GP - Misc Flashcards by Ellen Wong

What is conjunctivitis and what are the causes?

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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What are the clinical features of bacterial conjunctivitis?

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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What are the clinical features of viral conjunctivitis?

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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What are the clinical features of allergic conjunctivitis?

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

NO PAIN
NO PHOTOPHOBIA
NO REDUCED VISUAL ACUITY

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What is the management for conjunctivitis?

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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What is blepharitis?

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

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What are the clinical features of blepharitis?

Bilateral sx
Grittiness/discomfort around eyelid margins
Sticky eyes in mornings
Red/swollen eyelid margins

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What is the management for blepharitis?

Hot compress
Lid hygiene
Artificial tears

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What are styes?

Infections of internal/external eyelid glands

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What are the clinical features of styes?

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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What is the management for styes?

Hot compress
Analgesia
Topical abx e.g. chloramphenicol

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

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

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

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

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

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What is the difference between atopy and allergy?

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

Allergy = any exaggerated immune response to a foreign antigen

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What does vitamin D deficiency cause?

Rickets (children)
Osteomalacia (adults)

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What are some causes of osteomalacia?

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

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What are the clinical features of osteomalacia?

Bone pain
Bone/muscle tenderness
Fractures (especially femoral neck)
Proximal myopathy (waddling gait)

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What are the investigations and management for osteomalacia?

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

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What are the risk factors for rickets?

Deficiency (diet)
Prolonged breastfeeding
Unsupplemented cow’s milk formula
Lack of sunlight

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What are the clinical features of rickets?

Aching bones/joints
Bow legs
Knock knees
Kyphoscoliosis
Craniotabes (soft skull bone)

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What is the investigation and management for rickets?

Bloods = low vitamin D/calcium and raised alkaline phosphate
Oral vitamin D

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What are risk factors for osteopenia/osteoporosis?

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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What are the investigations for osteopenia/osteoporosis?

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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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

What are the causes of otitis externa?

- Bacterial (staph aureus/pseudomonas aeruginosa) - Fungal - Seborrhoeic dermatitis - Contact dermatitis - Recent swimming = trigger

What are the clinical features and investigations for otitis externa?

- Ear pain/itch - Ear discharge - Otoscopy = red/swollen/eczematous canal

What is the management for otitis externa?

- Topical abx +/- steroid - Ciprofloxacin/flucloxacillin/clarithromycin

What are the causes of otitis media?

- Bacterial (strep pneumoniae/haemophilus influenzae/moraxella catarrhalis) - Viral (RSV/rhinovirus)

What are the clinical features of otitis media?

- Otalgia - Fever - Reduced hearing in affected ear - URTI sx - Discharge (perforated TM)

What is the investigation for otitis media?

Otoscopy: - Bulging TM (loss of light reflex) - Opacification/erythema of TM - Perforation with purulent otorrhoea

What is the management for otitis media?

- Usually self-limiting - Abx = 5-7 day course of amoxicillin/erythromycin/clarithromycin

What are the complications of otitis media?

- Otitis media with effusion (glue ear) - Hearing loss - Perforated eardrum - Mastoiditis - Abscess

What are the causes of tonsilitis?

- Viral - Bacterial (strep pyogenes/strep pneumoniae/haemophilus influenzae/moraxella catarrhalis/staph aureus)

What area is affected in tonsilitis and what are the clinical features?

- Palatine tonsils - Sore throat - Fever - Painful swallowing

What are the investigations for tonsilitis?

- Throat examination = red/inflamed/enlarged tonsils +/- exudate - Anterior cervical lymphadenopathy

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

What is the management for tonsilitis?

- Analgesia/safety net advice - Abx = phenoxymethylpenicillin/clarithromycin

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

What are the complications of tonsilitis?

- Otitis media - Quinsy (peritonsillar abscess) - Rheumatic fever - Glomerulonephritis

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

What is the management for tinnitus?

- Treat underlying cause - Amplification device - CBT - Support groups

What is the cause of mumps/parotitis?

RNA paramyxovirus

What are the clinical features of mumps/parotitis?

- Fever - Muscles aches - Lethargy - Parotid gland swelling with associated pain

What are the investigations for mumps/parotitis?

- PCR testing on saliva swab - Bloods/saliva tested for antibodies

What is the management for mumps/parotitis?

- Notify public health - Usually self-limiting - MMR vaccine

What are the complications of mumps/parotitis?

- Pancreatitis - Orchitis - Meningitis/encephalitis - Sensorineural hearing loss

What is the triad of clinical features of nephrotic syndrome vs nephritic syndrome?

Nephrotic = proteinuria, hypoalbuminaeia, oedema Nephritic = proteinuria, haematuria, oliguria, HTN

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

What is the cause of chlamydia?

Chlamydia trachomatis - gram -ve bacteria

What is the cause of gonorrhoea?

Neisseria gonorrhoea - gram -ve diplococcus

What are the investigations for STIs?

- First catch urine for NAAT - Urethral swab for culture

What follow up is required for patients with STIs?

Test of cure

What is the cause of syphilis?

Treponema pallidum - spirochete

What investigations can be done for syphilis?

VDRL - present in active infection TPHA - present after treatment to confer immunity

What is the management for Wilson's disease?

Copper chelating agent e.g. penicillamine

What are sanctuary sites?

Sites protected from chemotherapeutic agents - CNS - Testes

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

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

What medications can cause AKI?

- NSAIDs - ACEis - ARBs - CCBs - Alpha blockers - Beta blockers - Opioids - Diuretics - Aciclovir - Trimethoprim - Lithium

What is the typical presentation of ischaemic hepatitis?

Liver failure following MI

What medication is given for pain in palliative care?

- Diamorphine/morphine - Oxycodone (if renal impairment)

What medication is given for distress/agitiation/breathlessness in palliative care?

Midazolam/haloperidol

What medication is given for respiratory tract secretions/bowel spasm in palliative care?

Buscopan (hyoscine butylbromide)

What medication is given for N+V in palliative care?

Haloperidol/metoclopramide

What are some causes of falls?

- Orthostatic hypotension - POTS - Anaemia - Arrhythmias - Epilepsy - Peripheral neuropathy - Ataxia/cerebellar disease - Vision problems - Drug induced e.g. antihypertensives

What medication is given in orthostatic hypotension?

Fludrocortisone/midodrine

How can falls risk be reduced in orthostatic hypotension?

- Stay hydrated - Compression stockings - Stand up slowly - Increased salt intake - Exercise

GP - Misc Flashcards

(68 cards)