Pearls from the GPSN GP Companion book Flashcards
ABCDs of Skin Cancer
A - asymmetry
B - borders (irregular/round/oval/linear)
C - colour/consistency
D - diameter
S - surface (crust/excoriation/horn/lichenification/maceration/scale)
S - superficial
S - secondary sites (psoriasis-nails, scabies-finger webs, fungal-toe webs)
What is lichenification?
Thickening of skin surface secondary to chronic scratching or rubbing
Macule/Papule
Nodule/Plaque
Vesicle/Bulla
Pustule/Weal
Macule - Circumscribed area of altered skin colour 0.5cm
Plaque - Flat topped palpable mass >1cm
Vesicle - Visible collection of fluid within skin 0.5cm
Pustule - Visible collection of pus within skin surface
Weal - Area of dermal oedema of any size
ABCDE of Melanoma
A - appearance and asymmetry B - border C - colour D - diameter and distribution E - evolution
Describe the typical morphology of BCCs
Pearly, raised rolled border, central depression, telangiectasia, non scaling lesions on sun-exposed areas
OGTT cut-offs for diagnosis of diagnosis of T2DM
11.1 - diabetes likely
Fasting glucose cut-offs for diagnosis of T2DM
7.0 - diabetes likely, repeat fasting on separate day
Pre-prandial and post-prandial goals for glycaemic control in T2DM?
Pre-prandial
Goal for HbA1c in T2DM?
For how long is HbA1c a measure of BGLs?
Index of mean plasma glucose levels over the preceding 2-3 months (the red blood cell lifecycle)
Causes of increased prolactin?
Physiological - pregnancy, breast stimulation, stress
Pathological - prolactinoma, pituitary tumour, hypothalamic disorders, phenothiazines, metoclopramide, oestrogens
The differentiating factor on TFTs between primary or secondary hypothryoidism?
TSH - increased in primary and decreased in secondary (pituitary dysfunction)
Modifiable lifestyle factors for BP and CVD risk?
SNAP S - Smoking N - Nutrition A - Alcohol P - Physical activity
BP treatment goals for general population and those with CVD, diabetes or CKD?
No cormorbidities -
Secondary causes of hypertension
Glomerulonephritis Reflux nephropathy Renal artery stenosis Primary aldosteronism Cushing's syndrome Phaeochromocytoma OCP Coarctation of the aorta Pregnancy Medications
What to do if blood pressure goals are not reached on initial treatment?
Add a second agent, then increase doses
Then add a third agent
Refer for specialist assistance
What agents should be used first line for hypertension?
ACEi or ARB
Calcium channel blocker
Low dose thiazide diuretic (for patients aged 65+ years)
ECG rate = how many large squares between R-R interval
1 = 300 2 = 150 3 = 100 4 = 75 5 = 60 6 = 50
What is a rough way of determining rate on an ECG?
Counting the number of QRS complexes in the standard rhythm strip and multiplying by 6
Which ECG leads correspond to which region of the heart (anterior, inferior, lateral, septal)?
Anterior: V3-V4
Inferior: II, III and aVF
Lateral: I, aVL, V5-V6
Septal: V1-V2
Timeframe of elevation of troponin T post-MI?
Begins 4-8 hrs post MI
Peaks at 10-12 hrs post MI
Remains elevated for up to 7 days
Causes of raised CK?
Myocardial damage Skeletal muscle damage Post IM injection Excessive exercise Rhabdomyolysis Myopathies Hypothyroidism
The 6 Ps of acute arterial insufficiency?
Pain Pulselessness Pallor Polar (cool) Paresthesia Paralysis
5As of smoking cessation?
Ask Assess Advise Assist Arrange
What is the MCV of microcytic anaemia?
List some causes.
MCV
What is the MCV range of normocytic anaemia?
List some causes.
MCV 80-95 Acute blood loss Anaemia of chronic disease Hypo-production of RBCs (renal failure EPO reduction, bone marrow failure) Pregnancy Hypothyroidism
What is the MCV range of macrocytic anaemia?
List some causes.
MCV >95 B12 and/or folate deficiency Drug induced Liver disease Alcohol abuse Bone marrow failure/infiltration Chronic hypoxic lung disease Hypothyroidism
Medications that can cause a neutrophilia?
Corticosteroids Cytokines Clozapine Lithium Tobacco
Broad causes of eosinophilia?
Medications
Atopic reactions (eczema/asthma)
Skin disorders (psoriasis/scabies)
Parasitic infections (malaria/toxo/ascaris/strongyloides)
Malignancy (radiation tx/Hodgkin’s/myeloproliferative disorders/eosinophilic granuloma)
Causes of aplastic anaemia?
Cytotoxic Irradiation Viral infection Parvovirus B19 AIDS
Bacterial cause of a monocytosis?
TB
List some acute phase reactants
CRP and ESR Fibrinogen Ferritin Haptoglobins Alpha-1 antitrypsin Caeruloplasim Facter VIII von Willibrand factor
Which is more sensitive? CRP or ESR?
CRP is more sensitive and elevates earlier than ESR
Except in SLE and UC where ESR is more sensitive
ESR >100 =
Multiple myeloma
TB
Temporal arteritis
Coag studies: APTT stands for what, relates to which pathway and which factors?
Activated partial thromboplastin time
Intrinsic pathway
Factors XII, XI, IX
Coag studies: PT stands for what, relates to which pathway and which factors?
Prothrombin time (converted to INR)
Extrinsic pathway
Factor VII
Coag studies: TT stands for what, relates to which pathway and which factors?
Thrombin time
Common pathway
Factors X, V, II, I (fibrinogen to fibrin clot)
Causes of increased D-dimer besides DVT/PE?
DIC Malignancy Post-surgery Pregnancy Severe infection Renal disease Liver disease Heart failure
Heparin causes what APTT and PT picture?
Prolonged APTT
Normal PT
Warfarin causes what APTT and PT picture
Normal APTT
Prolonged PT
If there is no bilirubin in the urine of a jaundiced patient what does that mean?
That the jaundice is due to unconjugated bilirubin eg haemolysis
When could you have urine nitrites negative but still have a UTI?
Gram-positive organisms
Pseudomonas
What conditions cause an elevated serum urea?
Conditions that cause decreased GFR
- Pre-renal or renal disease
- Bleeding into the GIT tract
- Hypercatabolic state
What conditions cause a decreased serum urea?
Pregnancy Water retention Decreased synthesis Decreased protein intake Severe liver disease Urea-cycle defects
Elevated serum bicarbonate = metabolic ….. or compensated respiratory …..
Decreased serum bicarbonate = metabolic …..
Elevated in metabolic alkalosis or compensated respiratory acidosis
Decreased in metabolic acidosis
(Also decreased as artefact if blood collection tube is partially filled or left uncapped due to loss of CO2)
Causes of decreased potassium
Loop or thiazide diuretics Vomiting or diarrhoea Alkalosis Treatment of acidosis Mineralocorticoid excess
Causes of increased potassium
Acidosis Tissue damage Renal failure Mineralocorticoid deficiency Iatrogenic excess Poor collection, delay in separation and refrigeration
High anion gap acidosis? What an anion other than chloride which can be elevated?
Lactate in lactic acidosis
States of kidney disease by eGFR?
Stage 1 - 90 Stage 2 - 60-89 Stage 3 - 30-59 Stage 4 - 15-29 Stage 5 -
Causes of increased albumin in blood?
Dehydration
Acute phase response
Excessive tourniquet time
Causes of decreased albumin in blood?
Fluid overload Chronic liver disease Protein losing disorders Malnutrition Burns
Causes of increased bilirubin in blood?
Hepatocellular disease Biliary disease Haemolysis Megaloblastic anaemia Gilbert syndrome
