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Clinical > Community health and GP > Flashcards

Community health and GP Flashcards

1
Q

What is anaphylaxis?

A

rapid onset of type 1 IgE hypersensitivity reaction that develops after pt is exposed to something - life threatening emergency

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2
Q

Causes of anaphylaxis?

A

insect stings, nuts, other food, abx, IV contrast, other medications

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3
Q

Clinical features of anaphylaxis?

A

skin reactions: widespread urticaria, itching, flushed skin
Resp: swollen tongue/lips, sneezing, wheeze
GI: abdo pain, nausea, vomiting, diarrhoea
Tachycardia
hypotension
serum levels of mast cell tryptase can be measured to confirm dx

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4
Q

Management of anaphylaxis?

A

remove trigger
call for help
ABCDE assessment
Administer O2
Lie pt flat, raise legs
Administer adrenaline - adult dose 500mg IM
admisiter chlorophenamine and hydrocortisone
IV fluid if hypotensive

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5
Q

Mechanism of action of donepezil and rivastigmine?

A

Acetylcholinesterase inhibitor - increases the availability of the neurotransmitter acetylcholine

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6
Q

What is mechanism action of memantine and when is it used?

A

Glutamate receptor antagonist - used in severe alzheimer’s disease

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7
Q

Which drug classes commonly cause delerium in the elderly?

A

benzodiazepines, opiaes, antiparkinsonian agents, tricyclic antidepressants, digoxin, beta blockers, steroids, antihistamines (chlorphenamine)

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8
Q

What is predominant toxic protein in alzheimer’s disease?

A

beta-amyloid

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9
Q

Which form of dementia is seen frequently in motor neuron disease?

A

frontotemporal dementia

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10
Q

What is semantic memory and in which dementia is this most affected?

A

the ability to associate meaning to objects presented via visual or auditory modalities - frontotemporal dementia

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11
Q

How does normal pressure hydrocephalus present?

A

urinary incontinence, gait instability, cognitive chnage

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12
Q

definitive treatment options for normal pressure hydrocephalus

A

ventriculoperitoneal shunt

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13
Q

Mechanism of action of tricyclic antidepressants

A

mixture of serotonin reuptake inhibition, noradrenaline reuptake inhibition, antimuscarinic activity and anti-histamine activity

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14
Q

What kind of drug is paroxetine?

A

SSRI

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15
Q

Sedation is most strongly associated with which type of antipsychotic?

A

typical

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16
Q

Name 3 atypical anti-psychotics

A

olanzapine, clozapine, risperidone

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17
Q

name 3 side effects of atypical anti-psychotics

A

weight gain, metabolic syndrome, agranulocytosis

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18
Q

Cautions with tricyclics

A

CI in those with previous heart disease, exacerbate schizophrenia, may exacerbate long QT syndrome
use in caution in pregnancy and breastfeeding
may alter blood sugar in T1 and T2 diabetes
may precipitae urinary retention - avoid in men with enlarged prostates

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19
Q

side effects of tricyclic anti depressants

A

2nd line medication
urinary retention, drowsiness, blurred vision, constipation, dry mouth

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20
Q

What kind of drug is amitryptiline

A

tricyclic antidepressant

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21
Q

What is iron deficient anaemia

A

caused by an increased loss of iron, reduced intake or malabsorption

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22
Q

Causes of iron deficient anaemia

A

increased loss: menorrhagia, GI bleeding, hookworm
Reduced intake: poor diet
Malabsorption: coeliac, IBD

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23
Q

Clinical features of iron deficient anaemia

A

lethargy, tiredness, weakness, jaundice, heavy periods, change in bowel habit

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24
Q

Dx of iron deficient anaemia

A

clinical sx
hypochromic, microcytic red cells
total iron binding capacity (TIBC) and ferritin may confirm dx

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25
Q

Mx of iron deficient anaemia

A

unexplained - investigation for underlying cause
Ferrous sulfate supplements

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26
Q

What is pernicious anaemia?

A

deficiency in red blood cells caused by lack of vit b12 in blood
autoimmune condition caused by autoantibodies to gastric parietal cells which leads to gastric intrinsic factor secretion. Results in poor vit B12 absorption which leads to anaemia.

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27
Q

Causes of B12 deficiency

A

gastric causes - pernicious anaemia, chronic severe atrophic gastritis
pancreatic - any cause of pancreatic insuffiency
small bowel bacterial overgrowth, terminal ileal resection, severe ileal disease (Crohn’s disease)
TB
Metformin therapy
Zollinger-Ellison syndrome
thyroid disease

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28
Q

Haematological features of pernicious anaemia

A

low hb
high MCV
high mean corpuscular haemoglobin (MCH)
normal mean corpuscular haem concentration (MCHC)
abnormally large and oval shaped RBCs in blood smear
Low vitB12
Low or normal folic acid
low reticulyte count

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29
Q

Mx of pernicious anaemia

A

life-long replacement treatment with cobalamin

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30
Q

Features of pernicious anaemia

A

lethargy
fatigue
chronic condition
red beefy tongue
erythema or ulcers in mouth

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31
Q

What confirms dx of pernicious anaemia

A

Anti-intrinsic factor antibodies

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32
Q

What causes anaemia of chronic disease

A

malignancy
chronic infections - TB
connective tissues disease - RA

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33
Q

Pathophysiology of anaemia caused by chronic disease

A

chronic disease causes formation of inflammatory cytokines such as IL-1 and IL-6. high levels of LH-6 stimulates hepcidin release from liver, which inhibitory in iron absorption, decreasing activity of ferropotin- iron export channel of basolateral surface of gut enterocytes and plasma membrane of reticuloendothelial cells (macrophages), so haemo production decreases.

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34
Q

Investigations of anaemia of chronic disease

A

normocytic type, but eventually progresses to microcytic.
Low total iron binding capacity, and high ferritin.

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35
Q

What is thalassaemia

A

group of inherited disorders characterised by abnormal haemoglobin production
alpha globin and beta globin - whichever is defective results in alpha thalassaemia or beta thalassaemia

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36
Q

What genetic pattern if alpha thalassaemia

A

autosomal recessive inheritence

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37
Q

clinical features of alpha thalassaemia

A

jaundice
fatigue
facial bone deformities

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38
Q

dx of alpha thalassaemia

A

genetic testing
FBC - microcytic anaemia

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39
Q

mx of alpha thalassaemia

A

blood transfusions and stem cell transplantation
splenectomy

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40
Q

what pattern of inheritence is beta thalassaemia

A

autosomal recessive

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41
Q

Clinical features of beta thalassaemia minor

A

isolated microcytosis and mild anaemia
pts usually asymptomatic

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42
Q

Clinical features of beta thalassaemia major

A

severe symptomatic anaemia at 3-9months age when foetal haemoglobin levels fall.
frontal bossing
maxillary overgrowth
extramedullary haematopoiesis (hepatosplenomegaly)
prognosis - death by heart failure if undiagnosed

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43
Q

mx of beta thalassaemia

A

regular blood transfusions
– reduce risk of iron overload toxicity; affects heart, joints, liver, endocrine glands
prevented by iron chelating agents (desferrioxamine)

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44
Q

Definition of haemorrhoids

A

occurs when cushoins within the anal canal expand and protrude outside the anal canal

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45
Q

Clinical features of haemorrhoids

A

bright red PR bleeding associated with defecation
no pain usually
anal itching or a mass may be felt

o/e: palpable anal mass present in prolapsing haemorrhoids

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46
Q

Risk factors for haemorrhoids

A

constipation, pregnancy, space occupying lesion

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47
Q

mx of grade 1 haemorrhoids

A

no prolapse
conservatively +/- topical corticosteroid to alleviate itching

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48
Q

mx of grade 2 haemorrhoids

A

prolapse on straining
rubber band ligation, sclerotherapy or infrared photocoagulation

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49
Q

mx grade 3haemorrhoids

A

prolapse on straining and require manual reduction
rubber band ligation

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50
Q

mx of grade 4 haemorrhoids

A

prolapse on straining and can’t be manually reduced
surgical haemorrhoidectomy
pts advised to eat high fibre diet and high intake of fluids

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51
Q

What’s GORD

A

dyspepsia, heartburn, acid reflux
reflux of gastric contents into oesophagus caused by defective lower oesophageal sphincter

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52
Q

dx of GORD

A

typical sx:
dyspepsia
sensation of acid regurgitation
can trial PPI to see if improves sx

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53
Q

Alarm sx of GORD - may be differential

A

weight loss
anaemia
dysphagia
haematemesis
melana
persistant vomiting

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54
Q

Risk factors for GORD

A

obesity
alcohol use
smoking
intake of specific foods; coffee, citrus food, spicy foods, fat

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55
Q

Investigations of GORD

A

trial PPI therapy
oesophagogastroduodenoscopy (OGD) if alarm features or atypical sx or relapsing sx
oesophageal manometry

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56
Q

Mx of GORD

A

lifestyle interventions - weight loss, dietary changes, elevation of head in bed at night, avoidance of late night eating
PPI therapy - pts <40 standard dose PPI for 8 weeks in combination of lifestyle changes
antacids for symptomatic relief
anti-reflux surgery for refractory cases

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57
Q

Complications for GORD

A

oesophageal ulcer
barrett’s oesophagus
oesophageal stricture
adenocarcionma of oesophagus

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58
Q

What is chronic kidney disease (CKD)

A

gradual, irreversible decline in kidney function. Criteria:
either decreased GFR (below 60ml/min/1.73m2) or markers of kidney damage (albuminuria, electrolyte abnormality, structural or histological renal abrnomalities) present for >3months

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59
Q

Staging of chronic kidney disease (CKD)

A

stage 1: eGFR >90ml/min/1.73m2 with demonstatable kidney damage (haematuria or proteinuria)
stage 2: eGFR 60-89 with haematuria, proteinuria, or raised albumin/creatinine ration
stage 3: eGFR 30-59
stage 4: 15-30
stage 5: <15

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60
Q

Causes of chronic kidney disease (CKD)

A

glomerular causes: primary (IgA nephropathy) or secondary (SLE (lupus))
vascular: vasculitis, renal artery stenosis
Tubulointerstitial: amyloidosis, myeloma
Congenital: Polycystic kidney disease and Alport syndrome
Systemic: diabetes, hypertension
Developmental: vesico-uteric reflux causing chronic pyelonephritis

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61
Q

Complications of chronic kidney disease (CKD) ((CRF HEALS)

A

Cardiovascular disease
renal osteodystrophy
fluid (oedema)
hypertension
electrolyte disturbance (hyperkalaemia, acidosis)
anaemia
leg restlessness
sensory neuropathy

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62
Q

features of renal osteodystrophy

A

reduce bone density (osteoporosis)
reduce bone mineralisation (osteomalacia)
secondary/tertiary hyperparathyroidism
Rugger Jersey spine

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63
Q

Mx of chronic kidney disease (CKD)

A

oedema: fluid and salt restriction - diuretics: furesomide
anaema: monthly subcut erythropoeitin
hypocalacaemia and hyperphosphataemia: restrict dietary potassium

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64
Q

What is COPD

A

irreversible obstruction of airways. Comprises of both chronic bronchitis (hypertrophy and hyperplasia of mucus glands in bronchi) and emphysema (enlargement of air spaces and destruction of alveolar walls)

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65
Q

Pathophysiology of chronic bronchitis

A

chronic exposure to noxious particles; smoking, air pollutants cause hypersectretions of mucus in large and small bronchi
airway inflammation and fibrotic changes result in narrowing of airways and subsequent;y airway obstruction

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66
Q

Clinical features of chronic bronchitis

A

chronic productive cough at least 3 months in at least 2 consequetive years without other identifiable causes
purulent sputum production
hypoxia
hypercapnia
exertional dyspnoea
cyanosis (blue bloaters)
peripheral oedema secondary to cor pulmonae

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67
Q

pathophysiology of emphysema

A

abnormal irreversible enlargement in airspaces distal to terminal bronchioles due to destruction of walls
reduce alveolar surface area thus impeding effiecient gaseous exchange

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68
Q

Types of emphysema and aetiology

A

centriacinar - cigarette smoking
panacinar - alpha1 antitrypsin deficiency
distal acinar - fibrosis, atelectasis

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69
Q

clinical features of emphysema

A

carbon dioxide retention
pursed lip breathing exertional dyspnoea
use of acessory muscles in breathing
barrel chest (hyperextended)
hyperresonant chest on percussion
sits forward in hunch over position

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70
Q

Symptoms of COPD

A

productive cough
wheeze
dyspnoea
reduced exercise tolerance

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71
Q

signs of COPD

A

acessory muscle use
tachypnoea
hyperinflation
reduction of cricosternal distance
reduced chest expansion
hyper-resonant percussion
decreased/quiet breath sounds
wheeze
cyanosis
cor pulomae (sign of R sided heart failure)

72
Q

Investigations of COPD

A

spirometry - FEV1 <80% predicted, FEV1/FVC <0.7
stage 1: FEV1 >80%
stage 2: FEV1 50-79%
stage 3: FEV1 30-49%
stage 4: FEV1 <30%

bloods: FBC (raised PCV: polycythaemia), ABG (reduced PaO2 +/- raised PaCO2 or type 2 resp failure)
ECG: P-pulmonae, right ventricular hypertrophy
Chest xray: hyperinflated chest, bullae, decreased peripheral vascular markings, flattened hemidiaphragms

73
Q

mx of acute exacerbation COPD

A

patent airway
O2 88-92%
nebulisers: salbutamol, ipratropium
steroids: oral prednisolone, IV hydrocortisone (if severe)
Abx if infection present
ITU input if pt doesnt improve

74
Q

non-pharm management of chronic COPD

A

stop smoking
nutritional support
flu vaccination s
pulmonary rehabilitation

75
Q

pharm mx chronic COPD

A

step 1: SABA / SAMA
step 2: LABA AND LAMA
step 3: LAMA AND LABA AND ICS started
step 4: specialist referral

76
Q

Indications for surgery in COPD

A

upper lobe predominant emphysema
FEV1 >20% predicted
PaCO2 below 7.3kPa
TICO above 20% predicted

77
Q

What is chronic fatigue syndrome

A

chronic disabling disease of reduced productivity, pts experience significant exhaustion and impairment following minimal physical or cognitive effort

78
Q

dx of chronic fatigue syndrome

A

prolonged functional impairment, post-exertional malaise, and appropiate exclusion of differentials

79
Q

Triggers for chronic fatigue syndrome

A

viral and bacterial infections, including EBV

80
Q

Distinguishing chronic fatigue syndrome and fibromyalgia

A

exertional exhaustion

81
Q

What’s cellulitis

A

bacterial soft tissue infection of dermis and subcutaneous tissue

82
Q

Risk factors for cellulitis

A

advancing age
immunocompromised e.g diabetic
Predisposing skin condition e.g ulcers, pressure sores, trauma, lymphodema

83
Q

Clinical features of cellulitis

A

erythema
calor (heat)
swelling
pain
poorly demarcated margins
systemic upset: fever, malaise
lymphadenopathy
often evidence of breach of skin barrier e.g trauma, ulcer

84
Q

Mx of cellulitis

A

blood tests and culture
skin swab for culture
oral or IV abx
elevate if possible
wound debridement may be necessary

85
Q

What is osteoarthritis

A

wear and tear of joints
onset over months/years
joint pain and stiffness in elderly
large, weight bearing joints usually affected: knee, hip, lumbar spine
distal and proximal interphalangeal joints of hands

86
Q

OA vs RA

A

OA - worse with movement and towards end of day
morning stiffness not prolonged <20mins

RA - improve with movement
morning stiffness >30mins

87
Q

O/e features of osteoarthritis

A

architecture of joints may be damaged, display reduced ROM & fixed deformity
slight swelling over joint, not hot or red
crepitus may be felt
Herbeden’s (distal interphalangeal) and Bouchard’s (proximal) nodes may be seen or felt

88
Q

xray features of osteoarthritis

A

LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

89
Q

Conservative mx of osteoarthritis

A

weight loss and exercise
weight bearing exercise should be avoided
physiotherapy and occupational therapy

90
Q

pharmalogical and surgical mx of osteoarthritis

A

pharm-
analegics (ladder)
intra-articular steroid injections

surgical -
joint replacement (athroplasty)
joint fusion or excision

91
Q

What is psoriasis

A

chronic autoimmune disease characterised by well-demarcated erythematous scaly plaques

92
Q

Classification of psoriasis

A
  1. chronic plaque psoriasis - commonest type - extensor surfaces
  2. Flexural (inverse psoriasis) - smooth, erythematous plaques without scale in felxures and skin folds
  3. guttate psoriasis - multiple, tear drop shaped erythematous plaques occur in trunk after streptococcal infection in young adults
  4. pustular psoriasis- multiple petechiae and pustules on palms and soles
  5. generalised/erythrodermic psoriasis - rare but serious characteriesed by erythroderma and systemic illness
93
Q

Nail changes in psoriasis

A

nailbed pitting: superficial depressions in nailbed
oncholysis: separation of nail plate from bed
Subungual hyperkeratosis: thickening of nail bed

94
Q

Risk factors for psoriasis

A

Skin trauma (Koebner phenomenon)
infection: strept, HIV
Drugs: beta blockers, anti-malarias, lithium, indomethacine/NSAIDs
withdrawal of steroids
stress
alcohol + smoking
cold/dry weather

95
Q

Topical mx for psoriasis

A

emollient - reduce scale and itch
1st: potent topical corticosteroid OD e.g Betnovate + topical vit D OD (Dovonex)
2nd: stop topical corticosteroid and apply topical vit D twice daily
3rd: stop topical vt D, apply potent top corticosteroid BD
4th: dithranol

96
Q

Phototherapy for psoriasis

A

1st: narroband UVB
2nd: psoralen + UVA

97
Q

Systemic mx for psoriasis

A

1st: methotrexate
2nd: ciclosporin
3rd: acitretin

98
Q

Biological mx for psoriasis

A

inflixamab
etanercept
adalimumab

99
Q

Topical steroid potencies ‘Help Every Budding Dermatologist’

A

Mild - hydrocortisone 0.5%
Moderate - Eumovate ( clobestasone butyrate 0.05%)
Potent - Betnovate ( betamethasone valerate 0.1% )
Very potent - Dermovate (clobetasol propionate 0.05%)

100
Q

Complications of systemic therapies for psoriasis

A

methotrxate: can cause pneumonitis, hepatotoxicity (monitor LFTs and FBCs)
acitretin: teratogenic
Anti-TNF biologics: reactivation of latent TB

101
Q

Side effects of ciclosporin (5H’s)

A

hypertrophy of gums
hypertrichosis
hypertension
hyperkalaemia
hyperglycaemia (diabets)

102
Q

Presentation of fibromyalgia

A

chronic widespread body pain and comorbid sx including fatigue, mood and sleep difficulties
at least 3 months 11/18 tenderpoints on examination
comorbid with rheumatological conditions

103
Q

Treatment for fibromyalgia

A

no cure
medicines; antidepressants and analgesics
talking therapies: CBT and counselling
llifestyle changes; exercise programmes and relaxation techniques

104
Q

What’s folliculitis

A

inflammation of a hair follicle resulting in papules or pustules

105
Q

Causes of folliculitis

A

staphylococcus aureus
gram negative

106
Q

Eosinophilic folliculitis

A

sterile folliculitis caused by immunosuppression, most commonly due to HIV
diagnosis by skin biopsy which reveals eosinophils on surface
Treatment is HAART and topical corticosteroids

107
Q

Peripheral features of hypothyroidism

A

dry, thick skin
brittle hair
scanty secondary sexual hair

108
Q

head and neck features of hypothyroidism

A

macroglossia
puffy face
loss of lateral third of eyebrow
goitre

109
Q

cardiac features of hypothyroidism

A

bradycardia
cardiomegaly

110
Q

neurological features of hypothyroidism

A

carapal tunnel syndrome
slow relaxing reflexes
cerebellar ataxia
peripheral neuropathy

111
Q

autoimmune causes of hypothyroidism

A

hashimoto’s thyroiditis
- anti-TPO (90%)
- anti-thyroglobulin 35-60%
- anti-TSH receptor blocking 10%
atrophic thyroiditis
autoimmune polyendocrine syndromes

112
Q

Iatrogenic causes of hypothyroidism

A

surgical
radiation
radioblation

113
Q

mx of hypothyroidism

A

levothyroxine 1st line (to replace thyroxine)

114
Q

What’s the most common cause of hypothyroidism?

A

iodine deficiency

115
Q

What’s next best investigation for someone with Hashimoto’s thyroiditis after TSH and T3/4 tests?

A

thyroid peroxidase antibodies - confirms dx of hashimoto’s

116
Q

Causes of primary hyperparathyroidism

A

parathyroid gland adenoma
hyperplasia of all 4 glands
two adenomas
parathyroid carcinoma (rare)

117
Q

Signs of hyperparathyroidism

A

Moans, stones, groans and bones

painful bones
renal stones
abdominal groans; abdo discomfort, nausea, vomiting, constipation, indigestion
moans: lethargy, fatugue, memory loss, psychosis, depression, poor concentration

118
Q

Causes of secondary hyperparathyroidism

A

vit d deficiency
loss of extracellular calcium

pancreatitis, rhabdomyolysis
hungry bone syndrome

calcium malabsorption
abnormal parathyroid hormone activity

CKD

inadequate calcium intake

119
Q

What is hyperparathyroidism

A

excessive secretion of parathyroid hormone (PTH)

120
Q

What is lichen sclerosus

A

inflammatory skin condition typically affects genital and anal areas

121
Q

Clinical features of lichen sclerosus

A

white patches, may scar
itchy and sometimes pain
may be irritated during urination or during sexual intercourse

122
Q

In what stage of life is lichen sclerosus most common

A

post menopausal women

123
Q

Mx for lichen sclerosus

A

topical steroids
avoidance of soaps on affected areas
emollients to relieve dryness and itching

124
Q

Aetiology of trichomoniasis infection

A

trichomonas vaginalis (flagellated protozoan)

125
Q

Clinical features of trichomoniasis infection

A

transmission usually sexual, incubation period 7days
sx women: asymptomatic, profuse yellow frothy discharge, vulval irritation, dyspareuria
sx men: non gonococcal urthretitis, can be asymptomatic

o/e women: normal, strawberry cervix rare sign

126
Q

dx of trichomoniasis infection

A

microscopy and culture

127
Q

mx of trichomoniasis infection

A

oral metronisazole 400-500mg BD 5-7 days, or 2g as single oral dose
abstain from sex atleast 1 week
screen for other STIs
contact tracing

128
Q

What causes chlamydia

A

chlamydia trachomatis bacterium - obligate intracellular bacterium
most common STI
high prevalance in 15-24yr olds

129
Q

Clinical features of chlamydia

A

asymptomatic common
common sx men: urethral discharge and dysuria
common sx women: dysuria, intermenstrual bleeding, vaginal discharge

neonates: pneumonia and conjunctivitis

130
Q

dx for chlamydia

A

vaginal: vulvovaginal swab (self taken or clinician taken)
penile: urine or urethral swab
anal: anal swab

131
Q

tx of chlamydia

A

oral doxycycline BD for 7 days

132
Q

What is bacterial vaginosis

A

bacterial imbalance in vagina
overgrowth anaoreobic bacteria and loss of lactobacilli

133
Q

Clinical features of bacterial vaginosis

A

increased vaginal discharge
grey-white watery discharge
characteristic fishy smell discharge

134
Q

dx for bacterial vaginosis

A

amsstel criteria 3/4 features needed
vaginal pH >4.5
homogenous grey or milky discharge
positive whiff test
clue cells present on wet mount

135
Q

mx for bacterial vaginosis

A

metronidazole or clindamycin

136
Q

What is candidiasis

A

thrush

137
Q

Risk factors for vaginal candidiasis

A

pregnancy
abx use
immunosuppression

138
Q

Clinical features of vaginal candidiasis

A

itching, white curdy or lumpy discharge, sour milk odour, dysuria, pruritis, tenderness, burning sensation

o/e women: redness, fissuring, swelling, interigo, thick white discharge
o/e men: dry dull red glazed plaquies and papules

139
Q

Investigations for vaginal candidiasis

A

only if history is chronic of natural, and complicated

microscopy or culture

140
Q

mx of vaginal candidiasis

A

oral -azoles (antifungal) fluconazole, itraconazole
clotrimazole pessary
topical clotrimazole cream

141
Q

What is chancroid

A

infection of genital skin caused by haemophilus ducreyi

produces painful potentially necrotic genital lesion
painful lymphadenopathy and bleeding on contact

142
Q

Mx of chancroid

A

abx - ceftriaxone, azithromycin, ciprofloxacin

143
Q

What is primary syphilis

A

9-90 days after exposure
genital or perianal lesions: painless and solitary in nature,

144
Q

What is secondary syphilis

A

4-10 weeks after infection
maculopapular symmetrical rash on palms, legs, sole of feet and face
may also be lymphadenopathy, mucosal ulcers

145
Q

What is tertiary syphilis

A

20-40 years after primary infection
cardiovascular complications
neuro complications

146
Q

Aetiology of genital herpes

A

herpes simplex virus
HSV-1 (now most common cause)
HSV-2

147
Q

Clinical features of genital herpes (HSV)

A

asymptomatic
multiple painful genital ulcers
dysuria
vaginal or urethral discharge
lesions typicallly crust and heal
may have fever, malaise, headache and urinary retention

148
Q

mg of genital herpes (HSV)

A

aciclovir 400mg 3 times daily for 5 days

valaciclovir 500mg twice daily for 5 days
Aciclovir 200mg 5 times a day for 5 days
famciclovir 250mg 3 times a day for 5 days

analgesics - topical lidocaine for sx relief

149
Q

Aetiology of genital warts

A

human papilloma virus
serotypes 6 and 11

150
Q

Clinical features of genital warts

A

painless lumps either keratinised or non-keratinised

151
Q

mx of genital warts

A

depends on pt, if want treatment or not

podophyllotoxin
imiquimod
cryotherapy
trichloroacetic acid

152
Q

Causes of Gonorrhoea

A

neisseria gonrrhoeae gram negative diplococcus

153
Q

Clinical features of Gonorrhoea

A

men: asymptomatic, discharge, dysuria, tender inguinal nodes
women: discharge, dysuria, abnormal bleeding

154
Q

dx of Gonorrhoea

A

vulvovagginal swab, 1st pass urine in men

microscopy: presence of monomorphic gram negative diplococci within polymorphonuclear leukocytes
NAAT
culture

155
Q

mx of Gonorrhoea

A

abx - ceftriaxone

156
Q

Complications of untreated Gonorrhoea

A

infertility
PID
epididymitis
increased risk of HIV and AIDs

157
Q

Clinical features of HIV

A

mild flu-like sx 2-6 weeks after exposure
fever + lymphadenopathy
maculopapular rash on upper chest, mucosal ulcers
myalgia, arthralgia, and fatigue

157
Q

Clinical features of HIV

A

mild flu-like sx 2-6 weeks after exposure
fever + lymphadenopathy
maculopapular rash on upper chest, mucosal ulcers
myalgia, arthralgia, and fatigue

158
Q

mx of HIV

A

dx ELISA test

combination antiretroviral (cART)
contact tracing

159
Q

what is Lymphogranuloma Venereum

A

STI caused by serovars L1,L2, or L3 chlamydia trachomatis

160
Q

Clinical features of Lymphogranuloma Venereum

A

painless genital ulcer
- appears 3-12 days after infection
inguinal lymphadenopathy
proctits, rectal pain, rectal discharge
systemic features: fever, malaise

161
Q

Investigations for Lymphogranuloma Venereum

A

PCR

162
Q

Mx for Lymphogranuloma Venereum

A

abx
oral doxycycline 100mg BD 21 days
oral tetracycline 2g daily 21 days
oral erythromycin 500mg 4 times daily 21 days

163
Q

What is error of inheriting thinking? (ethics)

A

when a working diagnosis is handed over and accepted without pause for consideration and determination whether it’s been substantially proven

164
Q

What is error of overattachment? (ethics)

A

conducting tests to confirm what we expect or want to see and not ruling out other causes

165
Q

What is error of bravado? (ethics)

A

typically working above compotence in a show of over confidence

166
Q

What is error of ignorance?

A

unconscious imcompetence

167
Q

what is QRISK used for

A

risk of developing heart attack or stroke in next 10 years
if risk greater than 10% prescribe statin

168
Q

rhesus negative and had termination of pregnancy. When is prophylactic anti D immnoglobulin given

A

rhesus negative women TOP after 10 weeks gestation

169
Q

commonest cause of convergent squint?

A

Hypermetropia

170
Q

Presentation of Shingles

A

unilateral vesicular rash follows dermatomal distribution
rash can be painful
pain- burning

171
Q

causative agent and mx of shingles

A

varicellar zoster virus

oral aciclovir

172
Q

Naturally occuring compounds of opioids

A

morphine, codeine, theabine, papveraine

173
Q

Semi-synthetic opioids

A

diamorphine (heroin)
dihydromorphine
buprenorphine
oxycodeine

174
Q

Synthetic opioids

A

pethidine
pentanyl
methadone

Clinical (12 decks)

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