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Year 4C - GP > Julia GP Collated > Flashcards

Julia GP Collated Flashcards

1
Q

What is Trichomonas Vaginalis?

A

T vaginalis infection is the most common nonviral STD in the world.

Many patients (20-50%) are asymptomatic.

If discharge is present, it is usually copious and frothy and can be white, gray, yellow, or green (the yellow and green colors are due to the presence of white blood cells [WBCs]). Local pain and irritation are common.

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2
Q

What are the risk factors of OP?

A

Epidemiological / Anthrolpological Risk Factors

  • Female
  • Older age
  • Early-onset menopause / menopause
  • Low BMI
  • Immobilisation

Lifestyle Risk Factors

  • ETOH
  • Smoking
  • Low calcium intake
  • Low vitamin D intake
  • Inadequate sun exposure

Medications / Disease Processes Risk Factors

  • Steroids
  • Anti-convulsants
  • HRT (protective)
  • Endocrine disorders:
    *Cushings
    *HyperPTH
    *Hyperthyroidism
  • Other disorders:
    *CKD
    *CLD
    *MM
    *Hysterectomy
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3
Q

What is a T score?

What is a Z score?

Which is used for the diagnosis of OP?

What is the other used for?

A

A T score is the number of standard deviations from the BMD of a young healthy adult (30 y.o.)

A Z score is the number of SDs you are from the BMD of someone your age and sex.

A T score is used in the diagonsis of osteopenia / osteoporosis

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4
Q

How do you diagnose OP and osteopenia?

A

DEXA scan

T score between -1 and -2.5 = osteopenia

Z score less than -2.5 = OP

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5
Q

what might artefactually increased BMD on a DEXA scan?

A

OA

Fracture

Deformity

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6
Q

What are the differential diagnoses of pathalogical fractures?

A

‘MR PPP MMM’

Malacia (Adults) / Rickets (Paeds) - vitamin D not mineralizing bone

Porosis / Penia - osteoclastic reabsorption of bony architecture

Pagets - abnormal osteoclasts, intense resorption of bone

Parathyroidism - primary, secondary

Malignant invasion - (think of hexagon: thyroid, breast, lung, kidneys, prostate)

MGUS / MM

Medication - steroids, anti-convulsants

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7
Q

What investigations would you order for someone with a pathological fracture?

A

Labratory Tests

  • Serum Vit D
  • CMP
  • UEC
  • LFT
  • PTH
  • TFT
  • Urinary cortisol (if cushings suggestive on history)
  • urine / serum proetin electrophoresis (if MGUS / MM suggestive on history)

Imaging

  • xray of painful site
  • DEXA scan
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8
Q

Describe your management of OP (which has been diagnosed on DEXA and without any pathalogical fracture)

A

Basics

Place & Person

Ix and Confirm Diagnosis

FRAX Risk Ax Tool - gives a 10 year probabilty of major osteoporotic fracture

Definitive Management

  • Lifestyle / Non-Pharmacological
    • cessation of ETOH
    • cessation of smoking
    • weight bearing activitiy
    • dietary chanages - calcium and vitmamin D
  • Pharmacologial
    • Bisphosphonates
    • Raloxifene
    • Antibody - denosumab
    • Calcium & Vitamin D
    • Endocrine (HRT, PTH)
    • Strontium ranelate

Referral

  • Physiotherapy - falls and balance classes
  • OT - gait aids
  • repeat DEXA every 2 years?
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9
Q

What is the mechanism of action of bisphosphonates?

What routes are they given in?

what are the AE of bisphosphonates?

What should you tell the patient?

A

Bisphosphonates inhibit osteoclastic activity.

They can be given as a weekly tablet or yearly IV (Zoledronic acid).

The AE of bisphosphonates are oesophagitis are:

  • oesophagitis / gastritis
  • osteonecrosis of the jaw (also for denosumab)
  • atypical fractures of the femoral neck

You should tell the patient

  • If taking oral - have the tablet once / week in the morning whilst sitting up, and don’t eat / drink or lie down for at least 30 minutes afterward
  • If taking either oral or IV, visit your dentist prior to commencement and have done any major dental work which needs doing
  • Ensure you are well hydrated prior to IV infusion, you will require some testing (of Ca, Vit D, eGFR)
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10
Q

when are bisphosphonates contraindicated? what is second line?

A

poor renal function

if this is the case –> denosumab

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11
Q

how is densoumab administered and what is its side effects?

A

6 monthly SC injection

Osteonecrosis of the Jaw

Atypical fractures

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12
Q

in whom may raloxifene be used when treating OP?

what is it’s MOA?

what is it’s AE?

A

women, usually younger post-menopausal women with spinal OP, especially in those with a high breast-Ca risk.

it is a SERM.

It has the same AE as other HRT, but it REDUCES the risk of breast cancer. It also can exacerbate vasomotor symptoms. It has been shown to increase spinal BMD but not femoral neck or elsewhere.

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13
Q

what is the MOA of teraperatide and who can prescribe it?

A

a PTH analogue

when given in a pulsatile fashion (daily SC injections) it increases BMD

it can only be prescribed by a specialist

it only increases vertebral BMD, not femoral

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14
Q

what is the mechanism of action of strontium ranelate?

A

Strontium, which has the atomic symbol Sr and the atomic number 38, belongs to the group II in the periodic table of the elements, just beneath calcium. Because its nucleus is very nearly the same size as that of calcium, the body easily takes up strontium and incorporates it into bones and tooth enamel in the place of calcium

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15
Q

which STI is usually asymptomatic?

A

chlamydia

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16
Q

If a male has uretheral disachrge, what should you test for?

A

Gohonorrhea

Chlamydia (even though usually symptomatic, is more common than gonorrhea)

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17
Q

how often should one be screened for chlamydia?

A

yearly from aged 15-30 if they are sexually active

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18
Q

how does chlamydia normally present?

A

normally asymptomatic

discharge from penis / vagina

pain during urination

pain during sex

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19
Q

What are the complications of chlamydia in men and women?

A

Men

  • Epididymitis & Epidydimo-Orchitis; which can lead to
    • Infertility
  • Reactive Arthritis (more common in men)

Women

  • Pelvic inflammatory disease; which can lead to
    • Infertility
    • Ectopic pregnancy
    • Persistent pelvic pain
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20
Q

Which STI can cause a reactive arthritis and in which sex?

A

chlamydia

reactive arthritis caused by chlamydia is more common in men than in women

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21
Q

What is the management of chlamydia?

A

Basics

Place & Person

Investigate & Confirm Diagnosis

  • NAAT: specimen collected by -
    • first pass urine
    • endocervical swab
    • cultured urethral discharge (if present)

Definitive Management

  • 1g azithromycin po as a single dose
  • Abstain from unprotected sexual intercourse for at least 7 days during and after treatment
  • A notifiable disease - must notify DHS within 5 days of diagnosis

Follow-Up

  • Contact tracing - advise to dicuss with sexual partners so they can be screened
  • Re-test for chlamydia 3-4 months post treatment
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22
Q

how do you investigate for chlamydia?

A

NAAT

Method of collection:

  • first pass urine
  • endocervical swab
  • urethral discharge (if present)
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23
Q

what is the typical presentation of gohnorrhea in men?

and in women?

A

Man with copious urethral discharge 2-10 days after unprotected sex (although chlamydia is still more common than gonorrhea, so still more likely to be chlamydia).

Women are usually asymptomatic or present with vague symptoms mimicking a UTI.

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24
Q

What is required to investigate for gonorrhea?

A

NAAT. Specimen collected by

  • Urine (mid stream)
  • Endocervical swab
  • Rectal swab
  • Throat swab
  • Culture of discharge

Also investigate for chlamydia if you suspect gonorrhea!

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25
Q

what is the definitive management of chlamydia?

what is the definitive management of gonorrhea?

how are these managements potentially related?

A

Chlamydia = 1g azithromycin po, single dose

Gonorrhea = Ceftriaxone 250mg IM, single dose

If you are treating for gonorrhea, but you haven’t ruled out chlamydia - treat for chlamydia as well

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26
Q

What is the management of gonorrhea?

A

Investigate and Confirm Diagnosis

  • NAAT, collected by:
    • MSU
    • Rectal swab
    • Pharyngeal swab
    • Endocervical swab
    • Cultured discharge (if present)

Definitive Management

  • IM 250mg ceftriaxone
  • Advise to abstain for sex for 7 days?

Follow Up

  • Notifiable disease - notify DHS within 5 days
  • Contact tracing - treat sexual partners empirically
  • Offer eductaion RE safe sexual practises
  • Re-investiage 3-4 months after treatment, to ensure complete treatment
  • ALSO TEST / TREAT CHLAMYDIA
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27
Q

Which STI is described as “the great imitator”?

A

Syphillus

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28
Q

What is the name of the microorganism which causes syphillus?

A

Treponema pallidum

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29
Q

How does primary syphillus present?

A

A single painless ulcer in the genital area (chancre)

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30
Q

What is the pathophysiological progression of syphillus?

A

Remember Syphillus happens in Stages

  • Primary = Chancre
  • Secondary = Secondary erruption on skin and mucous membranes (rash) +/- systemic symptoms
  • Then long periods of latency
  • Teritiary (10-30 years after infection) = late lesions of skin, bone, viscera, cardiovascular and central nervous systems (this is why it’s called the great mimcker)
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31
Q

How do you investigate for syphillus?

A

Syphillis EIA (blood test)

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32
Q

what is the definitife management of syphilllis?

A

early (

late (>2 years or unknown) = IM benzthine penicillin, weekly for 3 weeks

tertiatry syphillis (>2 years and with skin, bone, CVS or neurological involement) = IV benzylpenicillin

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33
Q

What is the overall management of syphillis?

A

Investigate and Confirm Diagnosis

  • Seroloigcal test - Syphillis EIA

Definitive Management

  • Early - IM benzathine penicillin, once off
  • Late or unknown - IM benzathine penicillin, once per week for 3 weeks
  • Tertiary - IV benzylpenicillin for 15 days
  • Abstain from sex until completion of treatment

Follow-Up / Other

  • Test for other STIs
  • Notifiable disease - contact DHS
  • Contact tracing
  • Retest 3-4 months after completion of treatment
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34
Q

what is a common presentation of bacteral vaginosis?

A

asymptomatic

fishy-smelling vaginal discharge

dysuria

vaginal pruritis

pyspareunia

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35
Q

how do you diagnose bacterial vaginosis?

A
  • Clincially
    • presence of mucous dishachrge
    • fishy smell
  • clue cells on micrscopy (culture not required)
  • Vaginal pH >4.5
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36
Q

What is the defitive management of bacterial vaginosis?

A

metronidazole (orally or vaginal gel)

OR clindamycin (orally or vaginal gel)

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37
Q

What is the pathophysiology of bacterial vaginosis?

A
  • Reduction in the acid-producing normal flora of the vagina [Lactobacillus]
  • Leads to growth of anaerobes and other fastidious microorganisms
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38
Q

What types of HPV are oncogenic?

What types are not?

A

HPV 6 & 11 = not oncogenic (cause geintal warts)

HPV 16 & 18 = oncogenic

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39
Q

What else, other than HPV infection, increase ones risk of cervical cancer?

A
  • HPV
  • Sexual activity
  • Cigarette smoking
  • OCP
  • Immunosupression
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40
Q

What type of epithelium is in the endocervical canal?

What type of epithelium is in the cervix?

What area of epithelium is most likely to become dysplastic when infected by HPV?

A

endocervical canal = columnar

cervix = squamous

between this is the transitional zone / where there is “cervical ectropion” - this is the area which is most likely to become dysplastic

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41
Q

What systems are used to grade dysplastic changes of the cervix?

A
  1. The Bethesda System (SIL system) - which looks at individual cells and their degree of displasia
  2. Cervical Intraepithelial Neoplasia system (CIN) - which looks at the degree of dysplasia and the depth of dysplasia
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42
Q

When is the Gardasil vaccine currently funded?

A

Boys and girls aged 12-13 (year 7)

Need to receive the three doses within a year (preferably at 0, 2 and 6 months)

If outside this age range - have to pay for it (most efficacious if haven’t already had sex)

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43
Q

What types of HPV does Gardisil proect against?

A

6, 11, 16 and 18

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44
Q

At what age is it recommended to first have Pap smears?

How often is it recommended to have them?

Until what age?

A

18-20 years old, or 2 years after one has first had sex (whichever is later)

(Girls who have had sex earlier than 18 years do not require a Pap smear until they are 18; even if they first has sex at the age of 15).

Current guidelines suggest having Pap smears every 2 years until the age of 70

(Note that women between 50-70 are the most uninvestigaed population)

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45
Q

Describe the difference between current guidelines with Pap smears and the new HPV testing which will likely roll out in May 2017

A

Changes

Age commencing cervical screening

From 18 years to 25 years

Test performed

HPV testing instead of Pap smear +/- liquid based cytology

Equipment used

Brush as for liquid-based cytology (instead of spatula)

Frequency of test

Every 5 years instead of every 2 years

Exit age

Between 70-74 years old (instead of 70)

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46
Q
A
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47
Q

bacteral vaginosis is potentially serious in what population?

A

pregnant women

increases the risk of miscarriage

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48
Q
A
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49
Q

What is the difference between Chancroid versus Chancre?

A

Chancre = painless ulceration most commonly formed during the primary stage of syphilis. This infectious lesion forms approximately 21 days after the initial exposure to Treponema pallidum.

Chancroid = painful ulceration which occurs 3-10 days after contact with Haemophilus ducreyi.

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50
Q

What is the typical presentation of HSV?

A

Multiple painful genital ulcers one to two weeks following exposure to the virus. Can also be associated with a systemic illness.

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51
Q

What is the treatment of HSV?

A

Acyclovir (cream, oral or IV depending on the severity)

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52
Q

What are the types of HSV and what do they cause?

A

HSV 1 = oral herpes

HSV 2 = genital herpes

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53
Q

What is the GP management mnemonic?

A

DKA EMP REAP

Diagnosis

Knowledge

Attitudes

Explain

  • NORMALISE
  • causes
  • symptoms
  • complications

Management

  • Basics
  • Place and Person
  • Ix and CD
  • Defitive Management
    • lifestyle
    • non-pharm
    • pharm
    • invasive / surgical
  • Prevention / Long Term / Follow Up

Preventative Opportunities

Reinforce

Evaluate the Consultation

Arrange Follow up

Pamphlet / Website!

  • A very good website is the better health channel
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54
Q

How do you organise your thoughts of prevntative opportunities in GP?

/ what do you say in an OSCE?

A

SCREEN

SNAP

CV risk

Reproduction

Emotions

Elderly

Neoplasms

Scripts:

  • Ascertain age.
  • Ascertain whether or not they have had the recent test you are going to propose / ascertain when their last GP visit was
  • “Now, because you are x years old and this is your first visit to the GP in y years – there are certain screening tests which are recommended we do every so often, to screen for certain conditions such as ….”*
  • “With this is mind, I think it would be wise to organize a, b and c, as well as consider the issue for which you have come to see me, today.”*
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55
Q

What is the definitive management + follow-up / long term management of psoriasis?

A

Lifestyle

  • Avoid skin damage & triggers
  • Moisturise

Pharmacological

Topical - “CC DD”

  • intermittent, short term potent Cortocistreoids
  • Calcipatriol (a vitamin D analogue)
  • Dithranol (inhibits DNA synthesis)

Systemic - refer to dermatologist

  • Oral mathotrextae
  • Biological agents - infliimab

Physical Therapy

  • Phototherapy with UV light

Follow Up

  • 2 - 3 x increased CV risk with psoriasis
  • Psoriatic arthritis
  • Eryhroderma
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56
Q

What are the complications of psoriasis?

A

Psoriatic arthritis

Erythroderma

2 - 3 x increased CV risk

Poor self esteem

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57
Q

What is the reassurance of eczema and psoriasis you should give patients?

A

Very common

Don’t cause scarring or disfigurment

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58
Q

What is the definitive management of eczema?

A

Lifestyle

  • Avoid skin breakdown
    • avoid dryness
    • avoid heat
    • avoid irritants
  • Restore skin barrier
    • moisturise+++

Pharmacological Treatment

  • Topical steroid cream: low, medium or high dose
  • If severe refer to dermatologist for oral steroid or immunsuppressive agents eg. methotrexate

Alternatives / Additions:

  • If want to avoid steroid –> pimecromilous
  • If have an itch –> anti-histamines
  • Wet dressings or occlusive dressings
  • If infected –> antibiotics + oatmeal washes / bleach baths
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59
Q

What is the definitive management of acne?

A

Lifestyle

  • wash skin
  • avoid sun damage
  • avoid squeezing lesions

Topical Treatment: ABC

  • Adapelene (topical retinoid)
  • Benzyl peroxide
  • Clindamycin (topical antibiotic)

Oral Treatment: DE

  • Doxycycline [replaces topical clindamycin]
  • Estrogren + progesterone [ie. OCP] in females

Referral

  • For isotretinoin

Ongoing

  • Psych
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60
Q

How do you diagnose T2DM?

A

5.5 - 7 - 11

Need two positive tests (preferably different)

Fasting > 7

Random > 11

  • If first test is uncertain* [fasting: 5.5-7 or random: 7-11] need to refer for 2OGTT [which is like a controlled random]
  • Can* refer for HbA1c now? >6.5% = T2DM
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61
Q

What is a relative contraindication to prescribing some an ACEi?

What would you prescribe instead?

A

angioedema

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62
Q

What is glaucoma and what are it’s types?

A

High intraoccular pressure causing death of optic nerve cells.

Open angle glaucoma = poor drainage of aqueous pressure due to dysfunctional drainge by the canal of schlemm

Closed angle glaucoma = poor drainage due to closure of the angle between the cornea and the iris

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63
Q

what is seen on opthalmoscopy in gluucoma?

A

Cupping

Measure the cup:disc ratio

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65
Q

What is the typical presentation of open angle glaucoma?

A

It is asymptomatic!

Patient’s may have loss of peripheral vision, but usually won’t notice

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66
Q

What examination findings are typical of glaucoma?

A
  1. raised pressure
  2. cupping on ophthalmoscopy
  3. loss of peripheral vision (might have to be measured by a special machine called an automated perimetry)
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67
Q

What is the typical presentation of acute glaucoma?

A

An extremely red and painful eye

+/- N&V

Patients may reoprt seeing halos around lights

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68
Q

what are the examination findings of acute angle glaucoma?

A

Pupil is sluggish and mid-dilated

Slightly cloudy cornea

High pressures

Rock hard eye on palpation

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69
Q

What is the treatment of chronic glaucoma?

A
  1. Topical beta-blockers
  2. Also topical alpha-agonists, carbonic anhydrase inhibitor (Diamox), and prostaglandin analogues
  3. Trabeculectomy
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70
Q

What is a cataract?

A

Any opacity of the lens, regardless of aetiology

(they can occur in different parts of the lens)

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71
Q

What are the causes of visual loss?

A

Gradual Visual Loss [COAD]

  • Cataracts
  • Open angle glaucoma
  • Age-related macular degeneration
  • Diabetic retinopathy

Suddent Visual Loss [BRCO]

  • Branch retinal vein occlusion
  • Retinal detachment
  • Central tretinal artery occlusion
  • Optic neuritis

Non-eye related causes [TMG]

  • TIA
  • Migraine
  • Giant cell arteritis
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72
Q

Which are arteries and which are veins?

A

Arteries - plaer, thinner

Veins - thicker, darker

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73
Q

What type of haemorrhages are seen in diabetic retinopathy?

A

dot and blot haemorrhages

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74
Q

what type of haemorrahes are seen on hypertensive retinopathy?

A

flame haemorrhages

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75
Q

What is the typical presentation of cataracts?

A

Gradual loss of vision

Reduced night vision

Glare from oncoming traffic

79
Q

What is a cotton wool spot and when do you see it?

A

ischaemic retina

diabetic retinopathy

80
Q

What is seen on ophthalmoscopy in diabetic retinoathy?

A

dot and blot haemorrhaes

cotton wool spots (ischaemic retina)

neovascularisation (which occurs in large areas of ischaemia)

hard exudates (lipid accumulation from swelling)

81
Q

What’s this?

A

Red cherry spot

Central retinal artery occlusion

82
Q

What are the three types of retinal detachment?

A

Rhegmatogenous (the usual type)

Tractional (can happen in diabetics)

Exudative (tumor or something pushing from below)

83
Q

What are the symptoms of retinal detachment? (And the DDx for each)

A
  • Flashing lights
    • DDx = migraine and posterior vistreous detachment
  • Floaters (look like dark specks that obscure vision - like a swarm of flies)
    • DDx = posterior vitreous detachment
  • Curtain of darkness coming down
    • DDX = TIA
84
Q

what is the typical presentation of age-related macular degeneration?

A

Older patient

Progressive steady decline in central vision

Difficulty in reading (new glasses don’t help)

85
Q

Elderly pt, sudden unilateral vision loss.

What are the DDx?

And what are the prognoses of each?

A

Branch retinal vein occlusion (will resolve spontaneously in 2 months)

Central retinal artery occlusion (requires urgent surgical referral)

87
Q

What is conjunctival injection?

88
Q

What is this and how is it treated?

A

Dendritic ulcer of HSV

Treated with antivirals

89
Q

What is the clinical presentation of optic neuritis?

A

Sudden vision loss (central scotoma is classic)
Decreased contrast and color sensitivity

Pain with eye movement

90
Q

What is optic neuritis associated with?

91
Q

What is the management of optic neuritis

A

Specialist referral

IV steroids

92
Q

What are the examination findings of optic neuritis?

A

Optic nerve head edema
Relative afferent pupillary defect

93
Q

painful eye in the context of a foreign body?

A

corneal abrasion

which if infected may lead to corneal ulcer

95
Q

What is this?

A

Anterior synechia

97
Q

What is the management of a dendritic ulcer on the cornea due to HSV?

A

antivirals prescribed by opthalmologist

DON’T prescribe steroids

98
Q

What is another name for anterior uveitis?

99
Q

What is another name for iritis?

A

anterior uveitis

100
Q

What’s this?

What is the epidemiology and typical clinical picture?

A

episcleritis

Affects young adults

Moderate ache

Milder symptoms than those experienced by patients with iritis

The conjunctival inflammation is usually localised to one sector

101
Q

What is erysipelas?

A

Caused by group A strep

involving the upper dermis that characteristically extends into the superficial cutaneous lymphatics.

Tender, intensely erythematous, indurated plaque with a sharply demarcated border. Its well-defined margin can help differentiate it from other skin infections (eg, cellulitis)

102
Q

What is the uvea?

A

iris, ciliary body, and the choroid

all
connected to each other and are histologically similar

103
Q

What is the aetiology of anterior uveitis?

A

idiopathy

or associated with rheumatological conditions (HLA-B27)

104
Q

What is the orbital septum?

describe the two types of cellulitis

A

pre-septal / peri-orbital cellulitis is anterior to the orbital septum

post-septal / orbital cellulits extends behind the septum

105
Q

What is a synechia?

A

A synechia is an eye condition where the iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e. posterior synechia).

107
Q

What is this?

A

stye

external hordeolum

108
Q

what is the aetiology of synechia?

A

Synechiae can be caused by ocular trauma, iritis or iridocyclitis and may lead to certain types of glaucoma.

109
Q

what is the management of anterior uveitis?

A

requires urgent referral!

Topical steroid drops reduce the inflammation

Topical cyclopentolate (dilate the pupil and break down synechiae)

110
Q

What is the episclera?

A

The episclera is a thin layer of tissue that lies between the conjunctiva and the connective tissue layer that forms the white of the eye (sclera)

111
Q

what is episcleritis?

What is it’s prognosis?

A

Benign self-limiting condition

Resolves in two weeks without treatment

113
Q

What’s this?

115
Q

What’s this?

What is it’s clinical presentation?

What is it’s aetiology?

What is it’s prognosis?

A

Large bleed + Painless + Normal vision

May be associated with hypertension or heavy bouts of coughing or straining

Resolves spontaneously within 2-3 weeks

116
Q

What’s this slight redness in the corner of my eye?

What treatment is required?

A

Pterygium

Common in hot climates

Benign fibrovascular growth from the conjunctiva

No treatment required unless growth reaches cornea à refer to ophthalmologist to be peeled back

118
Q

What is another name for pre-septal / post-septal cellulitis?

A

pre-septal = peri-orbital cellulitis

post-septal = orbital cellulitis

120
Q

What is the management of periorbital / orbital cellultis?

A

periorbital cellulitis

often managed with oral antibiotics

orbital cellulitis

​more serious condition requiring hospitalisation and parental antibiotics

complications such as intraorbital abscess formation may require surgical intervention

121
Q

How do you DDx between episcleritis and scleritis?

A

instillation of phenylephrine 2.5%

the phenylephrine blanches the conjunctival and episcleral vessels but leaves the scleral vessels undisturbed. If a patient’s eye redness improves phenylephrine instillation, the diagnosis of episcleritis can be made.

123
Q

What is the difference between a stye (external hordeolum) and a Chalazion (meibomian cyst)

A

Stye is an infection, red and tender

Chalazion is not tender, and is hard (due to sterile inflammation)

124
Q

What is another name for stye?

A

external hordeolum

125
Q

What is another name for a chalazion?

A

mebomiam cyst

126
Q

What is blepharitis

A

Blepharitis is a chronic eye condition characterised by inflammation of the eyelids.

127
Q

What is the name for inflammation of the eyelids?

A

Blepharitis is a chronic eye condition characterised by inflammation of the eyelids.

129
Q

What is Trichiasis?

A

Abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva

132
Q

what is photokeratitis?

A

photokeratitis is akin to a sunburn of the cornea and conjunctiva

133
Q

How do you differentiate between viral and bacterial conjunctivities?

A

There are no specific clinical signs to differentiate bacterial and viral conjunctivitis.

134
Q

What is the clinical picture fo conjunctivitis?>

A

Key features

  • Gritty red eye
  • Purulent discharge
  • Clear cornea

History

  • Purulent discharge which causes the eyelashes to stick together in the morning
  • Starts on one eye and spreads to the other (usually)
  • Hx of contact with a person that has similar symptoms
136
Q

What is a risk factor for retinal detachment?

137
Q

According to Monash, GPs can easilly treat foreign bodies, but after how long should the patient be reviewed?

A

In 24 hours

138
Q

What type of stroke is the most common cause of a homnymous hemianopia?

A

Posterior circulation stroke

(but MCA stroke can also cause symptoms)

139
Q

According to John Murtagh, if you diagnose a migraine when should you review the patient?

A

In 24 hours

If the pain hasn’t resoved reconsider the diagnosis

140
Q

What is the first line acute treatment for a migraine?

And what is second line?

A

Aspirin

Paracetmaol

Ibuprofen

Triptans

Ergot

141
Q

What is used for prophylaxis of migraines?

A

TCA

B-blocker

Sodium Valproate

Verapamil Sustained Release

142
Q

If someone presents to you (a GP) with acute angle glaucoma, what should you do?

A

Call an ambulance.

The patient should remain in the supine position as long as possible.

The urge to wear eye patches, covers, or blindfolds should be resisted. By maintaining the conditions that cause pupillary dilation, these articles help perpetuate the attack.

143
Q

Aortic stenosis gives you what type of pulse?

A

Pulsus parvus et tardus

Small volume pulse

Weak and small pulse

144
Q

What is the classic triad of Mennieres disease?

A

Vertigo, hearing loss and tinnitus

145
Q

What is the duration of the vertigo attaks in BPPV compared with Menierres disease?

A

Most attacks of meniere’s will last for hours compared to a few seconds in the case of BPPV

146
Q

According to Monash, what is unilateral hearing loss until proven otherwise?

A

Assume that any unilateral sensorineural hearing loss is caused by an acoustic neuroma until proven otherwise.

147
Q

What Ix do you have to do once you have prescribed someone an ACEi?

148
Q

When does the “dry cough” appear with an ACEi?

A

Doesn’t have to start striaght away!

149
Q

What is a known adverse effect of TCAs (which isn’t one of the usual)?

A

Intestinal obstruction

150
Q

What type of anaemia might metformin cause?

A

Megaloblastic

(B12)

151
Q

What test is commonly listed as positive in sarcoidosis?

A

ACE levels

152
Q

Why should GPs fluorsceine stain every eye?

And why shouldn’t GPs really be prescribing steroid eye drops?

A

Both answers - HSV!

153
Q

What parasite is associated wth bladder cancer?

A

Shistosomiasis

154
Q

What is used to diagnose active TB?

What is used to diagnose latent TB?

Which test might be positive is someone has had a TB injection?

A
  • Active = CXR + 3 x sputum samples
  • Latent =
    • Mantoux (Tuberculin Skin Test) - false positive from BCG test
    • Quantiferon Gold [interferon gamma release assays (IGRA)]
      • If these are +ve then do CXR to exclude active TB
155
Q

What is the first, second, third and fourth line treatments in hyperlipidaemia (elevated LDL)?

A
  1. statin
  2. ezetimibe
  3. bile acid binding resin
  4. nicotinic acid

(SEB + nicotinic acid is always last line)

156
Q

What is the first, second and third line treatments for hypertriglycerideaemia?

A
  1. fenofibrate
  2. fish oil
  3. nicotinic acid
157
Q

When would you use nicotinic acid in hyperlipidaemia?

A

Last line for both LDL and TGs

158
Q

What is the treatment target for total cholesterol?

159
Q

What is the treatment target for HDL?

160
Q

What is the treatment target for LDL?

161
Q

What is the treatment target for TGs?

163
Q

How often and how should you screen for OP?

A

Assess risk factors in women aged >45 and men aged >50 who are of average risk

In women and med of increased risk / risk factors refer for DEXA, do not repeat more freuently than every 2 years and only do so if it is likely to change treatment

164
Q

What score do you use to diagnose osteoporosis on DEXA scan?

What are the cut offs?

A

T score

> -1 is normal

between -1 and -2.5 is osteopaenic

165
Q

What are the risk factors for osteoporosis?

A

Lifestyle

  • smoking
  • ETOH
  • physical inactivity / immobilsation
  • Low Ca and Vitamin D intake

Anthropological

  • Female
  • Older age
  • Low BMI
  • Early menopause

Medical

  • Steroids
  • Anti-convulstandts
  • HRT (protective)
  • Endocrine
    • cushing’s
    • hyperPTH
    • hyperthyroidism
  • CKD
  • Chronic liver disease
  • MM
  • Hysterectomy
166
Q

What is Bacterial Vaginosis?

A

A change in the normal flora within the vagina

  • Reduction in Lactobacillus species
  • Overgrowth of anaerobic
    • Mobiluncus species
    • Gardnerella vaginalis
    • Atopobium vaginase
    • Mycoplasma hominis
167
Q

What is the clinical presentation of Bacterial vaginosis?

A
  • White-to-grey fishy smelling discharge
  • Dysuria
  • Vaginal pruritis
    *
168
Q

What is the Amsel Criteria for Diagnosis of BV?

A
  1. Clinician observed vaginal discharge - thin, white, adherent, homogeneous appearance.
  2. Vaginal pH of >4.5.
  3. The presence of “clue cells” on a gram stain or wet prep from a high vaginal swab.
  4. Positive amine (whiff) test.
169
Q

Who should be treated for bacterial vaginosis?

A
  • Symptomatic women
  • Women having a TOP
  • Women having IUDC insertion
  • WOmen who are pregnant and have a history of pre-term delivery
170
Q

What is the treatment for Bacterial Vaginosis?

A

One of the following

  • Metroniadazole orally - 5 days
  • Metronidazole vaginal gel - 5 nights at bedtime
  • Clindamycin - 7 days
  • Clindamycin vaginal cream - 7 nights

Not clindamycin cream is oil based and can weaken condoms

171
Q

What are the complication of untreated Chlamydia trachomatis?

A

Women

  • PID
  • Ectopic pregnancy
  • Infertility

Men

  • Epididymitis
  • Prostatis
172
Q

What is the treatment for chlamydia trachomatis?

A

1g of azithromycin as a single dose

173
Q

What organism is responsible for Chlamydia?

A
  • Chlamydia trachomitis
  • Gram-negative bacterium
  • Obligate intracellular parasite - replicates within the host cell and forms inclusion bodies which then reorganise and rupture within 2-3 days
174
Q

What is the incubation period for chlamydia?

175
Q

How can you investigate chlamydia?

A
  • First pass urine - NAAT
  • Culture of urethral discharge
176
Q

How long should people abstain from sexual contact after completion of antibiotic treatment for chlamydia?

A

At least 7 days

177
Q

What is the causative organism for Gonorrhea?

A
  • Neisseria gonorrhoeae
  • Gram negative diplococcus bacteria
178
Q

What is the clinical presentation of Gonorrhea?

A

Infections of the cervix, anus and throat usually cause no symptoms.

Men

  • Urethral discharge
  • 2 – 10 days after unprotected sex
  • Dysuria
  • Age 15-24
  • Men who have sex with men
  • Hx of STD
  • Multiple sexual partners
  • Inconsistent condom use

Women

Most women who are infected with gonorrhoea have no symptoms or vague symptoms that mimic common UTI.

179
Q

What is the definitive management for Gonorrhoea?

A

Ceftriaxone: 250mg IM as a single dose

(Ciprofloxacin can be used as an alternative to ceftriaxone when a sensitive strain has been identified.)

180
Q

What causes genital herpes?

A

HSV 1 or 2

Oral herpes is caused by HSV 1

181
Q

What is the clinical presentation of genital herpes?

A

Women

  • Genital pain
  • Discharge
  • Dysuria
  • Ulcerative lesions on the vulva, perineum, buttocks and cervix

Men

  • Vesicles on the penis shaft or glans
  • Urethritis
  • Protitis with discharge, rectal pain and tenesmus
  • Constipation
  • Impotence
  • Urinary retention after anorectal intercourse
182
Q

What is the management of Genital herpes?

A

Basics

  • Simple analgesia
  • Patient education
    • Avoid sexual contact when lesions are present
    • Use of condoms

Place and person

  • GP
    • Hospital admission if disseminated visceral involvement

Definitive managment

  • Aciclovir

Long term

  • Aciclovir can be used for up to 6 months for long term suppressive treatment
183
Q

What is the causative organism of syphilis?

A
  • Treponema pallidum
  • Spirochaete
184
Q

What is a chancre?

A

A painless ulcer, particularly one that develops on the genitals in venereal disease.

It is the first presentation of primary syphilis

185
Q

What are the stages of syphilis?

A
  • Early syphilis
    • Primary
      • Chancre
    • Secondary
      • Rash or condylomata lata
    • Latent
      • Asymptomatic of less than two years based on serology results
  • Late latent
    • Latent syphilis has existed for two or more years or of indeterminate duration, in the absence of neurosyphilis and other symptoms and signs of disease
  • Teritary syphilis
    • Cardiovascular and neurosyphilis is present
186
Q

What are the symptoms of secondary syphilis?

A

Secondary syphilis is caused by haematogenous spread of infection. This leads to a widespread vasculitis.

  • Non-itchy, reddish/brown skin rash + mucous membrane lesions.
  • Systemic symptoms inc fever, pharyngitis, headache and arthralgia
  • condylomata lata (clusters of soft, moist lumps in skin folds of the anogenital area)
187
Q

What is the treatment for early syphilis?

A

SIngle dose of Benzathine penicillin

188
Q

What is the treatment of late latent syphilis?

A

Once weekly x3 benzathine penicillin

189
Q

What are the types of cataracts?

A
  • Nuclear sclerosis
    • Age related
  • Cortical
    • Aging and diabetes
  • Posterior subscapsular
    • Steroid use, intraocular inflammation, diabetes, trauma, radiation and aging
190
Q

What is the clinical presentation of a cholesteatoma?

A

History

  • Trauma to or disease of middle ear
  • Hearing loss
  • Ear discharge resistant to ABx
  • Tinnitus

Examination

  • Otoscopy typically shows crust or keratin in the attic
191
Q

What are the differentials of sudden vision loss?

A
  • Branched retinal vein occlusion
  • Central retinal artery occlusion
  • Retinal detachment
  • Optic neuritis
  • TIA
  • Giant cell arteritis
  • Migraine
192
Q

When and how does secondary syphillus present?

A

4-10 weeks after the primary infection

Is caused by haematogenous spread of infection. This leads to a widespread vasculitis.

Secondary syphillus is known for the many different ways it can manifest!

But symptoms most commonly involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles.

193
Q

How do you investigate for syphillus?

A

Serological testing:

  • Reactive non-treponemal test
    • rapid plasma reagin [RPR] test
    • venereal disease research laboratory [VDRL] test
    • Treponema pallidum Particle Agglutination/Haemagglutination (TPPA/TPHA)
    • Enzyme Immune Assay (EIA);
194
Q

What is the treatment of gohnorrhea?

A

Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine

(PLUS Azithromycin 1g PO, stat)

195
Q

What is the treatment of syphillus?

A

Benzathine penicillin 1.8g IMI, stat

196
Q

What group of ‘reportable diseases’ are STIs?

How quickly should the GP notify?

What information is given?

A

Group C

Within 5 days of diagnosis

Only the patient’s initials, post code and DOB

197
Q

How do you test for HIV?

A

ELISA is the first test (HIV Ag/Ab)

There might be a false negative in the ‘Window Period’, may need to repeat

Then order the Western Blot

199
Q

Vaginal soreness, green / grey bubbling discharge with offensive odor two days after casual sex?

A

Trichomonas Vaginalis

Year 4C - GP (5 decks)

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