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Phase 2 > GP & Special Senses > Flashcards

GP & Special Senses Flashcards

1
Q

What is VITAMIN CDE?

A 
Vascular
Iatrogenic
Trauma
Autoimmune
Metabolic
Infective
Neoplasic
Congenital
Degenerative
Environmental
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2
Q

List different management options available (RAPRIOP)

A

Reassurance and explanation - ICE, of diagnosis
Advice - self care, OTC management
Prescription - ADRs
Referral - emergency (hospital), 2WW
Investigations - prove diagnosis
Observation - follow up, natural history
Prevention and health Promotion - smear test, smoking cessation, weight loss

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3
Q

Describe how to take a dermatology history

A

HPC - initial appearance and evolution, associated symptoms (itch, discharge, pain, bleeding), aggravating and relieving factors
PMH - atopy, autoimmunity, arthritis, skin cancer, suspicious skin lesions
DH - treatments for current problem, drug rash
FH - skin cancer
SH - occupation, exposure to irritants, travel, history of sunburn/tanning machines, stressful events, illness
QoL impact

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4
Q

Describe how to examine a dermatological lesion

A

Expose
Inspect:
General observation
Site
Number of lesions - distribution (multiple/localised/generalised, discrete/confluent, flexural/extensural), configuration (linear, target, ring, coin)
Describe:
Morphology - configuration, raised (papules/nodules), flat (macules)
Margin
SSCAM - size, shape, colour, associated changes (scaling, discharge, excoriation, lichenification, crust, fissures), morphology/margin
Palpate:
Surface, consistency, mobility, tenderness, temperature
Systemic check:
General examination, nails, scalp, hair, mucous membranes

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5
Q

List functions of the skin

A 
Protective layer
Temperature regulation
Vitamin D synthesis
Sensation
Immunosurveillance
Appearance/cosmetics
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6
Q

Describe the layers of the skin

A
  1. Epidermis
    Stratum basale - keratinocytes, melanocytes, Merkel cells
    Stratum spinosum - desmosomes, langerhan’s cells
    Stratum granulosum - keratinohyalin granules –> lipid layer
    Stratum lucidum
    Stratum corneum - continuously slough off
  2. Dermis
    Papillary - blood vessels, nerve endings, lymph, immune cells
    Reticular - glands, hair follicles, erector pili
  3. Hypodermis/subcutaneous fat
    Fat, nerves
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7
Q

Describe different types and growth cycles of hair

A

Lanugo - fine, long (fetus)
Villus - fine, short (on all body surfaces)
Terminal - coarse, long (scalp, eyebrows, eyelashes, pubic)
Anagen - long growing
Catagen - short, regressing
Telogen - resting/shedding

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8
Q

Describe the stages of wound healing

A
  1. Haemostasis - vasoconstriction, platelet aggregation, clot formation
  2. Inflammation - vasodilation, migration of neutrophils/macrophages, phagocytosis of debris/bacteria
  3. Proliferation - granulation tissue formation, angiogenesis, re-epitheliasation
  4. Remodelling - collagen fibre reorganisation, scar maturation
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9
Q

Explain the ABCDE symptoms of a skin lesion

A 
Asymmetry 
Border irregular
Colour >2
Diameter >6mm
Evolving - change

Other symptoms e.g. pain, itching, bleeding
>3 = urgent referral

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10
Q

Describe different types of skin cancer

A

BCC - nodular/superficial/cystic/morphoeic/keratotic, telangiectasia, ulcer with pearly rolled edge. Routine referral, does not metastasise.
SCC - poorly differentiated nodule, may ulcerate, keratotic (scaly/crusty) surface. Has potential to metastasise.
MM - superficial spreading/nodular/lentigo maligna/acral lentinous
Bowen’s disease - early SCC, red scaly patch on skin

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11
Q

Describe the history, common site, lesion, associated features, investigations and management of a venous ulcer

A

History - painful, worse on standing, history of venous disease e.g. varicose veins, DVT
Common site - malleolar area (medial > lateral)
Lesion - large, shallow, irregular ulcer, exudative, granulating base
Associated features - warm skin, normal pulses, leg oedema, pigmented skin, lipodermatosclerosis
Investigations - ABPI normal (0.8-1)
Management - compression banding

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12
Q

Describe the history, common site, lesion, associated features, investigations and management of an arterial ulcer

A

History - painful at night, when legs are elevated, history of arterial disease e.g. atherosclerosis
Common sites - pressure/trauma sites, distal points e.g. toes
Lesion - small, sharply defined, deep ulcer, necrotic base
Associated features - cold skin, weak/absent peripheral pulses, shiny pale skin, hair loss
Investigations - ABPI <0.8, Doppler studies, angiogram
Management - vascular reconstruction

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13
Q

Describe the history, common site, lesion, associated features, investigations and management of a neuropathic ulcer

A

History - painless, history of diabetes or neurological disease
Common sites - pressure sites e.g. soles, heels, toes, metatarsal heads
Lesion - variable size/depth, granulating base, hyperkeratotic lesion
Associated features - warm skin, normal peripheral pulses, peripheral neuropathy
Investigations - ABPI <0.8, X-ray for osteomyelitis
Management - wound debridement, regular repositioning, appropriate footwear, diet

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14
Q

Describe different dermatology management options

A

RAPRIOP
Medical - topical/systemic (steroids, tar, retinoids)
Physical - bandaging, cryotherapy, phototherapy, laser

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15
Q

What advice should be given to patient’s regarding sun exposure

A 
SMART/slip-slap-slop
Shade between 1100-1500
Make sure you never burn 
Aim to slip on a tshirt, slap on a hat, slop on sun cream and wear sunglasses 
Remember extra care with children 
Then SPF 30+
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16
Q

Describe the composition of each epidermal layer of skin

A

Stratum corneum (horny) - layers of keratin, most superficial, dead, continuously sloughs off
Stratum lucidum - paler, compact keratin, lost nuclei/organelles, dead
Stratum granulosum (granular) - lost nuclei, contain granules of keratinohyalin, secrete lipid into intercellular spaces
Stratum spinosum (prickle)
- differentiating cells, langerhan’s cells
Stratum basale (basal) - actively dividing cells, keratinocytes, melanocytes, deepest layer

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17
Q

Describe some pathology that may occur in the epidermis

A

Changes in epidermal changeover time - psoriasis (reduced turnover time)
Changes in surface of skin/loss of epidermis - scales, crusting, exudate, ulcer
Changes in pigmentation of skin - hypo (vitiligo)/hyper

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18
Q

Describe some pathology that may occur in the dermis

A

Changes in contour of skin/loss of dermis - papules, nodules, skin atrophy, ulcers
Disorders of skin appendages - hair, acne
Changes related to lymph/blood vessels - erythema, urticaria, purpura

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19
Q

Describe some pathology of hair

A

Reduced/absent melanin pigment production - grey/white hair
Changes in duration of growth cycle - hair loss (premature entry in telogen phase)
Shaft abnormalities

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20
Q

Describe some nail pathology

A

Abnormalities of nail matrix - pits, ridges
Abnormalities of nail bed - splinter haemorrhages
Abnormalities of nail plate - discolouration, thickening

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21
Q

Describe NICE guidance for management of asthma

A
  1. SABA e.g. salbutamol
    • ICS e.g. beclomethasone
    • LTRA e.g. montelukast
    • LABA (+/- LTRA)
  5. ICS + MART (formoterol) (+/- LTRA)
  6. increased ICS + MART (+/- LTRA)
  7. high dose ICS + SABA OR LAMA/theophylline
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22
Q

List ADRs of a SABA, ICS and theophylline

A

SABA - tremor, tachycardia, *DDI with B-blockers
ICS - oral thrush
Theophylline - psychomotor agitation

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23
Q

Describe NICE guidance for management of COPD

A
  1. Smoking - history, cessation
  2. Vaccinations - pneumococcal, influenza
  3. Pulmonary rehabilitation - if >MRC dyspnoea grade 3
  4. Inhaled therapy - SABA/SAMA –> + LABA/LAMA –> LABA + ICS OR LABA + LAMA
  5. Oral therapy - corticosteroid, mucolytics, theophylline
  6. Oxygen therapy - short burst/LTOT
  7. Physiotherapy
  8. Combined oral and inhaled therapy - B-agonist/anticholinrgic + theophylline
  9. Surgery - bullectomy, lung volume reduction surgery, transplant
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24
Q

Describe the MRC dyspnoea scale

A
  1. Not breathless except on strenuous exercise
  2. SOB when hurrying or walking up a slight hill
  3. Walks slower than contemporaries or has to stop for breath when alone
  4. Stops after 100m or a few minutes on level ground
  5. Too breathless to leave house or SOB when un/dressing
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25
Q

Suggest options for smoking cessation

A

Nicotine replacement patch
Varenicline - nicotine receptor partial agonist, 12 week course
Bupropion - SNRI, 7-9 week course

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26
Q

List ADRs/CIs for varenicline and bupropion

A

Varenicline - beware in history of depression, suicidal ideation
Bupropion - CI with alcohol/benzo withdrawal, bipolar disorder, epilepsy, liver cirrhosis, eating disorder

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27
Q

Describe requirements for LTOT

A

Non smoker
pO2 <7.3 or <8 if cor pulmonale/polycythaemia/nocturnal hypoxia/peripheral oedema/pulmonary HTN
>16 hrs/day

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28
Q

Describe NICE guidance for management of diabetes

A
  1. Lifestyle, diet
  2. Metformin
    • DPP-4 inhibitor/pioglitazone/sulphonylurea/SGLUT-2 inhibitor
    • GLP OR insulin
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29
Q

List ADRs of different hypoglycaemic agents

A

Metformin - GI disturbance, CI in patients with heart/renal hepatic failure due to risk of lactic acidosis
DPP-4 inhibitors - GI disturbance *expensive, weight neutral
TZDs - weight gain, oedema, osteoporosis, bladder cancer, CI in heart failure *no fine glycaemic control, heavily bound by plasma proteins
Sulphonylurea - GI disturbance, weight gain, hypoglycaemia
SGLUT-2 inhibitor - LUTI symptoms

30
Q

What is the target HbA1c level for diabetics?

A

Aim 6.5-7% (48-53 mmol/mol)

31
Q

Describe NICE guidance for management of hypertension

A
  1. Lifestyle - low salt diet, exercise, lower alcohol intake, stop smoking
  2. Antihypertensives (if <80 years with stage 1 and end organ damage/QRISK >20% OR any age with stage 2):
  3. ACEi/ARB (age <55) OR CCB (>55/black person)
  4. ACEi/ARB + CCB
  5. ACEi/ARB + CCB + thiazide like diuretic
    • diuretic, high dose thiazide like diuretic
  7. a-blocker OR b-blocker
    Review annually (other 5 yearly)
32
Q

What is the target blood pressure for hypertension

A

If <80 - 140/90

If >80 - 150/90

33
Q

List initial checks a GP should undertake on someone with suspected hypertension

A 
ABPM (>135/85)
QRISK2 tool (assess CVD risk)
Urine dipstick
Bloods (glucose, electrolytes, eGFR, creatinine, cholesterol)
Funduscopy
12 lead ECG
34
Q

Describe NICE guidance for secondary prevention of MI

A
  1. Lifestyle advice - smoking, diet, exercise, weight, alchol
  2. Cardiac rehabilitation (+ stress, depression, anxiety)
  3. Drug treatment - ACEi, aspirin, b-blocker, clopidogrel, statin
  4. Further advice - assess LV function/HF, bleeding risk, coronary revascularisation, return to work/sexual activity/driving, assess erectile dysfunction (PDE5i)
35
Q

Describe NICE guidance for secondary prevention of stroke/TIA

A
  1. Lifestyle - physical activity, smoking, diet, alcohol
  2. Review medication - anti platelet therapy (clopidogrel), lipid modification (atorvastatin 20-80mg OD), anti hypertensive (thiazide like diuretic/CCB/ACEi), anticoagulant (warfarin 2.0-3.0)
  3. Optimise comorbidity mangement (diabetes, sleep apnoea, HF)
36
Q

Describe a scoring tool used for assessing tonsiliitis

A

CENTOR - identify the likelihood of a bacterial infection in an adult complaining of a sore throat:
Tonsillar exudate, tender anterior cervical lymphadenopathy, fever (>38) by history, absence of cough –> 3 or 4 = will benefit from ABx
FEVERPAIN - predicts likelihood of strep. throat:
Fever in past 24h, Purulent tonsils, Attend rapidly (<3 days), Inflammation of tonsils, No cough –> 4 = consider ABx

37
Q

Describe management of tonsillitis

A

Non drug - avoid social contact, stay away from work, salt water gargle (watchful waiting)
Drug - antipyretic analgesia (paracetamol +/- ibuprofen), antibiotics (phenoxymethylpenicillin 10 days)

38
Q

Explain referral criteria for tonsillectomy

A

Recurrent tonsillitis (>5 per year for at least one year)
Severe enough to disrupt normal behaviour or day to day functioning
Guttatte psoriasis exacerbated by tonsillitis
History of sleep apnoea, daytime drowsiness, failure to thrive

39
Q

Describe clinical features and management of molluscum contagiosum

A

Usual onset - children (1-10 years)
Appearance - small (2-5mm), <30 pearly white/pink lumps, clusters, often trunk/flexures
Transmission - direct skin contact, infected surface, auto inoculation
Duration - 6-12 months, up to four years
Management - reassurance (self limiting), salicylic acid, retinoid, cimetidine, cryotherapy, curettage

40
Q

List eyelid pathology

A

Stye (hardeolum) = infection of sebum/sweat gland
Chalazion (Meibomian cyst) = retention cyst of Meibomian gland
Entropion - in-turning of eyelids
Ectropion - out-turning of eyelids
Blepharitis = inflammation of eyelid margins due to meibomian gland dysfunction/suborrhoeic dermatitis/staph. infection

41
Q

Describe presentation and management of a stye

A

CFs - painful lump on/inside eyelid, erythema, eye watering

Mx - analgesia, hot compress

42
Q

Describe presentation and management of a chalazion

A

CFs - firm, painless lump

Mx - spontaneously resolves, surgical drainage

43
Q

Describe presentation and management of blepharitis

A

CFs - bilateral, grittiness, discomfort around margins, sticky eyes in the morning, red margins, swollen eyelids, styes/chalazion common, secondary conjunctivitis
Mx - BD hot compress, mechanical removal of lid margin debris (lid hygiene with cotton wool buds), artificial tears

44
Q

List causes for dry eyes

A

Sjogren’s
Rheumatoid arthritis
Systemic sclerosis

45
Q

Describe the pathophysiology, risk factors and management of thyroid eye disease

A

Pathophysiology - autoimmune response to TSH receptor –> retro-orbital inflammation –> GAG/collagen deposition in muscles
RFs - smoking, radio iodine treatment
Mx - topical lubricants, steroids, radiotherapy, surgery

46
Q

Describe clinical features and management of corneal abrasion

A

= defect in corneal epithelium
CFs - eye pain, photophobia, fall in visual acuity, FB sensation, conjunctival infection
Ix - fluorescein stain with blue light
Mx - topical ABx drops

47
Q

Describe the causes, clinical features and management of cataracts

A

= lens of the eye gradually opacifies, leading to reduced/blurred vision and blindness
Causes - increased age, smoking, alcohol, trauma, diabetes, corticosteroids, radiation
CFs - reduced vision, faded colour vision, glare, halos around lights, defect in red reflex
Mx - stronger glasses, brighter lights (non surgical), surgery

48
Q

Describe the classification of cataracts

A

Nuclear - old age
Dot opacities - diabetes
Subcapsular - steroid use
Polar - inherited

49
Q

List complications of cataract surgery

A 
Posterior capsule opacification
Posterior capsule rupture
Retinal detachment
Endophthalmitis (humour inflammation)
Anterior uveitis
50
Q

List causes of congenital cataracts

A 
TORCH
Toxoplasmosis
Other - syphillis, varicella zoster, parvovirus B19
Rubella
CMV
Hepatitis, HIV, herpes
51
Q

List differentials for a FB sensation in the eye

A

FB in eye e.g. eyelash
Conjunctivitis
Entropion
Corneal ulcer

52
Q

List differentials for blurred vision

A

Generalised - cataracts, papilloedema, poor visual acuity

Central - macular degeneration, MS, malignant hypertension, pre-eclampsia

53
Q

List differentials for sudden painless loss of vision

A 
Amourosis fugax (GCA)
Retinal detachment
Vitreous haemorrhage
CRVO
CRAO
54
Q

List differentials for double vision

A

Cranial nerve pales (SOL)
Eye trauma
Thyroid eye disease

55
Q

List differentials for patients experiencing colour changes

A

Digoxin toxicity - yellow vision
Ethambutol - colour blindness
Fluorescein drops - orange vision

56
Q

Describe the presentation and management of acute angle closure glaucoma

A

CFs - severe ocular pain/headache, decreased visual acuity, hard red eye, halos around lights, semi dilated non reacting pupil, hazy cornea (corneal oedema)
Mx - immediate referral to ophthalmology –> acetazolamide, pilocarpine

57
Q

Describe the presentation and management of retinal detachment

A

CFs - 4Fs (Flashes, Floaters, loss of visual Fields, Fall in visual acuity), veil/curtain loss of vision, straight lines appear curved, central vision loss
Mx - immediate referral to ophthalmology –> surgery (vitrectomy, scleral buckling, pneumatic retinopexy)

58
Q

Describe the ophthalmology examination

A

Look - ptosis, pupil size
Visual acuity - Snellen chart (+/- pinhole)
Colour vision - Ishihara plates
Visual fields (+ blind spot testing)
Extraocular movements
Pupil reflexes
Pupil accommodation
Swinging light test
Ophthalmoscopy - red reflex, vessels, optic disc
Slit lamp examination + tonometry - intraocular pressure (normal = 11-21 mmHg)

59
Q

Describe the ear examination

A

Inspect pinna
Examine auditory meatus, tympanic membrane
Weber’s and Rinne’s (512Hz tuning fork)
Facial nerve function

60
Q

List risk factors for otitis media

A 
URTI
Bottle feeding
Passive smoking
Dummy use
Large adenoids
Asthma
Malformations e.g. cleft palate
Reflux
High BMI
61
Q

Describe the clinical presentation, investigations and management of BPPV

A

= displacement of otoliths stimulates semicircular canals
CFs - attacks last seconds-minutes, provoked by head turning
Ix - Dix-Hallpike tests
Mx - Epley manœuvres

62
Q

Describe the clinical presentation, investigations and management of Ménière’s disease

A

CFs - sudden attacks of vertigo lasting 2-4hrs, sensorineural hearing loss, ear pressure, nystagmus, +/- tinnitus, +/- nausea and vomiting
Ix - clinical diagnosis
Mx - prochlorperazine

63
Q

Describe the clinical presentation, investigations and management of labrynthitis/acute vestibular failure

A

CFs - sudden attacks of vertigo lasting 24h-1 week, unilateral vertigo, vomiting, history of recent URTI, nystagmus away from affected side
Mx - vestibular rehabilitation exercises

64
Q

Describe the clinical presentation, investigations and management of acoustic neuroma/vestibular schwannoma

A

CFs - unilateral sensorineural hearing loss, vertigo, tinnitus, impaired facial sensation
Ix - MRI head (cerebellopontine angle)
Mx - microsurgery

65
Q

List causes and management of epistaxis

A

Causes - local trauma (nose picking), facial trauma, dry/cold weather, haemophilia, septal perforation
Management:
1. Pinch lower part of nose for 20 mins, sit forward with mouth open
2. Ice pack on dorsum of nose
3. Silver nitrate cautery
4. Anterior nasal pack e.g. rapid rhino/nasal tampons)
5. Postnasal pack/foley urinary catheter
6. EAU/arterial ligation/embolisation

66
Q

What is Little’s area?

A 
LEGS
Superior Labial
Antetior Ethmoid
Greater palatine
Sphenopalatine
67
Q

What are the borders and contents of the anterior triangle?

A

Borders - midline of neck + anterior border of SCM + ower border of mandible
Contents - suprahyoid muscles, infrahyoid muscles, common carotid artery (bifurcates to external/internal carotid), internal jugular vein, facial, glossopharyngeal, vagus, spinal accessory and hypoglossal cranial nerves

68
Q

What are the borders and contents of the posterior triangle?

A

Borders - posterior border of SCM + anterior border of trapezius + middle 1/3 of clavicle
Contents - omohyoid muscle, external jugular vein, subclavian vein, transverse cervical, suprascapular veins and arteries, spinal accessory nerve, phrenic nerve, brachial plexus

69
Q

List differentials for a lump in the midline of the neck

A

Dermoid cyst

Thyroglossal cyst

70
Q

List differentials for a lump in the anterior triangle of the neck

A

Branchial cyst
Cystic hygroma
Carotid body tumour

71
Q

List differentials for a submandibular lump

A

Sialadenitis

Lymphadenopathy

Phase 2 (11 decks)

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