GP Flashcards
How can a lower urinary tract infection be differentiated from an upper urinary tract infection using the presenting sx?
Upper: fever, suprapubic pain, vomiting, haemautria
Lower: frequency, dysuria, suprapubic tenderness
What results on a dipstick would indicate a UTI?
Nitrites
Nitrites + Leukocyte Esterase
What would the presence of solely leukocyte esterase in the urine suggest?
Presence of white blood cells in the urine which may either be caused by inflammation or infection.
What are the most common organisms causing UTIs? (6)
E.coli
Klebsiella pneumoniae
Enterococcus
Pseudomonas auerginosa
Staphylococcus saprophyticus
Candida albicans
What are the treament options for a UTI?
First line - Nitrofurantoin or Trimethoprim
Second line - Pivemicillinam, Amoxicillin or Cefalexin
3 days - women with lower urinary tract infection.
5 days - immunocompromised women or women that have abnormal anatomy.
7 days - men, pregnant women or catheter-related UTI.
What is the management of a UTI for a pregnant woman?
7 days of antibiotics
Urine for culture and sensitivities
First line: Nitrofurantoin
Second line: Cefalexin or Amoxicillin
Why is nitrofurantoin contraindicated in the third trimester?
Can cause haemolytic anaemia.
Why is trimethoprim avoided in the first trimester?
Can affect the absorption of folic acid which results in spinal malformations.
What are the antibiotic options for managing pyelonephritis in the community?
cefalexin
co-amoxiclav
trimethoprim
ciprofloxacin
What are the options for managing influenza in people that are at risk of complications?
- oseltamivir 75mg twice daily for 5 days
- inhaled zanamivir twice daily for 5 days
Treatment needs to be initiated within 48 hours of symptom onset to be effective.
What are the options for post-exposure prophylaxis for influenza, for at risk patients?
Post-exposure prophylaxis (within 48 hours of exposure):
- oseltamivir 75mg once daily for 10 days
- inhaled zanamivir 10mg once daily for 10 days.
What are the most classical sx of seborrhoeic dermatitis and what is the firstline treatment?
The classic symptoms are dandruff and eczematous lesions with flakes on the periorbital, auricular and nasolabial folds.
Ketoconazole.
How many vaccinations for tetanus need to be given before the patient is considered to be fully immunised?
5
How may a patient with iliotibial band syndrome present?
Burning or sharp sensation around the lateral aspect of the knee.
How would a meniscal tear present?
Locking of the knee joint
Swelling
Pain
How would a patient with pityriasis versicolor present and how is this treated?
Hypopigmented lesions
Topical ketoconazole
What infection is orchitis commonly associated with?
Mumps
What is the eradication therapy for H.pylori? Will the patient need a follow up?
Amoxicillin
Metronidazole
Omeprazole
If symptoms resolve no need to repeat breath test.
What is the post-exposure prophylaxis therapy for exposure to HIV?
Oral antiretroviral therapy for 4 weeks
What is the name of the exercises that are recommended for patients with BPPV?
Brandt-Daroff exercises
What is the most common causative organism for otitis externa? What is another common causative organism?
Pseudomonas aeruginosa
Staphylococcus aureus
What is the main mechanism of action for the implantable contraceptive?
Inhibits ovulation
What pH is suggestive of an infection with Candidiasis? (vaginal thrush)
Less than 4.5
With osteoporosis when should the 10-year fracture risk be reassessed?
After 5 years of treatment with aldendronate.
Insulin-dependent diabetics must check their blood glucose every …………… whilst driving
2 hours
When should women without any risk factors have a FRAX assessment?
over 65
What is used to manage acute flares of rheumatoid arthritis?
IM methylprednisolone
What skin lesion can be present and used to make a clinical diagnosis of lyme disease?
Erythema Migrans
What is the firstline treatment for syphilis?
Benzylpenicillin IM
What are the atypical organsims that can cause chest infections?
Legionella pneumophilia
Chlamydia ptsittaci
Mycoplasma pneumoniae
Chlamydydiohilia pneumoniae
Q Fever (Coxiella burnetii)
What is the firstline treatment for a chest infection (typical organisms) for a patient who has NKDA? Penicillin allergy? What is the typical course length?
- Amoxicillin
- Erythromycin/Clarithromycin or Doxycycline
5-7 days
What are the typical organisms that cause bacterial chest infections?
Streptococcus pneumoniae.
Haemophilus influenzae.
Moraxella catarrhalis.
Pseudomonas aeruginosa.
Staphylococcus aureus
What does the CRB-65 score stand for and how is it used?
Confusion
Respiratory rate >30
Blood pressure <or= 60 (diastolic) or <90 (systolic)
Over 65?
0 = low risk
1-2 = intermediate risk
3-4 = high risk
Difficulty breathing is a sign that may suggest a more severe chest infection or pneumonia, name 5 more.
Oxygen saturation less than 90%.
Raised heart rate.
Grunting; very severe chest indrawing.
Inability to drink.
Lethargy; reduced level of consciousness.
What is the most common virus that causes URTIs?
Rhinoviruses
Being young, female and sexually active are all risk factors for the development of a UTI, name 4 more.
Diabetes
Hx of UTIs
Spermicide use
Catheters
In what circumstances would a urinary MCS also be indicated for a young female presenting with urinary sx (in the absence of vaginal sx)?
If there were signs of systemic upset, hx of diabetes, recurrent UTIs or if they were pregnant.
Why are nitrites present in the urine when there is a UTI?
As most urinary pathogens convert nitrates into nitrites.
What blood tests would be indicated if a patient was not responding to antibiotics as treatment of their UTI?
FBC
U+Es
CRP
(to assess kidney function)
When is radiological imaging indicated for a UTI?
For pyelonephritis that is not responding to conventional abx.
What is the firstline treatment for vaginal candidiasis? What can be used as an alternative?
One dose Fluconazole (oral)
Clotrimazole pessary
What are the features of vaginal candidiasis?
‘cottage cheese’, non-offensive discharge
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen
What is pneumonia?
Inflammation of the parenchyma of the lung.
What is the definition of hospital acquired pneumonia?
Pneumonia contracted more than 48 hours after hospital admission that was not incubating at the time of admission.
What are the most common organsims that cause HAP?
Gram-negative bacilli (e.g. Pseudomonas aeruginosa)
Staphylococcus aureus
Legionella pneumophila
Which pneumonia causing organism is associated with the reactivation of cold sores?
Streptococcus pneumoniae
What are the extra-pulmonary features that are associated with Mycoplasma pneuomoniae?
Erythema multiforme
Arthralgia
Myocarditis, pericarditis
Haemolytic anaemia
What biochemical abnormalities can sometimes be seen in patients with pneumonia caused by Legionella pneumophila?
Hyponatraemia (SIADH)
Hypophosphataemia
Raised serum ferritin
How can Legionella pneumophila pneumonia be diagnosed?
Urinary antigen testing
Sputum culture
PCR
A pneumothorax is a pulmonary complication of pneumonia - name 3 more pulmonary complications.
Parapneumonic effusion
Abscess
Empyema
What are two extra-pulmonary complications of pneumonia?
Sepsis
Atrial fibrillation
What investigations are indicated for a patient with suspected pneumonia?
Bedside: Obs, sputum sample, urinary sample (MCS to rule out UTI and urinary antigen) and ECG (AF risk).
Labs: FBC, U+Es, CRP, Blood cultures (source of infection)
Imaging: CXR
When is CRB-65 used over CURB-65?
CRB = deciding admission into hospital
CURB = when in hospital to decide between outpatient, inpatient and ITU.
What are the supportive management options for a patient hospitalised with pneumonia?
Oxygen (aim for 94-98% in pts with no previous lung disease, 88%-92% in pts with COPD).
IV fluids
Analgesia
What population of patients should have a repeat follow up CXR 6-8 weeks after pneumonia?
Smokers
Over the age of 50
Muscular and disc degeneration are two causes of mechanical back pain, name 4 more.
Spondylosis
Spinal fracture
Spinal stenosis
Radiculopathy
Malignancy is a cause of non-mechanical back pain, name 4 more.
Epidural abscess
Discitis
Osteomyelitis
Inflammatory arthropathy
Renal stones are a common cause of referred back pain, name 5 more.
Aortic dissection
Pancreatitis
Ruptured AAA
Pyelonephritis
Biliary colic
What two tests are commonly used to assess for nerve impingement in suspected lumbar radiculopathies and what are they testing for?
Straight leg raise for L5/S1 radiculopathy: worsening radicular pain on* raising the leg with the knee extended*. Pain should be relieved if the knee is flexed
Reverse straight leg raise for **L2-4 **radiculopathy: worsening radicular pain on extending the leg with the patient prone
High BMI and smoking are common risk factors associated with the development of GORD, name 4 more.
Genetics
Pregnancy
Hiatus hernia
NSAIDs, caffeine and alcohol (conflicting)
GORD classically presents as heartburn that classically occurs after meals and is made worse by leaning forwards or lying down. Name 7 more symptoms that can be associated with GORD.
Regurgitation
Dyspepsia
Chest pain
Dysphagia
Odynophagia
Cough
Hoarse voice
Nausea +/- vomiting
What are the common complicatoins of GORD?
Barrett’s oesophagus
Stricture
Erosive oesophagitis
Chronic describes constipation that has been present for ………… duration.
≥ 3 months
What are the red flag sx associated with constipation?
Weight loss
Rectal bleeding
Fhx of colorectal cancer
Sudden change in bowel habits
Abdominal pain
Iron deficiency anaemia
What criteria is used to assess and diagnose chronic constipation?
Rome IV criteria
For a young patient presenting with erectile dysfunction what is the firstline management step?
Referral to urology
Which nerve is affected in meralgia paraesthetica?
Lateral cutaenous nerve of thigh
In Vestibular neuronitis:
Prochlorperazine is used for ……………………
Betahistine is used for ………………….
Symptomatic relief
To prevent symptoms
What type of nystagmus do you get with vestibular neuronitis?
Horizontal nystagmus
What are the treatment options for mild-moderate acne?
…….. week course
Topical …………. + topical benzoyl peroxide
Topical …………… + topical …………………
Topical benzoyl peroxide + topical …………………..
Topical ………………………. (monotherapy)
12 week course
Topical adapalene + topical benzoyl peroxide
Topical tretinoin + topical clindamycin
Topical benzoyl peroxide + topical clindamycin
Topical benzoyl peroxide (monotherapy)
What are the treatment options for moderate to severe acne?
……… week course
Topical …………….. + topical benzoyl peroxide
Topical ……………… + topical ………………….
Topical ………………… + topical benzoyl peroxide + oral ……………./oral ………………..
Topical …………………… + oral …………………./oral …………………..
12 week course
Topical adapalene + topical benzoyl peroxide
Topical tretinoin + topical clindamycin
Topical adapalene + topical benzoyl peroxide + oral lymecycline/oral doxycline
Topical azelaic acid + oral lymecycline/oral doxycycline
