Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

My General Practise > Oxford Summary 4 > Flashcards

Oxford Summary 4 Flashcards

1
Q

Adult Severe asthma ≥1 of following:

A 
Previous near- fatal asthma or admission 
Need ≥ 3 classes of medications 
Heavy use of B2-agonist 
Repeated A&E attendances 
Brittle asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

adult asthma assessment

A

Peak expiratory flow rate- PEFR
Symptoms and response to self- treatment
HR and RR
O2 saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Adult moderate asthma exacerbation

A

Increasing symptoms
PEFR >50- 75% of expected
No features of acute severe asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Adult acute severe asthma:

A 
any of 
PEFR 33-50% best or predicted 
RR ≥25 breaths/min 
HR ≥110 bpm 
Cant speak in sentences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Adult life- threatening asthma: any of following with severe asthma

A

PEFR <33% best/ predicted
O2 sat <92%, feeble respiratory effort, silent chest
Bradycardia, dysrhythmia, hypotension, cyanosis
Exhaustion, confusion, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Adult near- fatal asthma

A

Respiratory acidosis and/ or need for mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Adult brittle asthma

A

Type 1: wide PEFR variability despite intense therapy
>40% diurnal variation for >50% in >150 days

Type 2: sudden severe attacks with well-controlled asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asthma Follow-up after treatment or discharge

A

GP review within 48 hours, check inhaler technique, written asthma action plan, modify treatment
Monitor symptoms and PEFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Child <2

Moderate asthma

A

SpO2 ≥92%
audible wheezing
accessory muscles
feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Child <2

Severe asthma

A

SpO2 <92%
marked distress
cyanosis
cant feed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Child <2

Life-threatening asthma

A

apnoea
poor respiratory effort
bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Child <2 asthma management

A
  • Intermittent wheezing- due to viral infection, poor response to bronchodilators
  • Mild/ moderate wheeze: metered dose inhaler + spacer with face mask
  • Severe wheeze: admit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Child 2-5

Moderate asthma definition

A

SpO2 ≥92%
Able to talk
HR ≤140bpm
RR ≤40/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Child 2-5

Moderate asthma Tx

A

Bs agonist: 2 puffs every 2 min with spacer ± mask- max 10
Prednisolone 20mg po
Poor response- admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Child 2-5

Severe asthma def

A 
SpO2 <92% 
Cant talk 
HR >140/min 
RR >40/min 
Accessory muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Child 2-5

Severe asthma Tx

A

Oxygen via face mask
B2 agonist: nebulized salbutamol 2.5mg or terbutaline 5mg
Prednisolone 20mg po
B2 agonist+ admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Child 2-5

Life-threatening asthma def

A 
SpO2 <92% +
Silent chest 
Poor resp effort 
Agitation 
Altered consciousness 
Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Child 2-5

Life- threatening asthma Tx

A

Oxygen

Nebulize: 
Salbutamol 2.5 mg or 
Terbutaline 5mg 
\+ 
ipratropium 0.25mg

Prednisolone 20mg or IV hydrocortisone 50mg

Repeat B2 agonist+ admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Child over 5 asthma management

A

inhaled SABA
Inhaled steroids
LABA
LTRA/ Theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hypoglycaemia

A

• Diabetic on insulin/ oral therapy
• Px: coma, fits, odd/ violent behavior, tachycardia, HT
• Young kids can px with behavioural change or headache
• Warning symptoms: sweating, hunger, tremor
• Investigation: blood sugar <2.5mmol/ L
• Action
o Conscious: simple carbs
o Unable to take oral: IM glucagon or IV glucose
o Once conscious: complex carbs like biscuits
o Glucose testing <15min, every hour for 4hrs, every 4hrs for 24hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hyperglycaemic Ketoacidotic Coma

A

• Type 1 diabetic: 2-3hx deterioration after infection
• Px: dehydrated, kussmal breathing, ketotic breath, shock, vomiting, abdominal pain
• Investigation: blood sugar >20mmol/L and ketone in urine
• Action: ABC
o Admit, if shocked lie flat and raise legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hyperosmolar hyperglycaemic state (HONK)

A

• Type 2 diabetic: <1 week deterioration
• Decreased consciousness, dehydration, hypotension
• Precipitated by infection, MI
• Can be presenting feature of T2DM
• Blood sugar >35mmol/L
Action: admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Myxedema coma

A
  • Px: >65, hx thyroid surgery/ radioactive I2
  • Precipitated by: MI, stroke, infection, trauma
  • Hypothermia, hyporeflexia, HF, brady, cyanosis, coma, seizures
  • Investigation: blood glucose may be low
  • Action: keep warm, treat HF with diuretics, opiods, nitrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Thyrotoxic Storm

A
  • Risks: recent thyroid surgery, hx radioactive I2
  • Precipitated by: MI, stroke, infection, trauma
  • Px: fever, agitation, coma, tachy/ AF, D+V, acute abdo, goiter ± thyroid bruit
  • Action: admit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Addisonian Crisis: hypoadrenal

A
  • Long-term steroid use stopped suddenly or not  in infection
  • Can be px of congenital adrenal hyperplasia or addisons
  • Px: vomiting, hypotension and shock
  • Management: admit and IV hydrocortisone
  • Prevention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Scalds and burns assess

A
  • Cause, size, thickness
  • Rule of nines to estimate extent of burn
  • Partial thickness: red and painful
  • Full thickness: painless and white or grey
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Scalds and burns action

A

Remove clothing and place in cold water >10 min or till painless
Don’t burst blisters
Give analgesia
Apply silver suldaziazine cream or paraffin-impregnated gauze and non-adherent dressing, change ever 1-2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Scalds and burns normal exam

A

Warn about headaches, tiredness, dizziness, tinnitus, poor concentration and poor memory for few days
Advice rest and paracetamol
Warning signs: drowsiness, severe headache, persistent vomiting, visual disturbances, behavioural changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Scalds and burns

rule of 9s for over 10 years old

A
  • Palm and genitals: 1%
  • Arm, head: 9% (head 14% in kids)
  • Leg, front, back: 18%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Sunburn

A

Tingling and then erythema 2-12 hours later
Redness maximal at 24hours and fades over 2-3 days  desquamation
Severe: blistering, pain, systematic upset. Tx calamine lotion
Predispose to skin cancer and photoaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Anemia def

A

Lack of sufficient RBC/ Hb. Males <13g/dL and females <12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Anemia causes

A

Decreased RBC production
Increased loss/ rate of destruction
Decreased tissue need for O2 - hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Anemia Px

A

Asymptomatic

Pallor, exertional SOB, tachycardia, palpitations, angina, night cramps, cardiac bruits, high output cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Anemia Investigations

A 
Blood film, reticulocyte count 
Ferritin, folate, B12 
CPR/ ESR/ plasma viscosity 
Hb electrophoresis 
LFT, TFT, RFT 
Serum bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MCV <80 DDX

A
  • Iron deficiency
  • Haemoglobinopathy- thalassemia
  • Lead poisoning
  • Anemia of chronic disorder
  • Sideroblastic anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

MCV normal DDX

A
  • Acute blood less
  • Haemolysis
  • Uremia
  • Anaplastic anemia
  • Marrow failure
  • Anemia of chronic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

MCV >100 DDX

A

Megaloblastic
o Folate deficiency
o B12 deficiency
o Orotic aciduria

Nonmegaloblastic
o Liver disease
o Alcoholism
Reticulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Iron deficiency ANAEMIA

A

microcytosis and hypochromia
• Due to chronic bleed, malnutrition, impaired absorption, increased demand
• Findings: low iron and ferritin, high TIBC
• Tx: PO iron- constipation and black stool
• No improvement consider H. Pylori, coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

B12 deficiency ANAEMIA

A

Found in liver, kidney, fish, chicken, dairy
Absorption depends on intrinsic factor (parietal cells)
Px: anemia, glossitis, mouth ulcers, peripheral neuropathy, ataxia, optic atrophy, memory loss, SCD
Causes: malnutrition, malabsorption, metformin, PPI and H2 antagonist, pernicious anemia
Tx: hydroxocobalamin IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Folate deficiency ANAEMIA

A
  • Found in liver, yeast, spinach, nuts
  • Px: anemia signs, polyneuropathy, dementia
  • Causes: malnutrition, malabsorption, increased need, anticonvulsants, trimethoprim
  • Tx: folate 5mg od for 4 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Thalassaemia AR

α thalassemia: decreased α- globin

A

o Cis deletions in Asians, trans in Africans
o 4 gene deletion: γ4 (barts hydrops) –> hydrops fetalis
o 3 gene deletion: HbH disease. Excess β globin –> β4
o 1-2 gene deletion: no clinical significance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

β thalassemia

A

point mutation in slice site and promotor sequence
o Mediterranean populations>
o Minor: heterozygote. β underproduced, asymptomatic
o Major: homozygote, β asent severe anaemia- need transfusions  2° haemochromatosis
o Marrow expansion  skeletal deformities. Chipmunk face, bossing of skull, thinning long bones, splnomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Sickle cell anemia

A

Point mutation at position 6 of β chai: glutamic acid with valine
When Hbs is deoxygenated it causes sickling of RBC –> shortened life span –> haemolytic aneamia and vasoocclusion
Newborns are asymptomatic because increased HbF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Anticoagulation

Long term indications

A

Prevent recurrent VTE

Prevent arterial thromboembolism with cardiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Anticoagulation

Short term indications

A

VTE ≥6weeks after below knee DVT and ≥3 months after proximal DVT/ PE
High risk: mural thrombosis after MI, post surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Tell me about NOACs

A

dabigatran, rivaroxaban
Prevent VTE in non-valvular AF
Fixed dose and do not need monitoring
Not easily reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Heparin/ LMWH
Enhances antithrombin activity
Uses:

A

o Initial tx in VTE
o Cancer/ pregnant VTE management
o When warfarin stopped before surgery
o High risk on PO anticoagulants if INR < than normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Warfarin

A

Check baseline FBC, clotting screen, RFT, LFT
+ antiplatelet: only if <12 months after stenting/ ACS
Monitoring: INR 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Candida
Risks:

Genital infection

Intertrigo

Oral

Nappy candidiasis

Chronic paronychia

Systemic candidiasis: immunocompromised- red skin nodules

A

Moist, opposing skin folds, humidity, poor hygiene
Obesity, DM, pregnancy, neonates

  • Pruritis, sore volvovaginitis, white cheesy discharge
  • Reddened, moist, glazed area in submammary, inguinal or axillary folds
  • Sore mouth, poor feeding in infants, poor oral hygiene, white plaques ± angular stomatitis
  • Wet workers at chronic nail fold inflammation
50
Q

Topical Treatment Fungal Infections

A
  • Mouth: nystatin or miconazole gel or oral suspension
  • Genital: imidazole cream or pessaries
  • Nail: use lacquer or paint, amorolfine
  • Skin: imidazole- cream/spray/powder or terbinafine cream
51
Q

Systemic Treatment Fungal Infections

A

• Oral, mucucutaneous, systemic: oral fluconazole 50mg od
• Genital: one dose 150-200mg fluconazole
• Tinea: terbinafine 250mg od or itraconazole 100mg od
• Nail: terbinadine 250mg or itraconazole 200mg bd
• Scalp: oral terfinafine 250mg od or grisofulvin 500mg-1g od
o Griseofulvin is teratogenic

52
Q

Dermatophyte infection

A

Corporis- ringworm on trunk or limbs
• Plaques with scaling and erythema, clear center

Cruris- jocks itch
• Associated with tinea pedis
• Upper thigh + scrotum. Red plaque with scaling at edge

Pedis- athletes foot
• Pruitis, maceration between toes
• Risks: swimmers, occlusive footwear, hot weather

Capitis
• Defines, inflamed scaly areas ± alopecia w/ broken hair shafts

Ungulum
• Begins distally and goes proximally
Thickening, yellowing and crumbling of nail plate

53
Q

Acute PID - chlamydia or gonorrhoea

A
  • Peak age 15-25
  • > 10% develop infertility after 1 episode, 50% after 3
  • Risk of ectopic
  • Hx: fever, acute bilateral pain, deep dyspareunia, dysuria, abnormal vaginal bleeding, discharge
  • Ex: pyrexia, bilateral tenderness, discharge, cervical excitation, adnexal tenderness
  • Dx: HVS/ endocervical swab, FBC, ESR/CRP
54
Q

Acute PID Management:

A

rest, analgesia
o Ofloxacin 400mg bd + metronidazole 400mg 2/52 OR
o 1 dose ceftriaxone 500mg IM then doxycyxline 100mg bd + metronidazole 400mg bd 2/52
o Persistent –> laproscopy

55
Q

Chronic PID Px:

A

pelvic pain
dysmenorrhea
dyspareunia ± menorrhagia

56
Q

Urethritis – males (feamles = mucopurulent cervicitis)

A

• Discharge and/or dysuria or asymptomatic
• Gonococcal or
• Non-gonococcal- chlamydia, ureaplasma, mycoplasma gentalium, tichomonas vaginalis
o Tx: azithromycin 1g stat
o Persistent/ reccurent: azithromycin 1g stat then 250mg od 4/7 + metronidazole 400mg bd 5/7

57
Q

Genital Herpes

Primary infection:

A

asymptomatic, painful genital ulcers on red background ± inguinal nodes, lesions crust then heal.
Complications: retention, aseptic meningitis

58
Q

Genital Herpes management

A

refer, acyclovir if within 5days, analgesia, ice packs, 5% lidocaine ointment for symptom relief

Recurrent: less severe. Tx with acyclovir 400mg bd

Neonatal: vesicular lesions> systemic. Prevent with CS

59
Q

Public lice Tx

A
  • Melathion 0.5% to dry hair and wash after 12hours
  • Permethrin 1% cream to damp hair and wash after 10min
  • Phenothrin 0.2% to dry hair and wash after 2 hours
  • Carbaryl 0.5-1% to dry hair wash after 12hours
60
Q

Chlamydia

A

• Men: asymptomatic> urethritis
• Women: asymptomatic > discharge, PCB/ IMB, PID, dysuria
o Mucopurulent cervicitis, hyperaemia and odema of cervix ± contact bleeding, tender adnexae, cervical ex.
• Neonates: conjunctivitis, pneumonia, otitis media, pharyngitis
• Dx: swab or first catch urine for NAAT
• Tx: doxycycline 100mg bd 1 week OR erythromycin 500mg qds 2/52 OR azithromycin 1g stat po

61
Q

Gonorrhoea

Male vs Female presentation

A

Men:
o Urethral: discharge, dysuria, prostitis, stricture> asym
o Rectal: asym> discharge, pain
o Pharyngeal: asymptomatic

Women: asymptomatic, discharge, lower abo pain, dysuria, bleeding, PID, bartholin gland abscess, miscarriage, preterm

62
Q

Gonorrhoea
Dx
Tx

A

Dx: first-catch urine NAAT, swab

Tx: ceftriazone 500mg IM once + azithromycin 1g stat po

63
Q

Trichomanis Vaginalis

A
  • Neonates: opthalmia neonatorum- discharge from eyes <21 days old
  • Men: dysuria, urethral discharge > asymptomatic
  • Women: asymptomatic, discharge, mucopurelent yellow- white, smelly discharge, soreness, pruitis, abdopain, dysuria
  • Ex: strawberry cervix, pH >4.5,
  • Tx: metronidazole po 2g state or tinidazole 2g state
  • Persistent: higher dose
64
Q

Genital warts

A

Due to HPV
Px: asymtpmpatic> pruitis, discharge, warts
Management: podophyllotoxin, imiquimod, excision, cryotherapy

65
Q 
Syphilis 
Teponema pallidum 
Incubation 9- 90 days 
Dx: VDRL, TPHA
Stages
A
  1. Primary: chancre at site
  2. Secondary: 4-8 weeks later. Fever, malaise, lymphadenopathy, conylomata lata, rash, alopecia
  3. Tertiary: 2-20 year later- gummas in connective tissue
  4. Quarternary: CV or neurological complications
66
Q

Sore Throat

70% are viral and rest are bacterial eg

A

group A β- haemolytic

67
Q

Sore Throat PC

A

• Painful swallowing, tonsillar exudate
• Headache, N & V
• Abdominal pain
Persistent feverglandular fever in YA

68
Q

Sore Throat Dx

A

Investigations
• Throat swab cant distinguish commensal from infectious
• Rapid antigen test: low sensitivity and limited usefulness

69
Q

Sore Throat Complications

rare

A
  • Quinsy or peritonsillar abscess- adults>
  • Retropharyngeal abscess
  • RF
  • Acute glomerulonephritis
70
Q

Tell me about quinsy

A

o Unilateral swelling, difficult swallowing, trismus

o IV abx ± incision and drainage

71
Q

Glandular fever (infectious mononucleosis)- EBV
Teens or YA with sore throat >1 week
Droplet or direct contact with 4-14 day incubation

Px
Dx

A

Px: sore throat, malaise, fatigue, lymphadenopathy, splenomegaly, palatal petechiae, rash

Dx: FBC for atypical lymphocytes and monospot for Ig

72
Q

Glandular fever
Tx
Comp

A

Management:
o Rest, fluids, analgesia, salt water gargles
o Avoid alcohol
o If severe: prednisolone
o 2° infections treated with Abx- not amoxicillin

Complications 
o	2° infections, pneumonitis
o	Rash with amoxicillin 
o	Hepatitis, jaundice
Neurological disturbances
73
Q

Tonsillectomy Indications

A

Recurrent acute tonsillitis: >5 attachs for 2 years
Airway obstruction
Chronic tonsillitis: >3 months + halitosis
Recurrent quinsy
Unilateral enlargement- exclude malignancy

74
Q

Tonsillar tumour

A

elderly

Px unilateral swelling, dysphagia, sore throat, earache

75
Q

Hoarseness

Causes:

A

Local: URTI, laryngitis, trauma, ca, hypothyroidism, acromegaly
Neurological: laryngeal nerve palsy, MND, MG, MS
Muscular dystrophy

Functional problems
• Psychological stress –> hysterical paralysis of vocal cord adductors –> whisper or loss of voice
• Young women. Speech therapy and psychological support

RULE OUT CA

76
Q

Hoarseness Assessment

A 
Weight
dysphagia
lumps
TFT
CXR
77
Q

Laryngitis

A
  • Hoarseness, mailase ± fever, pain on talking
  • Viral and self limiting 1-2 weeks >
  • Can get 2 bacterial infection
  • Tx: rest, OTC analgesia, phenoxymethylpenicillin 250qds
78
Q

Laryngeal carcinoma

A
  • Men>
  • Pc: hoarseness then stridor, dysphagia, pain
  • Management: laryngoscopy and bx, surgery ± RT
79
Q

Post Laryngectomy problems

A

Permanent tracheostomy, stenosis at site
Excessive secretions
Recurrent pneumonia

80
Q

Vocal cord nodules

A

Can cause hoarseness
Due to overuse
Visualized with laryngoscope
Tx: rest or surgery

81
Q

Stridor

A

Inspirational noise due to narrowing of lyarynx or trachea
Children
Signs of severe airway narrowing
Distress, pallor, cyanosis
Increased RR, use of accessory muscles and tracheal tug

82
Q

Laryngomalacia (congenital laryngeal stridor)

A

Small babies due to floppy aryatic fold and small airway

Louder during sleep, excitement, crying and URTI

83
Q

Adult epiglottitis

A

More rare than in children
Less likely to cause obstruction
Tx: IV Abx

84
Q

Croup: viral infection

A
  • Starts with mild fever + runny nose
  • Oedema and secretions –> barking cough and stridor
  • Cough starts at night and worse with crying
  • Recurrent attacks a/w viral URTI
  • Tx: steam, dexamethasone 0.15mg/kg PO or prednisolone 1-2mg/kg
85
Q

Acute epiglottitis in children

A

Bacterial infection, more rare with Hib vaccine
Can obstruct airway. Don’t examine bc can cause this
Stridor, drooling, fever and upright leaning forward
Tx: IV Abx

86
Q 
Acute sinusitis
≥1: maxillary, frontal, ethmoid or sphenoid 
Follows URTI- 10% after tooth infection 
Px: 
Management: most resolve in 7-10 days
A

Px: frontal headache/ facial pain, worse on movement ± purulent nasal discharge, fever

Management: 
o	 Analgesia, fluids and steam 
o	Decongestants 
o	Beclometasone 2 puffs in each nostril bd 
o	Amoxicillin 500mg tds

same tx for chronic sinusitis

87
Q

Chronic/ recurrent sinusitis

A

> 3 months of symptoms or >3 episodes in a year
Px: post-nasal drip, frontal headache/ facial pain, blocked nose
A/w: nasal polyps and vasomotor rhinitis

88
Q

Non-allergic rhinitis

A

Hay fever: rhinitis, conjunctivitis, wheeze, due to pollen
Same tx as allergic
Topical chromone eye drops- nedocromil

89
Q

Rhinitis
• Inflammation of nasal mucosa
• Allergic or non-allergic (vasomotor- physical/ chemical triggers)

Symptoms
Signs
Management

A

Sx
Nasal discharge, itching, sneezing ± nasal blockage
Moderate/ severe if ≥1: abnormal sleep, impairment of daily activities, problems at work/ school

Signs
Swollen inferior turbinates,  nasal airway, pale mucosa, discharge

Management if allergic: exposure, saline nose drops ± steam inhalation, drugs

90
Q

Medications for allergic rhinitis

A
  • Nasal steroids
  • Oral steroids
  • Oral antihistamine: loratadine 10mg od
  • Topical AH: azelastine nasal drops- rescue- fast acting
  • Leukotriene R antagonist: montelukast 10mg od
  • Topical/ oral decongestants: ephedrine nasal drops tds/ qds
  • Topical anticholinergics: ipratropium bromide nasal spray
  • Topical chromones: sodium cromoglicate or nedocromil sodium nasal spray
91
Q

Earache

Local causes:

A

o Outer ear: otitis externa, furunclosis, impacted wax, pinna pain, malignant disease of ear
o Middle ear: otitis media, barotrauma, myringitis, mastoiditis

92
Q

Earache

Referred pain:

A

o CN 5: dental abscess/ caries, impacted molar teeth
o CN 7: HSV infection, Ramsay Hunt
o CN 10: tumour piriform fossa, larynx or post-croicoid
o CN 11: tonsillitis/ quinsy/tumour base of tongue, tonsil
o CN 2/3: cervical spondylosis

93
Q

Myringitis

A

Inflammation of tympanic membrane

If vesicles- mycoplasma or viral URTI (ramsay hunt similar)

94
Q

Discharge from ear: otorrhea

A

Causes: otitis externa, media, cholesteatoma
Exclude perforated drum
If clear- might be CSF leak so test for glucose

95
Q

Ear wax

A

Only problem if deafness, pain, discomfort, tinnitus

Tx: ear syringing. Not if deaf in other ear, hx perforation of ear drum, px mastoid operation, middle ear disease

96
Q

Otitis externa
Def:
Risks:

A

Adults> a/w eczema of ear canal

swimming, humidity, narrow ear canal, hearing aid, trauma

97
Q

Acute otitis externa: <6 weeks

Px:

A

pain, discharge, hearing loss ± lymphadenopathy

Ear canal: red, swollen, inflamed

98
Q

Chronic otitis externa: >3 months

A

Discharge ± hearing loss
Leads to canal stenosis and permanent hearing loss
Severe necrotizing form can occur in diabetics/ immunocom

99
Q

otitis externa management:

A

analgesia, ear drops- aluminium acetate and Abx and/or steroid drops (locorten- vioform)
No response: otosporin (neomycin, hydrocortisone, polymyxin B- antifungal) ± oral antibiotic

100
Q

Furunculosis: boil in ear canal
Px:
Tx:

A

severe pain worse with moving tragus or jaw

Tx
No cellulitis: analgesia, hot compressions. If not working- topical abx and steroid drops hentisone, 3 drops qds 7days

Cellulitis: flucloxacillin 250-500mg qds 7 days

101
Q

Chondrodermatitis nodularis helicis (CNH)

A

Pressure on ear –> tender lump with scarring on outer helix
Advice relief ± topical steroid/ antiobitotic, if fails-cryotherapy or surgical removal
Infection of pinna due to ear piercing or lacteration
No treatment –> cauliflower ear

Pseudomonas> treat with ciprofloxacin 500-750mg bd PO

102
Q

Acute suppurative otitis media
Acute inflammation of middle ear
Can be viral/ bacteria- parental smoking increases risk

Px:
Tx:

A

Px: unilateral pain ± fever
o Discharge  pain relief- spontaneous drum perforation
o Red, bulging drum, pus if perforated
Management
o 80% resolve in ~4days- fluids, analgesia
o Amoxicillin tds if bilateral or acute + otorrhea, severe, immunosuppression, CF

103
Q

Chronic suppurative otitis media

A

• Drainage >1 month a/w perforation drum + CHL
• Not painful
• Type
o Central perforation: “safe disease”. Tx like otitis externa
o Attic/ marginal perforation: “unsafe” a/w cholestaetoma

104
Q

Serous/ secretory otitis media (glue ear)

A

• Non-infected fluid due to obstruction/ dysfunction of Eustachian- 2° to ear/ through infection, tonsillar hyperplasia
• Most common cause of hearing loss in children
• Common in down syndrome or cleft lip/ palate
• Px: deafness ± pain, difficulty with speech ± behavior issues
• Signs: dull, concave drum with visable BV ± fluid level/ air bubbles behind drum
• Tx: symptomatic- resolve alone, referral if not resolved
o Grommets: air-conducting tubes inserted through eardrum. Most extruded spontan <9months

105
Q 
Mastoiditis 
Rare complication of acute OM 
PC
Signs
Tx
A

PC: persistent, throbbing pain, cream, profuse discharge, worse CHL, fever, malaise

Signs: tenderness ± swelling over mastoid, ear sticking out, red/bulging or perforated drum

Tx: IV abx

106
Q

Cholestaetoma
Stratified squamous epithelium growing in middle ear
Damage to facial nerve, semicircular canals –> vertigo
Infected = discharges

Signs:
Tx:

A

perforation of pars flaccida of ear drum with pearly white discharge + conductive hearing loss

Tx: suction

107
Q

Tympanosclerosis

A

Thickening and calcification of tympanic membrane due to scarring from reccurent ear infections or grommet insertion
Asymptomatic> no tx

108
Q

Renal Stones

Risks

A
  • Fhx: X-linked nephrolithiasis, cystinuria, hyperoxaluria
  • Anatomically abnormal kidney: horseshoe, medullary sponge
  • Metabolic disease: gout, hypercalcaemia/ calcuria, cysinuria, renal tubular acidosis
  • Dehydration, immobilization
  • Chronic UTI
  • Drugs: allopurinol, aspirin, steroids, loop diuretics
109
Q

Renal Stones Px

A 
•	Pain ± N/V, radiates to tip of penis/ testis or labia majora
o	Loin pain= kidney stone 
o	Renal colic= ureteric stone 
o	Strangury= bladder stone 
o	Interruption of flow= urethral stone
110
Q

Renal Stones

Immediate management

A

Investigations: urine dipstick for RBC, WBC

Analgesia- diclofenac 75 mg IM/ 100 PR ± antiemetic

Admit if: fever, oliguria, poor fluid intake, preggos, >24hrs

111
Q

Renal Stones Investigations

A
  • U&E, creatinine, eGFR, Ca2+, PO43-, alk phos, uric acid, albumin
  • Urine: M, C&S, cysteine “spot test”, TPCR, , Ca2+, PO43, uric acid, sodium excretion
  • Xray KUB, USS for urate and xanthine stones
112
Q

Calcium oxalate: (80% hypercalcuria w/o hypercalcaemia) prevention:

A

o Potassium citrate- urinary alkalization
o Avoid chocolate, tea, rhubarb, spinach, nuts, beans
o Bendroflumethiazide 2.5mg od if hypercalcuria
o Pyridoxine if hyperoxaluria

113
Q

Calcium phosphate prevention:

A

o Low calcium diet, avoid vit D supplements

o Bendroflumethiazide 2.5mg od

114
Q

Staghorn/ triple phosphate prevention:

Ca2+, Mg2+, ammonium

A

A/w proteus species and urinary stasis UTI

115
Q

Urate prevention:

A

o Avoid beer, allopurinol

o Potassium citrate to alkalize urine (ph >6.5)

116
Q

Cysteine prevention:

A

potassium citrate to alkalize urine (ph >6.5)

117
Q

Hyperoxaluria
1° - 2 types

2° to gut resection/ malabsorption or increased spinach/ vit C

A

Type 1: calcium oxalate stones all over body. Px renal stones and nephrocalcinosis in kids. 80% CRF

Type 2: more benign, nephrocalcinosis and no CRF

118
Q

Cystinuria

A

Most common aminoaciduria
Px: stones at 10-30 years
Urine: increased cysteine, ornithine, arginine, lysine

119
Q

Haematuria

A

Frank or microscopic
Investigations: MSU for M, C&S, U&E, creatinine, eGFR

Causes 
Kidney: stones, infection, GN, tumour 
Ureter: stones, tumour 
Bladder: UTI, stones, tumour, chronic inflammation 
Prostate: prostatitis, tumour 
Urethral inflammation
120
Q 
Hypernephroma: clear cell AC of tubular epithelium
who
PC
Dx
Tx
A

Males, 50’s

Px: haematura, loin pain, abdo mass, anaemia, L varicoile

Investigations:
o Urine: RBCs
o Bloods: PCV, anemia, hypercalcaemia
o USS, CXR

Management: surgery ± CT, RT or biological therapy

121
Q

Bladder cancer
TCC most common in UK, SCC most common worldwide

Risks: male, smoking, aromatic amine exposure, Schistosomiasis, chronic UTI, urinary stasis

PC
Dx
Tx

A

Px: haematuria, recurrent UTI, pain, frequency, obstruction

Dx: MSU- M, C&S, microscopic haematuria

Management:
o T1: confined to mucosa/ submucosa. Tx TURBT ± CT
o T2: invasion of CT. Tx TURBT ± RT
 follow up with cystoscopy for T1 and T2
o T3: invasion into muscle. Tx radical cystectomy ± RT
o T4: beyond bladder. Tx TURBT for symptoms, RT ± CT

122
Q

Sterile pyuria:
WBC in urine and no UTI

DDx

A 
Inadequately treated UTI 
Appendicitis
Calculi, renal TB, papillary necrosis, interstitial nephritis, cystitis, polycystic kidney
Bladder tumour, cystitis due to RT
Prostitis

My General Practise (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions