MRCGP AKT High Yield Revision Webinar 3 - Emedica

AKT High Yield Revision Webinar

High Yield Topics + Revision Planning

Topic Review

www.emedica.co.uk

© Emedica Ltd AKT High Yield Revision Webinar 3 Page 1

MRCGP AKTHigh Yield RevisionWebinar 3

Audiograms

Bone conduction - [ ] or <>

Air conduction - X or O RED = R BLUE = L

Conductive loss Sensorineural loss


Epididymo-orchitis: presentation

• Gradual onset

• Painful / tender

• Palpable swelling

• Erythema

• Prehn sign +ve (relief of pain with elevationof testes)

Epididymo-orchitis: management

• If symptoms severe / very unwell: admit

• Refer to GUM within 24 hrs / treat in GP

• Treat based on likely cause

• STI / Gonorrhoea: Ceftriaxone +doxycycline +/- azithromycin

• Enteric organisms (UTI) / low risk for STI:

• Ofloxacin 200mg BD (14 days)

• Levofloxacin 500mg OD (10 days)


FeverPAIN• Score 1 for each of the following:

– Fever in the last 24 hours

– Purulence

– Attend rapidly (3 days or less from onset)

– Inflamed tonsils

– No cough or coryza

• Score 0-1: No antibiotics

• Score 2-3: Consider delayed script

• Score 4-5: Consider antibiotics

– 1st line: Penicillin V for 10 days

– If allergic: clarithromycin / erythromycin for 5 days

Health Records - Legislation

• Data Protection Act 2018

– access your own information

• Access to Medical Reports Act 1988

– companies accessing information on employees

• Access to Health Records Act 1990

– records of deceased patient


Data Interpretation• Prescribing data

• Regional disease incidence / prevalence

• Public health data

• Mortality rates

• Interpreting research


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Syringe drivers – useful for palliative care

• Calculate 24 hour oral morphine requirement

• Include breakthrough doses if used

• Convert to morphine via CSCI – divide by 2

• Convert to diamorphine via CSCI – divide by 3

Oral Morphine CSCI Morphine CSCI Diamorphine

30mg 15mg 10mg

60mg 30mg 20mg

120mg 60mg 40mg

240mg 120mg 80mg

600mg 300mg 200mg


Autosomal recessive

50% carriers25% - disease25% - healthy/ non-carriers

Modes of InheritanceAutosomal dominant

Marfan, achondroplasia, neurofibromatosis, Huntington’s

Autosomal recessive

Albinism, cystic fibrosis, phenylketonuria, sickle cell anaemia

X linked dominant

Alport / Rett syndrome, Vit. D resistant rickets, Fragile X

X linked recessive

DMD, haemophilia, G6PD def., Hunter syndrome, colourblindness

Polygenic: Neural tube defects, pyloric stenosis

Chromosomal: Trisomy 21, Turners (45XO), Klinefelter’s (47 XXY)


Premature Ovarian Insufficiency (POI)

• Suspect POI if age <40, not on COCP with

– Menopausal symptoms including infrequent / noperiods +/- spontaneous resumption of ovulation

– Raised FSH – 30 IU/L+ on 2 samples 4-6 weeksapart

– Additional testing as part of work-up: LH,.Oestradiol, prolactin, TSH, testosterone

• Do NOT routinely perform pelvicexamination or use AMH testing fordiagnosis

Receiving Gifts

GMC Guidance

• Not allowed to encourage gifts / donations

• Not allowed to alter management /services based on gifts

• Unsolicited gifts can be accepted

GMS Contract – nothing to do with GMC!

• Gifts worth £100+ must be recorded in aregister of gifts


Referral for Suspected RA

• Refer any suspected RA to a rheumatologistwithin 3 weeks

• Refer urgently - within 3 working days if any of:

• Small joints of the hands or feet are affected

• More than one joint is affected

• Delay in seeking medical advice of 3 months+

• Do not delay referral for blood tests that arenormal or awaited

Units of alcohol

• Wine (12%) – small glass (125ml)=1.5units, medium glass (175ml)= 2 large:(250ml)=3

• Beer – half pint (3.5%) = 1 unit, 1 pint = 2

• Premium beer / lager (5-6%) – 1 pint = 3

• Spirits – 25ml measure = 1 unit (40%)

• Cider – often strong! – 1 pint = 3 units

• Units = (volume (ml) x %ABV)/1000


Basal Insulin Regimes• NPH insulin (long acting) – OD or BD

• Continue metformin + review others

• Consider NPH + short acting insulin

• Especially if HbA1c is 75mmol/mol+

• Consider insulin detemir or insulin glargineinstead of NPH insulin

– Patient needs help with injections

– Recurrent symptomatic hypos

• Monitor blood sugars – may need a shortacting insulin before meals

Incidence• Rate of new cases of a disease

• Can be reported as a % or as a proportionof the population

• Usually reported over a time period

– E.g. 1% per year or 1 in 100 per year

– 2 per 100,000 per year = 0.002% per year

• (new cases / population)*100 = %age

• (new cases / population) *n = rate per n

– E.g. (new cases / population) *100,000 = rateper 100,000


Safe Prescribing• Recent MHRA alerts often tested

• Avoid prescribing opioids withbenzodiazepines

• Risk of respiratory depression / coma / death

• If absolutely necessary, lowest dose forshortest duration

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9.23.




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MRCGP AKT High Yield Revision Webinar 3 - Emedica

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