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Respiratory RACGP > Other Racgp > Flashcards

Other Racgp Flashcards

1
Q

Easy bruising
Petechiae
Bleeding
Often follows viral infection in children

A

Idiopathic thrombocytopenic Purpura

Usually acute in children, often chronic is adults
Immune mediated platelet destruction

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2
Q

Petichiae and bleeding - what tests to perform?

A

FBE - assess platelet numbers

Blood film to exclude leukaemia, aplastic anemia

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3
Q

Describe haemolytic uraemia syndrome

A
  • 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

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4
Q

Describe Henoch Schonlein Purpura

A
  • Palpable Purpura
  • Arthralgias, arthritis
  • Abdominal pain
  • renal involvement (haematuria, proteinuria/hypertension)
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5
Q

Suspect Henoch Schonlein PUrpura - what tests?

A
  • urinalysis only if classic presentation

- If renal involvement - urine mcs, PCR and ECU and albumin

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6
Q

Memory loss, urinary incontinence, ataxic gait =

A

Normal pressure hydrocephalus

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7
Q
  • decreased executive function
  • Parkinsonism
  • visual hallucinations
  • confusion varies from day to day/hour to hour
A

Lewy body dementia

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8
Q

Memory loss
Challenges with planning/problem solving
difficulty completing familiar tasks

A

Alzheimer’s dementia

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9
Q
  • change in behaviour/personality

- difficulty producing/comprehending language

A

Frontotemporal dementia

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10
Q

Vulval itch, white plaques, resorption of labia

A

Lichen sclerosus

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11
Q

What doe lichen sclerosus increase risk of

A

SCC

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12
Q

Which medication can be used for urge incontinence?

A

Oxybutynin

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13
Q

Causes of overflow incontinence (8)

A
  • 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
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14
Q

Non-drug management of urinary incontinence

A
  • no caffeine
  • limit fluid intake
  • avoid drugs - diuretics, CCB, alpha blockers, antipsychotics, benzos, antidepressants
  • treat constipation
  • weight loss
  • pelvic floor muscle training
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15
Q

Heaviness in eye with flashes and floaters

A

Posterior vitreous detachment

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16
Q

Urethritis, conjunctivitis/iritis, arthritis

A

Reactive arthritis

17
Q

Reactive arthritis presents 1-3 weeks after what most common pathogen

A

Chlamydia trachomatis

Also GI infection

18
Q

Treatment for reactive arthritis (3)

A
  • NSAIDs
  • intraarticular corticosteroid injection
  • Prednisolone 10-50mg orally daily until symptoms improve then taper to stop
19
Q

Medial tibial stress syndrome /Tibial periositis (shin splints) - what is it, where is pain, risk factors

Review this

A

-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

20
Q

Tibial stress fracture

A
  • 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
21
Q

Management principles for muscle strain or tear

A
  • 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
22
Q
  • Management principles for tendinopathy
A
  • 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
23
Q

management principles for ligament sprain or tear

A
  • 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
24
Q

Pain in shoulder/lateral upper arm
Night pain, interrupted sleep
Painful arc

A

Rotator cuff disease

25
Q

How to differentiate rotator cuff disease from glenohumeral OA and adhesive capsulitis

A

Passive ROM painless in rotator cuff disease

26
Q

Management of rotator cuff disease

A
  • 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
27
Q

Clinical diagnosis of adhesive capsulitis

A

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

28
Q

treatment of adhesive capsulitis

A

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

29
Q

Management of lateral and medial epicondylitis

A
  • 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
30
Q

Management of De Quervain tenosynovitis

A
  • local corticosteroid injection most effective
  • splinting
  • NSAIDs orally or topically
  • Rest if possible, can splint to immobilise thumb for 6 weeks then slowly reduced
31
Q

Carpal tunnel management

A
  • Treatment of underlying condition if present (hypothyroidism/DM/RA)
  • NSAID
  • corticosteroid injection (can repeat)
  • surgery
32
Q

Flexor tenosynovitis (trigger finger)

A
  • 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

33
Q

Greater trochanter is pain syndrome - trochanter is bursitis/gluteus medius/minimus tendinopathy

A
  • 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
34
Q

Test for phaeochromocytoma

A

24 hour urine metanephrines and catecholamines

35
Q

Surgical margins for 8mm BCC

A

3-4mm

36
Q

High risk factors for skin cancer

A
  • 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
37
Q

What tests to order for suspected renal calculus

A

Urine dipstick for blood and to exclude infection
CT KUB + KUB x-ray simultaneous (if young/pregnant consider USS instead)
EUC

38
Q

Renal calculi management

A

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

39
Q

Causes of urge incontinence

A 
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

Respiratory RACGP (9 decks)

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