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Junior blocks > GP > Flashcards

GP Flashcards

1
Q

What is the differential diagnosis for a red eye?

A 
Acute angle glaucoma
Corneal ulcer
Anterior uveitis (iritis)
Scleritis
Conjunctivitis
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2
Q

What causes acute angle glaucoma?

A

Aqueous humour produced by the ciliary body normally drains up and over the iris and into the trabecular mesh work.
If the angle between the cornea and the iris is narrowed eg sitting around in the dark and pupil dilates, the trabecular mesh work is occluded and the pressure backs up.

Raised intraocular pressure can lead to optic nerve damage and permanent blindness

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3
Q

What are the red flag signs and symptoms for acute angle glaucoma?

A 
Blurred vision and haloes
Severe pain and headache
Nausea and vomiting
Oval pupil - unreactive to light 
Photophobia 
Onset in the dark
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4
Q

What is the treatment for acute angle glaucoma?

A

Topical beta blocker and Pilocarpine - anti m3 ach to constrict the iris

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5
Q

What is a ciliary flush and what are the possible causes? How would you differentiate between them?

A

Red pattern around the iris

Corneal ulcer - associated with trauma, contact lenses etc
Anterior uveitis - associated with connective tissue disorder and photophobia
Scleritis - associated with connective tissue disorder and pain

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6
Q

What is the differential for a red non-painful/itchy eye?

A

conjunctivitis - diffuse pink

Subconjunctival haemorrhage - defined red

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7
Q

What are the risk factors for a subconjunctival haemorrhage?

A

Hypertension
Anticoagulant
Constipation/straining

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8
Q

What skin conditions are associated with blepharitis?

A

Acne Rosacea

Seborrhoea dermatitis

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9
Q

What are the 3 main causes of an inflamed eyelid? How would you differentiate them?

A

Hordeolum - Stye - external blocked ciliary sweat gland or internal blocked tarsus sebum gland - painful

Chalazion - Meibomiam cyst - retention of an internal stye - non painful.

Blepharitis - infective area around base of eyelids

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10
Q

Which bacteria is usually responsible for acne?

A

Propioni bacterium acnes

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11
Q

How is acne classified?

A

Mild - less than 30 lesions
Moderate - papules and pustules
Severe - nodular cystic

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12
Q

What are the indications referral to dermatology and isotretinoin treatment for acne?

A

Severe- nodular cystic acne
Plus scarring
Or not responding to oral antibiotics for 6 months

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13
Q

What are the side effects of isotretinoin? What must be monitored?

A 
Dry skin (v common)
Dry mucous membranes
Nose bleeds
Photosensitive 
Teratogenic 
Hepatotoxic - monitor LFTs
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14
Q

What is impetigo? How would you treat it?

A

Vesicular pustular lesion on the face usually
With honey coloured crusting.

Fusidic acid

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15
Q

What distinguishes acne vulgaris from acne rosacea?

A

Erythematous facial rash and telangectasia that is triggered by stress, alcohol etc.
May have eye signs including blepharitis or keratitis.

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16
Q

Which organisms are most commonly associated with impetigo?

A

Staph aureus and strep pyogenes

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17
Q

Which skin rashes can arise following herpes simplex virus?

A

Erythema multiforma

Eczema herpeticum

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18
Q

What skin rashes can arise following strep infection (strep threat or impetigo etc) ?

A

Guttate psoriasis

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19
Q

What organism is normally associated with warts?

A

Hpv

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20
Q

What is the pathology of shingles? What organism is associated with it?

A

Herpes zoster virus lies dormant in the dorsal root ganglion of a particular nerve following chickenpox infection.

Reactivated at a time of immune weakness.
Rash in a single dermatome.

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21
Q

Describe the management of shingles depending on severity.

A

Just vesicular rash in one dermatome - oral aciclovir to prevent post hermetic neuralgia.
Hutchinson’s sign (nose) or eye signs - secondary referral to ophthalmology.

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22
Q

What are molloscum contagiosum? Who gets them?

A

Smaill white or pink papules with a central punctum..

Spread easily by close contact so children and sexually active people like students.

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23
Q

What organism is associated with fungal skin infections?

A

Trichphyton.

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24
Q

What skin rash develops following a generic viral urti?

A

Pityriasis rosea

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25
Q

Describe the management of tinea pedis/corporis/capitals/ungium.

A

Topical ketoconazole.

Except ungium - nail - oral terbinafine. Be careful because hepatotoxic.

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26
Q

Describe the appearance of pityriasis versicolor. How is it treated?

A

Slows of pigment, less dramatic than vitiligo. Anti fungal cream.

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27
Q

What organism is associated with pityriasis versicolor?

A

Malssezia

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28
Q

Describe the appearance of pityriasis rosea. How is treated?

A

Herald patch following viral infection. Xmas tress macular red rash. Watch and wait.

29
Q

Describe the appearance of vitiligo. How is it treateD?

A

Well defined loss of pigment. Grows. Fhx.

Autoimmune. So can try topical steroids or tacrolimus.

30
Q

What are the main causes of erythema nodosum?

A

IBD
Sarcoidosis
Strep
Penicillin w

31
Q

What are the main causes of pyoderma gangrenosum?

A

IBD
Rheumatoid arthritis
Wegener’s - granulomatosis w/ polyangitis

32
Q

What are the main causes of acanthosis nigricans?

A 
Diabetes
ObeSity
Pcos 
Cushings
Thyroid
GI malignancy
33
Q

Describe the classic rash of Lyme disease?

A

Tick bite leading to Bulls eye or target rash leading to erythema migrans

34
Q

Describe the classic rash of scabies.

A

Tiny papules. Very itchy. Especially in the skin folds.

35
Q

Name 5 drugs and 4 other things that can exacerbate psoriasis.

A 
B blockers
NSAIDs
ACE
Lithium 
Infliximab

Trauma
Alcohol
Withdrawal of steroids
Stress

36
Q

Describe the treatment ladder for psoriasis.

A
  1. Topical steroid and vitamin d analogue OD.
  2. Increase vitamin d to bd
  3. Increase steroid to bd and consider coal tar.
  4. Dithranol reduces cell division. Stains skint yellow.
37
Q

Describe the treatment ladder for eczema.

A
  1. Emollient bd.
  2. Topical steroid for flare.
  3. Anti histamine for itch or topical tacrolimus
38
Q

Describe the pattern of atopical eczema in infants and older children.

A

Infant - face, neck, scalp and extensor surfaces

Older - flexor surfaces.

39
Q

What is eczema herpeticum ? Who is at risk?

A

Dangerous rash - monomorphic red blisters . Itchy, may bleed.
People with eczema following herpes simplex infection.

40
Q

What is the treatment for eczema herpeticum ?

A

IV aciclovir

41
Q

What is the most likely diagnosis for a waxy/greasy red rash on face or scalp?

A

Seborrhoeic dermatitis

42
Q

What rash is a common first presentation of hiv?

A

Seborrhoeic dermatitis

43
Q

What is the treatment for seborrhoeic dermatitis?

A
  1. Ketoconazole cream

2. Topical steroid

44
Q

Describe the two types of pemphigus.

A

Both autoimmune painful blistering disorders

Pemphigus vulgaris
Common includes mouth, common in ashkinazy Jews.

Bullous pemphigoid (avoid) 
Rare, avoids mouth
45
Q

How is pemphigus treated?

A

Oral steroid and referral to secondary care

46
Q

Describe the two types of lichen disease.

A

Lichen planus - papula polygonal pruritic rash

Lichen sclerosus - rash on vulva of elderly

47
Q

Give 3 risk factors for squamous cell carcinoma.

A

Pre cancerous changes eg - Actinic keratosis, Bowens disease
Sun exposure
Smoking

48
Q

Which potential skin cancers should be referred on a 2 week wait?

A

Squamous cell
Malignant melanoma

(Not basal cell)

49
Q

Describe the features of squamous cell carcinoma

A 
Painful
Ulceration
Fast growing
Can have keratin horn
Located in places with sun exposure
50
Q

Describe the features of malignant melanoma

A

Primary - change in colour, size or shape

Secondary - bigger than 6mm diameter
Inflammation
Discharge
Irregular border

51
Q

What factor determines the prognosis of a malignant melanoma?

A

Depth (Breslow score)

52
Q

Describe the appearance of a seborrhoeic keratosis

A

Large benign stuck onlooking with keratin plugs.
Affects elderly
Looks like a malignant melanoma except they have a velvety matte texture not a smooth surface.

53
Q

Describe the features of basal cell carcinomas

A

Slow growing
Over years
Nodular with a crater in the middle and telangectasia
Rolled edge

54
Q

Describe the symptoms of a migraine

A

Aura- parasthesia, photophobia, visual disturbance (blind spots, shimmering lights, zig zags)

Nausea and vomiting
Relieved in a dark room, sleep
Various triggers - stress, foods, alcohol
Lasts up to 3 days
± unilateral headache
55
Q

What differentiates a migraine from a tension headache?

A

Migraine - Aura, unilateral pain, relieved by the dark

Tension - Stress must be the trigger. Tight band of bilateral pain

56
Q

What is the differential for a headache?

A 
Migraine
Tension headache
Cluster headache
Depression
Drug induced - including rebound after painkillers
Haemorrhage
Tumour
Giant cell arteritis
57
Q

What are the cardinal signs of giant cell arteritis?

A

Jaw claudication
Swollen temporal arteries
Raised ESR

58
Q

What are the cardinal signs of meningitis?

A 
Neck stiffness
Photophobia
Fever
Cold extremities
(Headache)
(Non blanching rash)
59
Q

How is a brain tumour most likely to present?

A

Secondary met
UMN signs
Epilepsy
±Frontal headache

60
Q

What does a sudden onset thunderclap headache indicate?

A

Sub arachnoid haemorrhage

Venous sinus thrombosis

61
Q

What is the treatment for giant cell arteritis?

A

Immediate high dose oral prednisolone to prevent blindness

62
Q

What are the red flag symptoms of a sore throat?

A

Signs of obstruction eg epiglottitis or tonsillar abcess (quinsy)

Hoarse voice 
Dysphagia 
Drooling, 
Stridor 
Respiratory distress
63
Q

Describe the scoring system for tonsillitis

A

Centor

  1. Exudate
  2. Anterior cervical lymphadenopathy
  3. Fever
  4. Absent cough

3/4 Treat with abx

64
Q

Which URTIs would you consider abx for?

A

Otitis media with otorrhoea
Centor positive tonsillitis
Sinusitis with purulent discharge
Epiglottitis

65
Q

Why is epiglottitis an emergency? What is the treatment?

A

Blocks the airway

IV cephtriaxone like meningitis

66
Q

What is the recommended treatment for an URTI when you are not considering abx?

A

Fluids
Saline drops for blocked nose
Prop up children to sleep
Paracetamol and ibuprofen alternate 4 hours

Consider antihistamine at night to dry out mucous
Consider beconase spray for nasal inflammation/ blocked nose

Do not recommend decongestants due to rebound congestion. (rhinitis medicamentosa)

67
Q

What is rhinitis medicamentosa?

A

Rebound nasal congestion after 5-7 days of constant use of decongestion medication eg sudafed (phenylephrine)

68
Q

Which types of rashes might be described as violaceous?

A

Pyoderma gangrenosum

Dermatomyositis

Junior blocks (12 decks)

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