capsule GP Flashcards
signs of cauda equina (8)
inc back pain, bilateral sciatica, sensory loss in lumbosacral distribution, weakened lower limbs, reduced reflexes. perineal paraesthesia, erectile and bladder dysfunction
what can cause acute compression of cauda equina (6)
bony metastasis, myeloma, epidural abscess, disc prolapse (most common), epidrual haematoma, primary sacral tumour eg chordoma
what is 1st line management of presentation of Cauda equina to GP
urgent same day assessment by spinal surgeon via admission to spinal surgical team. they can then image and do surgical decompression as appropriate
cord compression vs cauda equina
CC: spastic paralysis with brisk reflexes. CE: flaccid paralysis with loss of reflexes. both cause sensory and power loss
most common form of psoriasis
plaque psoriasis
what can exacerbate psoriasis (6)
stress, infections, medications, smoking, alcohol, skin injury
treatment for psoriasis in primary care (4)
moisturisers, salicylic acid, vit D based reams (calcipotriol), topical steroids (ST)
red flags for GORD (5)
dysphagia, evidence of GI blood loss (melena, blood in stool, vomitting blood), persistent vomiting, upper abdo mass, unexplained weight loss
what drugs associated with dyspepsia (6)
calcium antagonists, nitrates, theophylines, bisphospphonates, corticosteroids, NSAIDS
how to manage GORD (5)
-over the counter antacids
-lifestyle advice on healthy eating and weight loss
-advice to avoid known precipitants eg alcohol, smoking, coffee
-advise to raise head of bed
-empirical treatment with PPI
RF for barrettes oesophagus
male, previous oesophagitis, previos hiatus hernia
screening tools for depression
PHQ-9
HADS-D
BDI-II
screening tools for anxiety
GAD7
treatment for mild depression (6)
watchful waiting, sleep and anxiety management, exercise, guided self help, computerised cognitive behavioural therapy, psychological interventions
glandular fever PC (7)
young patient age, sore throat sympotms, reduced apetitie, tiredness, palpable cervicle node (posterior), palpable spleen, blood film shows lymphocytosis
Ix for glandular fever (4)
epsitein barr virus serology (inc IgM), paul bunnel test, throat swab (make sure not streptococcal infection), HIV test for those with RF or immunocompromised
Mx for glandular fever (4)
analgesia, avoid alcohol, avoid physical contact, follow up (amoxicilin can cause rashes)
complication of glandular fever (4)
depression, meningitis, splenic rupture, thrombocytopenia
complications for ebstein barr virus
viral meningitis, burkitt’s lymphoma, GBS
what does phalens test
carpal tunnel syndrome
common adverse effects of NSAIDS (4)
bronchospasm, cardiovascular and renal complications, dyspepsia and other upper GI complications, skin reactions and angiodema
what do these 4 drugs treat? midazolam, morphone sulfate, cyclyzine, glycopyrronium
agitation, pain, nausea/ vomiting, resp secretions
what do these 4 drugs treat? midazolam, morphone sulfate, cyclyzine, glycopyrronium
agitation, pain, nausea/ vomiting, resp secretions
oral vs subcutaneous
oral dose needs be to halved when given subcutaenously as latter is more potent
what is cocodamol made up of
codein (need laxative and anti-emetic PRN) and paracetamol
anti emetics
The nausea is probably a consequence of her opioid use, and usually metoclopramide is the best choice because of its pro-kinetic action. Cyclizine is usually used for nausea and vomiting due to mechanical bowel obstruction, raised intracranial pressure and motion sickness, therefore it would not be the first-choice anti-emetic here
what further investigations needed for lung cancer
CT to define nature and location of mass
bronchoscopy and biopsy to determine tissue
PET for those being considered for curative surgery and bone scan for boney metastases
why can lung cancer possibly cause chest pain
due to chest wall involvement and presence of metastases in bones causing pleuritic pain
what common things cause left sided lung collapse/ consolidation
pneumonia, obstruction of left bronchus.
foreign body can cause collapse but not consolidation
what investigations do you need to confirm pneumonia
blood cultures, bronchoscopy +/- biopsy, CT chest, sputum MC&S
what is the diagnosis of the radiological finding of mutiplie ill defined foci of opacity in the lungs
pulmonary infarcts, pulmonary metastases, rheumatoid arthirits, granulomatosis with polyangiitis, septic emboli
breast cancer
Breast is the commonest source of lung metastasis, and also causes endobronchial lesions. Although rare, lung metastasis can cause pneumothorax and metastases can also calcify. lungs are a recognised site of metastases in renal carcinoma
Sx mesothelioma
Mesothelioma of the pleura. This tumour arises from the mesothelial cells of the pleura and spreads initially via the pleural space to encase the lung.
RF for mesothelioma
Virtually all cases of mesothelioma are due to exposure to asbestos. It is important to enquire about asbestos exposure which is usually occupational exposure. In particular: boilermakers, plumbers, heating engineers, electrical engineers and anyone working with building materials may have been exposed.
The “lead time” between asbestos exposure and development of mesothelioma is almost always more than 20 years. It is therefore important that enquiries about the occupational history go back in detail to the patients’ early career. Identifying which of several employments was the relevant exposure might be important if the relatives claim compensation.
metastases of mesotheliomas
other pleural cavity, lung, hilar lymph nodes
iX MESothelioma
thorascopy with biopsy and histology of pleura may be needed.
instillation of sclerosant substances may be used to prevent reaccumulation of pleural effusions
RF for multi drug resistance TB (6)
previous treatment for TB, previous residence in area of high prevalence, contact with case of HIV/AIDS + TB, male, recent residence in london, lifestyle
what is the management of multi drug resistance TB
requst PCR probe for rifampicin resistance, use standard 4 drug regime and streptomycin and ciprofloxacin. in patient treatment could be warranted
why should you do lung function tests for patients with dyspnoea
to assess if there is an obstructive/restrictive defect or any reversibility of symptom
how does mycoplasma pneumonia present
malaise, dry cough
what are some side effects of RIPE for TB
optic neuritis side effect for ethambutol
hepatitis side effect for rifampicin
peripheral neuropathy may occur with isoniazid so may need vitamin supplementation eg pyridoxine
Causes of cellulitis
Strep pyogenes, staph aureus, treat with fluclox and benzyl penicillin
Which drugs are excreted by kidneys and need dose reduction in Renal impairment
Gliclazide, gabapentin, morphine. Also don’t give NSAIDS for pt with renal impaired ent
