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Common GP Conditions Flashcards

1
Q

What advice would you give a patient that you have diagnosed with the ‘common cold’?

A

Advise that the average length of illness is 10 days
Advise steam inhalation, vapour rubs, paracetamol/ibuprofen, intranasal decongestants

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2
Q

State the three different types of Urinary Tract Infections

A

Lower UTI - cystitis, prostatitis
Upper UTI - Pyelonephritis
Abacterial

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3
Q

State four features that would cause a UTI to be classed as ‘complicated’?

A

Structural Abnormality
Obstruction
Catheter
Renal Obstruction

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4
Q

Name two common causative organisms of UTI

A

E.Coli
Staphylococcus Saprophyticus

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5
Q

Other than immunosupression, give four risk factors for UTI

A

Sex
Spermicide use
Menopause
Dehydration

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6
Q

State 4 symptoms of Cystitis

A

Frequency
Dysuria
Urgency
Haematuria

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7
Q

State 4 symptoms of Pyelonephritis

A

Fever
Rigors
Loin Pain
Vomiting

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8
Q

State 4 symptoms of Prostatitis

A

Pain (perineurium,rectum, penis)
Fever
Malaise
Urinary Symptoms

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9
Q

When do you investigate a UTI?

A

Non pregnant, under 65 and less than 3 symptoms
Pregnant Women
Men
Children

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10
Q

Do you treat Asymptomatic Bacteruria?

A

Not unless pregnant

MSU and 7d Nitrofurantoin

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11
Q

How do you treat non pregnant Women with UTI?

A

Lower UTI - 3 Day course of Trimethoprim/Nitrofurantoin (consider delayed prescription)
Upper UTI - 7 Day course of Co-amoxiclav

Fluids, Pain relief, Hygiene

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12
Q

How do you treat pregnant Women with UTI?

A

As long as not 3rd term

Nitrofurantoin/Cephalexin for 7 days and MSU

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13
Q

How do you treat Men with UTI?

A

Nitrofurantoin for 7 days
(If Prostatitis then consider 4 weeks of Ciprofloxacin - penetrates Prostatic fluid well)

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14
Q

What is Acute Bronchitis?

A

Short term inflammation of the Bronchi, usually a viral cause in origin

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15
Q

Give 4 features of Acute Bronchitis

A

Productive Cough
SOB
May have been preceded by URTI
Generally no systemic symptoms (might indicate Pneumonia)

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16
Q

What is Bronchiolitis?

A

Acute viral illness of Lower Respiratory Tract occurring primarily in the very young.
RSV responsible for 80%

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17
Q

Give four risk factors for Bronchiolitis, and one protective factor

A

Older Siblings, Nursery Attendance, Passive Smoking, Overcrowding
Breast Feeding is protective

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18
Q

Describe four features of presentation of Bronchiolitis

A

1-3 day history of coryzal symptoms
Persistent cough/chest recession/crackles
Fever
Poor feeding

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19
Q

If you suspected Bronchiolitis in a child, when would you refer to Secondary Care?

A

Apnoea
Chest recession/grunting
RR>70
02<92%
Central Cyanosis

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20
Q

How would you manage Bronchiolitis?

A

Self Limtiing
Fluids and nutrition
Anti - pyretics if child is in distress

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21
Q

Acute Conjunctivitis can be Viral/Bacterial/Parasitic/Allergic in origin. Give an example of a causative organism of each

A

Viral - Adenovirus
Bacterial - Staphylococcus
Parasitic - Lyme Disease
Allergic - Seasonal

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22
Q

Give 3 causes of Chronic Conjunctivitis

A

Recurrent Infective
Chlamydia
Toxic Reaction

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23
Q

Give 2 symptoms of Conjunctivitis

A

Red eye with irritation/grittiness
Discharge

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24
Q

Give 2 signs of Conjunctivitis

A

Conjunctival Oedema
Dilated Conjunctival Vessels

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25
What are Conjunctival Follicles?
White nodules on inferior eyelids If preauricular lymph nodes are enlarged - Toxic or Molluscum Contagiosum in causation If preauricular lymph nodes are not enlarged - HSV or Chlamydia
26
What are Conjunctival Papillae?
Red dots of varying size on inferior eyelids (Cobblestone) Allergic/Bacterial in cause
27
How would you manage BACTERIAL Conjunctivitis?
Advise self limiting nature (shouldn't last longer than 2 weeks) Lubricant eye drops Antibiotics - Chloramphenicol (not in pregnancy), Fusidic Acid Chlamydia - topical tetracycline and oral doxycycline Gonococcal - 1g IM Ceftriaxone
28
How would you manage VIRAL Conjunctivitis?
Supportive unless HSV (Topical Acyclovir)
29
How would you manage ALLERGIC Conjunctivitis?
Avoid rubbing Cool compreses Topical Antihistamines Oral Antihistamines (eg Chloramphenamine)
30
What is Blepharitis?
Inflammation of the edge of the eyelid Usually a chronic condition that never fully resolves Can be anterior (affecting eyelashes) or posterior (affecting meibomian glands)
31
Give 3 causes of Blepharitis
Staph Infection Seborrhoeic Dermatitis Meibomian Gland Dysfunction
32
Give 2 general symptoms of Blepharitis
Eyes are sore and gritty Eyes may stick together in the morning Symptoms are WORSE in the morning
33
Give 2 signs seen with each respective cause of Blepharitis
Staph Infection - Hyperaemia, Crusting of lash bases Seborrheic - Erythema, Hyperaemia Meibomian Dysfunction - oil globules on lid, chalazia
34
How would you manage Blepharitis?
Lid Hygiene (warm compress and massage to loosen meibomian content, and cleansing using cotton bud in baby shampoo) Abx only if evidence of unresolving infection
35
Give four causes of Cervical Back Pain
Cervical Spondylosis Cervical Prolapse Meningitis Torticollis
36
What is Torticollis?
Acute spasm of neck (often after 'sleeping funny')
37
Give 3 red flags for Cervical Back Pain
Weakness in more than one myotome Neurological symptoms Malaise/Weight Loss
38
Give four causes of Thoracic Back Pain
Poor posture Trauma Herniation Osteoporosis
39
What is Schuermann's Disease?
Vertebrae grow unevenly in childhood, with the posterior growing faster leading to exaggerated kyphosis
40
Give three red flags for Thoracic Back Pain
Trauma 20>Age or >50 HIV/Drug abuse
41
How would you manage simple back pain?
Promote activity not bed rest Low dose short course NSAIDs (paracetamol is ineffective) Weak Opioids
42
How would a Tension Headache present?
Bilateral Squeezing Pain May have associated neck pain Responsive to OTC medication
43
How would a Migraine Headache present?
Unilateral and throbbing Nausea Photophobia Aura (Zig Zag lines)
44
How would a Cluster Headache present?
Typically occurs at night Excruciating/Sharp/Penetrating around one eye Usually lasts 45-90 minutes
45
State four uncommon types of Primary Headaches
Valsalva Headache (when coughing) Primary Exertional (After exercise) Primary Sexual (Peaking at orgasm) SAH
46
State four types of SECONDARY headaches
Medication Overuse Referred from TMJ/Sinusitis/Tooth Ache Temporal arteritis Hypertension
47
How would a medication overuse headache present?
-Present on atleast 15 days of the month -History of regular use of Triptans/Opioids/Paracetamol/NSAIDs -Often worse in the morning and after sleeping -May coexist with depression and sleep disturbance
48
How would you manage a Tension Headache?
Reassurance and advice on stress management Ibuprofen/Asparin/TCA (eg Amitryptylline if frequent - SE is dry mouth)
49
State 5 triggers of Migraines
Stress Sleep Deprivation Dietary (Cheese/Chocolate/Alcohol) Menstruation Weather
50
How would you manage a Migraine?
Address triggers 1) Asparin/Ibuprofen/Buccal Prochlorperzine for nausea 2) Rectal Diclofenac and Rectal Domperidone 3) Triptans (5HT1 Antagonists)
51
What situations are Triptans contraindicated?
Uncontrolled Hypertension, CHD, CVD
52
Describe the 3 prophylactic drugs for Migraines
Beta Blockers (Atenolol) Amitryptylline Sodium Valproate/Topirimate
53
How would you manage Cluster headaches?
Good sleep hygiene Smoking Cessation Acute Attack - Sumatriptans (Subcut), 02 (15 min up to 5 times a day)
54
What prophylactic drugs can you use in Cluster Headaches?
Verapamil Prednisolone Lithium
55
Describe a 5 step management plan for Medication Overuse Headache
1) Explanation 2) Advice (stop headache medication for atleast one month, 3 week course of ibuprofen, will get withdrawal headaches) 3) Follow Up 4) Prophylaxis (Prednisolone or Amitryptyline) 5) Review
56
Define Sprain and Strain
Sprain - Ligament injury Strain - Overstretching of muscles or tendons
57
Describe the management of Sprains and Strains (PRICE, avoid HARM)
Protect from further injury, Rest for 48-72hrs, Ice (15-20mins every 3hrs), Compression, Elevation Heat (encourages blood flow so increases bruising and inflammation), Alcohol, Running, Massage
58
What is Sinusitis? Name the four Sinuses
Inflammation of the lining of one or more sinuses Ethmoidal, Frontal, Sphenoidal, Maxillary
59
State 4 risk factors for Sinusitis
URTI Allergy Asthma Smoking
60
Name 3 causative organisms of Sinusitis
Streptococcus Pneumoniae Haemophilus Influenza Moraxella Catarrhalis
61
How would you classify Sinusitis by timescale?
Acute: 7-30d Subacute: 4-12w Chronic: >90d
62
How would Sinusitis present?
Non resolving cold Pain over affected sinus (worse on bending forward)
63
How should you examine each Sinus respectively?
Frontal - Press upwards on medial side of supraorbital ridge Maxillary - Press on anterior wall below inferior orbital margin Ethmoidal - Press against medial wall of orbit
64
Describe four conservative managements for Sinusitis
- Reassure the patient that it will take a bit longer to resolve than a normal cold - Warm face packs (no evidence) - Nasal irrigation with warm saline - Paracetamol/Ibuprofen
65
Describe two pharmacological managements for Acute Sinusitis. When should these be used?
High dose nasal steroid for 2/52 Deferred Abx (5d of Pen V) If unwell for >10d
66
What is the difference between Tonsilitis, Pharyngitis and Laryngitis?
Tonsilitis - Inflammation of the tonsils Pharyngitis - Inflammation of the oropharynx Laryngitis - Inflammation of the Larynx (associated with hoarseness)
67
Describe 5 possible presentations of Tonsillitis
Pain in throat (worse on swallowing) Referred pain to ears Headache Loss of Voice Abdo Pain (in children)
68
Give two differentials of Tonsilitis and how they would present?
Coxsackie Virus - Blisters on tonsils and roof of mouth Glandular Fever - Extreme lethargy and enlarged spleen
69
Describe the features of the FEVER PAIN score, and how it is used.
Fever Pain Attend rapidly Inflamed tonsils No cough/coryzal symptoms 0 or 1 = No abx 2 or 3 = Delayed abx 4 or 5 = Abx
70
What antibiotics are given for Tonsillitis?
Phenoxymethylpenicillin 500mg QDS for 5-10d
71
What are the requirements for a Tonsillectomy?
Atleast 7 episodes in the past year OR 5 episodes each year for the past 2 years
72
Give 3 complications of Tonsillitis
Peritonsillar Abscess Acute Otitis Media Guttate Psoriasis
73
How does an atypical UTI present?
Delirium, generally unwell, elderly patient
74
State some gynae differentials for UTI
Atrophic vaginitis Lichen Sclerosus
75
What would be relevant in the PMH of UTI presentation
Diabetes Immunosupression Neurological
76
When should you culture urine when suspecting UTI?
If recent antibiotics If nitrites negative on dipstick If pregnant If catheterised
77
Give four non pharmacological managements for UTI
Avoid douching Wipe back to front Remain hydrated Don't delay habitual or post coital urination
78
How should you treat a catheterised UTI?
MSU Change catheter if in place for >7 days 7 days Nitrofurantoin
79
Give four complications of a UTI
Pyelonephritis Urosepsis Kidney Failure Perinephric abscess
80
Describe an alternative to MSU
Clean Catch Urine - Periurethral area is cleaned first then whole catch is sent for culture and sensitivity
81
Give a reason for a false positive and false negative in urine microscopy and sensitivity
False positive: contamination or stored at too high temperature False negative: incorrect ratio to boric acid (as boric acid is bacteriocidal)
82
How would you manage a male lower UTI?
7 days Nitro/Trimeth
83
When would you refer a male lower UTI?
If ongoing symptoms despite abx If recurrent (2 times or more within 6 months) Persistent haematuria
84
How would you manage chronic sinusitis
Extended course of nasal steroids (mometasone) up to 3 months Avoiding triggers where possible Smoking cessation

Year 3 GP (6 decks)

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