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General Medicine > Pearls from the GPSN GP Companion book > Flashcards

Pearls from the GPSN GP Companion book Flashcards

1
Q

ABCDs of Skin Cancer

A

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)

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2
Q

What is lichenification?

A

Thickening of skin surface secondary to chronic scratching or rubbing

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3
Q

Macule/Papule
Nodule/Plaque
Vesicle/Bulla
Pustule/Weal

A

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

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4
Q

ABCDE of Melanoma

A 
A - appearance and asymmetry
B - border
C - colour
D - diameter and distribution
E - evolution
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5
Q

Describe the typical morphology of BCCs

A

Pearly, raised rolled border, central depression, telangiectasia, non scaling lesions on sun-exposed areas

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6
Q

OGTT cut-offs for diagnosis of diagnosis of T2DM

A

11.1 - diabetes likely

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7
Q

Fasting glucose cut-offs for diagnosis of T2DM

A

7.0 - diabetes likely, repeat fasting on separate day

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8
Q

Pre-prandial and post-prandial goals for glycaemic control in T2DM?

A

Pre-prandial

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9
Q

Goal for HbA1c in T2DM?

A
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10
Q

For how long is HbA1c a measure of BGLs?

A

Index of mean plasma glucose levels over the preceding 2-3 months (the red blood cell lifecycle)

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11
Q

Causes of increased prolactin?

A

Physiological - pregnancy, breast stimulation, stress

Pathological - prolactinoma, pituitary tumour, hypothalamic disorders, phenothiazines, metoclopramide, oestrogens

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12
Q

The differentiating factor on TFTs between primary or secondary hypothryoidism?

A

TSH - increased in primary and decreased in secondary (pituitary dysfunction)

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13
Q

Modifiable lifestyle factors for BP and CVD risk?

A 
SNAP
S - Smoking
N - Nutrition
A - Alcohol
P - Physical activity
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14
Q

BP treatment goals for general population and those with CVD, diabetes or CKD?

A

No cormorbidities -

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15
Q

Secondary causes of hypertension

A 
Glomerulonephritis
Reflux nephropathy
Renal artery stenosis
Primary aldosteronism
Cushing's syndrome
Phaeochromocytoma
OCP
Coarctation of the aorta
Pregnancy
Medications
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16
Q

What to do if blood pressure goals are not reached on initial treatment?

A

Add a second agent, then increase doses
Then add a third agent
Refer for specialist assistance

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17
Q

What agents should be used first line for hypertension?

A

ACEi or ARB
Calcium channel blocker
Low dose thiazide diuretic (for patients aged 65+ years)

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18
Q

ECG rate = how many large squares between R-R interval

A 
1 = 300
2 = 150
3 = 100
4 = 75
5 = 60
6 = 50
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19
Q

What is a rough way of determining rate on an ECG?

A

Counting the number of QRS complexes in the standard rhythm strip and multiplying by 6

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20
Q

Which ECG leads correspond to which region of the heart (anterior, inferior, lateral, septal)?

A

Anterior: V3-V4
Inferior: II, III and aVF
Lateral: I, aVL, V5-V6
Septal: V1-V2

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21
Q

Timeframe of elevation of troponin T post-MI?

A

Begins 4-8 hrs post MI
Peaks at 10-12 hrs post MI
Remains elevated for up to 7 days

22
Q

Causes of raised CK?

A 
Myocardial damage
Skeletal muscle damage
Post IM injection
Excessive exercise
Rhabdomyolysis
Myopathies
Hypothyroidism
23
Q

The 6 Ps of acute arterial insufficiency?

A 
Pain
Pulselessness
Pallor
Polar (cool)
Paresthesia
Paralysis
24
Q

5As of smoking cessation?

A 
Ask
Assess
Advise
Assist
Arrange
25
Q

What is the MCV of microcytic anaemia?

List some causes.

A

MCV

26
Q

What is the MCV range of normocytic anaemia?

List some causes.

A 
MCV 80-95
Acute blood loss
Anaemia of chronic disease
Hypo-production of RBCs (renal failure EPO reduction, bone marrow failure)
Pregnancy
Hypothyroidism
27
Q

What is the MCV range of macrocytic anaemia?

List some causes.

A 
MCV >95
B12 and/or folate deficiency
Drug induced
Liver disease
Alcohol abuse
Bone marrow failure/infiltration
Chronic hypoxic lung disease
Hypothyroidism
28
Q

Medications that can cause a neutrophilia?

A 
Corticosteroids
Cytokines
Clozapine
Lithium
Tobacco
29
Q

Broad causes of eosinophilia?

A

Medications
Atopic reactions (eczema/asthma)
Skin disorders (psoriasis/scabies)
Parasitic infections (malaria/toxo/ascaris/strongyloides)
Malignancy (radiation tx/Hodgkin’s/myeloproliferative disorders/eosinophilic granuloma)

30
Q

Causes of aplastic anaemia?

A 
Cytotoxic
Irradiation
Viral infection
Parvovirus B19
AIDS
31
Q

Bacterial cause of a monocytosis?

A

TB

32
Q

List some acute phase reactants

A 
CRP and ESR
Fibrinogen
Ferritin
Haptoglobins
Alpha-1 antitrypsin
Caeruloplasim
Facter VIII
von Willibrand factor
33
Q

Which is more sensitive? CRP or ESR?

A

CRP is more sensitive and elevates earlier than ESR

Except in SLE and UC where ESR is more sensitive

34
Q

ESR >100 =

A

Multiple myeloma
TB
Temporal arteritis

35
Q

Coag studies: APTT stands for what, relates to which pathway and which factors?

A

Activated partial thromboplastin time
Intrinsic pathway
Factors XII, XI, IX

36
Q

Coag studies: PT stands for what, relates to which pathway and which factors?

A

Prothrombin time (converted to INR)
Extrinsic pathway
Factor VII

37
Q

Coag studies: TT stands for what, relates to which pathway and which factors?

A

Thrombin time
Common pathway
Factors X, V, II, I (fibrinogen to fibrin clot)

38
Q

Causes of increased D-dimer besides DVT/PE?

A 
DIC
Malignancy
Post-surgery
Pregnancy
Severe infection
Renal disease
Liver disease 
Heart failure
39
Q

Heparin causes what APTT and PT picture?

A

Prolonged APTT

Normal PT

40
Q

Warfarin causes what APTT and PT picture

A

Normal APTT

Prolonged PT

41
Q

If there is no bilirubin in the urine of a jaundiced patient what does that mean?

A

That the jaundice is due to unconjugated bilirubin eg haemolysis

42
Q

When could you have urine nitrites negative but still have a UTI?

A

Gram-positive organisms

Pseudomonas

43
Q

What conditions cause an elevated serum urea?

A

Conditions that cause decreased GFR

  • Pre-renal or renal disease
  • Bleeding into the GIT tract
  • Hypercatabolic state
44
Q

What conditions cause a decreased serum urea?

A 
Pregnancy
Water retention 
Decreased synthesis
Decreased protein intake
Severe liver disease
Urea-cycle defects
45
Q

Elevated serum bicarbonate = metabolic ….. or compensated respiratory …..
Decreased serum bicarbonate = metabolic …..

A

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)

46
Q

Causes of decreased potassium

A 
Loop or thiazide diuretics
Vomiting or diarrhoea
Alkalosis
Treatment of acidosis
Mineralocorticoid excess
47
Q

Causes of increased potassium

A 
Acidosis
Tissue damage
Renal failure 
Mineralocorticoid deficiency
Iatrogenic excess
Poor collection, delay in separation and refrigeration
48
Q

High anion gap acidosis? What an anion other than chloride which can be elevated?

A

Lactate in lactic acidosis

49
Q

States of kidney disease by eGFR?

A 
Stage 1 - 90
Stage 2 - 60-89
Stage 3 - 30-59
Stage 4 - 15-29
Stage 5 -
50
Q

Causes of increased albumin in blood?

A

Dehydration
Acute phase response
Excessive tourniquet time

51
Q

Causes of decreased albumin in blood?

A 
Fluid overload
Chronic liver disease
Protein losing disorders
Malnutrition
Burns
52
Q

Causes of increased bilirubin in blood?

A 
Hepatocellular disease 
Biliary disease
Haemolysis
Megaloblastic anaemia
Gilbert syndrome

General Medicine (5 decks)

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