GP Flashcards
1
Q
Head lice
A
- no sign of poor hygiene
- launder pillow cases using hot water or hot dryer
- pyrethin based scalp preparation thoroughly cover hair, thorough rinse, combing with fine toothed comb, dry with clean towel- repeat in 7 days
- alternative: conditioner and comb every 2 days until no lice are seen for 10 days,
- if resistent malthion based preparation
- treat family members if affected
- pyrethrin ci if allergy to ragweed, care in asthma
- can return to school day after treatment
- no need to shave of cut hair short
- exclude dermatitis scalp or confuse this with headlice
2
Q
Microcytic aneamia
A
Causes:
- iron deficiency
- Thalassamia
- sideroblastic
- chronic disease (more often normocytic)
- led poisoning.
Do: first iron studies, if iron deficiency arrange colonoscopy and endoscopy! in patients that are middle aged or older. Can start on H2 receptor antagonist while waiting, not necessary. Also do blood film.
3
Q
renal colic investigation
A
- urine dipstick (don’t forget endone seeking)
- culture to exclude infection
- US to rule out obstruction
- abdo x-ray
- GOLD standard: CT non-contrast shows stones not visible in x-ray
- do at least creatinin, urea, serum uric acid and calcium.
- investigate causes : hyperparathyroidism, hypercalcaemia, hyperoxaluria, UTI
- analyse stone
4
Q
Renal/ureteric colic management
A
- pain relief: NSAID is preferable (eg diclofenac 50 mgTDS for one week), opioids or panadene forte acceptable
- strain urine plus analyse
- avoid high fluid intake (increases dialation ureter) acc to murtagh but high fluid intake acc to AMC.
- refer to urologist if high-grade obstruction, not passing in 48 hours, fever/UTI, staghorn calculus, DM-II, single kidney, stone >5mm
- urologist may have to go in and retrieve stone or blast.
5
Q
renal/ureteric colic explain
A
- draw diagram of anatomy bladder, kidney, ureter and urethra
- explain pain might come back again
- explain management and investigations and follow-up in 48 hours or if febrile
- recurrence up to 75%
- reduce anaimal protein, increase fluid intake
6
Q
feacal soiling 2nd to chronic constipation management in child
A
- common
- pr allowed
- start with high dose oral laxatives
- enema
- suppositiries
- gastrointestinal lavage
- maintain regular Bowel motions with laxatives for months and prolonged follow-up
- regular toileting after meals
- fluid and fiber
- treat fissures
- exclude organic causes via hx or investigation and emotional stress
(overflow is liquidification of feaces, masses remain)
7
Q
psoriasis causes
A
- excact eatiology unknown
- inflamation, cell proliferation in epidermis
- triggers: lithium, B-blocker, chloroquine
- ## stress, infections, trauma
8
Q
Psoriasis management
A
- cave arthritis (mostly hands/fingers) and 2nd infections
- emollients
- weak topical corticosteroid
- tars
- keratolytics
- systemic: methotrexate, acitretin or cyclosporin
- phototherapy
- long term management
9
Q
UTI in men management and investigation
A
- dipstick + midstream culture if dipstick +
- trimethoprim 300 mg nocte or cephalexin 500 mg BD 10 days (and adjust according to sensitivity, both ok in penicillin sens), alt amocycillin if no penicillin sens
- ural may be tried (alkalisation urine)
- increase fluid intake
- childeren: inv vesicoureteric reflux
- younfer adults: foreign body bladder, STD
- older adults: calculi kidney, ureter or bladder, prostatitis, bladder polyps or ca, BPH or ca prostate, urethral stricture, TB –> arange US +PSA + creat folowed by CT, and urologist (cystoscopy or voiding cystourethrogram)
10
Q
Bed wetting (nocturnal enuresis) invx/hx
A
- fam hx, major stressors, sibblings, general health, development, growth percentiles
- urine dipstix
- urine MC&S
- growth and percentiles
- blood pressure
- Renal US only if abnormalities above
11
Q
Bed Wetting management without organical problems
A
- empathy and reassurance
- lifting and restrictions of fluids have not been shown to be effective but can be continued if parents wish so.
- Enuresis alarm (conditioning response to release of urine) (available in pharmacy, community health care centres) (may take weeks to be succesfull and months for desired effect)
- succes rate higher if child motivated
- reward system and star chart
- Arginine vasopressin nasal spray when it is improtant to stay dry (school camps etc)
- succes rate amitriptyline is low and can be dangerous
- review 2-3 weeks after start alarm
12
Q
Gout Presentation and risk factors
A
- metatarsophalangeal joint great toe (or other in feet or elsewhere), extremely painfull, red, tender, needle shaped cristals in aspirate (not required)
- elevated urate (can also cause CVD and chronic renal failure)
- longterm can cause destructive arthropathy,
- exacerbated by alcohol and drugs (thiazides, B-blockers, aspirin, niacin, ciclosporin) trauma, seafood, game, oval, shellfish
- associated with metabolic syndrome
- inherited
13
Q
Gout acute management
A
- NSAID eg indomethacin 50-75 mg stat, 50 mg 2 hrs later, 25mg TDS for 48 hours, than 25 mg BD for 1 week.
- alternative prednisolone 25 mg OD for 7-10 days, alternatively colchicine
- increase fluids
- elevate and rest for 24-48 hours
- additional paracetamol if required
- warn for side effects medications
- cease offending drugs, eg stop tiazide and start ACE
- should be improved in 48 hours
- blood for uric acid
- ddx septic
14
Q
gout long term management
A
- adequate water intake
- avoid diuretics or salicylates
- reduce weight
- reduce alcohol
- avoid purine rich food (offal, tinned fish, shell fish and game)
- start allopurinol in recurrent attacks +/- 8 weeks post attack 50-100 mg OD increase to 300 mg (colchicine can be given additionally if attack while starting allopurinol)
- aim to reduce uric acid < 0.4
- review CVD risk profile/ metabolic syndrome: BP, serum lipids, fasting blood sugars, urea, creatinin, electrolytes
15
Q
Benzodiazepam dependence approach
A
- inquire in history of habbit development
- open, non judgemental
- start cut-down with keeping diary, than very slow withdrawal, give information, offer referal to support groups
- know that there is a possibility to report to health department but don’t do this unless everything else failed
- work with patient
- advice on relaxation techniques, CBT etc
- get psych history (can be brief)
- consider changing to longer acting drug to ease withdrawal symptoms