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3a GP > GP > Flashcards

GP Flashcards

1
Q

At what age does acne peak?

A

18 years

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2
Q

What are other causes of acne?

A

Systemic steroids, physical occlusion, PCOS and cushings

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3
Q

What causes acne?

A

Androgen secretion results in increased sebum excretion

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4
Q

What are comedomes?

A

Dilated pores with black plug of keratin

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5
Q

What is the black tip of a comedone?

A

Oxidised sebum (not dirt)

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6
Q

How does Roaccutane work?

A

It is a topical retinoid which reduces sebum production, inflammation and bacterial growth

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7
Q

What are some side effects of Roaccutane?

A

Teratogenic, dry lips and skin, photosensitivity and suicidal ideation

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8
Q

What is the treatment for moderate acne?

A

Long-term oral antibiotics such as Tetracycline

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9
Q

What is acute bronchitis?

A

Inflammation of major bronchi which often follows viral URTI

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10
Q

What are the symptoms of acute bronchitis?

A

Cough, sputum, breathlessness, wheeze

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11
Q

What should you consider if acute bronchitis is recurrent?

A

COPD - chronic bronchitis

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12
Q

What is the treatment for those with more risk factors in acute bronchitis?

A

Amoxicillin 500mg TDS

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13
Q

What are some indications for medical treatment in acute bronchitis?

A

High risk of serious complications with pre-existing cormorbidities
Aged over 65 with acute cough
History of CCF
Current use of oral steroids
DM

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14
Q

What is a type I sensitivity?

A

IgE antibodies to a specific allergen trigger mast cells and basophils to release histamine

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15
Q

What is a type II allergic reaction?

A

IgG and IgM react to an allergen and activate the complement system leading to direct damage of local cells

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16
Q

Give an example of a type II reaction

A

Haemolytic disease of the newborn
Transfusion reactions

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17
Q

What is a type III allergic reaction?

A

Immune complexes accumulate and cause damage to local tissues

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18
Q

Give an example of a type III reaction?

A

SLE and RA

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19
Q

What is a type IV allergic reaction?

A

Cell mediated hypersensitivity caused by T lymphocytes

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20
Q

Give an example of a type IV allergic reaction?

A

Contact dermatitis

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21
Q

What is patch testing most useful for diagnosing?

A

Allergic contact dermatitis - latex, perfumes, cosmetics and plants
Not useful for food allergies

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22
Q

What is RAST testing?

A

Measures total and allergen specific IgE levels in the blood

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23
Q

What type of anaemia is iron deficiency?

A

Microcytic (<80)

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24
Q

What are the causes of iron deficiency?

A

Blood loss - menorrhagia, GI bleeding
Poor diet
Malabsorption - CD, IBD
Increased demand - lactation, growth and pregnancy

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25
Q

What are the symptoms of iron deficiency anaemia?

A

Fatigue
Dyspnoea
SOB
Brittle nails and hair
Atrophic glossitis
Angular stomatitis
Kolonychia
Systolic flow murmur

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26
Q

What do diagnostic tests show for iron deficiency anaemia?

A

Low ferritin
Low transferrin saturation (but increased receptors)
Low reticulocytes
Polikocytosis
Anisocytosis
Pencil and target cells

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27
Q

What is the treatment for iron deficiency anaemia?

A

Oral ferrous sulphate
Ascorbic acid may enhance iron absorption
Increase vitamin C

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28
Q

When should iron deficiency anaemia be treated as a red flag?

A

Unexplained in adults over 60 = 2-week wait for suspected colorectal cancer

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29
Q

What are some dietary management options for iron deficiency anaemia?

A

Increase red meat, spinach and broccoli
Iron from vegetables is non-heme so a smaller % is available for absorption

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30
Q

What should you consider if there is a failure to respond to iron supplements?

A

Non-compliance (side effects of constipation and black stools)
H.pylori test
Coeliac disease

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31
Q

What is the inheritance of sickle cell anaemia?

A

Autosomal recessive

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32
Q

What does sickle cell anaemia cause to red blood cells?

A

Abnormal beta globin chains cause sickling of the red blood cell shape so they are more likely to get stuck in circulation

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33
Q

What is the gold standard diagnostic method for sickle cell anaemia?

A

Hb electrophoresis

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34
Q

What is a sickle cell crisis?

A

Exacerbations from dehydration, infection, stress or cold weather

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35
Q

What is a vaso-occlusive crisis?

A

Sickle shaped RBCs clog capillaries and cause distal ischaemia
Presents with pain and swelling in hands and feet
Can cause priapism trapping blood in the penis

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36
Q

What is a splenic sequestration crisis?

A

RBCs block flood flow in the spleen causing an acutely enlarged and painful spleen and can lead to infarction

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37
Q

What does hyposplenism cause?

A

Susceptibility to infections from encapsulated bacteria such as Strep pneumoniae and Hib

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38
Q

What is an aplastic crisis?

A

Temporary absence of the creation of new RBC triggered by parvovirus B19 infection

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39
Q

What is acute chest syndrome?

A

Vessels supplying the lungs are clogged with sickled RBCs
Can be triggered by a vaso-occlusive crisis, fat embolism or infection

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40
Q

What will a CXR show for acute chest syndrome?

A

Pulmonary infiltrates

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41
Q

What is given as antibiotic prophylaxis for hyposplenism?

A

Penicillin V

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42
Q

What can be given to stimulate foetal Hb?

A

Hydroxycarbamide

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43
Q

What is a treatment for vaso-occlusive crises?

A

Crizanlizumab - a monoclonal antibody that prevents RBCs from sticking to the blood vessel walls

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44
Q

What are some long term problems of sickle cell anaemia?

A

Osteomyelitis - from Salmonella
Cardiomegaly and arrhythmias
Liver dysfunction from trapping sickle cells
Ischaemic colitis

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45
Q

What is hereditary spherocytosis?

A

Inherited abnormality of RBCs caused by defects in structural membrane proteins
Causes spherical RBCs that are removed by the spleen
Causes a very short RBC lifespan

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46
Q

What is the inheritance of hereditary spherocytosis?

A

Autosomal dominant

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47
Q

What are the symptoms of hereditary spherocytosis?

A

Jaundice, anaemia, splenomegaly, leg ulcers
Chronic haemolysis can lead to gallstones

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48
Q

What are the diagnostic tests for hereditary spherocytosis?

A

Spherocytes and reticulocytes on blood film
Serum bilirubin and urinary urobilinogen increased
Coombs test negative

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49
Q

What is the inheritance of G6PD deficiency?

A

X-linked recessive

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50
Q

What is G6PD deficiency?

A

Lack of G6PD enzyme which provides NADH to protect RBC from oxidate damage
Deficiency reduces lifespan

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51
Q

What are some triggers for symptoms of G6PD deficiency?

A

Quinine, fava beans, aspirin, Nitrofurantoin, henna

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52
Q

What are the blood film findings for G6PD deficiency?

A

Heinz bodies, bite cells and reticulocytosis

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53
Q

What is AIHA?

A

Immune system attacks RBCs as foreign molecules so the body produces autoantibodies causing extravascular haemolysis and spherocytosis

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54
Q

What are some secondary causes of AIHA?

A

Infection - HCV, HIV, EBV
Cancer
SLE
Slceroderma
NSAIDs

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55
Q

What are the two types of AIHA?

A

Warm - IgG mediated at 37 degrees
Cold - IgM at under 4 degrees

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56
Q

What are some symptoms of AIHA?

A

SOB, fatigue, palpitations, chest pain, headache, pale skin
Warm - dizziness, jaundice, palpitations
Cold - cold hands and feet, chest pain, arrhythmias

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57
Q

What is the treatment for warm AIHA?

A

Steroids/ immunosuppressants/ splenectomy

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58
Q

What is the treatment for cold AIHA?

A

Chlorambucil - interferes with DNA replication and damages cell DNA

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59
Q

What type of anaemia is folate deficiency?

A

Macrocytic

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60
Q

Where is folate absorbed?

A

Duodenum and start of jejunum

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61
Q

What is folate found in?

A

Green vegetables, nuts, yeast and liver

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62
Q

What are some risk factors for folate deficiency?

A

Elderly
Poverty
Alcoholics
CD and coeliac

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63
Q

What are some causes of folate deficiency?

A

Goat milk in infancy
Poor intake
Malabsorption
Increased demand
Trimethoprim
Methotrexate

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64
Q

What do diagnostic tests show for folate deficiency?

A

Macrocytic oval macrocytes with hypersegmented neutrophil polymorphs with 6+ nuclear lobes
Serum bilirubin may be raised

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65
Q

What is the treatment for folate deficency?

A

Treat underlying cause
Folic acid tablets - but never without B12 as it can mask deficiency

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66
Q

Why is folate given in pregnancy?

A

Prevent spina bifida

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67
Q

What type of anaemia is B12 deficiency?

A

Megaloblastic

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68
Q

What is pernicious anaemia?

A

Lack of intrinsic factor due to removal of terminal ileum

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69
Q

What is the role of B12?

A

Aids thymidine synthesis and hence DNA synthesis

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70
Q

What are some risk factors of B12 deficiency?

A

Elderly
Female
Vegan
Thyroid and Addisons disease
Metformin

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71
Q

What are some symptoms of B12 deficiency?

A

Anaemia
Mild jaundice
Glossitis and angular stomatitis
Symmetrical paraesthesia in fingers and toes
Ataxia and weakness

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72
Q

What is the treatment for B12 deficiency?

A

If malabsorption - hydroxycobalamin IM for 2 weeks
Oral B12 if problem is just dietary

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73
Q

What is thalassemia?

A

Defects in either the alpha or beta chain causing RBCs that are more fragile and break causing splenomegaly

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74
Q

What is the presentation of thalassemia?

A

Fatigue, pallor, jaundice, gallstones, splenomegaly, poor growth and development, frontal bossing, malar eminences

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75
Q

What is iron overload?

A

Result of faulty RBCs, recurrent transfusions and increased iron gut absorption in response to anaemia

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76
Q

What are some effects of iron overload?

A

Fatigue, liver cirrhosis, infertility, heart failure, diabetes, arthritis, osteoporosis

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77
Q

What is alpha thalassemia?

A

Defected alpha globin chains on C16 leading to excess unpaired beta globin chains

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78
Q

What is beta thalassemia?

A

Defected beta globin chains on C11 causing excess unpaired alpha globin chains

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79
Q

What is an anal fissure and what are the symptoms?

A

Tear in anal mucosa presenting with pain on defectation, constipation and fresh rectal bleeding

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80
Q

What is a sentinel pile?

A

Anal fissure - bunched up mucosa at the base of the tear

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81
Q

What is the management for anal fissure?

A

Soften stool with ispaghula husk
Analgesic suppositories
Surgery

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82
Q

What are some symptoms of anaphylaxis?

A

Urticaria
Itching
Angio-oedema
Abdominal pain
SOB
Stridor
Wheeze
Collapse

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83
Q

What is the treatment for anaphylaxis?

A

IM adrenaline 500mcg

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84
Q

What should be measured after 6 hours in anaphylaxis?

A

Serum mast cell tryptase

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85
Q

What is GAD?

A

Excessive, difficult to control worry about events/ activities occurring most days for over 6 months

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86
Q

What are the two aspects of OCD?

A

Compulsive acts and obsessive thoughts

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87
Q

What are the two main features of phobias?

A

Avoidance
Anticipatory anxiety

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88
Q

What is agoraphobia?

A

Fear away from home and in crowds

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89
Q

What are some risk factors for asthma?

A

Family history
Atopy
Low birth weight
Smoking/ exposure
Not breastfed

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90
Q

What are the symptoms of asthma?

A

Polyphonic bilateral wheeze
Diurnal variation
Chest tightness
Unproductive cough
Tachypnoea
Hyperinflation

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91
Q

What is the spirometry for asthma?

A

FEV1/FVC < 70%

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92
Q

What differentiates asthma from COPD?

A

reversibility testing with a bronchodilator

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93
Q

What is the treatment for asthma?

A

SABA
ICS
LTRA
LABA

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94
Q

What is the treatment for an asthma attack?

A

Oxygen with nebulised SABA
100mg hydrocortisone IV
IV magnesium
Escalate

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95
Q

What are the grades of PEFR?

A

Moderate 50-75%
Severe 33-50%
Life threatening under 33%

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96
Q

What are some markers of good asthma control?

A

No night symptoms
Inhaler used no more than 3 times per week
Normal LFT

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97
Q

What is ventricular tachycardia?

A

Broad QRS complexes over 100bpm
Give oxygen and IV lidocaine

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98
Q

What is long QT syndrome?

A

ECG shows prolonged QT interval and can have a genetic form that is AD or AR

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99
Q

What is atrial fibrillation?

A

Irregular atrial rhythm where there is uncoordinated activation and ineffective contraction

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100
Q

What is the consequence in atrial fibrillation?

A

Cardiac output falls by 10-20% as the atria are no longer primed reliably by the ventricles

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101
Q

What are the symptoms of atrial fibrillation?

A

Palpitations
Irregular pulse
Dyspnoea
Fatigue

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102
Q

What does the ECG for AF show?

A

Absent P waves
Narrow QRS
Irregularly irregular rhythm

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103
Q

What is the treatment for AF?

A

Acute - cardioversion
Chronic - beta blockers
Apixaban or warfarin

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104
Q

What should be calculated in AF?

A

CHADVASC score - calculate stroke risk and anticoagulation needs

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105
Q

What is atrial flutter?

A
  • Unorganised atrial rhythm with a rate of 250-350 bpm
  • Re-entrant circuit in the right atrium
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106
Q

What does ECG show for atrial flutter?

A

Sawtooth - F waves between QRS complexes from continuous atrial depolarisation

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107
Q

What is the gold standard treatment for atrial flutter?

A

Catheter ablation

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108
Q

What are some complications of eczema?

A

Skin thickening and scaling
Bacterial infection - staph aureus
Cataracts
Growth retardation

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109
Q

What are some management options for eczema?

A

Topical steroids - hydrocortisone
Topical immunosuppressants - Tacrolimus
Bandages and wet wrapping
Topical emollients
Loose cotton clothing

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110
Q

What is contact dermatitis?

A

Precipitated by an exogenous agent such as abrasives and chemicals or allergens such as nickel and rubber

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111
Q

What is atrophic vaginitis?

A

Dryness and atrophy of vaginal mucosa due to lack of oestrogen

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112
Q

When is atrophic vaginitis most likely to occur?

A

Menopause

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113
Q

What is the presentation of atrophic vaginitis?

A

Itching, dryness, dyspareunia, bleeding, recurrent UTI, stress incontinence

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114
Q

What are some findings on examination of atrophic vaginitis?

A

Pale mucosa, thin skin, reduced skin folds, erythema, inflammation, dryness, sparse pubic hair

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115
Q

What are some treatments for atrophic vaginitis?

A

Vaginal lubricants
Topical oestrogens

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116
Q

What is bacterial vaginosis?

A

Vaginal flora changes to anaerobes (most commonly Gardnerella vaginalis)

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117
Q

What are the healthy vaginal flora?

A

Lactobacilli
They produce lactic acid to keep vaginal pH under 4.5

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118
Q

What are some risk factors for bacterial vaginosis?

A

Multiple sexual partners
Excessive vaginal cleaning
Recurrent antibiotics
Smoking
Copper coil

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119
Q

What is the presentation of bacterial vaginosis?

A

Grey/ white thin, fish-smelling offensive discharge
Cervix looks normal
pH of secretions if > 4.5

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120
Q

What is shown on microscopy for BV?

A

Clue cells - epithelial cells from the cervix that have bacteria stuck inside them

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121
Q

What is the treatment for BV?

A

Metronidazole

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122
Q

What can metronidazole and alcohol cause?

A

A disulfiram-like reaction with N+V, flushing, shock and angioedema

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123
Q

What is Bell’s Palsy?

A

Isolated dysfunction of the facial nerve presenting with unilateral facial weakness of LMN

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124
Q

What is the treatment for Bell’s Palsy?

A

Give prednisolone if less than 72 hours after symptom onset

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125
Q

What is Ramsay-Hunt syndrome?

A

Severe pain in the ear precedes facial nerve palsy caused by VZV

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126
Q

What is the treatment for ramsay hunt syndrome?

A

Prednisolone and Aciclovir

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127
Q

What is blepharitis?

A

Inflammation of eyelid margins

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128
Q

What can blepharitis cause?

A

Gritty, itchy, dry eyes
Ingrowing eyelashes
Crusting at the base of eyelashes

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129
Q

What is the treatment for blepharitis?

A

Warm compress
Gentle cleansing
Topical antibiotic

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130
Q

What is a stye?

A

Infection of the glands of Zeis of glands of Moll

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131
Q

What are the glands of moll?

A

Sweat glands at the base of the eyelashes

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132
Q

What are the glands of zeis?

A

Sebaceous glands at the base of the eyelashes

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133
Q

What is entropion?

A

Eyelid turns inwards with lashes pressed against the eye

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134
Q

What is the treatment for entropion?

A

Same day surgery if there is a risk to sight

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135
Q

What is ectropion?

A

Eyelid turns outwards exposing the inner aspect

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136
Q

What can ectropion result in?

A

Exposure keratopathy as the eyeball is exposed and not lubricated

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137
Q

What is orbital cellulitis?

A

Infection around the eyeball requiring IV antibiotics and maybe surgical drainage

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138
Q

What is periorbital cellulitis?

A

Eyelid and skin infection in front of the orbital septum

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139
Q

What is benign paroxysmal positional vertigo?

A

Common cause of vertigo triggered by head movement as a peripheral cause

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140
Q

What is the cause of benign paroxysmal positional vertigo?

A

Calcium carbonate crystals become displaced in the semicircular canals disrupting normal flow of endolymph confusing the vestibular system

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141
Q

What is a treatment for
benign paroxysmal positional vertigo?

A

epley manoeuvre

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142
Q

What is a diagnostic test of benign paroxysmal positional vertigo?

A

dix-hallpike manoeuvre

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143
Q

What is BPH?

A

Enlargement of the inner transitional zone of the prostate which can partially block the urethra

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144
Q

What are the symptoms of BPH?

A

LUTS - polyuria, urgency, nocturia, incontinence, poor stream, straining, incomplete voiding

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145
Q

What is the diagnosis for BPH?

A

DRE - smooth but enlarged prostate
PSA levels
Bladder diary

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146
Q

What is the 1st line medication for BPH?

A

Alpha blockers such as Tamulosin

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147
Q

What is a side effect of an alpha blocker such as Tamulosin for BPH?

A

Postural hypotension

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148
Q

What is the gold standard treatment for BPH?

A

TURP
Side effect - retrograde ejaculation

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149
Q

What is 2nd line for BPH?

A

5-alpha reductase inhibitors - Finasteride

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150
Q

What is the conservative treatment for BPH?

A

Caffeine and alcohol reduction

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151
Q

What is breast mastitis?

A

Infected subareolar ducts presenting with breast tenderness and inflammation

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152
Q

What is the most common cause of mastitis?

A

Staph aureus

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153
Q

What is the treatment for mastitis?

A

Co-amoxiclav

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154
Q

What is lactational mastitis?

A

Obstruction in the ducts and accumulation of milk

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155
Q

What is the presentation of lactational mastitis?

A

Breast pain and tenderness, erythema, local warmth, inflammation, nipple discharge, fever

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156
Q

What is candida of the nipple?

A

Infection of the nipple after a course of antibiotics which can lead to recurrent mastitis

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157
Q

What is the presentation of candida of the nipple?

A

Bilateral sore nipples after feeding
Nipple tenderness and itching
Cracked, flaky areola
Nappy rash in the baby

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158
Q

What is the treatment for candida of the nipple?

A

Topical miconazole

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159
Q

What is bronchiolitis?

A

Inflammation in bronchioles usually caused by RSV

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160
Q

What is the presentation of bronchiolitis?

A

coryzal symptoms, dyspnoea, tachypnoea, poor feeding, mild fever, apnoeas, wheeze

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161
Q

What is trochanteric bursitis?

A

Inflammation of a bursa over the greater trochanter on the outer hip

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162
Q

What are bursea?

A

Sacs created by synovial membrane filled with synovial fluid

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163
Q

What are some causes of trochanteric bursitis?

A

Friction from repetitive movements, trauma, inflammatory conditions such as RA and septic bursitis

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164
Q

What is the presentation of trochanteric bursitis?

A

Aching and burning, disrupting sleep, hard to lie comfortably, tenderness, worse with activity

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165
Q

What are the two diagnostic tests for trochanteric bursitis?

A

Trendelenburg test
Resisted internal and external rotation and abduction

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166
Q

What sort of bacteria is chlamydia?

A

Gram negative

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167
Q

What are some symptoms of chlamydia in women?

A

Vaginal discharge, intermenstrual bleeding, PID, dysuria

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168
Q

What are some presentations of chlamydia in neonates?

A

Conjunctivitis, pneumonia, otitis media, pharyngitis

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169
Q

What is the treatment for chlamydia?

A

Doxycycline or erythromycin

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170
Q

What is lymphogranuloma venereum?

A

Affects lymphoid tissue around chlamydia site of infection
MC in MSM

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171
Q

What is chlamydial conjunctivitis?

A

Hand to eye spread when genital fluid comes into contact with the eyes

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172
Q

How long must fatigue be present for for a diagnosis of chronic fatigue syndrome?

A

over 4 months in adults and over 3 months in children

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173
Q

What are some red flags for chronic fatigue?

A

Significant weight loss
Sleep apnoea
Signs/ symptoms of CVD
Localising/ focal neurological signs

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174
Q

What are some risk factors for CKD?

A

DM, HTN, male, smoking, increasing age

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175
Q

Why does CKD cause HTN?

A

Thickening of afferent arteriole leading to ischaemia and further fluid overload due to RAAS activation

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176
Q

What does CKD show on bloods?

A

High creatinine, urea, phosphate and potassium

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177
Q

What is GFR of stage 1 CKD?

A

90 +

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178
Q

What is GFR of stage 2 CKD?

A

60-89

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179
Q

What is GFR of stage 3a CKD?

A

45-59

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180
Q

What is GFR of stage 3b CKD?

A

30-44

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181
Q

What is GFR of stage 5 CKD?

A

Less than 15

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182
Q

What is GFR of stage 4 CKD?

A

15-29

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183
Q

What respiratory failure does COPD lead to?

A

Type II

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184
Q

What are some risk factors for COPD?

A

Smoking, occupational pollutants, A1AD on C14, CF, males, poor diet, low birthweight

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185
Q

What is A1AD?

A

Dysfunction of A1AD on C14 which controls elastase activity so without there is uncontrolled build-up causing liver cirrhosis and emphysema in alveoli

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186
Q

What are people with chronic bronchitis called?

A

Blue bloaters

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187
Q

What does chronic bronchitis lead to?

A

Cor pulmonale - right sided heart failure

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188
Q

What are people with emphysema called?

A

Pink puffers

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189
Q

What are the symptoms of COPD?

A

Productive cough with white/clear sputum
SOB
Dypnoea
Wheeze
Weight loss, osteoporosis, HTN
Crackles
Pursed lips on expiration
Raised JVP
Cyanosis
Barrel chest

190
Q

What scale is used in COPD?

A

MRC dyspnoea scale

191
Q

What is the gold standard diagnosis for COPD?

A

Spirometry with FEV1:FVC < 0.7

192
Q

What does CXR show for COPD?

A

Hyperinflation, flattened diaphragm, barrel chest

193
Q

What are the target oxygen saturations in COPD?

A

88-92%

194
Q

What is the treatment for COPD?

A

SABA - LABA - LABA +ICS , LABA + Corticosteroid + LAMA

195
Q

What are exacerbations often caused by in COPD?

A

Hib and strep pneumoniae

196
Q

What vaccines in COPD?

A

Pneumococcal plus influenza

197
Q

What is the CAT score?

A

Quality of life in COPD

198
Q

What is conjunctivitis?

A

Inflammation of the conjunctiva which can be bacterial, viral or allergic

199
Q

What is the presentation of conjunctivitis?

A

Red, bloodshot eye, itchy, gritty, discharge

200
Q

How does bacterial conjunctivitis present?

A

Purulent discharge worse in the morning when eyes become stuck together

201
Q

How does viral conjunctivitis present?

A

Clear discharge, associated with dry cough, sore throat, blocked nose

202
Q

What are some causes of an acute red eye?

A

Scleritis
Anterior uveitis
Foreign body
Keratitis
Traumatic or chemical injury

203
Q

What are some causes of an acute painless red eye?

A

Conjunctivitis
Episcleritis
Subonjunctival haemorrhage

204
Q

How many bowel movements for it to be constipation?

A

Less than 2 per week

205
Q

What is constipation lifestyle advice for under 40s?

A

Increase fluids to 2L
Avoid alcohol
Increase exercise
Increase fibre

206
Q

What is some medical treatments for constipation?

A

Osmotic laxative
Stimulant laxative - Senna

207
Q

What is the management for constipation in over 40?

A

Any sustained change in bowel habits over 6 weeks needs investigation

208
Q

Give an example of an osmotic laxative

A

magnesium hydroxide

209
Q

Give an example of a bulk forming laxative

A

Ispaghula husk

210
Q

Give some presentations of constipation in elderly

A

Confusion
Urinary retention
Abdominal pain
Overflow diarrhoea
Loss of appetite and nausea

211
Q

What is gout?

A

Hyperuricaemia and deposition of urate crystals

212
Q

What are some gout risk factors?

A

Males, beer, diuretics, seafood, red meat, renal impairment, aspirin

213
Q

What is the patho of gout?

A

Purines are broken down into uric acid by xanthine oxidase
Uric acid is excreted by kidneys but if overwhelmed, converted to monosodium urate crystals and deposited in joints

214
Q

What is the most common joint of gout?

A

Big toe

215
Q

What is tophi gout?

A

Monosodium urate forming smooth white deposits in the skin

216
Q

What is the diagnosis of gout?

A

Fluid aspiration and microscopy - long needle crystals negatively bifringent under polarised light

217
Q

What is treatment of gout?

A

NSAIDs
Colchicine
Steroids
Weight loss, lower alcohol

218
Q

What is gout prophylaxis

A

Allopurinol
Febuxosat
Increase dairy

219
Q

What are some complications of gout?

A

Disability
Tophi
Renal disease

220
Q

What is pseudogout?

A

Deposition of calcium pyrosphosphate crystals on joint surfaces

221
Q

What are some risk factors for pseudogout?

A

Women, IV fluids, parathyroidectomy, hypomagnesia, hypoparathyroidism

222
Q

What are the common joints of pseudogout?

A

Knees, wrists and hands

223
Q

What is the diagnosis of pseudogout?

A

Joint aspiration and microscopy - small rhomboidal crystals positively bifringent under polarised light

224
Q

What is intertrigo?

A

Reddened, moist, glazed area in submammary, inguinal or axillary folds

225
Q

What are some drugs that can cause depression?

A

Beta blockers, antipsychotics, anticonvulsants, corticosteroids

226
Q

What is the criteria for depression diagnosis?

A

Symptoms present more than 50% of the time in the past 2 weeks
Depressed mood and/ or reduced interest or pleasure

227
Q

What is a severity measure of depression?

A

PHQ-9

228
Q

What are some SSRIs for depression?

A

Fluoxetine, Citalopram, Sertraline

229
Q

Elderly people taking SSRIs are prone to?

A

Hyponatraemia

230
Q

What is type I Diabetes?

A

Autoimmune destruction of beta cells of pancreatic islets of langerhans

231
Q

What are some T1DM risk factors?

A

Northern european, other AI condition, family history

232
Q

What are some symptoms of T1DM?

A

Polyuria, polydipsia, polyphagia, weight loss, thrush, visual blurring

233
Q

What is the diagnosis of T1DM?

A

Random plasma glucose over 11.1 mmol/L and fasting over 7 mmol/L

234
Q

What are some symptoms of hypoglycaemia?

A

Pale, difficulty concentrating, confusion, ketone breath, sweating, hunger, palpitations

235
Q

What is Whipples triad?

A

Symptoms associated with fasting or exercise
Symptoms relieved by glucose
Recorded hypoglycaemia with symptoms

236
Q

What is ketoacidosis

A

Absence of insulin leading to rising hyperglycaemia and ketogenesis

237
Q

What are some symptoms of ketoacidosis?

A

Pear drop breath, dehydration, vomiting, Kussmaul’s respiration, dehydration, vomiting, confusion

238
Q

What is the diagnosis for ketoacidosis?

A

Hyperglycaemia over 11mmol/L
Plasma ketones over 3 mmol/L
Bicarbonate over 5 mmol/L
Hyperkalaemia

239
Q

What is 1st line for ketoacidosis?

A

Rehydrate 0.9% IV saline

240
Q

What is the acronym for ketoacidosis management?

A

FIG PICK

  1. Fluids - IV fluid resuscitation with normal saline
  2. Insulin - fixed rate insulin infusion
  3. Glucose - closely monitor and add a glucose infusion when less than 14 mmol/ L
  4. Potassium - add potassium to IV fluids and monitor
  5. Infection - treat any underlying triggers
  6. Chart fluid balance
  7. Ketones - monitor blood ketones, pH and bicarbonate
241
Q

What are some risk factors for T2DM?

A

Obesity, lack of exercise, males, afro-caribbean, south asian, africans

242
Q

What is T2DM?

A

High blood glucose from a combination of insulin resistance and less severe insulin deficiency

243
Q

What is the diagnosis for pre-diabetes?

A

HbA1c 42-47

244
Q

What is the diagnosis for T2DM?

A

HbA1c over 48
Random glucose over 11.1
Fasting over 7

245
Q

What is the 1st line for T2DM treatment?

A

Lifestyle modification

246
Q

What is the 2nd line for T2DM treatment?

A

Metformin (reduced liver gluconeogenesis and increases peripheral utilisation of glucose)

247
Q

What is the final step of T2DM treatment?

A

Insulin

248
Q

What are some complications of T2DM?

A

Cataracts
Glaucoma
Retinopathy
Polyneuropathy
Depression
Diabetic foot

249
Q

When is diabetic eye screening done?

A

From age 12 in all with diabetes annually

250
Q

When is cervical screening done?

A

Women aged 25-64
Every 3 years in 25-49
Every 5 years in 50-65

251
Q

When is breast screening done?

A

Aged 50-70

252
Q

When is bowel cancer screened?

A

60-74 years every 2 years

253
Q

When is AAA screened?

A

Men in the year they turn 65

254
Q

What is tested for on a newborn blood spot test?

A

Sickle cell
CF
Congenital hypothyroidism
Inherited metabolic diseases
SCID

255
Q

What is diverticular disease?

A

Outpouching of the gut wall usually at sites of entry of perforating arteries - sigmoid colon

256
Q

What is diverticulosis

A

Presence of asymptomatic diverticula

257
Q

What is diverticular disease?

A

Symptomatic diverticula

258
Q

What is diverticulitis?

A

Inflammation of diverticula

259
Q

What are some risk factors of diverticular disease?

A

Over 50, low fibre, high salt, obesity, constipation, NSAIDs

260
Q

What are some symptoms of diverticular disease?

A

BBL - bowel habits changed, bloating, left lower quadrant pain
N+V

261
Q

What is the gold standard diagnosis for diverticular disease?

A

contrast CT scan

262
Q

What is treatment for diverticular disease?

A

High fibre diet
Antispasmodics such as Mebeverine
Antibiotics - Metronidazole for diverticulitis

263
Q

What is HTN?

A

above 140/90 mmHg

264
Q

What is normal BP?

A

120/80 mmHg

265
Q

What is severe HTN?

A

180/110 mmHg

266
Q

What are some risk factors for HTN?

A

Increasing age
Black ethnicity
Smoking
Stress
Poor diet
Overweight
Sedentary lifestyle

267
Q

What is the gold standard diagnosis for HTN?

A

Ambulatory BP monitoring

268
Q

What is needed to be calculated in HTN?

A

Q risk score - stroke and heart attack risk

269
Q

What is HTN treatment in under 55 or T2DM?

A

ACEi then CCD then TD

270
Q

What is HTN treatment in over 55 or Black African or Caribbean?

A

CCB then ACEi/ ARB then TD

271
Q

What is the final stage of HTN treatment?

A

low dose spironolactone if K+ is less than 4.5 and alpha/ beta blocker if more

272
Q

What is malignant HTN?

A

Sudden rise in BP leading to vascular damage and fibrinoid necrosis

273
Q

What is treatment for malignant HTN?

A

Sodium nitroprusside infusion

274
Q

What are symptoms of malignant HTN?

A

Blurred vision, chest pain, SOB, headache

275
Q

What is the most common secondary cause of HTN?

A

CKD

276
Q

What is folliculitis?

A

Superficial infection of the hair follicles caused by staph aureus

277
Q

What is GORD?

A

Reflux of gastric contents into the oesophagus due to LOS relaxation

278
Q

What are some risk factors for GORD?

A

Pregnancy
Obesity
Hiatus hernia
Smoking
NSAIDs
Alcohol and caffeine
Males

279
Q

What are symptoms of GORD?

A

Heartburn
Regurgitation
Epigastric pain
Dysphagia
Dyspepsia

280
Q

What is the treatment for GORD?

A

Antacids - Gaviscon
PPI
H2 receptor antagonist
Nissen fundoplication

281
Q

What is barretts oesophagus?

A

Metaplasia of oesophagus from stratified squamous to simple columnar

282
Q

What does Barretts oesophagus increase the risk of?

A

Oesophageal adenocarcinoma

283
Q

What is gonorrhoea?

A

STI caused by bacterium neisseria gonorrhoeae gram negative diplococcus

284
Q

What is the presentation of gonorrhoea in men?

A

Urethral discharge
Dysuria
Prostatitis
Anal discharge

285
Q

What is the presentation of gonorrhoea in women?

A

Vaginal discharge
Dysuria
Lower abdominal pain
PID
Abnormal vaginal bleeding

286
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone IM 500mg as a single dose
Azithromycin 1g

287
Q

What are some complications of gonorrhoea?

A

PID
Chronic pelvic pain
Infertility
Conjunctivitis
Skin lesions
Endocarditis

288
Q

What are haemorrhoids?

A

Enlarged and vascular cushions that can be internal or external

289
Q

What are some risk factors for haemorrhoids?

A

Constipation
Straining
Coughing
Pregnancy
Heavy lifting

290
Q

what are some symptoms of haemorrhoids?

A

Bright red rectal bleeding on wiping
Pruritus ani
Constipation
Straining
Lump around anus
Mucus discharge

291
Q

What is a hiatus hernia?

A

Herniation of the stomach up through the diaphragm

292
Q

What are some symptoms of hiatus hernia?

A

Dyspepsia
Heart burn
Acid reflux
Burping
Halitosis

293
Q

What is the conservative management of hiatus hernia?

A

PPI - omeprazole

294
Q

What is the surgical management of hiatus hernia?

A

Laparoscopic fundoplication

295
Q

What is hypothyroidism?

A

Underactive thyroid gland which is most likely from hashimotos thyroiditis (AI)

296
Q

What drugs can cause hypothyroidism?

A

Amiodarone
Lithium

297
Q

What is the presentation of hypothyroidism?

A

Weight gain
Cold intolerance
Constipation
Hoarse voice
BRADYCARDIC
Hertoge’s sign - loss of outer 1/3 of the eyebrows

298
Q

What is the diagnosis of hypothyroidism?

A

TFT - raised TSH, low T3 and T4
Anaemia
Raised AST
High cholesterol
Low sodium

299
Q

What is the treatment of hypothyroidism?

A

Levothyroxine T4 for life
Side effects - AF and osteoporosis

300
Q

What is hyperthyroidism?

A

Overproduction of thyroid hormone most likely from Graves disease with an AI attack on the thyroid

301
Q

What happens in Graves disease?

A

Serum IgG antibodies bind to TSH receptors in the thyroid and stimulate hormone production and thus cause excess secretion

302
Q

What are some symptoms of Graves Disease?

A

graves ophthalmopathy - exopthalmus and grittiness
Graves dermopathy - pretibial myoxema and thyroid acropachy

303
Q

What are some other causes of hyperthyroidism?

A

De quervains - after viral infection
toxic multinodular goitre
Drug induced - amiodarone
Post partum

304
Q

What are some symptoms of hyperthyroidism?

A

Palpitations
Diarrhoea
Weight loss
Palmar erythema
Hyperkinesis
Lid lag and stare
Heat intolerance
Increased appetite

305
Q

What are the tests for hyperthyroidism?

A

Raised T3 and T4
Low TSH
TSHR antibodies in Graves

306
Q

What is the treatment for hyperthyroidism?

A

Beta blockers for rapid symptom control
Carbimazole
Gold - radioactive iodine

307
Q

What is a side effect of carbimazole?

A

Agranulocytosis - sudden WBC drop which can present as a sore throat
Teratogenic

308
Q

What is impetigo?

A

Staph or strep skin infection

309
Q

What is the characteristic of impetigo?

A

golden crust

310
Q

What is bullous impetigo always caused by?

A

staph aureus

311
Q

What is another name for EBV/ glandular fever?

A

Infectious mononucleosis

312
Q

How is EBV spread?

A

saliva, kissing, toothbrushes

313
Q

What are some symptoms of EBV?

A

Fever, sore throat, fatigue, lymphadenopathy, tonsillar enlargement, splenomegaly, splenic rupture

314
Q

When does EBV cause an itchy rash?

A

In response to amoxicillin

315
Q

What lymphoma is EBV associated with?

A

burkitts

316
Q

What are the two most common types of influenza?

A

A and B

317
Q

What type of virus is influenza?

A

RNA

318
Q

What are some eligibility criteria for the influenza vaccine?

A

Over 65
Pregnant
COPD, asthma, heart failure
Diabetes
AI - coeliac disease
Healthcare workers

319
Q

What are some symptoms of influenza?

A

Fever
Dry cough
Headache
Muscle and joint aches
Lethargy
Fatigue
Anorexia

320
Q

What is the treatment for at risk people for influenza?

A

Oral oseltamivir and inhaled zanamivir

321
Q

Antispasmodics for IBS?

A

Mebeverine and buscapan

322
Q

Options for IBS-D treatment

A

Loperamide
Amitriptyline (TCA)

323
Q

Options for IBS-C treatment

A

Ispaghula husk and senna
Fluoextine

324
Q

What is lyme disease?

A

Spread by ticks and injected into the skin through saliva

325
Q

What is the presentation of lyme disease?

A

Erythema migrans - ring with a central cleaning
Arthralgia
Lympahdenopathy
Splenomegaly
Fever
Headache
Carditis

326
Q

What is the treatment for lyme disease?

A

Doxyxycline
IV cefotaxime in neurological disease

327
Q

What are the migraine triggers?

A

CHOCOLATE - chocolate, hangovers, organsms, cheese, lie-ins, alcohol, tumult, exercise

328
Q

What is a migraine prodrome?

A

Symptoms prior to the migraine of yawning, neck stiffness, thirst, food cravings

329
Q

What is an aura before a migraine?

A

Flashing lines, zig zags, spots, numbness

330
Q

What are the symptoms of a migraine?

A

Unilateral throbbing headache
N+V
Diarrhoea
Photophobia
Phonophobia
4-72 hours long

331
Q

What is the 1st line prophylaxis for migraines?

A

Propranalol

332
Q

What is the next line for migrianes?

A

Sumatriptan

333
Q

What is contraindicated in those who have migraine with aura?

A

COCP

334
Q

What are mumps?

A

Viral infection spread by respiratory droplets and classically affects the parotid glands

335
Q

What are mumps symptoms?

A

Flu like
Fever
Muscle aches
Parotid gland swelling and pain
Lethargy
Dry mouth
Headaches

336
Q

Is mumps notifiable?

A

yes

337
Q

What are some complications of mumps?

A

Hearing loss
Meningitis
Encephalitis
Pancreatitis

338
Q

What is BMI of obesity I?

A

30-34.9

339
Q

What is BMI of obesity II?

A

35-39.9

340
Q

What is the BMI of morbid obesity?

A

Over 40

341
Q

What is the waist circumference of obesity for a white male?

A

Over 102cm

342
Q

What are some causes of obesity?

A

SES factors
Smoking cessation
Polygenic genetic predisposition
Childbirth
Steroids
PCOS
Cushings
Physical inactivity
BED

343
Q

What is checked on presentation with obesity?

A

BP, blood glucose and fasting lipid profile

344
Q

What is a drug for obesity?

A

Orlistat

345
Q

What is a surgery for obesity?

A

Gastric banding

346
Q

What is osteoarthritis?

A

Wear and tear non-inflammatory joint disorder with deterioration of articular cartilage

347
Q

What are some risk factors for osteoarthritis?

A

Increasing age
Females after menopause
Polyarticular disease
Obesity
Trauma

348
Q

What are some symptoms of osteoarthritis?

A

Joint pain worse on movement - hips and knees
Stiffness at rest
Less than 30 minutes morning stiffness
Grating

349
Q

What are some hand signs of osteoarthritis?

A

Bouchards (PIPJ) and Heberdens nodes (DIPJ)

350
Q

What does osteoarthritis show on x-ray?

A

LOSS - loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts

351
Q

What are some anti-inflammatory foods for osteoarthritis?

A

Broccoli, spinach and ginger

352
Q

What is the 1st line medical treatment for osteoarthritis?

A

Paracetamol or topical capsaicin gel

353
Q

What is 2nd line for osteoarthritis?

A

Opioids
Oral NSAIDs (with PPI)
COX inhibitors

354
Q

What is osteoporosis?

A

Systemic skeletal disease with low bone mass/ density and increase in fractures

355
Q

What are the risk factors for osteporosis?

A

SHATTERED - steroid use, hyperthyroidism, alcohol, testosterone low, thin (BMI under 22), early menopause (before 45), renal or liver failure, erosive/ inflammatory bone disease and low dietary calcium

356
Q

What are some other causes of osteoporosis?

A

CF, COPD, CKD, coeliac disease, glucocorticoid use, hypogonadism, T1DM

357
Q

What is the pathophysiology of osteoporosis?

A

Increased osteoclast breakdown and reduced osteoblast formation

358
Q

What is a vertebral crush fracture?

A

Sudden pain onset radiating to the front

359
Q

What is a wrist presentation of osteoporosis?

A

Colles’ fracture of the wrist

360
Q

What is the gold standard for osteoporosis diagnosis?

A

DEXA scan

361
Q

What is a T-score?

A

Comparison to a healthy young adult

362
Q

What is a Z-score?

A

Comparison to an age and sex matched individual

363
Q

Where are the scores taken from in a DEXA scan?

A

Hip

364
Q

Describe the DEXA scan scores

A

More than -1 = normal
-1 to -2.5 = osteopenia
Less than -2.5 = osteoporosis
Less than -2.5 with a fracture = severe osteoporosis

365
Q

What are the bloods for osteoporosis?

A

Calcium, phosphate and ALP are all normal

366
Q

What is the risk assessment for osteoporosis?

A

FRAX - 10 year risk of fracture

367
Q

What are some lifestyle measures for osteoporosis?

A

Stop smoking and alcohol
Weight bearing exercises
Increase bone density
Calcium
Vitamin D

368
Q

What are some medical treatments for osteoporosis?

A

Bisphosphonates - Alendronate
Monoclonal antibodies - Denosumab
HRT

369
Q

How should bisphosphonates be taken?

A

Take on an empty stomach, first thing in the morning, 30 minutes before food, stay upright for 30 minutes after taking with large glass of water

370
Q

What is PID?

A

Inflammation and infection of the pelvic organs

371
Q

What are some causes of PID?

A

Gonorrhoea
Chlamydia
Gardnerella vaginalis
Hib
E.coli

372
Q

What are symptoms of PID?

A

Pelvic or lower abdo pain
Abnormal vaginal discharge
Abnormal bleeding
Pain in sex
Fever
Dysuria
Pelvic tenderness
Inflamed cervix

373
Q

What is the management of PID?

A

IM ceftriaxone for gonorrhoea
Doxycycline for chlamydia

374
Q

What is fitz-hugh-curtis syndrome?

A

A complication of PID caused by infection of the liver capsule leading to adhesions between the liver and peritoneum

375
Q

What is peripheral vascular disease?

A

Partial blockage of leg/ peripheral vessels by atherosclerotic plaques causing ischaemia

376
Q

What are symptoms of PVD?

A

Intermittent claudication
Hair loss
Ulcers
Numbness
Atrophic skin

377
Q

What is the 1st line diagnostic test for PVD?

A

Duplex USS then ABPI

378
Q

What is critical limb ischaemia?

A

Rest/ night pain with arterial insufficiency ulcers and gangrene as blood supply is barely adequate

379
Q

What is a key symptom of critical limb ischaemia?

A

Burning pain at night relieved by hanging the legs over the edge of the bed

380
Q

What are the 6 P’s of acute limb ischaemia?

A

Pale, pulselessness, paraesthesia, pallor, perishingly cold, paralysis

381
Q

What is the treatment for acute limb ischaemia?

A

Immediate IV unfractionated heparin then angioplasty/ bypass surgery/ amputation

382
Q

What is polymyalgia rheumatica?

A

Inflammatory condition that causes pain and stiffness in shoulders, pelvic girdle and neck
Often alongside GCA

383
Q

What are symptoms of polymyalgia rheumatica?

A

Bilateral shoulder pain and pelvic girdle pain
Interferes with sleep
More than 45 minutes morning stiffness
Systemic symptoms

384
Q

What is the diagnosis for polymyalgia rheumatica?

A

ESR and CRP usually elevated
ANCA negative
Serum alkaline phosphatase elevated
Creatinine kinase = normal
GCA on temporal artery biopsy

385
Q

What is the treatment for polymyalgia rheumatica?

A

Corticosteroids

386
Q

What are some risk factors for prostate cancer?

A

Afro-Caribbean
Family history
Age
Anabolic steroids
High fat diet

387
Q

What is the most common prostate cancer?

A

Adenocarcinomas of the peripheral prostate

388
Q

What are some symptoms of prostate cancer?

A

LUTS
Weight loss
Fatigue
Night sweats
Bone pain - metastasis

389
Q

What is the 1st line for prostate cancer diagnosis?

A

PSA and DRE - asymmetrical and craggy gland

390
Q

What is the gold standard diagnosis for prostate cancer?

A

Transrectal USS and biopsy

391
Q

What is the grading system for prostate cancer?

A

Gleason Grading System

392
Q

What is a medical treatment for prostate cancer?

A

Goserelin

393
Q

What are some side effects of Goserelin?

A

Hot flushes and low libido

394
Q

What are the nerve roots of the sciatic nerve?

A

L4-S3

395
Q

What does the sciatic nerve supply sensation to?

A

Lateral lower leg and foot and motor to posterior thigh, lower leg and foot

396
Q

What are some symptoms of sciatica?

A

Unilateral pain from buttock radiating down back of thigh to below knee or feet
Electric or shooting pain
Numbness, motor weakness

397
Q

What are some causes of sciatica?

A

Herniated disc
Spinal stenosis
Bilateral sciatica - cauda equina

398
Q

What are some treatments for sciatica?

A

Amitityptline or Duloextine
Epidural corticosteroid injections
Spinal decompression

399
Q

What is reactive arthritis?

A

Synovitis occurs in joints as a reaction to a recent infective trigger = Reiter syndrome

400
Q

What are the symptoms of reactive arthritis?

A

Can’t see, can’t pee, can’t climb a tree
Bilateral conjunctivitis and anterior uveitis
Circinate balantis
Arthritis of ankles and knees

401
Q

What is the diagnosis for reactive arthritis?

A

Raised CRP and ESR
ANA positive and RF negative

402
Q

What is the treatment for reactive arthritis?

A

NSAIDs and antibiotics

403
Q

What is sinusitis?

A

Inflammation of the paranasal sinuses in the face usually with nasal inflammation (rhinosinusitis)

404
Q

what can cause sinusitis?

A

Infection - URTI
Allergies
Obstructed drainage - poylps
Smoking
Asthma

405
Q

What are symptoms of sinusitis?

A

Facial pain
Headache
Facial swelling
Nasal congestion
Nasal discharge
Loss of smell
Fever

406
Q

What is rheumatoid arthritis?

A

Chronic systemic autoimmune disorder causing symmetrical polyarthritis

407
Q

What are some risk factors for rheumatoid arthritis?

A

Females
Family history
HLA-DR4
Smoking

408
Q

What are symptoms of RA?

A

More than 30 minutes morning stiffness
Symmetrical swelling usually MCP
Movement limitation
Muscle wasting

409
Q

What are some hand signs of RA?

A

Ulnar deviation
Swan neck
Z thumb
Boutonniere deformity

410
Q

What are some systemic symptoms of RA?

A

Scleritis
Pericarditis
Pleural effusion
Glomerulonephritis
Sjogrens

411
Q

What does X-ray show for RA?

A

LOES - loss of joint space, osteopenia, erosion of bone, swelling of soft tissue

412
Q

What is the most specific marker of RA?

A

Anti -CCP

413
Q

What is the treatment for RA?

A

Methotrexate

414
Q

What is taken with methotrexate?

A

Folic acid

415
Q

What is a complication of RA?

A

Felty syndrome - RA, splenomegaly and neutropenia

416
Q

What is a tension headache?

A

Episodic or chronic and rarely disabling

417
Q

What are some triggers of a tension headache?

A

Missing meals
STress
Fatigue
Noise
Concentrated visual effort

418
Q

What are symptoms of tension headaches?

A

Bilateral band pain
Pressure behind eyes
Can be daily
Not aggravated by exercise
Lasts minutes to days

419
Q

What is the treatment for tension headaches?

A

Simple analgesia such as aspirin or ibuprofen

420
Q

What is a cluster headache?

A

Severe and unbearable unilateral headaches usually around the eye

421
Q

How long does a cluster headache last?

A

15-180 minutes

422
Q

What is the nature of cluster headaches?

A

Clusters of attacks for days and then disappears for months

423
Q

What are the symptoms of a cluster headache?

A

Suicide headache
Red swollen eye
Rhinorrhoea
Facial swelling
Ptosis

424
Q

What is the treatment for cluster headaches?

A

Triptans, high flow oxygen for acute
Prophylaxis - verapamil, lithium, prednisolone

425
Q

What is the most common bacterial cause of tonsilitis?

A

Strep pneumoniae

426
Q

How can strep pneumoniae tonsilitis be treated?

A

Penicillin V

427
Q

What are the symptoms of tonsilitis?

A

Fever
Sore throat
Painful swallow
Poor oral intake
Headache
Vomiting
Red inflamed tonsils

428
Q

What is the centor criteria?

A

Used to estimate probability that it is due to bacterial infection and will benefit from antibiotics

429
Q

What are some complications of tonsilitis?

A

Quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis

430
Q

What is trigeminal neuralgia?

A

Affects branches of the trigeminal nerve from compression from aneurysms, tumours, meningeal inflammation and MS

431
Q

What are the symptoms of trigeminal neuralgia?

A

Unilateral facial pain in distribution of CN5
Reoccurring in paroxysmal attacks with a stabbing, knife-like pain precipitated by shaving, eating and talking

432
Q

What is the 1st line treatment for trigeminal neuralgia?

A

Carbmazepine

433
Q

What is surgery for trigeminal neuralgia?

A

Microvascular decompression
Gamma knife surgery

434
Q

What is urge incontinence?

A

Overactive bladder from overactivity of the detrusor muscle

435
Q

What is stress incontinence?

A

Pelvic floor is weakened so urine leaks at times of high pressure such as laughing or coughing

436
Q

What is overflow incontinence?

A

Chronic urinary retention due to obstruction to urine outflow

437
Q

What are some causes of overflow incontinence?

A

anticholinergic medications
Fibroids
Pelvic tumours
MS

438
Q

What are some investigations for incontinence?

A

Urine dipstick
Bladder diary
Post-void residual bladder volume
Urodynamic testing

439
Q

What is the management for stress incontinence?

A

Avoid caffeine and diuretics
Pelvic floor exercise
Duloxetine
Sling surgery

440
Q

What is the management of urge incontinence?

A

Bladder retraining
Oxybutynin
Mirabegron

441
Q

What are the most common causes of UTI?

A

KEEPS
Klebsiella
E coli
Enterococcus
Proetus
Staphyloccus saprophyriticus

442
Q

What is a complicated UTI?

A

Males
Pregnant
Children
Catheters
Immunosuppression
Anatomical or functional abnormalities

443
Q

What is the triad of a UTI?

A

Loin pain
Fever
Pyuria

444
Q

What is the gold standard diagnostic test for UTI?

A

Mid stream urine mc+s

445
Q

What is the 1st line test for UTI?

A

Urine dipstick

446
Q

What does urinalysis show for UTI?

A

Elevated nitrites and leukocytes

447
Q

What is the 1st line medication for UTI?

A

Trimethoprim 3 days in uncomplicated women and 7 days in men and complicated

448
Q

What are some prevention methods of UTI?

A

Void after intercourse
Frequent urination
Increase fluids
Double void

449
Q

What is urticaria?

A

superficial itchy swellings of the skin or weals come and go in an attack giving a shifting rash

450
Q

What are varicose veins?

A

Distended superficial veins more than 3mm in diameter usually in the legs

451
Q

How do varicose veins form?

A

When valves become incompetent blood is drawn down and pools in veins and feet leading to dilation and engorgement

452
Q

What are some risk factors for varicose veins?

A

Family history
Increasing age
Obesity
Female
DVT
Prolonged standing

453
Q

What are the symptoms of varicose veins?

A

Asymptomatic
Heavy or dragging sensation in legs
Aching
Itching
Burning
Oedema
Muscle cramps
Restless legs

454
Q

What is the cough test for varicose veins?

A

Apply pressure to SFJ and ask patient to cough and feel for a thrill

455
Q

What is an imaging method for varicose veins?

A

Duplex USS

456
Q

What is the first line for varicose vein treatment?

A

Conservative - weight loss, exercise, compression stockings

457
Q

What is the surgery for varicose veins?

A

Endothermal ablation
Sclerotherapy
Stripping

458
Q

What are arterial ulcers?

A

Insufficient blood supply to the skin due to PAD

459
Q

What are the associations of arterial ulcers?

A

Absent pulses, pallor and intermittent claudication
Well-defined borders
Pale due to poor blood supply
Painful and worse at night

460
Q

What are the presentation of venous ulcers?

A

Occur in the gaiter area
Larger and more superficial
Irregular
Sloping border
More likely to bleed
Less painful

461
Q

What is the management of an arterial ulcer?

A

Vascular for surgical revascularisation

462
Q

What is the management for a venous ulcer?

A

Community if ABPI > 0.8 but vascular surgery if < 0.8

463
Q

What is the score used to risk assess the development of a pressure ulcer?

A

Waterlow score

464
Q

What can e coli gastroenteritis lead to?

A

HUS

465
Q

how is e coli spread?

A

Unwashed salads, faeces and contaminated water

466
Q

What is a common cause of travellers diarrhoea?

A

Campylobacter jejuni

467
Q

What is the 1st line treatment for c. jejuni gastroenteritis?

A

Clarithromycin

468
Q

How to differentiate salmonella and shigella on XLD?

A

Salmonella produces black spots

469
Q

What are some complications of gastroenteritis?

A

Post infective IBS
Lactose intolerance
Reactive arthritis
GBS
HUS

470
Q

What is the only suitable contraception for postpartum women breastfeeding?

A

Progesterone only pill

3a GP (1 decks)

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