GP Week 1 Flashcards
Exam Prep
Presenting symptoms of breast cancer?
- New breast lump (most common)
- Thickening or ridge
- Breast or nipple asymmetry
- Skin changes (dimpling, redness)
- Nipple changes
- Nipple discharge
- Unilateral breast pain
The triple test refers to what three diagnostic components?
- Medical history and breast examination.
- Imaging; mammography and/ or ultrasound
- Non-excisional biopsy; core biopsy and/ or fine needle aspiration cytology
Risk factors of endometrial cancer.
- History of chronic anovulation.
- Exposure to unopposed oestrogen.
- PCOS
- Exposure to tamoxifen.
- Family Hx Lynch syndrome
- Nulliparity
- Obesity
Investigations for abnormal PV bleeding.
- Pelvic examination
- Bloods, and hormones
- Transvaginal ultrasound
- Endometrial biopsy
- Diagnostic hysteroscopy
- D&C
Treatment options for erectile dysfunction.
1st Line:
Alter modifiable risks and causes.
Facilitate sexual health.
2nd Line:
Oral PDE5 inhibitors.
Counselling and education.
Vacuum devices/ rings.
3rd Line:
Itracavernous vasoactive drug injection.
4th Line:
Surgical treatment ? implant.
Oral PDE5 Inhibitors for erectile dysfunction.
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Sildenafil (Viagra)
Types of lower urinary tract symptoms in men.
- Voiding (obstructive symptoms)
- Storage symptoms
- Complex symptoms.
Voiding or obstructive LUT symptoms in men.
- Hesitancy
- Poor stream.
- Intermittent flow.
- Incomplete emptying.
- Post-void dribbling.
- Overflow incontinence.
Storage LUT symptoms in men.
- Frequency.
- Nocturia.
- Urgency.
- Urgency incontinence.
Complex LUT symptoms in men.
- Haematuria.
- Recurrent UTI
- Acute or chronic urinary retention.
- Urinary incontinence.
Common causes of Storage LUT symptoms in men.
- UTI
- Bladder calculi
- Urothelial carcinoma
- Overactive bladder
Common causes of Voiding (obstructive) LUT symptoms in men.
- Benign prostatic enlargement
- Bladder neck stenosis
- Urethral stricture
- Poor detrusor contractility
Management options of LUTS in older men.
- Watchful waiting.
- Medical management.
- Surgical management.
Medical pharmoacotherapy for LUTS in men.
- Alpha blockers
- Antimuscarinics
- 5 alpha reductase inhibitors
- Combination therapy.
Role of alpha blockers to treat LUTS in men.
- Used to treat voiding/ obstructive symptoms.
2. Block alpha 1A adrenoreceptors to promote prostatic smooth muscle and bladder neck relaxation.
Role of antimuscarinics to treat LUTS in men.
- Used to treat storage symptoms.
2. Inhibits acetylcholines effect on muscarinic M3 receptors and hence reducing detrusor muscle contractions.
Role of 5 alpha reductase inhibitors to treat LUTS in men.
- Use to treat obstructive symptoms.
- They inhibit the enzyme 5 alpha reductase to block the conversion of testosterone into the more potent DHT form.
- This induces prostatic cell apoptosis and thus reduces prostate size.
Surgical treatments for LUTS.
- Ablative - needle ablation, or microwave therapy
2. Cavitating - TURP or laser
Symptoms of prostatitis.
- Dysuria
- Urgent need to urinate.
- Frequent urinating.
- Painful ejaculation.
- Pain, lower back and perineum
- Chills/ fevers
- Muscular pain
- General lack of energy
Investigation in prostatitis.
- DRE
- PSA
- Urinalysis, 1st pass for chlamydia and midstream for M/C/S
1st line treatments for bacterial vaginosis.
- Metronidazole
Usual testing method for suspected bacterial vaginosis.
- Microscopy of vaginal smear.
1st line treatments for candidiasis STI.
- Imidazole
Usual testing method for suspected candidiasis STI.
- Microscopy or culture of vaginal swab.
1st line treatment for first time genital herpes.
- Valaciclovir or aciclovir orally for 5-10 days
1st line treatment for recurrent genital herpes.
- Valaciclovir or aciclovir 3 -5 days, potentially daily for supressive treatment .
Usual testing method for suspected genital herpes.
- Swab lesion for HSV/ syphyilis NAAT
1st line treatment for genital warts.
- Non - pregnant; podophyllotoxin paint or imiquimod
2. Pregnant; cryotherapy
1st line treatment for trichomoniasis.
- Metronidazole, single dose
1st line treatment for chlamydia.
- Azithromycin
1st line treatment of gonorrhoea.
- Ceftriaxone and azithromycin.
1st line treatment of donovanosis.
- Azithromycin.
1st line treatment for syphilis.
- Penicillin.
2. Doxycycline if allergic to penicillin.
Usual testing method for suspected syphilis.
- Serology.
2. Ulcer swab.
1st line treatment for chancroid STI.
- Azithromycin.
1st line treatment for Viral Hepatitis A STI.
- No antiviral therapy available.
- Post exposure prophylaxis within 2 weeks of sexual exposure.
- Normal human immunoglobulin with 2 weeks of sexual exposure.
1st line treatment for Viral Hepatitis B STI.
- Acute infection doesn’t require treatment.
2. Post exposure prophylaxis - Hep B immunoglobulin IM with 72 hours.
1st line treatment for Viral Hepatitis C.
- Interferon and ribavirin.
1st line treatment of pelvic inflammatory disease.
- rule out pregnancy.
- NSAID for pain.
- Intial: Azithromycin oral plus ceftriaxone IM
- Outpatient: Doxycycline or azithromycin plus metronidazole
Contact tracing period for chlamydia.
- 6 months
Contact tracing period for gonorrhoea.
- 2 months
Contact tracing period for syphilis.
- Primary - 3 months plus duration of symptoms.
- Secondary - 6 months plus duration of symptoms.
- Early latent - 12 months
Contact tracing period for HIV.
- Start with recent sexual or injecting partners.
Contact tracing period for HBV and HCV.
- 6 months prior to onset of acute symptoms.
2. Contact public health unit for newly acquired case.
Usual testing methods for gonorrhoea.
- Vaginal swab
- First pass urine
- Throat swabs for sex workers and homosexual males
- Endocervical swabs for sex workers
- Rectal swabs for homosexual males
Usual testing methods for chlamydia.
- Vaginal swab
- First pass urine
- Endocervical swab
- Throat swab for homosexual males
- Rectal swab for homosexual males
Usual testing methods for HBV.
- HBsAg
- Anti - HBc
- Anti - HBs
Usual testing method for HCV.
- HCV Ab
Usual testing method for HIV.
- HIV Ab/Ag
Usual testing method for HAV.
- Anti - HAV Ig total
