Week 19- GP2

Question 1

Acne rosacea

Answer 1

Chronic rash of centre face with mild-severe papules, pustules and erythema. Telangiectasia. Advanced = rhinophyma/thickening. May be transient or persistent.

Related to UV damage, aggravated by temp and spice.

Inflammatory reaction due to high cathelicidins, neutrophils, nitric oxide, matrix metalloproteinases collagenase and elastase (latter two also thickens).

Yellow brown papules and nodules indicates granulomatous rosacea.

Metronidazole gel and/or azelaic cream 3-4 months, if bad or ineffective: ivermectin cream or doxycycline oral 40mg for 6-8 weeks.

Question 2

Nasal vestibulitis

Answer 2

Infection of nasal vestibule. Symptoms include fever, painful + swollen nose, furuncles, dry nose, crusting nostrils, nosebleeds, bumps filled with pus.

If reoccurring, might be bcc or scc. Caused by staph aureus, herpes simplex or zoster. Diabetic, immunocompromised. Risk of cellulitis, cavernous sinus thrombosis.

Give mucopiricin 2 wks if essential bc risk of mrsa transformation. If there’s boils or reoccurs add oral antibiotic cephalexin.

Question 3

Furunculosis

Answer 3

Deep infection of hair follicle from staph aureus. Painful, swollen bumps with pus. Warm, red and vary in size. If several abscesses/boils form in a cluster = carbuncle. Can become chronic.

Severe infections can give enflamed nodes, fever and fatigue. On eyes = stye, on gums = gum boil.

Treat with warm compresses 3-4 times a day. Incision + drainage, topical fusidic acid or mupirocin (note risk resistance). Oral abx includes flucloxacillin or dicloxacillin. Can refer and give rifampicin and clindamycin. Associated with B12 and vit C deficiencies.

Question 4

Hidradenitis suppurativa

Answer 4

long term abscesses and scarring with inflammation in armpits, groin, buttocks or breast. Inflamed, painful, pus-filed and itchy. Bad odour when leaking.

Give rifampicin and clindamycin. May need cortisone injection. Isotretinoin can be given for follicle repair.

Not seen out of reproductive age range. Linked to crohns and comorbid infections.

Question 5

Post-nasal drip

Answer 5

drainage of mucous from nose or paranasal sinuses into the pharnyx. Often chronic with repeated episodes of cold and flu. Accumilation of mucus in post nasal space indicates dec mucocilliary clearance. One cause in triad of chronic cough - with asthma and gord.

Also called rhinosinusitis. treat with steroid spray beclomethasone.

Question 6

Pneumococcal disease

Answer 6

Can be pneumonia, ear, RTI, sinus infection, meningitis, septicaemia.

Question 7

Chest infection types

Answer 7

Pneumonia, bronchitis, colds, flu, RTIs, bronchiolitis.

Question 8

Pneumonia (signs, sounds, treatment)

Answer 8

Produces mucus, cough with phlegm. High grade fever with chills, fast breathing, sob, chest pain on coughing, tachycardia, fatigue, D+V, cyanosis, haemoptysis.

Hear crackles, rumbling, consolidation, dull percussion, rhonchi, effusion, empyema (if so, sweating/night sweats).

Give levofloxacin or azithromycin. If viral = oseltamivir or zanamivir.

Question 9

RTI

Answer 9

Infection of sinus, throat, airway or lungs. Often self-resolving.

Has cough +/- phlegm, sneezing, runny nose, sore throat, headache, muscle ache, breathless, tight chest or wheezing, fever.

Question 10

Bronchitis

Answer 10

Larger airway infection than pneumonia. Has cough +/- mucus, mild fever/chills, chest discomfort, sob, myalgia, headache, blocked nose. Can lead to pneumonia.

Sounds include low pitched wheeze or rhonchi.

If risk factor positive for pneumonia- treat same- levofloxacin or azithromycin (+100bpm, RR >24, >38C, age 75+, decr O2 sat, signs of consolidation: rales, tactile fremitus, egophony).

Question 11

Causes of Atypical/walking pneumonia

Answer 11

Mycoplasma, chlamydophila pneumoniae, legionella pneumophilia.

Has headache, low grade fever or malaise.

Question 12

Treatment for epiglottitis

Answer 12

Cefotaxime

Question 13

Surfer’s ear/exostosis

Answer 13

Bone of ear canal develops multiple bony growths/exostoses leading to partial or complete blockage of ear canal from cold wind or water exposure.

Swimmer’s ear = otitis externa

Question 14

Sciatica causes and treatments

Answer 14

Causes: spinal disc herniation, spinal stenosis, piriformis syndrome, endometriosis, pregnancy, pelvic tumour, epidural abscess/tumour, cauda equina syndrome.

Treatments-
anti-inflammatory: celecoxib, diclofenac.
Narcotics: codeine, hydrocodone, oxycodone.
Muscle relaxants: carisoprodol, chlorzoxazone, thiocolonicoside and tricyclics.

Question 15

Beclomethasone

Answer 15

Nasal steroid. Anti-inflammatory. Local use can give irritation, sneezing, nausea and light-headedness.

Question 16

Ozempic/semaglutide

Answer 16

Antidiabetic medication and long term weight management. Taken once per month. Glucagon-like peptide. Can have reduced appetite, burping, cholelithiasis, GI interruption.

Question 17

Levetiracetam

Answer 17

Antiepileptic. Can cause drowsiness, headaches, vertigo, ENT signs. For myoclonic or tonic-clonic seizures. (ethosuximide for absence).

Question 18

Loperamide

Answer 18

Antimotility drug to treat acute diarrhoea, side effects include constipation, flatulence, headache, nausea.

Question 19

Lansoprazole

Answer 19

An alternative to omeprazole. For ulcers, gord, H.pylori/ Side effects can include stomach upset, dizzy, headache, oral dryness or itchy skin.

Question 20

Lamotrigine

Answer 20

Anticonvulsant for epilepsy or bipolar. Can get rash, headache, aches, stomach upset.

Question 21

Chlorphenamine maleate

Answer 21

For allergies- itching, hayfever, food, drugs, anaphylaxis. Antihistamine- feels dizzy, tired, blurred vision.

Question 22

Rigevidon

Answer 22

For contraception and menstrual issues. Combined oral contraceptive- sickness, headache, inc weight, breast tenderness, mood change, menstrual change.

Question 23

Pregabalin

Answer 23

For epilepsy, neuropathic pain, GAD, dizzy, headache, dry mouth, GI issues.

Question 24

Amitriptyline

Answer 24

For depression, migrane, nerve pain, nocturnal enuresis. A TCA.

Question 25

Quetiapine

Answer 25

Schizophrenia and bipolar- incr weight, dry mouth, shaky, blurred vision, stomach upset, neuroleptic malignant syndrome.

Question 26

Sulfasalazine

Answer 26

For ulcerative colitis, crohns, rheumatoid arthritis. An aminosalicylate. Can make dizzy and stain contact lenses.

Question 27

Zopiclone

Answer 27

For insomnia rather than benzos. Can leave bitter metallic taste and fatigue.

Question 28

Venlafaxine

Answer 28

SNRI- serotonin and noradrenaline reuptake inhibitor. For depression, gad, social anx, panic disorder or menopausal symptoms in those with breast cancer.

Question 29

Midazolam

Answer 29

Benzodiazepine for status epilepticus, agitation, anxiety, anaesthesia. Often used in palliative care.

Question 30

Cyanocobalamin

Answer 30

Vitamin B12 eg for tapeworm, bowel cancer, MS, neuropathy, pernicious anaemia, gord, alcoholism.

Question 31

Triptorelin

Answer 31

used with tamoxifen or aromatase inhibitor for breast cancer, endometriosis, fibroid reduction, central precocious puberty. Also treats advanced prostate cancer and male sexual deviation.

Side effects allergy, arthralgia, asthenia, asthma.

Question 32

Clopixol/depixol/zuclopenthixol

Answer 32

Drug for schizophrenia

Question 33

Rhonchi

Answer 33

Rhonchi, or “large airway sounds,” are continuous gurgling or bubbling sounds typically heard during both inhalation and exhalation. These sounds are caused by movement of fluid and secretions in larger airways (asthma, viral URI).

Question 34

cauda equina syndrome

Answer 34

Rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.

Symptoms include: sciatica on both sides. weakness or numbness in both legs that is severe or getting worse. numbness around or under your genitals, or around your anus.

Give decompression by a lumbar laminectomy.

Question 35

piriformis syndrome

Answer 35

The piriformis muscle, located in the buttock region, spasms from exercise, pressure or strain and causes buttock pain. The piriformis muscle also can irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

Treatment is physical therapy, exercise, and stretching.