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Sharon's Phase 3a > General Practice short > Flashcards

General Practice short Flashcards

Summary of important topics

1
Q

Ischaemic heart disease

A

A condition where there is cardiac myocyte damage due to insufficient blood supply. Most commonly caused atherosclerotic plaque build-up in coronary arteries.

Stable angina > unstable angina > NSTEMI > STEMI

RFs for atherosclerosis

Non-modifiable - age, family history, male

Modifiable - obesity, high fat diet, sedentary lifestyle, poor diet, alcohol, smoking, poor sleep, stress, diabetes

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2
Q

Stable angina

A

A condition where the narrowing of the coronary arteries leads to reduced supply of oxygen, which leads to ischaemia of the myocytes during times of increased demand, e.g. exercise.

RFs same as IHD as part of IHD

Key features: tight chest pain lasting 1 - 5 mins, relieved by rest or GTN spray

Ix: FBC, U+E before starting ACEi, LFTs before statins, ECG, HbA1c, cardiac stress test, gold standard is coronary angiography

Mx: glyceryl trinitrate spray, repeat after 5 mins if ineffective, call ambulance if repeat dose ineffective

Primary prevention:
- Lifestyle changes
- Low-dose aspirin 75mg daily

Secondary prevention: 4As
- Aspirin 75mg
- Atorvastatin 80mg
- ACE inhibitor
- Already on beta blocker (or CCB e.g. amlodipine) for symptom relief

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3
Q

Acute coronary syndrome

A

A condition caused by atherosclerotic plaque blocking the flow of blood through the coronary arteries.

Unstable angina > NSTEMI > STEMI

ECG and troponin:
- Unstable: both normal/ ECG: ST depression/T wave inversion)

  • NSTEMI: ST depression, T-wave inversion and raised troponin
  • STEMI: ST elevation, new left bundle branch block, raised troponin

Presentation: crushing chest pain with/without radiation to jaw/arm/neck, sweaty + clamminess, impeding sense of doom, SOB, palpitations, nausea and vomiting

Silent MI (usually diabetics): no chest pain, low-grade fever, sweaty, pale, clammy

Immediate Mx: CPAIN

  • Call an ambulance
  • Perform ECG
  • Aspirin 300mg
  • IV morphine for pain
  • Nitrate (GTN)
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4
Q

Management of STEMI

A

If symptom onset within 12 hours:

  • Percutaneous coronary intervention (PCI) if available in 2 hrs
  • Thrombolysis (e.g. alteplase) if PCI not available within 2 hrs
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5
Q

Management of NSTEMI

A

BATMAN

B- base decision about angiography and PCI on GRACE score (probability of death 6m after NSTEMI)

A - aspirin 300mg

T - Ticagrelor 180mg STAT

M - morphine

A - antithrombin therapy with fondaparinux

N - nitrate (GTN)

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6
Q

Secondary prevention of ACS

A

Echo - to asses damage to heart
Cardiac rehabilitation

6As
- Aspirin 75g
- Another antiplatelet e.g. clopidogrel or ticagrelor
- Atorvastatin 80mg
- ACEi
- Atenolol or bisoprolol
- Aldosterone antagonist for HF (i.e. eplerenone)

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7
Q

Atrial fibrillation

A

Irregularly irregular heart rhythm due to uncoordinated, irregular and rapid atrial contractions which overrides the regular electrical activity released by the sinoatrial node.

Causes: SMITH

Sepsis, MI, ischaemic heart disease, thyrotoxicosis, hypertension

Paroxysmal AF is when the AF is episodic, lasts 30s to 24hrs, needs ambulatory 24-hour ECG

Key features: palpitations, SOB, dizziness/syncope, symptoms of underlying disease

Ix: ECG: absent P waves, narrow QRS complex tachycardia, irregularly irregular ventricular rhythm

Mx: rate control and rhythm control, but most are on bisoprolol, anticoagulation (e.g. apixaban) due to x5 risk of stroke

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8
Q

Chronic heart failure

A

The inability of the heart to supply enough blood and oxygen to meet the demands of the body

Causes: IHD, valvar heart disease (e.g. aortic stenosis), HTN, AF

HFpEF = EF > 50%
HFrEF = EF < 40%

Key features: exertional SOB, cough with frothy white/pink sputum, pedal oedema, orthopnoea (SOB worse on lying down, how many pillows?), paroxysmal nocturnal dyspnoea

Dx: hx + examination (bi-basal crepitations), N-terminal pro-B type natriuretic peptide (NT-proBNP), ECG, echo

NT-proBNP between 400ng/L - 2000ng/L = specialist and echo within 6 weeks

NT-proBNP > 2000ng/L = specialist and echo within 2 weeks

Medical secondary prevention:

  • ACE inhibitor or ARB
  • Beta-blocker (e.g. bisoprolol)
  • Aldosterone antagonist (e.g. eplerenone or spironolactone) - only if above ineffective
  • Loop diuretics (e.g. furosemide) - only if above ineffective

Additional mx: annual flu and pneumococcal vaccine, stop smoking, optimise tx of co-morbidities, cardiac rehab (personalised exercise programmes)

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9
Q

Hypertension

A

Essential hypertension - 90%

> 140/90mmHg in clinic
135/85mmHg at home

Secondary causes: ROPED: renal disease, obesity, pre-eclampsia, drugs (steroids, alcohol, NSAIDs)

Patients with BP 140/90 - 180/120 need 24-hour ambulatory blood pressure

Stage 1: >135/85 (140/90)
Stage 2: > 160/100 (150/95)
Stage 3: > 180/120

Every new patient is assessed for end-organ damage:

  • Urine albumin: creatinine ratio and dipstick for kidney damage
  • ECG
  • Bloods: HbA1c, U+Es and LFTs
  • Fundus examination for hypertensive retinopathy

QRISK score = percentage risk of patient developing stroke or MI in the next 10 years, above 10% = statin

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10
Q

Management for hypertension

A

A. ACEi (ramipril)
B. Beta-blocker (bisoprolol)
C. Calcium channel blocker (amlodipine)
D. Diuretic (indapamide)
ARB (e.g. candesartan)

Step 1: A, unless > 55 and/or Afro-Caribbean then ARB

Step 2: A + C or A + D or C + D

Step 3: A + C + D

Step 4. A + C + D and

  • Serum K less than or equal to 4.5mmol/l = spironolactone (K-sparing)
  • Serum K above 4.5mmol/l = beta-blocker
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11
Q

Asthma

A

A chronic airway disease characterised by hypersensitive smooth muscle in the airways which constrict in response to stimuli and cause inflammation and obstruction in the airways.

Patients often have family or personal history of atopy.

Key features of poorly controlled asthma: diurnal variation, triggered by cold air, exercise, dust etc., sleep disturbance, symptoms between exacerbations

Dx:

  • (Quesmed): spirometry (FEV1/FVC of < 0.7) and bronchodilator reversibility , improvement in FEV1 of > 12% is significant
  • FeNO = ppb > 40 = positive and supports dx
  • Peak flow variability: peak flow diary reading at least twice a day over 2 to 4 weeks, variability > 20% = positive, supports dx
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12
Q

Asthma exacerbations

A

Key features: cough, tight feeling in chest, SOB, polyphonic wheeze on auscultation

Moderate exacerbation:
- PERF = 50 - 75% of predicted/best

Severe exacerbation:

  • PERF = 33 - 50% of predicted/best
  • RR > 25
  • HR > 110
  • Unable to complete sentences

Life-threatening:

92, 33 CHEST

  • PERF < 33% of best or predicted
  • Cyanosis
  • Hypotension/shock
  • Exhaustion/confusion/altered consciousness
  • Silent chest
  • Tachycardia (> 110), tachypnoea (>25)
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13
Q

Treatment for asthma exacerbation

A

Mild:

  • Inhaled SABA (e.g. salbutamol)
  • 4 x dose of their inhaled corticosteroid for up to 2 weeks
  • Oral prednisolone if high-dose ICS ineffective
  • Follow-up within 48 hours

Moderate

  • Consider hospital admission
  • Nebulised salbutamol
  • Steroids (e.g. oral prednisolone or IV hydrocortisone)

Severe: O SHIT ME

O2 to maintain 94 - 98%

Salbutamol IV
Hydrocortisone IV/oral prednisolone
Ipratropium bromide (nebulised)
Theophylline or aminophylline IV

Magnesium sulphate IV
Escalate care

Life-threatening asthma

  • Admission to ICU or ITU
  • Intubation/ventilation
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14
Q

Treatment ladder for asthma

A
  1. SABA (e.g. salbutamol)
  2. SABA + low-dose ICS (e.g. beclomethasone)
  3. SABA + low-dose ICS + LTRA
    • LABA (salmeterol)
  5. MART - maintenance and reliever therapy of low-dose ICS and LABA
  6. Increase to moderate-dose ICS
  7. Increase to high-dose ICS
  8. Specialist management (e.g. oral corticosteroids)
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15
Q

Chronic obstructive pulmonary disease (COPD)

A

Chronic, obstructive airway disease characterised by emphysema (increased mucus production and alveolar damage and dilatation) and bronchitis (chronic cough and sputum production due to inflammation in the bronchi) = decreased surface for gas exchange.

Biggest cause = smoking

Not reversible with bronchodilators

Key features: cough, wheeze, SOB, sputum production, recurrent chest infections (no clubbing, haemoptysis or chest pain)

Dx: clinical features and spirometry results (FEV1:FVC <0.7) and not bronchodilator reversible

Other Ix: BMI,FBC (anaemia and polycythaemia), sputum culture, ECG + echo (HF) , serum alpha-1 antitrypsin

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16
Q

Management of COPD

A

Step 1: SABA (salbutamol) and Short-Acting Muscarinic Antagonist (ipratropium bromide)

Then if not ineffective

If no asthma/steroid responsive features:

  • Combination of LABA and LAMA

If asthma/steroid responsive:

  • Combination of LABA and ICS

Final step = combination of LABA, LAMA and ICS (e.g. trimbow)

Annual flu and pneumococcal vaccinations

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17
Q

Community-acquired pneumonia

A

Lower-tract respiratory tract infection

Cough, sputum, fever, malaise, haemoptysis, pleuritic chest pain (sharp pain worse on inspiration)

CRB-65 = primary care score whether to send patient to hospital

  • Confusion
  • Respiratory rate 30 or more
  • BP systolic 90 or less, or diastolic 60 or less
  • 65 or older

Most common causes =
streptococcus pneumoniae and Haemophilus influenzae

Pseudomonas aeruginosa - in cystic fibrosis

Legionella pneumophila - contaminated aircon

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18
Q

Diagnosis and management of community-acquired pneumonia

A

CRP levels in primary care to guide management (if CRB-65 1 or less, no admission needed).

Hospital investigations:

  • CXR - consolidation
  • FBC
  • Renal profile
  • CRP

More severe:
- Sputum and blood cultures
- Pneumococcal and legionella urinary antigen

Mx: abx according to local guidelines: amoxicillin, doxycycline, clarithromycin

More severe = hospital for IV abx

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19
Q

Gastro-oesophageal reflux disease (GORD)

A

When acid travels from the stomach via the lower oesophageal sphincter, irritating the oesophageal lining.

Risk factors/precipitating factors: obesity, hiatus hernia (stomach content through the diaphragm), spicy/greasy food, alcohol, NSAIDs

Key features: dyspepsia, heartburn nocturnal cough, hoarse voice, bloating, retrosternal/epigastric pain

Mx:

Conservative: lifestyle changes (e.g. weight loss, reduce alcohol, stop smoking, smaller, lighter meals

Medication review: e.g. stop NSAIDs

Antacids e.g. Gaviscon

PPI e.g. omeprazole

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20
Q

When should you consider referring someone for 2ww direct-access endoscopy?

A
  • Dysphagia at any age! (food getting stuck etc.)
  • 55 is cutoff age to do urgent vs routine referral for the below symptoms
  • Weight loss
  • Anaemia
  • Thrombocytopenia
  • Treatment resistant dyspepsia
  • Nausea and vomiting
  • Upper abdominal mass on palpation
21
Q

Barrett’s oesophagus

A

When there is metaplasia of the oesophagus from squamous epithelium to columnar epithelium like in the stomach, due to chronic acid reflux.

Pre-malignant condition and high risk of developing oesophageal adenocarcinoma

Tx: endoscopic monitor for progression to cancer, PPIs, endoscopic ablation of abnormal epithelium

22
Q

Irritable bowel syndrome

A

Functional bowel disorder caused by a disturbance in the gut-brain axis

Key features: IBS

I - intestinal discomfort (abdominal pain related to the bowels, bloating)
B - bowel habit abnormalities (more/less frequent)
S - Stool abnormalities (watery, loose, hard or associated with mucus

Triggers: anxiety/depression, stress, sleep deprivation, illness, caffeine, alcohol

Dx: exclude serious pathology first

  • FBC (anaemia)
  • Coeliac serology - anti-TTG, anti-EMA
  • Faecal calprotectin
  • Inflammatory markers
  • CA125

Diagnostic criteria
At least 6m abdo pain or discomfort AND at least one:

  • Pain/discomfort relieved by opening bowels
  • Bowel abnormalities (more/frequent)
  • Stool abnormalities (hard, watery, mucus)

AND at least two of:

  • Straining, urgent need to empty bowels or incomplete emptying
  • Bloating
  • Worse after eating
  • Passing mucus

Mx: explanation and reassurance, hydration, adjust fibre intake, reduce stress, low FODMAP diet (dietician-guided)

Medical: loperamide (diarrhoea), bulking form laxatives (e.g. ispaghula husk), anti-spasmodic e.g. hyoscine butylbromide, peppermint oil

23
Q

IBD

A

Crohn’s: NESTS

  • No mucus or blood in stool (or less likely)
  • Entire GI tract affected
  • Smoking is risk factor
  • Terminal ileum most affected and Transmural (full thickness) inflammation
  • Skip lesions

Ulcerative colitis: CLOSE UP
- Continuous inflammation
- Limited to colon and rectum
- Only superficial mucus
- Smoking is protective
- Excrete blood and mucus
- Use aminosalicylates
- Primary sclerosing cholangitis

Dx: 1st line: faecal calprotectin, anti-TTG, stool microscopy and culture. Gold standard: colonoscopy and multiple intestinal biopsies

24
Q

IBD treatment

A
  • Acute (inducing remission during exacerbation)
  • Maintaining remission

Acute:

UC: 1st line is aminosalicylate (e.g. oral/rectal mesalazine), 2nd line is oral or rectal prednisolone

If severe = IV steroids in hospital

Crohns: steroids 1st line

Maintaining remission

UC: mesalazine (aminosalicylate)
Crohn’s: azathioprine/mercaptopurine

25
Q

Conditions associated with IBD

A

Erythema nodosum - tender, red nodules on shins

Enteropathic arthritis (inflammatory arthritis)

Primary sclerosing cholangitis

Red eye conditions (e.g. anterior uveitis)

26
Q

Gallstones (cholelithiasis)

A

Can be asymptomatic, but can cause cholecystitis, cholangitis and pancreatitis

4F - female, fat, fair, forty

Key features: biliary colic (severe RUQ/epigastric if gallstones blocking neck of gallbladder

  • After high-fat meals
  • Lasts 30 mins to 8hrs

Ix: 1st line is USS: presence of gallstones in gallbladder, ducts or dilatation of the duct

Thickened gallbladder wall and fluid/sludge = acute cholecystitis

27
Q

Liver function tests and their meanings

A
  • Raised bilirubin, pale stools, dark urine = obstructive
  • Alkaline phosphatase - raised in biliary obstruction if accompanied by biliary colic
  • Alanine aminotransferase (ALT) + Aspartate aminotransferase (AST) - raised in intrahepatic damage

ALP markedly raised, ALT and AST mildly raised = cholestasis “obstructive picture”

Mx: asymptomatic = conservative, symptomatic = laparoscopic cholecystectomy

28
Q

Management of cholecystitis

A

Inflammation of gallbladder and key complication of cholelithiasis

Fever, N+V, tachycardia, tachypnoea, Murphy’s sign (pressure on RUQ stops inhalation due to pain)

  • Emergency hospital admission
  • IV fluids
  • Nil by mouth
  • Antibiotics

Endoscopic retrograde cholangiopancreatography (ERCP) - inserting endoscopy into the common bile duct to the sphincter of Oddi = removal of gallbladders in the common bile duct

Surgery = cholecystectomy

29
Q

Appendicitis

A

Inflammation of appendix

Peak incidence: 10 - 20 years old

Food and bacteria become trapped at the opening of the appendix = infection, inflammation, gangrene, rupture = peritonitis

Key features: central abdo pain that moves to RIF within 24hrs, fever, nausea and vomiting, guarding, rebound tenderness, Rovsing’s sign (pressure on LIF causes pain in RF)

Dx: history and examination, CT scan when other pathology possible, USS in females to exclude ectopic and ovarian pathologies

Mx: emergency admission under surgical team for appendectomy (usually laparoscopic)

30
Q

Pyelonephritis

A

Inflammation of kidney due to bacterial infection, affects renal pelvis and parenchyma)

RFs: female, vesicoureteric reflux, structural urological abnormalities, pregnancy, diabetes

Causes: E.coli (same as lower UTI), klebsiella pneumoniae

Key features: dysuria, suprapubic discomfort and increased frequency + triad of: fever, loin pain/back pain, nausea/vomiting

Dx: urine dipstick (blood, nitrites, leukocytes) midstream urine (MSU) for microscopy, culture and sensitivities, bloods (raised CRP + raised WCC)

Mx: refer to hospital if sepsis or not safe to manage in community

Antibiotics: 7 - 10 days
- Cefalexin
- Co-amoxiclav (sensitivities known)
- Trimethoprim (sensitivities known)
- Ciprofloxacin (keep lowered seizure threshold in mind)

Systematically unwell patients need sepsis six pathway - 3 tests, 3 treatments

Tests: blood culture, blood lactate, urine output

Treatments: O2 to maintain 94 - 98%, empirical broad-spec abx, IV fluids

31
Q

Eczema (atopic eczema - a type of dermatitis)

A

Chronic atopic skin condition, caused by defects in the skin barrier = inflammation

Triggers: cold weather, certain foods, stress, washing powders

Key features:

  • Starts in infancy
  • Erythematous, weeping/crusted (exudative) and vesicular patches and lesions.
  • Flexor surfaces (inside elbows/knees), neck and face

Mx: flares and maintenance

Maintenance: artificial skin barrier with emollients, as greasy as tolerated and as often as possible

Acute: thicker emollients, topical steroids, wet wraps, tx infections (staphylococcus aureus or eczema herpeticum - HSV infection)

Topical steroid ladder: thins skin, which can worsen eczema and infections long-term

  • Mild: hydrocortisone 0.5, 1 and 2.5%
  • Moderate: eumovate (clobetasone butyrate)
  • Potent: betnovate (betamethasone 0.1%)
  • Vert potent: dermovate
32
Q

Psoriasis + psoriatic arthritis

A

Chronic autoimmune condition, caused by rapid regeneration of new skin cells - uncontrolled keratinocyte proliferation, leading to hyperkeratosis and parakeratosis

Triggers: skin trauma (Koebner phenomenon), infection (strep throat, HIV), drugs: BALI (beta-blockers, anti-malarial, lithium, NSAIDs), withdrawal of steroids, stress, alcohol + smoking, cold/dry weather

RFs: family history, obesity, smoking

Key features: dry, flaky, scaly, lightly erythematous skin lesions, raised and rough - commonly on extensor surfaces (although could be on flexor surfaces)

33
Q

Types of psoriasis

A

Plaque psoriasis - most common, symmetrical plaques on extensor surfaces . Itchy, well-defined circular to oval bright pink/red raised lesions with white/silvery scales. Nail changes: pitting, onycholysis (peeling of nails away from nailbed)

Guttate psoriasis - small, raised papules on trunk and limbs after streptococcal throat infection

Inverse (flexural) - smooth, erythematous plaques without scales in flexures and skin folds

Pustular psoriasis - multiple petechiae on palms and soles

Generalised/erythrodermic psoriasis - severe, rare form with systematic symptoms

34
Q

Management of psoriasis

A

Topical:
- Emollient to reduce scale and itch
- 1st line: potent topical corticosteroids (e.g. betnovate) + topical vitamin D (one AM and one PM, try for 4 weeks)
- 2nd line: repeat one (4 weeks) or topical vit D ( 12 weeks)
- 3rd line: topical dithranol, coal tar

Phototherapy:
- Narrowband UVB

Systemic:

1st line: Methotrexate (shared care protocol - initiated by secondary care, continued by primary care), give folic acid

DON’T GIVE TRIMETHOPRIM WITH METHOTREXATE

Take methotrexate once a week

Blood tests for patients on methotrexate

  • FBC, U+Es and LFTs every 2 weeks until dose is stable, then monthly for 3 months then at least 3 monthly afterwards
35
Q

Psoriatic arthritis

A

Inflammatory arthritis associated with psoriasis

Different types: asymmetrical oligoarthritis and symmetrical polyarthritis

Key features: affects DIP joints and axial skeleton, whereas rheumatoid arthritis does not

Signs: psoriatic plaques, nail pitting, onycholysis, dactylitis (inflammation of entire finger)

Screening: Psoriasis Epidemiological Screening Tool (PEST)

X-ray changes:
- Periostitis - inflammation of periosteum (thickened, irregular outline of bone)
- Ankylosis (fusion of bones at the joint
Osteolysis (destruction of bone)
Dactylitis (inflammation of whole digit)

Classic “pencil-in-cup” appearance due to erosion of bone at the joint

Mx: MDT between dermatologists and rheumatologists.

Tx combination of NSAIDs, steroids, DMARDs (e.g. methotrexate), anti-TNF medications

36
Q

Measles

A

Morbillivirus, not up to date with immunisations

Urgently notifiable within 24 hours

Key features: preceding sore throat, cough, conjunctivitis, coryza, high fever > 40

Maculopapular rash 2-5 days after - a “pot of paint” distribution - from head spreading down to trunk and limbs, Koplik spots pathognomonic for measles.

Dx: oral fluid sample for measles RNA and IgG and IgM antibodies specific to measles

Mx: supportive, absence from school until 4 days after rash development

Complications: AOM, pneumonia, blindness, subacute sclerosing panencephalitis

37
Q

Rubella - urgently notifiable within 24 hours

A

Rubella virus, not up to date with immunisation

Prodrome: coryza, fever, sore throat

Macular, pale-pink rash 1 - 2 days after, starts behind ears with post-auricular lymphadenopathy and spreads to face and trunk, limb-sparing

Dx: rubella-specific IgM serology

Mx: supportive, stay off school 5 days after rash develops

If unvaccinated pregnant woman, must isolate and if suspected or confirmed rubella - urgent referral to obstetrics

Congenital rubella syndrome before 20 weeks - cataracts, deafness and heart defects e.g. patent ductus arteriosus

38
Q

Parvovirus B19

A

Slapped cheek/fifth disease

Prodrome of fever, coryza and diarrhoea

Then 1- 2 weeks later, reticular, erythematous rash across whole body, bright-red cheeks, perioral sparing

Dx: clinical

Mx: supportive, children can go back to school once rash appears as no longer infectious

Complications: foetal hydrops (oedema) and aplastic crisis in sickle cell disease

39
Q

Scarlet fever - urgently notifiable 24 hours

A

Only bacterial cause of childhood exanthem, associated with tonsilitis

Streptococcus pyogenes

Prodrome: fever, sore throat, headache

Then 1 - 2 days later, widespread, macular, erythematous rash that starts on chest, rough “sand-paper” texture, peri-oral sparing, lymphadenopathy, strawberry tongue

Mx: phenoxymethylpenicillin (pen V) for 10 days, absence from school until 1st dose of abx

Complications: post-streptococcal glomerulonephritis, rheumatic fever

40
Q

Glandular fever

A

Infectious mononucleosis - Epstein Barr virus

Often presents as a widespread, maculopapular rash after being prescribed amoxicillin for suspected tonsilitis

Key features: fever, sore throat, fatigue, hepato/splenomegaly

Dx: clinical, but can give positive heterophil antibodies

Mx: supportive, go back to work or school once feeling better

41
Q

Chickenpox

A

Varicella zoster virus - highly contagious, intubation period of up to 21 days

Prodrome of fever, malaise, appetite loss

Then 1 - 2 days later, a very itchy, vesicular rash! Starts on chest or face and then spreads to the whole body for 2 - 5 days

No longer infectious when all lesions have crusted over and can go back to school

Mx: supportive with hygiene measures, oatmeal baths and calamine lotion

Complications: secondary bacterial infection due to scratching, pneumonia (mostly in adults), encephalitis, shingles

42
Q

Kawasaki’s disease

A

Prolonged, high-grade fever of more than 5 days and CREAM

C- conjunctivitis
R - rash
E - erythema of the palms and soles and desquamation
A - adenopathy (cervical - unilateral and non-tender)
M- mucosal inflammation (e.g. strawberry tongue)

Ix: echo, ECG

Mx: high-dose aspirin and IV immunoglobulins

Monitor with echo as risk of coronary aneurysms

43
Q

Impetigo

A

Common, superficial, highly contagious bacterial skin condition, pustular or bullous lesions that can appear anywhere on the body.

RFs: children, eczema, crowded environments, direct contact with infected person, poor hygiene

Non-bullous - pustules or vesicles, dries into honey-coloured crusted lesions

Bullous - bullae (blister > 1cm), ruptures and oozes pus, might be associated with fever, malaise, lymphadenopathy

Dx: clinical history and examination, swabs of weeping lesions can confirm cause and abx sensitivities

Mx:

Conservative: hygiene measures, wash affected areas with soap, wash hands, cover affected areas, stay off work or school until blisters are healed

Hydrocortisone cream 1% if not on face

Fusidic acid cream if on face

If widespread or bullous then oral flucloxacillin/clarithromycin

44
Q

Rheumatoid arthritis

A

Chronic inflammation affecting the joint, inflammatory arthritis

Symmetrical polyarthritis - multiple small joints: MCP, PIP, wrist, MTP

Large joints: ankles, hips, knees, shoulders

RFs: female, middle age (>40), obesity, smoking, HLA-DR4

Key features: worse in morning, stiffness/pain > 30 mins, worse with rest and improves with activity

Dx: Rheumatoid factor (positive in 70%), anti-cyclic citrullinated peptide antibodies (positive in 80%), CRP and ESR, X-ray of affected joints

Mx: refer to rheumatology, NSAIDs and baseline bloods while waiting. DMARDs e.g. methotrexate

45
Q

Osteoarthritis

A

Wear and tear of the synovial joint

RF: obesity, increased age, occupation that put stress on joints, family history, female, injury

Imbalance between cartilage damage and chondrocyte response = structural problems

Hips, knees, DIPs, carpometacarpal (base of thumb), lumbar spine, cervical spine

X-ray changes: LOSS

Loss of joint space
Osteophytes (new bony spurs)
Subchondral sclerosis
Subchondral cysts

Key features: pain/stiffness that is worse on activity and end of the day, bulky/bony enlargement, crepitus on movement, joint effusions, referred pain e.g. hip OA presenting as LBP

Hand signs: Bouchard’s nodes (PIP), Heberden’s nodes (DIP), squaring of CMC joint

Dx: clinical Dx if > 45 with typical OA symptoms and no morning stiffness (or < 30 mins)

Mx: therapeutic exercises, weight loss, occupational therapy e.g. walking aids

Topical NSAIDs for knee, oral NSAIDS + PPI for gastroprotection, intra-articular steroid injections for short-relief, joint replacement if severe

46
Q

Osteoporosis

A

Imbalance between osteoblast (bone remodelling) and osteoclast (bone breakdown) causing bone reabsorption to exceed remodelling = reduced tubercular bone density, increased risk of fragility and fractures.

RFs: FIGHT ME! SHATTERED

Female, Menopausal, Steroids, Hyperthyroidism/Hypothyroidism, Alcohol/smoking, low Testosterone, Thin (low BMI), Erosive disease (e.g. IBD), Renal/liver failure, Early Menopause, DMT1 or malabsorption

47
Q

Investigations for osteoporosis

A

Bone mineral density measured using DEXA scan, T-score used to make a diagnosis

T-score is the number of standard deviations the patient is away from the BMD of a healthy young adult

> -1 is normal

Between -2.5 to -1 is osteopenia

< -2.5 is osteoporosis

48
Q

Management of osteoporosis

A
  • Weight loss and regular exercise
  • Stop smoking and reduce alcohol
  • Adcal D3
  • 1st line medical tx: bisphosphonates e.g. alendronic acid (alendronate 70mg once weekly), interferes with osteoclast attachment to bone

Take on empty stomach, full glass of water, stand up or sit up for 30 mins after to reduce reflux and erosion of oesophagus

Side effects: reflux, oesophageal erosion, osteonecrosis of the jaw

Sharon's Phase 3a (10 decks)

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