General Flashcards
(187 cards)
1
Q
What types of conjunctivitis exist?
A
Conjunctivitis can be bacterial, viral, or allergic.
2
Q
What are the signs and symptoms of conjunctivitis?
A
- Gritty/itchy/foreign body sensation
- Blurring of vision due to disturbance of the tear film/corneal involvement (adenoviral)
- Viral often watery, associated with cold/sore throat, pre-auricular lymph nodes
3
Q
How does conjunctivitis differ from uveitis or scleritis?
A
In conjunctivitis, redness affects all conjunctiva, whereas in uveitis or scleritis, redness is only on the globe.
4
Q
What should be looked for during an eye exam for conjunctivitis?
A
Look for multiple fine white spots or fluorescein stains on the cornea; major corneal staining or clouding suggests an alternative diagnosis.
5
Q
What is the treatment for bacterial conjunctivitis?
A
Chloramphenicol eye drops four times daily.
6
Q
What is the treatment for viral conjunctivitis?
A
Topical lubricants and hygiene.
7
Q
What is the treatment for allergic conjunctivitis?
A
Antihistamine or anti-mast cell drops (e.g. cromoglycate, nedocromil, opatanol).
8
Q
What are the signs of dry eye?
A
Redness of the eyes and spotty (‘punctate’) fluorescein staining.
9
Q
How is dry eye treated?
A
Mild to moderate cases can be treated with over-the-counter artificial tear drops. Eye ointment can also be used at night.
10
Q
What is blepharitis?
A
Blepharitis is an inflammatory eyelid condition caused by chronic staphylococcal infection and malfunction of the meibomian glands.
11
Q
What is the treatment for blepharitis?
A
Eyelid hygiene and chloramphenicol ointment 1% twice daily for severe cases.
12
Q
What is a chalazion?
A
A chalazion is a firm round lump in the eyelid caused by chronic inflammation/blockage of the meibomian gland.
13
Q
How is a chalazion treated?
A
Apply a warm compress and prescribe chloramphenicol ointment if inflamed. Surgical incision may be needed if conservative therapy fails.
14
Q
What is a stye?
A
A stye is a small abscess of the lash root on the eyelid.
15
Q
What is the treatment for a stye?
A
Epilate the lash and prescribe chloramphenicol ointment. A warm compress may also be used.
16
Q
How is a corneal abrasion treated?
A
Instil chloramphenicol ointment and secure a double eye pad if >10mm. Advise oral analgesia.
17
Q
What is the treatment for corneal foreign bodies?
A
Instil proxymethacaine and fluorescein, then gently remove the foreign body with a moistened cotton bud.
18
Q
What is the treatment for subconjunctival hemorrhage?
A
If no trauma, reassure patient. If trauma, consider referral to an ophthalmologist.
19
Q
What are the four main categories of headache?
A
Migraine, tension-type headache, cluster headache, and other rare primary headaches.
20
Q
What is a secondary headache?
A
Head pain attributed to another condition.
21
Q
What are examples of causes of secondary head pain?
A
Head and neck trauma, cranial or cervical vascular disorders, non-vascular intracranial disorders, substance withdrawal, infections, and psychiatric disorders.
22
Q
What is cranial neuralgia?
A
A type of secondary headache associated with pain from abnormalities of the cranial nerves.
23
Q
What are three types of cranial neuralgia?
A
Trigeminal neuralgia, glossopharyngeal neuralgia, and postherpetic neuralgia.
24
Q
What should a headache examination include?
A
Measurement of blood pressure, palpation of temporal arteries, neurological examination, and neck examination.
25
Why palpate temporal arteries in patients over 50?
To assess the risk of giant cell arteritis.
26
What is giant cell arteritis?
An inflammation of the lining of arteries, especially in the temples.
27
What is papilloedema?
Optic disc swelling caused by increased intracranial pressure.
28
What should be considered if the cause of a headache cannot be diagnosed?
Ask the person to record a headache diary.
29
What are red flags for head pain?
Head pain following trauma, sudden onset with rapid peak intensity, and sudden neurological impairment.
30
What does unilateral eye pain indicate?
Higher risk than bilateral head pain.
31
What is associated with severe unilateral eye pain?
Acute glaucoma.
32
What is acute glaucoma?
A condition where the optic nerve is damaged with or without raised intraocular pressure.
33
What should be suspected when headache is localized to head and neck structures?
Other secondary causes.
34
What symptoms suggest migraine?
Recurrent episodes of severe disabling headache associated with nausea and light sensitivity.
35
What characterizes migraine without aura?
Recurrent episodes lasting 4 hours to 3 days, with nausea or photophobia and at least two other characteristics.
36
What suggests tension-type headache?
Bilateral headache that is non-disabling with a normal neurological examination.
37
How does trigeminal neuralgia present?
Episodic unilateral facial pain, sharp and intense, triggered by trivial stimuli.
38
How does a cluster headache present?
Episodic unilateral headache that is severe and orbital, supraorbital, or temporal.
39
What is trigeminal neuralgia?
Pepisodic unilateral facial pain, lasting a few seconds to 2 minutes, diagnosed when it occurs in areas supplied by divisions of the trigeminal nerve, is sharp, stabbing, intense in character, and triggered by a trivial stimulus, such as light touch.
40
How does a cluster headache present?
Episodic unilateral headache that is severe and orbital, supraorbital, or temporal. Severe pain lasts between 15 minutes and 3 hours, associated with intense restlessness and agitation, and may be triggered within 90 minutes of drinking alcohol. Episodes occur between one every other day and eight times daily, often waking the person at night.
41
What is a Hemicrania Continua?
A chronic and persistent form of headache marked by continuous pain that varies in severity, always occurs on the same side of the face.
42
What is paroxysmal hemicrania?
Pain lasts between 2 minutes and 30 minutes, occurs more than five times a day more than half of the time, and responds completely to therapeutic doses of indometacin.
43
Name all 12 cranial nerves.
Olfactory Nerve, Optic Nerve, Oculomotor Nerve, Trochlear Nerve, Trigeminal Nerve, Abducens Nerve, Facial Nerve, Vestibulocochlear Nerve, Glossopharyngeal Nerve, Vagus Nerve, Accessory Nerve, Hypoglossal Nerve.
44
Which cranial nerves are 'Group A' affecting the eye and surroundings?
CN I - Olfactory Nerve, CN II – Optic Nerve, CN III – Oculomotor, CN IV – Trochlear, CN VI - Abducens.
45
Which cranial nerves are 'Group B', affecting the face?
CN V – Trigeminal Nerve, CN VII – Facial Nerve.
46
Which cranial nerves are 'Group C', assessed at the ears, neck, and shoulders?
CN VIII – Vestibulocochlear Nerve, CN IX – Glossopharyngeal Nerve, CN X – Vagus nerve.
47
What is the function of the cerebellum?
Gait, Speech, Nystagmus, Coordination, Tone, Smooth Movement, Reflexes.
48
What is multiple sclerosis?
A presumed autoimmune inflammatory condition of the central nervous system (CNS) resulting in areas of demyelination, gliosis, and secondary neuronal damage throughout the CNS.
49
What are the three main patterns of MS?
Primary progressive MS (PPMS), Secondary progressive MS (SPMS), Relapsing–remitting MS (RRMS).
50
What is Primary progressive MS (PPMS)?
There is a steady gradual worsening of the disease from the onset, without remissions.
51
What is Secondary progressive MS (SPMS)?
The onset is of the RRMS pattern, but the disease course changes and neurological function gradually worsens, with or without continued relapses.
52
What is Relapsing–remitting MS (RRMS)?
Episodes of symptoms (relapses) are followed by recovery (remissions) and periods of stability.
53
If MS is suspected, what should be done?
Referred promptly to a consultant neurologist.
54
What should you consider if you suspect a person with MS is having a relapse?
Infections should be ruled out, particularly urinary tract and respiratory infections.
55
What is allergic rhinitis?
Inflammation of the nose caused by allergies.
56
What lines the inside of the nose?
Mucous lining.
57
Which cells are responsible for allergic rhinitis?
Mast cells and basophils.
58
Common signs and symptoms of allergic rhinitis?
Swelling & congestion, watery eyes, stuffed ears, nasal drip, sneezing, dyspnea.
59
Rhinorrhoea is either?
anterior, posterior, or both.
60
When should you refer to ENT for rhinitis?
Unilateral symptoms, heavily blood-stained discharge or pain, nasal blockage unrelieved by pharmacotherapy or structural abnormalities.
61
What is the acute treatment for tension-type headache?
Consider aspirin, paracetamol or an NSAID for acute treatment, considering the person's preference, comorbidities, and risk of adverse events.
62
Why should preparations containing aspirin not be offered to?
under 16s due to the association with Reye's syndrome.
63
What is the acute treatment for migraine with or without aura?
Offer combination therapy with an oral triptan and an NSAID.
64
What should not be offered for the acute treatment of migraine?
Ergots or opioids.
65
For the acute treatment of a cluster headache, offer?
Oxygen and/or a subcutaneous or nasal triptan.
66
What should not be offered for the acute treatment of cluster headache?
Paracetamol, NSAIDs, opioids, ergots, or oral triptans.
67
What is Acute narrow-angle glaucoma?
An uncommon eye condition that results from blockage of the drainage of fluid from the eye.
68
How is medication overuse headache treated?
By withdrawing overused medication.
69
What is vertigo commonly associated with?
Sensation of movement, horizontal spinning, nausea, vomiting, sweating, generally feeling unwell.
70
What does vertigo result from?
A mismatch between sensory inputs and vision, proprioception, and the vestibular system.
71
What are the three common conditions relating to vertigo?
Benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, labyrinthitis, and Meniere's disease.
72
What is the purpose of Romberg’s test?
To measure a person's sense of balance.
73
What is the use of the Dix-Hallpike test?
To identify benign paroxysmal positional vertigo (BPPV) and confirm the affected side.
74
What is the use of the Epley manoeuvre?
To treat BPPV once diagnosed by the Dix-Hallpike test.
75
What are three peripheral causes of vertigo?
BPPV, Meniere's, Acute vestibular neuronitis.
76
What are central causes of vertigo?
Posterior circulation infarct (STROKE), Tumours, MS, Vestibular migraine.
77
What is Benign paroxysmal positional vertigo (BPPV)?
A disorder of the inner ear characterized by repeated episodes of positional vertigo.
78
When should BPPV referral take place?
If the expertise to provide a canalith repositioning procedure is not available in primary care.
79
When should I admit or refer a person with BPPV?
If they have severe nausea and vomiting and are unable to tolerate oral fluids.
80
What is vestibular neuronitis?
Thought to be due to inflammation of the vestibular nerve, often after a viral infection.
81
How does vestibular neuronitis differ from labyrinthitis?
Labyrinthitis involves inflammation of the labyrinth and features hearing loss, while vestibular neuronitis does not.
82
What is the treatment for vestibular neuronitis?
To relieve severe nausea or vomiting, consider buccal prochlorperazine or an intramuscular injection.
83
When should I admit or refer a person with vestibular neuronitis?
If symptoms are not typical or persist without improvement for more than 1 week.
84
What is Ménière's disease?
A disorder of the inner ear characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness.
85
What symptomatic treatment is recommended for an acute attack of Ménière's disease?
Consider prescribing a short course of prochlorperazine or an antihistamine.
86
What is otalgia?
Ear pain.
87
What is a peritonsillar abscess?
Also known as quinsy.
88
What should be considered for severe nausea or vomiting?
Consider buccal prochlorperazine or a deep intramuscular injection of prochlorperazine or cyclizine.
89
What to do if symptoms do not improve after 5–7 days?
Reassess to exclude an alternative diagnosis.
90
What is a peritonsillar abscess?
A complication of acute tonsillitis in which pus collects in the peritonsillar space.
91
What is the Liverpool Peritonsillar Abscess (LPS) score?
A decision aid for patients with suspected peritonsillar abscesses.
92
What are complications of quinsy?
Retro- and parapharyngeal abscess, mediastinitis.
93
What are red flags for otitis media?
Meningitis, mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis.
94
What is a red flag for children with otitis media?
Children younger than 3 months with a temperature of 38°C or more.
95
What is the usual course duration of acute otitis media?
About 3 days, but can be up to 1 week.
96
What is the evidence for using decongestants or antihistamines in otitis media?
There is no evidence to support their use for the management of symptoms.
97
What is the first choice antibiotic for otitis media?
A 5–7 day course of amoxicillin.
98
What is the second choice oral antibiotic for otitis media?
A 5–7 day course of co-amoxiclav.
99
What is otitis media with effusion known as?
Glue ear.
100
What are the three bones of the middle ear?
Malleus, incus, and stapes.
101
What is Acute Mastoiditis (AM)?
A condition related to otitis media.
102
What is Otitis Externa?
An outer ear infection.
103
What is a Perforated Tympanic Membrane with otorrhoea?
A condition related to ear infections.
104
What is Otitis Media with Effusion (OME)?
Also known as glue ear.
105
What indicates a bulging and red tympanic membrane?
Acute Otitis Media (AOM).
106
What is the normal result for Weber's test?
Sound is heard equally in both ears.
107
What indicates sensorineural deafness in Weber's test?
Sound is heard louder on the side of the intact ear.
108
What indicates conductive deafness in Weber's test?
Sound is heard louder on the side of the affected ear.
109
What is the normal result for Rinne's test?
Air conduction > bone conduction (Rinne’s positive).
110
What indicates sensorineural deafness in Rinne's test?
Air conduction > bone conduction (Rinne’s positive) due to both being reduced equally.
111
What indicates conductive deafness in Rinne's test?
Bone conduction > air conduction (Rinne’s negative).
112
What is Lymphadenopathy?
A disease of the lymph nodes, abnormal in size or consistency.
113
What is recommended for otitis externa?
Consider use of over-the-counter acetic acid 2% ear drops or spray.
114
When should follow-up be arranged for otitis externa?
If symptoms are not improving within 48–72 hours or have not fully resolved after 2 weeks.
115
How does parotid gland swelling appear?
Causes loss of the angle of the jaw and a hamster-like appearance of the cheek.
116
How does submandibular gland swelling appear?
Apparent below and anterior to the angle of the mandible.
117
What is angular stomatitis?
An inflammatory condition affecting the corners of the mouth.
118
What is oral candidiasis?
A fungal infection characterized by pseudomembranous white slough.
119
What is periodontitis?
Inflammation of the periodontal ligament, leading to abscesses and tooth loss.
120
What is pharyngitis?
Inflammation of the pharynx with various potential causes.
121
What does the FeverPAIN score predict?
Likelihood of strep throat and need for antibiotics.
122
What does purulent tonsils indicate?
Tonsillitis.
123
What is the first line antibiotic for throat infections?
Prescribe phenoxymethylpenicillin.
124
What causes glandular fever?
Most commonly caused by the Epstein-Barr virus (EBV).
125
What does management of glandular fever include?
Symptomatic relief with paracetamol or ibuprofen.
126
What are red flags of a person with a neck lump?
Red flag symptoms suggestive of local or haematological malignancy.
127
When should antibiotics be prescribed for acute bronchitis?
If seriously ill, in high-risk groups, or with blood-stained sputum.
128
When to consider prescribing antibiotics for acute bronchitis?
If a smoker aged over 50 with prolonged symptoms >3 weeks.
129
What is the first choice antibiotic for chest infection?
Amoxicillin (5 days, 500mg TD).
130
What to use if allergic to penicillin for LTRI?
Clarithromycin (250mg BD).
131
When to consider a CRP blood test for pneumonia?
If there is diagnostic uncertainty.
132
What is the first choice antibiotic for pneumonia?
Amoxicillin (500mg 1x Daily).
133
Why is whooping cough common in under 3-month-old babies?
They are too young to be directly protected by routine immunization.
134
When should referral of adults be considered?
If there is bacterial resistance to oral antibiotics or unable to take oral medication.
135
What are causes of jaundice?
Hepatitis, liver cirrhosis, and biliary obstruction.
136
What are causes of frank haematemesis?
Mallory-Weiss tear, oesophageal variceal rupture.
137
What are causes of coffee grounds haematemesis?
Gastric or duodenal ulcer.
138
What is odynophagia?
Pain during swallowing.
139
What is steatorrhoea?
Presence of excess fat in faeces, causing pale stools.
140
What causes steatorrhoea?
Pancreatitis, pancreatic cancer, biliary obstruction, coeliac disease, and medications.
141
What is gastroenteritis?
A transient disorder due to enteric infection, characterized by sudden onset of diarrhoea.
142
What is acute diarrhoea defined as?
Three or more episodes of liquid or semi-liquid stool in 24 hours.
143
When should antidiarrhoeal drugs not be used?
If there is blood, mucus, pus in stools or high fever.
144
When to arrange emergency hospital admission for a child with suspected gastroenteritis?
If the child is systemically unwell or has severe dehydration.
145
What may intestinal obstruction present with?
Constipation, abdominal distension, abdominal pain, and vomiting.
146
What may intussusception present with?
Right lower quadrant tenderness, sausage-shaped mass, and redcurrant jelly stool.
147
What is a macular rash?
Flat, nonpalpable lesions usually < 10 mm in diameter.
148
What is a papular rash?
Red, raised, itchy bumps.
149
What is a vesicular rash?
Characterized by small, fluid-filled blisters.
150
Define a Macular rash
Macules are flat, nonpalpable lesions usually < 10 mm in diameter. Macules represent a change in color and are not raised or depressed compared to the skin surface. A patch is a large macule.
151
Define a papular rash
Red, raised, itchy bumps
152
Define a vesicular rash
A vesicular rash is characterized by small, fluid-filled blisters.
153
Define a erythema rash
Red, raised
154
Define a urticaria rash
Hives (swollen, raised areas with or without erythematous flares)
155
Define a petechia rash
Rais red bumps
156
Define a purpura rash
Purple, bruised like spots
157
What does the 'A' in ABCDE of dermatology stand for?
A is for Asymmetry. Most melanomas are asymmetrical.
158
What does the 'B' in ABCDE of dermatology stand for?
B is for Border. Melanoma borders tend to be uneven.
159
What does the 'C' in ABCDE of dermatology stand for?
C is for Color. Multiple colors are a warning sign.
160
What does the 'D' in ABCDE of dermatology stand for?
D is for Diameter or Dark. A lesion the size of a pencil eraser (about 6 mm) or larger is a warning sign.
161
What does the 'E' in ABCDE of dermatology stand for?
E is for Evolving. Any change in size, shape, color or elevation may be a warning sign.
162
What can the Weighted Glasgow 7-point checklist be used for?
Skin cancer: Diagnosis
163
What is impetigo?
A local superficial bacterial infection involving the epidermis.
164
What are risk factors for impetigo?
Poor hygiene, children, contaminant skin disease.
165
What is the management of impetigo?
Wash hands with soap, if contagious stay at home, usually self-resolving.
166
When should a female with a suspected UTI not have a urine dipstick?
If the woman is under 65 years of age, has two or three key symptoms of UTI, and has no risk factors for complicated UTI.
167
When should a female with a suspected UTI have a urine dipstick?
If the woman is under 65 years of age and has one key symptom of UTI or other urinary symptoms, arrange urine dipstick testing.
168
If the dipstick is positive for nitrite or leukocyte and red blood cells (RBCs), a UTI is ...?
Likely
169
When should pregnancy testing be performed?
The need for pregnancy testing varies depending on the circumstances, such as abdominal pain or a change in general health.
170
When should a referral to sexual health services be considered?
For general advice, risky sexual practices, or new onset of STI symptoms.
171
Who may require emergency contraception?
Women who have had unprotected sex or sexual assault.
172
What are the signs and symptoms of vaginal candidiasis?
Itching, soreness or irritation, discharge and dysuria.
173
What are the implications of abnormal heavy menstrual bleeding?
Heavy menstrual bleeding can impact quality of life and may indicate underlying conditions.
174
What is menopause?
Menopause occurs when ovarian follicular activism stops; a clinical diagnosis is usually made 12 months after one's last menstrual cycle.
175
What is the need for Hormone Replacement Therapy (HRT)?
HRT should be offered for treatment of vasomotor symptoms, mood disorders, urogenital symptoms, and altered sexual function.
176
When should a referral for HRT be considered?
When symptoms impact quality of life and benefits outweigh risks.
177
What non-pharmacological measures may relieve menopausal symptoms?
Lifestyle measures, SSRIs for mood disorders, and vaginal moisturizers for urogenital symptoms.
178
What is the need for fluorescein staining?
Fluorescein staining is useful for assessing superficial corneal injuries.
179
What are the clinical features of conjunctivitis?
Conjunctival erythema, discomfort or a discharge which may cause blurred vision.
180
What are the 'red flags' requiring urgent referral to ophthalmology?
Central visual disturbance, cranial nerve injury, visual loss, significant infection or trauma.
181
What should be considered when assessing mental health status?
Use a validated scoring tool and consider the onset, pattern, severity, and impact of symptoms.
182
What are the implications of a relevant existing mental health condition?
Poor mental health can limit activities and relationships, and increase risk of medical complications.
183
What should be included in a structured history for mental health assessment?
Full medical history, onset, pattern, severity, and impact of symptoms.
184
How to assess the impact of the person’s complaint on their daily life?
Establish a baseline for activities of daily living before the onset of mental ill health.
185
What are local guidelines for referral to other agencies in mental health?
Provide advice on depression, support materials, and local management pathways.
186
When to refer to the crisis team?
If the person is at significant risk of self-harm or suicide.
187
What is the need for further assessment, support, treatment or follow up/referral?
Referral is required for safeguarding concerns and to ensure adequate social support.
