GP

Question 1

Anorexia labs

Answer 1

hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3

Question 2

Posterior vitreous detachment

Answer 2

Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision

Question 3

Retinal detachment

Answer 3

Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

Question 4

Vitreous haemorrhage

Answer 4

Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
causes: diabetes, bleeding disorders, anticoagulants

Question 5

Primary open angle glaucoma mx

Answer 5

360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg
prostaglandin analogue (PGA) eyedrops should be used next-line (latanoprost)

the next line of treatments includes:
beta-blocker eye drops
carbonic anhydrase inhibitor eye drops
sympathomimetic eye drops

Question 6

Fibroadenoma when is surgical excision indicated

Answer 6

> 3cm
Otherwise first line is watchful waiting

Question 7

Mammary duct ectasia

Answer 7

Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

Question 8

Duct papilloma

Answer 8

Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge

Question 9

Somatisation disorder

Answer 9

multiple physical SYMPTOMS present for at least 2 years
patient refuses to acceptreassurance or negative test results

Question 10

Illness anxiety disorder (hypochondriasis)

Answer 10

persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

Question 11

Conversion disorder

Answer 11

typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 12

Perforated tympanic membrane mx

Answer 12

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time
it is common practice to prescribe antibiotics to perforations which occur following an episode of acute otitis media

Question 13

SSRIS specific preference

Answer 13

Sertraljne post MI
Fluoexetine children and adolescents

Question 14

SSRI interactions

Answer 14

NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

Question 15

SSRI discontinuation syndrome

Answer 15

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

Question 16

SSRI and pregnancy

Answer 16

BNF says to weigh up benefits and risk when deciding whether to use in pregnancy.
- Use during the first trimester gives a small increased risk of congenital heart defects
- Use during the third trimester can result in persistent pulmonary hypertension of the newborn
- Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Question 17

De Clerambault syndrome

Answer 17

patient believes that a person of a higher social or professional standing is in love with them. Often this presents with people who believe celebrities are in love with them.

Question 18

Ekbom syndrome

Answer 18

parasitosis and is the belief that they are infected with parasites or have ‘bugs’ under their skin.

Question 19

Capgras syndrome

Answer 19

Capgras delusion is the belief that friends or family members have been replaced by an identical looking imposter

Question 20

Cotard syndrome

Answer 20

Cotard syndrome is characterised by a person believing they are dead or non-existent

Question 21

What is glue ear

Answer 21

otitis media with an effusion

Question 22

Glue ear management

Answer 22

active observation: the management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required
grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months
adenoidectomy