GP

Question 1

LUTS symptoms

Answer 1

Storage - Frequency, urgency, incontinence, nocturia

Voiding - weak stream, dribbling, dysuria, straining

Question 2

Reluctance to discuss incontinence

Answer 2

Think it’s part of ageing
Shame/embarrassment
Think its side effect of child birth

Question 3

What would you look for on physical exam LUTS

Answer 3

Tenderness, kidney masses, abdominal masses, bladder fullness by percussion.

Digital rectal examination - prostate size, tenderness, cragginess.

Question 4

Things to look for on urine dipstick

Answer 4

Haematuria, pH, nitrites (gram neg - E coli), leukocytes

Question 5

LUTS investigations

Answer 5

Mid stream urine - checks for infection. Mid stream means no contamination from skin around urethral orifice.

PSA - prostate specific antigen. Produced by normal and cancerous prostate cells.

Urinalysis - dipstick/culture.

Question 6

Things that can raise PSA

Answer 6

Prostate enlargement.
Older age.
Infection.
Vigorous exercise, digital rectal exam, catheterization
Ejaculation
Normal prostate.

Prostate enlargement can also present with normal PSA. 5 alpha reductase inhibitor can also decrease PSA

Question 7

Factors affecting treatment of LUTS

Answer 7

Prostate size
Age
Overall health
If the patient is even experiencing discomfort

Question 8

Treatment for LUTS

Answer 8

BPH/PSA - Alpha 1 blocker tamsulosin - relaxes bladder walls
5 alpha reductase inhibitor - finasteride

UTI - Antibiotics. Nitrofurantoin, trimethoprim. Doxycycline, ciprofloxacin

Question 9

PSA Testing indications

Answer 9

Men with LUTS, erectile dysfunction, visible haematuria.

Question 10

Reasons against PSA screen

Answer 10

Can falsely suggest cancer, leading to unnecessary treatment and investigation.
Prostate cancer can be benign, or can be slow growing, meaning life is never affected by it.
Cancer may be benign.

Instead there is a free informed choice program for over 50s.

Question 11

Benefits vs Limitations of PSA testing

Answer 11

Benefits - Early detection and treatment of cancer

Limitations - False negative, false positive, Unnecessary treatment/investigation

Question 12

Risk factors for BPH

Answer 12

Age - rarely affects under 40. Testosterone only metabolised into dihydrotestosterone at 30. Symptoms usually start after 60
Family history
Diabetes
Obesity
Ethnicity - increased risk in black men
Smoking
Low vegetable intake, diet (high calcium(

Question 13

Tamsulosin action

Answer 13

Blocks alpha1 receptors around prostate, relaxing muscles and dilating urethra and bladder neck.

Contra indicated in syncope and postural hypotension. Can cause dizziness and dryness of mouth

Question 14

BPH Symptom score

Answer 14

International prostate symptoms score

Incomplete emptying, frequency, urgency, straining, weak stream, intermittency, nocturia

Question 15

Depression treatment

Answer 15

SSRI - selective serotonin reuptake inhibitor (sertraline)
Tricyclic antidepressant - Amitriptyline
SNRI - selective noradrenaline reuptake inhibitor - Duloxetine

Question 16

6 in 1 vaccine

Answer 16

diphtheria, Hep B, Hib, polio, tetanus, whooping cough

Given at 8,12,16 weeks

Question 17

Drugs used to manage MI

Answer 17

Antiplatelet- Prevent clotting of platelets
Aspirin - irreversible cyclooxygenase enzyme inhibitor
Clopidogrel - Irreversible inhibitor of ADP receptor, prevents platelet aggregation

ACEi - Reduces blood pressure
Ramipril - competitive inhibitor

Beta blocker - Reduces contractility, heart rate, cardiac work
Bisoprolol - Competitive antagonist of beta 1 adrenoreceptor

Statin - reduce LDL chloestrol
Atorvastatin

Question 18

Extra articular manifestations of RA

Answer 18

Uveitis, dry eyes, rheumatoid nodules, pleuritic chest pain (pericarditis association)

Question 19

Risk factors for RA

Answer 19

Female, obesity, smoking, HLA-DR4 and HLA-DRB1

Question 20

Additional manifestations for Rheumatoid arthritis

Answer 20

Leg ulcers especially in Felty’s syndrome (RF positive, neutropenia, splenomegaly), rashes and nail infarcts.

Pulmonary fibrosis

Pleural involvement

Caplans syndrome

Question 21

Investigations for joint pain/swelling

Answer 21

Needle joint aspiration - Pyogenic bacteria = septic arthritis
Neisseria gonnorhoeae - Gonococcal arthritis

Question 22

Stool chart

Answer 22

Bristol stool chart