capsule GP

Question 1

signs of cauda equina (8)

Answer 1

inc back pain, bilateral sciatica, sensory loss in lumbosacral distribution, weakened lower limbs, reduced reflexes. perineal paraesthesia, erectile and bladder dysfunction

Question 2

what can cause acute compression of cauda equina (6)

Answer 2

bony metastasis, myeloma, epidural abscess, disc prolapse (most common), epidrual haematoma, primary sacral tumour eg chordoma

Question 3

what is 1st line management of presentation of Cauda equina to GP

Answer 3

urgent same day assessment by spinal surgeon via admission to spinal surgical team. they can then image and do surgical decompression as appropriate

Question 4

cord compression vs cauda equina

Answer 4

CC: spastic paralysis with brisk reflexes. CE: flaccid paralysis with loss of reflexes. both cause sensory and power loss

Question 5

most common form of psoriasis

Answer 5

plaque psoriasis

Question 6

what can exacerbate psoriasis (6)

Answer 6

stress, infections, medications, smoking, alcohol, skin injury

Question 7

treatment for psoriasis in primary care (4)

Answer 7

moisturisers, salicylic acid, vit D based reams (calcipotriol), topical steroids (ST)

Question 8

red flags for GORD (5)

Answer 8

dysphagia, evidence of GI blood loss (melena, blood in stool, vomitting blood), persistent vomiting, upper abdo mass, unexplained weight loss

Question 9

what drugs associated with dyspepsia (6)

Answer 9

calcium antagonists, nitrates, theophylines, bisphospphonates, corticosteroids, NSAIDS

Question 10

how to manage GORD (5)

Answer 10

-over the counter antacids
-lifestyle advice on healthy eating and weight loss
-advice to avoid known precipitants eg alcohol, smoking, coffee
-advise to raise head of bed
-empirical treatment with PPI

Question 11

RF for barrettes oesophagus

Answer 11

male, previous oesophagitis, previos hiatus hernia

Question 12

screening tools for depression

Answer 12

PHQ-9
HADS-D
BDI-II

Question 13

screening tools for anxiety

Answer 13

GAD7

Question 14

treatment for mild depression (6)

Answer 14

watchful waiting, sleep and anxiety management, exercise, guided self help, computerised cognitive behavioural therapy, psychological interventions

Question 15

glandular fever PC (7)

Answer 15

young patient age, sore throat sympotms, reduced apetitie, tiredness, palpable cervicle node (posterior), palpable spleen, blood film shows lymphocytosis

Question 16

Ix for glandular fever (4)

Answer 16

epsitein barr virus serology (inc IgM), paul bunnel test, throat swab (make sure not streptococcal infection), HIV test for those with RF or immunocompromised

Question 17

Mx for glandular fever (4)

Answer 17

analgesia, avoid alcohol, avoid physical contact, follow up (amoxicilin can cause rashes)

Question 18

complication of glandular fever (4)

Answer 18

depression, meningitis, splenic rupture, thrombocytopenia

Question 19

complications for ebstein barr virus

Answer 19

viral meningitis, burkitt’s lymphoma, GBS

Question 20

what does phalens test

Answer 20

carpal tunnel syndrome

Question 21

common adverse effects of NSAIDS (4)

Answer 21

bronchospasm, cardiovascular and renal complications, dyspepsia and other upper GI complications, skin reactions and angiodema

Question 22

what do these 4 drugs treat? midazolam, morphone sulfate, cyclyzine, glycopyrronium

Answer 22

agitation, pain, nausea/ vomiting, resp secretions

Question 22

what do these 4 drugs treat? midazolam, morphone sulfate, cyclyzine, glycopyrronium

Answer 22

agitation, pain, nausea/ vomiting, resp secretions

Question 23

oral vs subcutaneous

Answer 23

oral dose needs be to halved when given subcutaenously as latter is more potent

Question 24

what is cocodamol made up of

Answer 24

codein (need laxative and anti-emetic PRN) and paracetamol

Question 25

anti emetics

Answer 25

The nausea is probably a consequence of her opioid use, and usually metoclopramide is the best choice because of its pro-kinetic action. Cyclizine is usually used for nausea and vomiting due to mechanical bowel obstruction, raised intracranial pressure and motion sickness, therefore it would not be the first-choice anti-emetic here

Question 26

what further investigations needed for lung cancer

Answer 26

CT to define nature and location of mass
bronchoscopy and biopsy to determine tissue
PET for those being considered for curative surgery and bone scan for boney metastases

Question 27

why can lung cancer possibly cause chest pain

Answer 27

due to chest wall involvement and presence of metastases in bones causing pleuritic pain

Question 28

what common things cause left sided lung collapse/ consolidation

Answer 28

pneumonia, obstruction of left bronchus.
foreign body can cause collapse but not consolidation

Question 29

what investigations do you need to confirm pneumonia

Answer 29

blood cultures, bronchoscopy +/- biopsy, CT chest, sputum MC&S

Question 30

what is the diagnosis of the radiological finding of mutiplie ill defined foci of opacity in the lungs

Answer 30

pulmonary infarcts, pulmonary metastases, rheumatoid arthirits, granulomatosis with polyangiitis, septic emboli

Question 31

breast cancer

Answer 31

Breast is the commonest source of lung metastasis, and also causes endobronchial lesions. Although rare, lung metastasis can cause pneumothorax and metastases can also calcify. lungs are a recognised site of metastases in renal carcinoma

Question 32

Sx mesothelioma

Answer 32

Mesothelioma of the pleura. This tumour arises from the mesothelial cells of the pleura and spreads initially via the pleural space to encase the lung.

Question 33

RF for mesothelioma

Answer 33

Virtually all cases of mesothelioma are due to exposure to asbestos. It is important to enquire about asbestos exposure which is usually occupational exposure. In particular: boilermakers, plumbers, heating engineers, electrical engineers and anyone working with building materials may have been exposed.
The “lead time” between asbestos exposure and development of mesothelioma is almost always more than 20 years. It is therefore important that enquiries about the occupational history go back in detail to the patients’ early career. Identifying which of several employments was the relevant exposure might be important if the relatives claim compensation.

Question 34

metastases of mesotheliomas

Answer 34

other pleural cavity, lung, hilar lymph nodes

Question 35

iX MESothelioma

Answer 35

thorascopy with biopsy and histology of pleura may be needed.
instillation of sclerosant substances may be used to prevent reaccumulation of pleural effusions

Question 36

RF for multi drug resistance TB (6)

Answer 36

previous treatment for TB, previous residence in area of high prevalence, contact with case of HIV/AIDS + TB, male, recent residence in london, lifestyle

Question 37

what is the management of multi drug resistance TB

Answer 37

requst PCR probe for rifampicin resistance, use standard 4 drug regime and streptomycin and ciprofloxacin. in patient treatment could be warranted

Question 38

why should you do lung function tests for patients with dyspnoea

Answer 38

to assess if there is an obstructive/restrictive defect or any reversibility of symptom

Question 39

how does mycoplasma pneumonia present

Answer 39

malaise, dry cough

Question 40

what are some side effects of RIPE for TB

Answer 40

optic neuritis side effect for ethambutol
hepatitis side effect for rifampicin
peripheral neuropathy may occur with isoniazid so may need vitamin supplementation eg pyridoxine

Question 41

Causes of cellulitis

Answer 41

Strep pyogenes, staph aureus, treat with fluclox and benzyl penicillin

Question 42

Which drugs are excreted by kidneys and need dose reduction in Renal impairment

Answer 42

Gliclazide, gabapentin, morphine. Also don’t give NSAIDS for pt with renal impaired ent