General Practice Flashcards
(35 cards)
1
Q
What is the pathophysiology of acne vulgaris?
A
- chronic inflammation ± localised infection
- increased production of sebum by sebaceous glands in pilosebaceous unit
- this traps keratin and blocks the pilosebaceous unit
- leads to swelling and inflammation
- androgenic hormones increase sebum production
2
Q
Which bacteria plays a role in acne?
A
- Propionibacterium acnes
- anaerobic
- colonises the skin
- topical benozyl perozide is toxic
3
Q
What is a comedone?
A
- dilated sebaceous follicle
- closed top: whitehead
- open top: blackhead
4
Q
What are papules and pustules?
A
- inflammatory lesions that form when the follicle bursts and releases irritants
- papules: small lumps
- pustules: pus filled
5
Q
What are the 3 types of scars that commonly form after acne?
A
- ice pick: small indentations
- hypertrophic: small lumps
- rolling: wave like irregularities on the skin
6
Q
What does drug induced acne look like?
A
- monomorphic
- often pustules in steroid use
7
Q
How is mild, moderate and severe acne differentiated?
A
- mild: open and closed comedones, may have sparse inflammatory lesions
- moderate: widespread non-inflammatory lesions, papules, pustules
- severe: extensive inflammatory lesions, nodules, pitting, scarring
8
Q
What is the 1st line management of mild to moderate acne?
A
- 12 week course combination therapy
- adapalene with benzyl peroxide
- tretinoin with clindamycin
- benzoyl peroxide with clindamycin
9
Q
What is the 1st line management of moderate to severe acne?
A
- 12 week course
- adapalene and benzoyl peroxide (+ oral lymecycline/doxycycline)
- tretinoin with clindamycin
- azelaic acid + either lymecycline/doxycycline
10
Q
Which oral contraceptive can be used in the treatment of acne?
A
- dianette: co-cyprindiol
- anti-androgenic effects
- higher VTE risk so max 3 months + risk counselling
11
Q
What is oral isotretinoin for acne treatment?
A
- Roaccutane
- retinoid
- reduces sebum, inflammation and bacterial growth
- prescribed by dermatologist
- teratogenic so must be on contraception and stop for >1mo before conceiving
12
Q
What are side effects of isotretinoin?
A
- dry skin and lips
- photosensitivity of skin
- depression, anxiety, suicidal ideation
13
Q
What are haemorrhoids?
A
- enlarged anal vascular cushions
- specialised sub-mucosal tissue
- supported by smooth muscle and connective tissue
14
Q
What are the causes of haemorrhoids?
A
- pregnancy
- obesity
- age
- inc intra-abdo pressure e.g. chronic cough
15
Q
Where are the anal cushions located?
A
- contain connections between arteries and veins > very vascular
- cushions located at 3, 7, 11 o’clock
- 12 is towards the genitals and 6 towards the back
16
Q
How are haemorrhoids classified?
A
- 1st: no prolapse
- 2nd: prolapse on straining, return on relaxing
- 3rd: prolapse on straining, don’t return on relaxing, can be pushed back
4th: permanently prolapsed
17
Q
What are the symptoms of haemorrhoids?
A
- painless bright red bleeding
- blood NOT mixed with stool
- sore/itchy anus + lumps
18
Q
What are external haemorrhoids?
A
- originate below dentate line
- prone to thrombosis + may be painful
19
Q
What are internal haemorrhoids?
A
- originate above dentate line
- don’t generally cause pain
20
Q
How are haemorrhoids managed?
A
- soften stools: inc fibre and fluid
- topical local anaesthetics and steroids
21
Q
What are non-surgical treatments for haemorrhoids?
A
- rubber band ligation: cuts off blood supply
- injection sclerotherapy: phenol oil causes sclerosis + atrophy
- infra-red coagulopathy: IR light damages blood supply
- bipolar diathermy
22
Q
What are thrombosed haemorrhoids and how are they managed?
A
- strangulation at haemorrhoid base > thrombosis
- appear purplish, tender, swollen lumps
- consider admission if presenting within 72hrs
- if >72hrs, offer conservative management
23
Q
What are surgical management options for haemorrhoids?
A
- artery ligation: suturing to cut off blood supply
- haemorrhoidectomy )can lead to faecal incontinence
- stapled haemorrhoidectomy
24
Q
What colours of blood suggest which origin of GI bleeding?
A
- bright red: rectal/anal canal
- dark red: more proximal
25
What are the 3 key signs of polycythaemia vera?
- conjunctival plethora
- ruddy complexion
- splenomegaly
26
What is pernicious anaemia?
- B12 deficiency
- parietal cells produce intrinsic factor for B12 absorption in ileum
- antibodies form against parietal cells or intrinsic factor
27
Why is vitamin B12 important?
- production of blood cells
- myelination of nerves
28
What are risk factors for pernicious anaemia?
- more common in females
- middle to old age
- associated with AI disorders: thyroid, T1DM, Addison's, RA
29
How does pernicious anaemia present?
- peripheral neuropathy: symmetrical, legs>arms, paraesthesia
- loss of proprioception
- visual changes
- mood/cognitive changes
- lemon yellow skin
- angular chelitis and glossitis
30
How is pernicious anaemia diagnosed?
- testing for auto-antibodies
- 1st line: intrinsic factor antibody
- low sensitivity but high specificity
- FBC shows macrocytosis in 70% pts
- hypersegmented polymorphs
31
How is pernicious anaemia treated?
- 1mg of IM hydroxycobalamin
- no neuro symptoms: 3x per week for 2 weeks followed by 3 monthly injections
- neuro symptoms: more frequent
32
What are the most common causes of vitamin B12 deficiency?
- pernicious anaemia
- post gastrectomy
- vegan/poor diet
- ileum disorders
33
What is the presentation of B12 deficiency?
- macrocytic anaemia
- sore tongue and mouth
- neuro: proprioception and vibration > distal parasthesia
- neuropsychiatric: mood disturbance
34
How is vit B12 deficiency managed?
- same as pernicious anaemia management
- if also deficient on folic acid: treat B12 FIRST to avoid subacute combined cord degeneration (demyelination in spinal cord)
35
