GP / general medicine Flashcards by Katie Pickett

What are the indications for TIPPS (Transjugular intrahepatic portosystemic shunt)

Secondary prophylaxis for oesophageal variceal bleeding
Treatment of refractory ascites
Treating portal hypertension in Budd-Chiari syndrome

How well did you know this?

Not at all

Perfectly

What type of laxative is Senna?

Stimulant laxative
(Bisacodyl and sodium picosulphate are also stimulants)

How well did you know this?

Not at all

Perfectly

What type of laxative is Movicol?

Osmotic laxative
(lactulose, laxido also)

How well did you know this?

Not at all

Perfectly

What type of laxative is docusate?

Poo-softener

How well did you know this?

Not at all

Perfectly

What type of laxative is Fybogel?

Bulk-forming laxative
(also methylcellulose)

How well did you know this?

Not at all

Perfectly

What is the order of laxatives that you try?

Bulk-forming
Osmotic
Stimulant

How well did you know this?

Not at all

Perfectly

What is a common side effect of calcium channel blocker?

Ankle swelling

How well did you know this?

Not at all

Perfectly

When are carpal tunnel symptoms worse?

At night

How well did you know this?

Not at all

Perfectly

What is the most likely cause of an atraumatic vertebral collapse fracture in an elderly man

Metastatic malignancy

How well did you know this?

Not at all

Perfectly

What is the management for an atraumatic vertebral collapse fracture due to metastatic malignancy?

Steroids
+/- surgical decompression if fit for surgery

How well did you know this?

Not at all

Perfectly

Signs of heart failure on a chest x ray: (ABDCE)

Alveolar oedema
(Kerley) B lines
Cardiomegaly
Dilated upper lobe vessels
(pleural) Effusions

How well did you know this?

Not at all

Perfectly

If coeliac isn’t treated with a gluten-free diet, what serious condition can it lead to in the future?

Lymphomas
Small bowel adenocarcinoma

How well did you know this?

Not at all

Perfectly

What is the proper name for tennis elbow?

Lateral epicondylitis

How well did you know this?

Not at all

Perfectly

What is the proper name for golfer’s elbow?

Medial epicondylitis

How well did you know this?

Not at all

Perfectly

Is lateral epicondylitis (tennis elbow) pain worse on pronation or supination of the forearm?

Supination (and extension of the wrist)
Remember:
Putt = pronation
Serve = supination

How well did you know this?

Not at all

Perfectly

Is medial epicondylitis (golfer’s elbow) pain worse on pronatin or supination of the forearm?

Pronation (and flexion of the wrist)
Remember:
Putt = pronation
Serve = supination

How well did you know this?

Not at all

Perfectly

What is CREST syndrome in scleroderma?

Calcinosis (white calcium deposits in pulp of fingers)
Raynaud’s phenomenon
Esophaegeal dysmotility
Sclerodactyly (tight skin across fingers)
Telangiectasia

How well did you know this?

Not at all

Perfectly

What is Morbilliform Eruption?

Maculopapular rash due to EBV + Amoxicillin

How well did you know this?

Not at all

Perfectly

Is episcleritis or scleritis painful?

Scleritis - also has reduced visual acuity. Tender on movement. Most common in middle-aged women.

How well did you know this?

Not at all

Perfectly

What are risk factors for scleritis?

Rheumatoid arthritis
Connective tissue disease

How well did you know this?

Not at all

Perfectly

What is the management of scleritis?

Ophthalmic emergency - requires systemic immunosuppression

How well did you know this?

Not at all

Perfectly

What is the aetiology of episcleritis?

Idiopathic, often in younger patients

How well did you know this?

Not at all

Perfectly

What is tumour lysis syndrome?

Life-threatening condition associated with rapid lysis of cancer cells, generally following chemotherapy.
Particularly high-grade lymphoma and leukaemia

How well did you know this?

Not at all

Perfectly

What are the features of tumour lysis syndrome?

AKI
U&E disturbance (high uric acid, potassium and phosphate, low calcium)
Symptoms: non specific features (e.g. Nausea and D&V, lethargy), tetany cardiac arrhythmias, seizures

How well did you know this?

Not at all

Perfectly

What is the management of tumour lysis syndrome?

Rasburicase - recombinant urate oxidase: metabolises uric acid to allantoin.

What are some antibiotic risk factors for Clostridium Difficile?

Clindamycin Ciprofloxacin Cephalosporins Penicillins

What is the management of Clostridium Difficile infection?

PO vancomycin +/- IV metronidazole if severe infection

What is the most common hereditary thrombophilia?

Factor V Leiden - 1 in 20 people

What are the features of MALT lymphoma?

Helicobacter pylori with gastric MALT (mucosa-associated lymphoma tissue): associated with non-Hodgkin's lymphoma

What is triple therapy?

PPI, Amoxicillin and clarithromycin or metronidazole

Is hereditary spherocytosis autosomal dominant or recessive?

Autosomal dominant. In severe cases it is treated with childhood splenectomy

What is the difference between erysipelas and cellulitis?

Cellulitis involves the dermis and the subcutaneous tissue whereas erysipelas involves the dermis and the upper subcutaneous tissue

What is erysipelas caused by?

Group A beta-haemolytic streptococci

What is management for primary idiopathic autoimmune haemolytic anaemia?

Corticosteroids

How is beta-thalassaemia major managed?

Fortnightly blood transfusions

What autoimmune condition is particularly linked to autoimmune haemolytic anaemia

SLE

What is the treatment for CML?

Imatinib

What is the investigation for osteomyelitis?

Bone biopsy

What is contraindicated with Sildenafil?

Nitrates: they both work in a similar way leading to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work. Can compound and cause death

Which viral infection is associated strongly with Hodgkin's lymphoma?

EBV

What cancer do you find Reed-Sternberg cells?

Hodgkin's lymphoma: they are large cells with bilobed nuclei and eosinophilic nucleoli

Where is the majority of alcohol absorbed in the digestive system?

Proximal small intestine

What is a indirect indicator of the rate of proliferation of non-Hodgkin's lymphoma?

Raised LDH

What is pernicious anaemia?

Autoimmune condition which targets the parietal cells in the stomach that produce intrinsic factor

What is intrinsic factor essential for?

The absorption of vitamin B12 in the terminal ileum

What is a seroma?

A localised accumulation of fluid beneath the skin surface. They commonly occur 7-10 days after surgery.

What is Rovsing's sign

Palpation of the left lower abdomen causes pain in the right lower abdomen (appendicitis)

What is seen on blood film in CLL?

Smudge cells

What is the target INR in recurrent VTE?

3-4

What is given in acute and severe falciparum malaria?

IV artesunate

What happens in refeeding syndrome?

At risk of low phosphate, magnesium and potassium levels as well as hyperglycaemia

What is an ECG feature of hypokalaemia?

prominent U waves

What is an ECG feature of hyperkalaemia?

Flattened P waves

What is sideroblastic anaemia?

When a microcytic anaemia is not responding to iron replacement consider this. Sufficient iron but ineffective erythropoiesis. Causes deposition of iron in multiple organs. Examination of the marrow will reveal ring sideroblasts in the nucleus

What is used in high risk patients for essential thrombocythaemia?

Hydroxyurea

What do you do in any man or woman who isn't menstruating who presents with iron deficiency anaemia with no obvious cause?

2 week wait referral for gastroscopy and colonscopy

What is the mutation associated with Polycythaemia rubra vera?

JAK2

What is the long-term management for a provoked PE?

Apixaban for 3 months

What apart from abuse can cause a subconjunctival haemorrhage in a baby?

Coughing and sneezing

How would you distinguish Menieres and BPPV?

Meniere's has tinnitus and hearing loss whereas BPPV doesn't

What should a patient do if she misses 1 pill on COCP?

Take missed pill along with the pill that is due

What is a factor in a patient's history that is associated with a good prognosis in schizophrenia?

High IQ

What should you do next if you suspect iron deficiency anaemia from a FBC?

Order haematinics

What types of contraception can a woman with current breast cancer use?

Non-hormonal types

GPs have a legal duty of care to anyone who needs emergency help where?

In the practice area

What is the first line management of PCOS for contraception?

COCP

What are the red flags for suspected malignant melanoma?

Asymmetry Border irregularity Colour variation Diameter >6mm Evolves over time

What should women taking the COCP have monitored?

Blood pressure

What are the features of rheumatic fever?

Joint pain Pancarditis Nodules Erythema marginatum Syndenham's chorea (late sign)

What anti-hypertensive drug can cause gynaecomastia?

Spironolactone

How do haemorrhoids often present?

Increased mucous Fresh red bleeding not mixed in with stool Itching

What type of human herpesvirus is chickenpox?

HHV-3

What type of human herpesvirus is EBV?

HHV-4

What type of human herpesvirus is roseola?

HHV-6. Roseola presents with a febrile prodrome and a lace-like rash that starts on the chest and spreads to the limbs. The rash is not itchy

What is a contraindication for ellaOne (Ulipristal acetate)?

Severe asthma due to its antiglucocorticoid effect

What are the symptoms of hypercalcaemia?

Bones Stones Groans and Moans Bone pains Renal stones Abdo discomfort and constipation Poor concentration, mood and fatigue

What is the most common cause of hypercalcaemia?

Primary hyperparathyroidism

What is a febrile non-haemolytic transfusion reaction?

Fever but otherwise well No haemolysis After blood transfusion Paracetamol

What is the karyotype of Klinefelter's?

47XXY

A starry sky appearance on lymph node biopsy is pathognomic for what?

Burkitt's lymphoma

What is Waldenstrom's macroglobulinaemia?

A low-grade lymphoma where monoclonal plasmacytoid lymphocytes in the marrow and organs secrete monoclonal IgM. Clinical features are caused by IgM deposition (hyperviscosity, polyneuropathy, organ infiltration, and pancytopaenia)

What is myelofibrosis?

An uncommon type of bone marrow cancer that disrupts your body's normal production of blood cells. Causes extensive scarring in your bone marrow, leading to severe anaemia that can cause weakness and fatigue

What does the blood film look like in myelofibrosis?

Leukoerythroblastic with massive splenomegaly (nucleated red blood cells, imature neutrophils, tear drop poikilocytes)

What antibiotics are given in neutropenic sepsis?

IV piperacillin with taxobactam

What is eosinophilia with granulomatosis and polyangiitis?

A rare, small vessel vasculitis characterised by late onset asthma and prominent upper resp tract symptoms Typical petechial/purpuric rash, and positive anti-myeloperoxidase antibody

After the initial CAGE questionnaire, what other questionnaire can be used to further assess alcohol intake?

AUDIT (alcohol use disorders identiication test)

Thrombotic thrombocytopenic purpura is associated with a deficiency in what?

ADAMTS-13 (an enzyme that cleaves vWF)

Weakness and difficulty walking which improves with walking should make you suspicious of what?

Lambert-Eaton myasthenic syndrome (LEMS) Often due to small-cell lung cancer

How does Lambert-Eaton myaesthenic syndrome usually present?

In smokers Ascending weakness which improves with use

What are the small cell cancer paraneoplastic syndromes?

SCLC: SIADH Cushing's LEMS Cerebellar degeneration