General Practice Flashcards
What is the definitive test for giant cell arteritis?
Temporal artery biopsy
It is not ‘first line’ and treatment would not be delayed while awaiting biopsy in a patient with suspected giant cell arteritis
Define arteritis
Pain and swelling in blood vessels
What is the first line investigation for giant cell arteritis?
Inflammatory markers, particularly ESR
The definitive investigation for giant cell arteritis is temporal artery biopsy. Why should quite a large section of the artery (3-5cm) be biopsied?
Due to the presence of skip lesions i.e the lesions are segmental and tend to skip parts of the artery
For the same reason a negative biopsy does not rule out giant cell arteritis
Giant cell arteritis should be treated immediately with what?
High dose steroids
Why is it important to treat giant cell arteritis with high dose steroids straight away?
To prevent blindness and stroke
What is the first line management of acute migraine attack
Oral triptan such as Sumatriptan AND Paracetamol or NSAID
White, creamy vaginal discharge with associated itching is pathognomonic of what condition?
Vaginal candidiasis
Bacterial vaginosis typically would not have itching or soreness
White vaginal discharge with no associated itching is pathognomonic of what condition?
Bacterial vaginosis
Vaginal candidiasis typically would have itching and/or soreness
For the copper intrauterine device (IUD) to be a suitable method of emergency contraception it needs to be inserted:
A) How may days after unprotected sexual intercourse?
OR
B) Up to how many days after the likely ovulation date
5 days for each
Suitable method if inserted 5 days after the unprotected sexual intercourse
OR
Up to 5 days after the likely ovulation date - roughly day 14-18 as ovulation is 14 days before the next cycle (28-14 = 14)
What is the best HRT regimen for this case:
Uterus in situ
Last menstrual cycle at least 1 year previous
Continuous combined HRT
Continuous is required in women who have ceased menstruating for over 1 year.
Combined is required for anyone who has a uterus as it contains an oestrogen to relieve symptoms, alongside a progestogen to protect the endometrium from hyperplasia
What is the best HRT regimen for this case:
Uterus in situ
Last menstrual cycle within the past year
Cyclical combined HRT
Cyclical is used in women who have last menstruated less than 1 year ago
Combined is required for anyone who has a uterus as it contains an oestrogen to relieve symptoms, alongside a progestogen to protect the endometrium from hyperplasia
Name some of the side effects of the oestrogen component of HRT
Breast tenderness
Leg cramps
Bloating
Nausea
Headaches
Name some of the side effects of the progesterone component of HRT
Premenstrual syndrome-like symptoms such as:
Mood swings
Breast tenderness
Backache
Depression
Pelvic pain
Fluid retention
Weight gain
Name some of the contraindications of HRT
Breast cancer
Oestrogen-dependent cancers
History of unprovoked venous thromboembolism (VTE)
Current VTE unless on anticoagulation
Thrombophilic disorders
Pregnancy
Active liver disease
Likely Dx:
Painless fresh red rectal bleeding that is not mixed in with the stool
Haemorrhoids
Haemorrhoids are engorged blood vessels around the anus
Likely Dx:
Painful fresh red rectal bleeding that is not mixed in with the stool
Anal fissure
When is it recommended to not have a pill-free contraceptive pill week in a month in regards to missed pills
Only suggested if two or more pills are missed during the 3rd week of the cycle
Migraine with aura is an absolute contraindication (UKMEC 4) for which type of contraceptive pill
Combined oral contraceptive pill
Name the risk factors for nasopharyngeal carcinoma
Male sex
Hx of glandular fever (Epstein–Barr virus)
Significant smoking history
What is the most common pathogen to cause urinary-tract infections (UTIs)
Escherichia coli
On what day of the menstrual cycle can the combined oral contraceptive pill be started that it gives protected from pregnancy immediately
First day of the period
What advise should you give a patient regarding contraception if they want to start the combined oral contraceptive pill on any after of her cycle except the first day of her period
Start the COCP and advise the use of additional precautions e.g. barrier contraception, for the next 7 days
When can women take the combined oral contraceptive pill postpartum if they are not breastfeeding
Can start taking it from 21 days after giving birth
What is the primary mechanism of action of the progesterone only pill (POP)
Thickening of the cervical mucus and thinning of the endometrium.
Thickening of the cervical mucus prevents sperm reaching the egg.
Whilst the thinning of the endometrium prevents implantation
What is the primary mechanism of action of the copper intrauterine device (IUD)
Makes the uterus toxic to sperm
IUD releases copper ions which is toxic to sperm, preventing fertilisation
What are the three diagnostic factors per NICE guidelines for stable angina
1) Pain precipitated by physical exertion
2) Constricting discomfort in the front of the chest, in the neck, shoulders, jaw, or arms
3) Pain relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes
Smoking more than how many cigarettes a day is an absolute contraindication for the combined oral contraceptive pill
Smoker over the age of 35 who smokes >15 cigarettes
What pharmacological agent may be offered to help with stress incontinence
Duloxetine (only if conservation measures are not useful)
SID - stress incontinence duloxetine
Define Stress incontinence
This involves leaking of urine when intra-abdominal pressure is raised, putting pressure on the bladder. The pressure of the urine overcomes the mechanisms designed to maintain continence
Define urge incontience
Sudden and involuntary loss of urine associated with urgency.
What is the first line management option for stress incontinence
Conservative management
General lifestyle advice such as avoiding caffeine, fizzy and sugary drinks
Pelvic floor exercises (useful for stress and urge incontinence)
What is the first line management option for urge incontinence
Conservative management
General lifestyle advice such as avoiding caffeine, fizzy and sugary drinks
Pelvic floor exercises (useful for stress and urge incontinence)
What pharmacological agent may be offered to help with urge incontinence if conservative options are not useful
Anticholinergic medications e.g. Oxybutynin
UAE - Urge AnticholinErgic
Helps reduce the symptoms of urge and overactive bladder by inhibiting the parasympathetic action on the detrusor muscle
Define functional incontinence
Having the urge to pass urine, but for whatever reason they’re unable to access the necessary facilities and as a result are incontinent.
What are the 5 types of urinary incontinence
1) Stress incontinence
2) Urge incontinence
3) Overflow incontinence
4) Functional incontinence
5) Mixed incontinence
What are the 5 causes of microcytic anaemia
TAILS:
Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia
What is the first line antibiotic cellulitis
Flucloxacillin
If penicillin allergic - doxycycline or macrolides such as clarithromycin or erythromycin
Likely Dx:
Preceding herald patch - a single, large, discoid (coin-shaped), erythematous patch
A few days later a widespread rash appears across the trunk consisting of multiple small, erythematous, scaly patches. These lesions are classically distributed across the trunk in a ‘christmas tree’ pattern.
Pityriasis rosea
Treatment for Pityriasis rosea
Self-limiting and benign
Often occurs after an upper respiratory tract infection and is thought to have a viral cause
What medication do you give immediately if you suspect bacterial meningitis in the community
IM benzylpenicillin pending hospital transfer
What is the treatment for lower urinary tract infection in a male
Either trimethoprim or nitrofurantoin for 7 days
Chronic asthma is treated in a stepwise approach based on BTS Guidelines.
What is step 1?
Short-acting inhaled B2-agonist (SABA) eg. Salbutamol
Chronic asthma is treated in a stepwise approach based on BTS Guidelines.
SABA only is not managing the symptoms.
What is the next step?
Add low-dose inhaled corticosteroid steroid (ICS)
SABA + ICS
Chronic asthma is treated in a stepwise approach based on BTS Guidelines.
SABA + LABA is not managing the symptoms.
What is the next step?
Add oral leukotriene receptor antagonist
SABA + ICS + LTRA
Chronic asthma is treated in a stepwise approach based on BTS Guidelines.
SABA + ICS + LTRA is not managing all the symptoms but they do have some symptomatic benefit of LTRA.
What is the next step?
Add long-acting B2-agonist (LABA) eg. Salmeterol
Review LTRA (can be kept if beneficial)
What is the recommended units of alcohol per week a man or woman can drink?
84%
No more than 14 units per week for men and women
What is the first line antidepressant in children
Fluoxetine
What is the first line antidepressant in severe depression in adults
Selective serotonin-reuptake inhibitor (SSRI) such as citalopram
What is most common cause of post-coital bleeding in premenopausal women
Ectropion
An ectropion appears as a bright red area surrounding the cervical os, which is areas of columnar epithelium on the ectocervix at the transformation zone. These cell changes are triggered by hormonal changes that may occur in pregnancy, during ovulation or secondary to the combined oral contraceptive pill
Which emergency contraception is contraindicated in severe asthma (needing oral steroid treatment)
Ulipristal acetate (ellaOne)
Melasma usually presents as which one:
A) hyperpigmented brown or grey areas
B) Hypopigmented pale areas
Melasma usually presents as hyperpigmented brown or grey areas
Associated with increased sun exposure and medications like NSAIDs and oral contraceptives
Vitiligo does what to the skin?
depigment skin “vitiliGO = GO bye bye to pigment”
Autoimmune condition, resulting in the loss of melanocytes and consequent depigmentation of the skin.
Usually patients have an autoimmune history or related conditions (such as type 1 diabetes, Addison’s, alopecia areata)
Intrauterine device (IUD) can be used in postpartum women who are breastfeeding.
What is the timescale in which it can be inserted?
Either 48 hours within giving birth
OR
Four weeks postpartum
Which smoking cessation medication is contraindicated in patients with a background Hx of epilepsy
Bupropion as it can lower seizure threshold
What is the first line treatment for Genital candidiasis
Orla fluconazole 150mg (single dose)
What antibiotic is used to treat an uncomplicated UTI in pregnancy
Oral amoxicillin
Oral nitrofurantoin may be used but remember it is contraindicated in the third trimester of pregnancy due to the risk of it causing haemolytic anaemia in the neonate
What is the investigations required to diagnosis a UTI in the >65 year old with suspected UTI symptoms
No investigations required in the over 65 with symptoms - commence antibiotic immediately
Bladder training is often used to treat with kind of incontinence
Urge incontinence - characterised by a strong, sudden urge to urinate and frequent urination
Bladder training (at least six weeks) involves retraining the bladder to hold more urine for extended periods and emptying it at scheduled intervals
Why should uric acid levels be taken minimum 2 weeks after a gout attack
As if taken at the time of the attack, the levels will be falsely low
What is the gold standard investigation for gout
Arthrocentesis with synovial fluid analysis
Characterised by urate crystals which are needle-shaped with negative birefringence
What are the ABCDE worrying features of a mole which suggests malignant melanoma
A: Asymmetry
B: Border irregularity (melanoma often has a ‘scalloped’ border)
C: Colour variation (a variegated lesion is one that consists of many colours)
D: Diameter > 6mm
E: Evolves over time
How is Hepatitis A transmitted
Faecal-oral route
More common in developing countries
“Eww you Ate that” - hepatatis A and E are transmitted in the faecal oral route
How is Hepatitis E transmitted
Faecal-oral route
More common in developing countries
“Eww you ate that”
What hepatitis is associated with polyarteritis nodosa
Hepatitis B
Electrocution is a recognised cause of what type of shoulder dislocation
Posterior shoulder dislocation (presents as light bulb sign)
What medication is the mainstay of treatment in poly/dermatomyositis
Prednisolone
They are started at high doses initially and creatinine kinase is then monitored to guide the rate of tapering the dose
What test may be used to aid a diagnosis of Sjögren’s syndrome (testing the dryness of the eyes)
Schirmer’s test
Anti-dsDNA is specific to what rheumatological condition
SLE
Charactaristic malar (butterfly) rash over his cheeks in combination with systemic illness and a mild arthritis / arthralgia
Anti-La and anti-Ro are specific to what rheumatological condition
Sjogren’s syndrome
Anti-centromere are specific to what rheumatological condition
Limited cutaneous systemic sclerosis
What criteria can be used to identify patients at low risk of C-Spine injury
NEXUS criteria
What is the gold standard imaging modality to visual and clear a C-Spine injury (used if you cannot clear it clinically)
Urgent CT cervical spine
Flexion deformities of his 4th and 5th digit which cannot be passively corrected is diagnostic of what condition
Dupuytren’s contracture
What is the treatment for Dupuytren’s contracture
Conservative treatment with physiotherapy and exercises.
Surgical management involves fasciectomy with a z-shaped scar to prevent recurrence.
Flexion deformities of 4th and 5th digit which CAN be passively corrected is diagnostic of what condition
Trigger finger
Pop-eye sign is pathognomonic of what condition
Proximal bicep tenden rupture
Osteolytic lesions with moth-eaten pattern of bone destruction are specific XR features of what condition
Chondrosarcoma
Malignant bone tumour that presents with progressive worsening of pain which is worst at night
“Moths are Cunts”
Sunburst appearance or codman triangles are specific XR features of what condition
Osteosarcoma
Malignant bone tumour that presents with progressively worsening pain which worsens at night
Erb’s palsy presents with the “waiter’s tip” sign.
What is this sign
Shoulder adduction
Elbow extension
Forearm pronation
Wrist flexion
Triple therapy for H. pylori eradication
Amoxicillin (in pen allergic clarithromycin)
Metronidazole
Proton pump inhibitor
