GP Flashcards
(470 cards)
1
Q
At what age does acne peak?
A
18 years
2
Q
What are other causes of acne?
A
Systemic steroids, physical occlusion, PCOS and cushings
3
Q
What causes acne?
A
Androgen secretion results in increased sebum excretion
4
Q
What are comedomes?
A
Dilated pores with black plug of keratin
5
Q
What is the black tip of a comedone?
A
Oxidised sebum (not dirt)
6
Q
How does Roaccutane work?
A
It is a topical retinoid which reduces sebum production, inflammation and bacterial growth
7
Q
What are some side effects of Roaccutane?
A
Teratogenic, dry lips and skin, photosensitivity and suicidal ideation
8
Q
What is the treatment for moderate acne?
A
Long-term oral antibiotics such as Tetracycline
9
Q
What is acute bronchitis?
A
Inflammation of major bronchi which often follows viral URTI
10
Q
What are the symptoms of acute bronchitis?
A
Cough, sputum, breathlessness, wheeze
11
Q
What should you consider if acute bronchitis is recurrent?
A
COPD - chronic bronchitis
12
Q
What is the treatment for those with more risk factors in acute bronchitis?
A
Amoxicillin 500mg TDS
13
Q
What are some indications for medical treatment in acute bronchitis?
A
High risk of serious complications with pre-existing cormorbidities
Aged over 65 with acute cough
History of CCF
Current use of oral steroids
DM
14
Q
What is a type I sensitivity?
A
IgE antibodies to a specific allergen trigger mast cells and basophils to release histamine
15
Q
What is a type II allergic reaction?
A
IgG and IgM react to an allergen and activate the complement system leading to direct damage of local cells
16
Q
Give an example of a type II reaction
A
Haemolytic disease of the newborn
Transfusion reactions
17
Q
What is a type III allergic reaction?
A
Immune complexes accumulate and cause damage to local tissues
18
Q
Give an example of a type III reaction?
A
SLE and RA
19
Q
What is a type IV allergic reaction?
A
Cell mediated hypersensitivity caused by T lymphocytes
20
Q
Give an example of a type IV allergic reaction?
A
Contact dermatitis
21
Q
What is patch testing most useful for diagnosing?
A
Allergic contact dermatitis - latex, perfumes, cosmetics and plants
Not useful for food allergies
22
Q
What is RAST testing?
A
Measures total and allergen specific IgE levels in the blood
23
Q
What type of anaemia is iron deficiency?
A
Microcytic (<80)
24
Q
What are the causes of iron deficiency?
A
Blood loss - menorrhagia, GI bleeding
Poor diet
Malabsorption - CD, IBD
Increased demand - lactation, growth and pregnancy
25
What are the symptoms of iron deficiency anaemia?
Fatigue
Dyspnoea
SOB
Brittle nails and hair
Atrophic glossitis
Angular stomatitis
Kolonychia
Systolic flow murmur
26
What do diagnostic tests show for iron deficiency anaemia?
Low ferritin
Low transferrin saturation (but increased receptors)
Low reticulocytes
Polikocytosis
Anisocytosis
Pencil and target cells
27
What is the treatment for iron deficiency anaemia?
Oral ferrous sulphate
Ascorbic acid may enhance iron absorption
Increase vitamin C
28
When should iron deficiency anaemia be treated as a red flag?
Unexplained in adults over 60 = 2-week wait for suspected colorectal cancer
29
What are some dietary management options for iron deficiency anaemia?
Increase red meat, spinach and broccoli
Iron from vegetables is non-heme so a smaller % is available for absorption
30
What should you consider if there is a failure to respond to iron supplements?
Non-compliance (side effects of constipation and black stools)
H.pylori test
Coeliac disease
31
What is the inheritance of sickle cell anaemia?
Autosomal recessive
32
What does sickle cell anaemia cause to red blood cells?
Abnormal beta globin chains cause sickling of the red blood cell shape so they are more likely to get stuck in circulation
33
What is the gold standard diagnostic method for sickle cell anaemia?
Hb electrophoresis
34
What is a sickle cell crisis?
Exacerbations from dehydration, infection, stress or cold weather
35
What is a vaso-occlusive crisis?
Sickle shaped RBCs clog capillaries and cause distal ischaemia
Presents with pain and swelling in hands and feet
Can cause priapism trapping blood in the penis
36
What is a splenic sequestration crisis?
RBCs block flood flow in the spleen causing an acutely enlarged and painful spleen and can lead to infarction
37
What does hyposplenism cause?
Susceptibility to infections from encapsulated bacteria such as Strep pneumoniae and Hib
38
What is an aplastic crisis?
Temporary absence of the creation of new RBC triggered by parvovirus B19 infection
39
What is acute chest syndrome?
Vessels supplying the lungs are clogged with sickled RBCs
Can be triggered by a vaso-occlusive crisis, fat embolism or infection
40
What will a CXR show for acute chest syndrome?
Pulmonary infiltrates
41
What is given as antibiotic prophylaxis for hyposplenism?
Penicillin V
42
What can be given to stimulate foetal Hb?
Hydroxycarbamide
43
What is a treatment for vaso-occlusive crises?
Crizanlizumab - a monoclonal antibody that prevents RBCs from sticking to the blood vessel walls
44
What are some long term problems of sickle cell anaemia?
Osteomyelitis - from Salmonella
Cardiomegaly and arrhythmias
Liver dysfunction from trapping sickle cells
Ischaemic colitis
45
What is hereditary spherocytosis?
Inherited abnormality of RBCs caused by defects in structural membrane proteins
Causes spherical RBCs that are removed by the spleen
Causes a very short RBC lifespan
46
What is the inheritance of hereditary spherocytosis?
Autosomal dominant
47
What are the symptoms of hereditary spherocytosis?
Jaundice, anaemia, splenomegaly, leg ulcers
Chronic haemolysis can lead to gallstones
48
What are the diagnostic tests for hereditary spherocytosis?
Spherocytes and reticulocytes on blood film
Serum bilirubin and urinary urobilinogen increased
Coombs test negative
49
What is the inheritance of G6PD deficiency?
X-linked recessive
50
What is G6PD deficiency?
Lack of G6PD enzyme which provides NADH to protect RBC from oxidate damage
Deficiency reduces lifespan
51
What are some triggers for symptoms of G6PD deficiency?
Quinine, fava beans, aspirin, Nitrofurantoin, henna
52
What are the blood film findings for G6PD deficiency?
Heinz bodies, bite cells and reticulocytosis
53
What is AIHA?
Immune system attacks RBCs as foreign molecules so the body produces autoantibodies causing extravascular haemolysis and spherocytosis
54
What are some secondary causes of AIHA?
Infection - HCV, HIV, EBV
Cancer
SLE
Slceroderma
NSAIDs
55
What are the two types of AIHA?
Warm - IgG mediated at 37 degrees
Cold - IgM at under 4 degrees
56
What are some symptoms of AIHA?
SOB, fatigue, palpitations, chest pain, headache, pale skin
Warm - dizziness, jaundice, palpitations
Cold - cold hands and feet, chest pain, arrhythmias
57
What is the treatment for warm AIHA?
Steroids/ immunosuppressants/ splenectomy
58
What is the treatment for cold AIHA?
Chlorambucil - interferes with DNA replication and damages cell DNA
59
What type of anaemia is folate deficiency?
Macrocytic
60
Where is folate absorbed?
Duodenum and start of jejunum
61
What is folate found in?
Green vegetables, nuts, yeast and liver
62
What are some risk factors for folate deficiency?
Elderly
Poverty
Alcoholics
CD and coeliac
63
What are some causes of folate deficiency?
Goat milk in infancy
Poor intake
Malabsorption
Increased demand
Trimethoprim
Methotrexate
64
What do diagnostic tests show for folate deficiency?
Macrocytic oval macrocytes with hypersegmented neutrophil polymorphs with 6+ nuclear lobes
Serum bilirubin may be raised
65
What is the treatment for folate deficency?
Treat underlying cause
Folic acid tablets - but never without B12 as it can mask deficiency
66
Why is folate given in pregnancy?
Prevent spina bifida
67
What type of anaemia is B12 deficiency?
Megaloblastic
68
What is pernicious anaemia?
Lack of intrinsic factor due to removal of terminal ileum
69
What is the role of B12?
Aids thymidine synthesis and hence DNA synthesis
70
What are some risk factors of B12 deficiency?
Elderly
Female
Vegan
Thyroid and Addisons disease
Metformin
71
What are some symptoms of B12 deficiency?
Anaemia
Mild jaundice
Glossitis and angular stomatitis
Symmetrical paraesthesia in fingers and toes
Ataxia and weakness
72
What is the treatment for B12 deficiency?
If malabsorption - hydroxycobalamin IM for 2 weeks
Oral B12 if problem is just dietary
73
What is thalassemia?
Defects in either the alpha or beta chain causing RBCs that are more fragile and break causing splenomegaly
74
What is the presentation of thalassemia?
Fatigue, pallor, jaundice, gallstones, splenomegaly, poor growth and development, frontal bossing, malar eminences
75
What is iron overload?
Result of faulty RBCs, recurrent transfusions and increased iron gut absorption in response to anaemia
76
What are some effects of iron overload?
Fatigue, liver cirrhosis, infertility, heart failure, diabetes, arthritis, osteoporosis
77
What is alpha thalassemia?
Defected alpha globin chains on C16 leading to excess unpaired beta globin chains
78
What is beta thalassemia?
Defected beta globin chains on C11 causing excess unpaired alpha globin chains
79
What is an anal fissure and what are the symptoms?
Tear in anal mucosa presenting with pain on defectation, constipation and fresh rectal bleeding
80
What is a sentinel pile?
Anal fissure - bunched up mucosa at the base of the tear
81
What is the management for anal fissure?
Soften stool with ispaghula husk
Analgesic suppositories
Surgery
82
What are some symptoms of anaphylaxis?
Urticaria
Itching
Angio-oedema
Abdominal pain
SOB
Stridor
Wheeze
Collapse
83
What is the treatment for anaphylaxis?
IM adrenaline 500mcg
84
What should be measured after 6 hours in anaphylaxis?
Serum mast cell tryptase
85
What is GAD?
Excessive, difficult to control worry about events/ activities occurring most days for over 6 months
86
What are the two aspects of OCD?
Compulsive acts and obsessive thoughts
87
What are the two main features of phobias?
Avoidance
Anticipatory anxiety
88
What is agoraphobia?
Fear away from home and in crowds
89
What are some risk factors for asthma?
Family history
Atopy
Low birth weight
Smoking/ exposure
Not breastfed
90
What are the symptoms of asthma?
Polyphonic bilateral wheeze
Diurnal variation
Chest tightness
Unproductive cough
Tachypnoea
Hyperinflation
91
What is the spirometry for asthma?
FEV1/FVC < 70%
92
What differentiates asthma from COPD?
reversibility testing with a bronchodilator
93
What is the treatment for asthma?
SABA
ICS
LTRA
LABA
94
What is the treatment for an asthma attack?
Oxygen with nebulised SABA
100mg hydrocortisone IV
IV magnesium
Escalate
95
What are the grades of PEFR?
Moderate 50-75%
Severe 33-50%
Life threatening under 33%
96
What are some markers of good asthma control?
No night symptoms
Inhaler used no more than 3 times per week
Normal LFT
97
What is ventricular tachycardia?
Broad QRS complexes over 100bpm
Give oxygen and IV lidocaine
98
What is long QT syndrome?
ECG shows prolonged QT interval and can have a genetic form that is AD or AR
99
What is atrial fibrillation?
Irregular atrial rhythm where there is uncoordinated activation and ineffective contraction
100
What is the consequence in atrial fibrillation?
Cardiac output falls by 10-20% as the atria are no longer primed reliably by the ventricles
101
What are the symptoms of atrial fibrillation?
Palpitations
Irregular pulse
Dyspnoea
Fatigue
102
What does the ECG for AF show?
Absent P waves
Narrow QRS
Irregularly irregular rhythm
103
What is the treatment for AF?
Acute - cardioversion
Chronic - beta blockers
Apixaban or warfarin
104
What should be calculated in AF?
CHADVASC score - calculate stroke risk and anticoagulation needs
105
What is atrial flutter?
- Unorganised atrial rhythm with a rate of 250-350 bpm
- Re-entrant circuit in the right atrium
106
What does ECG show for atrial flutter?
Sawtooth - F waves between QRS complexes from continuous atrial depolarisation
107
What is the gold standard treatment for atrial flutter?
Catheter ablation
108
What are some complications of eczema?
Skin thickening and scaling
Bacterial infection - staph aureus
Cataracts
Growth retardation
109
What are some management options for eczema?
Topical steroids - hydrocortisone
Topical immunosuppressants - Tacrolimus
Bandages and wet wrapping
Topical emollients
Loose cotton clothing
110
What is contact dermatitis?
Precipitated by an exogenous agent such as abrasives and chemicals or allergens such as nickel and rubber
111
What is atrophic vaginitis?
Dryness and atrophy of vaginal mucosa due to lack of oestrogen
112
When is atrophic vaginitis most likely to occur?
Menopause
113
What is the presentation of atrophic vaginitis?
Itching, dryness, dyspareunia, bleeding, recurrent UTI, stress incontinence
114
What are some findings on examination of atrophic vaginitis?
Pale mucosa, thin skin, reduced skin folds, erythema, inflammation, dryness, sparse pubic hair
115
What are some treatments for atrophic vaginitis?
Vaginal lubricants
Topical oestrogens
116
What is bacterial vaginosis?
Vaginal flora changes to anaerobes (most commonly Gardnerella vaginalis)
117
What are the healthy vaginal flora?
Lactobacilli
They produce lactic acid to keep vaginal pH under 4.5
118
What are some risk factors for bacterial vaginosis?
Multiple sexual partners
Excessive vaginal cleaning
Recurrent antibiotics
Smoking
Copper coil
119
What is the presentation of bacterial vaginosis?
Grey/ white thin, fish-smelling offensive discharge
Cervix looks normal
pH of secretions if > 4.5
120
What is shown on microscopy for BV?
Clue cells - epithelial cells from the cervix that have bacteria stuck inside them
121
What is the treatment for BV?
Metronidazole
122
What can metronidazole and alcohol cause?
A disulfiram-like reaction with N+V, flushing, shock and angioedema
123
What is Bell's Palsy?
Isolated dysfunction of the facial nerve presenting with unilateral facial weakness of LMN
124
What is the treatment for Bell's Palsy?
Give prednisolone if less than 72 hours after symptom onset
125
What is Ramsay-Hunt syndrome?
Severe pain in the ear precedes facial nerve palsy caused by VZV
126
What is the treatment for ramsay hunt syndrome?
Prednisolone and Aciclovir
127
What is blepharitis?
Inflammation of eyelid margins
128
What can blepharitis cause?
Gritty, itchy, dry eyes
Ingrowing eyelashes
Crusting at the base of eyelashes
129
What is the treatment for blepharitis?
Warm compress
Gentle cleansing
Topical antibiotic
130
What is a stye?
Infection of the glands of Zeis of glands of Moll
131
What are the glands of moll?
Sweat glands at the base of the eyelashes
132
What are the glands of zeis?
Sebaceous glands at the base of the eyelashes
133
What is entropion?
Eyelid turns inwards with lashes pressed against the eye
134
What is the treatment for entropion?
Same day surgery if there is a risk to sight
135
What is ectropion?
Eyelid turns outwards exposing the inner aspect
136
What can ectropion result in?
Exposure keratopathy as the eyeball is exposed and not lubricated
137
What is orbital cellulitis?
Infection around the eyeball requiring IV antibiotics and maybe surgical drainage
138
What is periorbital cellulitis?
Eyelid and skin infection in front of the orbital septum
139
What is benign paroxysmal positional vertigo?
Common cause of vertigo triggered by head movement as a peripheral cause
140
What is the cause of benign paroxysmal positional vertigo?
Calcium carbonate crystals become displaced in the semicircular canals disrupting normal flow of endolymph confusing the vestibular system
141
What is a treatment for
benign paroxysmal positional vertigo?
epley manoeuvre
142
What is a diagnostic test of benign paroxysmal positional vertigo?
dix-hallpike manoeuvre
143
What is BPH?
Enlargement of the inner transitional zone of the prostate which can partially block the urethra
144
What are the symptoms of BPH?
LUTS - polyuria, urgency, nocturia, incontinence, poor stream, straining, incomplete voiding
145
What is the diagnosis for BPH?
DRE - smooth but enlarged prostate
PSA levels
Bladder diary
146
What is the 1st line medication for BPH?
Alpha blockers such as Tamulosin
147
What is a side effect of an alpha blocker such as Tamulosin for BPH?
Postural hypotension
148
What is the gold standard treatment for BPH?
TURP
Side effect - retrograde ejaculation
149
What is 2nd line for BPH?
5-alpha reductase inhibitors - Finasteride
150
What is the conservative treatment for BPH?
Caffeine and alcohol reduction
151
What is breast mastitis?
Infected subareolar ducts presenting with breast tenderness and inflammation
152
What is the most common cause of mastitis?
Staph aureus
153
What is the treatment for mastitis?
Co-amoxiclav
154
What is lactational mastitis?
Obstruction in the ducts and accumulation of milk
155
What is the presentation of lactational mastitis?
Breast pain and tenderness, erythema, local warmth, inflammation, nipple discharge, fever
156
What is candida of the nipple?
Infection of the nipple after a course of antibiotics which can lead to recurrent mastitis
157
What is the presentation of candida of the nipple?
Bilateral sore nipples after feeding
Nipple tenderness and itching
Cracked, flaky areola
Nappy rash in the baby
158
What is the treatment for candida of the nipple?
Topical miconazole
159
What is bronchiolitis?
Inflammation in bronchioles usually caused by RSV
160
What is the presentation of bronchiolitis?
coryzal symptoms, dyspnoea, tachypnoea, poor feeding, mild fever, apnoeas, wheeze
161
What is trochanteric bursitis?
Inflammation of a bursa over the greater trochanter on the outer hip
162
What are bursea?
Sacs created by synovial membrane filled with synovial fluid
163
What are some causes of trochanteric bursitis?
Friction from repetitive movements, trauma, inflammatory conditions such as RA and septic bursitis
164
What is the presentation of trochanteric bursitis?
Aching and burning, disrupting sleep, hard to lie comfortably, tenderness, worse with activity
165
What are the two diagnostic tests for trochanteric bursitis?
Trendelenburg test
Resisted internal and external rotation and abduction
166
What sort of bacteria is chlamydia?
Gram negative
167
What are some symptoms of chlamydia in women?
Vaginal discharge, intermenstrual bleeding, PID, dysuria
168
What are some presentations of chlamydia in neonates?
Conjunctivitis, pneumonia, otitis media, pharyngitis
169
What is the treatment for chlamydia?
Doxycycline or erythromycin
170
What is lymphogranuloma venereum?
Affects lymphoid tissue around chlamydia site of infection
MC in MSM
171
What is chlamydial conjunctivitis?
Hand to eye spread when genital fluid comes into contact with the eyes
172
How long must fatigue be present for for a diagnosis of chronic fatigue syndrome?
over 4 months in adults and over 3 months in children
173
What are some red flags for chronic fatigue?
Significant weight loss
Sleep apnoea
Signs/ symptoms of CVD
Localising/ focal neurological signs
174
What are some risk factors for CKD?
DM, HTN, male, smoking, increasing age
175
Why does CKD cause HTN?
Thickening of afferent arteriole leading to ischaemia and further fluid overload due to RAAS activation
176
What does CKD show on bloods?
High creatinine, urea, phosphate and potassium
177
What is GFR of stage 1 CKD?
90 +
178
What is GFR of stage 2 CKD?
60-89
179
What is GFR of stage 3a CKD?
45-59
180
What is GFR of stage 3b CKD?
30-44
181
What is GFR of stage 5 CKD?
Less than 15
182
What is GFR of stage 4 CKD?
15-29
183
What respiratory failure does COPD lead to?
Type II
184
What are some risk factors for COPD?
Smoking, occupational pollutants, A1AD on C14, CF, males, poor diet, low birthweight
185
What is A1AD?
Dysfunction of A1AD on C14 which controls elastase activity so without there is uncontrolled build-up causing liver cirrhosis and emphysema in alveoli
186
What are people with chronic bronchitis called?
Blue bloaters
187
What does chronic bronchitis lead to?
Cor pulmonale - right sided heart failure
188
What are people with emphysema called?
Pink puffers
189
What are the symptoms of COPD?
Productive cough with white/clear sputum
SOB
Dypnoea
Wheeze
Weight loss, osteoporosis, HTN
Crackles
Pursed lips on expiration
Raised JVP
Cyanosis
Barrel chest
190
What scale is used in COPD?
MRC dyspnoea scale
191
What is the gold standard diagnosis for COPD?
Spirometry with FEV1:FVC < 0.7
192
What does CXR show for COPD?
Hyperinflation, flattened diaphragm, barrel chest
193
What are the target oxygen saturations in COPD?
88-92%
194
What is the treatment for COPD?
SABA - LABA - LABA +ICS , LABA + Corticosteroid + LAMA
195
What are exacerbations often caused by in COPD?
Hib and strep pneumoniae
196
What vaccines in COPD?
Pneumococcal plus influenza
197
What is the CAT score?
Quality of life in COPD
198
What is conjunctivitis?
Inflammation of the conjunctiva which can be bacterial, viral or allergic
199
What is the presentation of conjunctivitis?
Red, bloodshot eye, itchy, gritty, discharge
200
How does bacterial conjunctivitis present?
Purulent discharge worse in the morning when eyes become stuck together
201
How does viral conjunctivitis present?
Clear discharge, associated with dry cough, sore throat, blocked nose
202
What are some causes of an acute red eye?
Scleritis
Anterior uveitis
Foreign body
Keratitis
Traumatic or chemical injury
203
What are some causes of an acute painless red eye?
Conjunctivitis
Episcleritis
Subonjunctival haemorrhage
204
How many bowel movements for it to be constipation?
Less than 2 per week
205
What is constipation lifestyle advice for under 40s?
Increase fluids to 2L
Avoid alcohol
Increase exercise
Increase fibre
206
What is some medical treatments for constipation?
Osmotic laxative
Stimulant laxative - Senna
207
What is the management for constipation in over 40?
Any sustained change in bowel habits over 6 weeks needs investigation
208
Give an example of an osmotic laxative
magnesium hydroxide
209
Give an example of a bulk forming laxative
Ispaghula husk
210
Give some presentations of constipation in elderly
Confusion
Urinary retention
Abdominal pain
Overflow diarrhoea
Loss of appetite and nausea
211
What is gout?
Hyperuricaemia and deposition of urate crystals
212
What are some gout risk factors?
Males, beer, diuretics, seafood, red meat, renal impairment, aspirin
213
What is the patho of gout?
Purines are broken down into uric acid by xanthine oxidase
Uric acid is excreted by kidneys but if overwhelmed, converted to monosodium urate crystals and deposited in joints
214
What is the most common joint of gout?
Big toe
215
What is tophi gout?
Monosodium urate forming smooth white deposits in the skin
216
What is the diagnosis of gout?
Fluid aspiration and microscopy - long needle crystals negatively bifringent under polarised light
217
What is treatment of gout?
NSAIDs
Colchicine
Steroids
Weight loss, lower alcohol
218
What is gout prophylaxis
Allopurinol
Febuxosat
Increase dairy
219
What are some complications of gout?
Disability
Tophi
Renal disease
220
What is pseudogout?
Deposition of calcium pyrosphosphate crystals on joint surfaces
221
What are some risk factors for pseudogout?
Women, IV fluids, parathyroidectomy, hypomagnesia, hypoparathyroidism
222
What are the common joints of pseudogout?
Knees, wrists and hands
223
What is the diagnosis of pseudogout?
Joint aspiration and microscopy - small rhomboidal crystals positively bifringent under polarised light
224
What is intertrigo?
Reddened, moist, glazed area in submammary, inguinal or axillary folds
225
What are some drugs that can cause depression?
Beta blockers, antipsychotics, anticonvulsants, corticosteroids
226
What is the criteria for depression diagnosis?
Symptoms present more than 50% of the time in the past 2 weeks
Depressed mood and/ or reduced interest or pleasure
227
What is a severity measure of depression?
PHQ-9
228
What are some SSRIs for depression?
Fluoxetine, Citalopram, Sertraline
229
Elderly people taking SSRIs are prone to?
Hyponatraemia
230
What is type I Diabetes?
Autoimmune destruction of beta cells of pancreatic islets of langerhans
231
What are some T1DM risk factors?
Northern european, other AI condition, family history
232
What are some symptoms of T1DM?
Polyuria, polydipsia, polyphagia, weight loss, thrush, visual blurring
233
What is the diagnosis of T1DM?
Random plasma glucose over 11.1 mmol/L and fasting over 7 mmol/L
234
What are some symptoms of hypoglycaemia?
Pale, difficulty concentrating, confusion, ketone breath, sweating, hunger, palpitations
235
What is Whipples triad?
Symptoms associated with fasting or exercise
Symptoms relieved by glucose
Recorded hypoglycaemia with symptoms
236
What is ketoacidosis
Absence of insulin leading to rising hyperglycaemia and ketogenesis
237
What are some symptoms of ketoacidosis?
Pear drop breath, dehydration, vomiting, Kussmaul's respiration, dehydration, vomiting, confusion
238
What is the diagnosis for ketoacidosis?
Hyperglycaemia over 11mmol/L
Plasma ketones over 3 mmol/L
Bicarbonate over 5 mmol/L
Hyperkalaemia
239
What is 1st line for ketoacidosis?
Rehydrate 0.9% IV saline
240
What is the acronym for ketoacidosis management?
FIG PICK
1. Fluids - IV fluid resuscitation with normal saline
2. Insulin - fixed rate insulin infusion
3. Glucose - closely monitor and add a glucose infusion when less than 14 mmol/ L
4. Potassium - add potassium to IV fluids and monitor
5. Infection - treat any underlying triggers
6. Chart fluid balance
7. Ketones - monitor blood ketones, pH and bicarbonate
241
What are some risk factors for T2DM?
Obesity, lack of exercise, males, afro-caribbean, south asian, africans
242
What is T2DM?
High blood glucose from a combination of insulin resistance and less severe insulin deficiency
243
What is the diagnosis for pre-diabetes?
HbA1c 42-47
244
What is the diagnosis for T2DM?
HbA1c over 48
Random glucose over 11.1
Fasting over 7
245
What is the 1st line for T2DM treatment?
Lifestyle modification
246
What is the 2nd line for T2DM treatment?
Metformin (reduced liver gluconeogenesis and increases peripheral utilisation of glucose)
247
What is the final step of T2DM treatment?
Insulin
248
What are some complications of T2DM?
Cataracts
Glaucoma
Retinopathy
Polyneuropathy
Depression
Diabetic foot
249
When is diabetic eye screening done?
From age 12 in all with diabetes annually
250
When is cervical screening done?
Women aged 25-64
Every 3 years in 25-49
Every 5 years in 50-65
251
When is breast screening done?
Aged 50-70
252
When is bowel cancer screened?
60-74 years every 2 years
253
When is AAA screened?
Men in the year they turn 65
254
What is tested for on a newborn blood spot test?
Sickle cell
CF
Congenital hypothyroidism
Inherited metabolic diseases
SCID
255
What is diverticular disease?
Outpouching of the gut wall usually at sites of entry of perforating arteries - sigmoid colon
256
What is diverticulosis
Presence of asymptomatic diverticula
257
What is diverticular disease?
Symptomatic diverticula
258
What is diverticulitis?
Inflammation of diverticula
259
What are some risk factors of diverticular disease?
Over 50, low fibre, high salt, obesity, constipation, NSAIDs
260
What are some symptoms of diverticular disease?
BBL - bowel habits changed, bloating, left lower quadrant pain
N+V
261
What is the gold standard diagnosis for diverticular disease?
contrast CT scan
262
What is treatment for diverticular disease?
High fibre diet
Antispasmodics such as Mebeverine
Antibiotics - Metronidazole for diverticulitis
263
What is HTN?
above 140/90 mmHg
264
What is normal BP?
120/80 mmHg
265
What is severe HTN?
180/110 mmHg
266
What are some risk factors for HTN?
Increasing age
Black ethnicity
Smoking
Stress
Poor diet
Overweight
Sedentary lifestyle
267
What is the gold standard diagnosis for HTN?
Ambulatory BP monitoring
268
What is needed to be calculated in HTN?
Q risk score - stroke and heart attack risk
269
What is HTN treatment in under 55 or T2DM?
ACEi then CCD then TD
270
What is HTN treatment in over 55 or Black African or Caribbean?
CCB then ACEi/ ARB then TD
271
What is the final stage of HTN treatment?
low dose spironolactone if K+ is less than 4.5 and alpha/ beta blocker if more
272
What is malignant HTN?
Sudden rise in BP leading to vascular damage and fibrinoid necrosis
273
What is treatment for malignant HTN?
Sodium nitroprusside infusion
274
What are symptoms of malignant HTN?
Blurred vision, chest pain, SOB, headache
275
What is the most common secondary cause of HTN?
CKD
276
What is folliculitis?
Superficial infection of the hair follicles caused by staph aureus
277
What is GORD?
Reflux of gastric contents into the oesophagus due to LOS relaxation
278
What are some risk factors for GORD?
Pregnancy
Obesity
Hiatus hernia
Smoking
NSAIDs
Alcohol and caffeine
Males
279
What are symptoms of GORD?
Heartburn
Regurgitation
Epigastric pain
Dysphagia
Dyspepsia
280
What is the treatment for GORD?
Antacids - Gaviscon
PPI
H2 receptor antagonist
Nissen fundoplication
281
What is barretts oesophagus?
Metaplasia of oesophagus from stratified squamous to simple columnar
282
What does Barretts oesophagus increase the risk of?
Oesophageal adenocarcinoma
283
What is gonorrhoea?
STI caused by bacterium neisseria gonorrhoeae gram negative diplococcus
284
What is the presentation of gonorrhoea in men?
Urethral discharge
Dysuria
Prostatitis
Anal discharge
285
What is the presentation of gonorrhoea in women?
Vaginal discharge
Dysuria
Lower abdominal pain
PID
Abnormal vaginal bleeding
286
What is the treatment for gonorrhoea?
Ceftriaxone IM 500mg as a single dose
Azithromycin 1g
287
What are some complications of gonorrhoea?
PID
Chronic pelvic pain
Infertility
Conjunctivitis
Skin lesions
Endocarditis
288
What are haemorrhoids?
Enlarged and vascular cushions that can be internal or external
289
What are some risk factors for haemorrhoids?
Constipation
Straining
Coughing
Pregnancy
Heavy lifting
290
what are some symptoms of haemorrhoids?
Bright red rectal bleeding on wiping
Pruritus ani
Constipation
Straining
Lump around anus
Mucus discharge
291
What is a hiatus hernia?
Herniation of the stomach up through the diaphragm
292
What are some symptoms of hiatus hernia?
Dyspepsia
Heart burn
Acid reflux
Burping
Halitosis
293
What is the conservative management of hiatus hernia?
PPI - omeprazole
294
What is the surgical management of hiatus hernia?
Laparoscopic fundoplication
295
What is hypothyroidism?
Underactive thyroid gland which is most likely from hashimotos thyroiditis (AI)
296
What drugs can cause hypothyroidism?
Amiodarone
Lithium
297
What is the presentation of hypothyroidism?
Weight gain
Cold intolerance
Constipation
Hoarse voice
BRADYCARDIC
Hertoge's sign - loss of outer 1/3 of the eyebrows
298
What is the diagnosis of hypothyroidism?
TFT - raised TSH, low T3 and T4
Anaemia
Raised AST
High cholesterol
Low sodium
299
What is the treatment of hypothyroidism?
Levothyroxine T4 for life
Side effects - AF and osteoporosis
300
What is hyperthyroidism?
Overproduction of thyroid hormone most likely from Graves disease with an AI attack on the thyroid
301
What happens in Graves disease?
Serum IgG antibodies bind to TSH receptors in the thyroid and stimulate hormone production and thus cause excess secretion
302
What are some symptoms of Graves Disease?
graves ophthalmopathy - exopthalmus and grittiness
Graves dermopathy - pretibial myoxema and thyroid acropachy
303
What are some other causes of hyperthyroidism?
De quervains - after viral infection
toxic multinodular goitre
Drug induced - amiodarone
Post partum
304
What are some symptoms of hyperthyroidism?
Palpitations
Diarrhoea
Weight loss
Palmar erythema
Hyperkinesis
Lid lag and stare
Heat intolerance
Increased appetite
305
What are the tests for hyperthyroidism?
Raised T3 and T4
Low TSH
TSHR antibodies in Graves
306
What is the treatment for hyperthyroidism?
Beta blockers for rapid symptom control
Carbimazole
Gold - radioactive iodine
307
What is a side effect of carbimazole?
Agranulocytosis - sudden WBC drop which can present as a sore throat
Teratogenic
308
What is impetigo?
Staph or strep skin infection
309
What is the characteristic of impetigo?
golden crust
310
What is bullous impetigo always caused by?
staph aureus
311
What is another name for EBV/ glandular fever?
Infectious mononucleosis
312
How is EBV spread?
saliva, kissing, toothbrushes
313
What are some symptoms of EBV?
Fever, sore throat, fatigue, lymphadenopathy, tonsillar enlargement, splenomegaly, splenic rupture
314
When does EBV cause an itchy rash?
In response to amoxicillin
315
What lymphoma is EBV associated with?
burkitts
316
What are the two most common types of influenza?
A and B
317
What type of virus is influenza?
RNA
318
What are some eligibility criteria for the influenza vaccine?
Over 65
Pregnant
COPD, asthma, heart failure
Diabetes
AI - coeliac disease
Healthcare workers
319
What are some symptoms of influenza?
Fever
Dry cough
Headache
Muscle and joint aches
Lethargy
Fatigue
Anorexia
320
What is the treatment for at risk people for influenza?
Oral oseltamivir and inhaled zanamivir
321
Antispasmodics for IBS?
Mebeverine and buscapan
322
Options for IBS-D treatment
Loperamide
Amitriptyline (TCA)
323
Options for IBS-C treatment
Ispaghula husk and senna
Fluoextine
324
What is lyme disease?
Spread by ticks and injected into the skin through saliva
325
What is the presentation of lyme disease?
Erythema migrans - ring with a central cleaning
Arthralgia
Lympahdenopathy
Splenomegaly
Fever
Headache
Carditis
326
What is the treatment for lyme disease?
Doxyxycline
IV cefotaxime in neurological disease
327
What are the migraine triggers?
CHOCOLATE - chocolate, hangovers, organsms, cheese, lie-ins, alcohol, tumult, exercise
328
What is a migraine prodrome?
Symptoms prior to the migraine of yawning, neck stiffness, thirst, food cravings
329
What is an aura before a migraine?
Flashing lines, zig zags, spots, numbness
330
What are the symptoms of a migraine?
Unilateral throbbing headache
N+V
Diarrhoea
Photophobia
Phonophobia
4-72 hours long
331
What is the 1st line prophylaxis for migraines?
Propranalol
332
What is the next line for migrianes?
Sumatriptan
333
What is contraindicated in those who have migraine with aura?
COCP
334
What are mumps?
Viral infection spread by respiratory droplets and classically affects the parotid glands
335
What are mumps symptoms?
Flu like
Fever
Muscle aches
Parotid gland swelling and pain
Lethargy
Dry mouth
Headaches
336
Is mumps notifiable?
yes
337
What are some complications of mumps?
Hearing loss
Meningitis
Encephalitis
Pancreatitis
338
What is BMI of obesity I?
30-34.9
339
What is BMI of obesity II?
35-39.9
340
What is the BMI of morbid obesity?
Over 40
341
What is the waist circumference of obesity for a white male?
Over 102cm
342
What are some causes of obesity?
SES factors
Smoking cessation
Polygenic genetic predisposition
Childbirth
Steroids
PCOS
Cushings
Physical inactivity
BED
343
What is checked on presentation with obesity?
BP, blood glucose and fasting lipid profile
344
What is a drug for obesity?
Orlistat
345
What is a surgery for obesity?
Gastric banding
346
What is osteoarthritis?
Wear and tear non-inflammatory joint disorder with deterioration of articular cartilage
347
What are some risk factors for osteoarthritis?
Increasing age
Females after menopause
Polyarticular disease
Obesity
Trauma
348
What are some symptoms of osteoarthritis?
Joint pain worse on movement - hips and knees
Stiffness at rest
Less than 30 minutes morning stiffness
Grating
349
What are some hand signs of osteoarthritis?
Bouchards (PIPJ) and Heberdens nodes (DIPJ)
350
What does osteoarthritis show on x-ray?
LOSS - loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
351
What are some anti-inflammatory foods for osteoarthritis?
Broccoli, spinach and ginger
352
What is the 1st line medical treatment for osteoarthritis?
Paracetamol or topical capsaicin gel
353
What is 2nd line for osteoarthritis?
Opioids
Oral NSAIDs (with PPI)
COX inhibitors
354
What is osteoporosis?
Systemic skeletal disease with low bone mass/ density and increase in fractures
355
What are the risk factors for osteporosis?
SHATTERED - steroid use, hyperthyroidism, alcohol, testosterone low, thin (BMI under 22), early menopause (before 45), renal or liver failure, erosive/ inflammatory bone disease and low dietary calcium
356
What are some other causes of osteoporosis?
CF, COPD, CKD, coeliac disease, glucocorticoid use, hypogonadism, T1DM
357
What is the pathophysiology of osteoporosis?
Increased osteoclast breakdown and reduced osteoblast formation
358
What is a vertebral crush fracture?
Sudden pain onset radiating to the front
359
What is a wrist presentation of osteoporosis?
Colles' fracture of the wrist
360
What is the gold standard for osteoporosis diagnosis?
DEXA scan
361
What is a T-score?
Comparison to a healthy young adult
362
What is a Z-score?
Comparison to an age and sex matched individual
363
Where are the scores taken from in a DEXA scan?
Hip
364
Describe the DEXA scan scores
More than -1 = normal
-1 to -2.5 = osteopenia
Less than -2.5 = osteoporosis
Less than -2.5 with a fracture = severe osteoporosis
365
What are the bloods for osteoporosis?
Calcium, phosphate and ALP are all normal
366
What is the risk assessment for osteoporosis?
FRAX - 10 year risk of fracture
367
What are some lifestyle measures for osteoporosis?
Stop smoking and alcohol
Weight bearing exercises
Increase bone density
Calcium
Vitamin D
368
What are some medical treatments for osteoporosis?
Bisphosphonates - Alendronate
Monoclonal antibodies - Denosumab
HRT
369
How should bisphosphonates be taken?
Take on an empty stomach, first thing in the morning, 30 minutes before food, stay upright for 30 minutes after taking with large glass of water
370
What is PID?
Inflammation and infection of the pelvic organs
371
What are some causes of PID?
Gonorrhoea
Chlamydia
Gardnerella vaginalis
Hib
E.coli
372
What are symptoms of PID?
Pelvic or lower abdo pain
Abnormal vaginal discharge
Abnormal bleeding
Pain in sex
Fever
Dysuria
Pelvic tenderness
Inflamed cervix
373
What is the management of PID?
IM ceftriaxone for gonorrhoea
Doxycycline for chlamydia
374
What is fitz-hugh-curtis syndrome?
A complication of PID caused by infection of the liver capsule leading to adhesions between the liver and peritoneum
375
What is peripheral vascular disease?
Partial blockage of leg/ peripheral vessels by atherosclerotic plaques causing ischaemia
376
What are symptoms of PVD?
Intermittent claudication
Hair loss
Ulcers
Numbness
Atrophic skin
377
What is the 1st line diagnostic test for PVD?
Duplex USS then ABPI
378
What is critical limb ischaemia?
Rest/ night pain with arterial insufficiency ulcers and gangrene as blood supply is barely adequate
379
What is a key symptom of critical limb ischaemia?
Burning pain at night relieved by hanging the legs over the edge of the bed
380
What are the 6 P's of acute limb ischaemia?
Pale, pulselessness, paraesthesia, pallor, perishingly cold, paralysis
381
What is the treatment for acute limb ischaemia?
Immediate IV unfractionated heparin then angioplasty/ bypass surgery/ amputation
382
What is polymyalgia rheumatica?
Inflammatory condition that causes pain and stiffness in shoulders, pelvic girdle and neck
Often alongside GCA
383
What are symptoms of polymyalgia rheumatica?
Bilateral shoulder pain and pelvic girdle pain
Interferes with sleep
More than 45 minutes morning stiffness
Systemic symptoms
384
What is the diagnosis for polymyalgia rheumatica?
ESR and CRP usually elevated
ANCA negative
Serum alkaline phosphatase elevated
Creatinine kinase = normal
GCA on temporal artery biopsy
385
What is the treatment for polymyalgia rheumatica?
Corticosteroids
386
What are some risk factors for prostate cancer?
Afro-Caribbean
Family history
Age
Anabolic steroids
High fat diet
387
What is the most common prostate cancer?
Adenocarcinomas of the peripheral prostate
388
What are some symptoms of prostate cancer?
LUTS
Weight loss
Fatigue
Night sweats
Bone pain - metastasis
389
What is the 1st line for prostate cancer diagnosis?
PSA and DRE - asymmetrical and craggy gland
390
What is the gold standard diagnosis for prostate cancer?
Transrectal USS and biopsy
391
What is the grading system for prostate cancer?
Gleason Grading System
392
What is a medical treatment for prostate cancer?
Goserelin
393
What are some side effects of Goserelin?
Hot flushes and low libido
394
What are the nerve roots of the sciatic nerve?
L4-S3
395
What does the sciatic nerve supply sensation to?
Lateral lower leg and foot and motor to posterior thigh, lower leg and foot
396
What are some symptoms of sciatica?
Unilateral pain from buttock radiating down back of thigh to below knee or feet
Electric or shooting pain
Numbness, motor weakness
397
What are some causes of sciatica?
Herniated disc
Spinal stenosis
Bilateral sciatica - cauda equina
398
What are some treatments for sciatica?
Amitityptline or Duloextine
Epidural corticosteroid injections
Spinal decompression
399
What is reactive arthritis?
Synovitis occurs in joints as a reaction to a recent infective trigger = Reiter syndrome
400
What are the symptoms of reactive arthritis?
Can't see, can't pee, can't climb a tree
Bilateral conjunctivitis and anterior uveitis
Circinate balantis
Arthritis of ankles and knees
401
What is the diagnosis for reactive arthritis?
Raised CRP and ESR
ANA positive and RF negative
402
What is the treatment for reactive arthritis?
NSAIDs and antibiotics
403
What is sinusitis?
Inflammation of the paranasal sinuses in the face usually with nasal inflammation (rhinosinusitis)
404
what can cause sinusitis?
Infection - URTI
Allergies
Obstructed drainage - poylps
Smoking
Asthma
405
What are symptoms of sinusitis?
Facial pain
Headache
Facial swelling
Nasal congestion
Nasal discharge
Loss of smell
Fever
406
What is rheumatoid arthritis?
Chronic systemic autoimmune disorder causing symmetrical polyarthritis
407
What are some risk factors for rheumatoid arthritis?
Females
Family history
HLA-DR4
Smoking
408
What are symptoms of RA?
More than 30 minutes morning stiffness
Symmetrical swelling usually MCP
Movement limitation
Muscle wasting
409
What are some hand signs of RA?
Ulnar deviation
Swan neck
Z thumb
Boutonniere deformity
410
What are some systemic symptoms of RA?
Scleritis
Pericarditis
Pleural effusion
Glomerulonephritis
Sjogrens
411
What does X-ray show for RA?
LOES - loss of joint space, osteopenia, erosion of bone, swelling of soft tissue
412
What is the most specific marker of RA?
Anti -CCP
413
What is the treatment for RA?
Methotrexate
414
What is taken with methotrexate?
Folic acid
415
What is a complication of RA?
Felty syndrome - RA, splenomegaly and neutropenia
416
What is a tension headache?
Episodic or chronic and rarely disabling
417
What are some triggers of a tension headache?
Missing meals
STress
Fatigue
Noise
Concentrated visual effort
418
What are symptoms of tension headaches?
Bilateral band pain
Pressure behind eyes
Can be daily
Not aggravated by exercise
Lasts minutes to days
419
What is the treatment for tension headaches?
Simple analgesia such as aspirin or ibuprofen
420
What is a cluster headache?
Severe and unbearable unilateral headaches usually around the eye
421
How long does a cluster headache last?
15-180 minutes
422
What is the nature of cluster headaches?
Clusters of attacks for days and then disappears for months
423
What are the symptoms of a cluster headache?
Suicide headache
Red swollen eye
Rhinorrhoea
Facial swelling
Ptosis
424
What is the treatment for cluster headaches?
Triptans, high flow oxygen for acute
Prophylaxis - verapamil, lithium, prednisolone
425
What is the most common bacterial cause of tonsilitis?
Strep pneumoniae
426
How can strep pneumoniae tonsilitis be treated?
Penicillin V
427
What are the symptoms of tonsilitis?
Fever
Sore throat
Painful swallow
Poor oral intake
Headache
Vomiting
Red inflamed tonsils
428
What is the centor criteria?
Used to estimate probability that it is due to bacterial infection and will benefit from antibiotics
429
What are some complications of tonsilitis?
Quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis
430
What is trigeminal neuralgia?
Affects branches of the trigeminal nerve from compression from aneurysms, tumours, meningeal inflammation and MS
431
What are the symptoms of trigeminal neuralgia?
Unilateral facial pain in distribution of CN5
Reoccurring in paroxysmal attacks with a stabbing, knife-like pain precipitated by shaving, eating and talking
432
What is the 1st line treatment for trigeminal neuralgia?
Carbmazepine
433
What is surgery for trigeminal neuralgia?
Microvascular decompression
Gamma knife surgery
434
What is urge incontinence?
Overactive bladder from overactivity of the detrusor muscle
435
What is stress incontinence?
Pelvic floor is weakened so urine leaks at times of high pressure such as laughing or coughing
436
What is overflow incontinence?
Chronic urinary retention due to obstruction to urine outflow
437
What are some causes of overflow incontinence?
anticholinergic medications
Fibroids
Pelvic tumours
MS
438
What are some investigations for incontinence?
Urine dipstick
Bladder diary
Post-void residual bladder volume
Urodynamic testing
439
What is the management for stress incontinence?
Avoid caffeine and diuretics
Pelvic floor exercise
Duloxetine
Sling surgery
440
What is the management of urge incontinence?
Bladder retraining
Oxybutynin
Mirabegron
441
What are the most common causes of UTI?
KEEPS
Klebsiella
E coli
Enterococcus
Proetus
Staphyloccus saprophyriticus
442
What is a complicated UTI?
Males
Pregnant
Children
Catheters
Immunosuppression
Anatomical or functional abnormalities
443
What is the triad of a UTI?
Loin pain
Fever
Pyuria
444
What is the gold standard diagnostic test for UTI?
Mid stream urine mc+s
445
What is the 1st line test for UTI?
Urine dipstick
446
What does urinalysis show for UTI?
Elevated nitrites and leukocytes
447
What is the 1st line medication for UTI?
Trimethoprim 3 days in uncomplicated women and 7 days in men and complicated
448
What are some prevention methods of UTI?
Void after intercourse
Frequent urination
Increase fluids
Double void
449
What is urticaria?
superficial itchy swellings of the skin or weals come and go in an attack giving a shifting rash
450
What are varicose veins?
Distended superficial veins more than 3mm in diameter usually in the legs
451
How do varicose veins form?
When valves become incompetent blood is drawn down and pools in veins and feet leading to dilation and engorgement
452
What are some risk factors for varicose veins?
Family history
Increasing age
Obesity
Female
DVT
Prolonged standing
453
What are the symptoms of varicose veins?
Asymptomatic
Heavy or dragging sensation in legs
Aching
Itching
Burning
Oedema
Muscle cramps
Restless legs
454
What is the cough test for varicose veins?
Apply pressure to SFJ and ask patient to cough and feel for a thrill
455
What is an imaging method for varicose veins?
Duplex USS
456
What is the first line for varicose vein treatment?
Conservative - weight loss, exercise, compression stockings
457
What is the surgery for varicose veins?
Endothermal ablation
Sclerotherapy
Stripping
458
What are arterial ulcers?
Insufficient blood supply to the skin due to PAD
459
What are the associations of arterial ulcers?
Absent pulses, pallor and intermittent claudication
Well-defined borders
Pale due to poor blood supply
Painful and worse at night
460
What are the presentation of venous ulcers?
Occur in the gaiter area
Larger and more superficial
Irregular
Sloping border
More likely to bleed
Less painful
461
What is the management of an arterial ulcer?
Vascular for surgical revascularisation
462
What is the management for a venous ulcer?
Community if ABPI > 0.8 but vascular surgery if < 0.8
463
What is the score used to risk assess the development of a pressure ulcer?
Waterlow score
464
What can e coli gastroenteritis lead to?
HUS
465
how is e coli spread?
Unwashed salads, faeces and contaminated water
466
What is a common cause of travellers diarrhoea?
Campylobacter jejuni
467
What is the 1st line treatment for c. jejuni gastroenteritis?
Clarithromycin
468
How to differentiate salmonella and shigella on XLD?
Salmonella produces black spots
469
What are some complications of gastroenteritis?
Post infective IBS
Lactose intolerance
Reactive arthritis
GBS
HUS
470
What is the only suitable contraception for postpartum women breastfeeding?
Progesterone only pill
