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GP > GP Week 4 > Flashcards

GP Week 4 Flashcards

Exam Prep

1
Q

Acne treatment - mild comedonal.

A
  1. Topical retinoid
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2
Q

Acne treatment - mild papular/ pustular.

A
  1. Topical retinoid + benzoyl peroxide
    or
  2. Benzoyl peroxide + topical antibiotic
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3
Q

Acne treatment - moderate.

A

Either:
1. Topical retinoid + benzoyl peroxide
or
2. Benzoyl peroxide + topical antibiotic

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4
Q

Acne treatment - moderate to severe.

A

Either:
1. Topical antibiotic + benzoyl peroxide + topical retinoid
or
2. Oral antibiotic + benzoyl peroxide + topical retinoid

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5
Q

Acne treatment - severe.

A
  1. Oral isotretinoin.
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6
Q

Alternative acne treatment - mild to moderate.

A
  1. Salicylic acid.
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7
Q

Alternative acne treatments for females.

A
  1. +/- hormonal treatment to standard treatment regimen
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8
Q

Topical corticosteroid ladder: Mild (Class I)

A
  1. Hydrocortisone 0.5 - 1%
  2. Hydrocortisone acetate 0.5 - 1%
  3. Desonide 0.05%
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9
Q

Topical corticosteroid ladder: Moderate (Class II)

A
  1. Betamethasone
  2. Triamcinolone
  3. Clobetasone
  4. Methylprednisolone
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10
Q

Topical corticosteroid ladder: Strong (Class III)

A
  1. Bethamethasone D
  2. Betamethasone V
  3. Triamcinolone
  4. Momethasone
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11
Q

Topical corticosteroid ladder: Very Strong (Class IV)

A
  1. Betamethasone D (ointment)

2. Halcinonide

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12
Q

Bleach bath regimen for atopic dermatitis.

A
  1. 45 ml household bleach, 4% sodium hypochlorite
  2. Bath oil (2-3 full caps)
  3. 40 L lukewarm water
  4. Bath for 10 minutes and gently soak crusts off
  5. Apply topical steroids before moisturisers
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13
Q

Second line treatment for atopic dermatitis.

A
  1. Topical calcineurin inhibitors

2. (risk of immunosupression)

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14
Q

DDx for atopic dermatitis (atopic eczema).

A
  1. Contact dermatitis
  2. Impetigo
  3. Urticaria
  4. Scabies
  5. Psoriasis
  6. Seborrhoeic dermatitis
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15
Q

The skin barrier hypothesis of atopic dermatitis.

A
  1. Filaggrin gene mutation.
  2. Filaggrin is a protein needed to maintain integrity of epidermis by binding keratinocytes.
  3. Causes skin dysfunction and water loss from the skin.
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16
Q

The immunological hypothesis of atopic dermatitis.

A
  1. Imbalance of T-helper cells with predominance of Th2 cells
  2. Results in an increase of IgE through a pathway involving activation of interleukins.
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17
Q

The 8 clues to malignant skin lesion to support chaos.

A
  1. Grey or Blue structures.
  2. Eccentric structureless area
  3. Thick lines (reticular or branched)
  4. Black dots or clods (peripheral)
  5. Lines radial or pseudopods (segmental)
  6. White lines
  7. Polymorphous vessels
  8. Lines Parallel, ridges (palms and soles) or chaotic (nails)
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18
Q

Risk factors for melanoma.

A
  1. History of previous melanoma.
  2. 50 + moles
  3. Family history of melanoma.
  4. History of many sunburns.
  5. Sun sensitive skin
  6. Increasing age.
  7. Male sex.
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19
Q

Treatment of non- melanoma skin lesion: Surgery.

A
  1. Simple ellipse with primary closure under local.
  2. SCC - 4mm margin
  3. BCC - 3mm margin
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20
Q

Treatment of non- melanoma skin lesion: Cryotherapy

A
  1. Primary BCC away from head and neck
  2. Solar keratosis 5 x 10 seconds
  3. Bowenoid keratosis 3mm margin 30 seconds single freeze
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21
Q

Treatment of non- melanoma skin lesion: Curettage

A

1, Primary BBC deemed suitable

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22
Q

Treatment of non- melanoma skin lesion: Imiquimod

A
  1. BCC

2. Solar keratosis

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23
Q

Major risk factors for osteoporotic fractures: Modifiable

A
  1. Low BMD
  2. Low body weight
  3. Oral glucocorticoid therapy
  4. Increased risk of falls
  5. Cigarette smoking
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24
Q

Major risk factors for osteoporotic fractures: Non-modifiable

A
  1. Age > 65 years
  2. Female sex
  3. Early menopause
  4. Amenorrhoea > 6-12 months
  5. Primary hypogonadism
  6. Previous fragility fracture
  7. Family history of fragility fracture
  8. Slim build
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25
Q

Other significant (not major) risk factors for osteoporotic fractures.

A
  1. Excessive alcohol intake
  2. Sedentary lifestyle
  3. Prolonged immobilisation
  4. Inadequate calcium intake
  5. Vitamin D deficiency
  6. High bone turnover
  7. Secondary causes of osteoporosis.
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26
Q

Garvin Institute fracture risk calculator guiding factors.

A
  1. Age 60 - 96 years
  2. Gender
  3. Weight
  4. BMD T score or BMD
  5. Minimal trauma fracture since age 50 years
  6. Falls in the last six months.
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27
Q

Common medication classes associated with increased falls.

A
  1. Anticholinergics.
  2. Antidepressants.
  3. Antihypertensives.
  4. Antipsychotics.
  5. Benzodiazepines.
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28
Q

Common medications that may weaken bones.

A
  1. Glucocorticoids.
  2. Thyroid hormones.
  3. Heparin.
  4. Antiepileptics
  5. Gonadotrophin- releasing hormone agonists.
  6. Aromatase inhibitors.
  7. Glitazones.
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29
Q

Osteoporosis practice tips: Suspected vertebral fracture.

A
  1. Spine x-ray for:
    a. loss of height > 3 cm
    b. kyphosis
    c. unexplained back pain.
  2. Perform BMD at hip and spine if fractures is detected.
30
Q

Osteoporosis practice tips: Repeat BMD testing

A
  1. Not required unless medication change or interruption.

2. Minimum 2 years apart.

31
Q

Minimal trauma hip or vertebral fracture. Initial treatment.

A
  1. Bisphosphonates
  2. Denosumab
  3. Oestrogen replacement therapy
  4. Strontium (2nd line only)
32
Q

Minimal trauma fracture at any site other than hip or vertebra.: Initial management algorithm.

A
  1. DXA of spine and proximal femur.
  2. T-score < -1.5 = standard initial treatment
  3. T-score > -1.5 = specialist referral
33
Q

Health risks associated with obesity: Cardiovascular

A
  1. Stroke
  2. Coronary heart disease
  3. Cardiac failure
  4. Hypertension.
34
Q

Health risk associated obesity: Endocrine

A
  1. Type 2 DM

2. PCOS

35
Q

Health risk associated obesity: Gastrointestinal

A
  1. Non-alcoholic fatty liver disease
  2. Gallbladder disease
  3. Pancreatic disease
  4. GORD
  5. Cancers
36
Q

Health risk associated obesity: Pulmonary

A
  1. OSA
  2. Obesity hypoventilation syndrome
  3. Asthma
37
Q

Health risk associated obesity: Musculoskeletal

A
  1. OA - (knees)
  2. Spinal disc disorders
  3. lower back pain
  4. Disorders of MSK soft tissue
  5. Foot pain
  6. Mobility disorders
38
Q

Health risk associated obesity: Reproductive health

A
  1. Menstrual disorders
  2. Miscarriage or poor pregnancy outcome
  3. Infertility/ subfertility
  4. Breast cancer (postmenopausal)
  5. Endometrial cancer
  6. Ovarian cancer
39
Q

Health risk associated obesity: Mental health

A
  1. Depression
  2. Eating disorders (binge)
  3. Reduced health - related quality of life
40
Q

Classification of disease risk BMI:

A
  1. 18.5 - 24.9 = Normal
  2. 25 - 29.9 = Overweight
  3. 30 - 34.9 = Obese Class I
  4. 35 - 39.9 = Obese Class II
  5. > 40 = Obese Class III
41
Q

Approved pharmacotherapy for obesity.

A
  1. Orlistat

2. Phentermine

42
Q

Drug class/ action of phentermine.

A
  1. Dopaminergic agonist
43
Q

Drug class/ action of orlistat.

A
  1. Pancreatic and gastric lipase inhibitor.
44
Q

The most common chronic wounds seen in GP are:

A
  1. Leg ulcers (venous, arterial, mixed)
  2. Pressure wounds
  3. Skin tears.
45
Q

Pathophyisology summary of venous ulcer.

A
  1. Essentially breakdown of venous circulation in the leg.
  2. Associated with inability of leg to force blood trough various connecting veins via the bicuspid valve via muscular contraction.
  3. leads to increased venous pressure causing pitting oedema.
  4. Decreases perfusion to the skin that impedes healing if ulcer occurs.
46
Q

T2DM - Biguanides

A
  1. Metformin

2. Metformin XR

47
Q

T2DM - Biguanide MOA

A
  1. Reduces hepatic glucose output

2. Lowers fasting glucose levels

48
Q

Metformin contrainidcations.

A
  1. eGFR < 30

2. Severe hepatic impairment

49
Q

T2DM - Sulfonylureas

A
  1. Glibenclamide
  2. Gliclazide
  3. Glimepiride
  4. Glipizide
50
Q

Sulfonylureas MOA

A
  1. Triggers insulin release in a glucose-independent manner
51
Q

Sulfonylureas contraindications.

A
  1. Severe Renal impairment.

2. Severe Hepatic impairment

52
Q

T2DM - dipeptidyly peptidase -4 inhibitors (DPP-4i)

A
  1. Alogliptin
  2. Linagliptin
  3. Saxagliptin
  4. Sitagliptin
  5. Vildagliptin
53
Q

DPP-4 inhibitor MOA

A
  1. Decreases inactivation of glucagon-like peptide (GLP-1).
  2. Thereby increasing GLP-1 availability.
  3. GLP-1 stimulates beta cell insulin release.
54
Q

DPP-4 inhibitor contraindications.

A
  1. Pancreatitis.
55
Q

T2DM - Thiazolidinediones (TZD)

A
  1. Pioglitazone

2. Rosiglitazone

56
Q

Thiazolidinediones (TZD) MOA

A
  1. Transcription factor PPARy receptor agonist

2. Lowers glucose levels through insulin sensitisation.

57
Q

T2DM - Alpha 1 glucosidase inhibitors.

A
  1. Acarbose
58
Q

Alpha 1 glucosidase inhibitor MOA.

A
  1. Slows intestinal carbohydrate absorption.

2. Reduces postprandial glucose levels.

59
Q

Alpha 1 glucosidase contraindications.

A
  1. eGFR < 25
60
Q

T2DM - Sodium glucose co-transporter 2 inhibitors.

A
  1. Canaglifozin
  2. Dapaglifozin
  3. Empaglifozin
61
Q

What condition and drug class do these belong to?

  1. Canaglifozin
  2. Dapaglifozin
  3. Empaglifozin
A

T2DM - Sodium glucose co-transporter 2 inhibitors.

62
Q

What condition and drug class do these belong to?

  1. Pioglitazone
  2. Rosiglitazone
A

T2DM - Thiazolidinediones (TZD)

63
Q

What condition and drug class do these belong to?

  1. Alogliptin
  2. Linagliptin
  3. Saxagliptin
  4. Sitagliptin
  5. Vildagliptin
A

T2DM - dipeptidyly peptidase -4 inhibitors (DPP-4i)

64
Q

What condition and drug class do these belong to?

  1. Glibenclamide
  2. Gliclazide
  3. Glimepiride
  4. Glipizide
A

T2DM - Sulfonylureas

65
Q

Sodium glucose co-transporter 2 inhibitor MOA.

A
  1. Inhibits sodium glucose co-transporter
  2. Induces urinary glucose loss
  3. Decrease blood glucose levels
66
Q

Sodium glucose co-transporter 2 inhibitor contraindications.

A
  1. eGFR < 60
67
Q

T2DM - Glucagon like peptide 1 receptor (GLP-1) agonist.

A
  1. Exenatide
  2. Liraglutide
  3. Lixisenatide
68
Q

What condition and drug class do these belong to?

  1. Exenatide
  2. Liraglutide
  3. Lixisenatide
A

T2DM - Glucagon like peptide 1 receptor (GLP-1) agonist.

69
Q

Glucagon like peptide 1 receptor (GLP-1) agonist: MOA.

A
  1. Stimulates beta-cell insulin release

2. Slows gastric emptying

70
Q

Glucagon like peptide 1 receptor (GLP-1) agonist contraindications.

A
  1. History of pancreatitis or pancreatic malignancy

GP (7 decks)

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