Pearls from the GPSN GP Companion book

Question 1

ABCDs of Skin Cancer

Answer 1

A - asymmetry
B - borders (irregular/round/oval/linear)
C - colour/consistency
D - diameter
S - surface (crust/excoriation/horn/lichenification/maceration/scale)
S - superficial
S - secondary sites (psoriasis-nails, scabies-finger webs, fungal-toe webs)

Question 2

What is lichenification?

Answer 2

Thickening of skin surface secondary to chronic scratching or rubbing

Question 3

Macule/Papule
Nodule/Plaque
Vesicle/Bulla
Pustule/Weal

Answer 3

Macule - Circumscribed area of altered skin colour 0.5cm
Plaque - Flat topped palpable mass >1cm
Vesicle - Visible collection of fluid within skin 0.5cm
Pustule - Visible collection of pus within skin surface
Weal - Area of dermal oedema of any size

Question 4

ABCDE of Melanoma

Answer 4

A - appearance and asymmetry
B - border
C - colour
D - diameter and distribution
E - evolution

Question 5

Describe the typical morphology of BCCs

Answer 5

Pearly, raised rolled border, central depression, telangiectasia, non scaling lesions on sun-exposed areas

Question 6

OGTT cut-offs for diagnosis of diagnosis of T2DM

Answer 6

11.1 - diabetes likely

Question 7

Fasting glucose cut-offs for diagnosis of T2DM

Answer 7

7.0 - diabetes likely, repeat fasting on separate day

Question 8

Pre-prandial and post-prandial goals for glycaemic control in T2DM?

Answer 8

Pre-prandial

Question 9

Goal for HbA1c in T2DM?

Question 10

For how long is HbA1c a measure of BGLs?

Answer 10

Index of mean plasma glucose levels over the preceding 2-3 months (the red blood cell lifecycle)

Question 11

Causes of increased prolactin?

Answer 11

Physiological - pregnancy, breast stimulation, stress

Pathological - prolactinoma, pituitary tumour, hypothalamic disorders, phenothiazines, metoclopramide, oestrogens

Question 12

The differentiating factor on TFTs between primary or secondary hypothryoidism?

Answer 12

TSH - increased in primary and decreased in secondary (pituitary dysfunction)

Question 13

Modifiable lifestyle factors for BP and CVD risk?

Answer 13

SNAP
S - Smoking
N - Nutrition
A - Alcohol
P - Physical activity

Question 14

BP treatment goals for general population and those with CVD, diabetes or CKD?

Answer 14

No cormorbidities -

Question 15

Secondary causes of hypertension

Answer 15

Glomerulonephritis
Reflux nephropathy
Renal artery stenosis
Primary aldosteronism
Cushing's syndrome
Phaeochromocytoma
OCP
Coarctation of the aorta
Pregnancy
Medications

Question 16

What to do if blood pressure goals are not reached on initial treatment?

Answer 16

Add a second agent, then increase doses
Then add a third agent
Refer for specialist assistance

Question 17

What agents should be used first line for hypertension?

Answer 17

ACEi or ARB
Calcium channel blocker
Low dose thiazide diuretic (for patients aged 65+ years)

Question 18

ECG rate = how many large squares between R-R interval

Answer 18

1 = 300
2 = 150
3 = 100
4 = 75
5 = 60
6 = 50

Question 19

What is a rough way of determining rate on an ECG?

Answer 19

Counting the number of QRS complexes in the standard rhythm strip and multiplying by 6

Question 20

Which ECG leads correspond to which region of the heart (anterior, inferior, lateral, septal)?

Answer 20

Anterior: V3-V4
Inferior: II, III and aVF
Lateral: I, aVL, V5-V6
Septal: V1-V2

Question 21

Timeframe of elevation of troponin T post-MI?

Answer 21

Begins 4-8 hrs post MI
Peaks at 10-12 hrs post MI
Remains elevated for up to 7 days

Question 22

Causes of raised CK?

Answer 22

Myocardial damage
Skeletal muscle damage
Post IM injection
Excessive exercise
Rhabdomyolysis
Myopathies
Hypothyroidism

Question 23

The 6 Ps of acute arterial insufficiency?

Answer 23

Pain
Pulselessness
Pallor
Polar (cool)
Paresthesia
Paralysis

Question 24

5As of smoking cessation?

Answer 24

Ask
Assess
Advise
Assist
Arrange

Question 25

What is the MCV of microcytic anaemia? | List some causes.

Answer 25

MCV

Question 26

What is the MCV range of normocytic anaemia? | List some causes.

Answer 26

``` MCV 80-95 Acute blood loss Anaemia of chronic disease Hypo-production of RBCs (renal failure EPO reduction, bone marrow failure) Pregnancy Hypothyroidism ```

Question 27

What is the MCV range of macrocytic anaemia? | List some causes.

Answer 27

``` MCV >95 B12 and/or folate deficiency Drug induced Liver disease Alcohol abuse Bone marrow failure/infiltration Chronic hypoxic lung disease Hypothyroidism ```

Question 28

Medications that can cause a neutrophilia?

Answer 28

``` Corticosteroids Cytokines Clozapine Lithium Tobacco ```

Question 29

Broad causes of eosinophilia?

Answer 29

Medications Atopic reactions (eczema/asthma) Skin disorders (psoriasis/scabies) Parasitic infections (malaria/toxo/ascaris/strongyloides) Malignancy (radiation tx/Hodgkin's/myeloproliferative disorders/eosinophilic granuloma)

Question 30

Causes of aplastic anaemia?

Answer 30

``` Cytotoxic Irradiation Viral infection Parvovirus B19 AIDS ```

Question 31

Bacterial cause of a monocytosis?

Answer 31

TB

Question 32

List some acute phase reactants

Answer 32

``` CRP and ESR Fibrinogen Ferritin Haptoglobins Alpha-1 antitrypsin Caeruloplasim Facter VIII von Willibrand factor ```

Question 33

Which is more sensitive? CRP or ESR?

Answer 33

CRP is more sensitive and elevates earlier than ESR | Except in SLE and UC where ESR is more sensitive

Question 34

ESR >100 =

Answer 34

Multiple myeloma TB Temporal arteritis

Question 35

Coag studies: APTT stands for what, relates to which pathway and which factors?

Answer 35

Activated partial thromboplastin time Intrinsic pathway Factors XII, XI, IX

Question 36

Coag studies: PT stands for what, relates to which pathway and which factors?

Answer 36

Prothrombin time (converted to INR) Extrinsic pathway Factor VII

Question 37

Coag studies: TT stands for what, relates to which pathway and which factors?

Answer 37

Thrombin time Common pathway Factors X, V, II, I (fibrinogen to fibrin clot)

Question 38

Causes of increased D-dimer besides DVT/PE?

Answer 38

``` DIC Malignancy Post-surgery Pregnancy Severe infection Renal disease Liver disease Heart failure ```

Question 39

Heparin causes what APTT and PT picture?

Answer 39

Prolonged APTT | Normal PT

Question 40

Warfarin causes what APTT and PT picture

Answer 40

Normal APTT | Prolonged PT

Question 41

If there is no bilirubin in the urine of a jaundiced patient what does that mean?

Answer 41

That the jaundice is due to unconjugated bilirubin eg haemolysis

Question 42

When could you have urine nitrites negative but still have a UTI?

Answer 42

Gram-positive organisms | Pseudomonas

Question 43

What conditions cause an elevated serum urea?

Answer 43

Conditions that cause decreased GFR - Pre-renal or renal disease - Bleeding into the GIT tract - Hypercatabolic state

Question 44

What conditions cause a decreased serum urea?

Answer 44

``` Pregnancy Water retention Decreased synthesis Decreased protein intake Severe liver disease Urea-cycle defects ```

Question 45

Elevated serum bicarbonate = metabolic ..... or compensated respiratory ..... Decreased serum bicarbonate = metabolic .....

Answer 45

Elevated in metabolic alkalosis or compensated respiratory acidosis Decreased in metabolic acidosis (Also decreased as artefact if blood collection tube is partially filled or left uncapped due to loss of CO2)

Question 46

Causes of decreased potassium

Answer 46

``` Loop or thiazide diuretics Vomiting or diarrhoea Alkalosis Treatment of acidosis Mineralocorticoid excess ```

Question 47

Causes of increased potassium

Answer 47

``` Acidosis Tissue damage Renal failure Mineralocorticoid deficiency Iatrogenic excess Poor collection, delay in separation and refrigeration ```

Question 48

High anion gap acidosis? What an anion other than chloride which can be elevated?

Answer 48

Lactate in lactic acidosis

Question 49

States of kidney disease by eGFR?

Answer 49

``` Stage 1 - 90 Stage 2 - 60-89 Stage 3 - 30-59 Stage 4 - 15-29 Stage 5 - ```

Question 50

Causes of increased albumin in blood?

Answer 50

Dehydration Acute phase response Excessive tourniquet time

Question 51

Causes of decreased albumin in blood?

Answer 51

``` Fluid overload Chronic liver disease Protein losing disorders Malnutrition Burns ```

Question 52

Causes of increased bilirubin in blood?

Answer 52

``` Hepatocellular disease Biliary disease Haemolysis Megaloblastic anaemia Gilbert syndrome ```