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3a follow up > GP > Flashcards

GP Flashcards

1
Q

Initial investigations in coeliac disease?

A

TTG antibodies
Endomyseal antibodies

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2
Q

Gold standard for coeliac diagnosis?

A

Endoscopic intestinal biopsy - duodenum

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3
Q

Findings of biopsy in coeliac disease?

A

Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes

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4
Q

Which gene associated with coeliac disease?

A

HLA-DQ2 and HLA-DQ8

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5
Q

Investigations for colitis?

A

Colonoscopy and biopsy (flexi sig)

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6
Q

Findings on colitis biopsy?

A

Ulceration
No inflammation beyond submucosa
Continuous
Crypt abscesses
Pseudopolyps

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7
Q

Findings on crohn’s biopsy?

A

Inflammation in all layers
Skip lesions
Increased goblet cells

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8
Q

Fluid analysis findings in gout?

A

Needle shaped, negatively birefringent crystals

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9
Q

First line treatment for mild-moderate acne?

A

Topical combination:
Adapalene/Tretinoin/Clindamycin
+ benzoyl peroxide

12 week course

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10
Q

First line treatment for moderate-severe acne?

A

12-week course
Topical treatment + PO abx (tetracycline)

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11
Q

Alternative to topical antibiotics for women with acne?

A

COCP

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12
Q

Acute bronchitis signs over pneumonia?

A

Wheeze and no other focal chest signs (creps, dullness etc)

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13
Q

Most common causes of bronchitis?

A

Viruses

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14
Q

Treatment for acute bronchitis?

A

Supportive
Abx if:
Very unwell
pre-exisiting co-morbidities
CRP >100
Doxycycline

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15
Q

What is acute stress disorder?

A

Acute stress reaction within the first 4 weeks after traumatic event

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16
Q

Management of acute stress disorder?

A

Trauma-focused CBT first line
Benzo’s for acute symptoms (with caution)

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17
Q

Type 1 hypersensitivity reaction?

A

IgE - acute reaction

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18
Q

Investigations for allergies?

A

Skin prick testing
Food challenge testing
RAST

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19
Q

Key management/treatments of allergies?

A

Antihistamines e.g. cetirizine
Steroids
IM adrenaline

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20
Q

Adrenaline doses for anaphylaxis?

A

Adult (>12yrs) - 500mcg 1/1,000
6-12yrs - 300mcg 1/1,000
6m-6yrs - 150mcg 1/1,000
<6m - 100-150 mcg 1/1,000

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21
Q

Common causes of anaphylaxis?

A

Foods e.g. nuts
Drugs
Venom

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22
Q

Features of anaphylaxis?

A

Airway:
Swelling of throat and tongue
Hoarse voice/stridor

Breathing:
Respiratory wheeze
Dyspnoea

Circulation:
Hypotension
Tachycardia

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23
Q

How regularly can adrenaline doses be repeated?

A

Every 5 minutes

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24
Q

When can patients be discharged following an anaphylactic reaction?

A

2 hours - good response to single dose adrenaline
6 hours - 2 doses needed/prev biphasic reaction
12 hours - severe rxn, >2 doses, possible ongoing reaction

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25
Q

Causes of microcytic anaemia?

A

Iron deficiency
Congenital sideroblastic
Thalassaemia

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26
Q

Causes of iron deficiency anaemia?

A

Excessive blood loss
Dietary intake
Poor absorption

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27
Q

Symptoms of iron deficiency anaemia?

A

Fatigue, SOB, Palpitations, pallor, koilonychia

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28
Q

Management of iron deficiency anaemia?

A

Treat underlying causes
PO ferrous sulfate

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29
Q

How long to take ferrous sulfate for?

A

3 months after iron deficiency corrected

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30
Q

Causes of macrocytic anaemia?

A

B12 deficiency, folate deficiency, secondary to MTX

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31
Q

How to treat b12 deficiency?

A

Hydroxocovalamin IM 3x weekly for 2 weeks then 3 monthly

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32
Q

What is pernicious anaemia?

A

Autoimmune disorder affecting gastric mucosa = b12 deficiency
Abs to intrinsic factor

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33
Q

Causes of normocytic anaemia?

A

Anaemia of chronic disease
CKD
Aplastic anaemia
Haemolytic anaemia
Acute blood loss

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34
Q

What are anal fissues?

A

Tears of the squamous lining of distal anal canal

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35
Q

Risk factors for anal fissure?

A

Constipation
IBD
STIs

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36
Q

Features of anal fissures?

A

Painful, bright red, rectal bleeding

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37
Q

Management of acute anal fissure?

A

Stool softener
Lubricants
Topical anaesthetics
Analgesia

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38
Q

Management of chronic anal fissures?

A

Topical GTN cream

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39
Q

What is atrophic vaginitis?

A

Atrophy of vagina usually due to low oestrogen in post-menopausal women

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40
Q

Treatment of atrophic vaginitis?

A

Vaginal lubricants/moisturisers
Topical oestrogen

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41
Q

What is blepharitis?

A

Inflammation of the eyelids

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42
Q

Management of blepharitis?

A

Warm compresses BD
‘Lid hygiene’
Artificial tears if needed

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43
Q

What is a stye?

A

Hordeolum - inflammation of glands of the eyelids

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44
Q

Management of a stye?

A

Warm compresses BD
‘Lid hygiene’
Incision with a sterile needle
Topical/PO abx if recurrent/severe

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45
Q

What is entropian and ectropian (eyelids)?

A

Entropian = inward turning of eyelid
Ectropian = outward turning of eyelid

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46
Q

BPPV symptoms?

A

Vertigo triggered by change in head position
Lasts 10-20 seconds

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47
Q

Diagnosis and treatment manoeuvres for BBPV?

A

Dx: Dix-Hallpike
Tx: Epley

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48
Q

What is bursitis?

A

Inflammation of the bursa over joints

49
Q

Causes of bursitis?

A

Friction from repetitive movements
Trauma
Inflammatory conditions (RA/gout)
Infection

50
Q

Management of bursitis?

A

Aspiration if infx suspected
RICE
Protect joint
Abx if infected

51
Q

What is chronic fatigue syndrome?

A

At least 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease

52
Q

Management of CFS?

A

Refer to specialist service
Energy management
Limit physical activity and exercise
CBT

53
Q

Bacterial vs viral conjunctivitis?

A

Bacterial = purulent discharge, sitcky eyes
Viral = serous discharge, recent URTI, preauricular lymph nodes

54
Q

Treatment for bacterial conjunctivitis?

A

Chloramphenicol drops/ointment
Pregnant women - fusidic acid

55
Q

Crystal type (chemical) in gout vs pseudogout?

A

Gout = monosodium urate monohydrate
Pseudogout = calcium pyrophosphate dehydrate

56
Q

Affected joints in gout vs pseudo gout?

A

Gout = small joints, lower extremities
Pseudogout = Large joints e.g. hips, knees, shoulders

57
Q

Fluid analysis findings in pseudogout?

A

Weakly positive birefringent rhomboid crystal

58
Q

Cause of fungal infections?

A

Ringworm (Tinea)

59
Q

Where can ringworn infect?

A

Scalp
Foot
Groin
Body
Nail

60
Q

Treatment of fungal infections?

A

Cream/shampoo/nail lacquer
Anti-fungals = clotrimazole, miconazole, ketoconazole, fluconazole, terbinafine (nails)

61
Q

Treatment for warts?

A

Topical salicylic acid for 12w
or cryotherapy

62
Q

When is bowel cancer screening offered?

A

60-74 year olds every 2 years

62
Q

What is diverticular disease?

A

Out-pouching of the intestinal mucosa

62
Q

What is fibromyalgia?

A

Widespread pain throughout the body with tender points at specific sites

62
Q

Management of fibromyalgia?

A

Aerobic exercise
CBT
Meds - neuropathic pain

63
Q

What is folliculitis?

A

Inflammation of the hair follicles

64
Q

What are haemorrhoids?

A

Enlarged anal vascular cushions

65
Q

Treatment of haemorrhoids?

A

Topical treatments
Astringents - shrink haemorrhoids
Anaesthetics
Hydrocortisone - short term use only

66
Q

Symptoms of haemorrhoids?

A

Painless, fresh red bleeding
Itching/pruritis

67
Q

Most common cause of meningitis in adults?

A

Neisseri meningitidis

68
Q

Neisseri meningitidis on gram stain?

A

Gram negative spherical

69
Q

Most common cause of travellers diarrhoea?

A

Enterotoxigenic e. coli

70
Q

Stage 1 hypertension?

A

> = 140/90 (135/85)

71
Q

Stage 2 hypertension?

A

> = 160/100 (150/95)

72
Q

Flow chart for management of HTN in <55 years or T2DM?

A

1 - ACEi
2 - + CCB/thiazide
3 - All three
4 - + spiro/bb/alpha blocker

73
Q

Flow chart for management of HTN in >55years of black Afro-Caribbean ethnicity?

A

1- CCB
2 - +ACEi/thiazide
3 - All three
4 - + spiro/bb/alpha blocker

74
Q

When should antibiotics be given immediately in URTI?

A

Children <2 w/ bilateral otitis media
Children w otorrhoea
Patients with acute sore throat/pharyngitis/tonsillitis when 3+ centor

75
Q

What are the Centor criteria?

A

Tonsillar exudate
Cervical lymphadenopathy/lymphadenitis
History of fever
Absence of cough

76
Q

What are in the feverPAIN criteria?

A

Fever
Purulence
Attend rapidly (3 days or less)
Severely inflamed tonsils
No cough or coryza

77
Q

Stages of CKD parameters?

A

1 - 90-120ml/min
2 - 60-90ml/min
3a - 45-59ml/min
3b - 30-44ml/min
4 - 15-29ml/min
5 - less than 15ml/min

78
Q

Risk factors for AKI?

A

CKD
Diabetes
Heart failure
>65yrs
Liver disease
Use of nephrotoxic drugd

79
Q

Examples of nephrotoxic drugs?

A

NSAIDs
Aminoglycosides
ACEi/ARBs
Diuretics

80
Q

Diagnostic criteria for AKI?

A

Rise in creatinine 26µmol/L in 48hrs
>=50% rise in creatinine in 7d
Urine output <0.5ml/kg/hour for 6+ hours
>=25% fall in EGFR in 7 days (paeds)

81
Q

Typical organisms causing CAP?

A

Streptococcus pneumoniae
Hib
Staph aureus

82
Q

Atypical organisms causing CAP?

A

Mycoplasma pneumonia
Chlamydia pneumoniae
Coxiella burnetii

83
Q

Causes of HAP?

A

Klebisella
E. Coli
Pseudomonas

84
Q

Screening tool for risk of stroke in patients with AF?

A

CHA2DS2-VASc

85
Q

Risk factors in CHA2DS2-VASc?

A

Congestive heart failure
Hypertension
Age (2)
Diabetes
Prior Stroke/TIA/VTE (2)
Vascular disease
Sex (F)

86
Q

When to offer anticoagulation following CHA2DS2V-VASC?

A

Men = score of 1
Women = score of 2

87
Q

First line rate control in AF?

A

BB or rate limiting CCB (diltazem)

88
Q

Example of rhythm control in AF?

A

Amiodarone

89
Q

Asthma management steps in adults?

A

SABA
SABA + ICS
SABA + ICS + LABA
Increases ICS or add LTRA

90
Q

Most common organism causing infective exacerbations in COPD?

A

Hib

91
Q

Common causes of CKD?

A

Diabetic nephropathy
Chronic pyelonephritis/glomerulonephritis
HTN
Adult polycystic kidney disease

92
Q

Management for COPD?

A

SABA/SAMA (always included)

If asthmatic fx = LABA+ICS
No asthmatic fx = LABA+LAMA

LABA+LAMA+ICS

93
Q

Laxative preference in adult constipation?

A

First-line = bulk-forming
Second-line = osmotic

94
Q

Laxatives for opioid induced constipation?

A

Osmotic + stimulant laxative

95
Q

When is T2DM diagnosed?

A

HbA1c >=48mmol/mol

If symptomatic:
Fasting >=7mmol/L
Ransom >=11.1mmol/L

96
Q

Drug management order of T2DM?

A
  1. Metformin (CVD +SGLT2)
  2. Add DPP4, Sulfonylurea, SGLT2, Pioglitazone
  3. Add another or start insulin
  4. If triple therapy and BMI >35, switch one for GLP-1 agonist
97
Q

DPP-4 inhibitor examples and mechanism?

A

Sitagliptin, Linagliptin, Alogliptin

Increase insulin and lower glucagon

98
Q

Sulphonylurea examples and mechanism?

A

Gliclazide, Glimepiride

Augment insulin secretion

99
Q

SGLT2 inhibitor examples and mechanism?

A

Canagliflozin, empagliflozin,
dapagliflozin

Increase urinary glucose excretion

100
Q

Investigation if suspecting diabetes mellitus?

A

Fasting glucose tolerance test

101
Q

Treatment for scabies?

A

Premethrin 5% whole household

102
Q

Treatment for threadworm?

A

Mebendazole for whole household

103
Q

Up to how many IM adrenaline doses in anaphylaxis?

A

2 doses

104
Q

When to avoid NOACs in renal impairment?

A

If crcl <15mL/min

105
Q

Blood findings in alcoholic liver disease?

A

AST and ALT both increased
AST:ALT 2:1

106
Q

Most common causes of IECOPD?

A

Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis

107
Q

Treatment for mild otitis externa?

A

Topical acetic acid

108
Q

Treatment for moderate otitis externa?

A

Topical Abx and steroid
Neomycin + dexamethasone + acetic acid

109
Q

Blood results findings in haemophilia?

A

Prolonged APTT
Bleeding time, thrombin time, prothrombin time normal

110
Q

What is prolonged in haemophilia?

A

APTT

111
Q

First degree heart block on ECG?

A

PR interval >0.2s

112
Q

Secondary degree heart block on ECG?

A

T1 - progressive prolongation of the PR interval until a dropped beat occurs
T2 - PR interval is constant but the P wave is often not followed by a QRS complex

113
Q

Complete heart block on ECG?

A

There is no association between the P waves and QRS complexes

114
Q

Penicillins mechanism of action?

A

Inhibit cell wall synthesis

115
Q

How do extra agents with penicillins work e.g. clavulanic acid, tazobactam?

A

Beta-lactamase inhibitors

3a follow up (7 decks)

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