GP- Common presentations Flashcards

Question

What is Rx for gonorrhoea?

Answer 1

High dose azithromycin and cephalosporin

Answer 2

Joint pain with movement - usually improves with rest (may not in severe disease) Crepitus on joint movement Bony swelling Bony tenderness on palpation (esp. joint line) Bony enlargement or deformity Reduced range of movement Morning stiffness or 'gelling' after prolonged inactivity - time is less than in inflammatory arthritis (

Answer 3

``` Inflammatory symptoms (swelling, warmth, redness) Constitutional symptoms Sudden onset Nocturnal pain Pain which does not improve with rest Recent trauma Morning stiffness > 30 minutes Loss of function ```

Answer 4

Hx of injury/trauma to joint Significant physical activity - overuse, high impact Genetic - esp. when affecting small joints of hands Overweight/obesity Increasing age Female gender Muscle weakness - muscles contributing to joint stability & function Proprioceptive defects

Answer 5

Small joints of hands - DIP & PIP involvement (spaces MCP) 1st MCP and IP joints (thumb) & 1st MTP (toe) Weight bearing joints - knees, hips, spine Usually doesn't affect elbow, wrist or ankle

Answer 6

Loss of joint space (asymmetrical) Osteophytes Subchondrial sclerosis Subchondrial cysts

Answer 7

Clinical diagnosis which generally doesn't require other Ix Do not need to routinely XRAY - perform if red flags, severe impairment, to grade/identify severity of disease or initial diagnosis of HIP XRAY features have poor correlation with symptoms (except in advanced disease) If need to exclude inflammatory cause - ESR, CRP, Anti-CCP (ACPA), RF

Answer 8

Impact on function (occupational, ADLs, leisure), mood, sleep Psychosocial/Yellow flags contributing to chronic pain - i.e. attitudes to recovery Level of physical activity Treatments previously tried and their effectiveness

Answer 9

1. Lifestyle measures - Weight loss, exercise programs, psychological strategies to manage pain (i.e. CBT), consider physio referral, education on self-management & support groups 2. Simple analgesia +/- adjuvant topical treatments in short term (NSAIDs, capaicin - may provide some short term relief ~10days) 3. Consider short term NSAID use (must consider risks, if increased GIT risk co-prescribe PPI) 4. Consider intra-articular corticosteroid injection for short term benefit i.e. if travelling, particular event/task (can provide benefit for 4-12 weeks, should not be done >4/year) 5. Consider adjuvant complementary non-pharm techniques (may have some minimal evidence, but don't harm) i.e. accupuncture, TENS Glucosamine and chondriton don't have consistent evidence for benefit so should not be recommended

Answer 10

Optimal 4 - 6.1 Impaired GT 6.1 - 6.9 Diagnostic Random fasting >7 Random non-fasting >11 OGTT > 11.1 at 2 hours

Answer 11

Opacity/clouding of lens Myopic shift - vision improves with pin hole Loss of red reflex Normal pupil response May have halos around vision (more so at night) Glare sensitivity, difficulty driving at night Colours less bright Usually bilateral Risk factors - increasing age, steroids, myopia, diabetes, FHx, intra-ocular infection or trauma, HTN, increased alcohol

Answer 12

``` gradual, painless vision loss Peripheral vision effected - visual field defect - often bump into things Raised IOP > 21mmHg Usually asymmetrical (can be bilateral) Increased cup-disc ratio ``` Risk factors - diabetes, steroids, increasing age, HTN, graves disease, FHX

Answer 13

Most common cause of blindness Bilateral - one eye usually more effected Gradual loss of central vision Central scotoma - bits missing i.e. when reading Lines appear bent or wavy - distortion on amsla grid Can be wet or dry - Wet 10%, worse prognosis, choroidal neovascularisation, good treatment if early - Dry 90%, no specific/good treatment, drusen (yellow) spots +/- pigmentation changes Risk factors - increasing age, HTN, female, caucasian, smoking

Answer 14

1. Anterior V1 - V4 LAD 2. Lateral aVL, Lead I, V5 - V6 Circumflex 3. Inferior aVF, Lead II - III RCA

Answer 15

``` Hx recurrent or persistent wheeze Difficulty breathing tight chest cough Hx or FHx allergies FHx asthma Consistent clinical response to inhaled bronchodilator Symptoms worse at night or early morning Associated with triggers ```

Answer 16

Spirometry - if able to, usually older than 4-5 yrs Allergy testing - can help with trigger avoidance and prognostics Bronchial provocation test if diagnosis unclear CXR not routinely recommended

Answer 17

1. infrequent intermittent - flareups >6 weeks apart (no symptoms between) 2. persistent, intermittent - symptoms more than once every 6 weeks but no symptoms between 3a. Mild persistent - one of daytime symptoms >once/week or night time symptoms >2 month * FEV1 >=80% 3b. moderate persistent - any of daily daytime symptoms, night time symptoms >once/week or symptoms sometimes restrict activity/sleep * FEV1

Answer 18

Consider in frequent intermittent or any persistent asthma patterns ``` Trial medication and review in 2-4 weeks 1st line = sodium cromoglycate (1-2), montelukast (2+) 2nd line (if no response) = low dose ICS ```

Answer 19

1. Written and tailored to the child 2. Medication and instructions for preventer/maintenance therapy 3. Triggers to avoid, what to do before exercise 4. Signs that help parent determine the severity of the symptoms and instructions on Rx for each case (i.e. how to adjust Rx) 5. Signs for when to seek medical advice 6. Danger signs to seek urgent medical advice and appropriate action to take

Answer 20

Mild/moderate - can walk and talk in full sentences Severe - can't talk in full sentences, visible breathlessness and increased work of breathing, sats 90 - 94% Life-threatening - altered conscious state/collapsed, cyanotic, poor respiratory effort, sats

Answer 21

1. commence salbutamol therapy with spacer (use mask if very young or O2 driven nebuliser if can't breath with spacer or life-threatening asthma only) - can give every 20-30 minutes in mild-severe - continuous in life-threatening 2. Titrate O2 to maintain sats at least 95% 3. Arrange ICU transfer if life-threatening 4. Add ipratropium bromide every 20 mins if still no effect 5. Systemic steroids in first hour (oral or IV) - avoid if

Answer 22

``` Age: 65-74yo = 1, >75yo = 2 Stroke/TIA Hx = 2 DM = 1 Prior MI/vascular disease = 1 HTN = 1 CHF/LV dysfunction = 1 Female = 1 ```

Answer 23

``` All worth 1: Age >65yo Abnormal renal function (dialysis/transplant) Abnormal LFTs (cirrhosis, 3x ULN) Hx of major bleeding History of labile INR Alcohol use (>8 per week) Currently taking NSAID or antiplatelet ```

Answer 24

C/I = renal impairment (GFR

Answer 25

Low Vit D, low Ca and P, normal PTH, high ALP

Answer 26

High PTH, increased Ca, low P, increased ALP

Answer 27

Normal PTH, normal Ca and P, markedly increased ALP

Answer 28

MOA = increase insulin secretion ``` A/E: Weight gain Hypoglycaemia Anorexia, nausea, diarrhoea Rashes Blood dyscrasias ```

Answer 29

MOA = inhibit digestion of CHO A/E: Flatulence, bloating Rare liver abnormalities

Answer 30

MOA = sensitive liver and peripheral tissues to insulin C/Is = mod-sev HF, risk of bladder cancer ``` A/E: Increased subcutaneous fat Anaemia Increased # risk Increased LDL ```

Answer 31

MOA = increase levels of incretins A/E: Nasopharyngitis Headache URTI Sx

Answer 32

MOA = activate GLP-1 receptor A/E: N+V Pancreatitis (rare) Weight loss

Answer 33

MOA = prevent renal absorption of glucose C/I = renal impairment A/E: Weight loss Increased UTIs Aggravate dehydration

Answer 34

1. Short acting B2 adrenoreceptor agonist 2. Induces bronchial smooth muscle relaxation - limited systemic effect 3. Inhaler +/- spacer, nebuliser, oral 4. Tachycardia, tremor, hypokalaemia (very high doses)

Answer 35

1. Short-acting muscarinic receptor antagonist 2. Reduces parasympathic nerve activation (via ACh-MR path), thus reducing bronchoconstriction 3. Inhaler, nebuliser 4. Dry mouth, throat irritation

Answer 36

1. Long-acting B2-adrenoreceptor 2. Persistent low level activation of ARs, reducing constrictor binding, thus net resting bronchodilator tone 3. combination with ICS or turbuhaler & accuhaler individually 4. Tolerance can occur, tremor, palpitations, headache Improves QOL, symptoms and reduces frequency & severity of exacerbations in COPD

Answer 37

1. Inhaled corticosteroids 2. Decreased recruitment of inflammatory mediators and SMC - reduces remodelling (longer term) and inflammation and hyper-responsiveness (short-medium term) 3. Combined with LABA or indivudally 4. Dysphonia, oral thrush

Answer 38

SABA 1st line to SAMA SAMA ? increased risk CVD Can be used in combination

Answer 39

1. Long-acting muscarinic antagonist (LAMA) 2. persistent reduction of parasympathic nerve activation - reduced bronchoconstriction 3. Individually (spiriva inhalers) for COPD 4. Dry mouth, throat irritation Largely used for COPD, can be used to control asthma if on hgih dose ICS+LABA Improves QOL, symptoms and reduces frequency & severity of exacerbations in COPD

Answer 40

Both same benefits in improving QOL, symptoms & reducing frequency & severity of exacerbations Response is individual Can be used in combination

Answer 41

Rule of 15s: 15 grams of a quick acting CHO Wait 15 minutes and repeat BGL check If not rising, add another quick acting CHO If patient's next meal is >15 minutes away, provide a longer acting CHO Test glucose again during the next 2-4 hours

Answer 42

``` Dysphagia, odynophagia Unexplained weight loss Persistent vomiting Haematemesis, malaena Signs of anaemia ``` REFER TO ENDOSCOPY IF PRESENT

Answer 43

Weight loss Avoid exacerbating foods, eg/ spicy foods, citrus, fatty foods, caffeine, chocolate Avoid lying down after meals or late evening meals Reduce tobacco and alcohol consumption Avoid exacerbating medications, eg/ anticholinergics, b-blockers, benzos, NSAIDs, opioids

Answer 44

Excess alcohol consumption Chronic viral hepatitis, autoimmune hepatitis, haemochromatosis Thyroid and coeliac disease

Answer 45

``` Sudden onset, awoken from sleep Thunderclap nature Confusion, with drowsiness and/or vomiting Fever or neck stiffness Seizures or personality changes Morning vomiting Associated cerebral Sx Persistent neurological Sx Provoked by Valsalva (eg/ coughing) Aggravated by posture change ```

Answer 46

Subcutaneous sumatriptan or O2 Prevention = verapamil

Answer 47

Analgesics Anti-emetic if severe nausea or vomiting If above fails, use triptan or an ergot alkaloid

Answer 48

Oral corticosteroids with response in 24-72 hours

Answer 49

``` Age 50yo Progressive symptoms (>12w) despite treatment Cancer Unexplained weight loss Immunosuppression Prolonged use of steroids Intravenous drug use Urinary tract infection Pain that is increased or unrelieved by rest Tearing nature of pain, associated with pulsatile abdominal mass Fever Significant trauma related to age Bladder or bowel incontinence or pain Urinary retention (with overflow incontinence) Night pain Worsening pain ```

Answer 50

Belief that pain is harmful or potentially severely disabling Fear-avoidance behaviours and reduced activity levels Tendency to low mood and withdrawal from social interactions Drug seeking behaviours

Answer 51

Cyclical and persistent fever (>2w) Jaundice, hepatosplenomegaly Viral Sx: headache, nausea, malaise, diarrhoea LONG to INT IP

Answer 52

``` Maculopapular rash (after fever) Splenomegaly, thrombocytopaenia Viral Sx: headache, joint/muscle aches, anorexia, abdominal pain, N+V, malaise ``` SHORT IP

Answer 53

``` Maculopapular rash (chest and stomach) Hepatosplenomegaly Viral Sx: cough, sore throat, abdominal pain, constipation/diarrhoea ``` INT IP

Answer 54

FBE, UEC, LFTs Viral hepatitis serology Thick and thin films