GP Clinic

Question 1

62 y/o.
PHx: HTN, hypercholesterolaemia, haemorrhoids
PC: tenesmus, weight loss, PR bleed, diarrhoea.
DDx?

Answer 1

Colorectal cancer
Diverticulitis
IBD

Question 2

What Ix would you do for suspected colorectal cancer?

Answer 2

PR exam
Stool sample (FIT test)
FBC

Question 3

How do you managed colon cancer in primary care?

Answer 3

2 week wait referral

Question 4

71 y/o 
PHx: HTN, ED, IHD 
DHx: Viagra, indapemide, anti HTN 
PC: nocturia, weak flow, incomplete voiding 
DDx?

Answer 4

BPH
Prostate cancer
LUTI
T2DM

Question 5

What Ix would you do for suspected prostate cancer?

Answer 5

PR exam
Urine dip
FBC
PSA

Question 6

O/E, smoothly enlarged prostate and low PSA.

Dx?

Answer 6

BPH

Question 7

What is the Tx for BPH?

Answer 7

Alpha blocker eg tamsolusin for Sx relief

Alpha reductase inhibitor eg finasteride

Question 8

21 y/o
PC: stomach ache and bloating. Worse after eating.
DDx?

Answer 8

Coeliac, IBD, IBS

Question 9

What Ix would you do for a young person with bloating and stomach ache?

Answer 9

FBC
Anti TTG (coeliac screen) 
LFT and TFT 
Inflammation markers 
Stool culture inc foecal calprotectin

Question 10

How do you confirm a diagnosis of coeliac?

Answer 10

OGD with duodenal biopsy

Question 11

List an extraGI manifestation of coeliacs

Answer 11

Dermatitis herpetaformis (itchy rash on elbows / knees)

Question 12

51 y/o lady.
DH: HRT
PC: tired, putting on weight, dry skin, low appetite.
DDx?

Answer 12

Hypothyroidism, anaemia, depression, ovarian cancer

Question 13

22 y/o
Recent travel Hx.
PC: blood and ‘slime’ in poo. diarrhoea. Fever. Lost weight.
DDx?

Answer 13

Infection (salmonella, shigella etc)

IBD

Question 14

What is the treatment for IBD?

Answer 14

Urgent referal to gastro with colonoscopy
Hydration
Aminosalicylates

Question 15

68 y/o
Diabetic review.
PC: blister on R foot that doesn’t go away.
Tx?

Answer 15

Foot care

Podiatrists in community

Question 16

What Ix are done at a diabetic review?

Answer 16

BMI and BP 
General Hx inc compliance 
Assess mood 
Smoking / alcohol intake changes 
Bloods: HbA1c, U&Es, LFTs, cholesterol 
Opthalmoscopy 
Look at feet inc pulses / sensations 
Urine ACR

Question 17

32 y/o
PC: Right sided headache over eye. Red and watery eye. Gets 10 a day then stops for a few months.
Dx?

Answer 17

Cluster headache

Question 18

What can trigger a cluster headache?

Answer 18

Alcohol, exercise, lack of sleep, certain smells

Question 19

How do you Mx cluster headache?

Answer 19

Nasal / subcut triptans
Short burst O2 therapy
Headache diary and trigger avoidance
Verapamil