Common Conditions Management Flashcards
How do you diagnose stable Angina?
How do you diagnose unstable Angina?
When do you refer?
Medical Management?
How do you diagnose stable Angina?
● Chest pain on exertion relieved by rest
How do you diagnose unstable Angina?
● Chest pain even at rest
Medical Management? ● Aspirin 75mg OD ● ACEi (esp. if angina + DM) ● Statins: simvastatin 40mg ● Antihypertensives
COPD
You are the GP
A 65-year-old gentleman comes to the GP complaining of
● shortness of breath on exertion
● cough (3 months with regular sputum production)
● occasional wheeze
1) Based on this information alone give 2 differentials
2) Shortness of breath may be respiratory or cardiac what extra symptoms would point you towards a cardiac differential?
3) You find out that the 65-year-old gentleman has been heavily smoking for the last 20 years. What is the most likely diagnosis now?
4) You have completed the history and examination. Which investigation would be most helpful for confirming a diagnosis of COPD?
5) You have ordered the relevant tests and are now advising the gentleman that he must stop smoking. He asks for your help. What services are available to help him quit?
6) Management for COPD if patient is breathless as part of an acute exacerbation
give 2 differentials
1) Asthma, Heart Failure
cardiac symptoms
2) Swollen ankles, Chest pain
SOBoe + Smoking Hx Dx
3) COPD
Gold Igx COPD
4) Spirometry
5) Stop smoking ● - Specialist nurse ● - Nicotine replacement therapy ● - Bupropion, ● - Verenicline
6) Acute Exacerbation ● - Sit Up ● - 24% O2 (Venturi mask: SpO2 88-92%) ● - Nebulised SABA ● Extra Cough - Mucolytic
Anaemia
You are the GP
A 16-year-old girl comes in complaining of tiredness.
1) At this point give potential medical causes of tiredness in a girl this age. (Hint think of a must not miss cause)
2) What test do you need to do at the end of the consultation to rule out Anaemia?
3) give an example of a Microcytic anaemia
4) give an example of a Normocytic anaemia
5) give an example of a Macrocytic anaemia
6) give an example of a Haemolytic anaemia
1) Dx for tiredness ● Diabetes ● Anaemia ● Depression ● Anxiety ● Insomnia ● Early Pregnancy ● Chronic Fatigue Syndrome
2) FBC (purple bottle)
3) Microcytic - Thalassaemia, Iron Deficiency
4) Normocytic - Anaemia of chronic disease
5) Macrocytic - B12 Folate Deficiency
Heart Failure
You are the GP
A 75-year-old man has come in complaining of SOB but no chest pain. He has also noticed his ankles are swollen. Your differential diagnosis list at this point includes heart failure.
1) What is the most appropriate first-line investigation for suspected HF?
2) What would you do if the results of this test were high?
3) Medication should be prescribed based on?
4) Which medication would you prescribe for swollen ankles?
5) Medication for blood pressure in a patient with HF according to nice
1) First Line Igx for HF = Measure BNP
2) 2nd Igx = 2 wk referral for transthoracic Doppler 2D echocardiography
3) Symptoms
4) Diuretics for swollen ankles
5) Amlodipine for hypertension comorbidity
Colorectal Cancer Colon Rectum Anal Polyps
1) How do patients with colorectal cancer classically present?
2) What 2 red flags must ask about with any GI presentation of malaise?
3) How do you definitively diagnose colorectal cancer in a suspected patient without a major comorbidity?
4) How do you definitively diagnose colorectal cancer in a suspected patient if they have a major comorbidity?
5) How do you stage colorectal cancer?
1) Classic PC CRC
bowel obstruction
2) Unintentional weight loss, blood in the stool
3) Diagnosis young healthy colorectal cancer
Colonoscopy
4) Diagnosis major comorbidity colorectal cancer
Flexible Sigmoidoscopy + barium enema
5) Contrast enhanced CT scan of chest abdomen and pelvis
Prostate Cancer
You are the GP
A 70 year old man presents with urinary problems. He has noticed some hesitancy and poor flow when he goes for a wee.
How would you rule out UTI?
What is the most likely differential?
What information in the history and or examination would change the most likely differential from BPH to Prostate Cancer?
Ask about fever
BPH
Unintentional Weight Loss + Hard Asymmetrical Prostate on PR examination
Contraception
You are the GP
An 18 year old girl comes to the surgery asking for emergency contraception what type of history do you need to take?
Give some example questions
Sexual History
● When did you have sex?
● When was the first day of your last period?
● Are your periods regular?
● How often do you have a period?
● How important is it to you that you do not get pregnant?
Depression
What causes depression?
Who gets it?
What is the first line management?
Unknown Cause
More common in females
Talking Therapies
Domestic Violence
What is it? (in patient friendly terms?)
Any behaviour within an intimate relationship that causes physical, psychological or sexual harm
UTI
You are the GP
A 20 year old lady comes to the GP complaining of a burning pain when she wees. You are taking HxPC and want to discern between UTI and STI. What questions would help you discern?
Hint go through HxPC structure TOPSCERA and add some sexual history questions
● Do you have fever symptoms?
● Have you had any loin pain?
● Have you seen any blood in your urine?
● Do you have any vaginal discharge or itching?
● Have you had any new sexual partners in the past six months?
● When was your last period? Could you be pregnant?
Sexual History
Sylvia is a 24 year old presenting with bleeding between periods.
Take a focused HxPC of abnormal bleeding associated with periods + give a potential diagnosis
USE TOPSCERA S=Sex C=contraception
Timing = How Long? Timing = pattern i.e. regular? Timing = How Often? Sex = When? Active? C= Contraception?
Doxycycline 7 day
or
Azithromycin
Gonorrhoea
Young Lady presents with vaginal discharge
What type of history should you take
Treatment
Gynae / Obstetric / Sexual
Last Period? Regular periods? Length of Period? Abnormal Pain or Bleeding during periods? Post Sex Bleeding? Bleeding between periods?
Last Sexual contact? Consensual? Sex of partner? Type of sex? Contraception? Other partners last three months?
Ceftriaxone + Azithromycin
Genital Warts
Young man fleshy protuberances around his genitals
What type of history should you take?
What type of examination?
Medical + Procedural Management?
Answers
Medical : topical podophyllum 1st Line if lots
Procedural : cryotherapy 1st Line if one
2nd Line imiquimod
INFO: commonly used as first-line treatments depending on the location and type of lesion.
Syphilis
What is it?
How do I know I have it?
Management-
Infection by microorganism called spirochaete
Treponema pallidum
presenting complaint of rash + fever
examination finding of lymphadenopathy
benzylpenicillin
HIV
Answer the below qns about management
Aetiology
- What is it?
Epidemiology-
- Who gets it?
- Is it inheritable?
Presentation?
Investigation?
Mgx Medical
Infection by a virus normally through sexual contact.
More common in MSM.
Certain African countries
sore throat lymphadenopathy malaise, myalgia, arthralgia diarrhoea maculopapular rash mouth ulcers rarely meningoencephalitis
Antibody PCR Test + p24 test
Highly active anti-retroviral therapy (HAART)
at least three drugs,
- two nucleoside reverse transcriptase inhibitors (NRTI)
- protease inhibitor (PI) / non-nucleoside reverse transcriptase inhibitor (NNRTI).
Hepatitis B
Answer the below qns about management
Aetiology
- What is it?
Epidemiology
- Who gets it?
Presentation
- PC?
Igx
- diagnostic test?
Mgx
- first line medication
Aetiology
- Viral infection that hurts your liver
- 5 types
- Two main ones are B and C
Presentation
- PC - fever + jaundice
Igx
- HBsAg = ongoing infection, either acute or chronic if present > 6 months
Mgx
- pegylated interferon-alpha
Gastroenteritis
Answer the below qns about management
Aetiology-
- What is it?
- What causes it?
Presentation
- PC?
Infection of your digestive tract
Infection by one of these 8 bacteria
- Bacillus Cereus
- Cholera
- Staph Aureus
- E Coli
- Salmonella
- Campylobacter jejuni
- Shigella
- Giardiasis
- Amoeba
- Ordered by incubation period from quickest presentation
Presentation
- PC - Vomiting, Fever, Diarrhoea, Abdo Pain
GORD
Answer the below qns about management
Aetiology-
- What is it?
Epidemiology-
- Who gets it?
- Is it inheritable?
Presentation
- PC?
Investigation
- diagnostic test or procedure?
Management-
- Follow guidelines
Bringing up acid from stomach which causes symptom of heartburn
Presentation
- PC - heartburn
Investigation
- Endoscopy
- H pylori
Management-
- Confirmed GORD
- PPI for 1 month
- consider antacids
Alcohol Dependence
Presentation
- PC?
Mgx for severe dependence with withdrawal
- Medications and indication?
Not drinking produces withdrawal symptoms
Presentation - PC - • depression, • admission, • violent behaviour, • withdrawal
Mgx
- Chlordiazepoxide HCL for withdrawal
- Pabrinex - Vitamin B1 prevent Korsakoff and Wernicke
- Acamprosate -
Migraine
Answer the below qns about management
Aetiology-
1) What is it?
Epidemiology-
2) Who gets it?
Presentation
3) PC?
4) HxPC
Management-
5) What medications can be given 1st line in an acute situation
6) What medications can be given prophylactically?
7) SE of triptans
1) Migraine = Really Bad Headache
2) Women
3) PC: Headache
4)
• Prodrome of visual loss
• Severe unilateral or bilateral headache with a pulsatile quality.
• Nausea + Vomiting + sensitivity to light
Medical Management-
5) 1st line oral triptan, NSAID
propranolol
6) prophylactic for migraine = propranolol topiramate
7) tight throat and chest
Tension Headache
Answer the below qns about management
Aetiology-
- What is it?
Epidemiology-
- Who gets it?
- Is it inheritable?
Presentation
- PC?
Investigation
- diagnostic test or procedure?
Management-
- Medical
- Prophylaxis
Specific type of headache
PC - headache feels like tight band
Mgx - acute treatment: aspirin, paracetamol or an NSAID are first-line
- NICE recommend ‘up to 10 sessions of acupuncture over 5-8 weeks
Hypertension
Igx of Blood Pressure
1 - Stage 1 HTN is defined as?
2 - Stage 2 HTN is defined as?
3 - Stage 3 HTN is defined as?
Management
- Medical
- Step 1
- Step 2 combo of medications?
- Step 3 combo of medications?
- Step 4 combo of medications?
- Stage 1 135 / 85
- Stage 2 150 / 95
- Stage 3 180 / 110
Step 1
- under 55 ACE i
- above 55 or African Carribean Ca Channel Blocker
Step 2
- ACEi + Ca Channel Blocker
Step 3
- ACEi + Ca Channel Blocker + Indapamide
Step 4
- ACEi + Ca Channel Blocker + Indapamide + spironolactone
Acute Coronary Syndrome
Aetiology - What causes ACS?
- What causes IHD?
Presentation?
Key First Line Investigation?
Other Important Tests?
Mgx
- Primary Prevention?
- Secondary Prevention?
IHD
Smoking
HTN
High Cholesterol
Chest Pain
ECG
Troponin
Mgx Primary = lifestyle Secondary - Aspirin - Statin - - ACE inhibitor - Beta-blocker - a second antiplatelet - clopidogrel
Sciatica
Aetiology
- What is it? (in patient friendly terms?)
History
- Presenting Complaint?
- Red FLags?
Management-
Nerve Pain specifically back of legs
Back Pain
Incontinence, saddle anaesthesia, loss of sensation or paraesthesia
Analgesia WHO
Physio
Operation if indicated
Otitis Media
What is it?
You would like to manage the otitis media.
When should you prescribe antibiotics?
Which antibiotic?
If allergic to penicillin?
● Atbx for otitis media = Systemically unwell
● Atbx for otitis media = Immunocompromise
● high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
●Atbx for otitis media = age < 2 yr + bilateral otitis media
● Otitis media with perforation and/or discharge in the canal
● Amoxicillin
Erythromycin / Clarithromycin
Otitis Externa
Aetiology
- What is it? (in patient friendly terms?)
- What causes it?
Epidemiology
3. - Who gets it?
Presentation
- PC?
- ENT examination findings
- Medical Management short term
- Otitis Externa = Ear Infection
- Otitis Externa cause = Bacteria such as staph or pseudomonas
- People at risk = Ongoing
• Eczema,
• Seborrhoeic dermatitis,
• Contact dermatitis - Otitis Externa PC = ear pain, itch, discharge
- ENT findings = Red, swollen, or eczematous canal
- topical antibiotic
- combined topical antibiotic with steroid
Viral Sore Throat
- Differentials of sore throat?
Management
- General Medication?
- When can you prescribe antibiotics?
- Which antibiotic?
- What 2 things must you always do at the end of a consultation?
- Differentials of sore throat =
pharyngitis,
tonsillitis,
laryngitis - General Medication =
Paracetamol and NSAIDs (ibuprofen) - prescribe antibiotics =
- tonsillar exudate
- tender anterior cervical
- lymphadenitis
- history of fever
- absence of cough - antibiotics= phenoxymethylpenicillin
erythromycin - End of consultation = summary + follow up
Glandular Fever
- Aetiology of glandular fever
- Epidemiology
a. Who gets it?
b. Is it inheritable? - Presentation
a. PC? - Investigation
a. Diagnostic Test? - Management
a. Home or Hospital?
If yes to hospital
b. Meds?
c. Procedures?
d. Surgery?
If yes to home
a. lifestyle?
Bad sore throat
- Aetiology of glandular fever
Herpes virus specifically Epstein barr virus - Presentation
- sore throat
- lymphadenopathy
- pyrexia fever - Investigation
NICE guidelines suggest FBC and Monospot in the 2nd week - Management
- self-resolves 2-4 weeks
- rest
- fluid, avoid alcohol
- simple analgesia for any aches or pains
- avoid playing contact sports for 8 weeks to reduce the risk of splenic rupture
Tonsillitis
Answer the below qns about management
Aetiology
- What is it? (in patient friendly terms?)
- What causes it?
Epidemiology
- Who gets it?
- Is it inheritable?
Presentation
- PC?
Investigation
- Diagnostic Test?
Management
- When is a tonsillectomy indicated?
Throat infection
Bacteria called strep pyogenes
Children
PC: Sore throat, temperature, dysphagia
Igx - ENT exam
Mgx
NICE all of the following criteria
- sore throats are due to tonsillitis not recurrent URTI
- five or more episodes of sore throat per year
- symptoms occurring for at least a year
- episodes of sore throat disabling prevent normal functioning
Upper respiratory Tract Infection
Epidemiology
- Who gets it?
Presentation
- How does it commonly present?
Investigation
- Diagnostic Test?
Management
What medications do you generally give?
Which medication for croup?
Croup Tonsilitis Sinusitis Laryngitis Flu Common Cold
Commonly seen in children
PC - sore throat, temperature, generalised aches and pains, congestion
Igx = ENT examination
Mgx - Analgesia ibuprofen and steam inhalation Except croup which requires dexamethasone
Influenza
- You are the 4th year medical student what signs in presenting complaint would make you suspect influenza?
- HxPC influenza
- Management in the form of flu vaccinations
3a. Who gets the flu vaccination?
3b. how is the flu jab different for children
- PC influenza = fever, generalised aches and pains
- Influenza HxPC = sudden onset fever, chills, headache, myalgia and extreme fatigue. Other common symptoms include a dry cough, sore throat and stuffy
nose
3a. Flu vaccination recipients children and 65+
3b. children flu jab = live
Substance Misuse
- How does it present (PC)?
- Examination Findings on Inspection?
- Management
3a. First line medications for opioid abuse NICE?
3b. How long do they need to detox
3c. How long do they need to detox in the community
Opioid Misuse
PC
drowsiness
watering eyes
yawning
- Examination FIndings on Inspection = needle track marks + pinpoint pupils
3a.
first-line treatment for opioid detoxification = methadone
buprenorphine
- compliance is monitored using urinalysis
3b. detoxification up to 4 weeks in an inpatient/residential setting
3c. up to 12 weeks in the community
- specialist drug dependence clinics
- maintenance therapy
Diabetes
Presentation
- PC T1DM
- PC T2DM
- Different forms of diabetes
- Investigation to confirm Diabetes for symptomatic patient WHO?
- Investigation to confirm Diabetes for symptomatic patient WHO?
6. Mgx 6a what is T1DM 6b what is T2DM 6c. T2DM first line med 6d. T2DM second line med 6e T1DM management 6f target T1DM blood glucose levels on waking and before meals 6g T1DM insulin regimen
Problems controlling blood sugar
- T1DM = PC: Vomiting, Polyuria, Thirst
- T2DM = PC: Vomiting, Polyuria, Thirst
- • PreDiabetes
• Gestational Diabetes - diagnostic criteria diabetes symptomatic patient is :
fasting glucose > 7.0 mmol/l
random glucose > 11.1 mmol/l (or after 75g oral glucose tolerance test) - diagnostic criteria diabetes asymptomatic patient is : two separate occasions.
6a. Type 1 diabetes = no insulin
6b. Type 2 diabetes = too much sugar too much insulin insulin resistance
6c first-line T2DM med = metformin
6d. second-line drugs
• sulfonylureas,
• gliptins
• pioglitazone
6e. t1dm management = patient self monitor and physician monitor 3-6 month at target of 48 on HbA1c.
6f. T1DM target blood glucose levels
5-7 mmol/l on waking
4-7 mmol/l before meals at other times of the day
6g
twice‑daily insulin detemir is the regime of choice
rapid‑acting insulin analogues injected before meals
Anaemia
- Presentation
- PC? - Investigation
- Diagnostic Test? - Microcytic Anemia differentials?
- Macrocytic megaloblastic anaemia differentials?
- Macrocytic normoblastic anaemia differentials?
- Management anaemia?
- PC Anaemia = fatigue, bleeding
- Igx = FBC
- Microcytic Anemia =
iron-deficiency anaemia
thalassaemia* - Macrocytic anaemia =
vitamin B12 deficiency
folate deficiency
5. Macrocytic normoblastic anaemia differentials = alcohol liver disease hypothyroidism pregnancy
- Management anaemia:
Nutrition through diet leafy greens meat
Hypothyroidism
- Hypothyroidism PC
- Hypothyroidism PC picture
- Hypothyroidism examination findings on general inspection
- Hypothyroidism examination findings on inspection of scalp
- Hypothyroidism examination findings on inspection of hands
- Gold standard Igx?
- TFT pattern for Primary Hypothyroidism?
- TFT pattern for Secondary Hypothyroidism?
- TFT pattern for Subclinical Hypothyroidism?
- Treatment for hypothyroid?
1. Hypothyroidism PC Weight gain Lethargy Cold intolerance also constipation menorrhagia
- Hypothyroidism PC picture
Woman weight gain unknown reason - Hypothyroidism examination findings
yellowish skin
Dry (anhydrosis), cold, - Dry, coarse scalp hair, loss of lateral aspect of eyebrows
- Non-pitting oedema hands, face
- Gold standard Igx = TFT Blood Test
- TFT pattern for Primary Hypothyroidism = low T4 high TSH
- TFT pattern for Secondary Hypothyroidism = low T4, low TSH
- TFT pattern for Subclinical Hypothyroidism = normal T4 high TSH
- levothyroxine
Insomnia
What causes it
What causes insomnia
The most common causes are:
stress, anxiety or depression noise a room that's too hot or cold uncomfortable beds alcohol, caffeine or nicotine recreational drugs like cocaine or ecstasy jet lag shift work rule out hypothyroidism restless leg syndrom
Depression
What is it? (in patient friendly terms?)
Talking therapy and SSRI
Emergency Contraception
- Name two emergency contraceptive pills?
- What is the deadline for taking the emergency pill?
- What dose for taking the emergency pill?
- What is the deadline for taking the Morning after pill?
- What dose for taking the morning after pill?
- Alternative to pills (Gold Standard)?
- emergency contraceptive pills
Levonelle 48 hours Emergency
Ellaone 48 hours Morning After - deadline emergency pill = 72 hours
- Dose Emergency pill = 1.5 mg
- deadline morning after pill = 120 hours
- dose morning after pill = 300mg
- Alternative to pills = coil
Chronic Fatigue Syndrome
Answer the below qns about management
What is the aim of treatment?
Is treatment medical, surgical, lifestyle or therapy?
Treatments for CFS/ME aim to help relieve your symptoms
Medical, lifestyle and therapy
MI
secondary prevention
aspirin
statin
beta blocker
AF medications
DOAC or Warfarin
Prostate Cancer
You are the GP
A 70 year old man presents with urinary problems. After completing history and examination you order a PSA which comes back raised. You suspect Prostate cancer and need to break the bad news.
What are the 5 essential steps
● Find a comfortable environment
● Invite a friend or relative if possible
● Establish what the patient knows,
● Establish what has happened since last ● Give information in ‘small packages’
● arrange a specific time to meet again
A 58-year-old man with no past medical history of note is admitted to hospital with crushing central chest pain. ECG on arrival shows anterior ST elevation and he is subsequently thrombolysed with a good resolution of symptoms and ECG changes. Four weeks following the event, which combination of drugs should he be taking?
Hint secondary prevention
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
HTN medical mgx if patient already on ACEi + Ca channel blocker
add indapamide (diuretic)
Diabetes type 1
basal bolus
+
BD insulin
General Step by Step Management of Asthma?
General Step by Step Management ● SABA ● Inhaled Corticosteroid ● LABA ● Oral Steroid ● Increase Dose
