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GP - Misc Flashcards

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1
Q

What is conjunctivitis and what are the causes?

A

Inflammation of the conjunctiva - thin layer of tissue covering the inside of the eyelids/sclera to provide protection and lubrication

  • Bacterial
  • Viral
  • Allergic
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2
Q

What are the clinical features of bacterial conjunctivitis?

A
  • Red/bloodshot eye
  • Itchy/gritty sensation
  • Purulent discharge
  • Eyes may be ‘stuck together’ in the morning
  • Dry cough/sore throat/blocked nose (viral)

NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY

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3
Q

What are the clinical features of viral conjunctivitis?

A
  • Red/bloodshot eye
  • Itchy/gritty sensation
  • Serous discharge
  • Dry cough/sore throat/blocked nose (recent URTI)
  • Preauricular lymph nodes

NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY

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4
Q

What are the clinical features of allergic conjunctivitis?

A
  • Red/bloodshot eye
  • Itchy/gritty sensation
  • Watery discharge/swelling (allergic)

NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY

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5
Q

What is the management for conjunctivitis?

A
  • Usually resolves in 1-2 weeks without treatment
  • Hygiene measures
  • Bacterial = chloramphenicol/fusidic acid (pregnant) eye drops
  • Neonates <1 month = urgent ophthalmology assessment
  • Allergic = oral/topical antihistamines, topical mast-cell stabilisers e.g. sodium cromoglicate
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6
Q

What is blepharitis?

A

Inflammation of the eyelid margins –> lead to red eye/styes/chalazions

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7
Q

What are the clinical features of blepharitis?

A
  • Bilateral sx
  • Grittiness/discomfort around eyelid margins
  • Sticky eyes in mornings
  • Red/swollen eyelid margins
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8
Q

What is the management for blepharitis?

A
  • Hot compress
  • Lid hygiene
  • Artificial tears
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9
Q

What are styes?

A

Infections of internal/external eyelid glands

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10
Q

What are the clinical features of styes?

A
  • Small, painful lump on inside of eyelid/around eye
  • Swollen/red skin
  • May be filled with yellow pus
  • Red/watery
  • Vision unaffected
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11
Q

What is the management for styes?

A
  • Hot compress
  • Analgesia
  • Topical abx e.g. chloramphenicol
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12
Q

What is a chalazion, what are the clinical features and what is the management?

A
  • Retention cyst of the Meibomian gland
  • Firm, painless lump in the eyelid
  • Majority resolve spontaneously
  • Surgical drainage
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13
Q

What is an entropion/ectropion, what are the clinical features and what is the management?

A
  • In/out-turning of the eyelids
  • Entropion = inward-turning eyelid with lashes pressed against eye/pain/corneal damage and ulceration
  • Ectropion = outward-turning eyelid exposing inner aspect/usually affects bottom lid/exposure keratopathy
  • Entropion = taping eyelid down/lubricating eye drops/surgery
  • Ectropion = lubricating eye drops/surgery
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14
Q

What is trichiasis, what are the clinical features and what is the management?

A
  • Inward growth of the eyelashes
  • Pain
  • Corneal damage/ulceration
  • Remove affected eyelashes
  • Recurrent cases = electrolysis/cryotherapy/laser treatment
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15
Q

What is the difference between atopy and allergy?

A

Atopy = exaggerated IgE-mediated immune response (type I hypersensitivity)

Allergy = any exaggerated immune response to a foreign antigen

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16
Q

What does vitamin D deficiency cause?

A

Rickets (children)
Osteomalacia (adults)

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17
Q

What are some causes of osteomalacia?

A
  • Vitamin D deficiency (malabsorption/diet/lack of sunlight)
  • CKD
  • Drugs e.g. anticonvulsants
  • Liver cirrhosis
  • Coeliac
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18
Q

What are the clinical features of osteomalacia?

A
  • Bone pain
  • Bone/muscle tenderness
  • Fractures (especially femoral neck)
  • Proximal myopathy (waddling gait)
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19
Q

What are the investigations and management for osteomalacia?

A
  • Bloods = low vitamin D/calcium/phosphate and raised alkaline phosphate
  • X-ray = translucent bands
  • Vitamin D supplementation
  • Calcium supplementation
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20
Q

What are the risk factors for rickets?

A
  • Deficiency (diet)
  • Prolonged breastfeeding
  • Unsupplemented cow’s milk formula
  • Lack of sunlight
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21
Q

What are the clinical features of rickets?

A
  • Aching bones/joints
  • Bow legs
  • Knock knees
  • Kyphoscoliosis
  • Craniotabes (soft skull bone)
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22
Q

What is the investigation and management for rickets?

A
  • Bloods = low vitamin D/calcium and raised alkaline phosphate
  • Oral vitamin D
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23
Q

What are risk factors for osteopenia/osteoporosis?

A
  • Elderly
  • Female

SHATTERED:
- Steroid use
- Hyperthyroidism/hyperparathyroidism/hypercalciuria
- Alcohol/tobacco use
- Thin (BMI <18.5)
- Testosterone low
- Early menopause
- Renal/liver failure
- Erosive/inflammatory bone disease
- Dietary low calcium/malabsorption and diabetes type 1

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24
Q

What are the investigations for osteopenia/osteoporosis?

A
  • FRAX (major osteoporotic/hip fracture in next 10 years)
  • DEXA scan = BMD = Z score and T score

T score > -1 = normal
T score -1 to -2.5 = osteopenia
T score < -2.5 = osteoporosis

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25
What is the management for osteopenia/osteoporosis?
- Lifestyle changes - Vitamin D/calcium supplementation - Bisphosphonates (alendronate/risedronate/zoledronate) = take with full glass of water on empty stomach and remain upright for at least 30 mins after - Denosumab - HRT
26
What are the causes of otitis externa?
- Bacterial (staph aureus/pseudomonas aeruginosa) - Fungal - Seborrhoeic dermatitis - Contact dermatitis - Recent swimming = trigger
27
What are the clinical features and investigations for otitis externa?
- Ear pain/itch - Ear discharge - Otoscopy = red/swollen/eczematous canal
28
What is the management for otitis externa?
- Topical abx +/- steroid - Ciprofloxacin/flucloxacillin/clarithromycin
29
What are the causes of otitis media?
- Bacterial (strep pneumoniae/haemophilus influenzae/moraxella catarrhalis) - Viral (RSV/rhinovirus)
30
What are the clinical features of otitis media?
- Otalgia - Fever - Reduced hearing in affected ear - URTI sx - Discharge (perforated TM)
31
What is the investigation for otitis media?
Otoscopy: - Bulging TM (loss of light reflex) - Opacification/erythema of TM - Perforation with purulent otorrhoea
32
What is the management for otitis media?
- Usually self-limiting - Abx = 5-7 day course of amoxicillin/erythromycin/clarithromycin
33
What are the complications of otitis media?
- Otitis media with effusion (glue ear) - Hearing loss - Perforated eardrum - Mastoiditis - Abscess
34
What are the causes of tonsilitis?
- Viral - Bacterial (strep pyogenes/strep pneumoniae/haemophilus influenzae/moraxella catarrhalis/staph aureus)
35
What area is affected in tonsilitis and what are the clinical features?
- Palatine tonsils - Sore throat - Fever - Painful swallowing
36
What are the investigations for tonsilitis?
- Throat examination = red/inflamed/enlarged tonsils +/- exudate - Anterior cervical lymphadenopathy
37
What criteria is used for tonsilitis?
Centor criteria = estimates risk of bacterial infection (2 or more) - Fever - Tonsillar exudates - Absence of cough - Tender anterior cervical lymphadenopathy - Under 15
38
What is the management for tonsilitis?
- Analgesia/safety net advice - Abx = phenoxymethylpenicillin/clarithromycin
39
What are the indications for a tonsillectomy?
- Sore throats due to tonsilitis - 7 episodes per year for one year/5 per year for two years/3 per year for 3 years - Episodes of sore throat are disabling/prevent normal functioning
40
What are the complications of tonsilitis?
- Otitis media - Quinsy (peritonsillar abscess) - Rheumatic fever - Glomerulonephritis
41
What are the causes of tinnitus?
- Idiopathic (most common) - Meniere's disease - Otosclerosis - Sudden onset sensorineural hearing loss - Acoustic neuroma - Hearing loss - Drugs (aspirin/NSAIDs/aminoglycosides/loop diuretics/quinine) - Impacted ear wax
42
What is the management for tinnitus?
- Treat underlying cause - Amplification device - CBT - Support groups
43
What is the cause of mumps/parotitis?
RNA paramyxovirus
44
What are the clinical features of mumps/parotitis?
- Fever - Muscles aches - Lethargy - Parotid gland swelling with associated pain
45
What are the investigations for mumps/parotitis?
- PCR testing on saliva swab - Bloods/saliva tested for antibodies
46
What is the management for mumps/parotitis?
- Notify public health - Usually self-limiting - MMR vaccine
47
What are the complications of mumps/parotitis?
- Pancreatitis - Orchitis - Meningitis/encephalitis - Sensorineural hearing loss
48
What is the triad of clinical features of nephrotic syndrome vs nephritic syndrome?
Nephrotic = proteinuria, hypoalbuminaeia, oedema Nephritic = proteinuria, haematuria, oliguria, HTN
49
What is the most common cause of nephrotic syndrome and what is the management?
- Minimal change disease - High dose steroids - Alternative immunosuppressant e.g. ciclosporin
50
What is the cause of chlamydia?
Chlamydia trachomatis - gram -ve bacteria
51
What is the cause of gonorrhoea?
Neisseria gonorrhoea - gram -ve diplococcus
52
What are the investigations for STIs?
- First catch urine for NAAT - Urethral swab for culture
53
What follow up is required for patients with STIs?
Test of cure
54
What is the cause of syphilis?
Treponema pallidum - spirochete
55
What investigations can be done for syphilis?
VDRL - present in active infection TPHA - present after treatment to confer immunity
56
What is the management for Wilson's disease?
Copper chelating agent e.g. penicillamine
57
What are sanctuary sites?
Sites protected from chemotherapeutic agents - CNS - Testes
58
What are the stages of CKD?
- Stage 1 = >90 - Stage 2 = 60-89 - Stage 3a = 45-59 - Stage 3b = 30-44 - Stage 4 = 15-29 - Stage 5 = <15
59
What are the stages of AKI?
- Stage 1 = creatinine is 1.5-1.9 times higher than baseline/urine output <0.5ml/kg for >6 consecutive hours - Stage 2 = creatinine is 2-2.9 times higher than baseline/urine output <0.5ml/kg for >12 consecutive hours - Stage 3 = creatinine is >3 times higher than baseline/urine output <0.5ml/kg for >24 hours/anuria for >12 hours
60
What medications can cause AKI?
- NSAIDs - ACEis - ARBs - CCBs - Alpha blockers - Beta blockers - Opioids - Diuretics - Aciclovir - Trimethoprim - Lithium
61
What is the typical presentation of ischaemic hepatitis?
Liver failure following MI
62
What medication is given for pain in palliative care?
- Diamorphine/morphine - Oxycodone (if renal impairment)
63
What medication is given for distress/agitiation/breathlessness in palliative care?
Midazolam/haloperidol
64
What medication is given for respiratory tract secretions/bowel spasm in palliative care?
Buscopan (hyoscine butylbromide)
65
What medication is given for N+V in palliative care?
Haloperidol/metoclopramide
66
What are some causes of falls?
- Orthostatic hypotension - POTS - Anaemia - Arrhythmias - Epilepsy - Peripheral neuropathy - Ataxia/cerebellar disease - Vision problems - Drug induced e.g. antihypertensives
67
What medication is given in orthostatic hypotension?
Fludrocortisone/midodrine
68
How can falls risk be reduced in orthostatic hypotension?
- Stay hydrated - Compression stockings - Stand up slowly - Increased salt intake - Exercise

Phase 3a (21 decks)

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