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Year 3 GP > Common GP Conditions > Flashcards

Common GP Conditions Flashcards

1
Q

What advice would you give a patient that you have diagnosed with the ‘common cold’?

A

Advise that the average length of illness is 10 days
Advise steam inhalation, vapour rubs, paracetamol/ibuprofen, intranasal decongestants

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2
Q

State the three different types of Urinary Tract Infections

A

Lower UTI - cystitis, prostatitis
Upper UTI - Pyelonephritis
Abacterial

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3
Q

State four features that would cause a UTI to be classed as ‘complicated’?

A

Structural Abnormality
Obstruction
Catheter
Renal Obstruction

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4
Q

Name two common causative organisms of UTI

A

E.Coli
Staphylococcus Saprophyticus

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5
Q

Other than immunosupression, give four risk factors for UTI

A

Sex
Spermicide use
Menopause
Dehydration

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6
Q

State 4 symptoms of Cystitis

A

Frequency
Dysuria
Urgency
Haematuria

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7
Q

State 4 symptoms of Pyelonephritis

A

Fever
Rigors
Loin Pain
Vomiting

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8
Q

State 4 symptoms of Prostatitis

A

Pain (perineurium,rectum, penis)
Fever
Malaise
Urinary Symptoms

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9
Q

When do you investigate a UTI?

A

Non pregnant, under 65 and less than 3 symptoms
Pregnant Women
Men
Children

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10
Q

Do you treat Asymptomatic Bacteruria?

A

Not unless pregnant

MSU and 7d Nitrofurantoin

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11
Q

How do you treat non pregnant Women with UTI?

A

Lower UTI - 3 Day course of Trimethoprim/Nitrofurantoin (consider delayed prescription)
Upper UTI - 7 Day course of Co-amoxiclav

Fluids, Pain relief, Hygiene

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12
Q

How do you treat pregnant Women with UTI?

A

As long as not 3rd term

Nitrofurantoin/Cephalexin for 7 days and MSU

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13
Q

How do you treat Men with UTI?

A

Nitrofurantoin for 7 days
(If Prostatitis then consider 4 weeks of Ciprofloxacin - penetrates Prostatic fluid well)

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14
Q

What is Acute Bronchitis?

A

Short term inflammation of the Bronchi, usually a viral cause in origin

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15
Q

Give 4 features of Acute Bronchitis

A

Productive Cough
SOB
May have been preceded by URTI
Generally no systemic symptoms (might indicate Pneumonia)

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16
Q

What is Bronchiolitis?

A

Acute viral illness of Lower Respiratory Tract occurring primarily in the very young.
RSV responsible for 80%

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17
Q

Give four risk factors for Bronchiolitis, and one protective factor

A

Older Siblings, Nursery Attendance, Passive Smoking, Overcrowding
Breast Feeding is protective

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18
Q

Describe four features of presentation of Bronchiolitis

A

1-3 day history of coryzal symptoms
Persistent cough/chest recession/crackles
Fever
Poor feeding

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19
Q

If you suspected Bronchiolitis in a child, when would you refer to Secondary Care?

A

Apnoea
Chest recession/grunting
RR>70
02<92%
Central Cyanosis

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20
Q

How would you manage Bronchiolitis?

A

Self Limtiing
Fluids and nutrition
Anti - pyretics if child is in distress

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21
Q

Acute Conjunctivitis can be Viral/Bacterial/Parasitic/Allergic in origin. Give an example of a causative organism of each

A

Viral - Adenovirus
Bacterial - Staphylococcus
Parasitic - Lyme Disease
Allergic - Seasonal

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22
Q

Give 3 causes of Chronic Conjunctivitis

A

Recurrent Infective
Chlamydia
Toxic Reaction

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23
Q

Give 2 symptoms of Conjunctivitis

A

Red eye with irritation/grittiness
Discharge

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24
Q

Give 2 signs of Conjunctivitis

A

Conjunctival Oedema
Dilated Conjunctival Vessels

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25
Q

What are Conjunctival Follicles?

A

White nodules on inferior eyelids
If preauricular lymph nodes are enlarged - Toxic or Molluscum Contagiosum in causation
If preauricular lymph nodes are not enlarged - HSV or Chlamydia

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26
Q

What are Conjunctival Papillae?

A

Red dots of varying size on inferior eyelids (Cobblestone)
Allergic/Bacterial in cause

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27
Q

How would you manage BACTERIAL Conjunctivitis?

A

Advise self limiting nature (shouldn’t last longer than 2 weeks)
Lubricant eye drops
Antibiotics - Chloramphenicol (not in pregnancy), Fusidic Acid
Chlamydia - topical tetracycline and oral doxycycline
Gonococcal - 1g IM Ceftriaxone

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28
Q

How would you manage VIRAL Conjunctivitis?

A

Supportive unless HSV (Topical Acyclovir)

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29
Q

How would you manage ALLERGIC Conjunctivitis?

A

Avoid rubbing
Cool compreses
Topical Antihistamines
Oral Antihistamines (eg Chloramphenamine)

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30
Q

What is Blepharitis?

A

Inflammation of the edge of the eyelid
Usually a chronic condition that never fully resolves
Can be anterior (affecting eyelashes) or posterior (affecting meibomian glands)

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31
Q

Give 3 causes of Blepharitis

A

Staph Infection
Seborrhoeic Dermatitis
Meibomian Gland Dysfunction

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32
Q

Give 2 general symptoms of Blepharitis

A

Eyes are sore and gritty
Eyes may stick together in the morning
Symptoms are WORSE in the morning

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33
Q

Give 2 signs seen with each respective cause of Blepharitis

A

Staph Infection - Hyperaemia, Crusting of lash bases
Seborrheic - Erythema, Hyperaemia
Meibomian Dysfunction - oil globules on lid, chalazia

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34
Q

How would you manage Blepharitis?

A

Lid Hygiene (warm compress and massage to loosen meibomian content, and cleansing using cotton bud in baby shampoo)
Abx only if evidence of unresolving infection

35
Q

Give four causes of Cervical Back Pain

A

Cervical Spondylosis
Cervical Prolapse
Meningitis
Torticollis

36
Q

What is Torticollis?

A

Acute spasm of neck (often after ‘sleeping funny’)

37
Q

Give 3 red flags for Cervical Back Pain

A

Weakness in more than one myotome
Neurological symptoms
Malaise/Weight Loss

38
Q

Give four causes of Thoracic Back Pain

A

Poor posture
Trauma
Herniation
Osteoporosis

39
Q

What is Schuermann’s Disease?

A

Vertebrae grow unevenly in childhood, with the posterior growing faster leading to exaggerated kyphosis

40
Q

Give three red flags for Thoracic Back Pain

A

Trauma
20>Age or >50
HIV/Drug abuse

41
Q

How would you manage simple back pain?

A

Promote activity not bed rest
Low dose short course NSAIDs (paracetamol is ineffective)
Weak Opioids

42
Q

How would a Tension Headache present?

A

Bilateral Squeezing Pain
May have associated neck pain
Responsive to OTC medication

43
Q

How would a Migraine Headache present?

A

Unilateral and throbbing
Nausea
Photophobia
Aura (Zig Zag lines)

44
Q

How would a Cluster Headache present?

A

Typically occurs at night
Excruciating/Sharp/Penetrating around one eye
Usually lasts 45-90 minutes

45
Q

State four uncommon types of Primary Headaches

A

Valsalva Headache (when coughing)
Primary Exertional (After exercise)
Primary Sexual (Peaking at orgasm)
SAH

46
Q

State four types of SECONDARY headaches

A

Medication Overuse
Referred from TMJ/Sinusitis/Tooth Ache
Temporal arteritis
Hypertension

47
Q

How would a medication overuse headache present?

A

-Present on atleast 15 days of the month
-History of regular use of Triptans/Opioids/Paracetamol/NSAIDs
-Often worse in the morning and after sleeping
-May coexist with depression and sleep disturbance

48
Q

How would you manage a Tension Headache?

A

Reassurance and advice on stress management
Ibuprofen/Asparin/TCA (eg Amitryptylline if frequent - SE is dry mouth)

49
Q

State 5 triggers of Migraines

A

Stress
Sleep Deprivation
Dietary (Cheese/Chocolate/Alcohol)
Menstruation
Weather

50
Q

How would you manage a Migraine?

A

Address triggers
1) Asparin/Ibuprofen/Buccal Prochlorperzine for nausea
2) Rectal Diclofenac and Rectal Domperidone
3) Triptans (5HT1 Antagonists)

51
Q

What situations are Triptans contraindicated?

A

Uncontrolled Hypertension, CHD, CVD

52
Q

Describe the 3 prophylactic drugs for Migraines

A

Beta Blockers (Atenolol)
Amitryptylline
Sodium Valproate/Topirimate

53
Q

How would you manage Cluster headaches?

A

Good sleep hygiene
Smoking Cessation
Acute Attack - Sumatriptans (Subcut), 02 (15 min up to 5 times a day)

54
Q

What prophylactic drugs can you use in Cluster Headaches?

A

Verapamil
Prednisolone
Lithium

55
Q

Describe a 5 step management plan for Medication Overuse Headache

A

1) Explanation
2) Advice (stop headache medication for atleast one month, 3 week course of ibuprofen, will get withdrawal headaches)
3) Follow Up
4) Prophylaxis (Prednisolone or Amitryptyline)
5) Review

56
Q

Define Sprain and Strain

A

Sprain - Ligament injury
Strain - Overstretching of muscles or tendons

57
Q

Describe the management of Sprains and Strains (PRICE, avoid HARM)

A

Protect from further injury, Rest for 48-72hrs, Ice (15-20mins every 3hrs), Compression, Elevation

Heat (encourages blood flow so increases bruising and inflammation), Alcohol, Running, Massage

58
Q

What is Sinusitis? Name the four Sinuses

A

Inflammation of the lining of one or more sinuses
Ethmoidal, Frontal, Sphenoidal, Maxillary

59
Q

State 4 risk factors for Sinusitis

A

URTI
Allergy
Asthma
Smoking

60
Q

Name 3 causative organisms of Sinusitis

A

Streptococcus Pneumoniae
Haemophilus Influenza
Moraxella Catarrhalis

61
Q

How would you classify Sinusitis by timescale?

A

Acute: 7-30d
Subacute: 4-12w
Chronic: >90d

62
Q

How would Sinusitis present?

A

Non resolving cold
Pain over affected sinus (worse on bending forward)

63
Q

How should you examine each Sinus respectively?

A

Frontal - Press upwards on medial side of supraorbital ridge
Maxillary - Press on anterior wall below inferior orbital margin
Ethmoidal - Press against medial wall of orbit

64
Q

Describe four conservative managements for Sinusitis

A
  • Reassure the patient that it will take a bit longer to resolve than a normal cold
  • Warm face packs (no evidence)
  • Nasal irrigation with warm saline
  • Paracetamol/Ibuprofen
65
Q

Describe two pharmacological managements for Acute Sinusitis. When should these be used?

A

High dose nasal steroid for 2/52
Deferred Abx (5d of Pen V)

If unwell for >10d

66
Q

What is the difference between Tonsilitis, Pharyngitis and Laryngitis?

A

Tonsilitis - Inflammation of the tonsils
Pharyngitis - Inflammation of the oropharynx
Laryngitis - Inflammation of the Larynx (associated with hoarseness)

67
Q

Describe 5 possible presentations of Tonsillitis

A

Pain in throat (worse on swallowing)
Referred pain to ears
Headache
Loss of Voice
Abdo Pain (in children)

68
Q

Give two differentials of Tonsilitis and how they would present?

A

Coxsackie Virus - Blisters on tonsils and roof of mouth
Glandular Fever - Extreme lethargy and enlarged spleen

69
Q

Describe the features of the FEVER PAIN score, and how it is used.

A

Fever
Pain
Attend rapidly
Inflamed tonsils
No cough/coryzal symptoms

0 or 1 = No abx
2 or 3 = Delayed abx
4 or 5 = Abx

70
Q

What antibiotics are given for Tonsillitis?

A

Phenoxymethylpenicillin 500mg QDS for 5-10d

71
Q

What are the requirements for a Tonsillectomy?

A

Atleast 7 episodes in the past year
OR
5 episodes each year for the past 2 years

72
Q

Give 3 complications of Tonsillitis

A

Peritonsillar Abscess
Acute Otitis Media
Guttate Psoriasis

73
Q

How does an atypical UTI present?

A

Delirium, generally unwell, elderly patient

74
Q

State some gynae differentials for UTI

A

Atrophic vaginitis
Lichen Sclerosus

75
Q

What would be relevant in the PMH of UTI presentation

A

Diabetes
Immunosupression
Neurological

76
Q

When should you culture urine when suspecting UTI?

A

If recent antibiotics
If nitrites negative on dipstick
If pregnant
If catheterised

77
Q

Give four non pharmacological managements for UTI

A

Avoid douching
Wipe back to front
Remain hydrated
Don’t delay habitual or post coital urination

78
Q

How should you treat a catheterised UTI?

A

MSU
Change catheter if in place for >7 days
7 days Nitrofurantoin

79
Q

Give four complications of a UTI

A

Pyelonephritis
Urosepsis
Kidney Failure
Perinephric abscess

80
Q

Describe an alternative to MSU

A

Clean Catch Urine - Periurethral area is cleaned first then whole catch is sent for culture and sensitivity

81
Q

Give a reason for a false positive and false negative in urine microscopy and sensitivity

A

False positive: contamination or stored at too high temperature
False negative: incorrect ratio to boric acid (as boric acid is bacteriocidal)

82
Q

How would you manage a male lower UTI?

A

7 days Nitro/Trimeth

83
Q

When would you refer a male lower UTI?

A

If ongoing symptoms despite abx

If recurrent (2 times or more within 6 months)

Persistent haematuria

84
Q

How would you manage chronic sinusitis

A

Extended course of nasal steroids (mometasone) up to 3 months
Avoiding triggers where possible
Smoking cessation

Year 3 GP (6 decks)

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