General Practise Flashcards
1
Q
Recall the 3 principle processes by which spinal stenosis of the spinal cord occurs
A
- Loss of disc space
- Loss of oesteophytes
- Hypertrophic ligamentum flavum
2
Q
Spinal stenosis most often affects which areas of the spine?
A
Lumbar and/or cervical spine. Vary rarely affects the thoracic spine. Symptomatic thoracic back pain is much more indicative of malignancy
3
Q
Outline the 5 principle clinical characteristics of cervical spinal stenosis
A
- 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
4
Q
What is the most common cause of lumbar spinal stenosis?
A
Age related degenerative arthritis of the spine
5
Q
Suggest 7 causes of lumbar spinal stenosis
A
- Degenerative arthritis of the spine
- Congenital narrowing of the spinal canal
- Hyperparathyroidism
- Paget’s disease of bone
- Ankylosing spondylitis
- Cushing’s syndrome
- Acromegaly
6
Q
Describe the the ‘classical’ pain associated with lumbar spinal stenosis
A
Bilateral leg pain with burning or cramping sensation. Involves the buttocks and thighs and may spread distally in more severe disease
7
Q
What is spondyloisthesis?
A
Degenerative lumbar vertebral subluxation
8
Q
What is the principle differential diagnoses to consider when there is a clinical suspicion of lumbar spinal stenosis?
A
Cauda Equina Syndrome
9
Q
Name the 3 modes of conservative of management of lumbar spinal stenosis
A
- NSAIDS
- Physiotherapy
- Epidural steroid injections
10
Q
Suggest 6 potential causes of Cauda Equina Syndrome
A
- Trauma
- Disc herniation
- Spinal Stenosis
- Spinal neoplasm
- Chronic inflammation
- Infection
11
Q
Give 6 clinical features of Cauda Equina syndrome that will be found on examination
A
- 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
12
Q
Recall the cancer types that commonly metastases to bone from the mnemonic: Kinds Of Tumours Leaping Promptly To My Bones
A
K - Kidney O - Ovaries T - Thyroid L - Lung P - Prostate T - Testicular M - Myeloma B - Breast
13
Q
Suggest 3 infective causes of back pain
A
- Discitis
- Osteomylitis
- TB
14
Q
Give 4 clinical features of a spinal fracture
A
- 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
15
Q
What is the risk of taking Ibuprofen for patients that also have asthma?
A
Ibuprofen can cause bronchospasms
16
Q
Suggest 3 types of primary maligancy that may present with back pain
A
- Myeloma
- Chondrosarcoma
- Osteosarcoma
17
Q
Name a drug that can be used in the treatment of excessive respiratory secretions
A
Hyoscine hydrobromide
18
Q
Which 2 vitamins/minerals should be provided for patients during alcohol withdrawal?
A
- Thiamine
2. Folate
19
Q
Which medication can be prescribed in order to aid alcohol detoxification?
A
A reducing regime of chlordiazepoxide
20
Q
Cholesterol checking for asymptomatic patients can be offered between what age range on the NHS?
A
Patients between 40-75 years can have CVD risk check through the NHS
21
Q
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?
A
> 10%
22
Q
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?
A
20mg Atorvostatin
23
Q
How does a statin act to lower cholesterol levels?
A
Inhibits HMGcoA Reductase in the liver - preventing the conversion of saturated fats into cholesterol
24
Q
Suggest 5 potential signs of increased work of breathing in a child
A
- Tracheal tug
- Recession
- Increased respiratory rate
- Abdominal breathing
- Cyanosis
25
What are the 4 Centor Criteria used to evaluate whether a sore throat is likely to be due to a bacterial infection?
1. Presence of tonsillar exudate
2. Presence of tender anterior lymphadenopathy or lymphadenitis
3. History of fever (> 38 degrees)
4. Absence of cough
26
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
```
27
What are the 3 main methods of emergency contraception that can be offered?
1. EHC (Emergency Hormonal contraception) - Levonorgestrel
2. Copper coil IUD
3. EllaOne - Ullipristal acetate 30mg
28
What is the mechanism of action of Ullipristal acetate?
Binds with high affinity to progesterone receptors thereby delaying ovulation
29
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
30
What is the function of the COX-2 enzyme?
Produce prostaglandins that mediate pain and inflammation
31
Name 2 COX-2 specific NSAIDS
1. Celecoxib
| 2. Etoricoxib
32
Give 4 examples of COX non selective NSAIDS
1. Ibuprofen
2. Indometacin
3. Mefenamic acid
4. Naproxen
33
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
```
34
Suggest the 10 most common drug groups that are associated with hospital admission as a result of adverse drug reactions
1. NSAIDS
2. Diuretics
3. Warfarin
4. ACE
5. Antidepressants
6. Beta- blockers
7. Opiates
8. Digoxin
9. Prednisolone
10. Clopidogrel
35
Name the 5 possible forms of spondyloisthesis
1. Isthmic - usually acquired in adolescence as a consequence of spondylolysis
2. Degenerative
3. Traumatic
4. Pathologic
5. Dysplastic
36
Define spondylolysis
Bony defect ( commonly due to a stress fracture) in the pars interarticularis of the vertebral arch
37
Suggest 7 risk factors associated with an increased risk of spondylolysis developing into spondylolisthesis
1. Female gender
2. Younger age
3. Spina bifida
4. Vertebral wedging
5. Hyperlordosis
6. Positive family Hx
7. High impact sports
38
The presence of which biomarker can be indicative of coeliac disease?
Tissue Trans-glutaminase antibodies
39
What is the most common bacteria causing food poisoning in the UK?
Campylobacter
40
Give 3 clinical characteristics associated with Wernicke's Encephalopathy
1. Mental confusion
2. Oculomotor disturbance
3. Ataxia / lower limb paralysis
41
Unilateral tinnitus is a potential red flag symptom for which condition?
Acoustic neuroma
42
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
43
What is betahistine?
A vasodilator of the inner ear that can be used in the management of vertigo symptoms
44
Give 4 common side effects associated with furosemide
1. Mild GI disturbance
2. Postural hypotension
3. Electrolyte imbalances
4. Hypersensitivity reactions
45
What type of drug is bumetanide?
Loop diuretic
46
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?
47
Give 2 side effects commonly associated with Mirtazapine
1. Drowsiness
| 2. Weight gain
48
The unhappy triad associated with a lateral trauma to the knee involves damage to which 3 structures?
1. Anterior cruciate ligament
2. Medial collateral ligament
3. Meniscus (more commonly the lateral meniscus)
49
What is the most likely causative organism of a fungal nail infection?
Trichophyton rubrum
50
What is the first line treatment for a threadworm infection in a child > 6?
Single dose of mebendazole for child and all household contacts
51
Hx of schistosomiasis infection is a risk factor for which form of cancer?
Squamous cell carcinoma of the bladder
52
Name 2 medications which may cause hypothyroidism
1. Lithium
| 2. Amiodarone
53
What is the most appropriate initial investigation for the diagnosis of a suspected Achilles’ tendon rupture?
Ultrasound scan
54
Recall the components of Simmond’s triad for the assessment of a possible Achilles Tendon Rupture
1. Palpation of the tendon
2. Examining the angle of declination at rest
3. Calf squeeze test
55
What is the best immediate pharmacological treatment for variceal haemorrhage?
Terlipressin - Vasopressin analogue
56
What is the first line prophylactic treatment for cluster headaches?
Verapamil
57
What is the most common cause of sudden painless unilateral vision loss in patients with diabetes?
Vitreous haemorrhage
58
What is the management for a patient with a wound who has an uncertain tetanus vaccination Hx?
Give a tetanus booster + immunoglobulin
59
What is the conformational test used to confirm an on going C.Diff infection?
C.Difficile Toxin
60
Broca’s aphasia is associated with a lesion in which part of the brain?
Inferior frontal gyrus
61
Wernicke’s aphasia is caused by a lesion in which part of the brain?
Superior temporal gyrus
62
Radio-femoral delay is associated with which type of congenital abnormality?
Coarctation of the aorta
63
Briefly define Familial Mediterranean Fever
Autosomal recessive condition and more common in Mediterranean descent. It causes short, recurrent episodes of peritonitis, pleuritis, arthritis and fever
64
A positive Rovsing's sign is indicative of which condition?
Acute appendicitis
65
Describe a positive Rovsing's sign on clinical examination
Palpation of the left lower quadrant increases the pain felt in the right lower quadrant
66
'Skip lesions' are specific to which type of inflammatory bowel disease?
Crohn's disease
67
Suggest 4 extra-intestinal manifestations of Crohn's disease
1. Iritis
2. Arthritis
3. Erythema nodosum
4. Pyoderma gangrenosum
68
What is a Monteggia fracture?
Fracture of the proximal ulna + dislocation of the proximal head of the radius
69
What is a Galeazzi fracture?
Fracture of the distal radius + dislocation of the distal radioulnar joint
70
What is a Colle's fracture?
Distal radial fracture with dorsal displacement
71
What is a Smith's fracture?
Distal radial fracture with volar (anterior) displacement
72
What is a Bennett's fracture
Fracture of the base of the first metacarpal, that extends into the carpometocarpal joint
73
'Grey baby' syndrome is associated with the use of which medication in pregnancy?
Chloramphenicol
74
Lithium during pregnancy is associated with what type of foetal abnormality?
Ebstein's anomaly
75
The pathognomonic sign on AXR of intramural gas (pneumatosis intestinalis) is associated with which neonatal condition?
Necrotising entercolitis
76
What is the first line bisphosphonate used for bone protection in patients on long term steriod therapy?
Alendronate
77
What 2 ocular problems may be caused by long term Amiodarone therapy?
1. Corneal opacities
| 2. Optic neuritis
78
Give 4 medical causes of folic acid deficiency
1. Phenytoin
2. Methotrexate
3. Pregnancy
4. Alcohol excess
79
What is Hutchinson's sign and what condition does it indicate?
Rash on the tip or side of the nose that represents a shingles infection with involvement of the nasocilliary branch of the ophthalmic division of the trigeminal nerve. This is a strong risk factor for ocular involvement
80
What is the most common vectorbourne disease seen in the northern hemisphere?
Lyme Borreliosis
81
What is the first line treatment for erythema migrans?
Doxycycline
82
What is the stereotypical presentation of a patient with Paget's disease of bone?
Older male complaining of bone pain in the setting of an isolated raise in ALP on investigation.
83
What is the first line treatment for pseudo gout?
NSAIDS and colchicine
84
What 3 factors contribute to the venous insufficiency that results in lipodermatosclerosis?
1. Incompetent venous valves
2. Venous outflow obstruction
3. Dysfunction of the calf muscle pump
85
Suggest 5 potential differentials for lipodermatosclerosis
1. Cellulitis
2. Erythema nodosum
3. Localised scleroderma
4. Cutaneous vasculitis
5. Necrobiosis lipoidica
86
Which medication may be used in combination with compression bandages in the treatment of venous ulceration?
Pentoxifylline
87
Name 3 medications which can cause oculogyric crises
1. Haloperidol
2. Phenothiazines
3. Metoclopramide
88
What are the 4 most common congenital heart abnormalities associated with Down Syndrome?
1. Atrioventricular septal defect
2. Ventricular septal defect
3. Persistent ductus arteriosus
4. Tetralogy of Fallot
89
What 4 questions are important to ask when triaging a patient presenting with dysphagia?
1. What can the patient swallow?
2. Time frame + are they systemically well?
3. Are they getting lots of chest infections? (may suggest aspiration)
4. Is the dysphagia due to an anatomical obstruction or neurological dysfunction?
90
What is the mechanism of action of methotrexate?
Inhibits dihydrofolate reductase
91
Suggest 3 indications for the use of methotrexate
1. Inflammatory arthritis
2. Psoriasis
3. Chemotherapy e.g. for acute lymphoblastic leukaemia
92
Give 5 adverse affects that can be associated with methotrexate therapy
1. Mucositis
2. Myelosuppression
3. Pneumonitis
4. Pulmonary fibrosis
5. Liver fibrosis
93
Name 3 medications that interact with methotrexate
1. Trimethoprim - Increases risk of marrow aplasia
2. Co-trimoxazole - Increases risk of marrow aplasia
3. High dose aspirin - Causes reduced excretion of methotrexate which may in turn result in toxicity
94
What infective organism causes Roseola?
Human Herpes Virus type 6B
95
What are the 4 key clinical features associated with Roseola Infantum?
1. High fever (lasting for 3-5 days)
2. Runny nose
3. Irritability
4. Tiredness
96
Roseola infantum is most commonly seen in which age group?
Children aged between 6 months and 3 years
97
Suggest 4 differential diagnoses to consider in a patient with a positive Thomas test
1. Patellofemoral pain syndrome
2. Lower back pain
3. Osteoarthritis
4. Rheumatoid arthritis
98
What is Hidradenitis Suppurativa?
Chronic condition characterised by swollen painful lesions arising from apocrine sweat glands occurring in the armpit, groin, anal and breast regions
99
Suggest 5 potential differential diagnoses for fibromyalgia
1. Chronic fatigue syndrome
2. Hypothyroidism
3. Polymyalgia rheumatica
4. Inflammatory and metabolic myopathies
5. Polymyositis
100
Hairy leukoplakia is caused by infection with which virus?
Epstein Barr
101
How would you test for Hoffman's sign and what would a positive sign indicate?
Examiner should flick the patient's distal phalanx to cause momentary flexion. A positive test refers to exaggerated concurrent flexion of the thumb. This indicates an Upper motor neuron lesion
102
Which ophthalmological condition has an association with ankylosing spondylitis?
Anterior Uveitis - Both have an association with HLA-B27
103
Why is Suxamethonium contraindicated in burns/ trauma patients?
Depolarising neuromuscular blockers such as suxamethonium increase the risk of hyperkalemia in these patient groups.
104
What is the medical management for pyloric stenosis?
IV atropine
105
Which 2 organisms are the most commonly identified causative agents of cellulitis?
1. Streptococcus pyogenes
| 2. Staph. Aureus
106
What is the antibiotic treatment for severe cellulitis?
Benzylpenicillin + Flucloxacillin first line
107
What are the classical ECG changes associated with a pulmonary embolism?
1. Large S wave in lead I
2. Large Q wave in lead III
3. Inverted T wave in lead III
'S1Q3T3'
108
What type of anticoagulant is first line treatment once a diagnosis of pulmonary embolism is suspected?
DOAC's e.g. Apixaban or Rivaroxaban
109
Suggest 5 potential differential diagnoses for DVT
1. Cellulitis
2. Superficial thrombophlebitis
3. Dependent oedema
4. Liver Cirrhosis/ Nephrotic syndrome
5. Ruptured Baker's cyst
6. Trauma
110
What causes guttate psoriasis?
Often occurs following a streptococcal infection of the throat or a viral upper respiratory tract infection
111
Briefly describe Charcot arthropathy
A form of peripheral neuropathy ( due to diabetes or syphilis for example) in which patients experience joint dislocation, associated fractures and pathologic deformities of the limbs - principally the feet.
112
Suggest 4 examples of a lack of testosterone which may result in pathological gynaecomastia
1. Klinefelter's syndrome
2. Androgen insensitivity syndrome
3. Testicular atrophy
4. Renal disease
113
Give 7 medications which may cause gynaecomastia
1. Digoxin
2. Spironolactone
3. Metronidazole
4. Chemotherapy
5. Goserelin
6. Antipsychotics
7. Anabolic steroids
114
What is the most common complication associated with Shingles?
Postherpetic neuralgia (occurring in ~ 10-18% of cases)
115
What is the clinical term for 'frozen shoulder'?
Adhesive capsulitis
116
Suggest 5 possible differential diagnoses for fibromyalgia
1. Chronic fatigue syndrome
2. Hypothyroidism
3. Polymyalgia rheumatic
4. Inflammatory and metabolic myopathies
5. Polymyositis
117
Contrast the parts of a bone that are most commonly affected by osteomyelitis in adults and children respectively
Adults - Epiphysis
| Children - Metaphysis
118
What is the most common causative organism of osteomyelitis?
Staph. Aureus
119
What is the most common causative organism of osteomyelitis in Sickle cell patients?
Salmonella species
120
Name 5 predisposing conditions to the development of osteomyelitis
1. Diabetes
2. Sickle cell anemia
3. IVDU
4. Immunosuppression
5. Alcohol excess
121
Recall the conditions that lead to upper lobe fibrosis using the mneomonic CHARTS
```
C - Coal workers pneuomoconiosis
H - Histiocytosis - Hypersensitivity pneuomonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Sarcoidosis
```
122
What is the first line treatment for intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid
123
What is Lemierre's syndrome?
An infectious thrombophlebitis of the internal jugular vein. Normally seen following an untreated oropharyngeal infection that spreads to the carotid sheath.
124
Why is pyridoxine given alongside ethambutol as part of the quadruple anti-TB therapy?
Vitamin B6 is given concurrently in order to reduce the incidence of the optic neuropathy and colour blindness associated with ethambutol
125
Name 2 common medical conditions associated with an increased incidence of 'trigger finger'
1. Diabetes
| 2. Rheumatoid arthritis
126
Suggest 3 potential causes of renal tubular acidosis type 1
1. Rheumatoid arthritis
2. SLE
3. Sjorgen syndrome
127
What genetic defect is associated with Marfan' syndrome?
FBN1 gene on chromosome 15 - codes for protein fibrillin-1
128
Suggest 4 potential complications/ consequences of a dilated aortic sinus
1. Aortic dissection
2. Aortic regurgitation
3. Aortic aneurysm
4. Mitral valve prolapse
129
Recall the '6 P's' that reference the potential side effects associated with the use of amiodarone
1. Prolongs action potential duration
2. Photosensitivity
3. Pigmentation of the skin
4. Peripheral neuropathy
5. Pulmonary alveolitis and fibrosis
6. Peripheral conversion of T3 to T4 is inhibited - leading to hypothyroidism
130
Recall the members of the 'KEEPS' acronym for organisms that commonly cause UTI
```
K - Klebsiella species
E - Enterococcus faecalis
E - Enterobacter species
P - Pseudomonas aeruginosa/ Proteus mirabilis
S - Staph saprophyticus
```
131
What are the 3 main causes of bacterial pneumonia? (SIM)
S - Streptococcus pneumonia
I - Haemophilus influenza
M - Mycoplasma pneumonia
132
What are the 3 components of the 7 day triple therapy for H.Pylori infection? (PAC)
P - PPI e.g. lansoprazole
A - Amoxicillin
C - Clarithromycin
133
What is the hallmark clinical feature of anterior uveitis?
Presense of inflammatory cells in the aqueous
134
Recall the causes of pericarditis (DR IS TRUMP)
```
D - Dressler syndrome
R - Radiotherapy
I - Infection
S - SLE
T - TB
R - Rheumatoid arthritis
U - Uraemia
M - Malignancy
P - Post myocardial infarction (24 to 48 hrs)
```
135
What are the characteristic features/ treatment for Lichen Planus? ( use the mnemonic PLANUS)
P - Purple papules are flat topped and itchy
L - Lacy markings on the surface of the eruption = Wickham's stria
A -Aeitology unknown ? Hep C virus
N - Normally occurs at sites of trauma and affects flexor aspects of the wrists, forearms, ankles and legs
U - Usually persists for 16-18 months
S - Symptomatic treatment + steroids for severe itch
136
Which type of lung cancer can be associated with Cushing's syndrome? (as a paraneoplastic syndrome)
Small cell lung cancer
