GP Flashcards
1
Q
LUTS symptoms (9)
A
- hesitancy
-weak flow - urgency
- frequency
- intermittency
- straining
-terminal dribbling - incomplete emptying
- nocturia
2
Q
How should a LUTS/BPH pt be assessed? (5)
A
- urine dipstick (r/o infection etc)
- U+Es (esp if chronic retention suspected)
- PSA (pt preference, recommended if sx are mostly obstructive)
- urinary frequency volume chart (3 days fluid intake and output)
- DRE
3
Q
What can raise PSA? (6)
A
- prostate cancer
- BPH
- prostatitis
- UTI
- vigorous exercise (esp cycling)
- recent ejaculation/prostate stimulation
4
Q
How can benign and cancerous prostates differ on exam?
A
benign → smooth, symmetrical, slightly soft, maintained central sulcus
cancerous → firm/hard, asymmetrical, craggy/irregular, loss of central sulcus
5
Q
Medical mx of BPH
A
- alpha-blockers (e.g. tamsulosin, relaxes smooth muscle and improves sx)
- 5-alpha reductase inhibitors (e.g. finasteride, gradually reduces prostate size) *tends to only be indicated if enlargement is significant/high risk of progression
(however combo therapy more and more common - “moderate to severe voiding sx”)
6
Q
What is the most common surgical tx of BPH?
A
transurethral resection of the prostate (TURP)
7
Q
LOSS
What are the 4 key x-ray changes seen in osteoarthritis?
A
- Loss of joint space
- Osteophytes
- Subarticular sclerosis (incr density of bone along joint line)
- Subchondral cysts (fluid filled holes in bone)
8
Q
What are the most commonly affected joint in osteoarthritis? (6)
A
- hips
- knees
- DIP joints hands
- CMC joint (base of thumb)
- lumbar spine
- cervical spine (cervical spondylosis)
9
Q
What are the typical features of an osteoarthritis presentation? (6)
A
- joint pain and stiffness
- sx worsen with activity and by the end of the day
- bulky, bony enlargement of the joints
- restricted ROM
- crepitus on movement
- effusions around joint
10
Q
What are the hand signs specific to osteoarthritis? (3)
A
- bouchard’s nodes (PIP)
- heberden’s nodes (DIP)
B comes before H, proximal before distal - squaring at the base of the thumb (CMC)
11
Q
How is osteoarthritis dx according to NICE guidelines?
A
without ix if pt >45 and has typical pain associated with activity and NO morning stiffness (or lasts <30mins)
12
Q
NG osteoarthritis mx (pharmacological and non)
A
non-pharmacological → therapeutic exercise, WL, OT (to support ADLs)
pharmacological → topical NSAIDs (1st line for knee), oral NSAIDs (+PPI), weak opiates/paracetamol (short and infrequent use), intra-articular steroid injections (temporary sx relief - up to 10wks)
joint replacement in severe cases (hip, knee esp)
13
Q
What is the typical presentation of trigeminal neuralgia?
A
attack of facial pain (shooting, electric like) of sudden onset, lasting seconds to hours triggered by touch (eating, shaving, cold)
*can affect any combo of the branches of the trigeminal nerve (opthalmic, maxillary, mandibular)
14
Q
What can cause trigeminal neuralgia/is often associated with it? (2)
A
majority are idiopathic
- compression of trigeminal roots by tumours/vascular problems
- more common in pts with MS
15
Q
What is first line for trigeminal neuralgia?
A
carbemazepine
failure to respond or atypical features = prompt neuro referral
16
Q
What type of hypersensitivity is allergic contact dermatitis?
A
Type IV - delayed/cell mediated hypersensitivity (pts often have pre-existing atopy)
first contact does not result in allergy, can take months/years of contact
17
Q
What are the two main types of contact dermatitis?
A
irritant → a common, non-allergic reaction due to weak acids/alkalis (e.g. detergents, cement) - often seen on hands and mostly erythema
allergic → type IV hypersensitivity, uncommon and often seen on head follow hair dye - tends to present as acute weeping eczema
18
Q
What kind of dermatological presentation is nappy rash?
A
contact dermatitis (caused by friction between skin and nappy and contact with urine/faeces - hence why spares folds)
19
Q
What infections can occur where there is nappy rash?
A
- fungal (candida)
- bacterial (staph, strep)
due to skin breakdown and warm moist environment
20
Q
Treatment for fungal infection of nappy rash
A
clotrimazole or miconazole
21
Q
Treatment for bacterial infection of nappy rash
A
fusidic acid cream or oral flucloxacillin
22
Q
What layers of the bowel does diverticular disease involve?
A
herniation of the colonic mucosa through the muscle wall of the colon (rectum is usually spared due to lack of taenia coli - vessels that pierce the muscle to supply the mucosa)
23
Q
What are symptoms of diverticular disease?
A
- altered bowel habit
- rectal bleeding
- abdo pain (often LIF)
24
Q
What are potential complications of diverticular disease? (5)
A
- diverticulitis
- haemorrhage
- fistula development
- perforation and faecal peritonitis
- perforation and abscess development
25
Risk factors for diverticulosis (4)
- increased age (wear and tear)
- low fibre diets
- obesity
- NSAID use (esp haemorrhage)
26
Management of diverticulosis (3)
- increased fibre in diet
- bulk-forming laxatives (isphagula husk)
- surgery if severe
*AVOID stimulant laxatives (senna)*
27
Presentation of acute diverticulitis (7)
- LIF pain/tenderness
- fever
- diarrhoea
- nausea/vomiting
- rectal bleeding
- palpable abdo masses (is abscess formed)
- raised CRP/WBC
28
Management of uncomplicated acute diverticulitis (4)
- oral co-amoxiclav (625mg TDS for 5 days, then review)
- analgesia (avoid NSAIDs/opiates)
- only clear liquids until sx improve
- follow up in 2 days
29
What is the most common cause of bacterial tonsillitis?
group A streptococcus (strep pyogenes)
*second most common = strep pneumoniae
30
How is bacterial tonsillitis treated? (+ if allergic)
penicillin V (phenoxymethylpenicillin) 500mg QDS for 5-10 days
true penicillin allergy = clarithromycin
31
What complication is important to safety net when treating tonsillitis?
peritonsillar abscess (quinsy) → unilateral severe throat pain, uvula deviation to unaffected side, trismus, reduced neck mobility
32
Which points are key in both Centor criteria and FeverPAIN score for determining abx use in tonsillitis?
- fever
- purulence/tonsillar exudates
- absence of coryzal sx
- lymphadenopathy
33
When do NICE recommend considering tonsillectomy?
- sore throats due to tonsillitis (i.e. not recurrent URTIs)
- 7 episodes per year for one year, 5 eps for 2yrs or 3 eps for 3yrs
- episodes of sore throat are disabling and prevent normal functioning
*must meet all criteria*
34
What causes atrophic vaginitis?
GU syndrome of menopause - dryness and atrophy of the vaginal mucosa related to a lack of oestrogen
35
how does atrophic vaginitis present? (4)
- itching
- dryness
- dyspareunia
- bleeding (due to localised inflammation)
36
what other dx are associated with atrophic vaginitis?
- recurrent UTIs
- stress incontinence
- pelvic organ prolapse
37
TX options for atrophic vaginitis (2)
- vaginal emollients/lubricants (helps dryness sx)
- topical oestrogen (cream, pessaries, tablets) *similar CIs to systemic HRT*
38
What causes Parkinson's disease?
progressive reduction in dopamine in the basal ganglia leading to disorders of movement
39
Is Parkinson's typically symmetrical or asymmetrical?
asymmetrical
40
What is the classic triad of Parkinson's?
1. resting tremor (pill-rolling)
2. rigidity (cogwheel)
3. bradykinesia (slowness of movement)
41
How can bradykinesia present in Parkinson's? (4)
- micrographia
- shuffling gait
- difficulty initiating movement
- hypomimia
42
What are associated features of Parkinson's? (5)
- depression
- sleep disturbance/insomnia
- anosmia
- postural instability (incr falls risk)
- cognitive impairment/memory problems
43
What phenomenon can occur re Parkinson's meds?
on-off
pts feel their meds wear off and experience sx when their next dose is due
44
What are the 4 main medication options for Parkinson's?
1. levodopa (+carbidopa/benserazide to stop it being metabolised before reaches brain - combined this is co-careldopa)
2. COMT inhibitors (e.g. entacapone)
3. dopamine agonists (e.g. cabergoline)
4. monoamine oxidase-B inhibitors (selegiline, rasagiline)
45
Why is levodopa not 1st line for PD?
most effective for sx, but becomes less effective over time so tends to be reserved for when other tx aren't working
46
What is the main side effect of levodopa?
dyskinesia (anormal movements) such as dystonia, chorea, athetosis
47
How is amantadine used in PD?
may be used to manage dyskinesia associated with levodopa
48
What is at risk if PD meds aren't taken/properly absorbed (e.g. with gastroenteritis) - especially levodopa?
acute akinesia or neuroleptic malignant syndrome - caused by abrupt drop in dopamine levels
49
What class of medications poses a risk in PD pts?
antipsychotics (esp 1st generation) - they block dopamine receptors in the brain and as these are already damaged in PD this leads to an acute worsening of motor sx
50
Which bacteria most commonly cause UTIs? (3)
- Escherichia coli
- Klebsiella pneumoniae
- enterococci
51
What features suggest pyelonephritis not UTI? (4)
- fever
- loin/back pain
- nausea/vomiting
- renal angle tenderness OE
52
Is leukocytes or nitrites the better indicator of infection in a urine dipstick?
nitrites, only leukocytes is not enough to warrant tx, but if nitrites, both, or one + RBC are present then UTI is likely
53
How can you determine the causative organism of a UTI?
MSU sent for microscopy, culture and sensitivity testing (not necessary if uncomplicated)
54
What constitutes a complicated UTI?
- pt is pregnant
- UTIs are recurrent
- sx aren't improved w/ abx
- anatomical/functional abnormalities of the urinary tract
- immunosuppressed
- male
- indwelling catheter
55
Management of an uncomplicated UTI
trimethoprim or nitrofurantoin for 3 days
56
What is the duration of abx for UTIs in the immunosuppressed/abnormal anatomy or impaired kidney function?
5-10 days
57
What is the duration of abx for a UTI in men/pregnant women/those with catheters?
7 days
58
When should nitrofurantoin be avoided in pregnancy?
third trimester - risk of neonatal haemolysis
59
When should trimethoprim be avoided in pregnancy?
first trimester - it is a folate antagonist so can cause congenital malformations (esp neural tube defects)
60
What are risk factors for an anal fissure? (3)
- constipation
- IBD
- pregnancy
61
What are varicose veins?
distended superficial veins measuring more than 3mm (usually affects legs)
62
What are some RF for varicose veins? (7)
- increasing age
- FHx
- female
- pregnancy
- obesity
- prolonged standing
- DVT
63
What may a pt with varicose veins also present with signs and sx of?
chronic venous insufficiency (e.g. skin changes and ulcers)
64
What are some conservative measures for varicose veins?
- WL if appropriate
- staying physically active
- keeping the leg elevated when possible to aid drainage
- compression stockings
65
What type of palsy does Bell's present with?
unilateral LMN facial nerve palsy
66
What is the recovery like for Bell's palsy?
most fully recover over several weeks, but it can take up to 12 months and 1/3 are left with some residual weakness
67
What does NICE suggest if a Bell's palsy presents within 72hrs of sx onset?
prednisolone + lubricating eye drops (tape at night)
either 50mg for 10 days or 60mg for 5 days with a 5-day reducing regime
68
What is the worry in terms of ophthalmology in Bell's palsy?
no eye drops/taping = risks exposure keratopathy
69
What is the pathophysiology behind bacterial vaginosis?
overgrowth of predominantly anaerobic organisms (e.g. gardnerella vaginalis) leading to a consequent fall in lactic acid producing aerobic lactobacilli = raised vaginal pH
70
How often is BV asymptomatic?
50%
71
Amsel's criteria for BV (need 3/4 for dx)
- thin white homogenous discharge
- clue cells on microscopy
- vaginal pH >4.5
- positive whiff test
72
What is the tx for symptomatic BV?
oral metronidazole for 5-7 days
*70-80% initial cure rate, >50% relapse within 3mths
73
How is chronic fatigue syndrome diagnosed?
after at least 3mths of disabling fatigue affecting mental and physical function more than 50% of the time, in the absence of other disease which may explain sx
74
What are other recognised features of CFS besides fatigue?
- sleep problems
- muscle/joint pains
- headaches
-cognitive dysfunction
- painful lymph nodes without enlargement
75
What sleep problems are common in CFS? (4)
- insomnia
- hypersomnia
- unrefreshing sleep
- disturbed sleep-wake cycle
76
TATT bloods
- FBC, ferritin (anaemia, polycythaemia, haem malignancy)
- U+E (CKD, electrolytes)
- LFT
- glucose
- TFT
- ESR/CRP
- calcium (hypercalcaemia, multiple myeloma)
- CK
- coeliac screening
- urinalysis
77
triad of depression
persistent low mood, low energy and reduced enjoyment of regular activities (anhedonia)
78
What physical health conditions can trigger or exacerbate depression? (4)
- stroke
- MI
- MS
- Parkinsons
79
What are essential factors to explore when taking a depression hx? (5)
- caring responsibilities
- social support
- drug use
- alcohol use
- forensic hx (violence, abuse)
80
What should you risk assess in a depression consultation? (4)
- self-neglect
- self-harm
- harm to others (incl neglect)
- suicide
81
What questionnaire can be used to assess severity of depression?
PHQ-9
5-9 = mild
10-14 = moderate
15-19 = mod severe
20-27 = severe
82
4 different management options for depression
- active monitoring and self-help
- address lifestyle factors
- therapy (CBT, counselling, psychotherapy)
- antidepressants (SSRIs 1st line, then SNRIs)
83
What are the additional specialist treatments for unresponsive/severe depression? (3)
- antipsychotics
- lithium
- ECT
84
3 main components of psychosis
1. delusions
2. hallucinations
3. thought disorder
85
What are the types of urinary incontinence? (4)
urge = overactivity of the detrusor muscle (overactive bladder)
stress = weak pelvic floor allows urine to leak at times of increased pressure
mixed
overflow = chronic urinary retention due to obstruction of outflow
86
How is mixed urinary incontinence treated?
identify which type (urge/stress) has a bigger impact and address that first
87
What can cause overflow incontinence? (4)
- anticholinergic meds
- fibroids
- pelvic tumours
- neuro (MS, diabetic neuropathy, spinal cord injury)
88
What are modifiable lifestyle factors that can contribute to urinary incontinence? (4)
- caffeine
- alcohol
- medications
- BMI
89
What should you examine for with a urinary incontinence hx?
- pelvic organ prolapse
- atrophic vaginitis
- urethral diverticulum
- pelvic masses
90
Management of stress incontinence
- lifestyle - avoid caffeine/diuretics/excessive fluid intake, WL if appropriate
- supervised pelvic floor exercises (at least 3mths before surgery referral)
- surgery
- duloxetine (if surgery not preferred)
91
Management of urge incontinence
- bladder retraining (1st line, at least 6 weeks)
- anticholinergics (oxybutynin, tolterodine, solifenacin)
- mirabegron (alternative ^)
- invasive (botulinum injections, nerve stimulation, cystoplasty, urinary diversion)
92
Initial investigations for urinary incontinence (4)
- bladder diary (minimum 3 days)
- vaginal examination (exclude prolapse etc)
- urine dipstick and culture
- urodynamic studies
93
What causes acne?
chronic inflammation with or without localised infection in the pilosebaceous unit - increased production of sebum (hormones etc) trapping keratin and blocking the unit
(swollen and inflamed units are called comedones)
94
What hormones increase the production of sebum?
androgenic hormones (mostly testosterone - converted in females to oestradiol, a form of oestrogen)
95
What are some initial treatments for acne?
- topical benzoyl peroxide
- topical abx (clindamycin)
- oral abx (lymecycline)
- COCP (dianette best as has anti-androgen effects but higher DVT risk)
- topical retinoids (contraception needed)
last line = oral isotretinoin
96
What bacteria is felt to play an important role in acne?
Propionibacterium acnes
97
SE of isotretinoin
- dry skin and lips
- photosensitivity of skin
- depression, anxiety, suicidal ideation
- rarely stevens-johnson and toxic epidermal necrolysis
98
What are RF for developing a candida infection? (4)
- increased oestrogen (more chance in pregnancy, less pre-puberty/post-menopause)
- poorly controlled diabetes
- immunosuppression
- broad-spectrum abx
99
What can confirm a dx of candidiasis?
charcoal swab with microscopy
*not routinely indicated - can be treated based on sx alone
100
Candidiasis treatment
- clotrimazole cream (inserted into vagina via applicator)
- clotrimazole pessary
*both cream and pessary mean latex condoms and spermicides don't work*
- oral fluconazole
101
What are haemorrhoids?
enlarged anal vascular cushions (specialised submucosal tissue containing connections between arteries and veins) - often associated with constipation and straining
102
RF for haemorrhoids
- pregnancy
- obesity
- increased age
- increased intra-abdo pressure (weightlifting, chronic cough)
103
4 classifications of haemorrhoids
1. no prolapse
2. prolapse when straining, returns on relaxing
3. prolapse when straining, doesn't return on relaxing but can be pushed back
4. prolapsed permanently
104
How do haemorrhoids commonly present?
painless, bright red bleeding (NOT mixed with stool) with possible pruritis or a noticeable lump around/inside the anus
105
What are the topical treatments of haemorrhoids? (3)
- anusol (astringent)
- anusol HC (contains hydrocortisone - short term)
- germoloids (contain lidocaine)
106
What are some non-surgical treatments of haemorrhoids? (4)
- rubber band ligation
- injection scleropathy
- infra-red coagulation
- bipolar diathermy
107
How can you differentiate flu from common cold?
- flu has a more abrupt onset
- fever is typically more in flu
- those with flu tend to be far less able to do usual activities ("wiped out")
108
How can flu dx be confirmed?
viral nasal or throat swabs sent for PCR analysis
109
How and when is flu treated further than conservative measures?
if someone is at risk of complications (immunosuppressed etc)
antivirals - oral oseltamivir or inhaled zanamivir
*needs to be started within 48hr sx onset*
110
What is the first-line laxative for constipation?
isphagula (brand name fybogel) - bulk-forming (increases faecal mass which stimulates peristalsis)
111
What is the second-line laxative for constipation?
an osmotic laxative such as macrogol
112
What factors can exacerbate GORD?
- greasy/spicy foods
- coffee and tea
- alcohol
- NSAIDs
- stress
- smoking
- obesity
- hiatus hernia
113
What are some red flag sx for GORD?
- dysphagia (any age = 2ww)
- >55yrs
- weight loss
- upper abdo pain
- treatment resistant dyspepsia
- nausea/vomiting
- palpable upper abdo mass
- anaemia
- raised platelets
114
What does an OGD (oesophago-gastro-duodenoscopy) look for in a GORD presentation?
- gastritis
- peptic ulcers
- upper GI bleeding
- oesophageal varices (in liver cirrhosis)
- barretts
- oesophageal stricture
- malignancy
115
What test should be offered to anyone with dyspepsia?
H. pylori (can cause damage to epithelial lining) - need to be 2 weeks free of PPI beforehand
*can be stool antigen test, urea breath test, antibody test of blood etc
116
What viruses commonly cause gastroenteritis?
- rotavirus
- norovirus
- adenovirus (can also cause resp sx)
117
Why should abx be avoided if e.coli gastroenteritis is a possibility?
a certain strain of e.coli (0157) produces the shiga toxin which causes the gastro sx but also destroys blood cells, possibly leading to haemolytic uraemic syndrome (which abx also increases the risk of)
118
What is a common cause of travellers diarrhoea?
campylobacter jejuni - first line is clarithromycin
119
What is the treatment for gastroenteritis caused by shigella?
azithromycin or ciprofloxacin
120
Is food poisoning a notifiable disease?
yes - notify UK health security agency
121
What is the primary concern with regards to management of gastroenteritis?
dehydration - important to decipher if they can orally hydrate themselves or need IV fluids
consider oral rehydration salt solution (esp in frail pts)
122
123
What is primary hypothyroidism?
where the thyroid itself behaves abnormally and produces inadequate thyroid hormones
negative feedback is absent, so TSH production increases
TSH high, T3/4 low
124
What is secondary hypothyroidism?
also called central hypothyroidism - where the pituitary behaves abnormally, producing insufficient TSH resulting in under-stimulation of the thyroid gland
TSH, T/3 low
125
What are some causes of primary hypothyroidism?
- hashimoto's thyroiditis (most common in developed world)
- iodine deficiency (most common in developing)
- some treatments for hyperthyroidism (carbimazole, propylthiouracil, radioactive iodine, thyroid surgery)
126
What medications can cause hypothyroidism?
- lithium (inhibits production of thyroid hormones in the thyroid gland - can cause goitre)
- amiodarone (interferes with thyroid hormone production and metabolism - risk of thyrotoxicosis)
127
What are some causes of secondary hypothyroidism?
- tumours (pituitary adenomas)
- surgery (to pituitary)
- radiotherapy
- sheehan's syndrome (where major pph causes avascular necrosis of the pituitary)
- trauma
128
How does hypothyroidism present?
- weight gain
- fatigue
- dry skin
- coarse hair and hair loss
- fluid retention (incl oedema, pleural effusion, ascites)
- heavy/irregular periods
- constipation
129
What causes a goitre?
- iodine deficiency
- hashimoto's thyroiditis (there may then be atrophy of the gland)
130
What is levothyroxine?
it is a synthetic version of t4, and also metabolises to t3 in the body
131
How do you titrate levothyroxine dose according to TSH?
TSH high = increase dose (more -ve feedback)
TSH low = reduce dose
132
What is required of sx to be classified as generalised anxiety disorder?
sx should be persistent, occurring most days for at least 6mths, and not caused by substance use or another condition
133
What are some secondary causes of anxiety?
- substance use (e.g. caffeine, stimulants, bronchodilators, cocaine)
- substance withdrawal
- hyperthyroidism
- phaeochromocytoma
- cushing's
134
What are some second-line medications for GAD/panic disorder?
2. alternative SSRI/SNRIs (e.g. venlafaxine)
3. pregabalin
135
136
What causes lyme disease?
caused by the spirochaete Borrelia burgdorferi and is spread by ticks
137
How does early lyme disease typically present?
- erythema migrans ('bulls-eye' rash at tick bite site, usually 1-4wks after)
- headache
- lethargy
- fever
- arthralgia
138
What are the serious later features of lyme disease?
- cardio (heart block, peri/myocarditis)
- neuro (facial nerve palsy, radicular pain, meningitis)
139
How is lyme disease diagnosed?
- clinically if erythema migrans is present (start abx)
- otherwise ELISA antibodies to Borrelia burgdorferi
140
What is the management of lyme disease?
- doxycycline if early disease (amox if CI, e.g. in pregnancy)
- ceftriaxone if disseminated disease
141
What rare complication can be seen after initiating drug therapy in lyme disease?
Jarisch-Herxheimer reaction (also seen in syphilis, another spirochaete)
142
What is polymyalgia rheumatica?
an inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck
*strong association with GCA, more common in older white patients
143
What are the characteristics of the pain and stiffness in polymyalgia rheumatica?
- worse in the morning, takes at least 45 mins to ease
- worse after rest/inactivity
- interfere with sleep
- somewhat improves with activity
144
What are some associated features of polymyalgia rheumatica?
- systemic sx (fatigue, low-grade fever, WL)
- muscle tenderness
- carpal tunnel syndrome
- peripheral oedema
145
Are inflammatory markers raised in polymyalgia rheumatica?
usually, but can be normal
145
How is polymyalgia rheumatica diagnosed?
sx are very non-specific - dx based on clinical presentation, response to steroids and excluding differentials
146
What is the tx of polymyalgia rheumatica?
15mg prednisolone daily (initially, requires prolonged stepping down, course will last 1-2yrs)
follow-up after 1wk (should be a dramatic, ~70%, improvement in sx)
147
What is the additional management for pts on long-term steroids? (Don't STOP)
- Dependence occurs after 3wks of tx (stopping risks adrenal crisis)
- Sick day rules (dose may need to be increased if pt becomes unwell)
- Treatment card
- Osteoporosis prevention may be required (bisphos, calcium, vit D)
- PPIs considered
148
What causes BPPV?
crystals of calcium carbonate (otoconia) become displaced in the semicircular canals which disrupts the normal flow of endolymph through canals, affecting the vestibular system - head movement creates endolymph flow triggering vertigo
149
How is BPPV diagnosed and treated?
Dix-Hallpike manoeuvre to diagnose
Epley manoeuvre to treat
Brandt-Daroff can help pt improve sx at home also
150
What are factors that can speed up the decline/cause CKD?
- diabetes
- htn
- meds (NSAIDs, lithium)
- glomerulonephritis
- polycystic kidney disease
151
What are some signs/sx of CKD?
most are asx
- fatigue
- pallor (anaemia)
- foamy urine (proteinuria)
- nausea
- loss of appetite
- pruritis
- oedema
152
How is a dx of CKD made?
dx made when consistent results over 3mths
- eGFR <60
- urine ACR >3
153
What is involved in the management of CKD?
- monitoring for progression
- address any underlying cause (optimise diabetic/htn control, reduce/avoid nephrotoxic drugs, treat any glomerulonephritis)
- exercise, healthy weight, avoid smoking
- consider statin if CVD risk
- consider ACEi, SGLT-2 i (specifically dapagliflozin) - usually if pt also has diabetes/htn
154
What usually causes folliculitis?
staphylococcus aureus
155
What is the management of folliculitis?
- if infection is uncomplicated, topical 2% mupirocin
- if local tx uneffective or case is severe, 7 day course of oral fluclox/clarithro (if allergic)
156
What causes vasovagal syncope?
a problem with the autonomic nervous system regulating blood flow to the brain - happens when the vagus nerve receives a strong stimulus (such as emotional event, pain etc) and stimulates the parasympathetic nervous system (blood vessels to the brain dilate, cerebral circulation pressure drops - hypoperfusion and fainting occurs)
157
What features in a syncopal hx indicates vasovagal?
regaining consciousness once on the ground (blood returns to the brain) - can be some twitching/shaking which confuses it with a seizure, will be a bit groggy after but not post-ictal
158
What is the pathophysiology of eczema?
defects in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation and the associated symptoms
159
What is the key to maintenance management of eczema?
to create an artificial barrier over the skin to compensate for the skins defective one - emollients (as thick and greasy as tolerated, regularly as possible)
160
How are flares of eczema treated?
- thicker emollients than maintenance
- topical steroids
- wet wraps
161
What are some thin creams that can be used as emollients for eczema?
- E45
- diprobase cream
- oilatum cream
- aveeno cream
- cetraben cream
- epaderm cream
162
What are some thicker, more greasy emollients for eczema?
- 50:50 ointment (50% liquid paraffin)
- hydromol ointment
- diprobase ointment
- cetraben ointment
- epaderm ointment
163
What is the steroid ladder (mild, mod, potent, v potent) for eczema flares?
mild = hydrocortisone (0.5, 1, 2.5%)
moderate = eumovate (clobesatone butyrate 0.05%)
potent = betnovate (betamethasone 0.1%)
very potent = dermovate (clobetasol proprionate 0.05%)
164
