GP Flashcards
Acute bronchitis: definition, cause, symptoms
Definition: inflammation of the bronchial airways without pneumonia
Causes: Rhinovirus, influenza parainfluenza and coronavirus
Symptoms: Breathlessness, wheeze, pleuritic pain, fever, sore throat, rhinorrhoea. Diagnosed clinically
Acute Bronchitis management
- outpatient, stop smoking, over the counter remedies
- Safety netted for worsening or persistent symptoms
- Doxycyline if CRP >100 or the person is >65 and/or has comorbidities
- If CRP >20 can offer delayed prescription
Acute bronchitis: complications and prognosis
Mild and self limiting, though cough may persist up to 6 months. Can be complicated by development of pneumonia
Anal fissure: risk factors
- constipation
- Pregnancy
- inflammatory bowel disease
- sexually transmitted infections e.g. HIV, syphilis, herpes
Anal fissures: features
- painful, bright red, rectal bleeding
- Anal spasms, skin tag can be visible
- Majority occur on posterior midline, if not consider Crohns
- Inv: clinical, can do digital rectal exam if tolerates
Management of acute anal fissure <1 weeks
- soften stool
- dietary advice: high-fibre diet with high fluid intake
- bulk-forming laxatives (Ispaghula husk) are first-line - if not tolerated then lactulose should be tried
- lubricants such as petroleum jelly may be tried before defecation
- topical anaesthetics: lidocaine cream
- analgesia
Management of a chronic anal fissure
- Laxatives and lubricants
- Topical GTN (nifedipine) is first line, second line is topicl calcium channel blockers or oral nifedipine
- If topical GTN isnt effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
- If fissure <6 weeks they are acute if >6 weeks they are chronic
Bells palsy
Bell’s palsy is an idiopathic syndrome that causes damage to the facial nerve leading to a lower motor neuron facial palsy. Tends to affect 20-40 and pregnant women
No known cause might be due to viral reactivation of HSV-1 or EBV
Diagnosis is primarily clinical
Bell’s palsy signs and symptoms
- Acute but not sudden onset of unilateral lower motor neuron facial weakness, tends to affect the forehead
- Postauricular otalgia which might precede the paralysis
- Hyperacusis, dry eye
- Nervus intermedius symptoms, such as altered taste and dry eyes/mouth.
- ‘Numbness’ or ‘heaviness’
Management of Bell’s palsy
- 50mg of oral prednisolone followed by a taper
- Supportive treatment: artificial tears and lubricants and eye patch
- Long term: pain management, physical therapy, counselling
- Most people fully recover but a small proportion have incomplete recovery
- If paralysis not resolved in >3 weeks refer to ENT
Blepharitis
Inflammation of the eyelid, leading cause of dry eye disease. Symptoms: bilateral ocular irritation, foreign body sensation, burning, redness, crusting. Causes: atopic dermatitis, seborrheic dermatitis, acne rosacea, Demodex mites.
Blepharitis treatment
lid hygiene (warm compress, eyelid massage, cleaning), topical antibiotics (chloramphenicol), low-dose oral tetracyclines, omega-3 supplements.
Hordolum (stye) definition and treatment
Staphylococcal infection of an eyelash follicle (external) or meibomian gland (internal). Presents as tender, red eyelash follicle swellings.
- Treatment: warm compress, eyelash removal, incision with a sterile needle, topical/oral antibiotics if recurrent or severe.
Chalazion definition and treatment
Non-infectious granulomatous inflammation of a meibomian gland. Presents as painless red eyelid cysts. Often associated with blepharitis and acne rosacea.
- Treatment: warm compress, eyelid massage. Persistent cases require ophthalmology referral for incision and curettage.
Entropion definition and treatment
Inward turning of the eyelid, leading to corneal irritation and potential ulceration. Causes: age-related changes, eyelid irritation, scarring, trachoma.
- Treatment: examine for corneal abrasions/ulcers, prescribe lubricants, advise eyelid taping, refer for surgical correction.
Ectropion definition and treatment
Outward turning of the eyelid, often due to age-related changes or facial nerve palsy (Bell’s palsy). Presents with a sore, red, watery eye due to disrupted tear drainage.
- Treatment: lubricating eye drops, taping eyes shut at night, corrective surgery for severe cases. Urgent referral for exposure keratopathy.
Trichiasis definition and treatment
Inward-growing eyelashes due to damaged follicles, causing corneal irritation and potential ulceration. Often due to chronic blepharitis.
- Treatment: epilation of eyelashes, electrolysis, or laser ablation for more permanent solutions. Examine for corneal damage.
BPH: definition, symptoms and Investigations
Definition: non-malignant enlargement of the prostate gland. Occurs with age, can compression of the urethra and LUT’s symptoms.
Symptoms: Hesitancy, weak stream, frequency, urgency, nocturia, sensation of incomplete emptying
Investigations: assess IPSS score, digital rectal exam, do PSA if suspect prostate cancer.
Management of BPH
- Alpha blockers like Tamsulosin and 5-alpha reductase inhibitors i.e. Finasteride
- Alpha blockers offered if IPSS >8 provides symptomatic relief but doesn’t affect prostate size. Dont give if falls risk. First line
- High risk of progression and enlarged prostate: 5-alpha reductase inhibitors (reduce prostate size)
- Surgery: TURP or laser prostatectomy
Breast abscess: definition, cause, symptoms, investigations
The accumulation of pus within an area of breast tissue, often a complication of infectious mastitis
Cause: S.aureus
Symptoms: Fever, malaise, breast pain, erythema, fluctuant mass
Investigations: US, Needle aspiration (diagnostic and therapeutic)
Breast abscess management
- Incision and drainage if >5cm or needle aspiration if <5cm
- Oral or IV abx i.e. Flucloxacillin
- Continue to express breast milk
Olecranon bursitis
- Inflammation and swelling of the bursa over the elbow over the ulna
- Cause: repetitive movement, leaning on elbow
- Presentation: swollen, warm, tender, fluctuant
- Management: rest, ice, analgesia, protect elbow from pressure. Aspiration of fluid can relieve pressure. Steroids if severe
Only aspirate if suspect infection
Trochanteric bursitis
- Inflammation of the bursa over the greater trochanter of the femur
- Causes; friction from repetitive movement, trauma
- Presentation: lateral hip pain, swelling and positive trendelenberg test
- Inv: MRI or US
- Management: analgesia and physio. Steroid if refractory. Severe cases surgical removal of the bursa (bursectomy)
Only aspirate if suspect infection
Conjunctivitis: definition and causes
Definition: ‘pink eye’ inflammation (due to allergies) or infection of the conjunctiva
Causes of conjunctivitis
- Allergic: triggers include pollen, dust mites and pet dander. Most common type
- Viral: Tend to be adenovirus or Herpes simplex. Highly contagious. Associated with URTI
- Bacterial: S.aureus, S.epidermis, S.pneumonia. Can also be caused by sexually transmitted infections
Conjunctivitis signs and symptoms
- Eye redness
- Itching
- Irritation
- Excessive tearing
- Discharge from the eyes: viral is watery, bacterial is purulent (can cause eyelids to stick together)
- Photophobia, which suggests corneal involvement (keratoconjunctivitis)
Investigations: normally clinical but can take a swab if dont respond to treatment
Neonatal conjunctivitis
neonates under one month with conjunctivitis need urgent opthalmology assessment. May be caused by gonococcal infection which can cause permanent vision loss.
Management of conjunctivitis
- Allergic: avoid allergens, artificial tears, topical antihistamine, or mast cell stabilisers such as topical sodium cromoglycate
- Viral conjunctivitis: supportive
- Bacterial: tends to be self limiting but can prescribe topical antibiotics i.e. chloramphenicol and fusidic acid (for pregnant women).
- Conjunctivitis associated with contact lenses: give an aminoglycoside (e.g. gentamycin) or a quinolone (e.g. levofloxacin or moxifloxacin). Topical fluoresceins should be used to identify any corneal staining. Stop wearing contacts until symptoms resolve and antibiotics complete
- Dont share towels if infective
Constipation diagnosis
- Fewer than three bowel movements per week
- Hard stool in more than 25% of bowel movements
- Tenesmus (sense of incomplete evacuation) in more than 25% of bowel movements
- Excessive straining in more than 25% of bowel movements
- A need for manual evacuation of bowel movements
- Can either be primary or secondary
Risk factors: age, inactivity, low calorie diet, high fibre diet, certain medications, female
Causes of constipation
- Dietary factors: inadequate fibre or fluid intake
- Behavioural factors: inactivity (common cause of constipation in inpatients) or avoidance of defecation
- Electrolyte disturbances: hypercalcaemia
- Certain drugs, particularly opiates, calcium channel blockers and some antipsychotics
- Endocrine disorders: hypothyroidism
- Colon diseases: strictures or malignancies.
- Anal diseases: anal fissures or proctitis
Contact dermatitis: risk factors and inv
Risk factors: FH, occupational exposure (metal worker, healthcare, beutician), cosmetics
Normally clinical diagnosis but can confirm with patch testing and skin biopsy
Contact dermatitis
inflammation of the skin from due to direct contact with a substance that irritates the skin or provokes an allergic response
ALARM features which may indicate GI malignancy include
anaemia, weight loss, anorexia, recent onset, melaena/haematemesis/PR bleeding, swallowing difficulties
Types of contact dermatitis
- Irritant contact dermatitis: eczema due to contact with an irritant, localised to area of contact. Common with detergents and bleach. Associated with occupations that handle irritating material
- Allergic contact dermatitis: itchy, eczematous rash (vesicles, erythema) 24-48hrs after exposure. May extend beyond contact zone. Typical allergens are nickel, acrylate, fragrence, rubber, plastic. Type 4 hypersensitivity reaction, acute weepy eczema. Treat with potent steroid
2WW constipation
- Constipation (or diarrhoea) with weight loss, 60 and over. Consider an urgent, direct access CT scan, or an urgent ultrasound scan if CT is not available, to rule outpancreatic cancer
- FIT test if concerned about colorectal cancer
Types of laxatives
- Bulking agents; for example Ispaghula Husk
- Stimulant: i.e. Senna. Used for short term relief of constipation
- Stool softeners i.e. sodium Docusate, Macrogol. Used in fissures
- Osmotic laxative i.e. lactulose. Used in HE
- Phosphate enema. Used for rapid bowel evacuation often before a medical or surgical procedure
Constipation management
- Lifestyle: dietary improvements and increased exercise
- Laxatives: if they fail refer to specialist centre
- Use bulk forming laxatives first line then osmotic
Contact dermatitis management
- Avoidance: 8-12 weeks before improvements may be seen
- Emollients, oral antihistamine
- Topical steroids: to control symptoms
- Workplace modifications and protective measures may be needed: use of gloves
- Refer to dermatology if severe, chronic, difficult to treat or thought to be associated with occupation
Cutaneous fungal infection
also known as tinea corporis or ringworm are dermatophyte infections of the superficial infection of the skin. Tinea cruris affects the groin.
Aetiology of cutaneous skin infection
- Tinea corporis (body) is caused by Trichophyton rubrum and Tinea cruris (groin) is caused by Epidermophyton floccosum
- Tinea capitis affects the scalp, tinea pedis affects the feet, onchomycosis is fungal nail infection
- Spread by direct and indirect (towels) contact
- Risk factors: exposure to infection, immunosuppression, T2D, obesity
Clinical features of fungal infection and inv
- Patchy skin lesions which may be red or pink edged surrounding a central clearing and grow outwards
- Skaly, itchy
- Often in skinfolds, including the groin
Clinical diagnosis but can do skin biopsy and culture. Test HBA1c or HIV if recurrent
Management of cutaneous fungal infection
- Conservative: dont share towels, wear loose fitting clothes
- Mild disease: topical terbinafine or imadazole/fluconazole (antifungals)
- Severe or widespread: oral terbinafine or oral fluconazole
- Terbinafine: dont use if hepatic impairment, check LFT’s prior to treatment and after 4-6 weeks
- Fungal nail infection: amorolfine nail lacquer for 6-12 months, resistant cases need oral terbinafine
- A mild topical steroid can help with itching and inflammation i.e. Miconazole 2% and hydrocortisone 1% cream.
Tinea capitis (scalp ringworm)
- Can cause scarring alopecia or a kerion (spongey mass) if untreated
- Causes: Trichophyton tonsuran, Microsporin canis
- Diagnosis: scalp scrapings
- Management: oral antifungals like terbinafine. Topical ketoconazole shampoo is given for the first two weeks to reduce transmission
Tinea incognito
when a fungal skin infection has been treated with steroids. Can dampen immune response causing it to spread further but the rash becomes more mild.
Genital warts
- Caused by HPV 6 and 11, STI
- Small skin coloured growths in the genital area
- Painless
- Either keratinised (hard) or non-keratinised (soft)
- Clinical diagnosis can do biopsy
- Management: Podophyllotoxin or Imiquimod. Can use Cryotherapy (freezes wart)
Cutaneous warts: what are they
- I.e. varrucas
- Benign epithelial proliferations caused by HPV
- Hyperkeratotic papules with rough surfaces
- Caused by HPV types 1, 2 and 4
- Normally found on the hands, feet and face
Cutaneous warts: inv and management
- Either clinical or dermoscope
- Management: topical salicylic acid (first line), Podophylotoxin (for anogenital warts)
- Surgery: Cryotherapy or surgical excision or laser therapy
Classification of cutaneous warts
- Common warts (verruca vulgaris): typically found on the hands. Firm hyperkeratotic papule with roughened surface
- Flat warts (Verruca plana): smooth, flat topped papules. Appear in large numbers on the face, dorsum of hands and shins
- Plantar warts (Verruca Plantaris): located on the sole of feet and other weight bearing areas. Flat appearance with central black specks
- Anogenital warts: genital reign, variable appearance
Dementia
- A progressive and chronic syndrome which involves impairment of multiple higher cortical functions like memory, thinking, orientation, comprehension and language
- Can be primary or secondary to another condition
- Early onset dementia is <65
- A mini-mental state examination (MMSE) score of 24 or less out of 30 suggests dementia with scores of 20-24 mild, 13-20 moderate, and <12 severe.
Primary dementia and findings in the brain
- Tauopathies with Beta-Amyloid: Alzheimer’s Disease
- Tauopathies without Beta-Amyloid: Fronto-Temporal Dementia, Corticobasal Degeneration, Progressive Supranuclear Palsy
- Alpha-synucleinopathy: Lewy Body Dementia, Parkinson’s Disease, Multiple System’s Atrophy
- Polyglutamine disorders: Huntington’s Disease
- Vascular dementia
Secondary causes of dementia
- Infectious: Neurosyphilis, Encephalitis/Meningitis, AID’s dementia complex
- Trauma
- Toxins: alcohol
- Autoimmune: Sarcoidosis, late stage MS
- Metabolic: B1, B12, B9 deficiency, hepatic encephalopathy
- Endocrine: hypothyroidism and hypoparathyroidism
