GP Flashcards
What are some DDX for CAD?
Syphilis
Hyperthyroidism
Anaemia
Septic emboli
Collagen vascular disease (Kawasaki disease, polyarteritis nodosa, SLE, Ehlers-Danlos syndrome)
Other arrythmias (A Flutter, other atrial tachy-arrhythmias)
General categories of medications to manage CAD?
Rate control (beta blockers, CCBs, digoxin), Rhythm control, Anticoagulation (Warfarin, NOAC)
Which medications for CAD rate control do you choose if it is needed urgently IV?
Metoprolol 5mg (1mg/min) IV at 5 minute intervals up to max 20mg
Esmolol 500microg/kg over 1 min
Verapamil 1mg/min up to 15mg
What are some differentials for a sore throat?
Necrotising fasciitis Retropharyngeal abscess Lemierres syndrome Quinsy Otitis media Glomerulonephritis Rheumatic fever
What is first line management for Croup?
Inhaled corticosteroids (Budesonide, dex or pred) \+/- adrenalin 0.1% (1:1000, 1mg/kg) 4mL nebs Q30 mins
What is the six step asthma management plan?
Assess severity of asthma
Achieve best lung function
Avoid trigger factors
Maintain best lung function with optimal medication
Develop and individua`lised written action plan
Educate and review regularly
How do you make a clinical diagnosis of (acute) Sinusitis?
With 2+ of:
- Congestion
- Nasal discharge
- Facial pain
- Hypoxmia/anosmia
How do you make a clinical diagnosis of bacterial sinusitis?
Symptoms of rhinosinusitis lasting >1 week + any of:
- High fever lasting >3 days
- Purulent nasal discharge
- Sinus tenderness or maxillary toothace (esp. unilateral)
- Severe symptoms or worsening symptoms post-initial improvement
What are some complications of sinusitis?
Orbital cellulitis Osteomyelitis Abscess formation Venous sinus thrombosis Bacterial meningitis
What is first line for chronic sinusitis?
Prednisolone 25mg PO for 5-10/7
What is the BRAT diet?
Diet used for gastro if diarrhoea continues or worsesn over about 3 days: B = Bananas R = Rice A = Apples T = Toast
What are the clinical features of Hirschprung disorder?
Congenital Constipation from infancy Abdominal distension from infancy Possible anorexia and vomiting M:F ratio = 8:! Narrow or normal rectum on exam Dx confirmed by: full thickness biopsy showing absence of ganglion cells Absent rectoanal reflex on anal manometry
What are the causes of acquired megacolon?
Chronic laxative abuse Mild Hirschprung disorder Chagas disease Hypothyroidism/cretinism Systemic sclerosis
How do you manage angiodysplasia?
Blood transfusion - if loss significant
Cautery/argon plasma coag therapy through endoscopy
Management of gastroenteritis?
Fluid therapy
Electrolyte replacement
Empirical antibiotics:
- Cipro 500mg (child: 12.5mg/kg up to 500mg) orally once daily for 3/7 OR
- Norflox 400mg (child: 10mg/kg up to 400mg) orally adily for 3/7
Giardia: metronidazole 2g for 3/7
Entamoeba histolytica: Paromomycin 500mg (child: 10mg/kg up to 500mg), orally 8 hrly for 7 days
Clostridium difficile: Metronodazole 400mg for 10/7
When is empirical antibiotic therapy indicated for gastroenteritis?
When bacterial infection suspected in patients with features suggesting severe disease:
high fever, tachycardia, leukocytosis, abdominal tenderness or severe abdo pain, high-volume diarrhoea with hypovolemia, blood in the stool
Why is antibiotic therapy not recommended in children with bloody diarrhoea without fever?
If caused by EHEC can lead to haemolytic uremic syndrome
What are some red flags for GORD?
Anaemia Dysphagia Haematemesis and/or malaena Vomiting Weight loss
Management for GORD?
Non pharmacological:
- eating smaller meals
- drinking f luids mostly between meals rather than with meals
- avoiding lying down after eating
- avoiding eating or drinking for 2-3 hrs before bedtime
- avoid vigorous exercise before bedtime
- elevate head of bed
- stop smoking
Pharmacological:
- Antacid
- Alginate preparation 10-20mL PO PRN
- Mg hydroxide + Al hydroxide prep 10-20mL PO PRN
- H2 antagonist (ranitidine 150mg or famotidine 20mg PO BD)
- PPI (Esomeprazole/Omeprazole 20mg OR pantoprazole 40mg)
- Lap fundoplication
How often should a patient to get fasting lipids tested?
<45 or <35 for ATSI with fasting lipids tested every 5 years
What are the recommended treatment goals of dyslipidemia? (i.e. levels of lipids)
Total cholesterol <4.0 mmol/L
LDLC <2.5mmol/L
HDLC > 1.0 mmol/L
TG <1.5 mmol/L
What the pharmacological management options for dyslipidemia?
Statin - e.g atorvastatin 10-80mg
Ezetimibe
Bile acid binding resins
Nicotinic acid
Fibrates
What side effects are associated with nicotinic acid?
Flushing, gastric irritation, gout, impaired glucose tolerance
What interactions occur associated with fibrates?
Fibrates + Statins = increased risk of myositis
What are the presenting clinical features of patient with Vitamin B12 deficiency?
Anaemic symptoms: weakness, fatigue, palpitations, SOB, pallor
GIT symptoms: diarrhoea, consipation, loss ofbladder or bowel control
Neurological symptoms: Depression, Irritability, Peripheral neuropathy, Mania, Psychosis, Memory loss, Ataxia
Other: Tongue inflammation, Decreased taste, Poor growth and development, Easy bruising, bleeding, Bleeding gums
Other than other types of anaemia - what are some DDx of B12 deficiency?
Thiamine deficiency Alcohol intoxication Schizophrenia Depression Dementia DIabetes Leukemia
What is the acute management for Vitamin B12 deficiency?
Hydroxocobalmin 1mg IM, on alternate days for 2 weeks
If severe anaemia/neurological symptoms: give supplementation ASAP
What is the maintenance therapy for Vitamin B12 deficiency?
Lifelong therapy
- Hydroxocobalamin 1mg IM, once every 2-3 months OR
- Cyanocobalamin 50-200microg orally (daily between meals)
- +/- K supplementation
What is Wernicke’s encephalitis classical triad?
Opthalmoplegia (mostly bilateral LR with lateral nystagmus)
Ataxia
Confusion
What is the management for Thiamine deficiency?
Thiamine 100mg PO daily (start with higher dose)
- Administer thiamine before glucose for hypoglycemia as glucose can further deplete thiamine stores and precipitate Wernicke’s encephalopathy
+ promote increase in dietary thiamine
What are red flags for iron deficiency anaemia?
in >65. it is colorectal cancer until proven otherwsie - do a DRE and colonoscopy
How do you diagnose Haemophilia? (lab)
Normal BT, PT, TT
Prolonged PTT
How do you diagnose ITP?
Diagnosis of exclusion:
Low platelet count
Bone marrow biopsy
Bone marrow examination
No blood abnormalities other than platelet count or no physical signs other than bleeding
Exclude secondary causes: leukemia, vWD, antiphospholipid syndrome
How do you manage ITP?
MIld - careful observation
Mod-severe - Corticosteroids, IV Ig, Anti-D Ig, immunosuppressive drugs
Splenectomy - if unresponsive to steroid treatment
What is treatment for TTP?
Supportive + Plasmaphoresis + Transfusion contraindicate: fuels coagulopathy
What do these features indicate: malaise + pallor + bone pain?
ALL
What do these features indicate: malaise + pallor + oral problems?
AML
What do these features indicate: fatigue + fever + abdo fullness/splenomegaly?
CML
What do these features indicate: fatigue + weight loss + fever + lymphadenopathy?
CLL
How do you diagnose Hodgkin’s lymphoma?
Lymph node biopsy with histological confirmation
FBC
CXR, CT/MRI
Bone marrow biopsy, functional isotopic scanning
