GP

Question 1

The following as red flag symptoms and signs suggesting a serious underlying cause in the case of trigeminal neuralgia:

Answer 1

• 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

Question 2

Chickenpox is a risk factor for (organism name?).. soft tissue infections including…

Answer 2

Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis

Question 3

urticaria management

Answer 3

• 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

Question 4

which T1DM patients should receive metformin?

Answer 4

Patients with type I diabetes and a BMI > 25 should be considered for metformin in addition to insulin

Question 5

most important cause of ventricular tachycardia (VT) clinically

Answer 5

Hypokalemia is the most important cause of ventricular tachycardia (VT) clinically, followed by hypomagnesaemia.

Question 6

organism responsible for syphillis and the two first stages of syphillis presentation

Answer 6

** 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.

Question 7

Scalp psoriasis - first-line treatment is

Answer 7

Scalp psoriasis - first-line treatment is topical potent corticosteroids

Question 8

single most important blood test to assess a patient’s response to treatment with levothyroxine for Hashimoto’s thyroiditis.

Answer 8

TSH

Question 9

the investigation of choice for varicose veins/chronic venous disease

Answer 9

Venous duplex ultrasound is the investigation of choice for varicose veins/chronic venous disease - it will show retrograde venous flow

Question 10

Trichomonas vaginalis - treat with

Answer 10

oral metronidazole

Question 11

After smoking cessation,…. is one of the few interventions that has been shown to improve survival in COPD.

Answer 11

After smoking cessation, long-term oxygen therapy (LTOT) is one of the few interventions that has been shown to improve survival in COPD.

Question 12

Antibiotics should be prescribed for acute otitis media immediately if:

Answer 12

• 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.

Question 13

NICE recommend immediate referral for bronchiolotis (usually by 999 ambulance) if they have any of the following:

Answer 13

• 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.

Question 14

NICE recommend that clinicians ‘consider’ referring bronchiolitis to hospital if any of the following apply:

Answer 14

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.

Question 15

Unilateral glue ear in an adult needs evaluation for a

Answer 15

posterior nasal space tumour

Question 16

Bell’s palsy treatment

Answer 16

prednisolone and lubricating eye drops

Question 17

Subacute thyroditis definition/presentation

Answer 17

(also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.

Question 18

4 phases of subacute thyroditis

Answer 18

• 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

Question 19

investigations in subacute thyroditis

Answer 19

thyroid scintigraphy: globally reduced uptake of iodine-131

Question 20

treatment of subacute thyroditis

Answer 20

• 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

Question 21

Acute and prophylactic treatment of migraines

Answer 21

• acute: triptan + NSAID or triptan + paracetamol
• prophylaxis: topiramate or propranolol

Question 22

Acute heart failure with hypotension: which medication can be considered and who qualifies?

Answer 22

Acute heart failure with hypotension - inotropes be considered for patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock

Question 23

how to diagnose occupational asthma

Answer 23

Serial peak flow measurements at work and at home are used to detect occupational asthma

Question 24

Pain on longitudinal compression of the thumb is a sign of

Answer 24

scaphoid fracture

Question 25

First line treatment for early Lyme disease is

Answer 25

14-21 day course of oral doxycycline

Question 26

All patients with peripheral arterial disease should take

Answer 26

clopidogrel and atorvastatin

Question 27

3 classic features of reactive arthritis

Answer 27

Urethritis + arthritis +/- conjunctivitis = reactive arthritis

Question 28

first-line investigation in suspected prostate cancer

Answer 28

Multiparametric MRI has replaced TRUS biopsy as the first-line investigation in suspected prostate cancer

Question 29

treatement of asymptomatic bacteria in catheterised patients

Answer 29

Do not treat asymptomatic bacteria in catheterised patients

Question 30

Reactive arthritis definiton and triad of clnical signs

Answer 30

• 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’

Question 31

how to distinguish pseudogout from gout

Answer 31

chondrocalcinosis. This can be seen as linear calcifications of the meniscus and articular cartilage on an x-ray of the knee

Question 32

Joint aspiration in pseudogout:

Answer 32

Joint aspiration: weakly-positively birefringent rhomboid-shaped crystals

Question 33

how to assess for diabetic neuropathy in the feet

Answer 33

A 10 g monofilament should be used to assess for diabetic neuropathy in the feet

Question 34

Send an MSU for all women with a suspected UTI if

Answer 34

Send an MSU for all women with a suspected UTI if associated with visible or non-visible haematuria

Question 35

Alzheimer’s disease CT head findings

Answer 35

Alzheimer’s disease causes widespread cerebral atrophy mainly involving the cortex and hippocampus

Question 36

if chadvasc score is 0 how do you proceed with anticoag for AF?

Answer 36

if chadvasc score 0 arrange transthoracic echo to exclude valvular disease always

Question 37

The management for a child with a first presentation of otitis media with effusion

Answer 37

The management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required

Question 38

asymptomatic bacteuremia management in pregnancy

Answer 38

• 7 day antibiotic prescription:
  of either nitrofurantoin (should be avoided near term), amoxicillin or cefalexin.
• urine culture for test of cure

Question 39

common cause of bacterial otitis media

Answer 39

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

Question 40

how to switching from fluoxetine to another SSRI

Answer 40

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