GP Flashcards
The following as red flag symptoms and signs suggesting a serious underlying cause in the case of trigeminal neuralgia:
- Sensory changes
- Deafness or other ear problems
- History of skin or oral lesions that could spread perineurally
- Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
- Optic neuritis
- A family history of multiple sclerosis
- Age of onset before 40 years
Chickenpox is a risk factor for (organism name?).. soft tissue infections including…
Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis
urticaria management
- non-sedating antihistamines (e.g. loratadine or cetirizine) are first-line
for up to 6 weeks following an episode of acute urticaria - a sedating antihistamine (e.g. chlorphenamine) may be considered for night-time use (in addition to day-time non-sedating antihistamine) for troublesome sleep symptoms
- prednisolone is used for severe or resistant episodes in addition to antihistamines
which T1DM patients should receive metformin?
Patients with type I diabetes and a BMI > 25 should be considered for metformin in addition to insulin
most important cause of ventricular tachycardia (VT) clinically
Hypokalemia is the most important cause of ventricular tachycardia (VT) clinically, followed by hypomagnesaemia.
organism responsible for syphillis and the two first stages of syphillis presentation
** Treponema pallidum**.
- primary stage of syphilis often manifests as a painless genital ulcer (chancre) and regional lymphadenopathy.
- If untreated, it progresses to secondary syphilis which typically manifests as a widespread maculopapular rash that includes the palms and soles, along with mucous membrane lesions such as mouth ulcers.
Scalp psoriasis - first-line treatment is
Scalp psoriasis - first-line treatment is topical potent corticosteroids
single most important blood test to assess a patient’s response to treatment with levothyroxine for Hashimoto’s thyroiditis.
TSH
the investigation of choice for varicose veins/chronic venous disease
Venous duplex ultrasound is the investigation of choice for varicose veins/chronic venous disease - it will show retrograde venous flow
Trichomonas vaginalis - treat with
oral metronidazole
After smoking cessation,…. is one of the few interventions that has been shown to improve survival in COPD.
After smoking cessation, long-term oxygen therapy (LTOT) is one of the few interventions that has been shown to improve survival in COPD.
Antibiotics should be prescribed for acute otitis media immediately if:
- Symptoms lasting more than 4 days or not improving
- Systemically unwell but not requiring admission
- Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canal
If an antibiotic is given, a 5-7 day course of amoxicillin is first-line. In patients with penicillin allergy, erythromycin or clarithromycin should be given.
Parents should be advised to seek medical help if the symptoms worsen or do not improve after 3 days.
NICE recommend immediate referral for bronchiolotis (usually by 999 ambulance) if they have any of the following:
- apnoea (observed or reported)
- child looks seriously unwell to a healthcare professional
- severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- central cyanosis
- persistent oxygen saturation of less than 92% when breathing air.
NICE recommend that clinicians ‘consider’ referring bronchiolitis to hospital if any of the following apply:
a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
clinical dehydration.
Unilateral glue ear in an adult needs evaluation for a
posterior nasal space tumour
Bell’s palsy treatment
prednisolone and lubricating eye drops
Subacute thyroditis definition/presentation
(also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.
4 phases of subacute thyroditis
- phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
- phase 2 (1-3 weeks): euthyroid
- phase 3 (weeks - months): hypothyroidism
- phase 4: thyroid structure and function goes back to normal
investigations in subacute thyroditis
thyroid scintigraphy: globally reduced uptake of iodine-131
treatment of subacute thyroditis
- usually self-limiting - most patients do not require treatment
- thyroid pain may respond to aspirin or other NSAIDs
- in more severe cases steroids are used, particularly if hypothyroidism develops
Acute and prophylactic treatment of migraines
- acute: triptan + NSAID or triptan + paracetamol
- prophylaxis: topiramate or propranolol
Acute heart failure with hypotension: which medication can be considered and who qualifies?
Acute heart failure with hypotension - inotropes be considered for patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock
how to diagnose occupational asthma
Serial peak flow measurements at work and at home are used to detect occupational asthma
Pain on longitudinal compression of the thumb is a sign of
scaphoid fracture
First line treatment for early Lyme disease is
14-21 day course of oral doxycycline
All patients with peripheral arterial disease should take
clopidogrel and atorvastatin
3 classic features of reactive arthritis
Urethritis + arthritis +/- conjunctivitis = reactive arthritis
first-line investigation in suspected prostate cancer
Multiparametric MRI has replaced TRUS biopsy as the first-line investigation in suspected prostate cancer
treatement of asymptomatic bacteria in catheterised patients
Do not treat asymptomatic bacteria in catheterised patients
Reactive arthritis definiton and triad of clnical signs
- HLA-B27 associated seronegative spondyloarthropathy.
- triad of symptoms: arthritis, conjunctivitis and urethritis will be seen.
- following a diarrhoeal illness or sexually transmitted disease
- No organism growth on gram stain
- ‘Can’t see, pee or climb a tree’
how to distinguish pseudogout from gout
chondrocalcinosis. This can be seen as linear calcifications of the meniscus and articular cartilage on an x-ray of the knee
Joint aspiration in pseudogout:
Joint aspiration: weakly-positively birefringent rhomboid-shaped crystals
how to assess for diabetic neuropathy in the feet
A 10 g monofilament should be used to assess for diabetic neuropathy in the feet
Send an MSU for all women with a suspected UTI if
Send an MSU for all women with a suspected UTI if associated with visible or non-visible haematuria
Alzheimer’s disease CT head findings
Alzheimer’s disease causes widespread cerebral atrophy mainly involving the cortex and hippocampus
if chadvasc score is 0 how do you proceed with anticoag for AF?
if chadvasc score 0 arrange transthoracic echo to exclude valvular disease always
The management for a child with a first presentation of otitis media with effusion
The management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required
asymptomatic bacteuremia management in pregnancy
- 7 day antibiotic prescription:
of either nitrofurantoin (should be avoided near term), amoxicillin or cefalexin. - urine culture for test of cure
common cause of bacterial otitis media
viral upper respiratory tract infections (URTIs) typically precede otitis media, but most infections are secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
how to switching from fluoxetine to another SSRI
Switching from fluoxetine to another SSRI - withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI
