General Practice short Flashcards

Question

Conditions associated with IBD

Answer 1

Erythema nodosum - tender, red nodules on shins Enteropathic arthritis (inflammatory arthritis) Primary sclerosing cholangitis Red eye conditions (e.g. anterior uveitis)

Answer 2

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

Answer 3

- 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

Answer 4

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

Answer 5

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)

Answer 6

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

Answer 7

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

Answer 8

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)

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

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

Answer 22

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

Answer 23

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

Answer 24

- 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

General Practice short Flashcards

Summary of important topics (48 cards)