General Practice/ Progress Flashcards
An 11yo patient presents to GP with a sore throat, they have exudates on their tonsils, no cough and some elevated lymph nodes in the neck. There is no fever. How will you manage?
10 days of PenV
Supportive management
(CENTOR 3 justifies AB’s)
A young female patient presents with fatigue and is diagnosed with IDA. There are no red flags in the history. How should she be managed?
Ferrous sulphate 200mg Given BD (or TDS if they can tolerate)
Treat for 3-6 months
(FBC checked 2-4 weeks after Tx started)
A patient presents with symptoms suggestive of chlamydia, what are the two main antibiotic options?
Azithromycin - Single dose 1g
Doxycycline - 100mg BD for 7 days (CI in pregnancy)
You diagnose a 31year old female with a UTI. She is 20 weeks pregnant, what is the most appropriate management?
Nitrofurantoin 50mg QDS for 7 days
A 27-year-old woman complains of spasmodic pains in the left iliac fossa. These pains have been present for the past six months and sometimes radiate to the back. She often feels bloated, particularly around her period. She describes her bowels as being ‘stubborn’ but does not take a regular laxative. Vaginal and abdominal examination is unremarkable. MLD?
IBS
This woman has the classic ABC features of irritable bowel syndrome: Abdominal pain, Bloating and Change in bowel habit.
A 26-year-old women develops sudden onset right iliac fossa pains whilst playing netball. She is nauseated and has vomited twice. On examination she is tender in the right iliac fossa.MLD?
Ovarian torsion
The pain of appendicitis is unlikely to be of sudden onset.
A patient presents with painful genital ulcerations. Observations are normal. You suspect genital herpes, what is the most appropriate treatment?
Oral aciclovir TDS for 5 days
A 67yoF presents with a 3 weeks history of bilateral, severe and persistent neck pain and shoulders. She reports her neck and shoulders are often stiff in a morning for around an hour. She has pain when she moves her shoulders, and when you move them for her. What is the first investigation you do and what management do you suggest?
1st test: ESR/ CRP
- If raised very likely polymyalgia rheumatica
Management: Prednisolone (15mg for three weeks, then 12.5 for 3 weeks and gradually reduce)- NB also consider bisphosphates and calcium/vitD to protect against steroid
- PMR occurs almost exclusively in over 50’s (mean 73), with about 1 in 1000 affected. F3:1M
A 70yoF presents with numbness and tingling in her palm, thumb, index and middle fingers for over 8 months. She has a weakened grip and you notice some thenar muscle wasting. She reports that pain is worse at night but shaking her hand relieves the pain. What two tests could you do in the clinic to confirm the diagnosis?
Median nerve compression (Carpal tunnel synd)
- Phalens test: Flex wrist for 60 seconds = pain
- Tinels test: Tapping lightly over the median nerve causes parasthesia in distal nerve distribution
Electroneurography (ENG) is used as Gold Standard. Only needed if diagnostic doubt or if pre-surgery
A 30yoF presents with numbness in her palm, thumb, index and middle fingers for over 3 months. She has a weakened grip. She reports that pain is worse at night but shaking her hand relieves the pain. She is positive for Tinels and Phalens tests. How do you manage?
Symptoms likely to resolve in 6months (if young, short duration of symptoms or pregnant)
- Minimise activities which exacerbate symptoms
If symptoms continue work up from NSAIDS > Steroids > Surgery
A 15yoM presents with greasy skin, papules and pustles on his face and back. He has tried keeping his face clean, but now wants something to help get rid of it. Management?
Benzyl peroxide (5%)
- Start using sparingly, can work upto 10%. Can cause burning after application, especially with greasy skin.
Topical erythromycin/ clindamycin, but only use with Benzyl Peroxide, not alone (try to limit to 12 weeks)
ADD Topical Retinoid if no success
A 60yoM presents with burning, itching and tingling across a band on one side of his his chest. He is on long term steroids for lung fibrosis. It’s been going on for 7 days and over the last 3 days skin lesions (vesicles) have appeared and gone crusty. He describes the pain as intense and sharp. He asks what you’re going to do and if he is infective?
Yes- infective until lesions have dried (upto 21 days post onset)
Treatment:
Aciclovir PO 800mg 5x/day for 7-10days
Steroids/ amitriptyline/ gabapentin/ opioids for pain
A 70yoM presents with a red strip all across the width of his chest, he says it is painful and tells you he has shingles, how do you explain to the man that shingles is very unlikely?
Shingles may not affect the whole dermatome but it will not extend outside it. Hence any rash that crosses the midline is not shingles.
A 68yoM patient comes into your surgery complaining of unilateral deafness in his R ear. He has rheumatoid arthritis and also bronchiectasis, which is currently being treated for an exacerbation with clarithromycin. How do you manage his deafness?
Remove the clarithromycin and start on another agent
Macrolides can be ototoxic
A 2yo boy presents with extensive small, red pustules around the mouth for 2 days, starting with one which spread to more. Some have gone honey coloured and crusty. Mum says he has had some fever and vomiting, his temperature is 36.2. MLD and suggested treatment?
Impetigo- Most common skin infection in children
- Swabs may be taken if bad
- Treat with topical fusidic acid TDS 7days (mupirocin if MRSA suspected)
- Add oral fluclox if needed (7days)
- Note very contagious, avoid contact and sharing towels etc
STAPH AUREUS CAUSE
A 19-year-old female starts Microgynon 30 (combined oral contraceptive pill) on day 8 of her cycle. How long will it take before it can be relied upon as a method of contraception?
7 days
- Time until effective (if not first day period):
Instant: IUD (copper coil)
2 days: POP
7 days: COC, injection, implant, IUS (intrauterine system)
A 21yoF is about to be started on the combined oral contraceptive pill. What do you advise about:
a) When the pill becomes effective?
b) When to take the pill?
a) If the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
b) Taken for 21 days then stopped for 7 days - similar uterine bleeding to menstruation
A 22yoF was started on microgynon 30 (COC). She has had unprotected sex during the period that she was not taking the pill (i.e in the week off). She wants to know if she was still protected by the pill or not, as she can’t deal with being pregnant right now. How do you manage?
Give advice that intercourse during the pill-free period is only safe if the next pack is started on time
A 21yoF is about to be started on the combined oral contraceptive pill. What do you advise about harmful effects of the pill?
Potential harms and benefits:
- COC is > 99% effective if taken correctly
- Small risk of blood clots
- Very small risk of heart attacks and strokes
- Increased risk of breast cancer and cervical cancer
Name 3 risk factors for varicose veins?
Prolonged standing Obesity Pregnancy FHx COCP
What is the pathology in varicose veins?
Venous hypertension in long and short saphenous veins (superficial venous system)
Causes valve incompetence in the veins
Name 5 possible symptoms of varicose veins
"My legs are ugly" Pain Cramps Tingling Heaviness Restless legs (all syx not much more common than general pop)
What should prompt a referral with varicose veins?
Bleeding Pain Ulceration Thrombophelbitis or severe impact on QoL
Any others should just be managed conservatively
Name 5 pieces of lifestyle advice for someone with varicose veins?
Avoid prolonged standing Elevate legs Compression stockings Weight loss Regular exercise
