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Oishi's Final year flashcards > GP > Flashcards

GP Flashcards

1
Q

6 causes of cauda equina?

A

Malignancy:
Bony mets
Myeloma
Primary sacral tumour e.g. chordoma

Infection:
Epidural abscess

Trauma:
Disc prolapse
Epidural haematoma

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2
Q

What to do if a patient presents to GP with cauda equina?

A

Arrange urgent same day spinal surgery admission

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3
Q

How to tell the difference between cauda equina and cord compression?

A

Cauda equina compression causes flaccid paralysis with loss of reflexes
Cord compression usually causes spastic paralysis with brisk reflexes
Both cause sensory and power loss.

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4
Q

Red flag symptoms of lower back pain?

A 
Bilateral sciatica
Bladder dysfunction
Perianal paraesthesia
Gait disturbance
Lower limb weakness
Erectile dysfunction
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5
Q

SEs of metformin

A

GI upset - nausea & diarrhoea
Lactic acidosis (if renal failure)
Caution in RF if eGFR <30

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6
Q

What score can be used to calculate risk of CVD or stroke in the next 10 years? What age is it valid until?

A

QRisk2

84 years

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7
Q

Give some examples of meds used in migraine prophylaxis?

A

Amitryptiline
Propranolol
Topiramate

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8
Q

Mx of acute migraine?

A

Triptans

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9
Q

How to confirm Dx of HTN?

A

clinic blood pressure of 140/90 mmHg or higher AND

ABPM daytime average or HBPM average of 135/85 mmHg or higher

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10
Q

Beta-blocker CIs?

A 
asthma
cardiogenic shock
marked bradycardia
hypotension
third degree AV block
severe peripheral arterial disease
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11
Q

prophylaxis of chronic tension headache?

A

Amitriptyline

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12
Q

When to give abx in tonsillitis?

A

FeverPAIN score 2-3: consider delayed antibiotic prescription
FeverPAIN score 4-5: consider immediate antibiotic prescription

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13
Q

FeverPAIN criteria?

A 
Fever
Pus
Symptom onset <3 days
Inflamed tonsils
No cough/coryza
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14
Q

Tonsillitis tx?

A

Penicillin V (500mg QDS for 10 days) is the treatment of choice with erythromycin or clarithromycin being the choices for those allergic to penicillin

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15
Q

Dukes staging colorectal cancer?

A

Dukes A – tumour confined to bowel wall
Dukes B – tumour has gone through wall but not into nodes
Dukes C – tumour involving regional nodes
Dukes D – distant metastases are present

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16
Q

How to prescribe buproprion in patients trying to quit smoking?

A

Bupropion 150 mg OD for 6 days, increasing to 150 mg BD for a total of 7–9 weeks
Ask them to stop smoking 7-14 days after starting buproprion

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17
Q

Who should get a lower dose of buproprion?

A

elderly
patients who have mild to moderate liver impairment
renal impairment where GFR <50 mL/min.

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18
Q

CIs to buproprion?

A

Seizures
CNS tumour
Severe hepatic cirrhosis
Hx of BPD, anorexia or bulimia

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19
Q

Risk of PE after AZ vaccine? What to do if they come in?

A

4-28 days

Send to A&E for platelet count (if low high chance)

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20
Q

3 types of melanocytic naevi?

A

Compound naevi have nests of cells at the epidermal-dermal junction as well as within the dermis. They tend to have a raised area surrounded by a flat pigmented area.
Junctional naevi have nests of cells at the epidermal-dermal junction. They tend to be flat and coloured.
Dermal naevi have nests of cells in the dermis. They tend to raised and can be skin coloured or pigmented.

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21
Q

Benefits of metformin?

A

Moderately effective glycaemic control (GC)
Weight loss
CV protection

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22
Q

Benefits of sulfonylureas (gliclazide)?

A

Highly effective glycaemic control

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23
Q

SEs of sulfonylureas (gliclazide)?

A

Risk hypos
Weight gain
Caution renal impairment

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24
Q

Benefits of Gliptins (Sitagliptin/Linagliptin)?

A

Weight neutral

Good in CKD

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25
Q

SEs of Gliptins (Sitagliptin/Linagliptin)?

A

Least effective GC

potential risk HF

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26
Q

Benefits of Pioglitazone?

A

Mod effective GC

safe in renal impairment

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27
Q

SEs of Pioglitazone? ELBOW

A 
Edema (can worsen HF)
Liver impairment
Bladder cancer
Osteoporosis (fractures)
Weight gain
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28
Q

Benefits of SGLT2 inhibitors? (Empagliflozin)

A

Mod effective GC
weight loss
CV benefits

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29
Q

SEs of SGLT2 inhibitors (Empagliflozin)?

A

Genital infections
DKA
Amputation
Caution eGFR <60

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30
Q

Benefits of GLP-1s (injectable) (Exenatide)?

A

Highly effective GC
Weight loss
CV benefits

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31
Q

SEs of GLP-1s (injectable) (Exenatide)?

A

Cancer (breast)

Expensive

32
Q

Benefits of insulin?

A

Highly effective GC

33
Q

SEs of insulin?

A

Weight gain

34
Q

Another name for seborrheic keratoses?

A

Basal cell papilloma

35
Q

Standard uncomplicated UTI Tx in women?

A

Trimethoprim 200mg BD for 3 days

Nitrofurantoin 100mg modified release BD for 3 days (eGFR >40)

36
Q

Pyelonephritis tx?

A

Cephalosporin or co-amoxiclav for 7-10 days

Review in 24-48 hours if not in hospital

37
Q

When to organise USS in kids with UTI?

A
  1. In acute infection in all children with atypical features – poor urinary flow, abdominal/bladder mass, raised creatinine, sepsis, treatment failure, non-E.coli organism.
  2. During acute illness in children <6 months with recurrent UTIs
  3. Within six weeks, for children aged >6 months with recurrent UTIs
  4. Within six weeks, for all children <6 months of age with first time UTI that responds to treatment.
38
Q

What dose is used in UTI prophylaxis?

A

Reduced dose - usually 25-50% normal dose

39
Q

Which additional blood tests should be done if a patient’s LDL comes back increased?

A

TFTs
LFTs
U&Es
Fasting glucose

40
Q

How does Bezafibrate act?

A

reducing serum triglycerides

41
Q

Common SEs of statins?

A

Asthenia
Headache
Flatulence

42
Q

Causes of secondary hypercholesterolaemia?

A 
Obesity
CKD
Alcohol excess
Anorexia
Uncontrolled hypothyroidism
Thiazide diuretics and ciclosporin
43
Q

Which drugs are cautioned when a patient is taking a statin?

A

Clarithromycin

Grapefruit juice

44
Q

How to manage faecal impaction?

A

Combination of movicol orally and phosphate enemas

45
Q

Which laxative is used for bowel prep?

A

Picolax (sodium picosuphate with magnesium citrate)

46
Q

How to convert morphine from oral to SC?

A

Half the dose

47
Q

What anti-emetic is used in opioid induce nausea?

A

Metoclopramide 10mg TDS

48
Q

What type of nausea is cyclizine useful against?

A

Bowel obstruction
Raised ICP
Motion sickness

49
Q

When to stop statins due to myopathy?

A

If CK is 5-10x higher than normal

50
Q

When to stop statins due to abnormal liver function?

A

If LFTs are 3x higher than normal

51
Q

When to stop and restart pill due to surgery?

A

Stop 4 weeks before

Restart 2 weeks after

52
Q

What CHADsVASc score is needed for tx in AF?

A

2+

53
Q

Which type of ulcer is better after eating?

A

Duodenal

54
Q

Why do we check U&Es after starting an ACEi?

A

Renal artery stenosis

55
Q

What is does a feeling of heartbeat stopping followed by pounding suggest?

A

Ectopic supraventricular beats

56
Q

Superficial thrombophlebitis tx?

A

NSAID

57
Q

Hypertensive retinopathy stage 1 fundoscopy?

A

Arteriolar narrowing and tortuosity

Increased light reflex - silver wiring

58
Q

Hypertensive retinopathy stage 2 fundoscopy?

A

Arteriovenous nipping

59
Q

Hypertensive retinopathy stage 3 fundoscopy?

A

Cotton-wool exudates

Flame and blot haemorrhages

60
Q

Hypertensive retinopathy stage 4 fundoscopy?

A

Papilloedema

61
Q

standard antibiotic prophylaxis in patients with COPD?

A

Azithromycin

62
Q

Target BP in clinic?

A
  • If <80y/o - 140/90
  • If >80y/o - 150/90
  • If T2DM - 140/90 (130/80 if end organ damage)
  • If T1DM - 135/85 (130/80 if end organ damage)
63
Q

When to refer cardiac chest pain from GP?

A

current chest pain or chest pain in the last 12 hours with an abnormal ECG: emergency admission
chest pain 12-72 hours ago: refer to hospital the same-day for assessment
chest pain > 72 hours ago: perform full assessment with ECG and troponin measurement before deciding upon further action

64
Q

What to do if someone on immediate release metformin is struggling with SEs?

A

Switch to modified release and uptitrate whilst monitoring symptoms

65
Q

Sick day rules for DM?

A

Increase frequency of blood glucose monitoring to four hourly or more frequently
Encourage fluid intake aiming for at least 3L in 24hrs
If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
Do not stop insulin

66
Q

Otitis externa tx?

A

Topical antibiotic or combined topical antibiotic + steroid

Just antibiotics: Gentamicin/Chloramphenicol drops
Antibiotics + corticosteroids
• Dexamethasone + ciprofloxacin OR
• Betamethasone + Neomycin sulphate

67
Q

What to do if someone’s urine albumin:creatinine ratio >3mg/mmol and they have known diabetes?

A

Start ACEi

68
Q

When to refer to nephrology based off ACR?

A

ACR >70 and not known to have DM
ACR >30 + persistent haematuria (ruled out UTI)
ACR 3-29 + persistent haematuria + declining eGFR/CVD

69
Q

Glaucoma screening if positive family history?

A

Annual screening from 40 years old

70
Q

What is diabetic retinopathy stage 1 and what are the features?

A

Mild non-proliferative diabetic retinopathy

1 or more microaneurysm

71
Q

What is diabetic retinopathy stage 2 and what are the features?

A 
Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots
72
Q

What is diabetic retinopathy stage 3 and what are the features?

A

Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
intraretinal microvascular abnormalities in at least 1 quadrant

73
Q

What is diabetic retinopathy stage 4 and what are the features?

A

Proliferative diabetic retinopathy
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc

74
Q

What is the last stage of diabetic retinopathy and what are the features?

A

Diabetic maculopathy
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula

75
Q

How is bowel cancer screened for and who is it offered to?

A

FIT test

Men and women aged 60 -74

Oishi's Final year flashcards (9 decks)

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