General Practise Flashcards
Recall the 3 principle processes by which spinal stenosis of the spinal cord occurs
- Loss of disc space
- Loss of oesteophytes
- Hypertrophic ligamentum flavum
Spinal stenosis most often affects which areas of the spine?
Lumbar and/or cervical spine. Vary rarely affects the thoracic spine. Symptomatic thoracic back pain is much more indicative of malignancy
Outline the 5 principle clinical characteristics of cervical spinal stenosis
- Neck pain + restricted range of movement of the neck
- Instability of gait
- Loss of fine motor control of the upper limbs
- Weakness and sensory disturbance in the upper and lower limbs
- Urinary urge incontinence
What is the most common cause of lumbar spinal stenosis?
Age related degenerative arthritis of the spine
Suggest 7 causes of lumbar spinal stenosis
- Degenerative arthritis of the spine
- Congenital narrowing of the spinal canal
- Hyperparathyroidism
- Paget’s disease of bone
- Ankylosing spondylitis
- Cushing’s syndrome
- Acromegaly
Describe the the ‘classical’ pain associated with lumbar spinal stenosis
Bilateral leg pain with burning or cramping sensation. Involves the buttocks and thighs and may spread distally in more severe disease
What is spondyloisthesis?
Degenerative lumbar vertebral subluxation
What is the principle differential diagnoses to consider when there is a clinical suspicion of lumbar spinal stenosis?
Cauda Equina Syndrome
Name the 3 modes of conservative of management of lumbar spinal stenosis
- NSAIDS
- Physiotherapy
- Epidural steroid injections
Suggest 6 potential causes of Cauda Equina Syndrome
- Trauma
- Disc herniation
- Spinal Stenosis
- Spinal neoplasm
- Chronic inflammation
- Infection
Give 6 clinical features of Cauda Equina syndrome that will be found on examination
- Low back pain
- Unilateral or bilateral sciatica
- Saddle and perineal anaesthesia
- Bowel and bladder disturbances
- Muscle weakness
- Sensory deficits + reduced/ absent reflexes in the legs
Recall the cancer types that commonly metastases to bone from the mnemonic: Kinds Of Tumours Leaping Promptly To My Bones
K - Kidney O - Ovaries T - Thyroid L - Lung P - Prostate T - Testicular M - Myeloma B - Breast
Suggest 3 infective causes of back pain
- Discitis
- Osteomylitis
- TB
Give 4 clinical features of a spinal fracture
- Sudden onset, severe pain that is relieved by lying down
- Hx of trauma (this may only be minor in patients with osteoporosis)
- Structural spinal deformity
- Point tenderness over a vertebral body
What is the risk of taking Ibuprofen for patients that also have asthma?
Ibuprofen can cause bronchospasms
Suggest 3 types of primary maligancy that may present with back pain
- Myeloma
- Chondrosarcoma
- Osteosarcoma
Name a drug that can be used in the treatment of excessive respiratory secretions
Hyoscine hydrobromide
Which 2 vitamins/minerals should be provided for patients during alcohol withdrawal?
- Thiamine
2. Folate
Which medication can be prescribed in order to aid alcohol detoxification?
A reducing regime of chlordiazepoxide
Cholesterol checking for asymptomatic patients can be offered between what age range on the NHS?
Patients between 40-75 years can have CVD risk check through the NHS
According to NICE guidelines, a patient with a QRISK score greater than what level should be offered a discussion concerning lifestyle modification, support and further reassessment in the future?
> 10%
What is the recommended treatment regime for the primary prevention of of CVD in people with a greater than 10% 10 year risk of developing CVD?
20mg Atorvostatin
How does a statin act to lower cholesterol levels?
Inhibits HMGcoA Reductase in the liver - preventing the conversion of saturated fats into cholesterol
Suggest 5 potential signs of increased work of breathing in a child
- Tracheal tug
- Recession
- Increased respiratory rate
- Abdominal breathing
- Cyanosis
What are the 4 Centor Criteria used to evaluate whether a sore throat is likely to be due to a bacterial infection?
- Presence of tonsillar exudate
- Presence of tender anterior lymphadenopathy or lymphadenitis
- History of fever (> 38 degrees)
- Absence of cough
Recall the normal heart rate for children by age up to the age of 12
< 1 year - 110-160 1-2 years - 100-150 2-5 years - 95-140 5-12 years - 80-120 >12 years - 60-100
What are the 3 main methods of emergency contraception that can be offered?
- EHC (Emergency Hormonal contraception) - Levonorgestrel
- Copper coil IUD
- EllaOne - Ullipristal acetate 30mg
What is the mechanism of action of Ullipristal acetate?
Binds with high affinity to progesterone receptors thereby delaying ovulation
What is the function of the COX-1 enzyme?
Production of prostaglandins that help to maintain the gastric mucosal integrity and platelet initiated blood clotting
What is the function of the COX-2 enzyme?
Produce prostaglandins that mediate pain and inflammation
Name 2 COX-2 specific NSAIDS
- Celecoxib
2. Etoricoxib
Give 4 examples of COX non selective NSAIDS
- Ibuprofen
- Indometacin
- Mefenamic acid
- Naproxen
Recall the components of the ‘NO TEARS’ mnemonic used for an effective medication review
N - Need and indication O - Open questions T - Tests and monitoring E - Evidence and Guidelines A - Adverse events R - Risk reduction or prevention S - Simplification and switches
Suggest the 10 most common drug groups that are associated with hospital admission as a result of adverse drug reactions
- NSAIDS
- Diuretics
- Warfarin
- ACE
- Antidepressants
- Beta- blockers
- Opiates
- Digoxin
- Prednisolone
- Clopidogrel
Name the 5 possible forms of spondyloisthesis
- Isthmic - usually acquired in adolescence as a consequence of spondylolysis
- Degenerative
- Traumatic
- Pathologic
- Dysplastic
Define spondylolysis
Bony defect ( commonly due to a stress fracture) in the pars interarticularis of the vertebral arch
Suggest 7 risk factors associated with an increased risk of spondylolysis developing into spondylolisthesis
- Female gender
- Younger age
- Spina bifida
- Vertebral wedging
- Hyperlordosis
- Positive family Hx
- High impact sports
The presence of which biomarker can be indicative of coeliac disease?
Tissue Trans-glutaminase antibodies
What is the most common bacteria causing food poisoning in the UK?
Campylobacter
Give 3 clinical characteristics associated with Wernicke’s Encephalopathy
- Mental confusion
- Oculomotor disturbance
- Ataxia / lower limb paralysis
Unilateral tinnitus is a potential red flag symptom for which condition?
Acoustic neuroma
How do you check/ examine a patient of postural hypotension?
Check BP lying and then after standing at 1, 3 and 5 minute intervals. Ask the patient if they experience any symptoms at any point in the examination
What is betahistine?
A vasodilator of the inner ear that can be used in the management of vertigo symptoms
Give 4 common side effects associated with furosemide
- Mild GI disturbance
- Postural hypotension
- Electrolyte imbalances
- Hypersensitivity reactions
What type of drug is bumetanide?
Loop diuretic
Recall the HARK questions to ask any patient when domestic abuse may be suspected
H - (Humiliation) - Within the last year, have you been humiliated or emotionally abused in other ways by your partner or ex-partner?
A - (Afraid) - Within the last year, have you been afraid of your partner or ex-partner?
R - (RAPE) - Within the last year, have you been raped or forced to have any form of sexual activity by your partner or ex-partner?
K - (KICK) - Within the last year, have you been kicked, hit, slapped or otherwise physically hurt by your partner or ex-partner?
Give 2 side effects commonly associated with Mirtazapine
- Drowsiness
2. Weight gain
The unhappy triad associated with a lateral trauma to the knee involves damage to which 3 structures?
- Anterior cruciate ligament
- Medial collateral ligament
- Meniscus (more commonly the lateral meniscus)
What is the most likely causative organism of a fungal nail infection?
Trichophyton rubrum
What is the first line treatment for a threadworm infection in a child > 6?
Single dose of mebendazole for child and all household contacts
Hx of schistosomiasis infection is a risk factor for which form of cancer?
Squamous cell carcinoma of the bladder
Name 2 medications which may cause hypothyroidism
- Lithium
2. Amiodarone
What is the most appropriate initial investigation for the diagnosis of a suspected Achilles’ tendon rupture?
Ultrasound scan
Recall the components of Simmond’s triad for the assessment of a possible Achilles Tendon Rupture
- Palpation of the tendon
- Examining the angle of declination at rest
- Calf squeeze test