GP Flashcards
What is acne vulgaris?
A common skin disorder that usually occurs in adolescence, affecting the face, neck, and upper trunk, characterized by obstruction of the pilosebaceous follicles with keratin plugs.
How is acne classified?
Into mild, moderate, or severe.
What characterizes mild acne?
Open and closed comedones with or without sparse inflammatory lesions.
What characterizes moderate acne?
Widespread non-inflammatory lesions and numerous papules and pustules.
What characterizes severe acne?
Extensive inflammatory lesions, which may include nodules, pitting, and scarring.
List the first-line topical combination therapies for mild to moderate acne.
12 weeks
* Fixed combination of topical adapalene with topical benzoyl peroxide
* Fixed combination of topical tretinoin with topical clindamycin
* Fixed combination of topical benzoyl peroxide with topical clindamycin
When can topical benzoyl peroxide be used as monotherapy?
If other options are contraindicated or if the person wishes to avoid using a topical retinoid or an antibiotic.
List the treatment options for moderate to severe acne.
12 weeks
* Fixed combination of topical adapalene with topical benzoyl peroxide
* Fixed combination of topical tretinoin with topical clindamycin
* Fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
* Topical azelaic acid + either oral lymecycline or oral doxycycline
What are important points about oral antibiotic usage for acne?
- Tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years
- Erythromycin may be used in pregnancy
- Minocycline is less appropriate due to risk of irreversible pigmentation
- Only continue antibiotic treatment for more than 6 months in exceptional circumstances.
What should be co-prescribed with oral antibiotics to reduce antibiotic resistance?
A topical retinoid (if not contraindicated) or benzoyl peroxide.
True or False: Topical and oral antibiotics can be used in combination.
False.
What complication may occur due to long-term antibiotic use?
Gram-negative folliculitis.
What is effective for treating Gram-negative folliculitis?
High-dose oral trimethoprim.
What are combined oral contraceptives (COCP) used for in acne treatment?
As an alternative to oral antibiotics in women.
What is a specific COCP mentioned that has anti-androgen properties?
Dianette (co-cyprindiol).
What are the risks associated with using Dianette?
Increased risk of venous thromboembolism.
What is the recommendation for the use of Dianette?
Should generally be used second-line, only for 3 months, and women should be counselled about the risks.
What is the treatment protocol for oral isotretinoin?
Only under specialist supervision.
What is a contraindication for topical and oral retinoid treatment?
Pregnancy.
What treatments should not be used to reduce the risk of antibiotic resistance developing?
- Monotherapy with a topical antibiotic
- Monotherapy with an oral antibiotic
- A combination of a topical antibiotic and an oral antibiotic.
What are the NICE referral criteria for acne?
- Patients with acne conglobate
- Patients with nodulo-cystic acne.
Under what scenarios should a referral to a dermatologist be considered?
- Mild to moderate acne has not responded to two completed courses of treatment
- Moderate to severe acne has not responded to previous treatment that includes an oral antibiotic
- Acne with scarring
- Acne with persistent pigmentary changes
- Acne causing persistent psychological distress or a mental health disorder.
What are comedones due to?
A dilated sebaceous follicle
What is seen if the top of a comedone is closed?
A whitehead
What forms if the top of a comedone opens?
A blackhead
What forms when the follicle bursts releasing irritants?
Inflammatory lesions such as papules and pustules
What may result from an excessive inflammatory response?
Nodules and cysts
What can ultimately cause scarring in acne?
The sequence of events from comedones to inflammatory lesions
What are the types of scars that can result from acne?
- Ice-pick scars
- Hypertrophic scars
How is drug-induced acne often characterized?
Monomorphic lesions, such as pustules in steroid use
What is acne fulminans?
Very severe acne associated with systemic upset, such as fever
What is often required for the treatment of acne fulminans?
Hospital admission
What usually responds to treatment in acne fulminans?
Oral steroids
What is the prevalence of acne in individuals over 25 years old?
10-15% of females and 5% of males
Acne can persist beyond adolescence.
What causes the formation of a keratin plug in acne?
Follicular epidermal hyperproliferation
This is a key process in acne pathogenesis.
What results from the obstruction of the pilosebaceous follicle?
Formation of a keratin plug
This obstruction is a critical factor in acne development.
How may the activity of sebaceous glands be controlled?
By androgen
Androgens influence sebaceous gland function.
Is the level of androgens often normal in patients with acne?
Yes
Normal androgen levels can be present in those with acne.
Which bacterium is associated with acne colonization?
Propionibacterium acnes
This anaerobic bacterium plays a role in acne pathology.
What role does inflammation play in acne?
It is a contributing factor
Inflammation is part of the acne pathophysiological process.
What is acute bronchitis?
A type of chest infection resulting from inflammation of the trachea and major bronchi.
Is acute bronchitis usually self-limiting?
Yes, it is usually self-limiting in nature.
What are the typical symptoms of acute bronchitis?
Cough, sore throat, rhinorrhoea, wheeze.
What is the leading cause of acute bronchitis?
Viral infection.
What percentage of acute bronchitis episodes occur in autumn or winter?
Around 80%.
What is a common duration for the disease course of acute bronchitis?
Usually resolves before 3 weeks.
What percentage of patients may still have a cough beyond 3 weeks?
25%.
What are the examination findings in most patients with acute bronchitis?
Majority have a normal chest examination.
What additional symptoms may some patients with acute bronchitis present?
Low-grade fever, wheeze.
How can acute bronchitis be differentiated from pneumonia based on history?
Sputum, wheeze, breathlessness may be absent in acute bronchitis.
What focal chest signs are absent in acute bronchitis compared to pneumonia?
Dullness to percussion, crepitations, bronchial breathing.
What systemic features may be present in pneumonia but absent in acute bronchitis?
Malaise, myalgia, fever.
How is acute bronchitis typically diagnosed?
It is a clinical diagnosis.
What test may guide antibiotic therapy in acute bronchitis?
CRP testing.
What is one of the management strategies for acute bronchitis?
Analgesia.
What is recommended for fluid intake in patients with acute bronchitis?
Good fluid intake.
When should antibiotic therapy be considered for acute bronchitis patients?
If they are systemically very unwell, have pre-existing co-morbidities, or have specific CRP levels.
What CRP level indicates offering a delayed prescription for antibiotics?
CRP of 20-100mg/L.
What CRP level indicates offering antibiotics immediately?
CRP >100mg/L.
What is the first-line antibiotic recommended by the BNF for acute bronchitis?
Doxycycline.
Who cannot use doxycycline for acute bronchitis treatment?
Children or pregnant women.
What is an alternative antibiotic to doxycycline for treating acute bronchitis?
Amoxicillin.
What are anal fissures?
Longitudinal or elliptical tears of the squamous lining of the distal anal canal.
How are anal fissures classified based on duration?
Acute if present for less than 6 weeks; chronic if present for more than 6 weeks.
What are some risk factors for anal fissures?
- Constipation
- Inflammatory bowel disease
- Sexually transmitted infections (e.g., HIV, syphilis, herpes)
What are the common features of anal fissures?
- Painful, bright red rectal bleeding
- Approximately 90% occur on the posterior midline
- Alternative locations may indicate underlying causes (e.g., Crohn’s disease)
What is the management for an acute anal fissure?
- Soften stool
- High-fibre diet with high fluid intake
- First-line: bulk-forming laxatives; if not tolerated, try lactulose
- Lubricants (e.g., petroleum jelly) before defecation
- Topical anaesthetics
- Analgesia
What should be continued in the management of a chronic anal fissure?
The same techniques used for acute anal fissures.
What is the first-line treatment for a chronic anal fissure?
Topical glyceryl trinitrate (GTN).
What should be considered if topical GTN is ineffective after 8 weeks?
Referral for surgery (sphincterotomy) or botulinum toxin.
What is constipation defined as?
Defecation that is unsatisfactory because of infrequent stools (< 3 times weekly), difficult stool passage, or seemingly incomplete defecation.
What are the features of constipation?
The passage of infrequent hard stools.
What is the first step in managing constipation?
Investigate and exclude any secondary causes.
What should be considered when managing constipation?
Red flag symptoms.
What must be excluded during the management of constipation?
Faecal impaction.
What lifestyle measures are advised for managing constipation?
Increasing dietary fibre, ensuring adequate fluid intake, ensuring adequate activity levels.
What is the first-line laxative for treating constipation?
What is the 2nd line laxative for treating constipation?
Bulk-forming laxative, such as ispaghula.
Osmotic laxative, such as a macrogol.
What is a potential complications of constipation?
Overflow diarrhoea.
acute urinary retention.
common: haemorrhoids.
