Brainscape's Knowledge GenomeTM

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


See full index

402 - General Practice > Piss, Shit & Heartburn > Flashcards

Piss, Shit & Heartburn Flashcards

1
Q

What is the difference (in time) between acute and chronic diarrhoea?

A

4 weeks

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

Red flags for diarrhoea

A

Blood in the stool.
Recent hospital treatment or antibiotic treatment.
Weight loss.
Evidence of dehydration.
Nocturnal symptoms — organic cause more likely.

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

What do you need to know about the character of the diarrhoea?

A

Frequency

watery, fatty, containing blood or mucus

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

What factors are suggestive of an infective cause of diarrhoea?

A

Fever.
Vomiting.
Recent contact with a person with diarrhoea.
Exposure to possible sources of enteric infection (for example, having eaten meals out, or recent farm or petting zoo visits).
Travel abroad
Ask about potential exposures such as raw milk or untreated water.
Food handlers, nursing home residents, and recently hospitalized people

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

4 mechanisms of diarrhoea

A

Osmotic - intolerance/malabsorption
Secretion - infection
Inflammation - IBD/Shigella
Motility - diabetes/hyperthyroidism

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

Most common cause of infectious diarrhoea?

A

Virus - Noro

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

Prognosis for diarrhoea in relation to pathogen?

A

Viral - 2-3 days
Bacterial - 3-7 days
Parasite - potentially for ever

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

Other than infection, possible causes of diarrhoea

A 
Anxiety 
Radiotherapy of pelvis
New Medication
Alcohol
IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aside from red flags what do you need to assess in someone with acute diarrhoea?

A

Dehydration

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

Examinations for diarrhoea

A

Abdominal

DRE

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

Investigations diarrhoes

A

Consider stool sample

Blood tests if you suspect start of chronic cause

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

When to admit for acute diarrhoea?

A

Cannot keep down fluids because of vomiting
Features of dehydration or shock
Older age (people 60 years of age or older are more at risk of complications).
Home circumstances and level of support.
Fever.
Bloody diarrhoea.
Abdominal pain and tenderness.
Increased risk of poor outcome, for example

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When to refer for suspected cancer (2 week for dairrhoea)?

A

They are aged 40 and over with unexplained weight loss and abdominal pain, or
They are aged 50 and over with unexplained rectal bleeding, or
They are aged 60 and over with iron deficiency anaemia or changes in their bowel habit

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

10 red flags of chronic diarrhoea

A

Unexplained weight loss.
Unexplained rectal bleeding.
Persistent blood in the stool.
Abdominal mass.
Rectal mass.
Severe abdominal pain.
Iron deficiency anaemia.
Raised inflammatory markers (may indicate inflammatory bowel disease).
Nocturnal or continuous diarrhoea or both (suggestive of an organic rather than functional disorder).
Fever, tachycardia, hypotension, dehydration.

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

What is chronic fatty diarrhoea suggestive of?

A

pancreatic insufficiency

malabsorption (coeliac disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

With diarrhoea what is recent antibiotic or PPI use associated with?

A

C. diff

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

Possible underlying causes of chronic diarrhoea and what to enquire about?

A 
Travel - parasite, Giardia 
Drugs - laxatives
Surgery
Coeliac
Diabetes
Fam history IBD
Constipation
Immunocompromised
Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In chronic diarrhoea what could abdominal pain indicate?

A

coeliac disease,
Crohn’s disease,
or malignancy

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

What would chronic diarrhoea with Weight loss, anxiety, palpitations, tremor suggest

A

Hyperthyroidism

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

In chronic diarrhoea what could pyoderma gangrenosum or erythema nodosum suggest?

A

IBD

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

Investigations for chronic diarrhoea

A 
Full blood count — to detect anaemia.
Urea and electrolytes.
Liver function tests, including albumin level.
Calcium.
Vitamin B12 and red blood cell folate.
Iron status (ferritin).
Thyroid function tests.
ESR and CRP (C-reactive protein). 
Testing for coeliac disease — immunoglobulin A (IgA), and IgA tissue transglutaminase (tTG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In chronic diarrhoea what would you test for if they’d been abroad or it seemed infective?

A

Routine microbiology investigation and examination for ova, cysts and parasites

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

When would you perform faecal calprotectin testing?

A

to help differentiate between irritable bowel syndrome and inflammatory bowel disease in people under the age of 40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When would you not do faecal calprotectin testing?

A

With new onset rectal bleeding or bloody diarrhoea.

In whom there is a need to rule out cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Other than suspected cancer when would you refer a person with chronic diarrhoea?

A

Suspected coeliac disease
suspected IBD
Malabsorption
A person less than 40 years of age does not have typical symptoms of functional bowel disorder and/or has severe symptoms and documented diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Safety netting for acute diarrhoea

A

you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets
you or your child keep being sick and cannot keep fluid down
you or your child have bloody diarrhoea or bleeding from the bottom
you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Other than malignancy what would you consider if someone had the following symptoms for at least 6 months?

A

Abdominal pain, or
Bloating, or
Change in bowel habit

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

In addition to abdominal pain, what is a key feature for making a diagnosis of IBS

A

Related to defecation, and/or
Associated with altered stool frequency (increased or decreased), and/or
Associated with altered stool form or appearance (hard, lumpy, loose, or watery)

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

In order to make a diagnosis of IBS what other symptoms need to be present with Associated with altered stool form or appearance (hard, lumpy, loose, or watery)?

A

Altered stool passage (straining, urgency, or incomplete evacuation).
Abdominal bloating (more common in women than men), distension, or hardness.
Symptoms worsened by eating.
Passage of rectal mucus, and
Alternative conditions with similar symptoms have been excluded.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In addition to bowel symptoms, what else might someone with IBS present with?

A 
Lethargy, 
nausea,
 back pain, 
headache.
Bladder symptoms (such as nocturia, urgency, and incomplete emptying),
 dyspareunia, 
or faecal incontinence.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

IBS is a diagnosis of exclusion so what tests would you routinely preform?

A

FBC
ESR/CRP
Faecal calprotectin
Coeliac serology

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

Most common symptoms associated with bowel cancer?

A 
diarrhoea, 
constipation,
rectal bleeding,
loss of weight,
and abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If someone had rectal bleeding what additional symptoms would make you consider bowel cancer?

A

Abdominal pain.
Change in bowel habit.
Weight loss.
Iron-deficiency anaemia.

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

In a pt with unexplained chronic diarrhoea you find the following upon examination: Pallor, clubbing, aphthous mouth ulcers.
Abdominal tenderness or mass, for example in the right lower quadrant.
Perianal pain or tenderness, anal or perianal skin tag, fissure, fistula, or abscess
What do you suspect?

A

Crohns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What investigations would you preform in suspected Crohns?

A 
FBC - anaemia
CRP/ESR - active inflammation 
U&E - dehydration
Ferratin, B12 & folate - malnutrition 
Coeliac serology - to rule out
Stool microscopy  - rule out C.diff
Faecal calprotectin - negative in IBS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In a pt with chronic bloody diarrhoea where malignancy is not suspected you gain the following upon examination
Pallor, clubbing, or aphthous mouth ulcers.
Abdominal distension, tenderness or mass, for example in the left lower quadrant.
Signs of malnutrition or malabsorption
What do you suspect?

A

IBD - Ulcerative Colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In addition to malignancy what would you suspect with the following symptoms?

A

Faecal urgency and/or incontinence.
Nocturnal defecation.
Tenesmus (persistent, painful urge to pass stool even when the rectum is empty).
Abdominal pain, particularly in the left lower quadrant.
Pre-defecation pain, which is relieved on passage of stool.
Non-specific symptoms such as fatigue, malaise, anorexia, or fever (may suggest severe disease).
Weight loss

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

What do you not prescribe to someone with bloody diarrhoea where diagnosis is uncertain and why?

A

anti-diarrhoeal drugs

Risk of toxic mega-colon

39
Q

Bright red, painless rectal bleeding with streaks on the toilet paper is the most common symptom of what?

A

haemorrhoids

40
Q

Can people get tenesmus with haemorrhoids?

A

Yes - with large ones

41
Q

When do people get pain with haemorrhoids?

A

Internal - prolapse and becomes strangulated, resulting in intense pain
External - thrombosed

42
Q

What differentiates haemorrhoids from anal fissure in terms of pain an bleeding?

A

Fissure - always intense sharp pain on defecation, sometimes bleed
Haemorrhoids - often bleeding, may be painless.

43
Q

Do you perform a DRE on a suspected anal fissure?

A

No, will be too painful

44
Q

What are the mgmt options for haemorrhoids?

A

Admit - if extremely painful and thrombosed, sepsis
Refer - haemorrhoids too beg or cancer suspected
Advise - fibre intake & hydration, hygiene
Analgesia - NSAIDS, topical cream

45
Q

Safety netting for haemorrhoids

A

Temperature becomes high, pus leaking out
Come back if bleeding pain become worse.
If conservative measures dont work

46
Q

In suspected UTI, who would you not urine dipstick and why?

A

Over 65
Catheter
Unreliable

47
Q

6 symptoms that would make you suspect lower UTI in women?

A 
Dysuria
Frequency 
Urgency
Changes in urine appearance or consistency:
Nocturia
48
Q

What symptoms would make you suspect pyelonephritis over UTI?

A

fever,
loin pain
or rigors.

49
Q

6 Red Flags in suspected UTI

A 
haematuria
loin pain
rigors
 nausea
 vomiting
 altered mental state
50
Q

Relevant family history in suspected UTI?

A

polycystic kidney disease

51
Q

What must you suspect in all women of childbearing age until proven otherwise, especially with UTI symptoms?

A

Pregnancy

52
Q

What is relevant in the PMH with regard to UTI?

A 
neurological conditions,
 diabetes mellitus, 
immunosuppression, 
urolithiasis
bladder catheterisation
53
Q

Relevant medication in suspected UTI?

A

antibiotics

54
Q

What would you look for in examination in someone with suspect UTI?

A

Vital signs - sepsis

Flank and abdominal pain

55
Q

What does in mean if urine dipstick is positive for nitrite OR leukocyte AND red blood cells?

A

UTI likely

56
Q

What does it mean if urine dipstick is negative for nitrite and positive for leukocyte?

A

UTI is equally likely to other diagnosis.

57
Q

What does it mean if urine dipstick is negative for everything?

A

UTI likely

58
Q

When would you send urine for culture?

A

If UTI likely from dipstick and previous antibiotic treatment has failed
UTI is equally likely as other diagnosis

59
Q

When would you send for a urine culture in ALL women with suspected UTI?

A

Over 65
Pregnant
Have symptoms that are persistent or do not resolve with antibiotic treatment.
Have recurrent UTI (2 episodes in 6 months or 3 in 12 months).
Have a urinary catheter in situ or have recently been catheterised
Have atypical symptoms.
Have visible or non-visible (on urine dipstick) haematuria

60
Q

If there are urinary symptoms but no evidence of UTI then what are the potential differentials?

A 
Other urological or genitourinary conditions
Dermatological
Malignancy
STI
Trauma 
Drug Reaction
61
Q

Management of UTI without haematuria in a woman who is not pregnant or catheterized?

A

Refer is septic
Self care
Antibiotic - immediate/delayed

62
Q

What is the self care advice for UTI (no haematuria not pregnant)

A

NSAIDS

Fluids - not cranberry or alkalising agent

63
Q

What are the risk factors for complication of a UTI?

A

structural or neurological abnormalities of the urinary tract,
urinary catheters,
virulent or atypical infecting organisms
co-morbidities such as poorly controlled diabetes mellitus or immunosuppression

64
Q

When would you prescribe antibiotics for UTI?

A

Risk factors for complication

Recurrent

65
Q

When would you use a delayed prescription for UTI and what is the time delay?

A

Mild symptoms - no risk factors

48hrs

66
Q

Safety net for lower UTI in women

A

Symptoms worsen rapidly or significantly at any time or fail to improve within 48 hours of starting antibiotics

67
Q

Antibiotic of choice for lower UTI in women?

A

Nitrofurantoin

68
Q

How do you manage asymptomatic bacteriuria in pregnancy?

A

Prophylactic antibiotics

69
Q

Relevant FH in dyspepsia?

A

Oesophageal cancer

70
Q

What lifestyle factors are relvant to dyspepsia?

A 
Obesity
Smoker
Alcohol
Trigger foods
Stress/anxiety
71
Q

What are you looking for on examination in a pt with dyspepsia?

A

Weight loss by checking serial weight and body mass index (BMI) measurements.
Signs of anaemia.
Abdominal masses and tenderness

72
Q

Differential for dydpepsia?

A 
Upper GI maignancy
Gallstones
Pancreatitis 
Gastroenteritis 
Crohns
IBS
AAA
73
Q

Lifestyle advice for dyspepsia

A

Weight loss
Avoid trigger foods
Cut out booze & tabs
Smaller meals and not right before bed

74
Q

Management of dyspepsia

A 
Lifestyle change 
Antacids - short term
Medication change/stoppage - if relevant 
PPI
H.pylori test
75
Q

Red flags with dyspepsia?

A

Sudden onset - associations with angina/MI
Cancer B symptoms
Haematemesis

76
Q

What are the 2 types of urinary incontinence?

A

Stress incontinence and Urge incontinence (overactive bladder)

77
Q

8 red flags relating to incontinence?

A 
Haematuria
▪ Persistent UTI
▪ Constitutional symptoms
▪ Poor renal function
▪ Abnormal neurology
▪ Saddle anaesthesia
▪ Recent back trauma
▪ Recent pelvic surgery
78
Q

What is stress incontinence?

A

Urine leaks when the bladder is under pressure

79
Q

If someone is incontinent when they laugh or cough, what sort of incontinence is this?

A

Stress

80
Q

3 risk factors for stress incontinence?

A

Menopause
Age
Multiparity

81
Q

In females what condition may occur alongside stress incontinence?

A

Prolapse

82
Q

What questions would you ask about to assess if there might be prolapse?

A

Dragging sensation
lumps
pressure

83
Q

Conservative management option of stress incontinence?

A

– increase physical activity,
reduce weight,
physiotherapy & pelvic floor strengthening

84
Q

Medical management of stress incontinence?

A

Duloxetine (SSRI)

85
Q

Is there a surgical option for stress incontinence?

A

Tape and colposuspension if less invasive

methods fail

86
Q

What type of incontinence relates to an overactive bladder?

A

Urge

87
Q

What type of incontinance relates to these symptoms?
o Sudden, intense urge to pass urine
o Usually frequent passage of small volumes
o Nocturia may also be a problem

A

Urge

88
Q

2 risk factors for urge incontinence?

A

Detrusor overactivity,

high caffeine intake

89
Q

What 2 investigations would you perform for urge incontinence?

A 
Urine dipstick (infection),
 Incontinence diary
90
Q

5 aspects of conservative management for urge incontinence?

A 
Increase physical activity & reduce weight
• Reduce fluid intake
• Avoid caffeine
• Bladder training exercises and drills
• Review medications
91
Q

5 types of medication that can cause urge incontinence

A 
Angiotensin-converting enzyme (ACE) inhibitors
o Diuretics
o Some antidepressants
o Hormone replacement therapy (HRT)
o Sedatives
92
Q

2 medical management options for urge incontinence

A

Antimuscarinics

• Botox injections into Detrusor muscle

93
Q

Can you get mixed incontinence?

A

Yes

402 - General Practice (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions