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phase 3a medicine > GP > Flashcards

GP Flashcards

1
Q

what causes acne?

A

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

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2
Q

what is a pilosebaceous unit?

A

hair follicle and sebaceous gland

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3
Q

which hormones increase the production of sebum?

A

androgenic hormones- why its worse in puberty

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4
Q

which bacteria is thought to worsen acne?

A

propionibacterium acnes

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5
Q

what are macules?

A

flat marks on the skin

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6
Q

what are papules?

A

small lumps on the skin

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7
Q

what are rolling scars?

A

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

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8
Q

what does topical benzoyl peroxide do?

A

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

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9
Q

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

A

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.

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10
Q

what are some possible side effects of isotretinion?

A
  • dry skin and lips
  • photosensitivity
  • depression, anxiety, aggression and suicidal ideation
  • rarely Stevens-Johnson syndrome and toxic epidermal necrolysis
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11
Q

which contraceptive is most effective for acne?

A

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

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12
Q

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

A

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

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13
Q

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

A

blood loss

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14
Q

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

A

dietary deficiency

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15
Q

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

A

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)

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16
Q

How can iron deficiency anaemia present in children?

A

Pica e.g. eating dirt or soil

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17
Q

Where is Iron mainly absorbed?

A

the duodenum and jejunum

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18
Q

Why do protein pump inhibitors cause iron deficiency?

A

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

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19
Q

what is Total Iron-Binding Capacity?

A

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

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20
Q

what is transferrin saturation?

A

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

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21
Q

what is ferritin?

A

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

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22
Q

what does low ferritin suggest?

A

iron deficiency

23
Q

what could raised ferritin be caused by?

A

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

24
Q

when might serum iron be raised?

A

in the morning or after iron-containing meals

25
Q

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

A

iron deficiency

26
Q

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

A

iron overload

27
Q

when should transferrin saturation be measured?

A

after a fast

28
Q

what could iron overload be caused by?

A

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

29
Q

how should new iron deficiency in adults be treated?

A

INVESTIGATE FOR UNDERLYING CAUSE
iron replacement

30
Q

what are three options for treating iron deficiency?

A

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

31
Q

what are common side effects of oral iron?

A

constipation and black stools

32
Q

why should iron transfusions be avoided in infection?

A

it can ‘feed’ the bacteria

33
Q

what are the typical symptoms of asthma?

A

Shortness of breath
Chest tightness
Dry cough
Wheeze

they are episodic and have diurnal variability- worse at night

34
Q

what does a localised monophonic wheeze indicate?

A

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

35
Q

what are some typical triggers for asthma?

A

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

36
Q

what medications can worsen asthma?

A

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

37
Q

what is spirometry?

A

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

38
Q

what FEV1:FVC ratio would suggest an obstructive pathology?

A

<70%

39
Q

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

A

12%

40
Q

what initial investigations are recommended in suspected asthma?

A

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

41
Q

what is direct bronchial challenge testing?

A

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

42
Q

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

A

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

43
Q

what FeNO would support a diagnosis of asthma?

A

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

44
Q

How do SABAs work?

A

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

45
Q

how do LAMAs work?

A

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

46
Q

what are leukotrienes?

A

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

47
Q

what is a risk of theophylline?

A

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

48
Q

what would an ABG show in asthma?

A

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

49
Q

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

A

moderate

50
Q

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

A

severe

51
Q

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

A

life-threatening

52
Q

what are the features of a severe asthma exacerbation?

A

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

53
Q

what features would suggest a life-threatening asthma exacerbation?

A

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)

54
Q
A

phase 3a medicine (4 decks)

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