GP Flashcards
presentation of croup
sudden onset of seal-like barky cough respiratory distress (stridor, sternal/intercostal indrawing, tachypnoea) agitation hoarse voice fever
worse at night
management of croup
oral dexamethasone
nebulised adrenalin if severe (stridor, agitation, lethargy)
causes of croup
parainfluenza
adenovirus
influenza
differentials of croup
epiglottitis
foreign body inhalation
bacterial tracheitis
management of hypertension
lifestyle
ACEI (ARB if not tolerated)/CCB (<55/>55 or African/Caribbean)
add one of ACEI/ARB, CCB, thiazide diuretic
combination of all three
consider 4th drug (spironolactone or beta/alpha blocker) or increase thiazide dose
presentation of eczema
dry and itchy
common areas
infants: cheeks, forehead, scalp, flexor surfaces
children: ankles, wrists, popliteal and antecubital fossa
chronic: hands, feet, back, neck
management of eczema
emollients
hydrocortisone
chlorphenamine
Abx if signs of infection (cover for s. aureus)
presentation of psoriasis
red, white, scaly, papules, plaques
may be painful, pustular, bleed
common sites: elbows, knees, extensor surfaces, scalp
management of psoriasis
hydrocortisone phototherapy methotrexate phosphodiesterase 4 inhibitor biologics oral retinoid ciclosporin
cause of acne vulgaris
Propionibacterium
pathophysiology of acne
abnormal follicular differentiation -> retained keratinocytes
high androgens increase sebum viscosity and production
keratin and sebum blockage of sebaceous glands
colonisation of Propionibacterium
inflammatory/immune response -> papules, pustules etc. formation
management of Acne
topical retinoid (tretinoin) topical Abx (clindamycin) oral Abx (erythromycin) adjunct: benzoyl peroxide, COCP for severe: oral retinoid (isotretinoin)
side effects of isotretinoin
deranged LFTs
severe headaches
teratogenic
mood disturbances
risk factors for skin cancer
sunlight/UV radiation
fhx of skin cancers
HPV
moles
describe basal cell carcinoma
pearly papules and/or plaques associated with telangiectasia
commonly on head/neck
describe SCC of skin
ulcerated leion or exophytic tumour
may be friable and bleed
AK = irregular crusty lesion BD = red/brown scaly plaque
describe melanoma
deeply pigmented lesion
either new or change in size, shape or colour
management of SSC
AK/BD = cautery or 5 fluorouracil
SSC - 4mm margins
management of BCC
superficial = imiquimod or 5 fluorouracil deep = 4mm margins
management of melanoma
breslow <1mm = 1cm margins breslow >1mm = 2cm margins adjunct chemotherapy (ipilimumab, BRAF or MEK inhibitor)
CURB 65
confusion urea > 7 RR > 30 BP (S<90, D<60) age >65
causative organisms of pneumonia
strep pneumoniae
haemophilus influenzae
moraxella
mycoplasma
legionella
presentation of pneumonia
cough with purulent discharge
fever
dyspnoea
chest pain
atypical
persistent cough usually dry
diarrhoea (legionella)
clinical findings in pneumonia
crepitation
increase vocal resonance/fremitus
dull percussion
signs less prominent in atypical
investigations for pneumonia
WWC, CRP
urea
blood and sputum cultures
CXR
LFTs - elevated on mycoplasma and legionella
urine legionella
management of pneumonia based of CURB65
0-1 = oral amoxicillin
2-3 = hospital admission, IV amoxicillin, oxygen
> 4 = consider ICU, IV co-amoxicillin + IV clarithromycin, oxygen
management of atypical pneumonia
mycoplasma - clarithromycin/doxycycline
legionella - ciprofloxacin + clarithromycin
virchow triad
venous stasis (immobility, GA, advanced COPD/HR)
vessel wall damage (trauma, previous DVT, central venous catheterization)
hypercoagulability (high oestrogen, cancer, thrombophilia)
presentation of DVT
calf swelling/asymmetrical oedema
localised pain along deep venous system
prominent superficial veins
management of DVT
exercise anticoagulation (enoxaparin/rivaroxaban) - continue for 3 -6 months
presentation of chronic limb ischaemia
intermittent claudication rest pain (worse at night) - critical limb ischaemia
weak pulses
prolonged CRT
ulcers: punched out, painful, over pressure points
skin changes: cold, white, loss of hair
management of intermittent claudication
exercise, smoking cessation, weight loss, foot care
statin, glycaemic control, aspirin/clopidogrel
management of COPD
salbutamol/ipratropium
if signs of asthma
+ LABA and ICS
if no signs of asthma
+ LABA and LAMA
still not controlled = SABA + LABA + LAMA + ICS
management of asthma
SABA (salbutamol)
Escalate if required:
+ ICS (beclomethasone)
+ LABA (salmeterol)
+ leukotriene receptor antagonist (montelukast)/theophylline/LAMA(tiotropium)
management of hypothyroidism
levothyroxine + carbidopa
management of hyperthyroidism
1st line = carbimazole 2nd line = propylthiouracil (PTU) beta blocker for symptoms radioactive iodine thyroidectomy
causes of TATT
OSA depression anaemia B12/folate deficiency hypothyroidism adrenal insufficiency CKD
eradication therapy for h pylori
omeprazole + clarithromycin + amoxicillin
presentation of crohns
non bloody diarrhoea abdo pain perianal lesions oral ulcers fever
presentation of UC
bloody diarrhoea abdo pain rectal bleeding joint pain rashes (pyoderma gangrenosum, erythema nodosum) uveitis
how is acute severity of a UC flare up determined
truelove and witts criteria bloody stool/day HR temp Hb
management of crohns
Inducing remission
Steroids: IV methylprednisolone or oral prednisolone
Budesonide
5ASA: sulfasalazine or mesalazine
Add Immunomodulators if required: azathioprine, methotrexate
If refractory to above = Biologics: infliximab, adalimumab
Maintaining remission Smoking cessation Azathioprine Methotrexate = second line Mesalazine if the patient has had previous surgery
management of UC
Oral prednisolone Mesalazine (oral or topical) Azathioprine Infliximab, adalimumab colectomy
what should be included in fall risk of the elderly assessment
Falls history. Assessment of gait, balance, mobility. Osteoporosis risk (see Patients’ perceived functional ability and fear of falling. Vision. Cognition. Urinary incontinence. Home hazard assessment. Cardiovascular examination. Medication review
management of UTI
upper = ciprofloxacin/cefalexin lower = nitrofurantoin/trimethoprim
presentation of UTI
upper = systemic + bacteriuria
fever, malaise, fatigue, vomiting, loin pain, rigors
lower = urinary symptoms + bacteriuria
frequency, urgency, haematuria, dysuria
symptoms of BPH
voiding hesitancy, intermittency, slow stream, straining, terminal dribbling
management of BPH
alpha blockers - tamulosin
5a reductase inhibitor
management of angina
aspirin and statin GTN betablocker or CCB add BB/CCB nicorandil, long acting nitrate, ivabridine
