Introduction To General Practice

Front 1

What are the top 7 reasons a doctor may choose GP as a specialty?

Back 1

- Variety.
- "Cradle to grave"
- Connectivity.
- "First bite" medicine.
- Advanced detective work/problem solving.
- Teamwork.
- Ability to dictate work environment.

Front 2

What are the top 5 reasons a doctor may NOT want to choose GP as a specialty?

Back 2

- Only 'coughs and colds'.
- Keeping up to date in dozens of areas.
- Remuneration.
- Insoluble problems.
- Paperwork.

Front 3

What makes general practice so attractive?

Back 3

- Undifferentiated nature of general practice.
- Continuity of care.
- Relationships with patients and their families.
- Professional autonomy.
- Wide range of acute and chronic problems.
- Preventative medicine.
- Can work and train part time.
- Rewarding medicine, special interests.
- Can mix clinical with teaching, academic, research, and family.
- Ability to have special interests.

Front 4

List some of the unique features of general practice.

Back 4

- First contact.
- Domiciliary (home) care.
- Diagnostic methodology.
- Emergency care.
- Family care.
- Palliative care.
- Preventative care.
- Scope for health promotion.
- Holistic approach.
- Health care coordination (fullest picture of patient).
- Early diagnosis of life-threatening and serious disease.
- Continuity and availability of care.
- Personalised care.
- Care of acute and chronic illness.

Front 5

List the tasks in a typical GP consultation.

Back 5

1. Define the reasons for the patient's attendance.
2. Consider other problems (continuing or ongoing problems, at-risk factors).
3. Achieve a shared understanding of the problems.
4. Involve patients in choosing and implementing management; encourage them to take responsibility for their health.
5. Use time and resources appropriately.
6. Establish or maintain a relationship with the patient which helps to achieve these tasks.

Front 6

Reasons people go to the doctor.

Back 6

- Limit of physical tolerance.
- Limit of anxiety.
- An unrelated personal crisis.
- Problem interferes with life.
- Social pressures (e.g. spouse or employer).
- Failure of self-medication.
- Contact with other sick people.
- Administrative reasons.
- Advised to by professionals.

Front 7

List factors that influence the presentation of a patient to the GP practice.

Back 7

- Past experiences with health professionals.
- Health beliefs.
- Accessibility of the doctor.
- Person's personality.
- Current stress levels.
- Education.
- Support networks.
- Cultural background.
- Financial situation.

Front 8

What is the probability diagnosis of halitosis?

Back 8

- Dietary habits.
- Orodental disease.
- Dry mouth, e.g. on waking.
- Smoking/alcohol.

Front 9

What serious disorders should not be missed for a presenting complaint of halitosis?

Back 9

- Malignancy of the lung, oropharynx, larynx, stomach, nose, leukaemia.
- Pulmonary tuberculosis.
- Quinsy.
- Lung abscess.
- Blood dyscrasias/leukaemia.
- Uraemia.
- Hepatic failure.

Front 10

What are the pitfalls to be looked out for with halitosis?

Back 10

- Nasal and sinus infection.
- Systemic infection.
- Appendicitis.
- Bronchiectasis.
- Hiatus hernia.
- Pharyngeal and oesophageal diverticula.
- Sjogren's syndrome.
- Scurvy.

Front 11

What of the 7 masquerades could explain halitosis?

Back 11

Depression, diabetes, drugs.

Front 12

What are the important goals in a GP consultation?

Back 12

- Make use of the Dr/patient relationship in therapy.
- Involve the patient as far as possible in the management of his/her own problem.
- Educate the patient about the illness.
- Promote rational prescribing.
- Achieve compliance in therapy.
- Emphasise preventive opportunities.
- Provide appropriate reassurance.

Front 13

What is the 10-step sequence to a Management Plan in GP practice?

Back 13

1. Tell the patient the diagnosis (or if not possible, describe the problem).
2. Establish the patient's knowledge of the diagnosis (may know nothing, a lot or misinformation).
3. Establish the patient's attitudes to the diagnosis and management.
4. Educate the patient about the diagnosis.
5. Develop a management plan for the presenting problem:
- Immediate.
- Long term.
- Preventive.
6. Explore other preventive opportunities (and continuing other problems) e.g. smoking, alcohol, exercise, weight, screening.
7. Reinforce the information (summarise or ask patient the same).
8. Provide take-away information.
9. Evaluate the consultation (concerns/questions and is the patient happy/satisfied with the outcome and their expectations met)
10. Arrange follow-up and safety-netting (booked appointment or as needed, plan if symptoms worsen/change).

Front 14

What are the international challenges in GP practice?

Back 14

- Increased consumer pressure.
- Increased chronic disease and ageing.
- Explosion in healthcare costs in developed nations.
- Pressures on equity and access.
- 'Rationalisation' of resources.
- International commitment to primary health care.

Front 15

Explain the AMA.

Back 15

Australian Medical Association:
- Peak health advocacy organisation.
- Advance professional interests of doctors and the health of the community.

Front 16

What drugs can increase the risk of seizure with the atypical opioid, tramadol?

Back 16

- TCAs.
- SSRIs.
- Some antipsychotics.

Front 17

Can tramadol cause serotonin syndrome?

Back 17

Yes, if combined with other drugs that would contribute to the serotonin syndrome (i.e. most antidepressants, sumatriptan).

Front 18

What is the duration of action of codeine?

Back 18

3-4 hours (short).

Front 19

What side effects may occur with stronger opioids?

Back 19

- Nausea and vomiting (usually settles over the first week).
- Constipation (prolonged, so laxative is required).
- CNS effects (drowsiness, dizziness, headache).

Front 20

Oxycodone may have more CNS effects than morphine. True or false?

Back 20

False. Oxycodone may have FEWER CNS effects than morphine.

Front 21

When might oxycodone be used instead of morphine?

Back 21

- Renal impairment.
- True morphine allergy.
- ?CNS side effects too severe with morphine.

Front 22

Topical NSAIDs are effective for what duration?

Back 22

Mainly short-term use (<2 weeks) is effective. There is insufficient evidence determing its long-term effect.

Front 23

How long does an intra-articular corticosteroid injection to the knee help with pain and flare-up?

Back 23

A single injection can provide rapid relief of symptoms of OA of the knee for up to 4 weeks.

Front 24

Why should you be careful if you decide to prescribe both a beta blocker and verapamil?

Back 24

Although concurrent use can be beneficial, serious cardiodepression sometimes occurs (even with topical beta blockers). Use only under close supervision at start of therapy.

Front 25

What are the risk factors for a GI adverse effect for NSAID use?

Back 25

- Age over 65.
- History of ulcer.
- concomitant use of anticoagulants or corticosteroids.
- Presence of serious comorbidity.
- Use of NSAIDs with higher GI risk.
- Prolonged use of high NSAID doses (which includes the combination of aspirin and
another NSAID, or two non-aspirin NSAIDs).

Front 26

What might you consider using in combination with a conventional NSAID for people at high risk of GI adverse effects?

Back 26

Misoprostol or PPIs.

Misoprostol is the only drug shown to reduce the risk of NSAID-induced ulcer complications.
PPIs reduce the risk of gastroduodenal ulcers
detected by endoscopy but their effect on the risk of ulcer complications has not been assessed.

Front 27

What regular monitoring do you need to do for patients on NSAIDs?

Back 27

- Renal.
- Cardiovascular (check for signs and symptoms of heart failure).
Measure weight.
- Hypertension.
- Gastrointestinal.

Front 28

When a patient is put on NSAIDs, when should you do regular monitoring?

Back 28

2-4 weeks after initiation and at regular interviews during treatment.

Front 29

What are the risk factors for renal impairment in patients on NSAIDs?

Back 29

- Congestive heart failure.
- Cirrhosis.
- Glomerular filtration rate ≤ 60 mL/min.
- Age > 60 years.
- Use of diuretics, ACE inhibitors, angiotensin II receptor antagonists, cyclosporin or aspirin.
- Salt-restricted diet.

Front 30

What patients should not use glucosamine?

Back 30

- Known allergy to glucosamine.
- Seafood allergy (since some preparations are derived from shellfish protein).

Front 31

What is the maximum number of intraarticular glucocorticoid injections you can get per year for osteoarthritis?

Back 31

If there is a positive response to an intra-articular
injection, a maximum of three corticosteroid injections per joint per year is recommended.

Front 32

What are the potential side effects of intra-articular glucocorticoid injections for osteoarthritis?

Back 32

Caution is required in patients with diabetes, as blood sugar level may be elevated for up to 72 hours after an injection.

Patients should be informed about potential side effects, including the infrequent occurrence of a post-injection flare of symptoms. Injections should be avoided if there is concurrent skin or systemic sepsis, constitutional symptoms, unexplained acute symptoms that may be due to superimposed septic arthritis, or a history of allergy to corticosteroids.

Front 33

What are the contraindications for bulk forming laxatives?

Back 33

History of faecal impaction or bowel obstruction.

Front 34

What are the side effects for tramadol?

Back 34

Common side effects include nausea, vomiting, dizziness, constipation, tiredness and headache.