GP - Misc Flashcards
What is conjunctivitis and what are the causes?
Inflammation of the conjunctiva - thin layer of tissue covering the inside of the eyelids/sclera to provide protection and lubrication
- Bacterial
- Viral
- Allergic
What are the clinical features of bacterial conjunctivitis?
- Red/bloodshot eye
- Itchy/gritty sensation
- Purulent discharge
- Eyes may be ‘stuck together’ in the morning
- Dry cough/sore throat/blocked nose (viral)
NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY
What are the clinical features of viral conjunctivitis?
- Red/bloodshot eye
- Itchy/gritty sensation
- Serous discharge
- Dry cough/sore throat/blocked nose (recent URTI)
- Preauricular lymph nodes
NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY
What are the clinical features of allergic conjunctivitis?
- Red/bloodshot eye
- Itchy/gritty sensation
- Watery discharge/swelling (allergic)
NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY
What is the management for conjunctivitis?
- Usually resolves in 1-2 weeks without treatment
- Hygiene measures
- Bacterial = chloramphenicol/fusidic acid (pregnant) eye drops
- Neonates <1 month = urgent ophthalmology assessment
- Allergic = oral/topical antihistamines, topical mast-cell stabilisers e.g. sodium cromoglicate
What is blepharitis?
Inflammation of the eyelid margins –> lead to red eye/styes/chalazions
What are the clinical features of blepharitis?
- Bilateral sx
- Grittiness/discomfort around eyelid margins
- Sticky eyes in mornings
- Red/swollen eyelid margins
What is the management for blepharitis?
- Hot compress
- Lid hygiene
- Artificial tears
What are styes?
Infections of internal/external eyelid glands
What are the clinical features of styes?
- Small, painful lump on inside of eyelid/around eye
- Swollen/red skin
- May be filled with yellow pus
- Red/watery
- Vision unaffected
What is the management for styes?
- Hot compress
- Analgesia
- Topical abx e.g. chloramphenicol
What is a chalazion, what are the clinical features and what is the management?
- Retention cyst of the Meibomian gland
- Firm, painless lump in the eyelid
- Majority resolve spontaneously
- Surgical drainage
What is an entropion/ectropion, what are the clinical features and what is the management?
- In/out-turning of the eyelids
- Entropion = inward-turning eyelid with lashes pressed against eye/pain/corneal damage and ulceration
- Ectropion = outward-turning eyelid exposing inner aspect/usually affects bottom lid/exposure keratopathy
- Entropion = taping eyelid down/lubricating eye drops/surgery
- Ectropion = lubricating eye drops/surgery
What is trichiasis, what are the clinical features and what is the management?
- Inward growth of the eyelashes
- Pain
- Corneal damage/ulceration
- Remove affected eyelashes
- Recurrent cases = electrolysis/cryotherapy/laser treatment
What is the difference between atopy and allergy?
Atopy = exaggerated IgE-mediated immune response (type I hypersensitivity)
Allergy = any exaggerated immune response to a foreign antigen
What does vitamin D deficiency cause?
Rickets (children)
Osteomalacia (adults)
What are some causes of osteomalacia?
- Vitamin D deficiency (malabsorption/diet/lack of sunlight)
- CKD
- Drugs e.g. anticonvulsants
- Liver cirrhosis
- Coeliac
What are the clinical features of osteomalacia?
- Bone pain
- Bone/muscle tenderness
- Fractures (especially femoral neck)
- Proximal myopathy (waddling gait)
What are the investigations and management for osteomalacia?
- Bloods = low vitamin D/calcium/phosphate and raised alkaline phosphate
- X-ray = translucent bands
- Vitamin D supplementation
- Calcium supplementation
What are the risk factors for rickets?
- Deficiency (diet)
- Prolonged breastfeeding
- Unsupplemented cow’s milk formula
- Lack of sunlight
What are the clinical features of rickets?
- Aching bones/joints
- Bow legs
- Knock knees
- Kyphoscoliosis
- Craniotabes (soft skull bone)
What is the investigation and management for rickets?
- Bloods = low vitamin D/calcium and raised alkaline phosphate
- Oral vitamin D
What are risk factors for osteopenia/osteoporosis?
- Elderly
- Female
SHATTERED:
- Steroid use
- Hyperthyroidism/hyperparathyroidism/hypercalciuria
- Alcohol/tobacco use
- Thin (BMI <18.5)
- Testosterone low
- Early menopause
- Renal/liver failure
- Erosive/inflammatory bone disease
- Dietary low calcium/malabsorption and diabetes type 1
What are the investigations for osteopenia/osteoporosis?
- FRAX (major osteoporotic/hip fracture in next 10 years)
- DEXA scan = BMD = Z score and T score
T score > -1 = normal
T score -1 to -2.5 = osteopenia
T score < -2.5 = osteoporosis
What is the management for osteopenia/osteoporosis?
- Lifestyle changes
- Vitamin D/calcium supplementation
- Bisphosphonates (alendronate/risedronate/zoledronate) = take with full glass of water on empty stomach and remain upright for at least 30 mins after
- Denosumab
- HRT
What are the causes of otitis externa?
- Bacterial (staph aureus/pseudomonas aeruginosa)
- Fungal
- Seborrhoeic dermatitis
- Contact dermatitis
- Recent swimming = trigger
What are the clinical features and investigations for otitis externa?
- Ear pain/itch
- Ear discharge
- Otoscopy = red/swollen/eczematous canal
What is the management for otitis externa?
- Topical abx +/- steroid
- Ciprofloxacin/flucloxacillin/clarithromycin
What are the causes of otitis media?
- Bacterial (strep pneumoniae/haemophilus influenzae/moraxella catarrhalis)
- Viral (RSV/rhinovirus)
What are the clinical features of otitis media?
- Otalgia
- Fever
- Reduced hearing in affected ear
- URTI sx
- Discharge (perforated TM)
What is the investigation for otitis media?
Otoscopy:
- Bulging TM (loss of light reflex)
- Opacification/erythema of TM
- Perforation with purulent otorrhoea
What is the management for otitis media?
- Usually self-limiting
- Abx = 5-7 day course of amoxicillin/erythromycin/clarithromycin
What are the complications of otitis media?
- Otitis media with effusion (glue ear)
- Hearing loss
- Perforated eardrum
- Mastoiditis
- Abscess
What are the causes of tonsilitis?
- Viral
- Bacterial (strep pyogenes/strep pneumoniae/haemophilus influenzae/moraxella catarrhalis/staph aureus)
What area is affected in tonsilitis and what are the clinical features?
- Palatine tonsils
- Sore throat
- Fever
- Painful swallowing
What are the investigations for tonsilitis?
- Throat examination = red/inflamed/enlarged tonsils +/- exudate
- Anterior cervical lymphadenopathy
What criteria is used for tonsilitis?
Centor criteria = estimates risk of bacterial infection (2 or more)
- Fever
- Tonsillar exudates
- Absence of cough
- Tender anterior cervical lymphadenopathy
- Under 15
What is the management for tonsilitis?
- Analgesia/safety net advice
- Abx = phenoxymethylpenicillin/clarithromycin
What are the indications for a tonsillectomy?
- Sore throats due to tonsilitis
- 7 episodes per year for one year/5 per year for two years/3 per year for 3 years
- Episodes of sore throat are disabling/prevent normal functioning
What are the complications of tonsilitis?
- Otitis media
- Quinsy (peritonsillar abscess)
- Rheumatic fever
- Glomerulonephritis
What are the causes of tinnitus?
- Idiopathic (most common)
- Meniere’s disease
- Otosclerosis
- Sudden onset sensorineural hearing loss
- Acoustic neuroma
- Hearing loss
- Drugs (aspirin/NSAIDs/aminoglycosides/loop diuretics/quinine)
- Impacted ear wax
What is the management for tinnitus?
- Treat underlying cause
- Amplification device
- CBT
- Support groups
What is the cause of mumps/parotitis?
RNA paramyxovirus
What are the clinical features of mumps/parotitis?
- Fever
- Muscles aches
- Lethargy
- Parotid gland swelling with associated pain
What are the investigations for mumps/parotitis?
- PCR testing on saliva swab
- Bloods/saliva tested for antibodies
What is the management for mumps/parotitis?
- Notify public health
- Usually self-limiting
- MMR vaccine
What are the complications of mumps/parotitis?
- Pancreatitis
- Orchitis
- Meningitis/encephalitis
- Sensorineural hearing loss
What is the triad of clinical features of nephrotic syndrome vs nephritic syndrome?
Nephrotic = proteinuria, hypoalbuminaeia, oedema
Nephritic = proteinuria, haematuria, oliguria, HTN
What is the most common cause of nephrotic syndrome and what is the management?
- Minimal change disease
- High dose steroids
- Alternative immunosuppressant e.g. ciclosporin
What is the cause of chlamydia?
Chlamydia trachomatis - gram -ve bacteria
What is the cause of gonorrhoea?
Neisseria gonorrhoea - gram -ve diplococcus
What are the investigations for STIs?
- First catch urine for NAAT
- Urethral swab for culture
What follow up is required for patients with STIs?
Test of cure
What is the cause of syphilis?
Treponema pallidum - spirochete
What investigations can be done for syphilis?
VDRL - present in active infection
TPHA - present after treatment to confer immunity
What is the management for Wilson’s disease?
Copper chelating agent e.g. penicillamine
What are sanctuary sites?
Sites protected from chemotherapeutic agents
- CNS
- Testes
What are the stages of CKD?
- Stage 1 = >90
- Stage 2 = 60-89
- Stage 3a = 45-59
- Stage 3b = 30-44
- Stage 4 = 15-29
- Stage 5 = <15
What are the stages of AKI?
- Stage 1 = creatinine is 1.5-1.9 times higher than baseline/urine output <0.5ml/kg for >6 consecutive hours
- Stage 2 = creatinine is 2-2.9 times higher than baseline/urine output <0.5ml/kg for >12 consecutive hours
- Stage 3 = creatinine is >3 times higher than baseline/urine output <0.5ml/kg for >24 hours/anuria for >12 hours
What medications can cause AKI?
- NSAIDs
- ACEis
- ARBs
- CCBs
- Alpha blockers
- Beta blockers
- Opioids
- Diuretics
- Aciclovir
- Trimethoprim
- Lithium
What is the typical presentation of ischaemic hepatitis?
Liver failure following MI
What medication is given for pain in palliative care?
- Diamorphine/morphine
- Oxycodone (if renal impairment)
What medication is given for distress/agitiation/breathlessness in palliative care?
Midazolam/haloperidol
What medication is given for respiratory tract secretions/bowel spasm in palliative care?
Buscopan (hyoscine butylbromide)
What medication is given for N+V in palliative care?
Haloperidol/metoclopramide
What are some causes of falls?
- Orthostatic hypotension
- POTS
- Anaemia
- Arrhythmias
- Epilepsy
- Peripheral neuropathy
- Ataxia/cerebellar disease
- Vision problems
- Drug induced e.g. antihypertensives
What medication is given in orthostatic hypotension?
Fludrocortisone/midodrine
How can falls risk be reduced in orthostatic hypotension?
- Stay hydrated
- Compression stockings
- Stand up slowly
- Increased salt intake
- Exercise
