GP Flashcards
6 causes of cauda equina?
Malignancy:
Bony mets
Myeloma
Primary sacral tumour e.g. chordoma
Infection:
Epidural abscess
Trauma:
Disc prolapse
Epidural haematoma
What to do if a patient presents to GP with cauda equina?
Arrange urgent same day spinal surgery admission
How to tell the difference between cauda equina and cord compression?
Cauda equina compression causes flaccid paralysis with loss of reflexes
Cord compression usually causes spastic paralysis with brisk reflexes
Both cause sensory and power loss.
Red flag symptoms of lower back pain?
Bilateral sciatica Bladder dysfunction Perianal paraesthesia Gait disturbance Lower limb weakness Erectile dysfunction
SEs of metformin
GI upset - nausea & diarrhoea
Lactic acidosis (if renal failure)
Caution in RF if eGFR <30
What score can be used to calculate risk of CVD or stroke in the next 10 years? What age is it valid until?
QRisk2
84 years
Give some examples of meds used in migraine prophylaxis?
Amitryptiline
Propranolol
Topiramate
Mx of acute migraine?
Triptans
How to confirm Dx of HTN?
clinic blood pressure of 140/90 mmHg or higher AND
ABPM daytime average or HBPM average of 135/85 mmHg or higher
Beta-blocker CIs?
asthma cardiogenic shock marked bradycardia hypotension third degree AV block severe peripheral arterial disease
prophylaxis of chronic tension headache?
Amitriptyline
When to give abx in tonsillitis?
FeverPAIN score 2-3: consider delayed antibiotic prescription
FeverPAIN score 4-5: consider immediate antibiotic prescription
FeverPAIN criteria?
Fever Pus Symptom onset <3 days Inflamed tonsils No cough/coryza
Tonsillitis tx?
Penicillin V (500mg QDS for 10 days) is the treatment of choice with erythromycin or clarithromycin being the choices for those allergic to penicillin
Dukes staging colorectal cancer?
Dukes A – tumour confined to bowel wall
Dukes B – tumour has gone through wall but not into nodes
Dukes C – tumour involving regional nodes
Dukes D – distant metastases are present
How to prescribe buproprion in patients trying to quit smoking?
Bupropion 150 mg OD for 6 days, increasing to 150 mg BD for a total of 7–9 weeks
Ask them to stop smoking 7-14 days after starting buproprion
Who should get a lower dose of buproprion?
elderly
patients who have mild to moderate liver impairment
renal impairment where GFR <50 mL/min.
CIs to buproprion?
Seizures
CNS tumour
Severe hepatic cirrhosis
Hx of BPD, anorexia or bulimia
Risk of PE after AZ vaccine? What to do if they come in?
4-28 days
Send to A&E for platelet count (if low high chance)
3 types of melanocytic naevi?
Compound naevi have nests of cells at the epidermal-dermal junction as well as within the dermis. They tend to have a raised area surrounded by a flat pigmented area.
Junctional naevi have nests of cells at the epidermal-dermal junction. They tend to be flat and coloured.
Dermal naevi have nests of cells in the dermis. They tend to raised and can be skin coloured or pigmented.
Benefits of metformin?
Moderately effective glycaemic control (GC)
Weight loss
CV protection
Benefits of sulfonylureas (gliclazide)?
Highly effective glycaemic control
SEs of sulfonylureas (gliclazide)?
Risk hypos
Weight gain
Caution renal impairment
Benefits of Gliptins (Sitagliptin/Linagliptin)?
Weight neutral
Good in CKD
SEs of Gliptins (Sitagliptin/Linagliptin)?
Least effective GC
potential risk HF
Benefits of Pioglitazone?
Mod effective GC
safe in renal impairment
SEs of Pioglitazone? ELBOW
Edema (can worsen HF) Liver impairment Bladder cancer Osteoporosis (fractures) Weight gain
Benefits of SGLT2 inhibitors? (Empagliflozin)
Mod effective GC
weight loss
CV benefits
SEs of SGLT2 inhibitors (Empagliflozin)?
Genital infections
DKA
Amputation
Caution eGFR <60
Benefits of GLP-1s (injectable) (Exenatide)?
Highly effective GC
Weight loss
CV benefits
SEs of GLP-1s (injectable) (Exenatide)?
Cancer (breast)
Expensive
Benefits of insulin?
Highly effective GC
SEs of insulin?
Weight gain
Another name for seborrheic keratoses?
Basal cell papilloma
Standard uncomplicated UTI Tx in women?
Trimethoprim 200mg BD for 3 days
Nitrofurantoin 100mg modified release BD for 3 days (eGFR >40)
Pyelonephritis tx?
Cephalosporin or co-amoxiclav for 7-10 days
Review in 24-48 hours if not in hospital
When to organise USS in kids with UTI?
- In acute infection in all children with atypical features – poor urinary flow, abdominal/bladder mass, raised creatinine, sepsis, treatment failure, non-E.coli organism.
- During acute illness in children <6 months with recurrent UTIs
- Within six weeks, for children aged >6 months with recurrent UTIs
- Within six weeks, for all children <6 months of age with first time UTI that responds to treatment.
What dose is used in UTI prophylaxis?
Reduced dose - usually 25-50% normal dose
Which additional blood tests should be done if a patient’s LDL comes back increased?
TFTs
LFTs
U&Es
Fasting glucose
How does Bezafibrate act?
reducing serum triglycerides
Common SEs of statins?
Asthenia
Headache
Flatulence
Causes of secondary hypercholesterolaemia?
Obesity CKD Alcohol excess Anorexia Uncontrolled hypothyroidism Thiazide diuretics and ciclosporin
Which drugs are cautioned when a patient is taking a statin?
Clarithromycin
Grapefruit juice
How to manage faecal impaction?
Combination of movicol orally and phosphate enemas
Which laxative is used for bowel prep?
Picolax (sodium picosuphate with magnesium citrate)
How to convert morphine from oral to SC?
Half the dose
What anti-emetic is used in opioid induce nausea?
Metoclopramide 10mg TDS
What type of nausea is cyclizine useful against?
Bowel obstruction
Raised ICP
Motion sickness
When to stop statins due to myopathy?
If CK is 5-10x higher than normal
When to stop statins due to abnormal liver function?
If LFTs are 3x higher than normal
When to stop and restart pill due to surgery?
Stop 4 weeks before
Restart 2 weeks after
What CHADsVASc score is needed for tx in AF?
2+
Which type of ulcer is better after eating?
Duodenal
Why do we check U&Es after starting an ACEi?
Renal artery stenosis
What is does a feeling of heartbeat stopping followed by pounding suggest?
Ectopic supraventricular beats
Superficial thrombophlebitis tx?
NSAID
Hypertensive retinopathy stage 1 fundoscopy?
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
Hypertensive retinopathy stage 2 fundoscopy?
Arteriovenous nipping
Hypertensive retinopathy stage 3 fundoscopy?
Cotton-wool exudates
Flame and blot haemorrhages
Hypertensive retinopathy stage 4 fundoscopy?
Papilloedema
standard antibiotic prophylaxis in patients with COPD?
Azithromycin
Target BP in clinic?
- If <80y/o - 140/90
- If >80y/o - 150/90
- If T2DM - 140/90 (130/80 if end organ damage)
- If T1DM - 135/85 (130/80 if end organ damage)
When to refer cardiac chest pain from GP?
current chest pain or chest pain in the last 12 hours with an abnormal ECG: emergency admission
chest pain 12-72 hours ago: refer to hospital the same-day for assessment
chest pain > 72 hours ago: perform full assessment with ECG and troponin measurement before deciding upon further action
What to do if someone on immediate release metformin is struggling with SEs?
Switch to modified release and uptitrate whilst monitoring symptoms
Sick day rules for DM?
Increase frequency of blood glucose monitoring to four hourly or more frequently
Encourage fluid intake aiming for at least 3L in 24hrs
If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
Do not stop insulin
Otitis externa tx?
Topical antibiotic or combined topical antibiotic + steroid
Just antibiotics: Gentamicin/Chloramphenicol drops
Antibiotics + corticosteroids
• Dexamethasone + ciprofloxacin OR
• Betamethasone + Neomycin sulphate
What to do if someone’s urine albumin:creatinine ratio >3mg/mmol and they have known diabetes?
Start ACEi
When to refer to nephrology based off ACR?
ACR >70 and not known to have DM
ACR >30 + persistent haematuria (ruled out UTI)
ACR 3-29 + persistent haematuria + declining eGFR/CVD
Glaucoma screening if positive family history?
Annual screening from 40 years old
What is diabetic retinopathy stage 1 and what are the features?
Mild non-proliferative diabetic retinopathy
1 or more microaneurysm
What is diabetic retinopathy stage 2 and what are the features?
Moderate NPDR microaneurysms blot haemorrhages hard exudates cotton wool spots
What is diabetic retinopathy stage 3 and what are the features?
Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
intraretinal microvascular abnormalities in at least 1 quadrant
What is diabetic retinopathy stage 4 and what are the features?
Proliferative diabetic retinopathy
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
What is the last stage of diabetic retinopathy and what are the features?
Diabetic maculopathy
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
How is bowel cancer screened for and who is it offered to?
FIT test
Men and women aged 60 -74
