GP Flashcards by jenn martin

How can a lower urinary tract infection be differentiated from an upper urinary tract infection using the presenting sx?

Upper: fever, suprapubic pain, vomiting, haemautria
Lower: frequency, dysuria, suprapubic tenderness

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What results on a dipstick would indicate a UTI?

Nitrites
Nitrites + Leukocyte Esterase

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What would the presence of solely leukocyte esterase in the urine suggest?

Presence of white blood cells in the urine which may either be caused by inflammation or infection.

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What are the most common organisms causing UTIs? (6)

E.coli
Klebsiella pneumoniae
Enterococcus
Pseudomonas auerginosa
Staphylococcus saprophyticus
Candida albicans

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What are the treament options for a UTI?

First line - Nitrofurantoin or Trimethoprim

Second line - Pivemicillinam, Amoxicillin or Cefalexin

3 days - women with lower urinary tract infection.

5 days - immunocompromised women or women that have abnormal anatomy.

7 days - men, pregnant women or catheter-related UTI.

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What is the management of a UTI for a pregnant woman?

7 days of antibiotics
Urine for culture and sensitivities
First line: Nitrofurantoin
Second line: Cefalexin or Amoxicillin

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Why is nitrofurantoin contraindicated in the third trimester?

Can cause haemolytic anaemia.

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Why is trimethoprim avoided in the first trimester?

Can affect the absorption of folic acid which results in spinal malformations.

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What are the antibiotic options for managing pyelonephritis in the community?

cefalexin
co-amoxiclav
trimethoprim
ciprofloxacin

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What are the options for managing influenza in people that are at risk of complications?

oseltamivir 75mg twice daily for 5 days
inhaled zanamivir twice daily for 5 days

Treatment needs to be initiated within 48 hours of symptom onset to be effective.

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What are the options for post-exposure prophylaxis for influenza, for at risk patients?

Post-exposure prophylaxis (within 48 hours of exposure):

oseltamivir 75mg once daily for 10 days
inhaled zanamivir 10mg once daily for 10 days.

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What are the most classical sx of seborrhoeic dermatitis and what is the firstline treatment?

The classic symptoms are dandruff and eczematous lesions with flakes on the periorbital, auricular and nasolabial folds.
Ketoconazole.

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How many vaccinations for tetanus need to be given before the patient is considered to be fully immunised?

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How may a patient with iliotibial band syndrome present?

Burning or sharp sensation around the lateral aspect of the knee.

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How would a meniscal tear present?

Locking of the knee joint
Swelling
Pain

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How would a patient with pityriasis versicolor present and how is this treated?

Hypopigmented lesions
Topical ketoconazole

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What infection is orchitis commonly associated with?

Mumps

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What is the eradication therapy for H.pylori? Will the patient need a follow up?

Amoxicillin
Metronidazole
Omeprazole

If symptoms resolve no need to repeat breath test.

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What is the post-exposure prophylaxis therapy for exposure to HIV?

Oral antiretroviral therapy for 4 weeks

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What is the name of the exercises that are recommended for patients with BPPV?

Brandt-Daroff exercises

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What is the most common causative organism for otitis externa? What is another common causative organism?

Pseudomonas aeruginosa
Staphylococcus aureus

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What is the main mechanism of action for the implantable contraceptive?

Inhibits ovulation

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What pH is suggestive of an infection with Candidiasis? (vaginal thrush)

Less than 4.5

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With osteoporosis when should the 10-year fracture risk be reassessed?

After 5 years of treatment with aldendronate.

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Insulin-dependent diabetics must check their blood glucose every ............... whilst driving

2 hours

When should women without any risk factors have a FRAX assessment?

over 65

What is used to manage acute flares of rheumatoid arthritis?

IM methylprednisolone

What skin lesion can be present and used to make a clinical diagnosis of lyme disease?

Erythema Migrans

What is the firstline treatment for syphilis?

Benzylpenicillin IM

What are the atypical organsims that can cause chest infections?

Legionella pneumophilia Chlamydia ptsittaci Mycoplasma pneumoniae Chlamydydiohilia pneumoniae Q Fever (Coxiella burnetii)

What is the firstline treatment for a chest infection (typical organisms) for a patient who has NKDA? Penicillin allergy? What is the typical course length?

1. Amoxicillin 2. Erythromycin/Clarithromycin or Doxycycline 5-7 days

What are the typical organisms that cause bacterial chest infections?

Streptococcus pneumoniae. Haemophilus influenzae. Moraxella catarrhalis. Pseudomonas aeruginosa. Staphylococcus aureus

What does the CRB-65 score stand for and how is it used?

Confusion Respiratory rate >30 Blood pressure

Difficulty breathing is a sign that may suggest a more severe chest infection or pneumonia, name 5 more.

Oxygen saturation less than 90%. Raised heart rate. Grunting; very severe chest indrawing. Inability to drink. Lethargy; reduced level of consciousness.

What is the most common virus that causes URTIs?

Rhinoviruses

Being young, female and sexually active are all risk factors for the development of a UTI, name 4 more.

Diabetes Hx of UTIs Spermicide use Catheters

In what circumstances would a urinary MCS also be indicated for a young female presenting with urinary sx (in the absence of vaginal sx)?

If there were signs of systemic upset, hx of diabetes, recurrent UTIs or if they were pregnant.

Why are nitrites present in the urine when there is a UTI?

As most urinary pathogens convert nitrates into nitrites.

What blood tests would be indicated if a patient was not responding to antibiotics as treatment of their UTI?

FBC U+Es CRP (to assess kidney function)

When is radiological imaging indicated for a UTI?

For pyelonephritis that is not responding to conventional abx.

What is the firstline treatment for vaginal candidiasis? What can be used as an alternative?

One dose Fluconazole (oral) Clotrimazole pessary

What are the features of vaginal candidiasis?

'cottage cheese', non-offensive discharge vulvitis: superficial dyspareunia, dysuria itch vulval erythema, fissuring, satellite lesions may be seen

What is pneumonia?

Inflammation of the parenchyma of the lung.

What is the definition of hospital acquired pneumonia?

Pneumonia contracted more than 48 hours after hospital admission that was not incubating at the time of admission.

What are the most common organsims that cause HAP?

Gram-negative bacilli (e.g. Pseudomonas aeruginosa) Staphylococcus aureus Legionella pneumophila

Which pneumonia causing organism is associated with the reactivation of cold sores?

Streptococcus pneumoniae

What are the extra-pulmonary features that are associated with Mycoplasma pneuomoniae?

Erythema multiforme Arthralgia Myocarditis, pericarditis Haemolytic anaemia

What biochemical abnormalities can sometimes be seen in patients with pneumonia caused by Legionella pneumophila?

Hyponatraemia (SIADH) Hypophosphataemia Raised serum ferritin

How can Legionella pneumophila pneumonia be diagnosed?

Urinary antigen testing Sputum culture PCR

A pneumothorax is a pulmonary complication of pneumonia - name 3 more pulmonary complications.

Parapneumonic effusion Abscess Empyema

What are two extra-pulmonary complications of pneumonia?

Sepsis Atrial fibrillation

What investigations are indicated for a patient with suspected pneumonia?

Bedside: Obs, sputum sample, urinary sample (MCS to rule out UTI and urinary antigen) and ECG (AF risk). Labs: FBC, U+Es, CRP, Blood cultures (source of infection) Imaging: CXR

When is CRB-65 used over CURB-65?

CRB = deciding admission into hospital CURB = when in hospital to decide between outpatient, inpatient and ITU.

What are the supportive management options for a patient hospitalised with pneumonia?

Oxygen (aim for 94-98% in pts with no previous lung disease, 88%-92% in pts with COPD). IV fluids Analgesia

What population of patients should have a repeat follow up CXR 6-8 weeks after pneumonia?

Smokers Over the age of 50

Muscular and disc degeneration are two causes of mechanical back pain, name 4 more.

Spondylosis Spinal fracture Spinal stenosis Radiculopathy

Malignancy is a cause of non-mechanical back pain, name 4 more.

Epidural abscess Discitis Osteomyelitis Inflammatory arthropathy

Renal stones are a common cause of referred back pain, name 5 more.

Aortic dissection Pancreatitis Ruptured AAA Pyelonephritis Biliary colic

What two tests are commonly used to assess for nerve impingement in suspected lumbar radiculopathies and what are they testing for?

Straight leg raise for **L5/S1** radiculopathy: worsening radicular pain on* raising the leg with the knee extended*. Pain should be *relieved if the knee is flexed* Reverse straight leg raise for **L2-4 **radiculopathy: worsening radicular pain on *extending the leg with the patient prone*

High BMI and smoking are common risk factors associated with the development of GORD, name 4 more.

Genetics Pregnancy Hiatus hernia NSAIDs, caffeine and alcohol (conflicting)

GORD classically presents as heartburn that classically occurs after meals and is made worse by leaning forwards or lying down. Name 7 more symptoms that can be associated with GORD.

Regurgitation Dyspepsia Chest pain Dysphagia Odynophagia Cough Hoarse voice Nausea +/- vomiting

What are the common complicatoins of GORD?

Barrett's oesophagus Stricture Erosive oesophagitis

Chronic describes constipation that has been present for ............ duration.

≥ 3 months

What are the red flag sx associated with constipation?

Weight loss Rectal bleeding Fhx of colorectal cancer Sudden change in bowel habits Abdominal pain Iron deficiency anaemia

What criteria is used to assess and diagnose chronic constipation?

Rome IV criteria

For a young patient presenting with erectile dysfunction what is the firstline management step?

Referral to urology

Which nerve is affected in meralgia paraesthetica?

Lateral cutaenous nerve of thigh

In Vestibular neuronitis: Prochlorperazine is used for ........................ Betahistine is used for ......................

Symptomatic relief To prevent symptoms

What type of nystagmus do you get with vestibular neuronitis?

Horizontal nystagmus

What are the treatment options for mild-moderate acne? ........ week course Topical ............. + topical benzoyl peroxide Topical ............... + topical ..................... Topical benzoyl peroxide + topical ....................... Topical ............................ (monotherapy)

12 week course Topical adapalene + topical benzoyl peroxide Topical tretinoin + topical clindamycin Topical benzoyl peroxide + topical clindamycin Topical benzoyl peroxide (monotherapy)

What are the treatment options for moderate to severe acne? ......... week course Topical ................. + topical benzoyl peroxide Topical .................. + topical ...................... Topical ..................... + topical benzoyl peroxide + oral ................/oral .................... Topical ........................ + oral ....................../oral .......................

12 week course Topical adapalene + topical benzoyl peroxide Topical tretinoin + topical clindamycin Topical adapalene + topical benzoyl peroxide + oral lymecycline/oral doxycline Topical azelaic acid + oral lymecycline/oral doxycycline