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GP Flashcards

1
Q

presentation of croup

A 
sudden onset of seal-like barky cough
respiratory distress (stridor, sternal/intercostal indrawing, tachypnoea)
agitation
hoarse voice
fever

worse at night

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2
Q

management of croup

A

oral dexamethasone

nebulised adrenalin if severe (stridor, agitation, lethargy)

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3
Q

causes of croup

A

parainfluenza
adenovirus
influenza

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4
Q

differentials of croup

A

epiglottitis
foreign body inhalation
bacterial tracheitis

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5
Q

management of hypertension

A

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

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6
Q

presentation of eczema

A

dry and itchy

common areas

infants: cheeks, forehead, scalp, flexor surfaces
children: ankles, wrists, popliteal and antecubital fossa
chronic: hands, feet, back, neck

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7
Q

management of eczema

A

emollients
hydrocortisone
chlorphenamine
Abx if signs of infection (cover for s. aureus)

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8
Q

presentation of psoriasis

A

red, white, scaly, papules, plaques
may be painful, pustular, bleed
common sites: elbows, knees, extensor surfaces, scalp

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9
Q

management of psoriasis

A 
hydrocortisone
phototherapy
methotrexate
phosphodiesterase 4 inhibitor
biologics
oral retinoid
ciclosporin
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10
Q

cause of acne vulgaris

A

Propionibacterium

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11
Q

pathophysiology of acne

A

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

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12
Q

management of Acne

A 
topical retinoid (tretinoin)
topical Abx (clindamycin)
oral Abx (erythromycin)
adjunct: benzoyl peroxide, COCP
for severe: oral retinoid (isotretinoin)
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13
Q

side effects of isotretinoin

A

deranged LFTs
severe headaches
teratogenic
mood disturbances

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14
Q

risk factors for skin cancer

A

sunlight/UV radiation
fhx of skin cancers
HPV
moles

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15
Q

describe basal cell carcinoma

A

pearly papules and/or plaques associated with telangiectasia

commonly on head/neck

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16
Q

describe SCC of skin

A

ulcerated leion or exophytic tumour
may be friable and bleed

AK = irregular crusty lesion
BD = red/brown scaly plaque
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17
Q

describe melanoma

A

deeply pigmented lesion

either new or change in size, shape or colour

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18
Q

management of SSC

A

AK/BD = cautery or 5 fluorouracil

SSC - 4mm margins

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19
Q

management of BCC

A 
superficial = imiquimod or 5 fluorouracil
deep = 4mm margins
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20
Q

management of melanoma

A 
breslow <1mm = 1cm margins
breslow >1mm  = 2cm margins
adjunct chemotherapy (ipilimumab, BRAF or MEK inhibitor)
21
Q

CURB 65

A 
confusion
urea > 7
RR > 30
BP (S<90, D<60)
age >65
22
Q

causative organisms of pneumonia

A

strep pneumoniae
haemophilus influenzae
moraxella

mycoplasma
legionella

23
Q

presentation of pneumonia

A

cough with purulent discharge
fever
dyspnoea
chest pain

atypical
persistent cough usually dry
diarrhoea (legionella)

24
Q

clinical findings in pneumonia

A

crepitation
increase vocal resonance/fremitus
dull percussion

signs less prominent in atypical

25
Q

investigations for pneumonia

A

WWC, CRP
urea
blood and sputum cultures
CXR

LFTs - elevated on mycoplasma and legionella
urine legionella

26
Q

management of pneumonia based of CURB65

A

0-1 = oral amoxicillin
2-3 = hospital admission, IV amoxicillin, oxygen
> 4 = consider ICU, IV co-amoxicillin + IV clarithromycin, oxygen

27
Q

management of atypical pneumonia

A

mycoplasma - clarithromycin/doxycycline

legionella - ciprofloxacin + clarithromycin

28
Q

virchow triad

A

venous stasis (immobility, GA, advanced COPD/HR)
vessel wall damage (trauma, previous DVT, central venous catheterization)
hypercoagulability (high oestrogen, cancer, thrombophilia)

29
Q

presentation of DVT

A

calf swelling/asymmetrical oedema
localised pain along deep venous system
prominent superficial veins

30
Q

management of DVT

A 
exercise
anticoagulation (enoxaparin/rivaroxaban) - continue for 3 -6 months
31
Q

presentation of chronic limb ischaemia

A 
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

32
Q

management of intermittent claudication

A

exercise, smoking cessation, weight loss, foot care

statin, glycaemic control, aspirin/clopidogrel

33
Q

management of COPD

A

salbutamol/ipratropium

if signs of asthma
+ LABA and ICS
if no signs of asthma
+ LABA and LAMA

still not controlled = SABA + LABA + LAMA + ICS

34
Q

management of asthma

A

SABA (salbutamol)

Escalate if required:
+ ICS (beclomethasone)
+ LABA (salmeterol)
+ leukotriene receptor antagonist (montelukast)/theophylline/LAMA(tiotropium)

35
Q

management of hypothyroidism

A

levothyroxine + carbidopa

36
Q

management of hyperthyroidism

A 
1st line = carbimazole
2nd line = propylthiouracil (PTU)
beta blocker for symptoms
radioactive iodine
thyroidectomy
37
Q

causes of TATT

A 
OSA
depression
anaemia
B12/folate deficiency
hypothyroidism
adrenal insufficiency 
CKD
38
Q

eradication therapy for h pylori

A

omeprazole + clarithromycin + amoxicillin

39
Q

presentation of crohns

A 
non bloody diarrhoea
abdo pain
perianal lesions
oral ulcers
fever
40
Q

presentation of UC

A 
bloody diarrhoea
abdo pain
rectal bleeding
joint pain
rashes (pyoderma gangrenosum, erythema nodosum)
uveitis
41
Q

how is acute severity of a UC flare up determined

A 
truelove and witts criteria
bloody stool/day
HR
temp
Hb
42
Q

management of crohns

A

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
43
Q

management of UC

A 
Oral prednisolone
Mesalazine (oral or topical)
Azathioprine
Infliximab, adalimumab
colectomy
44
Q

what should be included in fall risk of the elderly assessment

A 
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
45
Q

management of UTI

A 
upper = ciprofloxacin/cefalexin
lower = nitrofurantoin/trimethoprim
46
Q

presentation of UTI

A

upper = systemic + bacteriuria
fever, malaise, fatigue, vomiting, loin pain, rigors

lower = urinary symptoms + bacteriuria
frequency, urgency, haematuria, dysuria

47
Q

symptoms of BPH

A

voiding hesitancy, intermittency, slow stream, straining, terminal dribbling

48
Q

management of BPH

A

alpha blockers - tamulosin

5a reductase inhibitor

49
Q

management of angina

A 
aspirin and statin
GTN
betablocker or CCB
add BB/CCB
nicorandil, long acting nitrate, ivabridine

finals (13 decks)

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