Conditions Flashcards
How would the acute abdomen present?
sudden onset, severe abdomen pain,
Pain!! may be unremitting/ radiating/ sharp/ focal/ N+V
What red flags would concern you with an acute abdomen?
bleeding - internal AAA, ruptured ectopic, peptic ulcer
peritonism - vicseral perforation?
falling vitals - tachycardia, hypotension etc
What differentials would you consider in the case of an acute abdomen?
severe pain out of proportion to signs, raised lactate - ischaemic bowel
bowel obstruction
lower right quadrant pain/ peritonism if ruptured - Appendicitis
colic - biliary causes
strangulated hernia
how would you manage an acute abdomen in general practise?
Hx and examination if possible, urine dip?
conduct A to E and determine need fro stabilisation with IV funds and then A&E if severe causes
consider referrals for admission or surgery (appendicitis)
What would you look for when assessing an unwell child?
appearance, breathing, circulation
fluid status
temperature
eating and drinking
urine output
sepsis?
How would you assess a patient presenting with SOB? what would you ask?
A : r/o obstruction, anaphylaxis, tension pneumothorax
B: RR, SATS, correct O2 needs (COPD with caution)
C: HF and pulmonary oedema?
ask about onset, duration, triggers, relieving and aggravating factors, exercise tolerance
PMH, drug hx, travel history
allergies? new pets? new changes into life?
SOB at night/ needs to prop up onto pillows?
infection? cough/ productive?
examination - CVS, resp, neuro exam, investigations like FBC for anaemia, D-dimers etc
What differentials would you be considering in a patient presenting with sob?
PULMONARY
acute asthma, COPD exacerbations, pneumonia, collapse, PE, pleural effusion, pneumothorax, lung cancer
CARDIAC
cardiac tamponade, CAD, SVT, MI, CCF, HTN
OTHER
acute blood loss, hyperventilation. anxiety, metabolic, neuromuscular, anaemia, obesity
how are you managing a patient with SOB in GP?
if saturations are low give oxygen until waiting
*assess and determine if admission required eg: asthma attack, COPD exacerbation, PE
- treat cause : anxiety, anaemia, pneumonia abx etc
- 2 week cancer referral if appropriate
- further investigations
- inhalers etc as required
How would you assess a pt with unilateral weakness in GP?
neuro exam
what differentials would you want to rule out with this presentation of uni weakness?
TIA
Bells palsy
how would you assess a pt presenting with anaphylaxis?
how would you manage???
Ambulance
how would you want to stabilise a patient before sending them to hospital?
oxygen and BP?
How might you assess back pain presenting in gp?
- ask about onset, time frame, radiation, morning stiffness
- exclude any red flags such as caudal equina symptoms, malignancy and fracture
- assess impact on day to day life
- examine gait, anal tone, neuro exam for lower limb and reflexes
- assess underlying cause
- MSK examination of affected
What differentials would you want to rule out and why in back pain?
BL leg weakness and pain, incontinence, saddle parasthesia –> caudal equina
severe central spinal pain, relieved by lying down –> spinal fracture
unremitting back pain, even at night affecting sleep, weight loss –> cancer
systemically unwell, IVDU, DM –> vertebral osteomyelitis, spinal or epidural abscess
N+V, urinary symptoms –> pyelonephritis kidney infection
how would you manage back pain ?
cause depending
- reassurance
- rest, offer sick note
- analgesia : paracetamol, IB gel or spray, physiotherapy if it gets worse
- lifestyle advice to lose weight and stop smoking
*admission with red flags
- review in 3-4 weeks if persisting
how would inflammatory joint disease present in gp?
- joint stiffness
- reduced range of motion
- red, swollen, hot to touch joint
- systemic illness like in lungs etc
- general lethargy and weakness
what differentials would you be considering for inflammatory joint disease?
RA
lupus
psoriatic arthritis
ankylosing spondylitis
psoriatic arthritis
( juvenile idiopathic arthritis )
gout
pseudo gout
how would you manage inflammatory joint disease in primary care?
*depends on cause
- anti-inflammatories such as NSAIDS
- DMARDs for RA
- physiotherapy
- MDT support
*exclude septic arthritis as risk of osteomyelitis developing
*referral to rheumatology
how would RA be presented in GP?
persistent symmetrical joint swelling (synovitis)
boggy feeling swelling, not bony
bilateral
morning weakness lasting longer than 1h
better with movement
*other symptoms like vasculitis (a rash of red, inflamed capillaries), malaise, fever, RA FH
how is RA managed and followed up in GP?
*referral to rheumatology where specialists will usually offer DMARDs 3m since onset of sympt
- regular blood checks for FBC, LFT : BM suppression
- glucocorticoids offered to treat flare ups
- ensure rapid access to specialists during flares
- drug monitoring, assess treatment targets, complications, lease with specialists
- pneumococcal and influenza vaccines
- offer help understanding of condition
When would you suspect a RA flare up?
- stiffness, joint pain, swelling, general fatigue worsening
- joint synovitis, joint tenderness, loss of joint function
- increased inflammatory markers CRP
how is OA presented in GP?
morning stiffness less than 1h or none
unilateral
functional impairment
activity related joint pain
bony swellings on joints, crepitus on movement
how Is OA managed in GP?
provide advice and support
weight loss, exercise, physio
psychological help
analgesia - topical NSAIDs
arrange referral according to clinical judgement
referral to physio, MSK clinic, OT, pain clinic and mental health help
how would osteoporosis present in GP?
what in hx would make you suspect?
- often no specific symptoms but a low impact fracture would make you suspect, loss height due to vertebral collapses
- diagnosed with a DEXA scan to measure density
- menopause, steroid use, female, older age, smoking, alcohol, previous fragility fracture, parental hx of hip fracture, high BMI