A Conditions

Question 1

Acute Bronchitis

Answer 1

• Viral infection - rhinovirus, enterovirus
• Autumn/Winter
• Self limiting 2-3 weeks
• Pneumonia complication
• CXR normal, maybe wheeze, cough

Fluid intake, paracetamol/ibuprofen for symptomatic relief
+
Stop smoking
+
Safety net
+
Oral doxycycline 18+ (not in pregnancy -> amoxicillin)

Question 2

Food Allergy

Answer 2

• Specialist referral for >1 episode of systemic symptoms
• Allergy testing for confirmation -> skin prick testing, serum-specific IgE testing

Question 3

Anaphylaxis

Answer 3

• Food, drugs and venom
• Looks and feels unwell, several minutes, anxiety and sense of impending doom
• Difficulty breathing, hoarse voice, stridor, cyanosis, SOB, pale, tachy
• Medical emergency, CPR, IM adrenaline in thigh

Question 4

Iron Deficiency Anaemia

Answer 4

• Dietary, malabsorption, increased loss (GI blood loss in menopause and adult men)
• Most common anaemia
• Impaired muscular performance, increased morbidity in pregnancy, preterm
• Dyspnoaea, fatigue, headache, cognitive dysfunction, restless leg syndrome
• Pallor, atrophic glossitis, dry and rough skin
• FBC -> low Hb and MCV (<95) -> ferritin
• Ferrous selphate 200mg once daily empty stomach
• Refer down suspected cancer pathway if >60
• Adverse -> consitpation, diarrhoea, epigastric pain

Question 5

GAD

Answer 5

• Impaired QoL, depression, suicidal ideation
• GAD-7 questionnaire
• Active monitoring -> individual self-help, guided self help -> CBT, SSRI (sertraline, but SNRI and SSRI are associated with increased risk of suicidal thinking and self-harm, review after 1 week) -> review treatments 4-6 weeks

Question 6

Arrythmias

Answer 6

• Onset associated with exercise - red flag
• Breathlessness, syncope, chest pain
• ECG
• Current palpitations -> arrange emergency admission -> ventricular tachycardia, SVT (valsalva)

Question 7

Dementia

Answer 7

• Alzheimers (most common, atrophy or cerebral cortex and formation of amyloid plaques and neurofibrillary tangles)
• Vascular demnetia (history of vascular disease), Lewy body (visual hallucinations), frontotemporal (personality change)
• Life limiting condition - no cure
• Memory loss, problems with reasoning, difficulty in making decisions, dysphasia
• MRI
• Offer early opportunities for planning ahead -> lasting power of attorney, advanced statement, planning place of care and death

Question 8

AF

Answer 8

• Due to hypertension, coronary artery disease, MI
• Stroke and thromboembolism, associated heart failure
• Breathlessness, palpitations, chest discomfort, syncope
• Suspect paroxysmal AF if <48h
• CONFIRM with ECG -> no P waves, irregularly irregular
• Emergency electrical cardioversion
• BB or CCB for long term rate control

Question 9

Asthma

Answer 9

• FH, male, infancy resp infection, exposure to smoking, obesity
• Wheeze, SOB, breathlessnes, cough -> diurnal, episodic triggered by exercise, viral infection and exposure to cold air or allergens
• Occupational -> refer
• Peak flow chart
• SABA inhaler as required; >3 inhaled SABA/>3 asthma symptoms per week give ICS

Question 10

Atopic Dermatitis and Eczema

Answer 10

• No single cause, 70% atopic FH, gneetics
• Triggers -> soaps, animal, dust, extreme temperatures, wool clothing, foods, stress
• Chronic illness with flare-ups
• Some children grow out of it
• Emollient cream, topical steroid (betamethasone valerate), severe itching -> anti-histamine

Question 11

Bronchiololitis

Answer 11

*<12Y
* RSV, lower bronchioles
* Coryzal 1-3 days followed by persistent cough, tachypnoea and wheeze, crackles on chest auscultation
* Self limiting usually (refer if >60breaths, breastfeeding difficulties, persistent sats <92)

Question 12

Hiatus Hernia

Answer 12

• Upper part of stomach bulges thorugh an opening in the diaphragm
• Weakened muscle tissue (unknown exact cause)
• GORD -> heatburn, chest pain, sour taste in mouth, stomach pain
• Normally asymptomatic
• FBC for anaemia, pH test for acid into oesophagus
• Antacids/H2 receptor blockers - laparoscopy, fundoplication

Question 13

Opioid Dependence

Answer 13

• Greater risk of staph A and group A strep due to poor hygeine and injection practices/HIV/HepC (most common amongst injections)
• Identify request for help
• Constriction of pupils, ithching and scratching, sedation, lower BP
• Acute -> watering eyes, yawning, sneezing, ab cramps)
• Psych history -> OD, depression, past custodial sentences, family problems, unemployment
• Urine screen + mouth swab
• Discuss maintenance + detoxification therapies
• Replacement -> methadone or buprenorphine with naloxone (high bioavailabilit causing withdrawal symptoms if injected)
• Supervised consumption for first 3 months
• Baseline liver and regular LFTs 6-9 months