Common Conditions Update Flashcards
Asthma
- You suspect Brittle asthma. Which PEF corresponds
● Brittle Asthma = Peak Flow 40% diurnal variation
- Moderate Asthma
Which PEF corresponds
● Moderate Asthma = Peak Flow > 50% - 75%
- Acute / Severe Asthma
Which PEF corresponds
● Acute Severe Asthma = Peak Flow 33% - 50%
- Life Threatening Asthma
Which PEF corresponds
● Life Threatening Asthma = Peak Flow <33%
secondary prevention following MI?
Medical Management? ● Aspirin 75mg OD ● ACEi (esp. if angina + DM) ● Statins: simvastatin 40mg ● Antihypertensives
Options to help patient stop smoking
Stop smoking ● - Specialist nurse ● - Nicotine replacement ● - Bupropion, ● - Verenicline
Give potential medical causes of tiredness in a girl aged 16 (Hint think of a must not miss cause)
Differentials for tiredness ● Diabetes ● Anaemia ● Depression ● Anxiety ● Insomnia ● Early Pregnancy ● Chronic Fatigue Syndrome
How do you definitively diagnose lung cancer in a suspected patient?
Diagnosis lung cancer
contrast-enhanced chest CT scan
What is the most common type of lung cancer
Most Common LC
NSCLC
How do you manage Small Cell LC initially
SCLC initial Mgx:
4-6 cycles of cisplatin-based combination chemotherapy
How do you manage Non Small Cell LC Stage 1 and 2
NSCLC Mgx
Lobar Resection
Which type of lung cancer has a worse prognosis?
Worse prognosis
SCLC
What are the sub groupings of NSCLC?
NSCLC
- adenocarcinoma
- squamous cell
What is the most common subtype of lung cancer
Common NSCLC
- adenocarcinoma
How do you definitively diagnose colorectal cancer in a suspected patient without a major comorbidity?
Diagnosis young healthy colorectal cancer
Colonoscopy
How do you definitively diagnose colorectal cancer in a suspected patient if they have a major comorbidity?
Diagnosis colorectal cancer for patient with major comorbidity
Flexible Sigmoidoscopy + barium enema
What does Triple Assessment involve?
Triple Assessment
Clinical assessment
Mammography
USS imaging
Core Biopsy + FNA
Domestic Violence
What is it?
Any behaviour within an intimate relationship that causes physical, psychological or sexual harm
Syphilis
How do I know I have it?
Syphilis
presenting complaint of rash + fever
examination finding of lymphadenopathy
Syphilis
What is it?
Syphilis
Infection by microorganism called spirochaete
Treponema pallidum
Syphilis
Management
Syphilis
benzathine benzylpenicillin 2.4 mega unit injection into the buttocks
HIV
Investigation?
HIV
Antibody PCR Test + p24 test
HIV
Treatment
HIV
2 NRTI + NNRTI / Boosted Protease inhibitor
nucleoside reverse transcriptase inhibitors
non-nucleoside reverse transcriptase inhibitor
protease inhibitor
Hepatitis B
Igx
HBsAg = ongoing infection, either acute or chronic if present > 6 months
Hepatitis B Chronic infection treatment
Hepatitis B Chronic infection
Mgx
- pegylated interferon-alpha
Migraine
Presentation
PC?
Migraine
- Prodrome of visual loss
- Severe unilateral or bilateral headache with a pulsatile quality.
- Nausea + Vomiting + sensitivity to light
Migraine
Management-
5) What medications can be given 1st line in an acute situation
Migraine
Medical Management-
1st line oral triptan,
NSAID
propranolol
Otitis Media
When should you prescribe antibiotics?
Otitis Media
●Atbx for otitis media = age < 2 yr + bilateral otitis media
Glandular Fever
Investigation
Diagnostic Test?
Glandular Fever
Investigation
NICE guidelines suggest FBC and Monospot in the 2nd week
Glandular Fever
Management
Do you need to treat it?
- rest
- fluid, avoid alcohol
- simple analgesia for any aches or pains
- avoid playing contact sports
self-resolves 2-4 weeks
Influenza
How is the flu jab different for children?
Influenza
children flu jab = live
Substance Misuse
First line medications for opioid abuse NICE?
Substance Misuse
first-line treatment for opioid detoxification = methadone
buprenorphine
Diabetes
Investigation to confirm Diabetes for symptomatic patient WHO?
Diabetes
ONCE fasting glucose > 7.0 mmol/l
OR
ONCE random glucose > 11.1 mmol/l
OR
after 75g oral glucose tolerance test blood glucose > 11.1 mmol/l
Diabetes
Investigation to confirm Diabetes for asymptomatic patient is ?
Diabetes
TWICE fasting glucose > 7.0 mmol/l on TWO separate occasions
OR
random glucose > 11.1 mmol/l
Diabetes
T2DM first line med
Diabetes
first-line T2DM med = metformin
Diabetes
T1DM insulin regimen
Diabetes
bi-basal insulin detemir
+
rapid‑acting insulin before meals
Anaemia
Macrocytic normoblastic anaemia differentials?
Anaemia
Macrocytic normoblastic anaemia differentials
alcohol
liver disease
hypothyroidism
pregnancy
Anaemia
Microcytic Anemia differentials?
Anaemia
iron-deficiency anaemia
thalassaemia*
Anaemia
Macrocytic megaloblastic anaemia differentials?
Anaemia
Macrocytic anaemia
vitamin B12 deficiency
folate deficiency
Hypothyroidism
Hypothyroidism PC
Hypothyroidism
Weight gain Lethargy Cold intolerance also constipation Menorrhagia Dry Skin
Hypothyroidism
Gold standard Igx?
Hypothyroidism
TFT Blood Test
Hypothyroidism
TFT pattern for Primary Hypothyroidism?
Hypothyroidism
Primary Hypothyroidism
LOW T4
HIGH TSH
Hypothyroidism
TFT pattern for Secondary Hypothyroidism?
Hypothyroidism
Secondary Hypothyroidism
LOW T4,
LOW TSH
Hypothyroidism
TFT pattern for Subclinical Hypothyroidism?
Hypothyroidism
Subclinical Hypothyroidism
NORMAL T4
HIGH TSH
Emergency Contraception
Name two emergency contraceptive pills?
Emergency Contraception
Levonelle-1
(Levonorgestrel)
48 hours Emergency
ellaOne
Ulipristal Acetate
48 hours Morning After
Emergency Contraception
What is the deadline for taking the emergency pill?
Emergency Contraception
72 hours
Emergency Contraception
What dose for taking the emergency pill - Levonelle-1
(Levonorgestrel)?
Emergency Contraception
1.5 mg single dose
Emergency Contraception
What is the deadline for taking the Morning after pill?
Emergency Contraception
120 hours
Emergency Contraception
What dose for taking the morning after pill ellaOne
Emergency Contraception
300 mg
Emergency Contraception
Alternative to pills (Gold Standard)?
Emergency Contraception
Copper Coil
Emergency Contraception
First choice emergency contraceptive pill
Levonorgestrel
Levonelle-1
Management Heartburn no redflags hint trial of common
trial PPI for one month
then try h pylori test
if still not then try endoscopy
Heartburn presentation things that make it worse hint 4 things hint position shx
worse after a meal
worse after lying down
worse after alcohol
worse after smoking
Dyspepsia exacerbating hint ibuprofen
Dyspepsia is associated with NSAID use
Differentials heartburn
common and red flag hint oesophagitis
Oesophagitis
Oesophageal cancer
Systems relevant in SR for heartburn hint pregnancy
Cardiac GI pregnancy and respiratory and neuro
Red flags of heart burn
pain swallowing difficulty swallowing nausea vomit colour change in appetite feeling full early weight loss dark stools waking up to wee
Stricture causing heartburn medical name?
achalasia
CAncer of the oesaophagus differentials
barrets
coeliac
Management heartburn
lifestyle
meals
alcohol
smoking
Information
leaflets
Medication
antacids such as gaviscon
PPI trial for 1 month or 2 months
Management heartburn
lifestyle
meals
alcohol
smoking
Information
leaflets
Medication
antacids such as gaviscon
PPI trial for 1 month or 2 months
refer to specialist
2 week wait
do a follow up
Management fo red flag heartburn bleedinig anaemia weight loss difficulty swallowing pain swallowing persistent vomiting mass barium meal
urgent referral
Igx in secondary care
1 endoscopy
2 barium meal
3 oesophagus pH
4 h pylori
Diarrhoea
Gastroenteritis antibiotics IBS IBD Bowel CAncer Overflow Alcohol Coeliac DIverticular SHort gut
Diarrhoea key points
Travel Diet Antibiotics Aching joints Headache Mucus Blood Pain
Diarrhoea Igx
Stool MCNS CRP FBC LFT TFT Tissue tranglutaminase UE faecal elastase FAecal calcipronectin
Diarrhoea Mgx
Hand washing
No work for 72 hours
No school 48 hours
Oral rehydration
2 litres clear fluid
oral rehydratioin salts
stop diurectic
ACEi
NSAID
Meds
Loperamide
notify if food poisioning
IBS key signs
relieved by defecationi
or bowel movement in general
diagnosis of exclusion
IBS mgx
Diet less fibre dietician no caffeine lots of clear fluid
lifestyle less stress
MEds
Anti spas mebeverine for bloating
anti dirrhoea for loperamide
TCA
for pain and diarrhoea
SSRI if TCA fails
linaclotide
for moderate to sever econstipation with IBS
