GP Flashcards
LUTS symptoms (9)
- hesitancy
-weak flow - urgency
- frequency
- intermittency
- straining
-terminal dribbling - incomplete emptying
- nocturia
How should a LUTS/BPH pt be assessed? (5)
- urine dipstick (r/o infection etc)
- U+Es (esp if chronic retention suspected)
- PSA (pt preference, recommended if sx are mostly obstructive)
- urinary frequency volume chart (3 days fluid intake and output)
- DRE
What can raise PSA? (6)
- prostate cancer
- BPH
- prostatitis
- UTI
- vigorous exercise (esp cycling)
- recent ejaculation/prostate stimulation
How can benign and cancerous prostates differ on exam?
benign → smooth, symmetrical, slightly soft, maintained central sulcus
cancerous → firm/hard, asymmetrical, craggy/irregular, loss of central sulcus
Medical mx of BPH
- alpha-blockers (e.g. tamsulosin, relaxes smooth muscle and improves sx)
- 5-alpha reductase inhibitors (e.g. finasteride, gradually reduces prostate size) *tends to only be indicated if enlargement is significant/high risk of progression
(however combo therapy more and more common - “moderate to severe voiding sx”)
What is the most common surgical tx of BPH?
transurethral resection of the prostate (TURP)
LOSS
What are the 4 key x-ray changes seen in osteoarthritis?
- Loss of joint space
- Osteophytes
- Subarticular sclerosis (incr density of bone along joint line)
- Subchondral cysts (fluid filled holes in bone)
What are the most commonly affected joint in osteoarthritis? (6)
- hips
- knees
- DIP joints hands
- CMC joint (base of thumb)
- lumbar spine
- cervical spine (cervical spondylosis)
What are the typical features of an osteoarthritis presentation? (6)
- joint pain and stiffness
- sx worsen with activity and by the end of the day
- bulky, bony enlargement of the joints
- restricted ROM
- crepitus on movement
- effusions around joint
What are the hand signs specific to osteoarthritis? (3)
- bouchard’s nodes (PIP)
- heberden’s nodes (DIP)
B comes before H, proximal before distal - squaring at the base of the thumb (CMC)
How is osteoarthritis dx according to NICE guidelines?
without ix if pt >45 and has typical pain associated with activity and NO morning stiffness (or lasts <30mins)
NG osteoarthritis mx (pharmacological and non)
non-pharmacological → therapeutic exercise, WL, OT (to support ADLs)
pharmacological → topical NSAIDs (1st line for knee), oral NSAIDs (+PPI), weak opiates/paracetamol (short and infrequent use), intra-articular steroid injections (temporary sx relief - up to 10wks)
joint replacement in severe cases (hip, knee esp)
What is the typical presentation of trigeminal neuralgia?
attack of facial pain (shooting, electric like) of sudden onset, lasting seconds to hours triggered by touch (eating, shaving, cold)
*can affect any combo of the branches of the trigeminal nerve (opthalmic, maxillary, mandibular)
What can cause trigeminal neuralgia/is often associated with it? (2)
majority are idiopathic
- compression of trigeminal roots by tumours/vascular problems
- more common in pts with MS
What is first line for trigeminal neuralgia?
carbemazepine
failure to respond or atypical features = prompt neuro referral
What type of hypersensitivity is allergic contact dermatitis?
Type IV - delayed/cell mediated hypersensitivity (pts often have pre-existing atopy)
first contact does not result in allergy, can take months/years of contact
What are the two main types of contact dermatitis?
irritant → a common, non-allergic reaction due to weak acids/alkalis (e.g. detergents, cement) - often seen on hands and mostly erythema
allergic → type IV hypersensitivity, uncommon and often seen on head follow hair dye - tends to present as acute weeping eczema
What kind of dermatological presentation is nappy rash?
contact dermatitis (caused by friction between skin and nappy and contact with urine/faeces - hence why spares folds)
What infections can occur where there is nappy rash?
- fungal (candida)
- bacterial (staph, strep)
due to skin breakdown and warm moist environment
Treatment for fungal infection of nappy rash
clotrimazole or miconazole
Treatment for bacterial infection of nappy rash
fusidic acid cream or oral flucloxacillin
What layers of the bowel does diverticular disease involve?
herniation of the colonic mucosa through the muscle wall of the colon (rectum is usually spared due to lack of taenia coli - vessels that pierce the muscle to supply the mucosa)
What are symptoms of diverticular disease?
- altered bowel habit
- rectal bleeding
- abdo pain (often LIF)
What are potential complications of diverticular disease? (5)
- diverticulitis
- haemorrhage
- fistula development
- perforation and faecal peritonitis
- perforation and abscess development
