SCA online - new presentations Flashcards
Achilles tendinopathy
Pain, stiffness, swelling of the strap (or tendon) that connects the heel bone to the calf.
Red flags - Achilles rupture - emergency admission
Risk factors
- Abx eg ciprofloxacin, ofloxacin
- hypercholesterolaemia
- Diabetes
Mx/
Lifestyle
- cold/ heat packs, analgesia, weight bearing exercise
Physio refer
Refer sports physician or ortho if above not suitable
Acne
inflammatory skin condition, leading to spots, and sometimes scarring.
Mx/
lifestyle - non oily skin products, avoid over cleaning
Be aware treatments last 8-12 weeks, can make skin more irritated initially
Regular FU
If PCOS - can start COCP
Mild (non inflamed lesions)
Topical Retinoids/ Abx/ Benz peroxide - eg Epiduo, Duac
Mod (more inflamed lesions)
Topical treatment + PO Abx (lymecycline/ doxycycline)
Severe (widespread, scarring, sig psych impact)
Refer Derm
Actinic (solar) keratosis
common skin lesion from sun exposure - rough and scaly on head/ face. Very common, often harmless.
Some studies have shown a link to developing SCC
Mx/
often leave them
Use sunscreen daily
Physical Mx - cryotherapy, cautery (burning), curettage (shaving), surgical excision
Top Mx - Diclofenac gel, 5-flurouracil (efudix) - skin can get worse before it gets better
If uncertainty for referral Derm - ?SCC
If a carer is unwell in emergency, what to do with the cared person
1st - friends, family who can come and look after cared person
2nd - Emergency scheme for carers
- emergency social services care - free, attend within 2 hours, provide a few days cover
ADHD
Common condition, effecting behaviour - difficulty concentrating, restless and impulsive
Referral
if in school - refer through school
if adult - complete self questionnaire, refer to psych neurodevelopment team
Asthma
Long term lung condition that leads to temporarily narrowing of the airways - leading to coughing, wheezing, difficulty breathing. With treatment, this can be very well managed
Initial Mx
ICS, peak flow, inhaler technique, personalised asthma action plan
Rv of ICS in 6-8 weeks
Red flags (for referral)
suspected eosinophilia, occupational asthma, abnormal cxr, unclear diagnosis
Bells palsy
Temporary weakness of the muscles of one side of the face. Most people fully recover but may take a few months.
mx/
often self resolve
PO pred if <3 days presentation (60mg for 5 days)
any doubt refer to ENT
DDX
ramsey hunt (shingles) - facial pain, vesicles
Stroke - forehead is sparred in UMN
space occupying lesion
Carpal tunnel syndrome
The nerve that runs through the middle of the wrist into the hand (aka carpal tunnel) is squashed or compressed. Common and can be managed with treatment
Risk factors - pregnancy, diabetes, use of power tools, obesity, family history
Red flags - for referral
- muscle wasting
- significant impact on daily life - all treatments used up
Mx/
Address underlying risk factors - lose weight, avoid power tools etc
Wrist splints
Analgesia
Physio
Often resolve within 6 months
Gout
Type of arthritis (which means joint inflammation), uric acid crystals within the joint - leading to swelling and pain.
Risk factors
- high Calcium, HTN, T2DM, high lipids, osteoarthritis, alcohol, sugary food, meat, obesity, family history
Acute Mx - Colchicine, NSAIDs, analgesia
Long term Mx
- allopurinol (at least 2-4 weeks after acute flare) (+ colchicine whilst starting allopurinol)
- manage risk factors
De Quervains Tendosynovitis
tendons (aka strap) at base of thumb become swollen and painful. Very common and treatable condition
Risk factors - new mums carrying new baby
Finkelstein test - thumb inside clasped fist, deviate hand to ulnar side - if pain = positive
Mx/
Non pharm - rest, wrist splint, avoid risk factors
Pharm - analgesia, steroid inject, physio
Dengue fever
viral infection spread by mosquitos, mainly in tropical areas. Is NOT spread from person to person.
Fx/ headaches, joint/ muscle pain
Mx/
self resolve within a week or two. Fluids, paracetamol
Red flags
- UGIB, abdo pain, vomit blood - seek medical advice
Eustachian tube dysfunction
the tube that connects your ear to your nose does not open or close properly - leading to feeling fullness, pressure, hearing loss on the affected side.
Mx/
Lifestyle
- avoid exacerbating factors - flying, diving
- self manage - chewing gum, Valsalva movements
Medication
- nasal corticosteroids/ decongestants
- antihistamines
Regular FU
Refer is no resolution after a few months, red flags (worsening hearing loss, pain, bleeding)
First seizure
Surge of electrical activity inside the brain, leading to a loss of consciousness.
Mx/
refer to neuro
Stop driving until seen by neuro
bloods, examination - assess cause
FU regular
Hyperthyroid (Graves) Mx
1st - B block - if symptomatic
2nd - Refer to endocrine - Antithyroid (carbimazole)
Haemorrhoids
AKA piles - swollen veins around the anus. Uncomfortable, sometimes bleed.
Risk factors
prolonged sitting - eg truck drivers, office workers
heavy lifting eg labours, weight lifters
Obesity
Diet/ hydration poor
Mx
Address risk factors
PO/ Top analgesia
Anusol HC
Refer if no improvement
Hepatitis A
liver infection by a virus spread through contaminated food/ water/ person.
Fx/
tiredness, jaundice, abdo pain, fevers
Mx/
Bloods - confirm diagnosis
Fluids, analgesia, rest
Itch Tx if required
Minimise transmission risk
FU for bloods and symptoms, safety netting
Irritable Bowel Syndrome
Common disorder that effects the gut - various symptoms including constipation, changing bowel habits, tummy pain.
Mx/
Assess for red flags (weight loss, bleeding etc.)
Address risk factors - stress, foods
Food diary, FODMAP
Exercise
CBT
Peppermint capsules
Address symptoms
- bloating/ cramping - hyoscine/ mebeverine
- constipation - laxatives
- diarrhoea - loperamide
SSRI/ TCA
Angina
Blood vessels that supply the heart become narrow, restricting blood flow to the heart muscle. When resting your heart can manage, but when active, your heart struggles, leading to pain. This is not a heart attack, but can lead to one if not managed appropriately
Mx/
lifestyle - exercise, diet, no smoke
aspirin daily
GTN spray
refer chest pain clinic
DVLA
Group 1 - no drive if symptomatic
Group 2 - no drive, inform dvla, until symptoms free >6 weeks
lymphadenopathy
Swollen glands, usually within our neck. Very common, often harmless. Often raised, tender, smooth lumps during URTinfections, stress, self resolve within a few weeks to months.
Red flags - weight loss, night sweats, abnormal bleeding, cough, bone pain
Mx/
self resolve within 6 weeks - if not for USS 2WW review .
Pagets disaese
Abnormal process of bone breakdown and regrowth. Weaker more fragile bones, leading to pain and risk of breakage.
Ix/
bloods - raised ALP
XR - lytic lesions on bones
Mx/
Bisphosphonates
Rheumatologist/ Endocrinologist
Refer
Peripheral vascular disease
The blood vessels that supply the leg are narrowed. During exercise, the muscles require more blood and oxygen, however, due to the narrowing of the vessels, not enough blood gets to the muscles, leading to acid build up and pain/ cramping. This is resolved at rest.
Mx/
Address risk - smoking, exercise, diet, weight, blood pressure
Clopidogrel > aspirin
Simple analgesia
Refer to vascular
Critical limb ischaemia
Pain
Pulseless
Pallor
Perishingly cold
Paraesthesia
Paralysis
Mx (critical limb) - urgent refer vascular
Polymyalgia Rheumatica
inflammatory condition causing pain and stiffness in the neck, shoulders and arms.
Fx/
bilateral shoulder pain
>50yo
morning stiffness
DDx/
Temporal arteritis - headache, jaw claudication
Rheumatoid
Ix/
Bloods inc ESR
Mx/
Low dose steroids, weaning regime - start Pred 15mg OD, reduce every 4 weeks by 2.5mg
Rv patient after 1 week of treatment - should have responded well. - refer rheum if so
bone protection - FRAX score - bisphos/ ca/ vit d
Post partum thyroiditis
Autoimmune condition presenting in first year post birth. Consisting of three phases
1 - Hyperthyroid - 1-3 months
2 - Hypothyroid - 3-6 months
3 - Recovery 6+
Mx/
refer endocrine
can start propranolol in hyperthyroid state if indicated
Reflux/ Dyspepsia/ Indigestion
Red flags - weight loss, dysphagia, persistent vomit, haematemesis
Mx/
Lifestyle - reduce caffiene, alcohol, smoking, spicy/ fatty/ sugary foods, reduce stress, lose weight
Meds - PPI, Gavison, ranitidine - for 1 month then rv. rv- aspirin, NSAIDs, steroids, bisphosphonates
H.Pylori - test = stool (only if PPI clear for 2 weeks) - 2x abx + PPI
Restless legs (in pregnancy)
Uncomfortable sensation in the legs, having the urge to move them. Very common, esp in pregnancy.
Ix/
Bloods - iron,
Risk factors - caffeine, sleep, exercise, diet,
Mx/
lifestyle - address RF, stay hydrated, massage
Iron supplements if deficient
regular monitorign
Back pain
Red flags
Ask about mood! Chronic disease = depression
Malignancy - Weight loss, fevers, night pain, cancers, >55yo (worse or new)
Ank spon - <20, morning stiffness
Cauda equina - neuro deficit, urinary/ bowel symptoms, perianal sensation loss
Migraine (paediatric)
episodes of headaches, other symptoms include feeling sick, vomiting. Very common but manageable with medication.
DDx/
Cluster - agitation, awful headache
tension - stress related, bilateral, no other symptoms
Mx/
check red flags
Acute - paracetamol, NSAID, aspirin (not under 16s), nasal triptan (not oral for under 18s), anti emetic (eg metoclopramide, prochlorperazine)
Prevention - specialist only
regular FU
Sleep apnoea
Causing your breathing to stop whilst asleep. Often waking you up and disturbing your sleep. Due to throat muscle relaxing, leading to narrowing of the airways in the neck.
Epworth sleepiness scale - daytime sleepiness - sitting/ reading, watching tv, in a meeting, passenger of car, lunch, at traffic lights
Mx/
local sleep clinic - sleep studies, CPAP
risk factors - weight, smoking, alcohol
DVLA - stop driving until controlled symptoms. in Group 2 needs to inform DVLA and consultant clearance to drive
Thrombocytopenia (low platelets)
DDx/
usually harmless, repeat test in 4-6 weeks.
Ca, leukaemia, myeloma, b12, fol, liver disease, pregnancy, alcohol, infections
Hx/
signs of bleeding - gums, stool, nose, urine
bruising
screen for Ca, infection, disease
Ix/
bloods inc blood film,
If pregnant speak to specialist - eg pre eclampsia, HELLP syndrome
tinnitus
Hearing sounds from outside of the body, it is common and can be caused by many factors. Although bothersome, it is not usually harmful.
DDX/
unilateral - Meniere’s (hearing loss, vertigo), Acoustic neuroma (dizziness)
bilateral - noise inducted hearing loss, drug inducted (aspirin, nsiads, ciprofloxacin, furosedmie, gentamicin), presbycusis (age related)
Mx/
Immediate Admission - suicidal, neurological symptoms (inc acute vertigo), stroke, head trauma, sudden with hearing loss
Urgent refer - effecting daily life, gradual hearing loss, persistent otalgia
Routine - persistent despite treatment
Mx in primary care
review risk factors - meds, stress, alcohol, occupation
sound therapy, cbt, hearing aids, address mental health impact
Tonsillectomy request
Not routinely performed anymore - as most sore throats are caused by viral infections which will improve without surgery. Most children will grow out of recurrent sore throats, surgery is for those who have severe, frequent and disruptive symptoms.
FeverPAIN - fevers <24hrs, exudate on tonsil, <3 day onset, inflamed tonsils, absence of cough
Criteria for ENT tonsillectomy
- sore throats are due to bacterial tonsillitis
- disturbing normal daily function
- >7 episodes in 1 year, >5/year for 2 years, >3/ year for 3 years
transient global amnesia
Short term memory loss for one to 24 hours . Usually harmless, no increase in likelihood of stroke. No further investigations.
Fx/
no neurological deficit, only amnesia
DDx/
TIA/ stroke
Transient epileptic amnesia
migraine associated amnesia
Ix/
bloods, MRI head, EEG - R/O other causes of amnesia/ cognitive impairment
Mx/
reassurance
routine FU
safety netting - if happens again go to hospital
Wet age related macular degeneration (AMD)
Blood vessels at the back of the eye leak fluid. Effects the central vision. Need to see an eye doctor immediately.
Fx/
central visual loss - rapid
Mx/
ophthalmology within one week
avoid driving
