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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
Suggest options for smoking cessation
Nicotine replacement patch Varenicline - nicotine receptor partial agonist, 12 week course Bupropion - SNRI, 7-9 week course
26
List ADRs/CIs for varenicline and bupropion
Varenicline - beware in history of depression, suicidal ideation Bupropion - CI with alcohol/benzo withdrawal, bipolar disorder, epilepsy, liver cirrhosis, eating disorder
27
Describe requirements for LTOT
Non smoker pO2 <7.3 or <8 if cor pulmonale/polycythaemia/nocturnal hypoxia/peripheral oedema/pulmonary HTN >16 hrs/day
28
Describe NICE guidance for management of diabetes
1. Lifestyle, diet 2. Metformin 3. + DPP-4 inhibitor/pioglitazone/sulphonylurea/SGLUT-2 inhibitor 4. + GLP OR insulin
29
List ADRs of different hypoglycaemic agents
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
What is the target HbA1c level for diabetics?
Aim 6.5-7% (48-53 mmol/mol)
31
Describe NICE guidance for management of hypertension
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): 1. ACEi/ARB (age <55) OR CCB (>55/black person) 2. ACEi/ARB + CCB 3. ACEi/ARB + CCB + thiazide like diuretic 4. + diuretic, high dose thiazide like diuretic 5. a-blocker OR b-blocker Review annually (other 5 yearly)
32
What is the target blood pressure for hypertension
If <80 - 140/90 | If >80 - 150/90
33
List initial checks a GP should undertake on someone with suspected hypertension
``` ABPM (>135/85) QRISK2 tool (assess CVD risk) Urine dipstick Bloods (glucose, electrolytes, eGFR, creatinine, cholesterol) Funduscopy 12 lead ECG ```
34
Describe NICE guidance for secondary prevention of MI
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
Describe NICE guidance for secondary prevention of stroke/TIA
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
Describe a scoring tool used for assessing tonsiliitis
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
Describe management of tonsillitis
Non drug - avoid social contact, stay away from work, salt water gargle (watchful waiting) Drug - antipyretic analgesia (paracetamol +/- ibuprofen), antibiotics (phenoxymethylpenicillin 10 days)
38
Explain referral criteria for tonsillectomy
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
Describe clinical features and management of molluscum contagiosum
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
List eyelid pathology
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
Describe presentation and management of a stye
CFs - painful lump on/inside eyelid, erythema, eye watering | Mx - analgesia, hot compress
42
Describe presentation and management of a chalazion
CFs - firm, painless lump | Mx - spontaneously resolves, surgical drainage
43
Describe presentation and management of blepharitis
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
List causes for dry eyes
Sjogren's Rheumatoid arthritis Systemic sclerosis
45
Describe the pathophysiology, risk factors and management of thyroid eye disease
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
Describe clinical features and management of corneal abrasion
= 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
Describe the causes, clinical features and management of cataracts
= 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
Describe the classification of cataracts
Nuclear - old age Dot opacities - diabetes Subcapsular - steroid use Polar - inherited
49
List complications of cataract surgery
``` Posterior capsule opacification Posterior capsule rupture Retinal detachment Endophthalmitis (humour inflammation) Anterior uveitis ```
50
List causes of congenital cataracts
``` TORCH Toxoplasmosis Other - syphillis, varicella zoster, parvovirus B19 Rubella CMV Hepatitis, HIV, herpes ```
51
List differentials for a FB sensation in the eye
FB in eye e.g. eyelash Conjunctivitis Entropion Corneal ulcer
52
List differentials for blurred vision
Generalised - cataracts, papilloedema, poor visual acuity | Central - macular degeneration, MS, malignant hypertension, pre-eclampsia
53
List differentials for sudden painless loss of vision
``` Amourosis fugax (GCA) Retinal detachment Vitreous haemorrhage CRVO CRAO ```
54
List differentials for double vision
Cranial nerve pales (SOL) Eye trauma Thyroid eye disease
55
List differentials for patients experiencing colour changes
Digoxin toxicity - yellow vision Ethambutol - colour blindness Fluorescein drops - orange vision
56
Describe the presentation and management of acute angle closure glaucoma
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
Describe the presentation and management of retinal detachment
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
Describe the ophthalmology examination
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
Describe the ear examination
Inspect pinna Examine auditory meatus, tympanic membrane Weber's and Rinne's (512Hz tuning fork) Facial nerve function
60
List risk factors for otitis media
``` URTI Bottle feeding Passive smoking Dummy use Large adenoids Asthma Malformations e.g. cleft palate Reflux High BMI ```
61
Describe the clinical presentation, investigations and management of BPPV
= displacement of otoliths stimulates semicircular canals CFs - attacks last seconds-minutes, provoked by head turning Ix - Dix-Hallpike tests Mx - Epley manœuvres
62
Describe the clinical presentation, investigations and management of Ménière's disease
CFs - sudden attacks of vertigo lasting 2-4hrs, sensorineural hearing loss, ear pressure, nystagmus, +/- tinnitus, +/- nausea and vomiting Ix - clinical diagnosis Mx - prochlorperazine
63
Describe the clinical presentation, investigations and management of labrynthitis/acute vestibular failure
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
Describe the clinical presentation, investigations and management of acoustic neuroma/vestibular schwannoma
CFs - unilateral sensorineural hearing loss, vertigo, tinnitus, impaired facial sensation Ix - MRI head (cerebellopontine angle) Mx - microsurgery
65
List causes and management of epistaxis
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
What is Little's area?
``` LEGS Superior Labial Antetior Ethmoid Greater palatine Sphenopalatine ```
67
What are the borders and contents of the anterior triangle?
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
What are the borders and contents of the posterior triangle?
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
List differentials for a lump in the midline of the neck
Dermoid cyst | Thyroglossal cyst
70
List differentials for a lump in the anterior triangle of the neck
Branchial cyst Cystic hygroma Carotid body tumour
71
List differentials for a submandibular lump
Sialadenitis | Lymphadenopathy

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