GP

Question 1

Bursitis

Answer 1

• Definition
• Symptoms
• Mx
• When to refer

Question 2

OA

Answer 2

• Definition
• Causes - primary and secondary
• Risk factors
• Symptoms
• Signs
• Ix
• Mx

Question 3

HTN

Answer 3

• Pathophysiology
• Complications (4)
• Risk factors - modify vs non
• Causes
• Symptoms
• Signs
• Ix + diagnostic criteria
• Mx + targets

Question 4

Acute bronchitis:

• Definition
• Organism causes
• Mx

Answer 4

• Definition: lower resp tract infection causing bronchial inflammation
• Causes: rhinovirus, enterovirus, influ A/B
• Symptoms: cough, chest pain, mildly unwell, maybe wheeze
• Mx: smoking, paracet, fluids, no abx (deoxy) unless v unwell or back up if higher risk of complications. Cough normally lasts 2-3 weeks

Question 5

Asthma:
- Definition
- Pathophysiology
- Triggers (10)
- Symptoms (5)
- Investigations
- Management
- Primary care mx

Answer 5

• Definition: intermittent bronchoconstriction chronic lung condition due to hypersensitivity
• Pathophysiology: inflammatory reaction of eosinophils/mast cells etc causing cytokine release and inflammation increasing sm and goblet cells
• Triggers (10): exercise, smoking, pets, dust, cold, URTI, night (inc psns), pollution, b blockers
• Symptoms (5): sob, dry cough worse night, widespread wheeze
• Investigations: clinical but if not spirometry with bronchodilator reversibility (FEV1 improves by >12%)
• Management: SABA, ICS + SABA, ICS + LABA
  If controlled maintain for 3 months then decrease before decreasing or if change review response in 4-8 weeks
• Prim care: asthma action plan + own peak flow meter, avoid triggers, vaccinations, smoking, annual follow up

Question 6

Chronic obstructive pulmonary disease:
- Definition
- Pathophysiology
- Causes (3)
- Symptoms (3)
- Signs
- DD
- Investigations
- Management (10)
- Health professionals involved in management (7)
- Complications (5)

Answer 6

Chronic obstructive pulmonary disease:
- Definition: progressive increased airway resistance causing airflow obstruction
- Pathophysiology: emphysema and chronic bronchitis (cough >3 months in each of 2 consecutive months - loss cilia, mucus gland hyperplasia)
- Causes (3): smoking, alpha1 antitrypsin deficiency, industrial exposure
- Symptoms (3): >35 years, progressive sob exertional, clear sputum, cough, freq infections
- Signs: barrel chest, purse lip breathing, hyperressonant percussion, accessory muscles
- DD: interstitial, lung ca
- Investigations: fbc (polycythaem), crp, serum antitrip, cxr, ecg, sputum, spirometry obstructive is diagnostic fev1/fvc<0.7
- Management (10):

smoking cessation
flu + pneum vaccine
pul rehab
copd care bundle
bronchodilator saba or antimuscarinic (LABA/LAMA if not controlled), ICS
Refer if severe, complication, uncertainity, <40, LTOT needed (sev sob, deteriorating, cyanosis, oedema, arrhythmia)

• Health professionals involved in management (7)
• Complications (5): hypercapnic resp failure, 2nd polycyth due to inc hb, cor pulmonale, bronchiectasis

Question 7

Influenza:

• Definition
• Symptoms
• Mx
• Complications

Answer 7

• Definition: RNA virus where A most common and is responsible for outbreaks, B less severe and C mild like a cold
• Symptoms: 2 days post exposure coryza, nasal discharge, cough, fever, gi symptoms, headache, malaise
• Mx: rest, fluids, paracet. If high risk e.g. resp, heart, diab, >65, <6 months, preg then oseltamivir in 48 hours (zanamivir in 36 in children)
• Complications: acute bronchitis, pneumonia, asthma/copd exacerbations, sinusitis

Question 8

CKD:
- Definition
- Staging
- Causes
- Symptoms
- Ix
- Mx

• Management in primary care (5)
• Follow up
• Referral
• Safety net

Answer 8

• Definition: presence of kidney damage >3 months defined by egfr or albumin: creatinine
• Causes: diabetes, htn, glomerulonephritis, pckd, obstructive nephropathy
• Symptoms: assymp, fatigue, pruritus, oedema
• Ix: u+es, urine alb: creatinine, renal uss
• Mx:
  1. treat underlying disease: e.g. diabetes meds, tolvaptan
  2. decrease cvs risk: atorvastatin 20mg, control bp, weight/smoking
  3. decrease progression: acei, monitor bloods, bp
  4. treat complications

1. Anaemia of chronic disease
2. Mineral bone disease
3. cvs complications
4. metabolic acidosis
5. uraemia pericarditis + encephalopathy
6. malnutrition
7. dyslipidemia
8. tertiary hyperparathyroidism

• Mx in prim care: provide info, reducing cvs risk, modify risk factors, primary prevention 20mg atorvastatin, offer vaccinations
• follow up: monitor egfr, urine acr, fbc, bone profile
  refer if egfr<30, complication, accelerated progression

Question 9

Restless leg syndrome:

• definition
• causes
• symptoms
• ix
• mx

Answer 9

• definition: neurolog disorder
• causes: idiopathic, ckd, preg, iron def, antidep
• symptoms: urge to move legs worse akathisia when lying down/sitting + relieved by movement
• ix: ferritin, u+es, fbc, tfts, glucose, b12
• mx: reduce alc + caffeine, smoking, ex, stretch, heat pads, quinine, dopamine agonist ropinirole, gabapentin

Question 10

Chronic fatigue syndrome
- Definition
- Risk factors
- Symptoms
- Ix
- Mx

Answer 10

• definition: persistent recurrent fatigue >3 months affecting mental and physical function and physical illness ruled out
• risk f: f, high bmi, low socioeconomic status, physical Comoro
• symptoms: unexplained fatigue, post exertion fatigue, memory problems, sleep issues, myalgia, headaches, nausea, dizzy
• ix: fbc (anaemia), tfts, u+es, lfts, hba1c, IgA tissue transglutaminase, crp, vit d
• mx: treat underlying, sleep hygiene, relaxation techniques, refer to cfs specialist can’t be managed in primary care

Question 11

Lyme disease:
- Definition
- Risk factor
- Symptoms
- Complications
- Ix
- Mx

Answer 11

• definition: bacteria (borrelia burgdorferi from a bite from an infected tick
• risk f: exposure to woodland/fields
• symptoms: erythema migranes within 30 days (bulls eye rash painless), headache, fever, lethargy
• complications: neurolog symptoms (facial nerve palsy, meningitis, radicular pain), myocarditis, heart block
• ix: diagnostic if rash, if not ELISA test within 4 weeks and if + then immunoblot test, if not repeat in 4-6 weeks
• mx: oral deoxy 21 days, if focal symptoms refer

Question 12

De Quervain’s tenosynovitis
- Definition
- Symptoms
- Mx

Answer 12

De Quervain’s tenosynovitis
- Definition: inflammation of sheath containing EPB + APL
- Symptoms: radial side of wrist pain, tender over radial styloid process, abduction of thumb against resistance, finkelstein’s test causes pain
- Mx: analgesia, steroid injection, splint, surgery