GP

Question 1

what causes acne?

Answer 1

increased production of sebum, trapping of keratin and blockage of pilosebaceous unit, causing swelling and inflammation in the pilosebaceous unit

Question 2

what is a pilosebaceous unit?

Answer 2

hair follicle and sebaceous gland

Question 3

which hormones increase the production of sebum?

Answer 3

androgenic hormones- why its worse in puberty

Question 4

which bacteria is thought to worsen acne?

Answer 4

propionibacterium acnes

Question 5

what are macules?

Answer 5

flat marks on the skin

Question 6

what are papules?

Answer 6

small lumps on the skin

Question 7

what are rolling scars?

Answer 7

irregular, wave-like irregularities on the skin that remain after acne lesions heal

Question 8

what does topical benzoyl peroxide do?

Answer 8

reduces inflammation, helps unblock the skin and is toxic to P. acnes bacteria

Question 9

What do women need to be cautioned before going on oral isotretinoin?

Answer 9

It is highly teratogenic- they need to be on effective and reliable contraception and must stop isotretinoin for at least a month before becoming pregnant.

Question 10

what are some possible side effects of isotretinion?

Answer 10

• dry skin and lips
• photosensitivity
• depression, anxiety, aggression and suicidal ideation
• rarely Stevens-Johnson syndrome and toxic epidermal necrolysis

Question 11

which contraceptive is most effective for acne?

Answer 11

Co-cyprindiol (Dianette), due to anti-androgenic effects

Question 12

what is the risk of Co-Cyprindiol (Dianette)?

Answer 12

higher risk of thromboembolism- treatment is usually discontinued once acne is controlled and not prescribed long term

Question 13

what is the most common cause of iron deficiency anaemia in adults?

Answer 13

blood loss

Question 14

what is the most common cause of iron deficiency in children?

Answer 14

dietary deficiency

Question 15

In non-menstruating people, what is the most common source of blood loss?

Answer 15

The GI tract such as:
Cancer (e.g., stomach or bowel cancer)
Oesophagitis and gastritis
Peptic ulcers
Inflammatory bowel disease
Angiodysplasia (abnormal vessels in the wall)

Question 16

How can iron deficiency anaemia present in children?

Answer 16

Pica e.g. eating dirt or soil

Question 17

Where is Iron mainly absorbed?

Answer 17

the duodenum and jejunum

Question 18

Why do protein pump inhibitors cause iron deficiency?

Answer 18

Iron can only be absorbed in solluble Fe2+ form, formed in more acidic conditions. PPIs produce less acidic conditions and insoluble ferric Fe3+ form.

Question 19

what is Total Iron-Binding Capacity?

Answer 19

the space for iron to bind on all the transferrin molecules combined

Question 20

what is transferrin saturation?

Answer 20

the proportion of the transferrin molecules bound to iron
serum iron / total iron-binding capacity

Question 21

what is ferritin?

Answer 21

a protein that stores iron inside cells, its is also an acute-phase protein released with inflammation

Question 22

what does low ferritin suggest?

Answer 22

iron deficiency

Question 23

what could raised ferritin be caused by?

Answer 23

Inflammation (e.g., infection or cancer)
Liver disease
Iron supplements
Haemochromatosis

Question 24

when might serum iron be raised?

Answer 24

in the morning or after iron-containing meals

Question 25

what would raised total iron-binding capacity and raised transferrin suggest?

Answer 25

iron deficiency

Question 26

what would low total iron-binding capacity and transferrin suggest?

Answer 26

iron overload

Question 27

when should transferrin saturation be measured?

Answer 27

after a fast

Question 28

what could iron overload be caused by?

Answer 28

Haemochromatosis Iron supplements Acute liver damage (the liver contains lots of iron)

Question 29

how should new iron deficiency in adults be treated?

Answer 29

INVESTIGATE FOR UNDERLYING CAUSE iron replacement

Question 30

what are three options for treating iron deficiency?

Answer 30

Oral iron (e.g., ferrous sulphate or ferrous fumarate) Iron infusion (e.g., IV CosmoFer) Blood transfusion (in severe anaemia)

Question 31

what are common side effects of oral iron?

Answer 31

constipation and black stools

Question 32

why should iron transfusions be avoided in infection?

Answer 32

it can 'feed' the bacteria

Question 33

what are the typical symptoms of asthma?

Answer 33

Shortness of breath Chest tightness Dry cough Wheeze they are episodic and have diurnal variability- worse at night

Question 34

what does a localised monophonic wheeze indicate?

Answer 34

inhaled foreign body, tumour or a thick sticky mucus plug chest x-ray

Question 35

what are some typical triggers for asthma?

Answer 35

Infection Nighttime or early morning Exercise Animals Cold, damp or dusty air Strong emotions

Question 36

what medications can worsen asthma?

Answer 36

Beta-blockers, particularly non-selective beta-blockers (e.g., propranolol), and non-steroidal anti-inflammatory drugs (e.g., ibuprofen or naproxen)

Question 37

what is spirometry?

Answer 37

an objective measure of lung function, involving different breathing exercises into a machine that measures volume of air and flow rates.

Question 38

what FEV1:FVC ratio would suggest an obstructive pathology?

Answer 38

<70%

Question 39

what improvement in FEV1 would you expect to see after giving bronchodilators in asthma?

Answer 39

12%

Question 40

what initial investigations are recommended in suspected asthma?

Answer 40

Fractional exhaled nitric oxide (FeNO) Spirometry with bronchodilator reversibility If these are uncertain then peak flow variability or direct bronchial challenge test.

Question 41

what is direct bronchial challenge testing?

Answer 41

the opposite of reversibility testing- histamine or methacholine are inhaled to stimulate bronchoconstriction, reducing FEV1 in patients with asthma

Question 42

what is a PC20 and what would be a positive test result?

Answer 42

The concentration of methacholine needed to cause a 20% reduction in FEV1 8mg/ml or less would suggest asthma

Question 43

what FeNO would support a diagnosis of asthma?

Answer 43

above 40 ppb smoking can lower FeNO so the result is unreliable

Question 44

How do SABAs work?

Answer 44

adrenergic agonists act on the smooth muscle of the airways to cause relaxation, reversing bronchoconstriction in asthma they work quickly but are short acting

Question 45

how do LAMAs work?

Answer 45

block acetylcholine receptors (stimulated by parasympathetic nervous system, cause bronchoconstriction)

Question 46

what are leukotrienes?

Answer 46

produced in immune response, cause inflammation, bronchoconstriction and mucus secretion

Question 47

what is a risk of theophylline?

Answer 47

it has a narrow therapeutic window and can be toxic in excess, so plasma monitoring is required.

Question 48

what would an ABG show in asthma?

Answer 48

respiratory alkalosis raised respiratory rate causes a drop in CO2 respiratory acidosis is very bad- they are getting tired

Question 49

would a peak flow of 50-75% best suggest moderate, severe or life threatening asthma?

Answer 49

moderate

Question 50

would a peak flow of 33-50% best suggest moderate, severe or life threatening asthma?

Answer 50

severe

Question 51

would a peak flow of below 33% best suggest moderate, severe or life threatening asthma?

Answer 51

life-threatening

Question 52

what are the features of a severe asthma exacerbation?

Answer 52

Peak flow 33-50% best or predicted Respiratory rate above 25 Heart rate above 110 Unable to complete sentences

Question 53

what features would suggest a life-threatening asthma exacerbation?

Answer 53

Peak flow less than 33% Oxygen saturations less than 92% PaO2 less than 8 kPa Becoming tired Confusion or agitation No wheeze or silent chest Haemodynamic instability (shock)