General Practice (Quesmed) Flashcards
What is the ABCDE approach to assessing Malignant Melanomas?
Asymmetry
Border Irregularity (Melanomas have Scalloped Borders)
Colour Variation (Variegated= many colours)
Diameter> 6mm
Evolves over time
What are the 4 types of Melanoma?
Superficial Spreading- Most common type- Horizontally first and then Vertically
- Different colours within the lesion
- Flat or slightly raised
Nodular Melanoma- Grows Vertically. Very Aggressive
- usually Black but also Pink, Red, Brown
- Dome shaped or raised
Lentigo Maligna Melanoma- Arises from Lentigo Maligna
- Flat
- Tan or Brown
Acral Lentiginous Melanoma- Palms/ Soles and Under Nails
- Looks like a Bruise
- More common in Dark Skin
- Under nails, palms and soles
What is Breslow Thickness?
It is the thickness of a Melanoma
If >1mm- a Sentinel Node Biopsy should be taken and evidences of Metastasis should be looked for
What is the management of a Melanoma according to the stage?
Excision of the melanoma
Stage 0- 0.5 cm around the melanoma
Stage 1- 1cm
Stage 2- 2cm
Stage 3 and 4 are metastatic so give Chemotherapy or Immunotherapy
What are the 4 signs of Acute Tonsillitis?
Sore Throat
Headache
Pyrexia
Lymphadenopathy
What are the 4 main complications of Tonsillitis?
Remember King Julien the Lemur
Recurrent Tonsillitis
Retropharyngeal Abscess- more common in young children- stiff, extended neck and refusal to eat
Peritonsillar Abscess (Quinsy)- (Throat is tight and painful cos of the abscess) Sore throat, Dysphagia, Peritonsillar bulge, Uvular deviation, Trismus (tightening of jaw muscles) and Muffled Voice
Lemierre’s Syndrome- Inflammation leads to Pharyngotonsillitis and leads inflammation within the Internal Jugular Vein and Septic Emboli. Give them High Dose Benzylpenicillin and Debridement
- Looks like Meningitis following a Sore Throat
What is the recommended Alcohol weekly intake?
14 units per week
Work out number of units= [Strength (ABV) x Volume (ml)] / 1,000
OR just Strength x Volume (litres)
What is the pathophysiology of Asthma?
It is a Type 1 Hypersensitivity Reaction
It is associated with a family history of Atopy (The Atopic Triad are Asthma, Atopic Eczema and Allergic Rhinitis)
TH2 Helper T Cells produce Cytokines such as:
- IL4 which facilitates class switching to IgE
- IL5 which facilitates release of Eosinophils
- IL13 which stimulates mucus production
What are the signs and symptoms of Asthma?
When are symptoms worse and when does the cough happen usually?
What are the 2 HYPERS?
Wheeze and Dyspnoea and (Nocturnal) Cough
Symptoms Worse in the Morning
Hyperinflated Chest
Hyperresonance on Chest Percussion
Wheeze on Auscultation
Which 3 investigations should be ordered more urgently in an acute Asthma Attack?
2 Bloods and 1 Chest
ABG- Type 2 Respiratory Failure (Low PaO2 and High PaCO2) is a sign of LIFE THREATENING ASTHMA
Routine Bloods- to look for a cause of the asthma (an infection)
Chest Xray- to exclude differentials and identify an infection
What is the management of Chronic Asthma (Not an Attack)?
Smoking Cessation/ Avoid Precipitants/ Review Inhaler Technique
Step 1- SABA (Salbutamol)
Step 2- add low dose inhaled ICS (<400)
Step 3- Add LTRA
Step 4- Add LABA
Step 4- Swap LABA and Low Dose ICS for MART (which is basically just low dose ICS and LABA)
Step 5- Then make it MEDIUM DOSE ICS (400-800) instead
What are the 3 main Asthma Mimics?
Which of these is associated with pANCA?
What is the management of each of these?
(Acid, Autoimmune, Fungus)
Acid Reflux-
- Risk Factors= Obesity, Smoking, CCBs, Alcohol
- Management- Antacids or Alginates + PPIs (Omeprazole) + H2 Blockers (Ranitidine)
Churg-Strauss Syndrome-
- Granulomatous Vasculitis associated with Asthma and Eosinophilia
- Conditions associated with this= Sinusitis, Asthma, Purpura and Peripheral Neuropathy
- pANCA positive and High IgE
- Management- Steroids and Immunological Agents (Rituximab)
Allergic Bronchopulmonary Aspergillosis (ABPA)-
- Type 1 and 3 hypersensitivity reaction to Aspergillus Fumigatus
- Symptoms= Wheeze, Dyspnoea, Sputum Production
- They IMMEDIATELY react to Aspergillus Fumigatus on the skin
- High IgE may also be there
- Management- Prednisolone in Acute. Itraconazole added to treatment regimes. Bronchodilators for Asthma Symptoms
What is Atopic Dermatitis?
Dry Skin and Itchy Poorly Demarcated Areas
Usually cheeks in Infants and insides of elbows and needs in Children and Adults
How is Atopic Dermatitis diagnosed?
Managed with Emollients and Topical Corticosteroids
Itchy Skin + 3 of the following
- Flexural eczema (or cheeks/ extensors if <1.5 years)
- History of Flexural eczema (or cheeks/ extensors if <1.5 years)
- History of Dry Skin
- History of Asthma or Allergic Rhinitis
- Onset < 2 years old
What are the 4 complications of Eczema?
Eczema Herpeticum- Caused by Disseminated HSV infection due to Impaired Skin protection. It results in a PROGRESSIVE, PAINFUL MONOMORPHIC VESICULAR RASH which can ulcer and crust. IV Acyclovir needed to treat
Superficial Bacterial Infection- Staph or Strep
Erythroedema- Erythema affecting >90% of the skin surface. Results in Heat and Fluid Loss
Side effects of Corticosteroids= Skin Thinning, Striae, Telangiectasia
What is Bell’s Palsy and what are the signs?
Which nerve is affected and what are the symptoms?
(Ear, Ear, Eye/ Mouth)
It is an Idiopathic Syndrome affecting the Facial Nerve
Signs
- Acute Onset (not sudden) Unilateral Lower Motor Neuron Facial Weakness- sparing the Extraocular Muscles and Muscles of Mastication. It does NOT SPARE THE FOREHEAD
- PostAuricular Otalgia (which may precede paralysis)
- Hyperacusis (sensitive to sounds)
- Nervus Intermedius symptoms (altered taste and dry eyes/ mouth)
What is the management of Bell’s Palsy? What is Ramsay Hunt Syndrome?
50mg OM (Cortico)Steroids for 10 days followed by a taper- Acyclovir if viral cause- Ramsay Hunt
Artificial tears and ocular lubricants help with the dry eyes
It is difficult to Distinguish Bell’s Palsy from Ramsay Hunt Syndrome (also facial weakness, otalgia, Vesicular rash in the auditory meatus, palate or tongue)
But Ramsay Hunt is caused by VARICELLA ZOSTER and there will be a VESICULAR RASH around the EAR
What are the signs of Cellulitis? It is usually caused by Streptococcus or Staphylococcus
Is there fever and is there lymphadenopathy?
Erythema, Calor, Pain, Swelling
Poorly demarcated regions
Systemic Upset (fever, malaise)
Lymphadenopathy
Evidence of skin breach (trauma, ulcer etc.)
What is the management of Cellulitis?
Which antibiotic is typically given?
(Find out what it is and give the antibiotics then elevate and debride)
Blood tests and Culture
Skin Swab and Culture
Oral or IV Antibiotics depending on the Severity
- Usually Flucoxacillin, otherwise give MACROLIDES
Mark the area of Erythema to identify whether it is rapidly spreading
ELEVATE if possible
Wound Debridement may be needed
What are the signs of Chronic Sinusitis?
What does it usually follow?
Sinusitis follows an Upper Resp Tract Infection
Tenderness and pain in Cheeks, Eyes, Forehead
Usually Bilateral Pain, Intense
Nose is Bilaterally Blocked
There may be Purulent Discharge
Pain is worse when sitting forward
What are the 7 differential diagnoses for Sinusitis?
My Terrible Neck Causes Terrible Vascular Headaches
Migraine
TMJ Dysfunction
Neuralgia
Cervical Spine Disease
Temporal Arteritis
Vasculitis (Granulomatosis with Polyangiitis)
Herpes Zoster
What are the 2 red flags for Chronic Sinusitis?
If the nose block is UNILATERAL (Unilateral Nasal Polyps are a red flag for Nasopharyngeal Carcinoma so REFER ASAP (2WW))
If there is UNILATERAL nose BLEEDING
What are the signs of Sialadenitis (Salivary Gland infection)?
STAPHYLOCOCCUS AUREUS INFECTION
How is it managed?
Is there a fever?
Is there lymphadenopathy?
Severe, Unilateral Tenderness and Pain in mouth with Fever (Over Parotid Gland if it infects the Parotid Gland)
There may also be PURULENT DISCHARGE
Submandibular Swelling and Lymphadenopathy
Manage with BROAD SPECTRUM ANTIBIOTICS and Supportive care
What are the signs of COPD?
What is the percussion like?
Also remember CORPULMONALE and PERIPHERAL OEDEMA
PRODUCTIVE Cough for at least 3 MONTHS in 2 Consecutive Years
Wheeze
Dyspnoea
Reduced Exercise Tolerance
Tachypnoea
Hyperinflation
Cyanosis
Reduced Chest Expansion
Decreased Breath Sounds
COR PULMONALE and therefore PERIPHERAL OEDEMA
Hyperresonant Percussion
REDUCED CRICOSTERNAL DISTANCE