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Practice Exams > 1/12/21 > Flashcards

1/12/21 Flashcards

1
Q

Risk Factors SCC

A
  • elederly males
  • oudoor
  • smoking
  • fair skin, blue eyes - aryan
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2
Q

Clinical features of SCC

A

Can appear suddenly, grow rapidly OR grow slowly over weeks to months

tender and painful

on sun exposed sites

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3
Q

Management of SCC + review?

A

excision 3-5mm
review 6 montly for 2 years

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4
Q

When to cease diabetic medication pre-op?

A

Patients on oral glucose-lowering medication EXCEPT **SGLT2 INHIBITORS** and patients on **injectable GLP-1 RAs**:

  • continue medications until day prior to surgery
  • withhold medication on the morning of the surgery → DOES NOT matter if on the morning of afternoon list
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5
Q

When to cease beta-blockers pre-op?

A

Beta-Blockers: Continue up to and including the day of surgery

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6
Q

ACEi management pre-op?

A

ACE Inhibitors: Continue therapy up to day of surgery and withhold morning dose unless heart failure or poorly controlled HTN

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7
Q

Diuretics management pre-op?

A

Diuretics: Continue therapy up to day of surgery but withhold the morning dose (unless fluid balance is difficult to manage)

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8
Q

Factors that impact on apixaban management pre-op?

A

bleeding risk and renal function

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9
Q

if apixaban, low risk + normal crc

A

cease 24hours prior

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10
Q

if apixaban, low risk + low CRC

A

cease 48 horus prior

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11
Q

if apixaban, high risk + normal Crc

A

cease 48-72 hours prior

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12
Q

if apixavan, high risk nad low crc

A

cease 72 hours prior

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13
Q

Causes of Psychosis

A
  • Functional Psychosis → schizophrenia, schizoaffective disorder, schizophreniform disorder, bipolar mood disorder
  • Drug Induced Psychosis → amphetamines, hallucinogens, cannabis
  • Organic → temporal lobe epilepsy, CNS infections (HIV), Brain Tumours, Thyrotoxicosis, CVD, Wilsons Disease, SLE, head injury
  • Other - delusional disorder
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14
Q

Investigations for first episode psychosis

A
  • FBE, UEC
  • CMP
  • LFTs
  • BGL
  • TFT
  • Urine Toxicology
  • Inflammatory Markers
  • ECG
  • CT Brain
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15
Q

Investigations or examinations to monitor once started anti-psychotic therapy?

A
  • BP + HR
  • BMI + waist circumference
  • BGL + HbA1c
  • Lipid + TGs
  • FBC
  • PROLACTIN → many antipsychotics can cause dose-dependent hyperprolactinaemia
  • can cause infertility, sexual difficulties, gynaecomastia, galactorrhoea, menstrual disturbance, erectile dysfunction and pubertal delay
  • ECG
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16
Q

History questions to establish psychosis and cause of psychosis

A

Anxiety, Elevated or Down Mood, Hallucinations, Delusions - guilt, grandeur, control, reference, Thought - insertion, withdrawal, broadcasting, echo

Self-Harm/Suicide

Illicit Substances

FHx of psychotic disorders or schizophrenia

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17
Q

Examination of Female Urinary Incontinence

A

BMI + Waist Circumference

Abdominal Examination

Pelvic Examination - prolapse, pelvic floor, atrophic vaginitis

Rectal Examination

Neurological Examination - LL weakness, decreased reflexes or decreased tone

Urine Dipstick - leukocytes, nitrates, blood

Fingerprick BSL

Leakage of Urine on Coughing or Straining

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18
Q

Non-Pharmacological Management of Female Urinary Incontinence.***

A
  1. Water → 6-8 cups of fluid a day, reduce fluids after the evening meals
  2. Caffiene and Alcohol → eliminate caffeiene, fizzy drinks + alcohol can worsen symptoms
  3. Fibre → avoid constipation, maintait soft bowel motions
  4. Physical Activity → 30mins of exercise most day of the week. Avoid fitness activities that cause bladder leakage
  5. Maintain BMI between 18.5-24.9
  6. Pelvic Floor Exercises
  7. Avoid lifting - can weaken pelvic floor
  8. Toilet Habits → empty bladder with urge, do not strain to empty bladder
  9. Bladder Training → referral to continence nurse or pelvic floor physiotherapist
  10. Continence pads or accessories - increase QoL
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19
Q

Causes of Urinary Incontienence

A

Pelvic Organ Prolapse, Weak Pelvic Floor Muscles, Intrinsic Sphincteric Deficiency, Urethral Hyper-mobility
Overactive Bladder Syndrome
Bladder Outlet Obstruction - fibroids, advanced Ca
UTI
Cancer
Constipation
Diabetes
Vaginal Atrophy

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20
Q

Management of bartholin’s abscess

A

marsupialisation with gynae

21
Q

Clinical Features of Pityriasis Rosea?

A
  • can follow a viral URTI
  • herald patch → oval pick or red plaque 2-5cm in diameter with scale trailing just inside the edge of the lsion
  • secondary lesions → more scaly patches (flat lesions) or plaques (thickened lesions) appear on the chest or back.
  • CHRISTMAS TREE → follow relaxed skin tension lines or cleavage lines
22
Q

DDx of pityriasis rosea

A

guttate psoriasis
secodnary syphillis

23
Q

Management of pityriasis rosea

A

manage the itch
betamethasone valerate 0.02% cream topically once or twice daily

24
Q

Management of Perthe’s Disease

A

Urgent Referral to Orthopaedic Surgeon
Analgesia
NWB with crutches

25
Q

Age group for pErthes Disease

A

3-12yo

26
Q

How to deal with complaints?

A

Discuss with MDO

Discuss with other GPs involved in case

F2F appointment patient to discuss concerns

Apologise

Document all correspondance

Advise on complaints policies and procedures

27
Q

Cholestasis Causes

A
  • Common Causes:
  • Biliary Pathology
  • Cholelithiasis
  • Choledocolithiasis
  • Cholangiocarcinoma/Carcinoma of the Pancreas
  • Primary Bilary Cirrhosis/Primary Sclerosing Cholangitis
  • Ascending Cholangitis
  • Pregnancy
  • Drugs → erythromycin, oestrogen
  • Infiltration → Malignancy
28
Q

Treatment of a digital myxoid pseudocyst

A
  • press firmly
  • drain cyst
  • cryotherapy
  • steroid injection
  • sclerosant injection
  • surgical removal
29
Q

Antenatal Bloods in ATSI, <25yo

A

FBE
Fasting BGL
beta-HCG
Group and Hold
Rubella
Syphillis
Urine MCS
Chlamydia Urine PCR
Vit D
Hepatitis B and C
HIV
Fe Studies

30
Q

Important points in pregnancy counselling?

A

Non-Directive Counselling → many patients can resolve their own problems without being provided with a solution by the counsellor
- pregnancy, child-birth, motherhood, parenting

Family member or support person involved in counsult
Follow-up appointment in 5-7 days
Confidentiality
Safety at home
Decision is patients to make and cannot be forced to make a decision

31
Q

Examinations for Strabismus in a child.

A
  1. Corneal Light Reflex - central light reflex
  2. Cover Test - look at normal eye
  3. Cover/Uncover Test - look at fixation of rapidly uncovered eye
32
Q

When to refer turning in of the eye

A
  1. intermittent after 3 months
  2. constant large before or after 3 months
  3. constant after 9 years
  4. true acute onset - URGENT REFERRAL
33
Q

Abdominal Pain IN Children or Adolescents

A
  1. Dyspepsia etc
  2. Coeliac
  3. functional abdo pain
  4. abdominal migraine
  5. IBS
  6. IBD
  7. Anxiety/Depression
    Constipation
    lactose intolerance
    t1dm - DKA
    food allergy
    UTI
34
Q

Constipation management in paeds

A
35
Q

Screening for normal risk risk patients for breast ca?

A

every 2 years from 50-74

36
Q

Who qualifies as moderately increased risk of breast Ca?

A

1 FDR ,50
2 FDR same side of family
2 second degree relatives same side with at least 1 <50yo

37
Q

for moderately increased risk of breast Ca - what testing?

A

at least every 2 years from 50-74yo. consider annually from 40yo if FDR <50 diagnosed with breast Ca

38
Q

Crystal type in gout vs pseudogout?

A

Negative in Gout

Positive in Pseudogout

39
Q

Acute Gout Management

A

Local Corticosteroid Injection

NSAID orally until symptoms abate (up to 3-5 days) - Non-Steroidal Anti-Inflammatories (NSAIDs) - diclofenac 50mg BD

Prednisolone 15-30mg PO, daily until symptoms abate (3-5 days)

Colchicine 1mg orally initially then 500microg 1 hour later as a single (one-day course)

40
Q

Diagnosis of Gout + Other investigations for gout?

A

Definitive Diagnosis → identification of monosodium urate crystals under microscopy in synovial fluid or tophi

ONCE DIAGNOSIS IS MADE - NO NEED FOR RECURRENT ASPIRATION OF CRYSTALS FROM THE JOINT

Serum uric acid should be measures BUT hyperuricaemia is not enough to diagnose gout and in patient with acute gout, uric acid may be normal.

Xray - joint damage due to gout

Renal Function → risk factor and consequence of gout

41
Q

Dosing of Urate Lowering Therapy.

A

Allopurinol 50mg PO daily for 4/52, then increase by 50mg every 2-4 weeks to achieve target serum uric acid concentration, up to maintenance maximum of 900mg daily

42
Q

Flare Prophylaxis when altering urate lowering therapy?

A

colchicine 500 micrograms PO, once or twice daily

43
Q

Non-Pharmacological Management of Gout

A

Limit Alcohol Intake

Reduction of High Purine Foods

Reduction of Fructose containing beverages

Regular exercise of at least 150min/week

Avoid Dehydration

Maintain ideal BMI <25

44
Q

Bridging therapy for medication overuse headache?

A

naproxen 750mg MR daily for 5/7 in first week and then drop to 3-4 times per week for 2 weeks then stop

or pred 50mg for 3/7 then wean over 10 days then stop.

45
Q

Prophylaxis of Tension Type Headaches

A

amytriptilline 10mg nocte → increased dose by 10mg up ot max 75mg PO nocte for 8/52 then review

46
Q

Acute treatment of tension type headaches.

A

Aspirin 600-900mg PO

Diclofenac Potassium 50mg PO

Ibuprofen 400mg PO

Naproxen 500-750mg PO

Paracetamol Soluble 1g PO

47
Q

Treatment of pityriasis versicolour?

A

econazole 1% solution topically to wet skin, for 3 nights, leave overnight

oral therapy - fluconazole 400mg po orally stat

consider prophylaxis -> itraconazole 200mg PO BD on one day per month for 6 months, then review

48
Q
A

Practice Exams (45 decks)

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