GP Flashcards
(397 cards)
1
Q
what is the pathophysiology of acne?
A
chronic inflammation +/- localised infection in pileosebaceous units within the skin. increased sebum preduction traps keratin and blocks the pulosebaceous unit leading to swelling and inflammation. Androgenic hormones increase production of sebum => increased in puberty
2
Q
what are macules?
A
flat marks on skin
3
Q
what are papules?
A
small lumps on skin
4
Q
what are pustules?
A
small lumps with pus
5
Q
what are comedones?
A
skin coloured papules due to blocked pilosebaceous units
6
Q
what are blackheads
A
open comedones with black pigmentation in the middle
7
Q
what are ice pink scars?
A
small indentations that remain in skin after acne lesion heals
8
Q
what are hypertrophic scars?
A
small lumps in skin that remain after acne lesions heal
9
Q
what are rolling scars?
A
irregular wave like irregularies of the skin that remain after acne lesions heal
10
Q
what acne medication if teratogenic?
A
retinoids
11
Q
what is general advice for acne?
A
avoid overwashing
use non-alkaline synthetic detergent BD
avoid oil based cosmetics and suncream
avoid picking
treatment may irritate skin initially
not enough evidence to support diets for acne
12
Q
what treatments can be used for acne?
A
Topical benzoyl peroxide - reduces inflammation toxic to p.acnes bacteria
Topical retinoids - slow sebum production
Topical Abx - clindamycin (+benzoyl peroxide)
Oral Abx - lymecycline
OCP - stabilise female hormones
13
Q
what contraceptive pill is best at reducing acne?
A
COCP (co-cyprindiol (Dianette)) - anti-androgenic effect
14
Q
what is the last line option for acne (specialist)?
A
oral retinoids (isotretinoin(accutane))
15
Q
what are 4 side effects of accutane?
A
dry skin and lips
photosensitivity of skin
depression, anxiety, aggression, suicidal ideation
Stevens-johnson syndrome and toxic epidermal necrolysis
16
Q
what are the WHO ranges for anaemia?
A
Hb <11 g/dL <5 years
Hb <11.5 g/dL 5-11
Hb <12 women + 12-14 yo
Hb <13 g/dl >15 males
17
Q
what are 5 causes of normocytic anaemia? mnumonic
A
AAAHH
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
18
Q
what are 5 causes of microcytic anaemia?
A
TAILS
Thalassemia
Anaemia of chronic disease
Iron deficiency
lead Poisoning
Sideroblasticanaemia
19
Q
what are 6 causes of macrocytic anaemia?
A
FAT RBCs
Foetus
Alcohol
Thyroid disease - hypo
Reticulocytosis
B12 and folate deficiency
Cirrhosis and liver disease
20
Q
where is iron absorbed?
A
mainly duodenum and jejunum
21
Q
what is the normal range for MCV?
A
80-100 femtolitres
22
Q
what are 5 specific signs of IDA?
A
Pica
hair loss
koilonychia
angular cheilitis
atrophic glossitis
23
Q
what change occurs in barret’s oesophagus?
A
stratified squamous to simple columnar epithelium
24
Q
what are 5 triggers for GORD?
A
greasy/spicy/acidic food
tea and coffee
alcohol
NSAIDs
Stress
Smoking
25
what are GORD red flags?
Dysphagia
>55 yo
weight loss
Reflux
Treatment resistance
26
what is the medical management for GORD?
PPIs - omeprazole, lansoprazole
Histamine h2 receptor antagonists - famotidine
27
what are 4 investigations for H Pylori?
stool antigen tet
urea breath test
H.pylori antibody test
rapid urease test - during endoscopy
28
what is the management of h pylori?
triple therapy
PPI
2x ABx - amoxicillin + clarithromycin
29
what are the 4 types of hiatus hernia?
1 - sliding
2 - rolling
3 - combination
4 - large opening allowing additional abdo organs into thorax
30
what surgery can be done for hiatus hernia?
laparoscopic funcoplication
31
what are 3 management options for barrets oesophagus?
PPIs
endoscopic monitoring
endoscpoic ablation
32
what is metaplasia?
change in type of cells
33
what is dysplasia?
change to abnormal cells
34
what is zollinger-ellison syndrome?
rare condition of duodenal or pancreatic tumours which secrete excess gastrin causing severe dyspepsia, diarrhoea and peptic ulcers
may be associated with MEN1 which also causes parathyroid and pituitary tumours
35
what are 4 risk factors for diverticular disease?
increased age
low fibre diets
obesity
NSAIDs
36
what kind of laxatives should be avoided in diverticulosis?
stimulant laxitives
37
what is the management of uncomplicated diverticulitis?
oral co-amoxiclav 5 days
analgesia
clear liquids and no solid food until symptoms improve
Follow up in a few days
38
what is the management for severe diverticulitis?
nil by mouth or clear fluids only
IV Abx
IV fluids
Analgesia
Urgent investigations +/- surgery
39
what are 6 complications of diverticulitis?
perforation
peritonitis
peridiverticular abscess
large haemorrhage
fistula
ileus/obstruction
40
what is the blood supply to the anal cushions?
rectal arteries
41
what are 4 treatments for heamorrhoids?
anusol - astrigents shrink haemorrhoids
anusol HC - + hydrocortisone
germoloids - contain lidocaine
proctosedyl ointment - cinchocaine and hydrocortisone
42
what are 4 non-surgical options for haemorrhoids?
rubber band ligation
injection sclerotherapy
infra-red coagulopathy
bipolar diathermy
43
what are 3 surgical options for haemorrhoids?
haemorrhoidal artery ligation
haemorrhoidectomy
stapled haemorrhoidectomy
44
what are thrombosed haemorrhoids?
strangulated haemorrhoids - very painful but will resolve with time (several weeks)
45
what tool is used for cardiovascular risk assessment?
QRISK3
46
what counts as high blood pressure in clinic?
>140/90 mmHg
47
what counts as hypertension in ambulatory monotoring?
>135/85 mmHg
48
what 4 tests can be done for end organ damage in HTN diagnosis?
Urine sample for estimated albumin:creatinine ratio and haematuria
HbA1c, electrolytes, eGFR, creatinine, cholesterol
Fundoscopy - for retinopathy
ECG
49
what is the first line intervention for HTN?
LIFESTYLE ADVICE
50
what is the first line medication for HTN in those with T2DM or <55 and of non-african family origin?
ACEi (ramipril) or ARB (candestartan)
51
what is the first line medication for HTN in someone >55 or of african family origin?
Calcium channel blockers - amlodipine
52
what can be used for HTN if a calcium channel blocker isn't tolerated or as 3rd line medication?
thiazide-like diuretic (indapamide, bendroflumethiazide)
53
what is the management of HTN uncontrolled by one agent?
+ CCB/ACEi
OR Thiazide-like diuretic
54
what is the management of HTN uncontrolled by two agents?
CCB + ACEi AND Thiazide-like diuretic
55
what is the management of HTN not controlled by three agents?
Consider Spironolactone (If K+ <4.5)
Consider Beta blocker/Alpha blocker (if K+ >4.5)
56
what is classed as severe hypertension?
180/120 mmHg
57
what is stage 1 HTN?
Clinical - 140/80 mmHg to 159/99mmHg
Home - 135/85 - 149/94
58
what is stage 2 HTN?
Clinical - 160/100 - 180/120
Home - 155/95 - 175/115
59
what is stage 3 HTN?
180/120 +
60
what is the white coat effect?
discrepancy of 22/10mmHg between clinical and home BP
61
what are 5 renal causes of HTN?
CKD
Chronic pyelonephritis
Diabetic nephropathy
Glomerulonephritis
Polycystic kidney disease
62
what are 2 vascular causes of secondary HTN?
coarctation of aorta
rental artery stenosis
63
what are 5 endocrine causes of HTN?
Primary hyperaldosteronism
Phaeochromocytoma
Cushings syndrome
Acromegaly
Hyper/Hypothyroid
64
what are 5 drugs that can cause HTN?
alcohol + other substances
COCP/Oestrogens
Eythropoietin
corticosteroids
NSAIDs
65
what are 3 things that conjunctivitis will not cause?
Pain
Vision loss
Photophobia
66
what is the presentation of viral conjunctivitis?
clear discharge from eyes, associated with cold symptoms
may have tender periauricular lymph nodes
67
what are 3 differentials of painless red eye?
conunctivitis
episcleritis
subconjunctival haemorrhage
68
what are 7 differentials for painful red eye?
glaucoma
anterior uveitis
scleritis
corneal abrasions or ulceration
keratitis
foreign body
trauma or chemical injury
69
what medication can be given for bacterial conjunctivitis?
chloramphenicol and fuscidic acid eye drops
70
which patients should always be referred to ophthalmology with conjuncitivitis?
<1 month
could be gonococcal infection - can cause sight loss and pneumonia
71
what is the management of allergic conjunctivitis?
antihistamines
mast cell stabilisers - with chronic seasonal symptoms
72
what is stage 1 HTN?
140/80 mmHg to 159/99mmHg CLINICALLY
73
what is stage 2 HTN?
160/100 mmHg to 180/120mmHg CLINICALLY
74
what is stage 3 HTN?
>180/120 mmHg
75
what is the middle ear?
between tympanic membrane and inner ear (cochlea, vestibular apparatus and nerves)
76
what is the most common causative organism for otitis media?
strep pneumoniae
77
what are 3 other common causative organisms for otitis media?
H. Influenzae
Moraxella catarrhalis
Staph aureus
78
what are 5 presenting features of otitis media?
ear pain
reduced hearing
feeling generally unwell - fever
URTI symptoms
balance issues
79
what are 8 complications of otitis media?
hearing loss
perforated tympanic membrane
labrynthitis
mastoiditis
abcess
fascial nerve palsy
meningitis
80
what is the first line treatment for otitis media?
amoxicillin 5-7 days
clarithromycin - in penicillin allergy
81
what is the management of otitis media in pregnant women allergic to penicillins?
erythromycin
82
what are the two most common causes of otitis externa?
pseudomonas aeruginosa
staph aureaus
83
what kind of bacteria is pseudomonas aeruginosa?
gram neg aerobic bacilli
naturally resistant to many antibiotics - tx with aminoglycosides (gent) or quinolones (ciproflox)
84
what are 4 typical symptoms in otitis externa?
ear pain
discharge
itchiness
conductive hearing loss
85
what 4 things can be seen o/e in otitis externa?
erythema and swelling
tenderness
pus/discharge in ear canal
lymphadenopathy
86
what is the treatment for mild otitis externa?
acetic acid 2% (earcalm)
can also be used prophylactically
87
what is the management of moderate otitis externa?
topical Abx + steroid
neomycin + dexamethasone and acetic acid (OTOMISE)
Gentamicin and hydrocortisone
ciproflaxacin and dexamethasone
88
what is a contraindication to using gentamicin/neomycin in otitis externa?
perforated tympanic membrane - they are ototoxic
89
what is the management of sever/systemic otitis externa?
oral Abx - fluclox/clarithromycin
90
what is the treatment for fungal otitis externa?
clotrimazole ear drops
91
what is malignant otitis externa?
severe otitis externa where infection spreads to temporal bone. Causes severe persistant headache and fever
granulation tissue is found at junction between bone and cartilage in ear canal
92
what is the most common causative organism of bacterial tonsilitis?
Group A strep - strep pyogenes
93
What is the treatment for bacterial tonsilitis?
1st - penicilin V (phenoxymethylpenicillin) 10 days
penicillin allergy - clarithromycin
94
what is the second most common bacterial cause of tonsilitis?
strep pneumnoniae
95
what 2 criteria can be used to determine the probability that tonsilitis is bacterial?
Centor criteria
FeverPAIN score
96
what is the centor criteria?
for bacterial tonsilitis
fever >38
tonsillar exudates
absence of cough
tender anterior cervical lymph nodes
score >3 => offer Abx
97
what is the feverPAIN score
for bacterial tonsilits
Fever in last 24 hours
Purulence
Attended in 3 days of onset
Inflamed tonsils
No cough or coryza
score >4 - consider Abx
98
what are 6 complications of bacterial tonsilits?
peritonsillar abcess (quinsey)
otitis media
scarlet fever
rheumatic fever
post-streptococcal glomerulonephritis
post-streptococcal reactive arthritis
99
what is acute sinusitis?
<12 weeksw
100
what is chronic sinusitis?
>12 weeks
101
what are the 4 pairs of paranasal sinuses?
frontal - above eyebrows
maxillary - either side of nose
ethmoid - in middle of nasal cavity
sphenoid - in back of nasal cavity
102
what are 4 causes of sinusitis?
infection
allergies
obstruction of drainage - foreign body, polyps
smoking
103
what is the typical presentation of acute sinusitis? 5
nasal congestion and discharge
facial pain/headache
facial pressure
facial swelling
loss of smell
104
what 5 things may be seen o/e of sinusitis?
tenderness to palpation
inflammation and oedema of nasal mucosa
discharge
fever
signs of systemic infection
105
how long should you wait to give abx for sinusitis?
10 days
106
what is the management of sinusitis?
high dose steroid nasal spray for 14 days - 200mcg Mometasone BD
Delayed till day 17 phenoxymethylpenicillin
107
what are 4 risk factors for vaginal thrush?
increased oestrogen (high in preggo)
Poorly controlled diabetes
immunosupression
Broad spectrum Abx
108
what is the presentation of vaginal thrush?
thick white unsmelly discharge
vulval and vaginal itching, irritation or discomfort
109
what are 6 complications of vaginal thrush?
erythema
fissures
oedema
dysparaunia
dysuria
excoriation
110
what is the vaginal pH of candida?
<4.5
111
what is the vaginal pH of trichomonas?
>4.5
112
what is the management of vaginal thrush?
antifungal cream - clotrimazole (one off)
pessary - clotrimazole (one off 500mg or 3 doses 200mg)
oral - fluconazole (one off 150mg)
113
what is a warning that should be given with antifungal creams/pessaries?
can damage latex condoms and prevent spermacides - use alternative protection for 5 days
114
what is the most common fungus that causes ringworm?
trichophyton
115
what the name of ringworm?
tinea
tinea pedis - athletes foot
tinea capitis - ringworm of scalp
tinea cruis - groin
tinea coporis - body
onchomycosis - nail
116
what does ringworm look like?
itchy rash
erythematous, scaly and well demarcated
one or multiple rings with more prominent edges
117
what is the management of cutaneous fungal infections?
cream - terbinafine, clotrimazole, miconazole
shampoo - ketocanazole
oral - fluconazole, griseofulvin, itraconazole
nail laquer - amorolfine (6-12 months)
118
what is a kerion?
an abscess caused by a fungal infection most often causes by tinea capitis - causes boggy pus filled lump on scalp with localised alopecia
119
what are 6 risk factors for nappy rash?
delayed changing
irritant soaps/vigorous cleaning
poorly absorbant nappies
diarrhoea
oral Abx - predispose to candida
pre-term infants
120
what is the difference between nappy rash and candida infection?
candida doesnt spare skin folds
candida has larger red macules
candida has a well demarcated scally border
candida has satelite lesions
121
what are the 3 most common bacteria in cellulitis?
staph aureus
group A strep (pyogenes)
group C strep (dysgalactiae)
122
what classification is used for cellulitis?
eron classification
123
what is the management for cellulitis?
1 - flucloxacillin
clarithromycin
clindamycin
co-amox
124
what are 6 risk factors for OA?
obesity
age
occupation
trauma
female
Fhx
125
what are 5 x-ray findings of OA? mneumonic
JOSSA
joint space narrowing
osteophytes
Subarticular sclerosis
Subchondral cysts
Abnormalites of bone contour
126
what are 3 hand signs in OA?
heberden's nodes
bouchard's nodes
squaring at base of thumb
127
what joint does heberden's nodes affect?
DIP
128
what joint does bouchard's nodes affect?
PIP
129
what are 4 side effects of NSAIDs?
GI - gastritis, ulcers
renal - AKI (acute tubular necrosis), CKD
CV - HTN, heart failure, MI, stroke
exacerbation of asthma
130
how do NSAIDs cause HTN?
block prostaglandins which cause vasodilation => use with caution in HTN
131
what antibodies are in RhA?
rheumatoid factor
anti-CCP (cyclic citrullinated peptide) - most specific and sensitive
132
what is atlantoaxial sublaxation?
complication of RhA where the axis and odontoid peg shift within atlas causing localised sinovitis and damage to ligaments which can cause spinal cord compression
133
what are RhA signs in the hands?
Z shaped deformity of thumb
swan neck deformity (hyperextended PIP and flexed DIP)
boutonnieres deformity - hyperextended DIP with flexed PIP
ulnar deviation
134
what are 10 extra-articular manifestations of RhA?
pulmonary fibrosis (caplan's syndrome)
Bronchiolitis obliterans
Feltys syndrome (RhA, neutropenia, splenomegaly)
Secondary Sjogren's syndrome
anaemia of chronic disease
CVD
episcleritis and scleritis
rheumatoid nodules
lymphadenopathy
carpal tunnel
amyloidosis
135
what are 4 x-ray features of RhA?
erosions
synovitis
deformity and joint destruction
symmetrical pattern
136
what is felty's syndrome?
complication of RhA
RhA + neutropenia +splenomegally
137
what is caplan's syndrome?
complication of RhA
pulmonary fibrosis in people with RhA usually in relation to particulate exposure
138
which joint is spared in rheumatoid?
Distal interphalangeal
139
when is urgent referral for RhA needed?
if small joints of hands and feet are affected
if multiple joints are affected
if symptoms >3 months
140
what score can be used to objectively measure severity of RhA?
disease activity score (DAS) 28
141
what score can be used to measure subjective severity of RhA?
health assessment questionaire
142
what is the long term treatment of RhA?
Acute - NSAIDs/Coxibs (+PPI), glucocorticoids (only in confirmed)
long term
1st - DMARDs (methotrexate, leflunomide, sulfasalazine), hydroxychloroquine consider in mild disease
2nd - combination DMARDs
3rd - DMARD + biologics (TNF inhibitor, JAK inhibitors)
4th - DMARD + rituximab
143
how long can it take for DMARDs to work?
2-3 months
144
what is a side effect of biological agents?
immunosuppression
145
what are 4notable side effects of methotrexate?
mouth ulcers and mucositis
liver toxicity
bone marrow suppression and leukopenia
teratogenic
146
how is methotrexate taken?
orally once a week
OR
Injection once a week
147
what should always be co-prescribed with methotrexate?
folic acid 5mg OW - to be taken on different day to methotrexate
148
how does methotrexate work?
interferes with folate metabolism
149
what are 5 notable side effect of leflunomide?
raised BP
rashes
peripheral neuropathy
teratogenic
bone marrow suppresion
150
how does leflunomide work?
interferes production of pyrimidine used to make RNA and DNA
151
how does hydroxychloroquine work as an immunosuppressant?
interferes with toll-like receptors disrupting antigen presentation
152
what are 4 notable side effects of hydroxychloroquine?
nightmares
macular toxicity
liver toxicity
skin pigmentation
153
what is a notable side effect of sulfasalazine?
male infertility - reduction in sperm count
154
what is a notable side effect of anti-TNF?
reactivation of TB and hepatitis B
155
what are 2 notable side effects of rituximab?
night sweats
thrombocytopenia
156
what are 9 LUTS in BPH?
storage - urgency, frequency, nocturia
voiding - hesitancy, weak flow, terminal dribbling, intermittency, straining, incomplete emptying
157
what is the initial investigations of suspected BPH?
DRE
abdo exam
urinary frequency volume chart
urine dip
PSA
158
what are 6 causes of a raised PSA?
prostate cancer
BPH
prostatitis
UTI
vigorous exercise
recent ejaculation or prostate stimulation
159
what are 2 options for medical management of BPH?
alpha blockers (tamulosin) - relaxes muscle rapid symptom improvement
5-alpha reductase inhibitors (finasteride) - gradually reduces size of prostate over time
160
what are 4 surgical options for BPH?
transurethral resection of prostate
transurethral electrovaporisation of prostate
holmium laser enucleation of prostate
open prostatectomy
161
what is a side effect of alpha blockers?
postural hypotension
162
what is the most common side effect of finasteride?
sexual dysfunction
163
what are 6 complications of TURP?
infection
urinary incontinence
erectile dysfunction
retrograde ejaculation
164
what is the name of the extra-articular manifestationof gout which causes lumps to be seen in skin?
gouty tophi - subcutaneous uric acid deposits
165
what are 8 risk factors for gout?
male
FHx
obesity
high purine diet - meat and seafood
alcohol
diuretics
CVD
kidney disease
166
what be seen on joint aspiration in gout?
needle shaped negatively bifringent monosodium urate crystals
167
what crystals cause gout?
monosodium urate
168
what are 4 x-ray findings in gout?
maintained joint space
lytic lesions
punched out erosions
erosions may have sclerotic borders with overhanding edges
169
what is the acute management of gout? (3)
1 - NSAIDs + PPI
2 - Colchicine
3 - oral steroids (pred)
170
when might NSAIDs be contraindicated in acute gout treatment?
renal impairment, significant heart disease
use colchicine instead
171
what are 2 side effects of colchicine?
abdo symptoms and diarrhoea
172
what is the prophylactic management of gout?
allopurinol
or Febuxostat
173
what medication is allopurinol?
xanthine oxidase inhibitor
174
what crystals cause pseudogout?
calcium pyrophosphate crystals
175
what do calcium pyrophosphate crystals look like?
rhomboid shaped positively birefringent
176
what classical X-ray change can be seen in pseudogout?
chondrocalcinosis - calcium deposits in joint cartilage
177
what gene is linked to seronegative spondyloarthropsthies?
HLA B27
178
what are 4 other symptoms associated with reactive arthritis?
bilateral conjunctivitis
anterior uveitis
urethritis/balantitis
CANT SEE, CANT PEE, CANT CLIMB A TREE
179
what are the 2 most common causes of reactive arthritis?
GI infection
STI
180
what are 5 risk factors for IE?
IVDU
Structural heart pathology
CKD
immunocompromised
Hx of IE
181
what is the most common causative organism of IE?
s. aureus
182
what are 8 signs on examination of IE?
new/changing murmur
splinter haemorrhages
petichae
janeway lesions
osler nodes
roth sponts
splenomegaly
clubbing
183
what investigation is used to diagnose IE?
echo - transoesophageal (TOE) is more sensitive and specific that transthoracic
184
what are 2 investigations that can be does in those with prosthetic valves for IE?
18F-FDG PET/CT
SPECT-CT
185
what criteria is used to diagnose IE?
Duke criteria
186
what are the 2 major Duke's criteria for IE?
+ve blood cultures
image findings (ECHO vegitations)
187
what are the 5 minor Duke's criteria for IE?
risk factors
Fever >38
vascular phenomena (splenic inferct, intracranial haemorhage, janeway lesions)
immunological pheomena (osler nodes, roth spots, glomerulonephritis)
microbiological phenomena
188
what is the management for IE?
IV broad spectrum Abx - Amox + gent
4 weeks for native valves
6 weeks for prosthetic valves
189
what are 4 complications of IE?
heart valve damage
heart failure
infective/non-infective emboli - abcess, stroke, splenic infarct
glomerulonephritis
190
what two conditions are encompassed with COPD?
chronic bronchitis
emphysema
191
what scale is used to grade COPD?
MRC dyspnoea scale
192
what is grade 1 on the MRC dyspnoea scale?
breathless on strenuous exercise
193
what is grade 2 on the MRC dyspnoea scale?
breathless walking up hill
194
what is grade 3 on the MRC dyspnoea scale?
breathless walking on the flat
195
what is grade 4 on the MRC dyspnoea scale?
breathlessness walking less than 100m on flat
196
what is grade 5 on the mrc dyspnoea scale?
unable to leave house due to breathlessness
197
what will be seen on spirometry with COPD?
obstructive => FEV1:FVC <70%
little/no reversibility
198
how can severity in COPD be measured?
FEV1
199
what is the non-medical management of COPD?
annual flu and pneumococcal vaccine
pulmonary rehab
stop smoking
200
what is the medical management of COPD?
1 - SABA or SAMA (ipratropium bromide)
2 - un steroid responsive - LABA + LAMA
2- steroid responsive - LABA and ICS (fostair, seretide)
3 - LABA, LAMA, ICS combo - trimbow, trelegy
201
when might someone with COPD need LTOT?
if chronically hypoxic - O2 SATs <92%
polycythaemia
cyanosis
cor pulmonale
202
what is cor pulmonale?
R sided heart failure causes by resp illness - COPD, pulmonary embolism, ILD< CF, pulmonary hypertension
203
what is the first line management of trigeminal neuralgia?
carbamazepine
204
how long does kidney function need to be reduced to define it as chronic?
3 months
205
what are 5 risk factors for CKD?
diabetes
hypertension
meds - NSAIDs, Lithium
glomerulonephritis
polycystic kidney disease
206
what is eGFR in stage one CKD?
>90 ml/min/1.73 m2
207
what is eGFR in stage 2 CKD?
60-89 ml/min/1.73 m2
208
what is eGFR in stage 3a CKD?
45-59 ml/min/1.73 m2
209
what is classed as CKD?
eGFR <60 ml/min/1.73 m2
or Urine albumin:creatinine ratio >3 mg/mmol
for 3 months
210
what is stage 3b eGFR in CKD?
30-44 ml/min/1.73 m2
211
what is stage 4 eGFR in CKD?
15-29 ml/min/1.73 m2
212
what is stage 5 eGFR in CKD?
<15 ml/min/1.73 m2
213
what are 6 complications of CKD?
anaemia
renal bone disease
CVD
peripheral neuropathy
end stage kidney disease
dialysis related complications
214
what tool can be used to estimate 5 year risk of kidney failure requiring dialysis?
kidney failure risk equation
215
what is the management of CKD?
Tx underlying conditions
BP <130/80 - ACEi, SLGT-2 inhibitors (dapagliflozin)
lifestyle
Atorvostatin 20mg
Tx complications
216
what is the management of renal bone disease?
low phosphate diet
phosphate binders
active form of vit D
ensure adequate ca intake
217
what is the most common cause of hypothyroidism in developed world?
Hashimotos thyroiditis
218
what antibodies are seen in hashimotos?
anti-thyroid perxidase (anti-TPO) antibodies
anti-thyroglobulin antibodies
219
what is the most common cause of hypothyroid in developing world?
iodine deficirency
220
what are 4 meds that can cause hypothyroidism?
carbimazole - over tx for hypert
propylthiouracil - over Tx for hyper
LITHIUM
Amiodarone - can also cause thyroidtoxicosis
221
what are 5 causes of secondary hypothyroidism?
tumours
surgery to pituitary
radiotherapy
sheehan's syndrome - major PPH causes avascular necrosis of pituitary
Trauma
222
what medication is used to manage hypothyroidism?
levothyroxine - titrate dose to response
223
what antibodies are present in graves disease?
TSH receptor antibodies
224
what are 4 signs that are specific to graves disease?
exophthalmos (bulging eyes)
pretibial myxoedema
diffuse goitre
thyroid acropachy (hand swelling and finger clubbing)
225
what are 4 causes of thyroiditis?
de quervains thyroiditis
hashimotos
post partum thyroiditis
drug induced thyroiditis
226
what is the first line management for hyperthyroidism?
carbimazole
227
what are 2 complications of carbimazole?
pancreatitis
agranulocytosis
228
what is the 2nd line management for hyperthyroidism?
propylthiouracil
229
what are the 2 shockable pulseless rhythms?
ventricular tachycardia
ventricular fibrilation
230
how long should the QRS complex be?
0.12 seconds
3 small squares
231
what are the 4 main causes of narrow complex tachycardias?
sinus tachy
supraventricular tachy
AF
Atrial flutter
232
what is the management for suraventricular tachycardia?
vagal manoeuvres - valsalva, diving reflex
adenosine
233
what is a prolonged cQT interval?
> 0.44s in men
> 0.46s in women
234
what is torsades de pointes?
type of ventricular tachycardia caused by long QT which causes progressive changing heights of QRS complexes with ventricular tachycardia which can either revert to sinus rhythm or progress to ventricular tachycardia
235
what are 3 causes of long QT?
long QT syndrome
medications
electrolyte imbalances - hypokalaemia, hypomagnesaemia, hypocalcaemia
236
what are 6 meds that can cause long QT?
antipsychotics
citalopram
flecainide
sotalol
amiodarone
macrolides
237
what is the acute management of torsades du pointes?
correct underlying cause
magnesium infusion
defibrilation
238
what PR interval indicates 1st degree heart block?
>0.2 s (one big square)
239
what is 2nd degree mobitz type 1 heart block?
PR interval gets progressively longer until conduction fails and then the cycle repeats
240
what is 2nd degree type 2 heart block?
intermittent failure of conduction in a certain ration of P waves to QRS complexes
241
what is 3rd degree heart block?
no relationship between p waves and QRS complexes
242
what is sick sinus syndrome?
dysfunction of SA node often causes by idiopathic degenerative fibrosi s
243
what arrhythmia carry risk of asystole?
mobitz type II
3rd degree HB
previous asystole
ventricular pauses longer than 3s
244
what medication can be used first line in unstable patients at risk of asystole?
IV atropine
245
what are 4 features of AF?
irregularly irregular hr
tachycardia
heart failure - due to impaired filling in diastole
increased risk of stroke (5X)
246
what are 5 common causes of AF? mneumonic
SMITH
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension
Alcohol and caffeine
247
what are 3 ecg findings in AF?
absent p waves
narrow QRS complex tachycardia
irregularly irregular ventricular rhythm
248
what is the first line management for AF?
rate control
1 - beta blocker - propanolol
2 - calcium channel blockers (diltiazem or verapamil), digoxin
249
what score is used to assess need for anticoagulation in AF?
CHA2DS2-VASc
250
what is the first line anticoagulant to be used in AF?
DOAC - apixiban, edoxaban, riveroxaban
2 - warfarin
251
how do DOACs work?
direct factor Xa inhibition
252
what is the antidote to apixiban?
andexanet alfa
253
what is he target range for INR?
2-3
254
what does chad2ds2-Vasc stand for?
Congestive heart failure
Hypertension
Age >75 (2+)
Diabetes
Stroke or TIA (+2)
Vascular disease
Age 65-74
Sex (female)
255
what is the ORBIT score?
bleed risk in anticoag in af
Older age >75
Renal impairment
Bleeding previously
Iron - low haemoglobin/haematocrit
Taking antiplatlets
256
what can be seen on ecg with supraventricualar tachycardia?
tachycardia with narrow complex QRS COMPLEXES (<0.12s)
257
what is wolff-parkinson white syndrome?
caused by extra electrical pathway connecting atria and ventricles which leads to episodes of supraventricular tachycardia
258
what ecg changes are seen in woff-parkinson white syndrome?
short PR <0.12s
Wide QRS complexes >0.12s
delta waves - slurred upstroke in QRS complexes
259
what is a major complication of wolff-parkinson white syndrome?
if in combination with AF can cause polymorphic wide complex tachycardia which is lifethreatening
260
what medications are contraindicated in wolff-parkinson white syndrome?
most anti-arrythmics as increase risk of conduction through acessory pathways
261
what is the stepwise management of supraventricular tachycardia?
vagal manoeuvers
adenosine
verapamil/beta blocker
Synchronised DC cardioversion
262
in what conditions is adenosine contraindicated?
Asthma or COPD
COPD
Heart failure
heart block
severe hypotension
potential atrial arrhythmia with underlying pre-excitation (WPW syndrome)
263
what is the stepwise dosage of adenosine?
6mg
12mg
18mg
264
what is a side effect of adenosine bolus?
feeling of impending doom like dying
265
what is the secondary prevention for cardiovascular disease?
4As
Antiplatelets - aspirin, clopi, ticagrelor
Atorvostatin 80mg
Atenolol - or other beta blocker
Acei - ramipril
266
what is the antiplatelet of choice in peripheral arterial disease?
clopidogrel
267
what are 6 features of critical limb ischaemia?
6Ps
Pain
Pallor
Pulseless
Paralysis
Paresthesia
Perishingly cold
268
what are 7 features of arterial ulcers?
smaller than venous
deeper than venous
well defined borders
punched out appearance
occur peripherally
reduced bleeding
painful
269
what are 7 features of venous ulcers?
occur after minor injury
larger than arterial
more superficial than arterial
irregular gently sloping borders
affect gaiter areas - mid calf to ankle
less painful
occur with other signs of chronic venous insuficciency
270
what are 3 investigations for peripheral vascular diseae?
ankle branchial pressure index
duplex uss
angiography - ct or mri
271
what medication can be used in peripheral vascular disease that acts as peripheral vasodilator?
naftidrofuryl oxalate - 5-HT2 receptor antagonist
272
what condition is polymyalgia rheumatica associated with?
giant cell arteritis
273
what is the presentation of polymyalgia rheumatica?
2 weeks of
pain and stiffness in shoulders, pelvic girdle or neck
worse in morning and after rest, interferes with sleep, takes 45mins+ to ease with activity
systemic symptoms
muscle tenderness
carpal tunnel
peripheral oedema
274
what is the management of polymyalgia rheumatica?
15mg prednisolone daily for 1 week then follow up till symptoms controlled then slowly reduce steroid over time
usually dramatic response to steroids
275
what is the management for patients on long term steroids?
Don't STOP
Don't - steroid dependance after 3 weeks - DONT STOP ABRUPTLY
S ick day rules
T reatment card
O steoporosis prevention - bisphosphonates +
calcium + vit D immediately
P roton pump inhibitors
276
what is the management of bursitis?
rest
ice
compression
analgesia
protect joint from pressure/trauma
?aspirate to relieve pressure
?steroid injection
277
what is a t-score for osteoporosis?
<-2.5
278
what is the t-score for osteopenia?
-1 to -2.5
279
what are 5 medications that increase risk osteoporosis?
Corticosteroids (long term 7.5mg+ for 3 months+)
SSRIs
PPIs
antiepileptics
anti-oestrogens
280
what are 3 chronic diseases that increase risk of osteoporosis?
ckd
hyperthyroidism
rheumatoid arthritis
281
what are 7 risk factors for osteoporosis?
older age
post menopausal
reduced mobility and activity
lower bmi <19
low calcium or vitamin d
alcohol and smoking
FHx or personal history
282
what is the management of osteoporosis?
Address reversible risk factors Add calcium and vitamin D
1 - Bisphosphonates (alendronate, risendronate, zoledronic acid)
283
what are 4 side effeccts of bisphosphonates?
reflux and oesophageal erosions
atypical fractures
osteonecrosis of the jaw
osteonecrosis of external auditory canal
284
how shoes bisphosphonates be taken?
on an empty stomach
with full glass of water
sit upright for 30 mins before moving or eating
285
what are 4 medications for osteoporosis started by a specialist?
denosumab - MAB targeting osteoclasts
Romosuzumab
Teriparatide - acts as parathyroid hormone
HRT
Raloxifene - selective oestrogen receptor modulator
strontium ranelate
286
what are 2 side effects of strontium ranelate?
increased VTE risk
increased MI risk
287
what is menopause?
12 months no period
288
when iis the average menopause?
51 years
289
what is premature menoopuse?
<40 years
290
what are 8 perimenopausal symptoms?
hot flushes
emotional lability/low mood
premenstrual syndrome
irreular periods
joint pain
heavier or lighter peiods
vaginal dryness and atrophy
reduced libido
291
what are 4 conditions that reduced oestrogen increases the risk of?
CVD and stroke
osteoporosis
pelvic organ prolapse
urinary incontinence
292
what are 5 good contraceptive options in women approaching menopause?
barrier methods
mirena or copper coil
progesterone only pill
progesterone implant
sterilisation
293
what are 2 side effects of the progesterone depot injection?
weight gain
reduced bone mineral density
294
what are 8 management options for perimenopausal symptoms?
HRT
tibolone - only after 12 months amenorrhoea
clonidine
CBT
SSRIs
testosterone - for libido
vaginal oestrogen
vaginal moisturisers
295
what are the 2 most common mets sites for prostate cancer?
lymph nodes
bone - spine v comon
296
what is the first line investigation for prostate cancer?
multiparametric mri
297
what are 2 methods of prostate biopsy?
transrectal ultrasound guided biopsy
transperineal biopsy
298
what grading system is used for prostate cancer>
gleason grading system
299
what are 2 hormone therapies used in prostate cancer?
androgen receptor blockers - bicalutamide
GnRH agonists - goserelin or leuprorelin
300
what are 4 types of psoriasis?
plaque - normal psoriasis plaques
guttate psoriasis
pustular psoriasis - med emergency
erythrodermic psoriasis - extensive erythema which peels in large patches - med emergency
301
what is guttate psoriasis?
common in children, many small papules on trunk and limbs that develop to plaques. usually after strep throat infection
302
what are 3 specific signs of psoriasis?
auspitz sign - small points of bleeding when plaques scraped off
koebner phenomenon - psoriatic lesions in areas of trauma
residual pigmentation once lesions resolve
303
what is the management of psoriasis?
topical steroids
topical vitamin D
topical dithranol
topical calcineurin inhibitors - tacrolimus
phototherapy with narrow band uv b light
304
what are 2 potent steroid + vitamin d
dovobet and enstilar
305
305
what are 5 hand signs of psorisis?
nail pitting
oncholysis
dactylisis
nail thickening
swollen joints
306
how many tender sites must be identified in fibromyalgia?
11/18 designated tender point sites
307
How often is diabetic eye screening?
annually from age of 12
308
in what age range is cervical screening every 3 years?
25-49 = every 3 years
309
in what age range is cervical screening every 5 years?
50-70 = every 5 years
310
in what age range is breast screening offered?
50-70 years
311
how often is breast screening?
every 3 years
312
In what age range is bowel screening offered?
60-74 years
313
How often is bowel screening done?
every 2 years
314
at what age are men screened for AAA?
65
315
what happens if HPV is found on a smear?
another smear in 1 year
316
what happens if there is inadequate results on a smear?
another smear in 3 months
317
what happens if HPV is detected on a smear twice in a row?
colposcopy
318
what are 4 screening tests in pregnancy?
Hep B, HIV and syphilis screen
Down's, pataus and edwards screen - combined/quadruple test
sickle cell/thallsaemia test
20 week anomaly scan
diabetic eye screen - if have diabetes
319
what are 3 new born screening tests?
NIPE
hearing test
blood spot heel prick test
320
what is the presentation of anal fissure?
severe pain on defecation - like passing broken glass
fresh blood on stool
O/E - spasm of sphincter muscles and significant tenderness
321
what is the management of anal fissures?
Conservative - high fibre diet, fluids, baths. topical analgesia, stool softeners
topical glyceryl trinitrate or diltiazem
surgery in severe resistance
322
what is acute bronchitis?
LRTI - usually resolves in 3 weeks
323
when do you offer Abx in acute bronchitis?
if CRP >20 offer delayed prescription
if CRP >100 offer ABx now
324
what is the first line abx in acute bronchitis?
doxycycline
not in preggos or children - Amoxacillin
325
what is acute stress disorder?
features of ptsd - intrusive thoughts, dissociation, negative mood, avoidance, arousal
in the first 4 weeks after a traumatic even
326
what is the management of acute stress disorder?
trauma focused CBT
Benzodiazepines - used for acute symptoms
327
what is a Meibomian cyst?
internal infection of meibomian glands in eyelid causing lump - like what dan had - hot compress and analgesia should go away on own
328
what is lyme disease caused by?
Borrelia burgdorferi spirochaete
329
what are 2 early (<30 days) features of lyme disease?
erythema migrans - bullseye rash develops 1-4 weeks after bite usually painless and >5cm
systemic features - headache, lethargy, fever, arthralgia
330
what are 5 late (>30 days) features of lyme disease?
cardiovascular
- heart block
- peri/myocarditis
Neuro
- facial nerve palsy
- radicular pain
- meningitis
331
what is the 1st line investigation for lymes disease?
enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi
332
what is the gold standard test for lyme disase?
immunoblot test
333
what is the management of lyme disease?
Doxycycline if early disease (amox if contraindicated)
Ceftriaxone if diseminated disease
334
what is Jarisch-Herxheimer reaction?
fever, rash and tachycardia after 1st dose Abx in spirochaete disease - lyme disease and syphilis
335
what is the management for gingivostomatitis (ulcers) in HSV?
oral acyclovir and chlorohexadine mouth wash
336
what is the management for genital herpes?
acyclovir
337
what is the management of herpes in pregnancy?
elective c-section if primary genital infection >28 weeks
338
which herpes virus is most commonly responsible for herpes encephalitis?
HSV-1
339
BMI =
weight/height squared
340
what is the medical management of obesity?
orlistat
liraglutide
341
when is orlistat used?
BMI >28 with 2+ risk factors
BMI >30
with continued weight loss of 5% at 3 months
use for <1 year
342
how does orlistat work?
pancreatic lipase inhibitor
343
How does liraglutide work?
glucagon-like peptide mimetic used in T2DM given OD SC injection
344
when is liraglutide used?
BMI > 35 kg/m²
prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)
345
what are varicose veins?
distended superficial veins measuring more than 3mm in diameter, usually affecting the legs.
346
what are reticular veins?
dilated blood vessels in the skin measuring less than 1-3mm in diameter
347
what is Telangiectasia?
dilated blood vessels in the skin measuring less than 1mm in diameter. They are also known as spider veins or thread veins.
348
what are 3 signs of chronic venous insuficiency that can be seen in the lower legs?
brown discolouration due to haemosiderin
venous eczema
lipodermatosclerosis
349
what are 5 special tests for varicose veins?
Tap test
cough test
Trendelenburghs test
Perthes test
Duplex ultrasound
350
what are 3 surgeries for varicose veins?
Endothermal ablation
Sclerotherapy – injecting the vein with an irritant foam that causes closure of the vein
Stripping
351
what is the ideal blood glucose conc?
4.4-6.1 mmol/L
352
what are 4 macrovascular complications of DM?
coronary artery disease
Peripheral ischaemia
Stroke
HTN
353
what are 3 microvascular complications of DM?
peripheral neuropathy
retinopathy
kidney disease
354
what are are 4 infection related complications of DM?
UTI
Pneumonia
skin and soft tissue infection
fungal infection
355
How often do diabetics get their HbA1c measured?
every 3-6 months
356
what is the name of the darkening skin on neck axilla and groin seen in insulin resistance?
acanthosis nigricans
357
what HbA1c level is pre-diabetes?
42-47 mmol/mol
358
what is the HbA1c level for diabetes?
>48 mmol/mol
359
what is the 1st line treatment for T2DM?
metformin
360
what medication can be added to patients on metformin with an existing CVD or QRisk >10%?
SGLT-2 inhibitor - dapagliflozin
361
what is the second line management of T2DM?
sulfonylurea
pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor
362
what is the MOA of metformin?
increases insulin sensitivity and decreases glucose production - a biguanide
363
what are 2 side effects of metformin?
GI symptoms
Lactic acidosis - secondary to AKI
NOT hypos NOT weight gain
364
what is the MOA of SGLT-2 inhibitors?
prevent sodium glucose co-transporter 2 protein from reabsorbing glucose in proximal tubules allowing for greater excretion
365
what are 8 side effects of SGLT-2 inhibitors?
Glycosuria
Increased urinary output and frequency
UTIs + genital infections
weight loss
DKA
Lower limb amputation
Fourniers gangrene
Hypoglycaemia
366
what are 4 side effects of pioglitazone?
weight gain
heart failure
increased risk bone fractures
small increase risk bladder cancer
367
what are 2 side effects of sulfonylureas?
weight gain
hypoglycaemia
368
what is a rapid acting insulin and how long does it work for?
Novorapid - works after 10 mins for 4 hours
369
what is a short acting insulin and how long does it work for?
Actrapid - works after 30 mins for 8 hours
370
what is an intermediate acting insulin and how long does it work for?
Humulin I - works after 1 hour for 16 hours
371
what is a long acting insulin and how long does it work for?
Levemir and lantus - works after 1 hour for 24 hours
372
what is the 1st line antihypertensive in T2Dm?
acei
373
what are 4 signs of PE? (CXR and ECG)
Fleischner sign = dilated central pulmonary vessel. Westermark sign (collapse of vasculature distal to PE) Hampton’s hump - wedge-shaped infarct
ECG features - sinus tachycardia and/or ST depression.
374
what is the management of pericarditis?
NSAIDs
375
what is the MOA of N-acetylcysteine?
Replenishes body stores of glutathione preventing hepatocyte damage.
376
what is the moa of methotrexate?
competitively inhibits dihydrofolate reductase
377
what drug can be used to reverse heparin?
Protamine
378
what medication can be used to reverse DOACs?
Beriplex
379
what is the chronic management for ACS?
Block An ACS
Beta Blocker + ACEi + Aspirin + Clopidogrel + Statin
380
what is the MOA of aspirin?
Cox-1 inhibitor
381
what is the MOA of clopidogrel?
P2Y12 inhibitor
382
what are 6 symptoms of glandular fever?
fever
lymphadenopathy
sore throat
non-specific rash
hepato/splenomegaly
383
what is stage 1 AKI?
Creatinine is 1.5-1.9 times higher than baseline/ urine output < 0.5ml/kg for > 6 consecutive hours
384
what is stage 2 AKI?
Creatinine is 2-2.9 times higher than baseline/ urine output < 0.5ml/kg for > 12 consecutive hours
385
what is stage 3 AKi?
Creatinine is >3 times higher than baseline / urine output < 0.5ml/kg for > 24 consecutive hours/ anuria for > 12 hours
386
what is conn syndrome?
adrenal hypertrophy causing increased aldosterone leading to hypertension, hypernatraemia and hypokalaemia
387
what is the management of conn syndrome?
spironolactone
388
what is severe asthma in adults?
PEF 33–50% best or predicted
RR ≥25/min
HR ≥110/min
inability to complete sentences
389
what is life threatening asthma in adults?
PEF <33% best or predicted
SpO2 <92%
PaO2 <8 kPa
‘normal’ PaCO2 (4.6–6.0 kPa)
altered conscious level
exhaustion
arrhythmia
hypotension
cyanosis
silent chest
poor respiratory effort
390
what is chronic suppurative ottitis media?
otitis media >2 weeks with recurrent ear discharge
391
what is the 1st and 2nd line management of UTI in men and women?
1 - Nitrofurantoin OR Trimethoprim
2 - Nitro (if not used) or Pivmecillinam
Treat for 3 days BD in women and 7 days BD for men
392
what risk score is used for pressure ulcers?
Waterlow score
393
what risk score is used for upper GI bleeds?
Glasgow-Blatchford
394
what is the name of the sign where muscle twitching is elicited in the face by tapping in front of the ear which is indicative of hypocalcaemia?
Chvostek sign
395
what is examination finding in otitis media with effusions?
grey tympanic membrane
fluid level
loss of cone of light reflex
AKA glue ear
396
what is examination findings in suppurative otitis media?
mucopurulent discharging ear
