GP

Question 1

presentation of croup

Answer 1

sudden onset of seal-like barky cough
respiratory distress (stridor, sternal/intercostal indrawing, tachypnoea)
agitation
hoarse voice
fever

worse at night

Question 2

management of croup

Answer 2

oral dexamethasone

nebulised adrenalin if severe (stridor, agitation, lethargy)

Question 3

causes of croup

Answer 3

parainfluenza
adenovirus
influenza

Question 4

differentials of croup

Answer 4

epiglottitis
foreign body inhalation
bacterial tracheitis

Question 5

management of hypertension

Answer 5

lifestyle
ACEI (ARB if not tolerated)/CCB (<55/>55 or African/Caribbean)
add one of ACEI/ARB, CCB, thiazide diuretic
combination of all three
consider 4th drug (spironolactone or beta/alpha blocker) or increase thiazide dose

Question 6

presentation of eczema

Answer 6

dry and itchy

common areas

infants: cheeks, forehead, scalp, flexor surfaces
children: ankles, wrists, popliteal and antecubital fossa
chronic: hands, feet, back, neck

Question 7

management of eczema

Answer 7

emollients
hydrocortisone
chlorphenamine
Abx if signs of infection (cover for s. aureus)

Question 8

presentation of psoriasis

Answer 8

red, white, scaly, papules, plaques
may be painful, pustular, bleed
common sites: elbows, knees, extensor surfaces, scalp

Question 9

management of psoriasis

Answer 9

hydrocortisone
phototherapy
methotrexate
phosphodiesterase 4 inhibitor
biologics
oral retinoid
ciclosporin

Question 10

cause of acne vulgaris

Answer 10

Propionibacterium

Question 11

pathophysiology of acne

Answer 11

abnormal follicular differentiation -> retained keratinocytes
high androgens increase sebum viscosity and production
keratin and sebum blockage of sebaceous glands
colonisation of Propionibacterium
inflammatory/immune response -> papules, pustules etc. formation

Question 12

management of Acne

Answer 12

topical retinoid (tretinoin)
topical Abx (clindamycin)
oral Abx (erythromycin)
adjunct: benzoyl peroxide, COCP
for severe: oral retinoid (isotretinoin)

Question 13

side effects of isotretinoin

Answer 13

deranged LFTs
severe headaches
teratogenic
mood disturbances

Question 14

risk factors for skin cancer

Answer 14

sunlight/UV radiation
fhx of skin cancers
HPV
moles

Question 15

describe basal cell carcinoma

Answer 15

pearly papules and/or plaques associated with telangiectasia

commonly on head/neck

Question 16

describe SCC of skin

Answer 16

ulcerated leion or exophytic tumour
may be friable and bleed

AK = irregular crusty lesion
BD = red/brown scaly plaque

Question 17

describe melanoma

Answer 17

deeply pigmented lesion

either new or change in size, shape or colour

Question 18

management of SSC

Answer 18

AK/BD = cautery or 5 fluorouracil

SSC - 4mm margins

Question 19

management of BCC

Answer 19

superficial = imiquimod or 5 fluorouracil
deep = 4mm margins

Question 20

management of melanoma

Answer 20

breslow <1mm = 1cm margins
breslow >1mm  = 2cm margins
adjunct chemotherapy (ipilimumab, BRAF or MEK inhibitor)

Question 21

CURB 65

Answer 21

confusion
urea > 7
RR > 30
BP (S<90, D<60)
age >65

Question 22

causative organisms of pneumonia

Answer 22

strep pneumoniae
haemophilus influenzae
moraxella

mycoplasma
legionella

Question 23

presentation of pneumonia

Answer 23

cough with purulent discharge
fever
dyspnoea
chest pain

atypical
persistent cough usually dry
diarrhoea (legionella)

Question 24

clinical findings in pneumonia

Answer 24

crepitation
increase vocal resonance/fremitus
dull percussion

signs less prominent in atypical

Question 25

investigations for pneumonia

Answer 25

WWC, CRP urea blood and sputum cultures CXR LFTs - elevated on mycoplasma and legionella urine legionella

Question 26

management of pneumonia based of CURB65

Answer 26

0-1 = oral amoxicillin 2-3 = hospital admission, IV amoxicillin, oxygen > 4 = consider ICU, IV co-amoxicillin + IV clarithromycin, oxygen

Question 27

management of atypical pneumonia

Answer 27

mycoplasma - clarithromycin/doxycycline | legionella - ciprofloxacin + clarithromycin

Question 28

virchow triad

Answer 28

venous stasis (immobility, GA, advanced COPD/HR) vessel wall damage (trauma, previous DVT, central venous catheterization) hypercoagulability (high oestrogen, cancer, thrombophilia)

Question 29

presentation of DVT

Answer 29

calf swelling/asymmetrical oedema localised pain along deep venous system prominent superficial veins

Question 30

management of DVT

Answer 30

``` exercise anticoagulation (enoxaparin/rivaroxaban) - continue for 3 -6 months ```

Question 31

presentation of chronic limb ischaemia

Answer 31

``` intermittent claudication rest pain (worse at night) - critical limb ischaemia ``` weak pulses prolonged CRT ulcers: punched out, painful, over pressure points skin changes: cold, white, loss of hair

Question 32

management of intermittent claudication

Answer 32

exercise, smoking cessation, weight loss, foot care | statin, glycaemic control, aspirin/clopidogrel

Question 33

management of COPD

Answer 33

salbutamol/ipratropium if signs of asthma + LABA and ICS if no signs of asthma + LABA and LAMA still not controlled = SABA + LABA + LAMA + ICS

Question 34

management of asthma

Answer 34

SABA (salbutamol) Escalate if required: + ICS (beclomethasone) + LABA (salmeterol) + leukotriene receptor antagonist (montelukast)/theophylline/LAMA(tiotropium)

Question 35

management of hypothyroidism

Answer 35

levothyroxine + carbidopa

Question 36

management of hyperthyroidism

Answer 36

``` 1st line = carbimazole 2nd line = propylthiouracil (PTU) beta blocker for symptoms radioactive iodine thyroidectomy ```

Question 37

causes of TATT

Answer 37

``` OSA depression anaemia B12/folate deficiency hypothyroidism adrenal insufficiency CKD ```

Question 38

eradication therapy for h pylori

Answer 38

omeprazole + clarithromycin + amoxicillin

Question 39

presentation of crohns

Answer 39

``` non bloody diarrhoea abdo pain perianal lesions oral ulcers fever ```

Question 40

presentation of UC

Answer 40

``` bloody diarrhoea abdo pain rectal bleeding joint pain rashes (pyoderma gangrenosum, erythema nodosum) uveitis ```

Question 41

how is acute severity of a UC flare up determined

Answer 41

``` truelove and witts criteria bloody stool/day HR temp Hb ```

Question 42

management of crohns

Answer 42

Inducing remission Steroids: IV methylprednisolone or oral prednisolone Budesonide 5ASA: sulfasalazine or mesalazine Add Immunomodulators if required: azathioprine, methotrexate If refractory to above = Biologics: infliximab, adalimumab ``` Maintaining remission Smoking cessation Azathioprine Methotrexate = second line Mesalazine if the patient has had previous surgery ```

Question 43

management of UC

Answer 43

``` Oral prednisolone Mesalazine (oral or topical) Azathioprine Infliximab, adalimumab colectomy ```

Question 44

what should be included in fall risk of the elderly assessment

Answer 44

``` Falls history. Assessment of gait, balance, mobility. Osteoporosis risk (see Patients’ perceived functional ability and fear of falling. Vision. Cognition. Urinary incontinence. Home hazard assessment. Cardiovascular examination. Medication review ```

Question 45

management of UTI

Answer 45

``` upper = ciprofloxacin/cefalexin lower = nitrofurantoin/trimethoprim ```

Question 46

presentation of UTI

Answer 46

upper = systemic + bacteriuria fever, malaise, fatigue, vomiting, loin pain, rigors lower = urinary symptoms + bacteriuria frequency, urgency, haematuria, dysuria

Question 47

symptoms of BPH

Answer 47

voiding hesitancy, intermittency, slow stream, straining, terminal dribbling

Question 48

management of BPH

Answer 48

alpha blockers - tamulosin | 5a reductase inhibitor

Question 49

management of angina

Answer 49

``` aspirin and statin GTN betablocker or CCB add BB/CCB nicorandil, long acting nitrate, ivabridine ```