GP Flashcards
1
Q
what are teh test and treatment manouver for BPV
A
Dix - hallpike - test (nystagmus
epley - treatment
2
Q
pathophys of BPPV
A
Calcium carbonate crystals (otoconia) become dispalced in the semicircular canals (normally posteior). Ciral infections, head trauma or ageing can causes this. This disrupts the endolymph flow and confses eh vestibular system leading to vertigo when the head movements creasts the flow of endolymph.
3
Q
presntatons of bursitis
A
- Pain
- Localised tenderness
- Limited motio
- Swelling and redness
- If chronic ti may lead to deteroation of muscles and limited range of movement
- Swollen, warm, tender, fluctulant
- If tis infected it will be hot, more tender, erythemous, fever, sepsis
- Differetiate from sptic arthiritis by swelling a the joint, painfua dn reduced range of meovement
4
Q
test and treatment of bursts
A
Aspiration of fluid if suspected infected
* Pus indicates infectio
* Straw coloure means probs not an infection
* Blood stained - trauma, infection or inflamatory cause
* Milky - pesudogout
* Sent to lab for microscpoy and culture (gout or infective causes)
- Rest, ice, comepression
- Analgesia
- Aspiratio to remove presssure
- Sterorid injections
- Antibiotics (flucloxacillin first line
- If they are systemically unwell, hospital - bloods, blood cultre, IV antibiotis, IV fluids.
5
Q
whatare teh cases of conjunctivitis and how to dustuingish between teh different types
A
iral, allergic
bacterial - H influenzea or s pneumonia
- Bacterial will have purulent discharge which is worse in the morning, highly contagious
viral conjunctivitis - clear discharge, also other symptoms of viral infetio - sore throat blocked nose ect
6
Q
what are red flags that conjunctvts shouldnt cause adn also teh norla symptoms
A
photophoba
pain
changes in vision
7
Q
management of conjunctovitis
A
- No treatment needed normally and it will resolve I 1-2 weeks.
- Hygiene measures, and cleaning the eyes with warm water can help
- Chloramphenicol or fusidic acid eye drops can be used for bacterial infection
- Neonates conjunctivitis needs urgernt opthalmology assesment as it coudk be gonococcal
Inallergci conjunctivitis it might be itching and watery eyes - antihistamines and mast cell stabilises can be used
8
Q
differential of conjunctivits
A
Causes of an acute painful red eye include:
Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury
9
Q
causes of constipatipns
A
- Not enough fibre
- Not enough fluids
- Not enough movement/less activity
- Changes in diet and to daily routine
- Side effects of medicine
- Stress, anxiety or depression
- IBS
- Old age
- Hosptal enviroment
- Fissures
- Rectal prolapse
- Cancer
- Pelcis ass
- Pseudo obstruction
- Hypercalcaemia
- Hypothroidism
- Porphyria
*
10
Q
what drugs can causes constpatipon
A
Opiate use
* Anitcholinergivs
* Diuretis
Ccbs
11
Q
treatetment of consitatuoin - drugs ajd not
A
- Eat a healthy balanced diet, high in sorbitol (apples, grapes, apricots, raspberries)
- Increase fibre
- Increase fluid intake and avoid alcohol
- Rest feet on a low stool
- Try to poo at the same time and place every day
- Medications:
- Bulking agent : Ishpaghula husk, bran powder, glycol
- Stimulant laxatives: bisacodyl tablets, senna (don’t use in intestinal obstruction
- Stool softeners: arachis oil enemas liquid parrafin
- Osmotic stimulant: lactulose, macrogel (movicol) magnesium enemas, sodium dalts and phosphate enemas
Fecal impaction might requre dsmpacton regime
12
Q
criteria for constipation
A
- Rome criteria is important. More than 2 symptoms of
- Straing for >25% of BM
- Sensationof blockede
- Lumpy or hard stool
- Manual manouvers required
Fewer than 3 BM a week
13
Q
ocntact dermatts explnaton and epdemology
A
Type 4 hypersensitivity
Skin irritation that occurs minutres to hours after touching the itttaating substance
People who come in contact with a lot of chemicals- mechanics, landscapers, cleaners, hairstylists
Allergy’s - soap, perfume
Allergen - posin ivy, nickel, wool sweater
14
Q
presentaton and treatment of contact dermatts
A
- Red rash on the area of skin that makes contact with something that causes a reaction
- Severe itching
- Cracked, dry, or scaly skin
- Raised red bumps that may crack and ooze
- Swollen, hot, blistered skin
- Avoid triggers
- Keep skin moisturised - emollients
- Steroid creams - can auses thinni of skin
- Sterod tablets
- Photoherapy
15
Q
presentatons of rng orm
A
- Itchy erythematous skin
- Scaly
- Well demarcated
- Several rings that spread out and the edge s more prominent red
- tinea capittis an present with hairloss and is more common in children’s
Tinea pedis - white or red cracked itchy skin between the toes. May split and bleed
16
Q
management of rnngworm
A
- Antifungal medication
- Anti-fungal creams such as clotrimazole and miconazole
- Anti-fungal shampoo such as ketoconazole for tinea capitis
- Oral anti-fungal medications such as fluconazole, griseofulvin and itraconazole
- Nal fungus must be treated with amorolfine nail lacquer for 6 – 12 months. Resistant cases may need oral terbinafine,
- A mild steroid can help settle the nflamaton - mconazole 2% and hydrocortsone 1%
- Wear loose breathable clothng
- keep the area clean and dry
Avoid sharing towels and bedding
17
Q
what s the cause of warts
A
nfecton of keratonocytes by HPV
18
Q
what s teh screenng n pregnancy
A
Pregnancy
- screening for infectious diseases (hepatitis B, HIV and syphilis)
- screening for Down’s syndrome, Patau’s syndrome and Edwards’ syndrome
- screening for sickle cell disease and thalassaemia
- screening to check the physical development of the baby (known as the 20-week scan or mid-pregnancy scan)
- diabetic eye screening if you are pregnant and have type 1 or type 2 diabetes
19
Q
what as teh screeng n newborns
A
Newborns
- a physical examination, which includes the eyes, heart, hips and testes
- a hearing test
- Blood test for 9 conditions -
sickle cell
CF
congenital hypothyroidism
phenylketonuria (PKU)
medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
20
Q
what are teh screenngs n adulthood
A
People with diabeties aged 12
Annual diabetic eye check looking for diabetic retinopathy
Females 25-64
Cervical screening every 3 years aged 25 to 49, and every 5 years from the ages of 50 to 64.
Females 50-70
Breast screening
Everyone 60
Bowel cancer screening every 2 years
Men aged 65
AAA
21
Q
management of atopc dermatitis
A
- Management falls into maintenance and management of flares.
- Maintinance is creating an artifical skin barrier - emolients used as often as possible
- Avoid breaking the skin barrier - no scrubbing, hot water or harsh soaps.
- Enviromental triggers - climate, certain diets, washing powders, stress
- Flares can be treated with wet wraps (emoleitnt covered with a wrap over night to lock in the moisture)
- Antibiotics might need ti be used
Zinc impregnated cangades, tacroliums, phototheraoy, corticosteroids, methotrexate and azathioprine
use a thck a cream as tolerates -
thin:
E45
dprobase cream
cetraben cream
aveeno
thick:
hydromol ointment
diprobase ointment
epaderm ointment
22
Q
what is the steroid ladder
A
Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
23
Q
eczema herpeticum define and presintations
A
a viral skin infection caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV). Previously known as kaposi vericelliform eruption.
Herpes smplex 1 an dit may be associated with a coldsore, it normally occurs in those with excema aready.
- Widespread painful vesicua rash
- Systmic features - fever, legarthym irritability, reduced oral intake
- Lymphadenopathy
Rash - erythemous, painful vesicles containg pus, punched out ulcers with a red base
24
Q
test and treatment for eczema herpaticum
A
viral swabs = treatment with aciclovir
24
pathophys of impertigo
* If SA it will have a charactersitic golden crust
* It is very contagous and children should be lept off of school
* It can be classified as bullous or non bullous
* Non bullous is typically arounf the nose and mouth and it forms a golden crust
* Bullous - the SA produce epidermolysis toxins, these break down skin proteins and causes fluid vesicles to form
It is more common in neonates and infants under 2. they may be feverish and generally unwell.
25
treatment and complications of impertigo
Non bullous
* Topical fusidic acid or hydrogen peroxide 1% cream
* Oral flucloxacillin for severe impertigo
* Patiens given advice on not scratching, avoind sharing twoes and not going to school untill the lesions have healed
Bullous
* Flucloxacillin orla ot IV if they are very unwell
* Cellulitis
* Sepsis
* Scarring
* Stapylococcus scalded skin syndreom
26
medications for flu
* Post exposure prophylaxis can be given if high risk, it has been less than 48 hours and they are not protected by vaccination
* Oral oseltamivir 75mg once daily for 10 days
Inhaled zanamivir 10mg once daily for 10 days
27
medicaiton for influenza
* Post exposure prophylaxis can be given if high risk, it has been less than 48 hours and they are not protected by vaccination
* Oral oseltamivir 75mg once daily for 10 days
Inhaled zanamivir 10mg once daily for 10 days
28
complications of flu
* Otitis media, sinisitis and bronchitis
* Secondary bacterial pneumonia
* Woresning chronic conditions (COPD or HF)
Encephalitis
29
w with a blunt objectcute causs of soft tissue injury
ACUTE:
* Sprains
* stretch/tear of ligaments
* Ankle rolls outwards, knees twists and wrists are falls on outstretched hands
* Grade 1 is slight stretching
* Grade 2 is partial tear and abnormal laxity in the joint
* Grade 3 is complete tear and significant instability.
* Strains
* Complete or partial tear) to a muscle/tendon
* Pain, muscle spasm, weakness, swelling, cramping
* Contusions
Bruise - direct blow with a blunt object
30
chronic causes of soft tissue injury
CHRONIC:
* Tendinitis:
* Inflammation of a tendon or the tendon sheath causes by repeated small stresses
* Pain that worsens with activity
* Bursitis:
Swollen bursa, often associated with tendinitis
31
management of soft tissue injusy
* In acute: RICE - rest, ice, compression, elevation
* Occasionally splinting
* In chronic: rest, ibuprofens, steroid injections, splinting,
Surgery potentialtk to remove bursa
32
pregnancy quadrpue test meaning and results
test to screen for down syndomre in those with risk factors
alpah fetoprotien
unconjugated oestriol
HCG
inhibin A
13 - low AFP, Oestrio, HCG and high inhibin A
21- low afp and oestriol but high HCG and inhibin A
33
what is teh cases of rosela infantum
human herpes virus 6
34
ou decide to prescribe ulipristal acetate as a form of emergency contraception.
When can she restart her normal hormonal contraception?
After taking ulipristal acetate women should wait 5 days before starting regular hormonal contraception
35
when is theestimated date of delivery for a baby and what is naegekes rule
40+0
first day of LMP - add 1 year , take away 3 months, add 7 dyas
36
key presentatons of lymes dsease - ntal and advanced
* Bullseye rash
* Regional lymphadenopathy
* Fever
* Headache
* Later on:
* Arthralgia
* Malaise
* Systmic reactions
* Carditis
Neurological involvement
37
management and complcatons of lymes dsease
* Doxyxycline/amoxicillin for 14 days
* IV cefataxime in neurological disease
Prevention:
* Protective clothing, insect repellants
* Special hare handalling pets
* Prompt removla of ticks
* Reductino in deer
Polyneuritis
Encephalopathy
Arthiriris
38
what s teh solaton te for measeld
5 days after teh arreance of rash
39
treatment and complcatons of measles
* Keep of school 5 days after the appearance of the rash
* Isolation in hospital
* Adequate nutrition
* Vitamin A
* Ribavirin antiviral
* Otitis media
* Pneumonia
blndness
* Encephalitis
* Subacute sclerosing panencephalitis (SSPE) extremely rare–Presents approx 7 years after measles infection. Will cause progressive dementia (over several years) and eventual death. Occurs in 1 in 100 000 cases of measles.
40
mumps man symptoms
CCCK
coryzal
conjunctvts
cough
koplik spots
41
what s teh vrus behnd measles
RNA morbillivirus
42
mumps ey presentatos
flu s teh prodorme
then massve swellng of teh partotd gland!!
Fever
* Muscle aches
* Lagarth
* Reduced appetitie
* Headache
* Dry mouth
There may also be:
* Abdominal pain - pancreatitis
* Testicular pain
Confusion, neck stiffness and headache - meningitis/encephalitis
43
management and complcatons of mumps
* Self limiting and improves withtin a week
* Notafiable disease
* Supportiev management - rest, fluids, analgesics,
* Pancreatitis
* Orchitis and reduced fertlty
* Meningitis
* Hearing loss
44
secndary casues of obesty
medcatons
hypothyrodsm
PCOS
poor sleep
mental health dsorders
reduced moblty
cushngs
45
5 As of weght loss management
* Ask -about their concerns with weight
* Assess - BMI, diet, sleep, exerice
* Advise - descrie benefits of weight loss
* Assist - set goals, refer to diatician
Arrange - follow up every 2-3 month
46
medcaton and surgery for weght loss
* Ortlistat - reduces absorbtion of fat by inhibiting lipase
* Phentermine- (duromine/metermine) suppresses hunger (its an anphetamine)
* Lignatride - GLP1 antagonist - delays gastric emptying
* Intragastric balloon - provides feeling of satiety
* Bariatric surgery - restrict gastric capacity
* GLP1 analouge injection - semaglutide, also called Wegovy
47
complcatons of obesty
* Arthritis - 4x reduction in joint stress for each kg of weight loss
* Chronic pain
* Depression and anxiety
* Overall mortality
* GORD
* Sleep apnoea
* Cardiovascular disease
* Metabolic disorder - PCOS, t2dm
* Gallstones
* Erectile dysfunction
48
causes of otitis media
* Streptococcus pneumonia - mst common
* Heamophillus influenzea
* Staph aureus
Moraxella catarrhalis
49
symptoms of otitis medica
* Ear pain
* Reduced hearing
* Fever, cough, sore throat, coryzal symtoms
It can present unspecifically in children, so it is always worth examining both ears and the throat of unwell children
50
treatment of otitis media
* Admit to pediatrics if <3 months or diagnostic doubt.
* Antibiotics genrally not needed, unless significant coorbidity or immunocompromised. Amoxicillin for 5 days, clarithromycin is an alternative.
* Anelgics to help with pain and fever
Safety net on when to seek further medical stteneiton
51
treatment of otitis externa
* Bacterial - pseudomonias auerginosa and staph aureus
* Fungal
* Eczema
* Contact dermatitis
* Seborrheic dermatitis
Psudomas aeruginosa is a GN rod bacteria that likes moist oxygenated environments. Treated with aminoglycosides (e.g., gentamicin) or quinolones (e.g., ciprofloxacin).
52
otitis externa symotoms
* Ear pain
* Discarge
* Itchiness
* Conductive hearing loss
Examination:
* Erythem and swelling
* Tendernes
* Pus and discharg e
Lymphadenompathy
53
treatment of otitis externa
* Mild - Acetic acid 2%
* Moderate - topical antiobiotics -
* Neomycin, dexamethasone and acetic acid (e.g., Otomize spray)
* Neomycin and betamethasone
* Gentamicin and hydrocortisone
* Ciprofloxacin and dexamethasone
Aminoglycosides are pornetiall otocix and causes hearig loss if they get past the tympanic membranse so it is crucial to rule out a perforated membrane before use
Sever- oral flucloxacillin or IV and ENT admission
Ear wicks can be used if the ear is very swollen
Fungal infections can be treated with clotrimazole ear drops.
54
bg complcatno of otts externa
Malignant otitits externa
* The infection spreads othteh bone and causes osteomyeleitis of the temporal bone
* It normally has underlying risk facotr =- diabeties, HIV, immunosupressant medications
* Granulation tissue at the junction between the bone and cartilage
* Admission to hospital under the ENT team
* IV antibiotics
* Imaging (e.g., CT or MRI head) to assess the extent of the infection
If left untreated it can causes - facial nerve damae, meningitis and death .
55
trggers of porass flares
Drugs that can trigger it:
* NSAIDS
* Antimalarial
* Ace inhibitors
* Beta blockers
Also can be triggerd by viruses
56
types of psorass
* Plaque - most common from in adults
* Guttate - small raised papules, most commn in children and is triggerd by strep throat infection, stress or medication. Resolve in 3-4 months
* Pustular - pustules form under erythematous skin, medicla emergany
Erythrodermic - the skin comes away coepleyelt - admit emergancy
57
key presentation of psoriasis
* Dry, flaky, patchy skin
* Raised and rough plaques
* On extensor surfaces - elbows, knees, scalp
* Caused by rapid generation of new cells resulting is a thickening of skin
* Symmetrical
Specific signs of psoriasis -
* Auspitz sign- small point of bleeding when the plaueq is scraped off
* Koebner phenomenon - psoriatic lesions in area of skin affected by trauma
Residual pigmentation of eth skin once the lesion resolves
58
manageent and treatment of psoriasis
* Topical steroids
* Topical vitamin d analogues (calcipotral)
* Topical calcineurin inhibitors - tacrolimus
* Phototherapy and narrow band ultraviolet B light
Sometimes if uncontrolled, children might be started on methotrexate, cyclosporine, retinoids or biologic medications.
Dovobet and enstilar are unlicenced but can be used (these are creams that are a mixture of vit d and steroids, but are more expensive so not recommended by nice lolol.
Steroid ladder:
* Hydrocortisone (1)
* Eumavate (2.5)
* Betnovate (10)
* Dermavate (50)
* Nail psoriasis
* Psoratic arthiritis can also occur
* Psychosocal implications - depressiona nd anxiety
* Patients with nail disease are increaed risk of psoriatic arthiritis
* Any autoimmune diseases will increase risk of CVD
59
treatment of sinusistis
* If systemic/sepsis admiyt them
* If symptoms don’t imporve after 10 days, high nose of nasal steroids for 14 days
* Delayed antibiotic prescription if it doesn’t improe in 7 days, (phenoxymethylpenicillin)
For chronic:
* Saline irrigation
* Steroid sprays
* Functional endoscopic sinus surgery - small endoscope used to clear blocked passages
Nasal spray:
* Tilting the head slightly forward
* Using the left hand to spray into the right nostril, and vice versa (this directs the spray slightly away from the septum)
* NOT sniffing hard during the spray
* Very gently inhaling through the nose after the spray
If they can tatste the spray, they are breathing too hard and it si not working!!!!
60
presentation of rhunosinusitis
* Recent viral resp infection presenting
* Nasal congesiotn
* Nsasl discharge
* Loss of smell
* Faicle swelling
* Facial pressure
* Facial pain
* Tenderness to palpatino fo areas
* Discharge
* Fever
* Inflamation to nasal mucosa
Chornic:
* Similar symptoms but lats longer thab 12 weeks
Nasal polyps are associated sometimes
61
defie and epi of radiculopathies
Radiculopathy - compression of the nerve roots as they exit the spinal cord and spinal column, leading to motor and sensory symptoms. * A nerve is pinched coming out of the cervical, thoracic or lumbar spine
Trauma, bone spurs and herniated disks can all cause it, it can also happen as peopke age and the disks loos their shape
People over 50
Rare
62
presentation test and management for radicuopathies
* Pain
* Tingeling
* Numbness
* Muslce weakness
* Cervicial can cuases difficulty moving neck
* Thoracic - pain in chest, when breathing
* Lumbar - pain in lower back that ca spread to legs
* Xray
* CT scan
* MRI
* EMG - measures if your muscles are working
* Ice or heat
* Adjusting posture
* Physical therapy y
* NSAIDs
* Corticosteroids
* Surgery
63
pathophys of alcohol addiction
Pathophysiology
It affects the basal ganglia, amygdala and prefrontal cortex. It causes a release of dopamine giving pleasurable feelings and reinforcing the habit. Operant conditioning is the basis of addiction. It disrupts the equilibrium of GABA and glutamate, as there are more sedatives (GABA). The body then makes more glutamate to rebalance, and when the drug is stopped there is too much glutamate, this causes withdrawal symptoms such as anxiety, sweating, and shaking.
64
what are teh criteria for substanc emissuse
You need at least 2 of the following:
1. Impaired control over substance use
2. Increasing priority over other aspects of life or responsibility
Psychological features suggestive of tolerance and withdrawal
65
what are eth CAGE questions
ever flet teh need to cut doen
Annoyed yb people criticising yoru drinking
gulity aur drinking
eye opener
2/4 is positive for excessive dronking
66
medications for alcohol
* Chlordiazepoxide can reduce symptoms
* Naltrexone - opiate blocker that makes alcohol less enjoyable
* Acamprotase - increases GABA and decreases cravings
* Disulfiram - causes unpleasant side effects on driking of alcohol
Prescribe thiamine and offer psychological interventions!!!
67
opiates signs and withdrawl effects
* Physiological: euphoria and reduced pain, sedation, respiratory depression, meiosis, constipation, skin warmth and flushing
* Psychological: apathy, disinhibition, drowsiness, impaired judgment and attention, slurred speech
Withdrawals
* Rhinorrhoea
* Lacrimation
* Diarrhoea
* pupillary dilation
* piloerection
tachycardia and hypertension.
68
alcohol dependance tests
Tests
* CAGE questionnaire for alcohol
* AUDIT C questionnaire for alcohol
69
presintation and withdrawl of benzodiazapines
* Physiological effects: altered mental status, slurred speech, ataxia, respiratory distress, hypothermia, and coma if overdosed
* Psychological effects: euphoria, disinhibition, apathy, aggression, anterograde amnesia, labile mood
Withdrawl can cause:
* Tremor
* N&V
* Headache
* Hallucinations
Tachycarida and postural hypotention
70
LSD
ecstacy and PCP affects
LSD: lethargy, psychomotor agitation, craving, insomnia, and unpleasant dreams
Marijuana: increased appetite and conjunctival injection
Ecstasy: bruxism, hyperthermia, hyponatremia, and hepatotoxicity
PCP: loss of painful stimuli, vertical nystagmus, psychosis with hallucination, violence, and agitatio
71
causes of tonsillitus
Bacterial - Group A strep (strep pyogenes) is most common!!!
Second commonest: streptococcus pneumonia
Others:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
The palatine tonsils are affected in tonsilitis
72
how to decide if to give antobiotics or not
* Fever pain score - . A score of 2 – 3 gives a 34 – 40% probability, and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:
* Fever during previous 24 hours
* P – Purulence (pus on tonsils)
* A – Attended within 3 days of the onset of symptoms
* I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
73
key presentations of antibiotics
* Fever
* Sore throat
* Pain on swallowign
* Red inflamed tonisla, peotenaitll with exudate
* Anterior cervical lymphadenopathy
Centor criteria
* A score of 3 or more estimates 40-60 probibilty that is is bacterial tonsillitis and antibiotics should be given!!!
* Fever over 38
* Tonsillar exudates
* Absence of cough
Tender anterior cervical lymph nodes
74
management of tonsilitts
* Consider admissin if patine tis immucopompramised, systemically unwell, dehydrated, stridor, respiratry distress, peritonsillar abcess present, cellulitis.
* Safety net - analgesisa for pain, return if still fore after 3 days or fever is above 38.3
* Score 0-1: Use no antibiotics
* Score 2-3: Use a 3-day back-up antibiotic prescription
* Score 4 or more: Use immediate antibiotics if severe, or a 48-hour short back-up prescription
*
* Penicillin V (also called phenoxymethylpenicillin) for a 5-day course is typically first-line. It has a relatively narrow spectrum of activity and is effective against Streptococcus pyogenes.
* For 10 days for scarlett fever
Clarithromycin is the usual first-line choice in true penicillin allergy.
75
conpmications of tonsillittis
Peritonsillar abscess, also known as quinsy
Otitis media, if the infection spreads to the inner ear
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
76
acute and chronic causes of urticaria
cute:
* Allergies to food
* Contact with chemicals
* Medications
* Vira infections
* Insect bites
* Dermatographias
Chronic:
* Chronic idiopathic urticaria - no trigger
* Chronic injucable urticaria - temp, sunlight, exercise, strong emotion, cold weather, pressure
Autoimmune uriticaria - underlying conditions like SLE
77
treatment for urticaria
* Antihistamines - fexofenadine
* Oral steroids
* Montelukast
* Omalizumab
Cyclosporin
78
chickenpox cirus and course of illness
* Widespread erythema's, raised, vesicular blistering lesions
* Starts on trunk or face and spreads over 2-5 days
* Fever, itch, general fatigue
Become symptomatic 10 days -3 weeks after exposure. Stop being contagious after all of the lesions are crusted over.
79
treatment and complicatinos of chickenpox
* Self limiting
* Acyclovir - immunocompromised, adults over 14
* Encephalitis needs admission
* Calamine lotion and chroephenphrine antihistamine
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis (presenting as ataxia)
It can live in cranial nerves and dorsal root ganglion cells as shingles
80
varicose veins definition adn risk factors
* Distended superficial veins measuring more than 3mm in diameter.
* Reticular - dilated blood vessels measuring less than 1-3m
* Telangiectasia - dilated blood vessels in the skin
* Age
* Family history
* Female
* Obesity
* Pregnancy
* DVT
* Prolonged standing
81
pathophysiooloyg of varicose veins
* The valves become incompetent and the blood is pooled down
* Chronic venous insufficiency:
* Perforating veins allow blood to flow form the superfical to the deep veins. When the valces are incompetant the blood flows back though the perforators into the superficial vwins cauign dilation and engorgement
* When blood pools the blood can leak out into neary tissues
* This causes the blood to breakdown into haemosiderin which causes brown discoloration
* Pooling of blood in the distal tissues can causes venous eczema
It can causes the tissue to become fibrotic, becoming narrow and hard - called lipodermatosclerosis
82
key presentations of varicose veins
* Asymptomatic
* Heavy or dragging sensation in the legs
* Aching
* Itching
* Burning
* Oedema
* Muscle cramps
* Restless legs
Skin ulcers, changes
83
tests for varicose veins
* Tap test: put pressure on SFJ, tap distal vein, feel fo a thrill
* Couugh test -prrressure the SFJ and get them to cough, feel for thrills
* Trendelenburg’s test – with the patient lying down, lift the affected leg to drain the veins completely. Then apply a tourniquet to the thigh and stand the patient up. The tourniquet should prevent the varicose veins from reappearing if it is placed distally to the incompetent valve. If the varicose veins appear, the incompetent valve is below the level of the tourniquet. Repeat the test with the tourniquet at different levels to assess the location of the incompetent valves.
* Perthes test – apply a tourniquet to the thigh and ask the patient to pump their calf muscles by performing heel raises whilst standing. If the superficial veins disappear, the deep veins are functioning. Increased dilation of the superficial veins indicates a problem in the deep veins, such as deep vein thrombosis.
* Duplex ultrasound can be used to assess the extent of varicose veins. It is an ultrasound that shows the speed and volume of blood flow.
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management of varicose veins
* Weight loss
* Exercise
* Eelvation of leg
* Compression stockings
Surgical:
Endothermal ablation – inserting a catheter into the vein to apply radiofrequency ablation
Sclerotherapy – injecting the vein with an irritant foam that causes closure of the vein
Stripping – the veins are ligated and pulled out of the leg
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venous ulcer characterisitsc
* Gater area
* Large
* Superfical
* Liekly to bleed
* Less painful than arterial
* Pain relived on elevation of leg
CVC - hyperpigmentation, venous eczema and lipodermatosclerosis
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treatment of venous ulcers
Vascular surgery where mixed or arterial ulcers are suspected
Tissue viability / specialist leg ulcer clinics in complex or non-healing ulcers
Dermatology where an alternative diagnosis is suspected, such as skin cancer
Pain clinics if the pain is difficult to manage
Diabetic ulcer services (for patients with diabetic ulcers)
* Distirct nurses and tissue viability nurses
* Clean wound, debridemnet, dressing
* Compression therapy
* Pentoxifylline (taken orally) can improve healing in venous ulcers (but is not licensed).
* Antibiotics are used to treat infection.
Analgesia is used to manage pain (avoid NSAIDs as they can worsen the condition).
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bowings disease and epidemiology
Early form of skin cancer that's easily treatable The main sign is a red, scaly patch on the skin. early squamous cell carcinoma
* HPV virus
* Radiotherapy
* Sun exposure
* 60-70 years old
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bowings disease presentation
atch on the skin with clear edges that does not heal
* Itchy
* Scaly and crus
* Raised or flat
* Often in commonly exposed arreas
Bleeding, lumps and ulcers are signs it’s a SCC instead
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bowings diseas test differentail and management
* Dermatology referral
* Biopsy
* Psoriasis
* Eczema
* Cryotherapy
* Surgical removeal
* Photodynamic therapy
* imiquimod cream or chemotherapy cream (such as 5-fluorouracil)
* Curettage/cautery - burned off
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signs of a mole being melanoma
ABCDE
Asymetry
borders
colour
diameter
evoloving
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most common type f skin cancer and second most
commonest - Basal cell carcinoma
shiny/pearly nodule wth umbilicaed cnetre an telangiectaiss
does not invae teh baseemt membrane
squamous cell - more common in immunosurpressed patietns
hyperkeratotic lesions with crustig and ulceration
more agressove
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what are teh 5 causes of seconday hypertention
5 Cs -
* chronic renal disease
* Contraceticve pill ,Corticosteroids ,Antiinflamatory medications
* Cushings
* Coarctation of the aorta
* Conns - hyperaldosteronism! - high NA low K!
Pheocromacytoma
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casues of ankle swelling
* Poor venous return
* Amlodapine
* DVT
* HF
* Chronic kidney disease
* Liver failure
94
what s teh score used and preffered antcoagulant for afib
chadsvasc
rvoroxban
95
what does amoderone do
slows overreactve sgnals n the heart
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key presentatons and symptos of BPH
Storage -
* Frequency increases
* Urgancy
* Nuctura
* Urgancy incontinence
Voiding - SHIPP
* Straining
* Hesitancy
* Incomplete ememptying
* Poor intermittant stream
* Post micuration dribiling
Bladder stones
Urinary retention
UTIs
Haemataure, painful urination are red flags
Painless haematuria is cancer until proven otherwise!!!
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treatment of BPH
* Avoid caffeine and alcohol
* 1st line - selective 1- adrenergic receptor antagonist - oral tamsulosin or alfuzosin- relaxes the smooth muscle of the bladders increase urinary flow rate - risk of postural hypotension so should be taken at night
* 2nd - 5-a-reductase inhibitors - finasteride, dutasteride, inhibit conversion of testosterone to ore active dihydrotestosterone
* Catheterisation
* Bladder training
Surgical treatment - transurethral resection of the prostate is the gold standard
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treatment for chlamydia, gonnoheoa, BV and thrush
c - doxyxyclon 7 days
g - ceftraxone IM
B - metronidazole
t - clotrimazole
99
define CKD
a reducton n GFR 60ml/mn/173m2 for longer than 3 months
100
treatment of CKD
* Treat underlying causes - antibiotics, immunosurpressant for vasculitis, metabolic controll in diabetties, stop nephrotoxic drugs, IV fluid for volume depletion, manage blood pressure,
* Statins
* Lifestyle - less sodium and potassiom, vitamin d supplement
* Stop nephrotoxic drugs
* Treat hyperkalaemia
* Dialysis
Kindney transplant
101
what are the COPD exascubations caused by
h influenzea
strep pneumonia
morexella catarrhalis
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what are the classfcatons and treatments steps for COPD
* Gold group A (>80%) - SAMA or LABA
* B (50-79%) - LABA or LAMA
* C (230-49%) - LAMA
* D (<30%) - LAMA or LABA+LAMA or LABA +ICS
If dyspnoea persists keep adding until its LABA +ICS + LAMA
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gout treatment
* Lifestyle - calorie restriction, modify diet, weight loss, reduce alcohol
* Diary - cherries and vit C are good, eat dairy
* Allopurinol - xanthine oxidase inhibitor
* NSAIDs
* Colchicine - reduces pain and is protective, used in those where NSAIDs aren't appropriate such as renal or heart problems
* Prednisolone
* Xanthase oxidase inhibitors - allopurinol/febuxostat is contraindicated - do not start
Colchaine daily for 6 months to avoid flareups
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what s teh defnton of hypertenton
140/90 on two seperate occasson
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lst causes of seconddary hypertenton
renal ssues
cushngs
pjeocchromacytoma
conns
acromegally
coarctaton of the aorta
preeclampsa
drugs - HRT COCP NSAD sterods
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what tests to run for someone wth htn
urne dp
ECG
HBA1C
renal functon test
fundoscopy
lpd profle
q rs
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what are teh treatment groups for hypertenton
if diabetic gve ace
if not dabetc and less than 55 guve ace
if not diabetc and ovver 55 or black give CCB
then second line is to add teh other one or a thiazide like diuretic
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list anticholinergoc side effects
constipation, dry mouth, dry eyes, tachycardia, urinary retention, agitation, confusion, delirium, falls, hallucinations, and cognitive dysfunction
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risk factors for GORD
obesity
hiatus hernia
overeating
male
smokinf
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treatent for GORD
* Weight loss, stop smoking small regular meals
* Antacids - gaviscon
* Proton pump inhibitors - lansoprazole, omeprazole
* H2 receptors antagonists - cimetedine
Surgery
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test for hayus herna
uppr gi endoscopy
barum swallow
112
dagnostc crtera and treatment for IBS
rome II
Lifestyle modification- fluids, avoid caffeine alcohol and fizzy drinks, have fibre for wind and bloating
* Pain/bloating - Buscopan (muscle relaxer)
* Constipation - laxative such as senna
* Diarrhoea - anti motility -loperamide
* If none of the above work - try amitriptyline
FODMAP diet - avoid foods with short chain carbohydrates such as in flour, lactose and onion and garlic
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what are teh rs factors for oestopoross
* Secondary- SHATTERED
* Steroid use
* Hyperthyroidism/hypoparathyroidism
* Alcohol/smoking
* Thin
* Testosterone low
* Early menopause
* Renal/liver failure
* Erosive/inflammatory bone disease
Dietary low calcium
Think patient, diseases, medication!
* Patient - Old, female, low BMI, diet (lactose intolerant), athletes, alcohol and smoking
* Disease - join disease (ra, sle), hypoparathyroidism and hyperthyroidism, Cushing's, low oestrogen, renal disease (vit D), previous fractures, anorexia
Medication - corticosteroids, GnHr analogues, androgen deprivation (prostate cancer)
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treatement for osteopososs
* Lifestyle - quit smoking, drink less, vit D,
* 1st line - oral bisphosphonates (alendronate)
* 2nd line – different oral bisphosphonate e.g. risedronate (daily), ibandronate (weekly)
* 3rd line - Strontium ranelate – reduces fracture rate and Recombinant human parathyroid peptide (anabolic) e.g. teriparatide
Increases osteoblast activity and bone formation
Primary prevention:
* Adcal D3 – Vitamin D + calcium
* Calcium-rich diet e.g. dairy or sardines, white beans
* HRT – menopausal women
* Corticosteroids – consider prophylactic bisphosphonates
* Regular weight bearing exercise
* Smoking and alcohol cessation
* DEXA scans
If someones FRAX is over 10% they are elodigble for a DEXA scan!
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what s teh test for pertussus
nasal swab
116
what are teh blood results of PCOS
rased LH:FSH hormone
testosterone normal or mldly elevated
SHBG normal to low
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medcatos for parkinsons
Ldopa (combined with peripheral dopa-decarboxylase inhibitor) - sinemet
dopamne agonsts - cabergolone bromogcrptine
catechol-o-methyl-transferase nhbtors - comtess
monoamne oxadase B nhbtor- sleglne rasagilne
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medcatons for perpheral artery dseae
Naftidrofuryl oxylate - peripheral vasodilator
Cilostazol - relax blood vesse and prevent platelets from sticking together
clopdogrel
119
what gradng s used n prostate cancer
gleason gradng
TNM - how far teh tuour has nvaded locallt lymoh nodes and metastass
partns nomographs predcst pathologcal
120
what trad s assocated wth reactve artherts
reiters triad - cant see ppe climb a tree
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treatment for sympylss
M njecton of Pen G
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what bacteria causes syphylsis
trepnema pallidum
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test for gonnohrea and chlamydia
NAAT test - nucleic acd amplificaton test
124
what are teh stages of syphyliss
primary - painless ulcer in genitals (chancre)
SECONDARY -- SYSTEMIC SYMPTOMS RESLOVING AFTER 3-12 WEEKS t
latent - aymptomatic phase
tertiary - lots of complications and gummas formation!! bad. very bad.
systemioc symptoms - fever, fatigue, headache, muscle aches, weight loss, hair loss, lymphadenopathy
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heasache red flags -
over 50
chnge in peronality
vomitig
jar claudication
visula disturbacnes
sudden onset
fever
hgh esr
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treatment of trigeninal neuralgia
carbamezapine
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what does the fever pain score stand for and it prescribing impoplcatios
fever
Purulance
Attends rapidly
Inflamed otnsils
No cough
2/3 - delayed prescription
4/5 - antibiotic
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