PRIMARY CARE - psych, opthalmology, derm, paeds, GU, sexual health, misc Flashcards
how is dementia investigated in primary care? (3)
1) initial assessment - hx (from px and family/friend) and examination (neuro signs, visual or auditory probs, cardio signs)
2) bloods to rule out organic causes - FBCs (anaemia), U&Es (metabolic), TFTs (hyper/hypo), serum B12 and folate (deficiency), calcium, HbA1c
3) assess cognition
examples of cognition screening tests that can be used when diagnosing dementia in primary care
10-point cognitive screener (10-CS), 6-item cognitive impairment test (6CIT), mini-cog
dementia management if the patient is severely disturbed/a health and safety risk OR if assessment in primary care isn’t appropriate?
arrange admission to secondary care
dementia management if urgent admission is not required?
refer to specialist dementia diagnostic service e.g. memory clinic
define fibromyalgia
chronic pain syndrome diagnosed by the presence of widespread body pain
epidemiology of fibromyalgia
more common in F
aetiology of fibromyalgia
unknown - associated with abnormalities in the stress response system and triggering events.
stressful event/s is a RF
signs and symptoms of fibromyalgia
- diffuse tenderness on exam (commonly neck, shoulders, elbows, knees, buttocks)
- chronic pain
- fatigue unrelieved by rest
- sleep & mood disturbance
- stiffness
- headaches
how is fibromyalgia diagnosed?
presence of >3 months of widespread pain and associated symptoms
non-pharm and pharm management of fibromyalgia
NON PHARM
- exercise
- relaxation therapy
- CBT
PHARM
- analgesia e.g. paracetamol, weak opioids
- antidepressants e.g. amitriptyline or duloxetine
what is acne vulgaris? what is it caused by?
a chronic inflammatory skin condition affecting mainly the face (99%), back and chest
blockage and inflammation of the pilosebaceous unit (hair follicle, shaft and sebaceous gland)
define mild, moderate and severe acne
mild - a few non inflamed lesions with or without sparse inflammatory lesions
moderate - more widespread, more inflammatory papules and pustules
severe - widespread inflammatory papules, pustules, nodules and cysts. may have scarring
what is the name for non-inflammatory lesions in acne? what are the subtypes?
= comedones
blackheads - open comedones
whiteheads - closed comedones
types of inflammatory lesions in acne
- papules and pustules - superficial raised lesions <5mm
- nodules/cysts - deeper, palpable, painful, >5mm
- sinuses - a cluster of severe nodules
how does acne vulgaris present? what MUST be present for diagnosis?
- usually pubertal age
- most present with a mix of inflammatory and noninflammatory (comedones) lesions
- comedones must be present
investigations for acne vulgaris
normally clinical diagnosis
take detailed history
- duration, type and distribution of lesions
- prev tx
- psychosocial impact
- fam hx e.g. endocrine, PCOS, acne, skin conditions
- potential underlying causes e.g. drug hx, hyperandrogenism
management of mild to moderate acne
1st line = 12-week course of topical combination therapy:
- topical adapalene with topical benzoyl peroxide (AB)
- topical tretinoin with topical clindamycin (TC)
- topical benzoyl peroxide with topical clindamycin (BC)
management of moderate to severe acne
1st line = 12-week course of one of the following:
- topical adapalene with topical benzoyl peroxide
- topical tretinoin with topical clindamycin
- topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
- topical azelaic acid + either lymecycline or doxycycline
what is a complication of long-term abx use in patients with acne?
gram-negative folliculitis
alternative tx to oral antibiotics in women with acne
COCP
should be used in combo with topical agents
when should patients with acne be referred to a dermatologist?
- if conglobate acne (rare, severe, nodules sinuses and cysts)
- if nodulo-cystic acne
what is
a) mean corpuscular volume (MCV)
b) mean corpuscular haemoglobin (MCH)
c) haematocrit
a) the average size of RBCs
macrocytic (>100fl), normocytic (80-100fl), microcytic (<80fl)
b) avg amount of haemoglobin in each RBC
hypochromic = less than normal
c) percentage expressed of the mass of RBCs compared to the plasma
normal haemoglobin in
a) men
b) women
a) 13-16 g/dl
b) 11-15 g/dl
what is iron deficiency anaemia?
what type of anaemia is it?
anaemia caused by lack of Fe > cannot support RBC production
microcytic anaemia