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338 Cards in this Set
- Front
- Back
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BreastCheck |
50-69. Every 2 years |
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Who to refer with breast cancee |
- first degree female relative diagnosed less than 40 - first degree male relative diagnosed at any age - first degree relative with bilateral breast cancer diagnosed less than 50 - 2 first degree relatives at any age - 1 first and 1 second degree relative at any age - 1 first/second degree relative with breast and 1 with ovarian at any age |
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Cervical check |
25-44 - 3 yearly 45-60 - 5 yearly |
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Levo |
72 hours (3 days) Vomit less than 2 hours |
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EllaOne |
120 hours (5 days) Vomit -3 hours |
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HTN drugs |
1) amlodipine 5mg OD (5-10mg) - side effect is ankle swelling 2) bendroflumethiazide 2.5mg 3) ramiprol 2.5mg - dry cough, lightheadedness, renal impairment
Check kidneys after 2 weeks. Check bp after 4 weeks. |
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Warning with csrbimazole |
If they get a sore throat or feel unwell. Stop tablet and come and get FBC. |
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Tonsils |
Paradise Criteria
-impacting in school attendance - 7 or more n past year, 5 or more in each past two years and 3, or more in each past 3 years - sleep apnoea - 2+ episodes of quinsy |
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BPH meds |
1) alpha blockers. Eg tamsulosin 0.4mg OD. Relax bladder muscles
2) 5 alpha reductase inhibitors eg finasteride 1mg OD. Anti androgen. Shrink prostate |
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Target hBA1c |
7 . 53 6.5 (48) |
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Things to avoid headaches |
Stress, chocolate, cheese, alcohol, missed meals, sleep, cocp. |
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Headache red flag |
1) Raised ICP: headache on walking, coughing, sneezing 2) thunderclap headache |
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DVT exam |
- measure the calf circumference 10cm below the tibial tuberosity - look for more than 3 cm difference in calf circumference |
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What to avoid with contact dermatitis |
Aqueous cream and E45- these contain lanolin and sodium lauryl sulphate which can irritate the skin further. |
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Down Syndrome risk |
25: 1 in 1200 30: 1 in 800 35: 1 in 350 40: 1 in 100 45: 1 in 50
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Risk of CVS |
1% |
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Exam in Erectyle Dysfunction |
1) CVD 2) Hypogonadism: testiculsr size and body hair 3) Anatomical : Peyronie's, phimosis 4) Prostate exam |
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What to tell PT on Viagra |
Advise them to attend ED if it lasts more than 4 hours |
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Shingles treatment |
800mg five times a day X 7 days Within 72 hours |
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Common is acne? |
5 in 100 suffer with it every year |
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SSRI drug of choice for anxiety |
Sertraline |
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Causes of falsely high BNP |
Anaemia, renal failure, age, liver disease, sepsis |
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Diabetes dx |
Symptomatic and rbg 11.1 Asymptomatic: - fbg 7 (repeat) - OGTT 11.1 - hBA1c 48 |
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IGT |
OGTT 7.8-11.1 |
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Hba1c target in diabetics |
53 (7.0) 58 (8.0) if elderly or having lots of hypos 48 (6.5) if very young!!! |
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Diet advice for diabetics |
- Reduce saturated fat, trans fat and cholesterol intake - Increase omega 3, fibre |
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Metformin MOA |
Decreases hepatic gluconeogenesis and increases insulin sensitivity |
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Sulphonylurea MOA |
Stimulates insulin secretion |
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DPP4 MOA |
Increases insulin secretion |
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MOA SGLT2 |
Reduces glucose reabsorption therefore increasing renal glucose excretion |
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DM management (Medication) |
1) Metformin 500mg BD. Titrate to 1g BD if still above 53!
2) if still above 53. Add Sitagliptin, a DPP4 . Aka janumet If over weight add either SGLT, Forxiga or gLP1 victoza |
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How much exercise in diabetes |
150 minutes a week over at least 3 days. Or 90 minutes vigorous exercise. No more than 2 days between each session. Try to break up amounts of time spent sitting |
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Orlistat |
Recommended if 1) BMI more than 30 2) BMI more than 28 with significant comorbidities X3 months then we weigh. Only continue if weigh loss more than 5%>.
MOA: works by blocking chemicals in your gut which digest fat. Nearly a third of the fat that you ear is blocked by orlistst. Therefore the undigested fat is not absorbed into your body and is passed out with ur stools. |
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Drugs that can cause hyperthyroidism |
1) Amiodarone 2) Lithium |
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Risk with carbimazole |
Agranulocytosis, aplastic anaemia, hepatitis. So NB to check FBC and LFT |
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Effectiveness of statin |
Reduce risk by 25% over a ten year period |
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Raynaud's meds |
Nifedipine 5mg TDS |
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Tx for CCF |
1) diuretic (symptom control only)
With either:
- ace first (if diabetic) if EF less than 40% - beta blocker first (if angina)
Then add in other drug. |
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Role ace |
Improves LV function and prognosis |
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Role beta blockers in ccf |
Improves exercise tolerance, ejection fraction and prognosis |
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NICE statin targete |
Total less than 4 LDL less than 2 |
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Mg PVD |
Risk factor mg: 1)aspirin switch to clopidogrel 2) weight loss 3) smoking cessation 4) BP review 5) cholesterol Ischaemic mg: Exercise therapy. 5x 30 minute episodee |
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ABI results |
1) normal greater than or equal to 1 2) intermittent claudication 0.5- 0.9 3) critical limb ischaemia less than 0.5 |
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Starting dose amlodipine and side effects |
5mg. Ankle swelling |
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Starting dose ACE and side effects |
RAMIPRIL 1.25MG. DRY COUGH, LIGHT- HEADEDNESS, RENAL IMPAIRMENT |
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BP Targets
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140/90 or more. Repeat. If different repeat again. Record the lower of the last two. If higher get ABPM (135/85)
Less than 140/90 In those under 80 Less than 150/90 in those over 80 Less than 140/80 if diabetic Less than 130/70 if microalbuminuria |
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Meningitis prophylaxis for contacts |
Rifampicin no longer used. Ciprofloxacin is used in all including those pregnant; Adults and children over 12: 500mg stat Children 5-12: 250mg stat -prolonged close contact eg living together during 7 days before onset of illness - transient close contact ONLY if they have been directly exposed to droplets/secretions from respiratory tract |
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Risk of getting meningitis in schiol |
Pre school 1/1500 Primary: 1/18000 Secondary: 1/33000 |
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Meningitis red flags |
Confusion Photophobia Rash Neck pain/stiffnees |
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When to refer mouth ulcers/ white patches |
White patches if painful/bleeding/swollen Or if persisting more than 3 wreks |
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When to refer hoarseness |
More than 3 weeks!!! |
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Bells palsy |
LMN. So forehead is affected. |
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Tx Bells Palsy |
1) if within 3 days. Prediction 25mg BD for ten days has been shown to improve chance of full recovery 2) no antiviral meds (unless rash/vesicles) 3) lubricating eye drops and taping eye closed at night if they can't close it |
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IBS diagnose |
Recurrent ab pain or discomfort at least 3 days a month in the last 3 months with: -improvement with defecation - change in frequency of stool - change in appearance of stool |
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Explain two types of Fybogels |
1) Anti-spasmotic: Fybogel mebeverine 2) Bulk-laxative: Fybogel Ispaghula |
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Mother to baby risk of hep C transmission |
6% |
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Hep C facts |
25% clear it, 75% develop a chronic infection. Of these 80% go onto develop hepatitis which puts them at increased risk of HCC or liver failure |
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Ankle capsular pattern |
1) ankle. Dorsiflexion more than plantar flexion 2) Sub-talar: equal limitation of inversion and eversion 3) mid tarsal: limited adduction and medial rotstion |
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Toe and heel walking |
Toe walking: L5/S1 Heel walking: L4 |
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Special test in lumbar spine |
Slump, straight leg raising |
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Capsular pattern at hip |
Internal rotation more than flexion more than abduction |
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Causes of haemarthrosis |
ACL Patellar dislocation Tibial condyle fracture Rarely- peripheral meniscal tear |
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Gout uric acid levels |
Aim to treat until levels less then 300mcg. |
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Gout treatment doses |
Colchicine 500mcg BD to QDS Naproxen 750mg stat then 250mg TDS |
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Failure rate of vasectomy |
1: 2,000 |
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Riska of tubal ligation |
1: 200 More complications |
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Causes of gynaecomastia |
1) physiological- puberty and older men 2) cancers 3) hyperthyroidism 4) obesity 5) medications: - alcohol, steroids - testosterone inhibitors eg finasteride, PPIs - increase prolactin: eh antipsychotics, TCA - testosterone production inhibitors: metronidazole, spironolactone
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Causes of premature ejaculation |
1) anxiety 2) drugs eg cocaine 3) MS 4) erectile dysfunction 5) medicines |
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Med for premature ejaculation |
SSRI Dapoxetine. Much faster acting than usual SSRI. |
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Preventors for migraines |
1) Topiramate 25mg, titrated up weekly (risk of fetal abnormalities)
2) propranolol 80mg. |
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Red flags of migraine |
1) Fever 2) trauma 3) thunderclap headache 3) raised ICP (headache on waking, coughing, sneezing) 4) SOL ( postural, early morning, vomiting) |
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Things not to do before PSA |
1) active urinary infection 2) ejaculated in previous 48 hours 3) prostate biopsy in previous 6 weeks |
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Prostate cancer fact |
Leading cause of cancer in men 1/4 of men with raised PSA will have cancer on subsequent biopsy
Only 1 in 8 screening detected cancers are likely to cause death if left untreated!!!!! |
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Who should get screened??? |
1) 50-70 years. 2) 45 years if first degree relative with prostate cancer or if you are Afro Carribean |
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PSA normal levels |
Less than 50: less than 2 50-59: less than 3 60-69: less than 4 70+: less than 5 |
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ADHD treatment |
Behavioural therapy Family therapy Sometimes medications |
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Criteria for ADHD |
1) onset before 12 years 2) must occur in more than one settling 3) affect their ability to function socially and academically 4) inattention 5) hyperactive |
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How common are migraines |
1 in 4 women 1 in 12 men |
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Red flags with constipation |
1) from birth 2) ribbon stools 3) meconium passed more than 48 hours of birth 4) FTT 5) vomiting |
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Autism features |
1) Social interaction 2) Communication 3) No imaginative play |
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How common is colic? |
3 out of every 10 babies - usually goes away by the age of 3-4 months, at the latest 6 months |
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Growth per year |
4-8 cm per year from age 3 Then at puberty they grow 8-10cm per year |
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HPV side effects |
1)1 in 10: erythema, pain/swelling in injection site, headache 2) 1 in 100: nausea, mild fever, pain in arm 3) 1 in 1000/10,000: urticaria 4) 1 in a million: severe allergic reaction |
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When to investigate delayed puberty |
1) no puberty signs in girl aged 13 2) boy aged 14 |
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CI for EllaOne? |
Breastfeeding or asthma |
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Treatment of genital herpes |
Aciclovir 200mg five times a day for five days (start within five days of lesions) |
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Contraception and age |
Coco: stop age 50 Pop: stop age 55 Depo: stop age 50 Implanon: stop age 55 Copper: if inserted over 40 years can be kept in until or has gone through menopause Mirena: if inserted at 45 it can be kept in
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Increased breast cancer risk |
From 30 in 10,000 to 38 in 10,000 |
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HRT options |
1) cyclical: femoston 1/10mg OD 2) continuous with uterus: femoston conti 0.5mg OD 3) continuous with no uterus: femotab 1mg OD |
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Med to treat urge incontinence and side-effects |
Oxybutynin. Dry mouth + constipation |
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Treatment if risk of PET |
Aspirin 75 after week 12: - more than 10 years since last pregnant - over 40 or BMI more than 35 at presentation - first preg- more than 10 years since last pregnant- over 40 or BMI more than 35 at presentation- previous PET- FH (first degree)- diabetes/HTN, renal disease preg- more than 10 years since last pregnant- over 40 or BMI more than 35 at presentation- previous PET- FH (first degree)- diabetes/HTN, renal disease - previous PET ) - FH (first degree)- diabetes/HTN, renal disease - diabetes/HTN, renal disease |
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Infertility stats |
With 100 healthy couples who try to conceive naturally, 84% will succeed in one year, 92% will succeed in 2 years In 1/4 cases a specific case is not found. |
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Frequency of menopause symptoms |
8 in 10: vasomotor symptoms. Usually last around 2-5 years but can last up to 10 years 30%: vaginal symptoms (dryness, itching, dyspareunia) |
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Ponston dose |
500mg TDS |
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Transexamic acid dose |
1g TDS |
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Buproprion CI (Xyban) |
- seizure disorders - eating disorders (due to higher risk of seizure) - MAO-i |
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E cigarette safety profile |
95% safer than cigarettes as per Bmj article in Feb/March time |
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Stage COPD |
1) stage 1= FEV1 more than 80% 2) 50-79 = stage 2 3) 30-49 = stage 3 4) less than 30 = stage 4 |
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Gout risk factors |
Alcohol Purines (red meat, seafood) Drugs that raise plasma urate levels: aspirin, diuretics, ciclosporim FH Kidney disease |
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Allopurinol |
Starting dose 100mg Titrate until serum acid level is below 300mcg Prescribe colchicine also to prevent acute attack (for 3 months) or NSAID for 6 weeks with PPI. |
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Concussion symptoms |
C: onfusion H: headache I: mbalance P: ersonality
Causes functional disturbances rather than structural injury to brain, so standard imaging typically does not detect anything |
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Concussion recovery |
80-80% resolve in 7-10 days! Staged rehab! |
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Concussion recovery times |
23 days- Irish rugby football union. At least 24 hours at each stage 1) no activity 2) light aerobics 3) sport specific exercise 4) non contact drinks.5) full contact 5) return to play |
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Medication for weight loss |
Orlistst. If BMI more than 30. 3 month trial Side effects are an cramps, fatty stools, anal leakage |
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Thrush in pregnancy |
Treat only if symptomatic Top pessaries for 7 days! |
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Chronic pain treatment |
1) Acupuncture 2) Exercise therapy (good for elderly) 3) Self help books. Everything Arthritis UK Chronic Pain Guide for patients 4) Refer to pain management programme 5) Progressive relaxation exercises- online |
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Chadsvasc |
C: CF. 1 H: TN. 1 A: ge -75. 2 D: M. 1 S: troke/TIA/VTE. 2
V: ascular disease. 1 A: he 65-74. 1 S: ex; Female. 1
Do not treat if under 65 and chadsvasc 0 for men and 0 or 1 for women. Low risk!!!!!! Women: 0/1 low risk. Do nothing Men: 0 means no need for anti-coagulation |
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PPI |
Preferred drug is lansoprazole 30mg OD X 1 month. |
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Define recurrent UTI |
3 or more per year |
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EpiPen dose |
150mcg kids 300mcg adults |
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Median nerve distribution |
Lateral 3.5 |
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Tetanus |
Adult: More than 10 years Less than 3 doses Child: More than 5 years Less than 3 doses
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Men B advice |
Fever is common: - 2.5mg at time of vaccine - further dose 4-6 hrs later - 3rd dose 4-6 hrs later - 4th dose 4-6 hrs later if still has fever only. |
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Amoxicillin dose |
1-11 months: 125mg TDS 1-4 years: 250mg TDS 5+: 500mg TDS |
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UTI tx in kids |
Trimethoprim for three days |
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UTI referral |
More than 2 in 6 months and more than 3 in a year. Any in men!!! |
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Viagra dose |
100mg four a month. Use half. |
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Down Syndrome explain what they are like |
1) learning disability 2) medical problems (hearing, vision, cardiac, obesity, diabetes, fertility) Severity varies. Everyone with DS is different. Can have an active and full life |
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Harmony test done from |
Week 10 |
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What is anaemis |
Means that you have less RBC's than normal or that you have less Hb than normal in each RBC. This means that less oxygen is carried around in the bloodstream. |
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Domestic abuse supports |
Women's Aid AMEN |
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Risk factors for ED |
Diabetes Smoking Drugs Alcohol Vasectomy |
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How long for Viagra to work |
1) by mouth- 30 mins 2) under tongue- 15 mins |
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Cream for ED |
Alprostadiol cream |
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5 step asthma plan from asthma-ireland |
1) take 2 puffs of reliever. 1 at a time 2) sit up and stay calm 3) take slow steady breaths 4) if no improvement. Take 1 puff every 2 minute: Less than 6- 6 puffs in 10 minutes More than 6- 10 puffs in 10 mins 5) if after 10 mins no improvement. Call for help and repeat step 4 if ambulance do not arrive within 4 mins |
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Joints of ankle |
Ankle joint Sub-talar (talus and calcaneus) Mid-tarsal joint |
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Syndesmosis |
Holds tubular and fibula together |
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Capsular patterns |
Ankle - dorsiflexion more than plantar flexion at ankle - equal at subtalar - limited adduction and medial rotation at mid-tarsal joint |
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Nerve innervation in hands |
1) ulnar nerve: 4.5 and 5 2) median nerve: 1, 2, 3, 4.5 |
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Bedwetting is normal until what age? |
Age of 5 ERIC charity page online |
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Meds for bed wetting |
Desmopressin. Risk of low sodium. Only use for short term eg sleepover or holiday . Don't drink for one hour before to 8 hours after to prevent low sodium |
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Orlistat side effects |
Ab cramps Fatty stools Leakage/faecal urgency Causes low fat soluble vitamins (A D E K) so important to have a healthy balanced diet. |
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Safest anti depressant when breastfeeding |
Fluoxetine |
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Supports for Post Natal Depression |
Post natal depression Ireland.ie |
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MMR vaccine side effects |
Pain, temperature , mini measles (small rash 6-10 days after that settles itself)
30 years of experience and evidence with MMR vaccine here in Ireland.
15 years ago in Lancet
The age that children show signs of MMR is generally the age that children are given the vaccine. It is coincidence.
HSE website with info. Immunisations.ie |
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Who is excused from Jury duty? |
Over 65 Doctors/nurses/midwives/dentists/vets/chemists/teachers/ Jury duty within 3 years |
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Drugs payment scheme |
Adult partner and any children under 18 or up to 23 if in full time education. Max €134. |
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Facts re occurance if SAH |
1 in 20 of population over age of 30 harbour an unruotured asymptomatic aneurysm |
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Symptoms of CKD |
Weakness, lethargy, fatigue, oedema, SOB |
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Safety net for CKD |
I'd any illness eg diarrhoea and vomiting he is at risk of damage to kidneys from dehydration so important to maintain hydration and to be reviewed early. |
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Behavioural issues in kids |
Early intervention Team (6 or less years): MDT assessment of children and families needs:
- parenting course - individual intervention - group intervention School Age Team (5-18) |
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Red flags with PVD |
1) rest pain. Severe unrrlentless pain in lower limbs. Worse when legs elevated and improve when sitting or standing 2) night pain 3) all the P's |
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Don't confuse migraine with |
Giant cell arteritis |
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PMR treatment |
15mg OD X 3 weeks Calcichew Aspirin 75mg only for GCA!!!!! Aledronate Lansoprazole |
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Steroid side effects |
Gastric Bone thinning Weight gain Mania Immunosuppression |
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Drugs for incontinence |
1) anticholinergic; oxybutynin 2) betmiga |
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What not to forget in CKD management??? |
CVD!!! |
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Resisted lateral and medial rotations at shoulder and muscles |
Lateral: infraspinatus Medial: subscapularis |
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Hip capsular pattern |
Internal rotation more than flexion more than abduction |
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Stat about domestic abuse |
25% of women experience abuse |
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Causes of secondary amenorrhiea |
Pregnancy Stress/exercise/weight loss Thyroid Prolactinoma Premature menopause |
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Define premature menopause |
Before 40's
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Define primary amenorrhoea |
Absence of menses at age 15 years in the presence of norm growth and secondary sexual characteristics |
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How many with raised PSA have ca |
1/4 of men will have cancer diagnosed on subsequent biopsy |
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ACR levels in diabetics and non diabetics |
More than or equal to: 2.5 in men 3.5 incwomen Non diabetics Greater than or equal to 30 gets ACE-i |
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Name of living will from hospice |
ThinkAhead |
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Alcohol units/week |
17 men 11 women |
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Alcohol vitamins |
Vitamin B1 (thiamine) 100mg TDS (one TDS) Vitamin B complex Vitamin C ( ascorbic acid)
Librium: 15mg QDS for 2 days 10mg QDS for two days
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Risk factors for carpal tunnell |
Diabetes Hypothyroid COCP Trauma Arthritis |
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NOAC of choice |
Apixaban |
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DVT tx |
Clexane until scan. 1mg/kg BD SC
Then Apixaban for three months All need tests if unprovoked: - CXR - FBC, serum calcium, LFTs, anti-phospholipids - Urinalysis - CT ab/pelvis if over 40 COCP counts as provoked |
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How to confirm contact dermatitis |
Patch testing |
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How long menopause symptoms last |
80% have vasomotor symptoms. Usually last around 2-5 years. 30% have urinary/vaginal symptoms |
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Website for menopause |
Menopause matters |
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HRT options |
Menstruating (cyclical). Femoston Uterus (continuous). Femoston Conti No Uterus (continuous). Femotab |
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HRT risk of breast cancer |
Under 50: no additional risk 50-54: slight increased risk More than 54: from 30/10,000 to 38,10,000 |
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Driving and first seizure |
Group 1: 6 months |
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Transgender support group Ireland |
Transgender Equality Ireland |
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If eGFR less than 60? |
Repeat in 2/52 with ACR |
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Capsular pattern at elbow |
Flexion more than extension. Pronation equals supination |
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Codeine pain meds |
Solpadeine (8mg codeine, caffeine)
Co-codamol 15mg codeine
Tylex/co-codamol/Solpadol (30mg codeine)
Side effects: constipation, nausea, light-headedness |
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ED and anti hypertensives |
Older drugs (beta blockers, diuretics). Newer drugs seem to have neutral effects. |
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Flying and pregnancy rules |
Up to 36 weeks (32 if twins). After 28 weeks need a letter to say they are fit to fly! |
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With PMR what to always ask about??? |
Eye symptoms |
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Dementia supports |
Helpline 6/7 Publications posted for free Dementia advisors to help link with services Day care Respite Home care packages Social clubs Alzheimer's cafe |
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Floaters risk factors and causes |
Benign age related changes Retinal detachment Refer urgently!!!!!
Risks: Trauma Cataract surgery Previous retinal detachment Near slightness Age |
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Mean parental height |
Plus or minus 7cm |
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Recurrent UTI in men think??? |
STI |
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Hand foot and mouth |
Coxsackie virus No treatment Not linked to animals |
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Scarlet fever |
Causes by strep V contagious. Sneezing, coughing Notifiable disease Tonsillitis and then fine red rash in chest and stomach first that then spreads to body Sandpaper rash Desquamation as rash settl r White strawberry tongue Flushed red cheeks with mouth spared
Avoid school until on antibiotics x24 hours. Contact precaution. 10 days of abx School is ok 24 hours after and started |
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Risks for breast cancer |
Early menarche (less than 11) Late menopause (more than 55) Number of children (reduces risk) COCP/HRT Breastfeeding (reduces risk) |
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Earliest date of possible ovulstion |
Shortest cycle length minus 14 |
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How do EllaOne and levo work? |
Ella one- delays ovulation X 5 days Levo- inhibits or delays ovulation X5 days |
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CI Ellaone |
Asthma Breastfeeding (need to discard x1/52) |
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Two emergency pills in a month |
Levo cannot be given within 5 days of Ella Ella cannot be given within 7 days of levo |
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Treating thyroid disease in a pregnant lady |
Check if she plans to get pregnant!!!!! |
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Risks for thrush |
1) high dose oestrogen 2) condoms 3) vaginal douching 4) bubble baths 5) tight fitting clothes |
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What to rule out with recurrent thrush |
Diabetes HIV (blood transfusions, IVDU, multiple sexual partners) Immunosuppression |
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Tx recurrent thrush |
4 or more episodes per year
Fluconazole 150mg every 3 days for three doses , then 150mg weekly for 6 months.
No evidence to treat asymptomatic male sexual partners Vulval moisturisers. Friction from sex may cause tiny tears which makes it more prone for candida to thrive |
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Menieres disease |
Inner ear Vertigo Tinnitus Deafness |
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Causes of vertigo |
Vestibular neuritis BPPV Menieres Vestibular migraines |
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Vertigo red flags |
Unilateral hearing loss New headache Tinnitus Double vision Dysphagia Ataxia |
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What tinnitus to refer??? |
Unilateral Pulsatile Dizziness, vertigo, imbalance, usis HyperacusisBad effect on life |
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When to refer squint ? |
3 months |
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Center criteria |
3-14 years Exudate Tender lymphadenopathy Temp more than 38 No cough 2-3: test 4: treat empirically!!!!! |
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Warfarin advice!!!!! |
- Take at same time each day - Limit alcohol- max 2 units/day - Avoid cranberry juice - Check with pharmacist about taking any OTC meds eg aspirin avoid - Let your doc know if you have any falls or injuries - Do not get pregnant. - Any dental procedures- tell the dentist! - carry pt alert card
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Anti epileptic of choice in pregnancy |
Lamotrigine If changing or coming meds in pregnancy. Can't drive for 6 months |
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Driving and epilepsy |
First seizure: 6 months and review by neurologist 5 years for group 2 Epilepsy: Seizure free X 12 months and can only get 3 yr licence. Need to be seizure free X 5 years to get it for 10 years Group 2: seizure free for ten years off meds!!!!! Provoked seizures can drive! |
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Orlistat - targets |
Only continue if at least 5% weight loss in 3/12 |
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Metformin starting dose |
500mg BD. Max 1g BD |
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2nd diabetic drug |
BMI less than 30: sitagliptin BMI more than 30: GLP or SGLT |
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Combo drug for less than 30 BMI |
Janumet (Metformin and sitagliptin) |
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DPP4 drug and MOA |
Sitagliptin (Januvia)
MOA: increases insulin produced by the body. Insulin helps control the levels of glucose in your body. It also reduces AMT of glucagon produced. Glucagon is used by liver to make sugar. |
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GLP-1 drug and MOA |
Trulicity ( weekly) Victoza (daily) Increases the AMT of insulin produced by the body and reduces the amount of glucagon being produced. |
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Gastro when back to work |
48 hours after diarrhoea has completely settled. Always ask re occupation |
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Explain CBT |
Works by helping you to understand that your thoughts and actions affect how you feel |
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Sleeping tablets facts |
100 people 7 would sleep better (extra 25mins a night) 75: nothing 17: side effects |
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NF inheritance |
Both types are AD. But 50% are new mutation Learning disability seizures Autism Lisch nodules Cafe au lait |
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Haemochromatosis inheritance |
AR with incomplete penetrance and variable expressivity.
Test first ferritin and iron. Then if high- do genetics! |
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PET bp |
More than 140 or more than 15 above booking visit |
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How to delay oeriod |
Primolut Medroxyprogesterone acetate if over 35, smoking |
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Drugs that can cause hair loss |
Carbimazole Warfarin Heparin Chemo |
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Cause of male pattern baldness |
High levels of dihydrotestosterone. (DHT) |
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Advance Care Directive |
Signed into law December 2015, but not yet commenced into effect. |
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Sciatic nerve roots |
L4, L5, S1 |
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Fact re X ray and spine issuee |
X rays detect serious pathology in 1 in 2,500 patients |
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Capsular pattern at neck |
Limitations of all movements except flexion |
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What diabetics need statins |
All over 40. Unless planning pregnancy. Aim. LDL less than or equal to 2.5 if no CVD. Less than or equal to 1.8 if history of CVD. |
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Planning pregnancy and diabetic |
5mg folic acid Stop teratogenic meds Check 7 times a day Educate re hypos Retinal and renal screen Book early Refer to diabetic centre for pre pregnancy care Smoking and alcohol |
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WL on Forxiga |
0.5kg per week |
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Apixaban dose |
5mg BD 2.5mg BD if over 80, less than 60 kg, Cr greater than 133 |
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Meds post MI and drivinf |
Not for 4 weeks. Ace BB (erectile Dysfunction) station, anti platelet |
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Raynaud's history??? |
Outrule CT disorders: - morning stiffness - swollen joints - rash - family history Triggers: - COCP - BB - Migraine meds - vibrating tools - smoking |
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Side effect Nifedipine for Raynauds |
Headaches Flushing Dizziness |
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What to tell people with CVD |
Can't do much about your non modifiable risk factors - age, gender, genetic Lots to do with modifiable risk factors !!!!! |
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Cholesterol advice |
Side effects: - headaches - ab pains - nausea - diarrhoea
Rarely. Muscle inflammation. So tell ur doc if u have muscle cramps pain. Do not eat grapefruit Some meds may interfere with statins so tell ur doc! |
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How to take GTN |
Take one spray under tognue and wait 5 minutes. If pain does not ease take second spray and wait another 5 minutes. If pain still there call ambulance. No Viagra 24 hours before or after. Due to risk of low bp |
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Side effects of hyperthyroidism |
Osteoporosis A fun Angina Heartbfailure |
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Radioactive iodine |
6 months no pregnancy. 4 months for men!!!!! |
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Reflux tips |
Avoid over feeding
Avoid over feeding Pre thickened feeds Keep upright for 30 mins after feed Avoid over feeding Pre thickened feeds Gaviscon instead of pre thickened feeds Ranitidine only if above fails. Occurs in 50%> settles with age
Ranitidine only if above fails.
Occurs in 50%> settles with age |
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Marker of CMPA |
High pitched screaming Vomiting PR blood Diarrhoea Crying not fitting with usual evening clusters Back arching Clenched fists Pained face when crying |
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Colic fact |
Cue based care from birth with an average of 10 hours of physical contact a day is associated with 50% less crying!!!!!!! Purple crying.info |
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Adequate breastfeed |
Adequate WG More than 5 wet nappies a day Good latch Milk is seen in their mouth |
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PEP |
Within 72 hours. Side effects: Diarrhoea Vomiting Headache |
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Fibre in irritable bowel |
Avoid insoluble fibres eg bran Use soluble fibres eg oat, ispahulga |
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Freq of ab pain in kids??? |
1-2 out of every 10 kids with have abdominal pain |
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Medications that cause hair loss |
Carbimazole Warfarin Heparin Chemotherapy |
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Zika and baby |
Small head Limb defects Eyes Hearing |
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Zika virus and pregnancy |
8 weeks for women 6 months for men If partner is pregnant use a condom!!! |
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Symptoms HD |
Involuntary movements Speech and swallow Short term memory loss Behavioural |
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Glaucoma risk factors |
Over 40 FH Short sighted Diabetes |
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Red flags for sexual abuse in children |
Anogenital bruising Recurrent UTI Vaginal discharge Sexual precocious behaviour Enuresis Behavioural change |
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Domestic violence supports for |
Women: Women's Aid Men: Amen |
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CF features and risk |
Chest infections Digest food- poor growth Incidence 1 in 2500 |
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Commonest symptoms of PKD |
HTN Kidney failire |
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SSRI withdrawal side effects |
Like having the flu - dizziness - light headedness - N and V - irritable - headaches |
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SSRI side effects |
N + V Constipation Sexual dysfunction Reduced or increased appetite Discontinuation symptoms |
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Online CBT |
Moodgym |
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Side effects of alcohol |
HTN Stroke Heart disease |
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Alcohol meds |
1) Vitamins Thiamine TDS Vitamin B complex Vitamin C 2) Librium 20mg QDS X 2 days Then 15 mg QDS Supervised Daily dispensing |
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What is MND? Law |
Progressive weakness of many of the muscles in the body Up to 15 years in prison! |
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Dying |
- Care plan in place eg Think Ahead - Hydration status - Anticipatory prescribing: pain, breathlessness, anxiety, agitation, nausea, respiratory secretions - Book-keeping when breath becomes air. |
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Potentially reversible causes of memory loss |
Depression Thyroid Vit B12 |
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Dementia bloods |
FBC U and E Calcium TSH Glucose B12 Folate |
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Drug of choice for dementia |
1) Donepezil. GI side effects. It increases a chemical called acetylcholine. This allows nerve cells in the brain to communicate with each other. People with dementia have low levels of acetylcholine. 2) Thiamine 3) Souvenaid: nutrients required to make new connections in the brain. Difficult to achieve by diet alone.
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A fib risks??? |
Increases risk of stroke X 5 times |
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Management of PSA results |
Less than 2: repeat in 2 years More than 2: yearly repeat |
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What is the prostate |
Chestnut organ that sits below bladder. It produces semen |
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How long till baldness |
15-25 years from first signs |
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Causes of gynaecomastia |
- Puberty - Obesity - Medications- finasteride, TCA, alcohol, steroids - Hyperthyroidism - Renal or liver disease - Cancer: CXR, testicular, prostate, breast |
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Vasectomy explain |
Cut the vas deferens. The tube that takes sperm from the testicles to the penis. Sperm is made in the penis. Once cut. Sperm cannot get into the semencthat comes out during sex. |
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Aftercare vasectomy |
2 samples, 4 weeks apart. |
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S/E Vasectomy |
Not reversible Risk of failure Haematoma and infection Chronic scrotal pain 10% Does not protect against STI's! |
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Treatment of premature ejaculation |
1) Self help pages 2) masturbating 1-2 hours before sex 3) using a thick condom 4) topical local anaesthetic eg Instillagel 5) couples therapy/ sexual therapy 6) SSRI- Dapoxetine. |
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Important q in people with seizure |
What are your hobbies eg swimming, rock climbing etc |
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Chicken pox exposure and pregnant |
VZIG within 10 days as long as you don't yet have chicken pox symptoms. It may prevent chickenpox and if not, it reduces symptom severity and duration. You can give it again as long as it's 3 weeks since previous injection |
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Why sign a DNR? |
1) Patient request 2) CPR will not work 3) Burden of CPR is greater than benefit. ie patient will be left with a v poor quality of life! |
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Risk factors for squint |
FH Prematurity Facial abnormalities CP |
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Homeopathy |
Idea that 'like cures Luke's Remedies are used in small amounts to treat symptoms that they would actually cause in large amounts. Usually from plants. Evidence in food allergies/hay fever Good for self-limiting conditions. |
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Risks from needle stick injury |
HIV: 0.3% Hep B: 6-30% chance Hep C: 1.8% |
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Needle stick injury tx |
Hep B vaccine Tetanus booster PEP if within 72 hours |
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Risk with needle stick |
HIV, hepatitis CMV, EBV, Parvovirus, malaria |
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What not to forget with asthma |
Triggers!!!!!!!! Cold air, animals, dust |
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Smoking cessation meds |
Buproprion (Zyban) Take it while still smoking and stop 1-2 weeks later. 150mg X 6 days then BD for 7-9 weeks. Varenicline (champix). Same story |
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COPD management + Always mention????? |
FEV1 more than 50%: 1) SABA eg Ventolin 2) LAMA eg Spiriva Respimat 3) LABA and ICS eg Seretide or Symbicort FEV1 less than 50% 1) SABA eg Ventolin 2) LABA and ICS eg Seretide or Symbicort Mood!!!!!!!!! |
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Gastro rules |
Not until 48 hours clear of symptoms No swimming x 2 weeks |
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CI menopause |
Suspected breast/endometrial cancer Undiagnosed genital bleeding VTE hx Liver disease Active gallbladder disease Pregnancy/breastfeeding |
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Tests for infertility |
Irregular cycle: LH, FSH TFTs Day 21 Progesterone to make sure you are ovulating AMH Semen analysis Modifiable risk factors: bmi, smoking, drugs, stress |
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COCP and age |
Stop aged 50! Stop aged 35 if smoking 15 plus a day |
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|
Chlamydia testing |
Wait till 2 weeks post episode |
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|
How many people with RA have a positive test??? |
70% |
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Acne mg |
Facial wash with 2% salicylic acid. Eh clearasil Moisturise with no oil eg effaclar Make up- non comedomic General. No scratch pick, fresh air and exercise ,balanced diet 1) BPO mane CAN BLEACH clothes!!! 2) BPO mane and topical retinoid 3) BPO mane and Diabetes/abx Tetralysal or erythromycin if female Min 3 months. Max 6 months. |
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Skin formuls |
A symmetry B order irregular C olour variation D iameter more than 6mm Elevation Firm Growing |
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Psoriasis explain |
Affects skin, but other part of body such as nails and joints. Normally skin regularly sheds its top layer. In psoriasis the top layer sheds too quickly create omg a thickened, whitish appearance and possible flaking. Blood vessels underneath come nearer the surface giving an underlying redness. |
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Mg psoriasis |
Meds: 1) emollients 2) vit d eg calcipotriol mane and potent steroid evening. 3) if scale thick- use topical salicylic acid Avoid triggers: Alcohol Smoking Stress Beta blockers |
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If breast feeding with CMPA |
Add 1000mg calcium and 10mcg vitamin to prevent nutritional deficiencies |
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Fingertip rule |
Hands: 1 unit Chest and abdomen: 7 units Back: 7 units |
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What to screen for with gout |
HTN CVD Diabetes |
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When to treat shingles |
Within 72 hours and - 50+ - less than 50 if Ophthalmic involvement Immunocompromised Non truncal Mod/severe pain Mod/severe rash Not in children!!!!!!!! |
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Chicken pox VZIG |
Works until 10 days post exposure |
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Chicken pox risks to mam |
Chest infection Liver Brain Death |
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|
Chicken pox risks to baby |
36/40 to 7 days post psetun. They may get chickenpox Less than 28 weeks. Small chance of abnormalities to legs, arms eyes brain bowel. |
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Website for enuresis |
ERIC |
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Vaccine covers how many cancers? |
70% of cancers |
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|
Causes of pubertal delay??? |
90% temporary delay Systemic illness AN Chromosomal eg Turner's Hypothyroidism Raised prolactin |
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|
Describe concussion????? |
Disturbance in brain function rather than structure. So imaging does not usually detect abnormalities. |
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|
Rules post concussion |
Rest x24 hours then staged rehab No alcohol No sleeping tablets Paracetamol or codeine No aspirin or anti-inflammatory meds Do not drive, train or play sports until cleared!!! |
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|
Hep C testing |
1) Check hep C antibody. Window period of 3-6 months. So recheck in 6 months. 2) if positive. Check HCV RNA. Positive = active hep c |
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|
Hep C management |
1) Refer 2) Stop alcohol 3) Stop spread: condoms, needs sharing 4) Contact tracing 5) Test for: HIV Hep A Ferritin Glucose LFTs |
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|
TIA |
Age over 60 BP more than 140/90 Clinical features. 2 for unilateral weakness. 1 for speech Duration. 2 for over 60 mins. 1 for 10-59 minutes Diabetes. Less than 4: aspirin 300mg and seen in one week More than 4: aspirin 300mg and seen now!!! |
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Website for colic |
Purple Crying! |
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|
Red flags with vertigo |
Isolated vertigo with nystagmus is unlikely to be due to a central cause - unilateral hearing loss - new headache - tinnitus - double vision - dysphagia - ataxia If so think: MS, tumours, vascular |
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|
Menieres triad |
Vertigo Tinnitus Hearing loss |
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|
Tx for colic |
1) cue based care 2) skin to skin 3) ensure correct feeding technique 4) winding 5) probiotics 6) baby massage 7) SUPPORT FOR MAM Purple Crying 😀 |
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|
Doctor I'm afraid I might get dementia |
Non modifiable risk factors. Age Down syndrome FH of first degree relative Sex Modifiable Smoking Low saturated fats, anti oxidants Alcohol Exercise Weight Mental activity |
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|
Exercise for kids and who get referred |
60 mins a day Refer: - Learning disability - Short stature - Dysmorphic features |
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|
Obesity websites |
Get Ireland active Littlesteps |
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|
Cause of delayed puberty? |
90% temporary Other: Systemic illness Thyroid Prolactin Chromosomal eg Turner's A.N. |
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|
What to avoid with constipation |
Filling up on milk as this can lead in a poor diet! |
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|
Enuresis is normal under age of??? |
5 |
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|
Explain shingles |
Sleeps inside your nerves. Hibernates. |
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|
FTU |
1 = hand space
Chest and abdomen = 7 units Back = 7 units Most eczema is not related to CMPA |
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|
Mg gout |
1) Naproxen first line or else colchicine 2) screen for CVD and diabetes 3) avoid triggers: - alcohol - purines (red meat, seafood) - drugs (aspirin, diuretics) - CKD 4) Lifestyle Rest Fluids Ice pack 5) Prevent if more than 1 attack in 13 months Allopurinol With -Colchicine for 3 months Naproxen for 6 weeks 6) Life long uric acid levels every year!!!!! |
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|
CI levo |
Epilepsy Weight over 75mg need to double dose!!! |
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|
Risk of pregnancy PP??? |
From day 21! |
|
|
Best time to have smear |
Mid cycle Avoid sex x24 hours prior |
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|
ED meds |
Viagra: take it an hour before. Lasts 4-5 hours Cialis: lasts around 36 hours. Side effects = headaches |
|
|
Who to refer with a limp??? |
Less than 3 years Unable to weight bear Fever Older than 9 with reduced ROM at hip (to exclude SUFE) |
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|
Risk of infection from a needle stick |
HIV: 0.3% Hep B: 6-30% Hep C: 1.8% Also risk of: Parvovirus CMV EBV |
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|
UTI guidelines for tests |
Less than 3 months get referred for tx Less than 3 years get referred if no improvement after 24-48 hours Tests: - less than 6 months: ultrasound within 6 weeks. If atypical get ultrasound then and follow up DMSA and MCUG - 6months to 3years: ultrasound during infection if atypical AND DMSA later on - over 3 years: ultrasound during infection if atypical All recurrent UTI: ultrasound and DMSA |
|
|
Frontanelles close when |
Anterior: 8-12 weeks Posterior: 12-21 months Refer if premature closing |
|
|
Acne rosacea tx |
1) avoid triggers (alcohol, heat, exercise) 2) Mirvaso gel PRN. Works within 30 mins and lasts up to 13 hours 3) top metronidazole |
|
|
Familial hypercholesterolaemia |
AD Exam Tendon xanthomatosis Xanthelasma Corneal arcus Total child more than 6.7 Total adult more than 7.5 |
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|
Why sign a DNR??? |
Patient request CPR will not prolong life Burden of CPR is greater than the benefit. ie patient is likely to be left with a v poor quality of life! |
|
|
When to investigate neck lump??? |
If it persists more than 6 weeks. |
|
|
Center criteria |
3/4 out of the following: - fever - purulent tonsils - cervical adenopathy - no cough |
|
|
Tests for SIJ??? |
Telescope PSIS asymmetry FABER produces pain in the back |
|
|
Ages for hip pathology |
4-10: Perthe's 10-15: SUFE Late teens to 40's: FAI |
|
|
Mallet finger |
Rupture of extensor tendon. Cant extend |
|
|
Jersey finger |
Rupture of flexor digitorum profundum |
|
|
Tx for premature ejaculatiom |
Dapoxetine (SSRI- short-acting) |
|
|
What is the prostate??? |
Chestnut sized organ. Sits under the bladder Produces semen |
|
|
Causes of Gynaecomastia????? |
- Physiological - Obesity - Medications- alcohol, finasteride, PPI, anti psychotics, anti depressants - Hyperthyroidism - Renal/liver disease - Cancers |
|
|
DPP4 side effects and CI |
CI: Pancreatitis Side effects: nausea, GI upset, diarrhoea |
|
|
GLP side effects |
GI symptoms Increases HR CI: pancreatitis, thyroid cancer Benefits: Weight loss |
|
|
Mg HRT |
1) Lifestyle Alcohol Smoking Diet Weight bearing exercise Layer clothing Evening primrose
2) HRT
3) SSRI 4) Bloods to outrule other conditions Thyroid FBC Lipids Glucose |
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|
CI HRT |
1) suspected cancer 2) Undiagnosed genital bleeding 3) VTE hx 4) Liver disease 5) Galladder disease 6) Pregnancy/ breast-feeding 7) CVD |
|
|
HRT and breast cancer risk |
Less than 50 = no risk 50-54 = small increased risk Over 54 = 30/10,000 to 38/10,000 |
