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General medicine > GP general topics > Flashcards

GP general topics Flashcards

1
Q

Define osteoarthritis

A

Degenerative joints disorder in which there is progressive loss of hyaline cartilage

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2
Q

Risk factors for osteoarthritis

A 
Age
Obesity
Joint abnormality 
Trauma 
Occupation
Bone density
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3
Q

Clinical features of osteoarthritis

A

Affects

  • Knee
  • Hips
  • DIPs ( distal intraphaengal joint)
  • PIPs (proximal intraphaegenal joint)
Bouchards node (prox) 
Herberdens node ( distal) 
Crepitus
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4
Q

Features seen on image in OA

A

Loss of joint space
Osteophytes
Subarticular scleorosis
Subchondrial cyst

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5
Q

Management of OA

A

Conservative

  • Decrease wt
  • Physio
  • Walking aids

Medical

  • Paracetamol
  • NSAIDs ( also topical)
  • Tramadol
  • Steroid injections

Surgical

  • Arthroscopic wash out
  • Arthroplasty
  • Osteotomy
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6
Q

Define rheumatoid arthritis

A

Auto inflammatory condition, reaction of the microcirculation. Movement of the WBC and fluid into the extravascular space.
Pro-inflammatory cytokines

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7
Q

Clinical features of RA

A

4 Classical signs

  • Redness
  • Swelling
  • Hot
  • Pain
Pain will ease on movement 
Stiffness (am)
Swelling
Hot and red
Respond to NSAID's

Arthritis: symmetrical polyarthritis of MCP joints of hands or feet

  • Swann neck
  • Boutonniere
  • Z-thumb
  • Ulnar deviation
  • Dorsal subluxation

Nodules: firm, non tender, mobile or fixed

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8
Q

Features seen on imaging RA

A

Swelling of soft tissues
Osteopenia
Loss of joint space
Deformity of the joint

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9
Q

Management of RA

A

Medical

  • NSAID’s ( be careful of the kidneys)
  • DMARDs ( methotrexate) can cause mylosupression
  • Biologics ( Infliximab)
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10
Q

Define osteoporosis

A

Low bone mass and microarchitecture deterioration of the bones

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11
Q

Risk factors for osteoporosis

A 
SHATTERED
Steroids
Hyperthyroidism 
Alcohol and cigarettes
Thin (BMI<22)
Testosterone levels decrease
Early menopause
Renal/liver failure
Erosive/Inflam bone disease
Dietary Ca decrease (malabsorption)
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12
Q

Management of osteoporosis

A

Conservative

  • Stop smoking, decrease alcohol
  • Wt bearing or balancing exercises
  • Fall prevention assessment

Medical

  • Bisphosphonates
  • Adcal
  • Teriparetide
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13
Q

Classify the different types of diabetes

A

Type I: Autoimmune destruction of the beta cells of the pancreas

Type II: Insulin resistance and beta cell dysfunction ( increased insulin resistance)

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14
Q

Define metabolic syndrome

A 
Central obesity (BMI>30) 
2 of the following 
- BP>130/85
- Triglycerides >1.7mmol/L
- HDL <1.03
- Fasting glucose >5.6mmol/L
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15
Q

Clinical features of diabetes

A

Polyuria
Polydipsia
Decrease weight
Lethary

Type I can present in DKA

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16
Q

Treatment guidelines for HTN

A

1) If under 55 = ACE inhibitor
Black or >55 = CCB

2) Add an ACE inhibitor or thiazide diuretic
3) CCB + ACEi + Thiazide diuretic
4) Add in further diuretic, alpha blocker or beta blocker

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17
Q

Drugs used in the treatment of heart failure

A 
Beta blockers 
Ace inhibitors 
Loop diuretics 
Spironolactone
Digoxin  
Nitrates
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18
Q

Protecting your practise from TB

A
  • Raising awareness: TBAlert publishing TB and making people aware of the symptoms, removing the stigma of TB
  • Contract tracing
  • Vaccinations (only give to at risk indivivduals)
  • Latent TB screening
  • Tackling TB in the underserved and at risk populations
  • Ensuring stafff are aware of how to prevent TB
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19
Q

Challenges of a language barrier

A
  • Poor understanding of the problem
  • Lack of knowledge re other medical conditions
  • Medications misunderstanding
  • Vulnerability in confiding details, relient on other people
  • Frustration from both sides
  • Reduced ability to build rapport.
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20
Q

Use of chaperones in medical appointments

A

A chaperone is present as a safeguard for all parties (patient and practitioners) and is a witness to continuing consent of the procedure.

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21
Q

Discuss the issues that can arise with teenage pregnancies

A
  • Teenage mothers have x3 postnatal depression
  • Infant mortality is 60% higher

-Less likely to finish education
and have an increased risk of poverty, poor housing and lower rates of economic activity

-High cost to the economy linked to teenage pregnancies, includes but not specific to teenage abortion, delivering teenage births and social security

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22
Q

List the different types of consent

A

Implied consent: provided by the behaviour of the patient

Express consent: Anything other than implied consent, may be oral or written

Informed consent: consent must be obtained after a reasonable explanation of the proposed procedure to patient, so that he/she is able to make an informed decision whether to submit or not

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23
Q

Explain Gillick competence and Fraser guidelines

A

Gillick competence refers to prescribing contraceptions in those who are under 16

Fraser Guidelines
- Patient understands his advice ( U16)

  • Patient cannot persuaded to inform her parents or allow the dr to informer parents
  • Patient will continue to have intercourse regardless of if she has contraception or not
  • If she does not receive contraception her mental and physical health will suffer
  • It is in her best interests for her to receive the contraception.
24
Q

Discuss the safeguarding issues raised in dealing with underage sex

A

-Age of consent

-Age of the partner (same age relantionship, age difference)

- Does the partner give you anything( eg drink, drugs, money) in return for sex

- Vulnerable person involve
d
- Under 13 not able to be invovled in a sexual activity = criminal offence, statutory rape

-Over 16 = legally have sex

25
Q

Outline the management for heart failure

A
  1. ACEi and B-blocker ( do not start at the same time)
  2. Aldosterone antagonist
  3. Digoxin

Diuretics are used as symptomatic relief
( loop diuretic)
Offer influenza and pneumococcal vaccine

26
Q

List the effects of BNP

A

Vasodilator
Diuretics and natriuretic
Suppress sympathetic tone and the renin angiotensin aldosterone system

27
Q

Symptoms and signs of heart failure

A

Breathlessness
Reduced exercise tolerance
Oedema
Fatigue

Signs 
Cyanosis 
Tachycardia 
Elevated jugular venous pressure 
Displaced apex beat 
S3 heart sound
28
Q

Define COPD

Differentiate between the pink puffers and the blue bloaters

A

Obstructive airway disease
Consists of chronic bronchitis and emphysema

Pink Puffers

  • Increase alveolar ventilation
  • Near normal PaO2
  • Low PaCO2
  • Progress to Type I reps failure

Blue bloater

  • Decreased alveolar ventilation
  • Low PaO2
  • High PaCO2
  • Cyanosed
  • Resp drive is in sensitive to high Co2 levels
  • Be careful giving O2
29
Q

Investigations to confirm COPD

A

Post bronchodilator spirometry ( assess reversibility and demonstrate airway obstruction)
CXR ( exclude lung cancer)
FBC ( exclude secondary polycythaemia)

30
Q

Management of COPD

A

General

  • Stop smoking
  • Encourage exercise
  • Treat poor nutrition

Medication
1. SABA/SAMA (ipratropium)

Depends on FEV1
A. If FEV1 >50% 
 1) LABA/LAMA
2) LABA + ICS
3) LAMA + ICS + LABA

B. FEV < 50%

1) LABA + ICS OR LAMA+ ICS
2) LABA+ICS +LAMA

Advanced

  • Consider LTOT PaO2< 7.3
  • Pulmonary rehabilitation
  • Mucolytics
31
Q

Management of AF

A

Goal: Rate control and anticoagulation

Rate control:

  • B blocker
  • Ca2+ channel blocker ( Amiodarone)
  • Digoxin **

Rhythm control:
- Cardioversion

Antocoagulation

  • Chronic AF use warfarin
  • INR 2-3

NOTE CHA2Ds2VASc

32
Q

Management of angina

A 
Modify risk factors 
Aspirin ( 75-100mg daily) 
B-Blockers
Nitrate (GTN spray)
Long acting Ca channel blockers ( Amlodopine)
33
Q

Micro-organism that commonly cause infective exacerbations of COPD

A

Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis

34
Q

Management of TIIDM

A 
Aim for HBA1c 48mmol/mol (6.5%)
1. Metformin (500mg BD) 
 if HBA1c > 58mmol/mol 
2. Sulfonylurea ( Gliclazide)
3. Insulin 
4. Glitazone (pioglitazone)
5. Sulfonylurea receptor binders ( nateglinide)
6. Glucagon-like peptide (GLP) analogues (exenatides)
7. DPP-4 inhibitors (sitagliptin)
Mono therapy
if fails dual therapy 
if fails triple therapy 
All with metformin 
Can also consider insulin
35
Q

Outline the difference between impaired glucose tolerance and fasting glucose tolerance

A

IMPAIRED GLUCOSE TOLERANCE

  • Fasting plasma glucose <7mmol/L
  • Oral glucose tolerance 2hr >7.8mmol/L

IMPAIRED FASTING GLUCOSE
- Fasting plasma glucose >6.1mmol/L but <7mmol/L

36
Q

Criteria for diagnosing DMTII

A 
Polyuria
Polydipsia
Unexplained weight loss
Visual blurring 
Genital thrush 
Raised venous glucose 
-Fasting >7mmol/L
- Random >11.1mmol/L
37
Q

Tests for Tired all the time

A 
FBC
ESR/CRP
WCC
LFT and U&amp;E's 
IgA TTG
Thyroid function 
EBV screen
38
Q

Treatment of hyperthyroidism

A

Block and replace

  • Carbimazole ( 20-40mg)
  • Thyroxine

Titration
- Carbimazole
Be aware of neutropenia

Radioiodine

Thyroidectomy

39
Q

Treatment of hypothyroidism

A

Thyroxine

40
Q

Antibodies raised in coeliac disease

Definitive diagnosis of coeliac disease

A

Anti-alpha gliadin
Tissue transglutaminase
Anti-endomysial

Biopsy of the duodenum

  • Sub total villous atrophy
  • Crypt hyperplasia
  • Intraepithelial lymphocytes
41
Q

Treatment of crohn’s attacks

A

Mild Attacks
- Prednisolone 30mg/d

Severe Attacks

  • May require admission
  • Hydrocortisone
  • Metronidazole
  • Infliximab
42
Q

Management of crohns

A

Azothioprine
Methotrexate
Infliximab

43
Q

Management of UC

A

Sulfasalazine
Azathioprine
Infliximab

44
Q

Treatment and prevention of gout

A

Acute Rx:

  • NSAID
  • Colchicine

Prevention

  • Loss weight, avoid triggers
  • Allopurinol ( Xanthine Oxidase inhibitor)

Will see negatively bifrigent needle shaped crystals on polarised light microscopy

45
Q

Signs of venous leg ulcers

A 
Shallow 
Large 
Painless 
Associated with varicose veins and varicose eczema 
Caused by incompetent valves
46
Q

Management of a venous leg ulcer

A 
Measure ABI if <0.8 than it is arterial disease 
Graduated compression bandages 
Cleaning and debridement 
Dressing 
Good skin care ( treat eczema)
47
Q

Signs of an arterial leg ulcer

A

Distal, dorsum of the foot
Clearly defined borders
Grey granulation tissue
Nocturnal pain

48
Q

Management of arterial ulcers

A

Measure ABI if less than <0.8 arterial disease
Modifications of cardiovascular risk factors
Dressings
Anti platelet drug in symptomatic patients

49
Q

List the headache red flags

A 
Early morning vomiting 
Worse on lying down, sneeze or bending over
Papillodema
Seizures 
Focal neurological deficit
50
Q

List the contraindication for starting the pill

A 
Age over 50
BMI >35
Smokers 
Migraine with aura 
Breastfeeding mothers 6 weeks postnatal 
Multiple CV risk factors such as smoking HTN, CVD 
Family hx of breast Ca 
VTE history
Atrial fibrillation 
Past medical hx of stroke 
SLE
51
Q

Emergency contraception options

A

An oral progestogen-only emergency contraceptive (POEC) - levonorgestrel (LNG): Inhibits ovulation
A selective progesterone receptor modulator (SPRM) - ulipristal acetate (UPA: Inhibits or delays ovulation
A copper intrauterine contraceptive device (Cu-IUCD): prevents implantation

52
Q

Outline the 2 week wait guidelines for suspected cancer referrals

A

People with suspected cancer should be seen by a specialist within two weeks of the inital referral being made

53
Q

General management of eczema

A

Emollients (Dermol/Diprbase/E45)
Mild corticosteriods ( Hydrocortisone 15)
Moderate steroid ( betamethasone valerate 0.25%)
Finger tip unit ( amount on one fingertip)

54
Q

Differential diagnosis of a cough

A 
GORD
Asthma 
Heart failure 
Cold 
Pneumonia (CAP/HAP)
TB
55
Q

Reasons for a CXR with a hx of cough

A 
Persistent cough 
Query TB
Ongoing pneumonia 
Weight loss 
Haemotapesis
56
Q

Antibiotics for otitis media

A

Ciprofloxacin (=/- dexamethasone)

4drops each day each ear

General medicine (1 decks)

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