GP From another persons deck Flashcards
Name the common differentials for TATT
- VITAMIN DCE
- Anaemia
- Hypothyroidism
- Diabetes
- Depression
- Stress
- Post-viral
- Neoplasm
- Chronic inflammatory conditions
Describe the different types of headache and the main symptoms
Name some signs of iron deficiency anaemia
- Pallor
- Atrophic glossitis
- Angular cheilosis (ulceration in corners of mouth)
- Nail changes
- Longitudinal ridging
- Koilonychia (spoon shaped)
- Tachycardia, murmurs, cardiomegaly, heart failure if severe
Name the categories of anaemia and some examples for each
Microcytic = TAILS
- Thalassaemia
- Iron deficiency
- Sideroblastic anaemia
Macrocytic = FAT RBC
- Folate
- Alcoholism
- B12
- Myelodysplastic syndromes
Which antibiotic for bacterial tonsilitis?
Penicillin / erythromycin (7 days)
Which antibiotic for lower respiratory tract infection?
Amoxicillin or doxycycline (5 days)
Which antibiotic for uncomplicated UTI?
Trimethoprim or nitrofurantoin (3 days)
Which antibiotic for complicated UTI?
Trimethoprim or nitrofurantoin (5 days)
Which antibiotic for UTI in pregnancy?
Nitrofurantoin or Trimethoprim (7 days)
Which antibiotic for cellulitis?
Flucloxacillin (7 days)
Which antibiotic for meningitis?
- Refer to A&E immediately
- IV penicillin before
Describe the appearance and protein content of transudates and exudates
Transudate:
- Clear/pale yellow
- Protein < 30g/L
Exudate:
- Turbid/bloody
- Protein > 30g/L
Name some examples of transudate and exudate
Transudate = failure syndromes
- Heart failure
- Cirrhosis
- Nephrotic syndrome
- Hypothyroidism
- Meig’s
Exudate:
- Infection
- RA/SLE
- Malignancy
- Pancreatitis
- PE
Name some tumour markers in the blood
- Colorectal = CEA
- Ovarian = CA-125
- Pancreatic/bile duct = CA19-9
- Liver/germ cell = AFP
- Prostate = PSA
- Breast = CA27.29 / CA-125
- Germ cell = B-HCG
Name some classes of antibiotics and their mechanism of action
Name some enzyme inducers and inhibitors
Name the cranial nerves
Antibiotic for pyelonephritis?
Co-amoxiclav 14 days
What is a migraine?
Neurovascular disorder in a genetically predisposed (trigeminal network) characterised by episodic unilateral throbbing headache lasting 4-72 hours
- More common in young women
- May be preceded by visual aura
- Increase in serotonin
What are the clinical features of migraine?
- Nausea/vomiting
- Photophobia/Phonophobia/Osmophobia (smell)
- Unilateral (2/3) or bilateral (1/3)
- Behind or along inner angle of eye
- Radiates to occiput or neck
- Dull to throbbing
- May be preceded by focal neurological symptoms
- Aura
- Visual
- Parasthesia
- Hemiparesis
Describe the IHS criteria for migraine
Without aura:
- 4 hours - 3 days
- Nausea/vomiting/photophobia
- 2 of
- Unilateral
- Moderate/severe pain
- Aggravation by physical activity
- Pulsating
With aura (At least 3 of):
- Reversible brainstem/cortical dysfunction
- Aura > 4 mins or 2 auras in succession
- Aura lasts > 60 mins
- Headache < 60 mins after aura
How is acute migraine managed?
- Analgesia with antiemetics (aspirin 1g and metoclopramide 10mg)
- Triptans (sumatriptan/zolmitriptan) = serotonin agonists
- Avoid MAOI, propanolol, SSRI = serotonin syndrome
- Ergotamine tartrate if intolerant to 5-HT agonist
What is the prophylaxis management of migraines?
If at least 2 attacks per month or affecting lifestyle
- Avoid triggers - stress, lack of sleep, hypohylcaemia, exercise, heat etc
- If OCP/HRT - stop if migraine with aura
- Drugs
- Beta blockers
- Amitriptyline
- Verapamil
- Sodium valproate
- Topiramate
- Pizotifen
What are the features of tension headache?
Diffue ‘band-like’ dull headache
- May be accompanied by scalp tenderness
- May be aggravated by noise or light
- Lasts hours to days
- No physcial signs (vomiting, photophobia, throbbing etc)
- Can be exacerbated by analgesic overuse
How is tension headache managed?
If episodic (<15 days a month)
- Physical treatments (massage)
- Simple analgesics (paracetemol, aspirin, NSAIDs)
If chronic (>15 days)
- Amitriptyline
- Avoid chronic analgesics
What are the features of cluster headache?
Severe unilateral orbital/supraorbital/temporal pain lasting 15 mins-3 hours
- Abrupt onset and cessation
- Associated autonomic features (ipsilateral)
- Lacrimation
- Nasal congestion
- Rhinorrhoea
- Facial sweating
- Miosis
- Ptosis
- Eyelid oedema
What is the acute management of cluster headache?
- SC sumatriptan 6mg
- 100% O2 7-12L/min for 20 mins via non-rebreathe
- Topical lidocaine intranasally
- Prednisolone for 5 days
- Methysergide (serotonin antagonist) for 6 months
- Ergotamine 1-2mg PO 1 hour prior to attack
What is the long term management of cluster headaches?
- Verapamil
- Baseline ECG
- Lithium 300mg BD
- Renal and liver function tests
What are the signs of raised intracranial pressure?
- Generalised ache
- Aggravated by bending, coughing, straining
- Worse in morning
- Accompanied by
- Vomiting
- Visual obscurations
- Focal neurological signs
- Papilloedema
- Risk of herniation = coning
What are the features of trigeminal neuralgia?
Sudden and severe unilateral paroxysms of electric shock-like/shooting pain usually in V2/V3 distributions of the trigeminal nerve
- Usual onset after 40
- Attacks last a few seconds, can be several times/min
- Triggers - washing, shaving, cold wind, eating, talking
- Not associated with physical signs
How is trigeminal neuralgia managed?
- Drugs
- Carbamazepine
- Baclofen
- Surgical if intolerable side effects or unresponsive to drugs
- Alcohol injection
- Microvascular depression
- Cryotherapy
What is Idiopathic Intracranial Hypertension (IIH)?
Raised intracranial pressure without hydrocephalus or mass lesion
- Most common in young, overweight women
- Normal CT/MRI
What is infectious mononucleosis? How does it present
EBV infection, usually in children and young adults
- Fever
- Sore throat
- Cervical lymphadenopathy
- Tonsil swelling
- Membranous exudate (greyish)
NB: Diffuse rash with amoxicillin
How is infectious mononucleosis investigated and managed?
- FBC (high lymphocytes)
- Blood film (atypical lymphocytes)
- Monospot/Paul Bunnell test positive (heterophile antibody)
Treat if severe with high dose steroids
Causes and features of malaria
Plasmodium falciparum/vivax/malariae
- Malaise and fatigue
- Fever
- Headache
- Rigors
- Sweating
- Jaundice
- Splenomegaly
How is malaria investigated?
- Blood film (thin and thick)
- FBC
- Glucose
- U&E
- Urine dip (Blood0
How is malaria managed?
- Advice from infectious disease specialist
- Quinine
- Doxycycline
