1/12/21 Flashcards
Risk Factors SCC
- elederly males
- oudoor
- smoking
- fair skin, blue eyes - aryan
Clinical features of SCC
Can appear suddenly, grow rapidly OR grow slowly over weeks to months
tender and painful
on sun exposed sites
Management of SCC + review?
excision 3-5mm
review 6 montly for 2 years
When to cease diabetic medication pre-op?
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
When to cease beta-blockers pre-op?
Beta-Blockers: Continue up to and including the day of surgery
ACEi management pre-op?
ACE Inhibitors: Continue therapy up to day of surgery and withhold morning dose unless heart failure or poorly controlled HTN
Diuretics management pre-op?
Diuretics: Continue therapy up to day of surgery but withhold the morning dose (unless fluid balance is difficult to manage)
Factors that impact on apixaban management pre-op?
bleeding risk and renal function
if apixaban, low risk + normal crc
cease 24hours prior
if apixaban, low risk + low CRC
cease 48 horus prior
if apixaban, high risk + normal Crc
cease 48-72 hours prior
if apixavan, high risk nad low crc
cease 72 hours prior
Causes of Psychosis
- 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
Investigations for first episode psychosis
- FBE, UEC
- CMP
- LFTs
- BGL
- TFT
- Urine Toxicology
- Inflammatory Markers
- ECG
- CT Brain
Investigations or examinations to monitor once started anti-psychotic therapy?
- 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
History questions to establish psychosis and cause of psychosis
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
Examination of Female Urinary Incontinence
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
Non-Pharmacological Management of Female Urinary Incontinence.***
- Water → 6-8 cups of fluid a day, reduce fluids after the evening meals
- Caffiene and Alcohol → eliminate caffeiene, fizzy drinks + alcohol can worsen symptoms
- Fibre → avoid constipation, maintait soft bowel motions
- Physical Activity → 30mins of exercise most day of the week. Avoid fitness activities that cause bladder leakage
- Maintain BMI between 18.5-24.9
- Pelvic Floor Exercises
- Avoid lifting - can weaken pelvic floor
- Toilet Habits → empty bladder with urge, do not strain to empty bladder
- Bladder Training → referral to continence nurse or pelvic floor physiotherapist
- Continence pads or accessories - increase QoL
Causes of Urinary Incontienence
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
Management of bartholin’s abscess
marsupialisation with gynae
Clinical Features of Pityriasis Rosea?
- 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
DDx of pityriasis rosea
guttate psoriasis
secodnary syphillis
Management of pityriasis rosea
manage the itch
betamethasone valerate 0.02% cream topically once or twice daily
Management of Perthe’s Disease
Urgent Referral to Orthopaedic Surgeon
Analgesia
NWB with crutches
Age group for pErthes Disease
3-12yo
How to deal with complaints?
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
Cholestasis Causes
- 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
Treatment of a digital myxoid pseudocyst
- press firmly
- drain cyst
- cryotherapy
- steroid injection
- sclerosant injection
- surgical removal
Antenatal Bloods in ATSI, <25yo
FBE
Fasting BGL
beta-HCG
Group and Hold
Rubella
Syphillis
Urine MCS
Chlamydia Urine PCR
Vit D
Hepatitis B and C
HIV
Fe Studies
Important points in pregnancy counselling?
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
Examinations for Strabismus in a child.
- Corneal Light Reflex - central light reflex
- Cover Test - look at normal eye
- Cover/Uncover Test - look at fixation of rapidly uncovered eye
When to refer turning in of the eye
- intermittent after 3 months
- constant large before or after 3 months
- constant after 9 years
- true acute onset - URGENT REFERRAL
Abdominal Pain IN Children or Adolescents
- Dyspepsia etc
- Coeliac
- functional abdo pain
- abdominal migraine
- IBS
- IBD
- Anxiety/Depression
Constipation
lactose intolerance
t1dm - DKA
food allergy
UTI
Constipation management in paeds
Screening for normal risk risk patients for breast ca?
every 2 years from 50-74
Who qualifies as moderately increased risk of breast Ca?
1 FDR ,50
2 FDR same side of family
2 second degree relatives same side with at least 1 <50yo
for moderately increased risk of breast Ca - what testing?
at least every 2 years from 50-74yo. consider annually from 40yo if FDR <50 diagnosed with breast Ca
Crystal type in gout vs pseudogout?
Negative in Gout
Positive in Pseudogout
Acute Gout Management
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)
Diagnosis of Gout + Other investigations for gout?
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
Dosing of Urate Lowering Therapy.
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
Flare Prophylaxis when altering urate lowering therapy?
colchicine 500 micrograms PO, once or twice daily
Non-Pharmacological Management of Gout
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
Bridging therapy for medication overuse headache?
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.
Prophylaxis of Tension Type Headaches
amytriptilline 10mg nocte → increased dose by 10mg up ot max 75mg PO nocte for 8/52 then review
Acute treatment of tension type headaches.
Aspirin 600-900mg PO
Diclofenac Potassium 50mg PO
Ibuprofen 400mg PO
Naproxen 500-750mg PO
Paracetamol Soluble 1g PO
Treatment of pityriasis versicolour?
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
