Other Racgp Flashcards
Easy bruising
Petechiae
Bleeding
Often follows viral infection in children
Idiopathic thrombocytopenic Purpura
Usually acute in children, often chronic is adults
Immune mediated platelet destruction
Petichiae and bleeding - what tests to perform?
FBE - assess platelet numbers
Blood film to exclude leukaemia, aplastic anemia
Describe haemolytic uraemia syndrome
- Microangiopathic haemolytic anaemia
- acute renal failure
- thrombocytopenia
Usually follows GIT infection with shiva-toxin Ecoli but also others.
Symptoms - oliguria, haematuria, anaemia, oedema, renal failure, hypertension
Describe Henoch Schonlein Purpura
- Palpable Purpura
- Arthralgias, arthritis
- Abdominal pain
- renal involvement (haematuria, proteinuria/hypertension)
Suspect Henoch Schonlein PUrpura - what tests?
- urinalysis only if classic presentation
- If renal involvement - urine mcs, PCR and ECU and albumin
Memory loss, urinary incontinence, ataxic gait =
Normal pressure hydrocephalus
- decreased executive function
- Parkinsonism
- visual hallucinations
- confusion varies from day to day/hour to hour
Lewy body dementia
Memory loss
Challenges with planning/problem solving
difficulty completing familiar tasks
Alzheimer’s dementia
- change in behaviour/personality
- difficulty producing/comprehending language
Frontotemporal dementia
Vulval itch, white plaques, resorption of labia
Lichen sclerosus
What doe lichen sclerosus increase risk of
SCC
Which medication can be used for urge incontinence?
Oxybutynin
Causes of overflow incontinence (8)
- anticholinergic agents
- BPH
- Pelvic organ prolapse
- DM
- MS
- spinal cord injuries
- fecal impaction
- prostatomegaly or pelvic mass
- usually occurs with post-void residual of >300ml
Non-drug management of urinary incontinence
- no caffeine
- limit fluid intake
- avoid drugs - diuretics, CCB, alpha blockers, antipsychotics, benzos, antidepressants
- treat constipation
- weight loss
- pelvic floor muscle training
Heaviness in eye with flashes and floaters
Posterior vitreous detachment
Urethritis, conjunctivitis/iritis, arthritis
Reactive arthritis
Reactive arthritis presents 1-3 weeks after what most common pathogen
Chlamydia trachomatis
Also GI infection
Treatment for reactive arthritis (3)
- NSAIDs
- intraarticular corticosteroid injection
- Prednisolone 10-50mg orally daily until symptoms improve then taper to stop
Medial tibial stress syndrome /Tibial periositis (shin splints) - what is it, where is pain, risk factors
Review this
-overuse injury or repetitive load injury (often running)
- distal and posteromedial tibia
- risk factors - not enough shock absorption, sudden increase in training, over-pronation or increase internal tibial rotation
Need X-ray to exclude stress fracture
- treatment - activity modification - decrease running distance, frequency and intensity by 50%
-regular stretching and strengthening
- run on synthetic track
- avoid running on hills, uneven or hard surfaces
- correct foot wear
- orthotics if pes plants
- physio
Tibial stress fracture
- overuse injury - repetitive stress -> microfracures, mostly runners, seen after change in training routine
- initially pain with training -> everyday activities
- X-ray/bone scan
- treatment - activity restriction with protected weight bearing (with crutches). If tension fracture from posterior muscle force will need surgery
- avoid NSAIDs - delay bone healing
Management principles for muscle strain or tear
- RICE
- Paracetamol preferred.NSAIDs should not be used for more than 48 hours
- physio referral
- to reduce risk of recurrence avoid returning to full pre-injury activity until near full pre-injury flexibility and 85% pre-injury power. Gradual return recommended
- Management principles for tendinopathy
- avoid or modify activities that aggravate discomfort or place high loads on affected tendon
- Rest not recommended
- Physio referral - progressive loading program - isometric loading -> eccentric or eccentric - concentric loading
- if no response after 6 months refer to specialist
management principles for ligament sprain or tear
- RICE
- NSAIDs
- refer physio for restoration of range of motion, proprioception training, local muscle strengthening and functional exercises
- supportive taping during early phase of return to activity
Pain in shoulder/lateral upper arm
Night pain, interrupted sleep
Painful arc
Rotator cuff disease
How to differentiate rotator cuff disease from glenohumeral OA and adhesive capsulitis
Passive ROM painless in rotator cuff disease
Management of rotator cuff disease
- analgesia
- exercise
- avoid or modify activities that aggravate discomfort or place high loads on affected tendon
- physio for range of motion and strengthening exercises
- consider subacromial corticosteroidinjection
- consider suprascapular nerve block
- refer ortho after 3-6 months if progressive weakness suggestive of full thickness tear or severe symptoms
Clinical diagnosis of adhesive capsulitis
History - painful phase - development of diffuse severe shoulder pain, worse at night -> stiff phase -> recovery phase
Severe global passive movement loss
Before global passive movement is loss may mimic rotator cuff disease
treatment of adhesive capsulitis
Painful phase - avoid or modify aggravating activities, simple analgesia; pred 30mg orally daily for 3 weeks then taper dose over 2 weeks then stop (don’t use with NSAIDs_)
Stiff phase - continue activity modification and analgesia. Do strengthening and active ROM exercises. Arthrographic distension of glenohumeral joint may help pain, function and ROM - injection of local anaesthetic, corticosteroid and saline under radiological guidance
Management of lateral and medial epicondylitis
- simple analgesia/topical NSAID
- exercise - progressive loading
- avoid or modify aggravating activities and avoid high loads on affected tendon
- consider local corticosteroid injection, can be repeated
Management of De Quervain tenosynovitis
- local corticosteroid injection most effective
- splinting
- NSAIDs orally or topically
- Rest if possible, can splint to immobilise thumb for 6 weeks then slowly reduced
Carpal tunnel management
- Treatment of underlying condition if present (hypothyroidism/DM/RA)
- NSAID
- corticosteroid injection (can repeat)
- surgery
Flexor tenosynovitis (trigger finger)
- DDx is Dupuytren contracture and if multiple digit involvement spondyloarthritides, RA
- NSAID
- splinting
- Local corticosteroid injection in the region around the A1 pulley highly effective
- Surgery
trigger finger - inflammation of synovium surrounding tendon, painful, clicking, popping, get stuck in flexion requiring manual extension
Dupuytren contracture, not pain, thinking of facia, pulling tendon down. progressive. can cause fixed flexion deformity
Greater trochanter is pain syndrome - trochanter is bursitis/gluteus medius/minimus tendinopathy
- refer physio for strengthening exercises of gluteus medius and minimus even if relief with analgesia
- ## avoid compression of gluteal tendons over greater trochanter - avoid sitting cross legged, side lying
Test for phaeochromocytoma
24 hour urine metanephrines and catecholamines
Surgical margins for 8mm BCC
3-4mm
High risk factors for skin cancer
- red hair
- age >45 and type 1 skin
- age >65 and type 2 skin
- history of melanoma
- history of non-melanoma skin cancer or > 20 solar keratoses
- > 100 naevi or > 10 atypical naevi
- family history of melanoma in a first degree relative >15yo
What tests to order for suspected renal calculus
Urine dipstick for blood and to exclude infection
CT KUB + KUB x-ray simultaneous (if young/pregnant consider USS instead)
EUC
Renal calculi management
Stones 5-7jmm - 60% pass
Oral/rectal NSAID
Tamsulosin 400mcg daily
Strain urine to avoid unnecessary imaging if stone doesn’t pass
F/U scan (X-ray or CT KUB) at 4 weeks if stone has not been collected
Causes of urge incontinence
I - UTI N - BPH N - stroke, Parkinson, MS, spinal cord injury D - Age related atrophic changes I - idiopathic, medications, etOH S - poor bladder habits, anxiety
