GP

Question 1

which gout treatment should not be started within 28 days of an acute attack?

side effects of colchicine?

*meat seafood alcohol increase risk of gout, cheese/dairy products decrease risk

Answer 1

allopurinol

GI symptoms including hemorrhage, inhibition of spermatogenesis

Question 2

in addition to EBV serology, and throat swab, what other test can be done for infectious mono?

complications?

Answer 2

paul bunnel test (heterophile antibody - non specific)

meningitis, splenic rupture, thrombocytopenia, depression

Question 3

sebhorreic warts/ keratosis aka basal cell papillomas look how?
malignant?

managment?

Answer 3

like raised brown lesions, may resemble a melanoma
not malignant
increase with increasing age

only if symptomatic or diagnostic uncertainty
curettage or liquid nitrogen therapy

Question 4

psoriasis management?

Answer 4

1. emollients to soften skin
2. sialicylic acid to soften scales + topical steroids (use short period)
3. vitamin D creams eg calciptriol work well on plaque psoriasis

Question 5

when would you consider excision for a melanocytic naevus?
how do you differentiate it from melanoma

Answer 5

rapid growth, bleeding, irregular and changing features
unlike melanoma, uniform colour all around

Question 6

contact dermatitis treatment?

Answer 6

short course of steroids
tacrolimus may be given
wash hands with aqueous cream NOT soap

Question 7

athletes foot treatment

Answer 7

azoles
terbinafine
whitfield ointment

Question 8

what tests should be done to rule out IBS differentials?
management?

Answer 8

fbc - anemia
esr crp - rule out infection and inflammation
coeliac serology

treat symptoms -> antispasmodic agents, loperomide for diarrhea, constipation. cbt

Question 9

R Arthritis features in hand?

investigations?
management?

conditions associated with RA?

Answer 9

swan neck deformity
synovial swelling at wrist
swelling of MTP joints

Rhuematoid factor
anti CCP
ANA

management = DMARDS FIRST line (methotrexate, sulfasalzine, hydroxychloroquine)
prednisolone can be used in acute flares or initially when dmards started before they take in to effect

scleritis/other eye stuff
pericarditis/CVD
pulmonary fibrosis
amyloidosis (due to chronic inflammation)

smoking status, depression screening, FRAX score to check comorbidities

Question 10

management of suspected reactive arthritis?

Answer 10

joint aspiration and culture -> rule out septic arthritis
GUM clinic referral for STD screen
Check HLA-B27 = poor prognostic indicator! for reactive arthritis

do NOT prescribe antibiotics until you know the cause

Question 11

name conditions/ syndromes with a risk of colorectal cancer

Answer 11

FAP
Putz jeghers syndrome
ulcerative colitis
lynch syndrome

*dukes staging for colorectal cancer

Question 12

what is the threshold for treating HTN in individuals with no evidence of end organ damage (kidney, eyes)

Answer 12

> /= 160
/= 100

Question 13

when should buproprion be started for a smoker?
contraindications?

Answer 13

whilst still smoking

current seizures, a history of seizure, a central nervous system tumour, severe hepatic cirrhosis and if there is a history of bipolar disorder, anorexia nervosa or bulimina.

Question 14

side effects of OCP?

Answer 14

Side effects associated with oestrogen may include:

Fluid retention
Headache
Nausea and vomiting
Venous thrombosis
Increased cervical secretion / cervical erosion
Those associated with progestogen may include:

Breast fullness
Decreased libido
Dry vagina
Reduced menstrual flow
Disturbance in menstrual cycle
Acne
Premenstrual depression

Question 15

bacterial tonsilitis treatment?

Answer 15

penicillin V

Question 16

otitis externa vs otitis media treatment

Answer 16

externa = ciprofloxacin ear drops

media = uncomplicated give analgesia, if not give oral amoxicillin

note - media infection can cause perforation of eardrum and leakage of pus