, may require anti-fungal prescription) 4. bloating, indigestion, abdominal pain 5. loss of appetite

Question 39

List 4 differentials for a chronic cough

Answer 39

1. Rhinitis and post-nasal drip 2. ACEi 3. GORD 4. Asthma

Question 40

Compare differences between the blue vs brown inhaler for Asthma, incl the most common medication in each

Answer 40

Question 41

The purple inhaler for Asthma most often contains what medication(s)

Answer 41

Usually a combined inhaler, both a reliever and a preventor

Question 42

List 4 risk factor that may increase severity of COVID

Answer 42

1. Age 2. Co-morbidities 3. Obesity 4. Underlying respiratory condition

Question 43

Compare peripheral neuropathy vs PVD in terms of pathophysiology and presentation

Answer 43

_Peripheral Neuropathy_ Nerve damage due to prolonged ↑ in blood sugar - most commonly due to diabetes "diabetic neuropathy" Presents as burning, tingling and/or general weakness in the limbs, usually legs, feet or hands. If untreated can progress to complete numbness _Peripheral Vascular Disease_ Narrowing, blocking or spasming of the BVs most commonly in the lower regions (legs, calves, thighs, hips or buttocks) Presents as intermittent claudication - aching, cramping, weakness that occurs when walking and goes away with rest

Question 44

Do we prescribe Abx for a sore throat? Explain

Answer 44

Acute sore throat (incl pharyngitis and tonsillitis) is **self‑limiting** and most often triggered by a **viral** infection of the URT

Question 45

People with a sore throat caused by _______ bacteria are more likely to benefit from antibiotics What 2 criteria can help identify people in whom this is more likely?

Answer 45

**Streptococcal** Criteria: * FeverPAIN criteria * Centor criteria

Question 46

Explain the FeverPAIN criteria

Answer 46

Question 47

Explain the Centor criteria

Answer 47

Question 48

1st line treatment for tonsillitis?

Answer 48

Phenoxymethylpenicillan

Question 49

What must we NEVER prescribed for a sore throat (of any cause)? Why?

Answer 49

Amoxicillan - only useful in strep throat If used for any other sore throat, can develop an antibiotic rash haracteristic of infectious mononucleosis

Question 50

List 4 contraindications for prescribing the OCP

Answer 50

1. Migraines 2. DVT or Fx of clots 3. breast cancer 4. Hypertnesion?

Question 51

List 2 drugs which display zero order kinetics

Answer 51

1. Asprin 2. Phenytoin 3. Ethanol 4. Fluoxetine