General Practice notes

Question 1

What mechanism is the reason we have a warmer core temp and a cooler peripheral temp?

Answer 1

Counter current heat exchange

Question 2

Name a side effect of simvastatin and atorvastatin. Which statin is less likely than these 2 to cause side effects?

Answer 2

Muscle aches and pains. Pravastatin is less likely to cause S/Ex (it is fat soluble)

Question 3

What class of drug is Mirtazapine? 
What is it's MOA?

Answer 3

Atypical anti-depressant.

It is a Noradrinergic and specific serotoninergic anti-depressant. (NaSSA)

Question 4

How many weeks must bowel related symptoms go on for before a referral for further Ix is warranted?

Answer 4

> 6 weeks

Question 5

Tx for labyrinthitis

Answer 5

Beta Histine

Question 6

If a patient complains of dizziness, what must you ask to differentiate vertigo from postural hypotension or vasovagal syncope ?

Answer 6

“Is the room spinning?”

If the room IS spinning - think vertigo

If the room is NOT spinning - think postural hypotension or vasovagal syncope

Question 7

What is the underlying cause of Conn’s syndrome?

Essentially, what does this underlying cause result in?

Answer 7

Primary hyperaldosteronism

Hyperaldosteronism results in fluid retention.

Question 8

If a patient presents with hypertension and hypokalaemia, what is a likely diagnosis?

Why?

Answer 8

Hyperaldosteroneism

The excess aldosterone causes excess reabsorption of Na and fluid.

Excess aldosterone also leads to excessive passing of K - resulting in hypokalaemia

Question 9

What drug is used to treat primary hyperaldosteronism?

Why?

Answer 9

Spironolactone

It is a potassium SPARING diuretic - it will reduce fluid overload without exacerbating the hypokalaemia

Question 10

What is the difference between Basal cell carcinomas and Squamous cell carcinomas

Answer 10

BCCs: ulcerated, crater-like, pearly rolled edges when pinched, indentation

SCCs: Red, fiery, inflamed with uneven borders

Question 11

What does an absence of the lines of langerhan’s suggest?

Answer 11

Cellulitis

The absence of lines of langerhan’s suggests turgid skin and/or presence of oedema - this indicates cellulitis.

Question 12

What is solifenacin and what can it be used for?

Answer 12

Anti-muscarinic

Can be used for urinary incontinence

Question 13

What do the presence of satellite lesions on the skin indicate?

Answer 13

A fungal skin infection

Question 14

Tricyclic antidepressants (such as amitriptyline) can cause what broad side effect?

Answer 14

Anti-cholinergic side effects

Question 15

Describe the presentation of anti-cholinergic side effects

Answer 15

Ataxia 
Blurred vision 
Confusion/constipation  
Dry mouth 
Urinary stasis

Question 16

What mnemonic can be used to examine for cerebellar disease?

Answer 16

Dododyskinesia 
Ataxia 
Nystagmus 
Intention tremor 
Staccato speech (speaking in fragments which are interrupted by pauses) 
HyPOtonia

Question 17

Why are statins recommended to be taken in the evening ?

Answer 17

Most cholesterol is synthesised when dietary intake is at the lowest (i.e. during the night)

Question 18

What medication can be taken for vertigo and sickness? 
What class of drug is it?

Answer 18

Cyclizine

Drowsy anti-histamine

Clozapine is an atypical antipsychotic - don’t get confused!

Question 19

Are fasciculations a LMN or UMN sign?

What disease do they indicate?

Answer 19

LMN sign

Motor Neurone disease

Question 20

Which is more worrying; horizontal or vertical nystagmus?

Answer 20

Vertical nystagmus

vertical nystagmus is more likely to be indicative of central neurological problems

Question 21

How can sciatic stretch be assessed?

Answer 21

Straight leg raise

Patients who exhibit sciatic stretch will have a reduced ROM on straight leg raise

Question 22

Which 2 classes of drug can cause QT prolongation?

Answer 22

SSRIs

marcrolides

in particular, Citalopram

Question 23

Where does a Bartholin’s cyst occur?

What is it a result of?

Answer 23

Bartholin’s cyst occur as a result of a blocked duct.

The blocked duct is located between the upper 2/3 and lower 1/3 of the vulval canal.

Question 24

In which age group is a Bartholin’s cyst most likely?

Answer 24

Younger females - due to the presence of hormones

Question 25

How do you treat bacterial vaginosis?

Answer 25

Metronidazole

Question 26

In patients who present with ear pain, what must you always ask about?

Answer 26

Their balance! Has it been affected?