Schofield GP SAQs Flashcards
Questions to ask about rash:
Itchy?
Painful?
Does it occur anywhere else?
Has it spread?
Aggrevating/relieving factors?
FHX?
History of atopy?
Describe the appearance of psoriasis
Red, scaly, well demarcated
Silver scales
Name the types of psoriasis?
Plaque psoriasis
Guttate psoriasis
Flexural psoriasis
Pustular psoriasis
What other areas should you examine in someone presenting with a psoriasis lesion?
Scalp
Nails
Other extensor surfaces
Treatments for psoriasis?
Emollients
Topical steroids
Vit D analogues (calcipotriol)
Phototherapy
Ashkenazi Jew with eruption of blisters, particularly in the mouth, easily burst?
Pemphigus vulgaris
Medical term for large blister?
Bulla
Questions to ask about a mole?
Any changes in colour?
Does it itch?
Does it bleed?
Is it symmetrical?
Fhx of melanoma?
Does it have a regular border?
Risk factors for malignant melanomas?
Fair complexion
Sun exposure
Fhx
Sunburn
Describe appearance of BCC?
Pearly-white nodule
Telangiectasia
Rolled edges
Central ulcer
Pathophysiology of acne?
Increased production of sebum. Pilosebaceous follicles become blocked and infected.
Bacterial organism in acne?
Propionibacterium acnes
Name for carcinoma in situ of squamous cell carcinoma?
Bowen’s disease
Which virus causes shingles?
Varicella-zoster virus
2 groups more susceptible to shingles?
Elderly
Immunocompromised
Differentials for RLQ pain (women)
Ectopic pregnancy
Acute appendicitis
Ovarian torsion
Renal colic
Factors predisposing to ectopic pregnancy?
Previous PID
Previous ectopic pregnancy
Presence of intrauterine contraceptive device
How is diagnosis of postural hypotension made?
Drop in systolic BP 20mmHg and/or drop in diastolic BP 10mmHg within the first 10 minutes of standing.
Causes of postural hypotension?
Antihypertensives
Drugs (diuretics, nitrates, SSRIs)
Excessive alcohol use
Hypovolaemia
Primary autonomic failure (Parkinson’s)
Secondary autonomic failure (e.g. diabetic neuropathy)
How to manage postural hypotension?
Lifestyle:
Increase salt in diet
Stand slowly
Pharmacological:
Midodrine
Fludrocortisone
Factors that increase risk of falls in the elderly?
Reduced muscle strength
Reduced proprioception
Reduced cognition
Arthritis
Polypharmacy
Define delirium
Delirium is defined as a acute onset transient reversible state of reduced cognition with impaired consciousness.
What test helps distinguish between delirium and dementia?
4AT test
Causes of delirium?
Infection
Electrolyte imbalance
Constipation
Urinary retention
Hypoxia
Uncontrolled pain
How may bacteria develop resistance to penicillin based abx?
Beta-lactamase production (breaks down the beta-lactam ring)
Many penicillins are used in combination e.g
Co-amoxiclav (amoxicillin + clavulanic acid)
Tazocin (tazobactam + piperacillin)
How do these additional drugs work?
Beta-lactamase inhibitors
How does dementia present?
Personality change
Memory loss
Inattention
Loss of judgement
Disorientation
Reversible causes of dementia?
B12 deficiency
Thiamine deficiency
Uraemia
Hypothyroidism
Hypoglycaemia
What will a MRI brain scan show in Alzhemier’s?
Cortical atrophy
Ventricular enlargement
Hippocampal atrophy
What class of medication is given for Alzhemier?s
Anticholinergics:
Donepezil
Rivastigmine
How do anticholinergics work?
They inhibit acetylcholinesterase, so less acetylcholine is broken down and hence more is available at the synapse.
Drugs that may precipitate urinary incontinence?
Diuretics
Sedatives (e.g. opiates, antipsychotics)
Drugs that cause urinary retention?
Anticholinergics (e.g. oxybutynin, tolterodine)
NSAIDS (e.g. naproxen, diclofenac, ibuprofen)
Conservative measures for stress incontinence?
Pelvic floor exercises
Reduce caffeine
Stop smoking
Lose weight
What drug can be given for stress incontinence and how does it work?
Duloxetine (SNRI)
Inhibits noradrenaline reuptake at the synapse so increased NA available which increases the tone of the internal urethral sphincter.
How does warfarin work?
Inhibits the reductase enzyme responsible for regeneration of active vitamin K.
Hence inhibits the production of Vit K dependent clotting factors. (II, VII, IX, X)
Contraindications for thrombolysis?
Active internal bleed
Recent haemorrhage, trauma or surgery
Coagulation/ bleeding disorders
Stroke <3 months
Recent head injury
Severe HTN
Common sites where osteoporotic fragility fractures occur?
Pubic ramus
Hip
Distal radius
Proximal humerus
Vertebrae
DEXA scan T score and Z score meaning?
T score: based on bone mass of young reference population
Z score: adjusted for age, gender and ethnic factors
T score:
>-1.0 = normal
-1.0 to -2.5 = osteopenia
<-2.5 = osteoporosis
Side effects of bisphosphonates?
Oesophageal ulcers
Ostenecrosis of the jaw
Increased risk of atypical stress fractures
What is Parkinson’s?
A progressive neurodegenerative disorder caused by degeneration of dopaminergic neurone in the substantial nigra.
Triad: bradykinesia, tremor and rigidity
Why is levodopa given with carbidopa?
They are peripheral decarboxylase inhibitors, preventing L-dopa from being broken down outside the CNS.
Clinical signs of bronchiolitis?
Fever
Dry cough
Increasing dyspnoea
Wheeze
Most common cause of bronchiolitis?
Respiratory syncytial virus
What features of bronchiolitis prompt admission?
Apnoea
Severe resp distress (e.g. grunting, chest recession, RR>70, central cyanosis)
Oxygen sats <92%
Symptoms of croup?
Barking cough
Stridor
Fever
Hoarseness
Most common virus causing croup?
Parainfluenza virus
Croup treatment?
Single dose oral dexamethasone (0.15mg/kg) regardless of severity
Signs of respiratory distress?
Nasal flaring
Tracheal tug
Rib recession
Cyanosis
What age does pyloric stenosis present?
2-8 weeks
Acid-base disturbance in pyloric stenosis?
Metabolic alkalosis
Electrolyte abnormalities associated with pyloric stenosis?
Hypokalaemia
Hypochloraemia
What cartilage makes up the epiphyseal plate?
Hyaline cartilage
Causes of jaundice in a newborn?
Rhesus haemolytic disease
ABO incompatibility
Hereditary spherocytosis
G6PD deficiency
Causes of prolonged jaundice (14 days)?
Biliary atresia
Baby will also have pale stools and raised conjugated bilirubin levels.
In a febrile seizure lasting >5 mins what class of drug should be given?
Benzodiazepines
Describe intussusceptions?
One segment of bowel telescopes into a distal segment of bowel, causing obstruction
