Community health and GP Flashcards
What is anaphylaxis?
rapid onset of type 1 IgE hypersensitivity reaction that develops after pt is exposed to something - life threatening emergency
Causes of anaphylaxis?
insect stings, nuts, other food, abx, IV contrast, other medications
Clinical features of anaphylaxis?
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
Management of anaphylaxis?
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
Mechanism of action of donepezil and rivastigmine?
Acetylcholinesterase inhibitor - increases the availability of the neurotransmitter acetylcholine
What is mechanism action of memantine and when is it used?
Glutamate receptor antagonist - used in severe alzheimer’s disease
Which drug classes commonly cause delerium in the elderly?
benzodiazepines, opiaes, antiparkinsonian agents, tricyclic antidepressants, digoxin, beta blockers, steroids, antihistamines (chlorphenamine)
What is predominant toxic protein in alzheimer’s disease?
beta-amyloid
Which form of dementia is seen frequently in motor neuron disease?
frontotemporal dementia
What is semantic memory and in which dementia is this most affected?
the ability to associate meaning to objects presented via visual or auditory modalities - frontotemporal dementia
How does normal pressure hydrocephalus present?
urinary incontinence, gait instability, cognitive chnage
definitive treatment options for normal pressure hydrocephalus
ventriculoperitoneal shunt
Mechanism of action of tricyclic antidepressants
mixture of serotonin reuptake inhibition, noradrenaline reuptake inhibition, antimuscarinic activity and anti-histamine activity
What kind of drug is paroxetine?
SSRI
Sedation is most strongly associated with which type of antipsychotic?
typical
Name 3 atypical anti-psychotics
olanzapine, clozapine, risperidone
name 3 side effects of atypical anti-psychotics
weight gain, metabolic syndrome, agranulocytosis
Cautions with tricyclics
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
side effects of tricyclic anti depressants
2nd line medication
urinary retention, drowsiness, blurred vision, constipation, dry mouth
What kind of drug is amitryptiline
tricyclic antidepressant
What is iron deficient anaemia
caused by an increased loss of iron, reduced intake or malabsorption
Causes of iron deficient anaemia
increased loss: menorrhagia, GI bleeding, hookworm
Reduced intake: poor diet
Malabsorption: coeliac, IBD
Clinical features of iron deficient anaemia
lethargy, tiredness, weakness, jaundice, heavy periods, change in bowel habit
Dx of iron deficient anaemia
clinical sx
hypochromic, microcytic red cells
total iron binding capacity (TIBC) and ferritin may confirm dx
Mx of iron deficient anaemia
unexplained - investigation for underlying cause
Ferrous sulfate supplements
What is pernicious anaemia?
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.
Causes of B12 deficiency
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
Haematological features of pernicious anaemia
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
Mx of pernicious anaemia
life-long replacement treatment with cobalamin
Features of pernicious anaemia
lethargy
fatigue
chronic condition
red beefy tongue
erythema or ulcers in mouth
What confirms dx of pernicious anaemia
Anti-intrinsic factor antibodies
What causes anaemia of chronic disease
malignancy
chronic infections - TB
connective tissues disease - RA
Pathophysiology of anaemia caused by chronic disease
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.
Investigations of anaemia of chronic disease
normocytic type, but eventually progresses to microcytic.
Low total iron binding capacity, and high ferritin.
What is thalassaemia
group of inherited disorders characterised by abnormal haemoglobin production
alpha globin and beta globin - whichever is defective results in alpha thalassaemia or beta thalassaemia
What genetic pattern if alpha thalassaemia
autosomal recessive inheritence
clinical features of alpha thalassaemia
jaundice
fatigue
facial bone deformities
dx of alpha thalassaemia
genetic testing
FBC - microcytic anaemia
mx of alpha thalassaemia
blood transfusions and stem cell transplantation
splenectomy
what pattern of inheritence is beta thalassaemia
autosomal recessive
Clinical features of beta thalassaemia minor
isolated microcytosis and mild anaemia
pts usually asymptomatic
Clinical features of beta thalassaemia major
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
mx of beta thalassaemia
regular blood transfusions
– reduce risk of iron overload toxicity; affects heart, joints, liver, endocrine glands
prevented by iron chelating agents (desferrioxamine)
Definition of haemorrhoids
occurs when cushoins within the anal canal expand and protrude outside the anal canal
Clinical features of haemorrhoids
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
Risk factors for haemorrhoids
constipation, pregnancy, space occupying lesion
mx of grade 1 haemorrhoids
no prolapse
conservatively +/- topical corticosteroid to alleviate itching
mx of grade 2 haemorrhoids
prolapse on straining
rubber band ligation, sclerotherapy or infrared photocoagulation
mx grade 3haemorrhoids
prolapse on straining and require manual reduction
rubber band ligation
mx of grade 4 haemorrhoids
prolapse on straining and can’t be manually reduced
surgical haemorrhoidectomy
pts advised to eat high fibre diet and high intake of fluids
What’s GORD
dyspepsia, heartburn, acid reflux
reflux of gastric contents into oesophagus caused by defective lower oesophageal sphincter
dx of GORD
typical sx:
dyspepsia
sensation of acid regurgitation
can trial PPI to see if improves sx
Alarm sx of GORD - may be differential
weight loss
anaemia
dysphagia
haematemesis
melana
persistant vomiting
Risk factors for GORD
obesity
alcohol use
smoking
intake of specific foods; coffee, citrus food, spicy foods, fat
Investigations of GORD
trial PPI therapy
oesophagogastroduodenoscopy (OGD) if alarm features or atypical sx or relapsing sx
oesophageal manometry
Mx of GORD
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
Complications for GORD
oesophageal ulcer
barrett’s oesophagus
oesophageal stricture
adenocarcionma of oesophagus
What is chronic kidney disease (CKD)
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
Staging of chronic kidney disease (CKD)
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
Causes of chronic kidney disease (CKD)
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
Complications of chronic kidney disease (CKD) ((CRF HEALS)
Cardiovascular disease
renal osteodystrophy
fluid (oedema)
hypertension
electrolyte disturbance (hyperkalaemia, acidosis)
anaemia
leg restlessness
sensory neuropathy
features of renal osteodystrophy
reduce bone density (osteoporosis)
reduce bone mineralisation (osteomalacia)
secondary/tertiary hyperparathyroidism
Rugger Jersey spine
Mx of chronic kidney disease (CKD)
oedema: fluid and salt restriction - diuretics: furesomide
anaema: monthly subcut erythropoeitin
hypocalacaemia and hyperphosphataemia: restrict dietary potassium
What is COPD
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)
Pathophysiology of chronic bronchitis
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
Clinical features of chronic bronchitis
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
pathophysiology of emphysema
abnormal irreversible enlargement in airspaces distal to terminal bronchioles due to destruction of walls
reduce alveolar surface area thus impeding effiecient gaseous exchange
Types of emphysema and aetiology
centriacinar - cigarette smoking
panacinar - alpha1 antitrypsin deficiency
distal acinar - fibrosis, atelectasis
clinical features of emphysema
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
Symptoms of COPD
productive cough
wheeze
dyspnoea
reduced exercise tolerance
signs of COPD
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)
Investigations of COPD
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
mx of acute exacerbation COPD
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
non-pharm management of chronic COPD
stop smoking
nutritional support
flu vaccination s
pulmonary rehabilitation
pharm mx chronic COPD
step 1: SABA / SAMA
step 2: LABA AND LAMA
step 3: LAMA AND LABA AND ICS started
step 4: specialist referral
Indications for surgery in COPD
upper lobe predominant emphysema
FEV1 >20% predicted
PaCO2 below 7.3kPa
TICO above 20% predicted
What is chronic fatigue syndrome
chronic disabling disease of reduced productivity, pts experience significant exhaustion and impairment following minimal physical or cognitive effort
dx of chronic fatigue syndrome
prolonged functional impairment, post-exertional malaise, and appropiate exclusion of differentials
Triggers for chronic fatigue syndrome
viral and bacterial infections, including EBV
Distinguishing chronic fatigue syndrome and fibromyalgia
exertional exhaustion
What’s cellulitis
bacterial soft tissue infection of dermis and subcutaneous tissue
Risk factors for cellulitis
advancing age
immunocompromised e.g diabetic
Predisposing skin condition e.g ulcers, pressure sores, trauma, lymphodema
Clinical features of cellulitis
erythema
calor (heat)
swelling
pain
poorly demarcated margins
systemic upset: fever, malaise
lymphadenopathy
often evidence of breach of skin barrier e.g trauma, ulcer
Mx of cellulitis
blood tests and culture
skin swab for culture
oral or IV abx
elevate if possible
wound debridement may be necessary
What is osteoarthritis
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
OA vs RA
OA - worse with movement and towards end of day
morning stiffness not prolonged <20mins
RA - improve with movement
morning stiffness >30mins
O/e features of osteoarthritis
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
xray features of osteoarthritis
LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
Conservative mx of osteoarthritis
weight loss and exercise
weight bearing exercise should be avoided
physiotherapy and occupational therapy
pharmalogical and surgical mx of osteoarthritis
pharm-
analegics (ladder)
intra-articular steroid injections
surgical -
joint replacement (athroplasty)
joint fusion or excision
What is psoriasis
chronic autoimmune disease characterised by well-demarcated erythematous scaly plaques
Classification of psoriasis
- chronic plaque psoriasis - commonest type - extensor surfaces
- Flexural (inverse psoriasis) - smooth, erythematous plaques without scale in felxures and skin folds
- guttate psoriasis - multiple, tear drop shaped erythematous plaques occur in trunk after streptococcal infection in young adults
- pustular psoriasis- multiple petechiae and pustules on palms and soles
- generalised/erythrodermic psoriasis - rare but serious characteriesed by erythroderma and systemic illness
Nail changes in psoriasis
nailbed pitting: superficial depressions in nailbed
oncholysis: separation of nail plate from bed
Subungual hyperkeratosis: thickening of nail bed
Risk factors for psoriasis
Skin trauma (Koebner phenomenon)
infection: strept, HIV
Drugs: beta blockers, anti-malarias, lithium, indomethacine/NSAIDs
withdrawal of steroids
stress
alcohol + smoking
cold/dry weather
Topical mx for psoriasis
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
Phototherapy for psoriasis
1st: narroband UVB
2nd: psoralen + UVA
Systemic mx for psoriasis
1st: methotrexate
2nd: ciclosporin
3rd: acitretin
Biological mx for psoriasis
inflixamab
etanercept
adalimumab
Topical steroid potencies ‘Help Every Budding Dermatologist’
Mild - hydrocortisone 0.5%
Moderate - Eumovate ( clobestasone butyrate 0.05%)
Potent - Betnovate ( betamethasone valerate 0.1% )
Very potent - Dermovate (clobetasol propionate 0.05%)
Complications of systemic therapies for psoriasis
methotrxate: can cause pneumonitis, hepatotoxicity (monitor LFTs and FBCs)
acitretin: teratogenic
Anti-TNF biologics: reactivation of latent TB
Side effects of ciclosporin (5H’s)
hypertrophy of gums
hypertrichosis
hypertension
hyperkalaemia
hyperglycaemia (diabets)
Presentation of fibromyalgia
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
Treatment for fibromyalgia
no cure
medicines; antidepressants and analgesics
talking therapies: CBT and counselling
llifestyle changes; exercise programmes and relaxation techniques
What’s folliculitis
inflammation of a hair follicle resulting in papules or pustules
Causes of folliculitis
staphylococcus aureus
gram negative
Eosinophilic folliculitis
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
Peripheral features of hypothyroidism
dry, thick skin
brittle hair
scanty secondary sexual hair
head and neck features of hypothyroidism
macroglossia
puffy face
loss of lateral third of eyebrow
goitre
cardiac features of hypothyroidism
bradycardia
cardiomegaly
neurological features of hypothyroidism
carapal tunnel syndrome
slow relaxing reflexes
cerebellar ataxia
peripheral neuropathy
autoimmune causes of hypothyroidism
hashimoto’s thyroiditis
- anti-TPO (90%)
- anti-thyroglobulin 35-60%
- anti-TSH receptor blocking 10%
atrophic thyroiditis
autoimmune polyendocrine syndromes
Iatrogenic causes of hypothyroidism
surgical
radiation
radioblation
mx of hypothyroidism
levothyroxine 1st line (to replace thyroxine)
What’s the most common cause of hypothyroidism?
iodine deficiency
What’s next best investigation for someone with Hashimoto’s thyroiditis after TSH and T3/4 tests?
thyroid peroxidase antibodies - confirms dx of hashimoto’s
Causes of primary hyperparathyroidism
parathyroid gland adenoma
hyperplasia of all 4 glands
two adenomas
parathyroid carcinoma (rare)
Signs of hyperparathyroidism
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
Causes of secondary hyperparathyroidism
vit d deficiency
loss of extracellular calcium
pancreatitis, rhabdomyolysis
hungry bone syndrome
calcium malabsorption
abnormal parathyroid hormone activity
CKD
inadequate calcium intake
What is hyperparathyroidism
excessive secretion of parathyroid hormone (PTH)
What is lichen sclerosus
inflammatory skin condition typically affects genital and anal areas
Clinical features of lichen sclerosus
white patches, may scar
itchy and sometimes pain
may be irritated during urination or during sexual intercourse
In what stage of life is lichen sclerosus most common
post menopausal women
Mx for lichen sclerosus
topical steroids
avoidance of soaps on affected areas
emollients to relieve dryness and itching
Aetiology of trichomoniasis infection
trichomonas vaginalis (flagellated protozoan)
Clinical features of trichomoniasis infection
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
dx of trichomoniasis infection
microscopy and culture
mx of trichomoniasis infection
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
What causes chlamydia
chlamydia trachomatis bacterium - obligate intracellular bacterium
most common STI
high prevalance in 15-24yr olds
Clinical features of chlamydia
asymptomatic common
common sx men: urethral discharge and dysuria
common sx women: dysuria, intermenstrual bleeding, vaginal discharge
neonates: pneumonia and conjunctivitis
dx for chlamydia
vaginal: vulvovaginal swab (self taken or clinician taken)
penile: urine or urethral swab
anal: anal swab
tx of chlamydia
oral doxycycline BD for 7 days
What is bacterial vaginosis
bacterial imbalance in vagina
overgrowth anaoreobic bacteria and loss of lactobacilli
Clinical features of bacterial vaginosis
increased vaginal discharge
grey-white watery discharge
characteristic fishy smell discharge
dx for bacterial vaginosis
amsstel criteria 3/4 features needed
vaginal pH >4.5
homogenous grey or milky discharge
positive whiff test
clue cells present on wet mount
mx for bacterial vaginosis
metronidazole or clindamycin
What is candidiasis
thrush
Risk factors for vaginal candidiasis
pregnancy
abx use
immunosuppression
Clinical features of vaginal candidiasis
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
Investigations for vaginal candidiasis
only if history is chronic of natural, and complicated
microscopy or culture
mx of vaginal candidiasis
oral -azoles (antifungal) fluconazole, itraconazole
clotrimazole pessary
topical clotrimazole cream
What is chancroid
infection of genital skin caused by haemophilus ducreyi
produces painful potentially necrotic genital lesion
painful lymphadenopathy and bleeding on contact
Mx of chancroid
abx - ceftriaxone, azithromycin, ciprofloxacin
What is primary syphilis
9-90 days after exposure
genital or perianal lesions: painless and solitary in nature,
What is secondary syphilis
4-10 weeks after infection
maculopapular symmetrical rash on palms, legs, sole of feet and face
may also be lymphadenopathy, mucosal ulcers
What is tertiary syphilis
20-40 years after primary infection
cardiovascular complications
neuro complications
Aetiology of genital herpes
herpes simplex virus
HSV-1 (now most common cause)
HSV-2
Clinical features of genital herpes (HSV)
asymptomatic
multiple painful genital ulcers
dysuria
vaginal or urethral discharge
lesions typicallly crust and heal
may have fever, malaise, headache and urinary retention
mg of genital herpes (HSV)
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
Aetiology of genital warts
human papilloma virus
serotypes 6 and 11
Clinical features of genital warts
painless lumps either keratinised or non-keratinised
mx of genital warts
depends on pt, if want treatment or not
podophyllotoxin
imiquimod
cryotherapy
trichloroacetic acid
Causes of Gonorrhoea
neisseria gonrrhoeae gram negative diplococcus
Clinical features of Gonorrhoea
men: asymptomatic, discharge, dysuria, tender inguinal nodes
women: discharge, dysuria, abnormal bleeding
dx of Gonorrhoea
vulvovagginal swab, 1st pass urine in men
microscopy: presence of monomorphic gram negative diplococci within polymorphonuclear leukocytes
NAAT
culture
mx of Gonorrhoea
abx - ceftriaxone
Complications of untreated Gonorrhoea
infertility
PID
epididymitis
increased risk of HIV and AIDs
Clinical features of HIV
mild flu-like sx 2-6 weeks after exposure
fever + lymphadenopathy
maculopapular rash on upper chest, mucosal ulcers
myalgia, arthralgia, and fatigue
Clinical features of HIV
mild flu-like sx 2-6 weeks after exposure
fever + lymphadenopathy
maculopapular rash on upper chest, mucosal ulcers
myalgia, arthralgia, and fatigue
mx of HIV
dx ELISA test
combination antiretroviral (cART)
contact tracing
what is Lymphogranuloma Venereum
STI caused by serovars L1,L2, or L3 chlamydia trachomatis
Clinical features of Lymphogranuloma Venereum
painless genital ulcer
- appears 3-12 days after infection
inguinal lymphadenopathy
proctits, rectal pain, rectal discharge
systemic features: fever, malaise
Investigations for Lymphogranuloma Venereum
PCR
Mx for Lymphogranuloma Venereum
abx
oral doxycycline 100mg BD 21 days
oral tetracycline 2g daily 21 days
oral erythromycin 500mg 4 times daily 21 days
What is error of inheriting thinking? (ethics)
when a working diagnosis is handed over and accepted without pause for consideration and determination whether it’s been substantially proven
What is error of overattachment? (ethics)
conducting tests to confirm what we expect or want to see and not ruling out other causes
What is error of bravado? (ethics)
typically working above compotence in a show of over confidence
What is error of ignorance?
unconscious imcompetence
what is QRISK used for
risk of developing heart attack or stroke in next 10 years
if risk greater than 10% prescribe statin
rhesus negative and had termination of pregnancy. When is prophylactic anti D immnoglobulin given
rhesus negative women TOP after 10 weeks gestation
commonest cause of convergent squint?
Hypermetropia
Presentation of Shingles
unilateral vesicular rash follows dermatomal distribution
rash can be painful
pain- burning
causative agent and mx of shingles
varicellar zoster virus
oral aciclovir
Naturally occuring compounds of opioids
morphine, codeine, theabine, papveraine
Semi-synthetic opioids
diamorphine (heroin)
dihydromorphine
buprenorphine
oxycodeine
Synthetic opioids
pethidine
pentanyl
methadone
