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
