General 2 Flashcards
1
Q
Shingles medical mx (2)
A
- Antivirals if presenting within 72 hours
- if immunocompromised
- severe/moderate pain
- >50yo to reduce risk of post herpetic neuralgia - Can give steroids if immunocompromised with anti-virals
2
Q
Shingles pain mx (2)
A
- Simple analgesia
- If not effective trial amitryptiline, gabapentin or duloxetine or pregabalin
- Topical capsaicin
3
Q
Shingles counselling (8)
A
- You cannot give shingles to other people, but you can give people who have not had chickenpox, chickenpox.
- Infectious until all lesions have crusted over (usually 1 week post rash developing)
- Avoid sharing towels
- Wash hands regularly
- Loose fitting clothing
- Cover lesions that are not under clothes
- Keep clean and dry to avoid infection
- Avoid work if you cannot keep the rash covered whilst it is weeping.
4
Q
Post herpetic neuralgia general mx (3)
A
- Ice packs
- Cover areas that are particular sensitive
- Loose fitting silk/ cotton clothing
5
Q
AK one lesion mx
A
- 5-FU once daily for 4 weeks then review - wash hands after use, apply at night and wash off in the morning
- Tirbanibulin OD for 5/7
6
Q
AK multiple lesions (2)
A
- 5-FU ON for 4 weeks, to all over head, apply thinly with a gloved finger
- Imiquimod three times a week for four weeks
Consider use of HC after treatment to reduce inflammation
7
Q
Who is high risk for a fragility fracture? (6)
A
F >65yo
M >75yo
OR
All 50yo+ with
1. Previous fracture
2. Low BMI
3. Smoker
4. Use of steroids
5. Frequent faller
6. >14units of ETOH
8
Q
High risk of fragility fracture –>
A
DEXA, treat if T score less than -2.5
If greater than -2.5 modify risk factors
9
Q
Modification of RF osteoporosis (6)
A
- Smoking
- Low BMI
- ETOH >3 units
- Menopause
- Immobility
- SSRI, PPI
10
Q
Who do you offer a DEXA w/o FRAX to?
A
> 50yo with hx fragility fracture
<40yo with a major RF
Otherwise, for all other people offer Qfracture/FRAX scoring
Check calcium and vitamin D
11
Q
Interpretation of qfracture/ FRAX
A
High >10%
Intermediate close to 10%
Low <10%
12
Q
Lifestyle advice for low risk of fragility fracture (4)
When to review?
A
- Stop smoking
- Regular exercise including strength training
- Balanced diet
- Drink ETOH within recommended limits
Rv in 5 years
13
Q
If T is less than -2.5 how do you medically manage? (2)
A
- Alendronate OR risedronate (once weekly and daily in both options)
- Calcium + vitamin D replacement
14
Q
Counselling bisphosphonates - what drug, how often, how to take
A
Risedronate –> should be taken before breakfast, OR two hours before you eat something and two hours since you’ve eaten something
Alendronate –> should be taken before brekky.
Do not suck/ bite/ chew. Drank with a large glass of water as can cause ulceration. Must be in an upright position and not lay down for 30 minutes.
15
Q
Bisphosphonates counselling structure
A
- What drug, how often to take it
- How to take it and why
- Missed doses
- SE
- CI
16
Q
Bisphosphonates missed doses
A
If taken daily, skip missed dose, do not double up the next one.
If taken weekly, take it when you remember and return to original day that you take it per week, do not take two on the same day
17
Q
Bisphosphonates SE (5)
A
- Reflux - improves over time
- Osteonecrosis of the jaw (must have dentist appt before starting) - maintain oral hygiene and regular dentist appts
- Bone/ joint pain
- Oesophageal reactions (irritation, ulcers, strictures etc)
- Atypical stress fractures
18
Q
Drug interactions for bisphosphonates (3)
A
- Calcium supplements and antacids affect absorption
- Food and drink
- NSAIDs (due to gastro irritation)
19
Q
How to reduce your risk of colon cancer in general and for those with IBD? (7)
A
- Stop smoking
- High fibre diet
- Reduce your red meat
- Limit ETOH
- Take vitamin D supplement
- Physical activity
- Osteoporosis prevention
20
Q
Drugs used in Crohns?
A
- Steroids to induce remission
- AZT/ mercaptopurin/ MTX
- Adalimumab
- Mesalazine (to induce remission)
21
Q
Drugs used in UC
A
- Mesalazine to induce remission
- Steroids to induce remission
- AZT, mercap, MTX
- Infliximab
22
Q
Counselling ciprofloxacin
A
- Tendon rupture
- Long QT
- Electrolyte imbalances
- Mood changes
Warn about rare SE, stop if any muscle aches, tingling sensation in arms or legs, confusion/ anxiety/ depression
23
Q
Chronic prostatitis explanation
A
Inflammation of the prostate which can lead to symptoms of LUTS and pain in the penis/ anus/ pelvic area that come and go and last >3 months
Usually lasts 6 months, can last up to 1 year, in rarer cases it can last longer.
24
Q
Chronic prostatitis mx (7)
A
- Simple analgesia
- If LUTS - trial an alpha blocker (tamsulosin)
- CBT
- If symptoms <6 months could trial a 4-6 week course of abx (trimethoprim/ doxy BD)
- Stool softener
- Acupuncture
- Refer to urologist
25
Sudden onset, painless and progressive visual field loss, described as a shadow/ curtain from the periphery to the centre =
Retinal detachment
26
Sudden, painless reduction or loss of visual acuity, usually unilaterally, retinal haemorrhages, 'stormy sunset' =
Retinal vein occlusion
27
RF retinal vein occlusion (5)
1. Increasing age
2. HTN
3. CVD
4. Glaucoma
5. Polycythaemia
28
Retinal vein occlusion mx
1. Usually managed conservatively
2. Injections of anti-VEGF
3. Laser photocoagulation
29
sudden, painless unilateral visual loss
cherry red spot, pale disc
=
Retinal artery occlusion
30
RF central artery occlusion
1. Atherosclerosis
2. Temporal arteritis
31
Explain glaucoma
The main nerve supply to the eye (optic nerve) becomes damaged, usually due to a build up fluid thus pressure in the eye. Usually gradual and leads to a loss of peripheral vision. This is called primary open angle glaucoma.
32
Painful, red, eye with haloes, semi-dilated non-reacting pupil, dull, hazy cornea + systemic upset =
Acute angle closure glaucoma
33
Glaucoma mx (5)
1. BB - reduced aqueous humour production
2. Pilocarpine - opens trabecular meshwork and allows for increased outflow
3. IV acetozolamide
4. Steroid drops
5. Surgery
34
Explain age related macular degeneration
Affects central vision, doesn't lead to complete blindness, but can lead to difficulty in every day tasks and recognising faces.
35
RF age related macular degeneration (4)
1. Age
2. Smoking
3. FH
4. CVD
36
Floaters and cobwebs sudden loss of vision
Vitreous haemorrhage
37
A patient presents with an acute, painful red eye associated with photophobia and epiphora. Fluorescein staining reveals a ragged area on the cornea
Herpes simplex keratitis
38
An elderly short-sighted man presents with a floater on the temporal field of vision. Visual acuity is normal for the patient
posterior vitreous detachment
39
A young man presents with an acute, painful red eye associated with photophobia and blurred vision. On examination the pupil is small and irregular
Anterior uveitis
39
An elderly man presents an acute, painful red eye associated with decreased visual acuity. His symptoms are worse in the dark. On examination he has a semi-dilated non-reacting pupil
Acute angle closure glaucoma
40
An elderly female smoker presents with reduced visual acuity, complaining of 'blurred' vision. On examination there is a central scotoma and fundoscopy reveals multiple drusen
Macular degeneration
41
an elderly man with a long history of diabetes presents with sudden visual loss in one eye. For the past few days he had been experiencing floaters and 'cobwebs'. Visual acuity is reduced to sensing light
Vitreous haemorrhage
42
a woman is noted to have a unilateral mydriatic pupil which is minimally reactive to light
Holmes- Adie
43
small, irregular pupils
no response to light but there is a response to accommodate
Argyll Robertson Pupil
Accommodation reflex present
Pupillary reflex absent
44
Explain cardiomyopathy
Dilated - muscle of the heart becomes thin and stretches out, difficult to pump blood around the body
Hypertrophic - muscle becomes thickened and difficult to pump blood around the body.
It can lead to issues such as heart failure, valvular problems and irregular heartbeats.
45
What is telogen effluvium?
Diffuse hair loss with no evidence of inflammation and can impact up to 50% of the scalp.
Caused by any triggering factor such as sun exposure, acute or chronic illness, stress, an accident, discontinuation of COCP etc. Usually occurs 2-4 months after triggering event.
46
Mx telogen effluvium -->
1. Balanced healthy diet
2. Ensure thyroid, vitamin D, iron, folic acid etc are normal
3. Gentle handling of the hair
47
Female pattern hair loss mx (4)
1. No treatment
2. Topical minoxidil trial for 1 year, if not effective stop. Otherwise continue for life otherwise rebound effect. R/v at 6 months
3. Cosmetic wigs etc
4. Hair transplant
48
Alopecia areata explanation
Autoimmune condition, if mild hair loss, often has hair regrowth within a year.
Uncommon to lead to complete hair loss
But unable to cure the condition and will not know when/ if more hair loss will occur.
49
Alopecia areata mx (6)
1. Sunblock to areas
2. If you see regrowth no treatment needed
3. If minimal hair growth but not distressing can do nothing
4. Betnovate/ dermovate OD for three months (off label) (can take three months to see results)
5. If hair regrows, usually fine and depigmented before it returns to its original colour
6. Consider referral
50
Vitiligo
51
Topical steroids counselling -->
1. Skin thinning
2. Skin changes such as redness or inflammation
3. Systemic absorption if continued use which can lead to increased BP and insulin resistance
4. Acne
52
Cosmetic options for hair loss (4)
1. Hair styling - waves/ sprays/ mousses
2. Tattooing
3. Hats etc
4. Hair camouflage
53
What may a dermatologist do for alopecia? (3)
1. Intra-lesional steroids every few weeks
2. PO steroids
3. Topical minoxidil
54
Osgood Schlatter explain
Pain and tenderness around tibial tuberosity (patella)
Usually in teenage sporty boys
Quadriceps overuse causing stress on the muscle which is attached to the still growing tibia
Usually resolves within a few months, but can last up to 2 years/ when the child has finished growing.
55
Osgood Schlatter mx (3)
1. Avoid repetitive overuse
2. Ice packs pre and post
3. Physio
56
Symptoms of hypercalcaemia (4)
Aching bones
Mood swings/ depression
Renal stones
Polydipsia and polyuria
57
When to suspect multiple myeloma? (6)
Symptoms of hypercalcaemia
>60yo
Persistent bone pain (usually in the back)
Blurred vision, dizziness or headaches – caused by thickened blood (hyperviscosity)
58
Mx mulitple myeloma and explanation
Cancer of the bone marrow which produces lots of different cells in the body. Usually in men more than women over the age of 60.
Incurable, relapsing and remitting blood cancer.
Refer to haematology who will usually do a whole body MRI, may want to get a biopsy from the bone marrow.
Annual influenza and one off pneumococcal
59
What is smouldering myeloma?
Smouldering myeloma is a less severe form which requires more active monitoring.
60
Explain Hodgkin's lymphoma
Most survive, very aggressive but easily treatable cancer. Cancer of the cells in the body that fight infection. Travels through the lymph nodes/ glands/ vessels in the body.
61
Treatment myeloma (4)
1. Bisphosphonates to reduce bone disease
2. Chemo
3. Steroids
4. Blood thinners to prevent DVTs
62
How to explain IBS
We are not sure exactly what causes IBS but there are some theories around:
1. Altered brain gut signals
2. Changes to the gut microbiome
3. Psychological co-morbidity
Chronic condition with fluctuating symptoms, can be triggered by different things including stress, infection, medications and food.
63
General advice IBS (6)
1. Diet - healthy, balanced diet and adjust fibre intake according to symptoms.
2. Drinking plenty of fluids
3. If you are wanting to take a probiotic - do so for 12 weeks, if no improvement then stop
4. Regular exercise - 30 minutes of moderate exercise, x5 times per week.
5. Identify triggers
6. Reduce caffeine, ETOH, carbonated drinks
64
IBS mx if lifestyle advice has been ineffective
Refer to?
If constipated (2)
If diarrhoea (1)
For spasms (2)
Other (3)
1. Dietician referral - low FODMAP
2. If constipated - bulk forming laxative e.g ispaghula (fybogel) - rv at 3 months
3. Constipation tx failed after 12 months - trial linaclotide
4. If diarrhoea - trial loperamide rv at 3 months
5. If spasms Peppermint tea
6. OR mebeverine, rv at 3 months
7. Amitriptyline, rv and increase every 4 weeks
8. SSRI
9. IBS CBT
65
Hyperparathyroidism explained
Hyperparathyroidism is related to a gland in the neck called the parathyroid gland (x4 total). It's main purpose is to produce PTH which controls the amount of calcium in the blood. If raised PTH then increased reabsorption from the kidney, increased breakdown of bone to create more calcium and increased absorption from the gut. PTH also increased the amount of vitamin D which acts in the same way on the gut, bone and kidneys.
Raised calcium = low phosphate
66
Difference between primary and secondary hyperPTHism
1. Parathyroid tumour
2. Low vitamin D or CKD leading to
67
Painful crops of genital blisters -->
Genital herpes
68
Explain genital herpes
Two types, HSV 1 and HSV 2 --> oral and genital respectively. Transmitted from skin to skin contact/ sexual contact/ orogenital contact.
Easily spread through shedding of the skin even without lesions.
Primary infection is usually the worst/ most painful, body builds an immunity to it. Can reoccur when immune system is lowered and lesions typically last a week.
HSV dies once at room temperature, so not passed on with use of towels.
Most likely to be passed on when lesions are present, but not impossible to pass through shedding.
69
Primary herpes infection general mx (7)
1. Saline bathing to prevent infection
2. Simple analgesia
3. Avoid tight clothing
4. Can prescribe a topical lidocaine for when PU
5. Drink water to dilute PU
6. Asymptomatic shedding
7. Condom use
70
Primary herpes infection medical mx
1. Aciclovir TDS for 5/7
2. Attend sexual health clinic
71
Recurring herpes <6 episodes per year
> 6 episodes per year
1. Episodic aciclovir
2. Prophylactic aciclovir for maximum 1 year until re-review
72
2ww head and neck
1. Oral ulceration >3 weeks
2. Persistent, unexplained lump in neck
3. Red and white patch/ erythroleukoplakia.
73
Nappy rash general advice (7)
1. Appropriate fitting nappy
2. Keep nappy's off for as long as possible to allow area to breathe and not be in contact with urine/ faeces etc
3. Change nappies every 2-3 hours
4. Clean area with water, avoid fragrance/ ETOH free baby wipes
5. Don't rub vigorously
6. Bath the child daily, not more as may dry the skin
7. Avoid using soap/ bubble baths/ lotions etc
74
Nappy rash mx
1. Barrier cream - zinc or castor oil ointment
2. If red apply HC (thin layer before the thin layer of barrier cream)
3. If fungal - apply antifungal and do not use barrier cream until fungal infection has cleared.
75
Molluscum explained
Caused by poxvirus, we are not sure how to clear the virus. Can take up to two years to clear, in children usually clears within a year.
They are infectious, important to keep covered up if they are visible. Avoid scratching to prevent infection.
76
Breast pain mx (3)
When to refer? What may they offer? (2)
1. Breast pain diary
2. Well fitting bra
3. Simple analgesia
4. Failed treatment >3 months
- may offer danazol/ tamoxifen
77
Breast 2ww guidelines (2)
Consider (1)
Verusus non 2ww (2)
1. Breast lump >30yo
2. > 50yo with discharge/ retraction
Consider >30yo if lump in the axilla
1. Breast lump <30yo
2. Pain associated with lump
78
Lower GI cancer 2ww guidelines
1. 50yo >= with change in bowel habit/ IDA/
79
AAA screening programme
65yo one off US
<3 - discharge
3-4.4 - repeat in 12 months
4.5-5.4 - repeat in 3 months
>5.5 - refer
80
Bowel screening programme
Stool sample every 2 years
One off flexi sig age 55yo
Age 50-74
81
Breast screening
50-70
3 yearly mammograms
82
Cervical cancer screening
25-49 every 3 years
50-64 every 5 years
83
Cervical cancer risk factors (7)
1. Smoking
2. Multiple partners
3. Early menarche
4. Low socioeconomic BG
5. COCP
6. Increased parity
7. HPV
84
Breast cancer RF (6)
1. COCP
2. Smoking
3. FH
4. Nulliparity
5. Late menopause
6. Obesity
85
Bowel cancer RF (7)
1. IBD
2. Smoking
3. Red meat
4. Obesity
5. FH
6. Polyp
7. ETOH
86
Chilblains general mx (6)
1. Reassure resolves on its own after 2-3 weeks
2. Drying and gradually warming the skin
3. Do not apply direct heat
4. Avoid smoking
5. Avoidance of cold, damp conditions
6. Appropriate clothing/ footwear
87
Chilblains medical mx (2)
1. Nifedipine 20mg OD can up-titrate if needed until resolved
2. Check BP
88
When to suspect premature ovarian insufficiency?
What to do next?
<40yo with menopausal sx
FSH >30 x2 4-6 weeks apart
89
Menopause when to do investigations? (4)
Consider FSH if <45yo with menopausal symptoms
>45yo with atypical sx
<40yo with suspected premature ovarian insufficiency
>50yo using progestogen only contraception
90
What investigations could you do for premature ovarian insufficiency? (5)
Prolactin
TFTs
FSH
LH
Testosterone
91
Mx non hormonal mx of menopause
Mood swings (1)
Urogenital (1)
1. SSRI
2. Local oestrogen/ lubricants
92
Coeliac's investigations
Need to have eaten gluten for at least 6 weeks before testing --> check TTGA antibodies, doesn't diagnose it but will indicate if further tests are needed.
If +ve, will refer to gastro for endodscopy and biopsy to confirm
93
Coeliac's mx (5)
1. Refer to dietician
2. Check nutritional deficiencies
3. Mood
4. BMI monitoring
5. Annual bloods - Coeliac serology, ferritin, TFTs, LFT, vitamin D, B12 and folate
94
Gluten free dietary advice (3)
1. Avoid wheat, barley, rye including - breakfast cereals, bread, flour, pasta, cakes, pastries, and biscuits.
2. Sometimes people don't work well with oats either
3. Alternative sources of starch, such as corn, rice, and potatoes are ok to eat
95
Explain Coeliac's
Risks/ complications (4)
Autoimmune condition where body attacks itself - specifically the small bowel when gluten is eaten. Prevents the ability to absorb all nutrients needed.
Can cause abdominal sx but can also:
1. Rash - dermatitis herpetiformis
2. Difficulties in falling pregnant (rare) and low birth weight
3. Peripheral neuropathy
4. Increased risk of small bowel ca and lymphoma
96
Recurrent miscarriage =
>=3 miscarriages
