Baz Y4 > 01.1 GP > Flashcards

01.1 GP Flashcards

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1
Q

What questions are important to ask to rule out uveitis in a case of conjunctivitis?

A

Pain?
Is vision affected?
Conjunctivitis should only be itchy and not affect vision

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2
Q

Acne order of treatment

A
  1. Benzine peroxide
  2. Anitbiotics
  3. Hormone pill
  4. Accutane
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3
Q

What do you have to check for before giving oral anti fungal?

A

Liver function test

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4
Q

What questions should you ask in the case of a UTI?

A

Back pain, fever? Rule out spread to pyelonephritis

Any chance of pregnancy? For antibiotic choice and asymptomatic treatment

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5
Q

Where is midazolam metabolised? What does this mean about cautions?

A

Metabolised in the kidney.

Caution must be given dose-wise in kidney injury as the half-life is extended massively

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6
Q

What blood test do you order with suspected ovarian cancer?

A

CA125

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7
Q

What blood test do you order with suspected prostate cancer?

A

Prostate specific antigen

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8
Q

What blood test do you order with suspected testicular cancer?

A

hCG

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9
Q

If a patient might have hypotension and you don’t have a way to measure to blood pressure or you are worried about a faulty cuff.

How can you use pulses to measure minimum diastolic blood pressure?

A
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10
Q

What are reticulocytes? What does they tell you about the cause of macrocytic anemia?

A

Reticulocytes are immature red blood cells (RBCs) released from the bone marrow, containing residual RNA that forms a mesh-like network, making them slightly larger than mature RBCs.

Macrocytosis + high reticulocytes = haemolysis or actute blood loss, prescence of aneamia causes bone marrow to release RBCs early to compensate.
Macrocytosis + low reticulocytes = megaloblastic anaemia, problem with dna synthesis

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11
Q

What is megaloblastic anaemia? What are the common causes?

A

This is a form of macrocytic anemia caused by an inability to synthesise DNA.

Main causes are B12/Folate deficiency (including pernicious anemia)

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12
Q

Does alcoholism cause macrocytic aneamia? is it megaloblastic?

A

It’s always macrocytic.

Whether or not it’s megaloblastic it depends.

Can lead to folate deficiency causing megaloblastic anemia.

But is also directly toxic to bone marrow causing non-megaloblastic aneamia.

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13
Q

What happens to MCV in blood loss anemia?

A

It depends.

In an acute bleed initially it’s normocytic as bone marrow hasn’t had time to respond, but then 3-5 days later it becomes macrocytic as Erythropoietin rises stimulating release of reticulocytes (mimiking hemolysis).

In chronic bleeding you end up with IDA as iron stores are depleted (different to hemolysis as in hemolysis iron is recovered). This results in microcytic aneamia.

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14
Q

Why is aneamia of chronic disease often normocytic?

A

Inflammation suppresses erythropoiesis, including EPO and bone marrow response to EPO.

So there is less RBCs getting made however they are normal.

Although it also causes functional iron deficiency due to hepcidin increase surpressing iron release from stores this doesn’t reduce it enough to affect hemoglobin quality as only a little is being made anyway. It can, however, sometimes lead to microcytic anaemia if inflammation is extreme and very chronic. The way to tell the difference will be ferritin/transferrin studies.

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15
Q

What is thalassemia?

A

Inherited anemia caused by gene mutations affected ability to make haemoglobin properly.

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16
Q

Causes of microcytic anaemia?

How to tell the difference?

A

IDA (includes chronic bleeds)
Thalassemia
AoCD (in extreme cases)

Can tell apart with ferritin/transferrin/free iron/RBC count

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17
Q

Causes of normocytic anaemia?

A

Aneamia of chronic disease
CKD/Low erythropoietin
Bone marrow failure (in this case all other white cells and platelets would also be low)

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18
Q

Causes of macrocytic aneamia?

A

B12/ Folate deficiency
Alcoholism
Heamolysis
Acute bleeds

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19
Q

In a coagulation screen what coagulation pathways do PT and APTT represent?

A

Prothrombin Time
extrinsic pathway – PeT

Activated Partial Thromboplastin Time
intrinsic pathway – APinTT

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20
Q

Solve this

A

Result 1: PT ↑, APTT normal, fibrinogen normal

PT measures: extrinsic pathway (Factor VII)

APTT normal → intrinsic pathway fine
✅ This pattern fits Warfarin therapy (affects vitamin K-dependent factors like VII → PT prolonged first).

Result 2: PT normal, APTT ↑, fibrinogen normal

APTT measures: intrinsic pathway (Factors VIII, IX, XI, XII)

PT normal → extrinsic pathway fine
✅ This fits Boy with factor VIII deficiency (Hemophilia A).

Result 3: PT ↑, APTT ↑, fibrinogen ↓

Both pathways prolonged + low fibrinogen
✅ Classic for advanced liver failure (all clotting factors produced in liver, plus fibrinogen can drop).

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21
Q

In an FBC, what happens to neutrophils, leukocytes and platelets during infection/inflammation?

A

All can be raised

(sometimes neutrophils are reduced in acute infection due ot all being used up)

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22
Q

In an FBC, what happens to neutrophils, leukocytes and platelets during bone marrow failure?

A

All can be lowered

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23
Q

What can happen to platelet count in IDA?

A

Raised

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24
Q

What can happen to platelet count in blood loss?

A

Lowered

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25
What can happen to lymphocyte count in ageing?
Lowered
26
What can happen to lymphocyte count in lymph malignancy?
Raised
27
What can happen to neutrophil count when on steroids?
Raised (counterintuitive but I think it's because they are accumulating in the blood as immune sytem is suppressed so not being deployed to other parts of the body)
28
What is FIRES (Febrile Infection-Related Epilepsy Syndrome)
This is a rare condition where patients develop treatment-resistant seizures in response to any fevers.
29
What does the BIND acronym stand for when opening any consultation with a young infant?
B - Birth: delivery, early, late, complications? I - Immunisations: are they up to date with jabs? N - Nutrician: have they been eating/ drinking? weight? D - development: Have they been meeting developmental milestones? Any concerns from the health visitors?
30
When opening any paediatric consultation what extra part of WINDEC should you do?
Name of child and adult. Confirm the adult's relationship to the child.
31
What is suborrheic dermatitis? What is another name for it? What does it look like? WHat are the treatments?
Seborrheic dermatitis is a common, chronic inflammatory skin condition causing red, itchy, and greasy, scaly patches, primarily affecting oil-rich areas like the scalp, face, and chest. Also known as cradle cap. It is linked to the Malassezia yeast, which feeds on skin oil. Treatment: Antifungal & anti-inflammatory shampoos or creams
32
What is Oxymetazoline?
A short acting alpha-adrenergic agonist used for nasal congestion.
33
Why is Oxymetazoline often not advised?
If used for more than 3-7days it can cause rebound congestion and dependance
34
If someone has chronic congestion what medication should you ask about?
Nasal sprays Particularly oxymetazoline. If used long term can actually be the cause of the congestion.
35
If thinking about a penacillin antibiotic, what is the rule of thumb what the part of the body?
Respiratory: Ammoxacillin Skin: Flucoxacillin For Otitis externa/ media why give ammox? Because it has a respiratory element due to the connection to the nose/throat via the ustacian tube.
36
How do children present differently to adults when unwell?
They can present very non-specifically. They are also better at masking. When a child is visibly sick, often their obs will be extreme.
37
For eye issues, what is the rule of thumb for it being infectious or allergic?
Unilateral: often infective Bilateral: often allergic
38
What eye red flags q are there?
Change in vision? Photophobia? Pain?
39
If someone has otitis media following a cold would you be thinking viral or bacterial?
Viral. It will have likely travelled up the eustachian tube following a viral infection
40
If someone has had otitis media and now the pain suddenly clears and there is discharge, would you consider antibiotics?
Yes. Even if it was viral to begin with now that it has perferated you must give antibiotic to prevent bacteria in the external ear canal travelling back into the middle ear.
41
What surgical intervention might chronic otitis media require?
A gromit to allow draining and allow hearing to return
42
What is this?
Guttate psoriasis. An acute, often temporary form of psoriasis characterized by a sudden outbreak of small, teardrop-shaped, salmon-pink scaly patches, typically appearing on the torso and limbs.
43
What is this?
A melonoma on the nail bed
44
Which age group is doxycycline contraindicated?
Under 12. Affects bone development.
45
What would be the normal alternative ot pennicillin in someone with a penicillin allergy?
Doxycycline
46
Main menopausal symptoms
Hot flushes Brain fog Mood swings
47
When in perimenopause, when do people experience symptoms in terms of oestrogen level?
When the oestrogen swings low. You get peaks and troughs resulting in periodic symptoms
48
With combined HRT. What is the difference between continuous combined (both oestrogen and progesterone all the time) and sequential combined (oestrogen for 14 days, then both for 14 days)
Sequential mimica a menstrual cycle and can give withdrawal bleeds
49
Who might you give unopposed oestrogen-only HRT to?
Those with a hysterectomy or other uterine protection such as a Mirena coil.
50
What criteria should you consider when prescribing contraception?
UK-MEC
51
Important contraindication questions to ask when prescribing contraception?
Blood pressure Clotting risk PMH
52
How long can it take for HRT effects to begin?
It can take a few weeks to start to feel the effects. Can take 3 months to feel full effects.
53
When can testosterone help in HRT?
Labido Spontaneity Myalgia Brain fog
54
Why can testosterone alone not help with some of the testosterone deficiency symptoms in women?
It needs a little bit of oestrogen to work. If oestrogen low you can still get symptoms of teststerone deficiency even if testosterone is normal
55
Main long term benefit vs risks of HRT?
Long term prevention of osteoporosis. Cardiovascular protection (bad if started too late as can destabilise existing plaques) Increased risk of breast cancer in combined HRT
56
Back pain red flags
Cauda Equina: Saddle aneastesia Urinary/ Bowel incontinance Bilateral radiating leg pain Cancer: Night pain Weight loss PMH/FH cancer Weakness Fracture: Kyphosis Sudden onset PMH falls Osteoporosis Tenderness Infection: Eryhtema Systemic features of infection
57
Medications for neurological back pain
Paracetamol/ NSAIDs Amitriptyline Gabapentin/ Pregabolin Duloxatine Lidocain/Capsaicin
58
Medications for muscles back pain
Lifestyle Paracetamol/ NSAIDs Opiates Diazapam Lidocaine/Capsaicin
59
6 causes of testicular lumps from most common to least common?
1) Epididymal cyst / Spermatocele Fluid-filled sac arising from the epididymis Usually painless, smooth, and separate from the testicle 2) Varicocele Enlarged veins in the scrotum (“bag of worms” feel) 3) Hydrocele Collection of fluid around the testicle Causes scrotal swelling rather than a discrete hard lump 4) Epididymitis Inflammation/infection of the epididymis Painful swelling, often with redness or urinary symptoms 5) Inguinal hernia Bowel or fat protruding into the scrotum Lump may increase with coughing or straining 6) Testicular cancer Less common overall, but the most important not to miss Typically a firm, painless lump within the testicle itself Most common in men aged 15–40
60
What is hydrocele? How do you test for it?
Hydrocele Collection of fluid around the testicle Causes scrotal swelling rather than a discrete hard lump Usually painless You test for it using transillumination, this is where oyu shine a light through the testicle. Redness represents harmless fluid aka hydrocele. If it is dark this would be something more concerning.
61
What is priaprism?
Erection without stimulation lasting >4h. Medical emergency
62
What is Bartholin's cyst?
This is a swelling on the sides of the vulva causes by a blockage in one of the bartholin's ducts (duct's responsible for lubrication)
63
When would a Bartholin's cyst need treatment? What would this be?
If the cyst becomes infected, it would now be called a bartholin's abcess. You will know as it be extremely painful, affecting walking and sitting. Requires draining with a wound catheter and antibiotics.
64
What age would you typically expect a bartholin's cyst to appear in?
Reproductive age. A cyst in menopausal women would be more alarming and you would consider malignancy
65
A 3y/o presents with confusion and eventually LOC. Their mum says they were at a party and they drunk a slushy. What should you check?
Check BMs. Could be glycerol toxcity which presents with sever hypoglyceamia.
66
What would a deviated uvia hint at?
Quinsy
67
What is quinsy?
Peritonsiler abcess. Usually a complication of tolsilitis. Gives hot potato voice.
68
Is hand, foot and mouth viral or bacterial?
Viral Usually clears up after 7-10 days. Best to give antihystermines and safety net.
69
What is costochondritis?
It is where the costochondral joints (where ribs meet the sternum) become inflamed after an extreme cough. Mimics pleuracy. Difference is it will be tender to touch. Pleuritic pain can't be ilicited on touch.
70
What is the centor score?
Score used to assess likelyhood of strep throat. If low sugests no action. If mid suggests swab for culture. If high suggest swab and emperical antibiotics.
71
What factors is the centor score based off?
Age 3-14 years: +1 15-44 years: 0 ≥45 years: -1 Exudate or swelling on tonsils: +1 Tender/swollen anterior cervical lymph nodes: +1 Temp >38°C: +1 Cough absent: +1
72
What is a seroma?
It is a non infected fluid filled sac that can sometimes form after and operation
73
If someone with inflamatory arthritis comes into GP with a flare up can you prescribe steroids?
Yes! If someone doesn't have a diagnosis and you are referring then you should avoid prescribing steroids as it will make it harder for the rheumatologist to assess.
74
Common biomarker for heart failure?
B-type natriuretic peptide (BNP)
75
What should you bare in mind when prescribing metronidazole?
Avoid alcohol
76
What pelvic inflammatory disease?
An infection of the female reproductive organs (uterus, fallopian tubes, ovaries) Can be caused by things like untreated chlamydia or gonorrhea
77
What obs should you always get for a presenting headache?
BP
78
What can cause high ferritin?
Liver failure Haemochromotosis
79
What things should you consider in a head to toe check up on an elderly person that has had an fall?
Causes for fall: neuro, aneamia, low BP etc. Check for injuries. Check for weakness. Palpate for tenderness. Always think of pneuthorax if injury involves chest.
80
What causes of syncope should you consider in a history/ examination?
Neuro causes (focal neuro signs) Respiratory causes (listen to chest) Cardiac causes (listen to heart) Postoral hypotension (do a sitting/standing blood pressure)
81
What blood tests make up dizzyness bloods?
Thyroid FBC Iron B12/Folate U+E
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