Round Up Email March 2021

Question 1

The section on chronic suppurative otitis media has been updated on GPnotebook. How is CSOM diagnosed? What are the red flags? Are systematic antibiotics indicated?: Chronic suppurative otitis media (CSOM)

1) Which statement regarding chronic suppurative otitis media is false

evidence that it is very certain systemic antibiotics are more effective than placebo or no treatment for CSOM
clinical features (red flags) suggested when to consider either intracranial complications or mastoiditis include nystagmus
most patients with CSOM experience temporary or permanent hearing loss with average hearing levels typically between 10 and 40 decibel

Question 2

Itchiness in the patient with end-stage kidney disease. Is it common? How should this condition be managed?: Uraemic pruritus

2) Which statement regarding uraemic pruritus is false

uraemic pruritus affects 42% to 57% of people on dialysis
evidence that gabapentinoids (gabapentin and pregabalin) show the greatest reduction in itch scores
mechanisms driving uraemic itch are well understood

Question 3

Frostbite and frostnip – an update of this section in GPnotebook.: Frostbite

3) Which statement regarding frostbite and frostnip is false

frostnip is a precursor to frostbite that presents with symptoms similar to grade 1 frostbite
frostbites are commonly seen in hand and feet which accounts for 90% of cases
good prognostic signs include cloudy or haemorrhagic (bloody) fluid in the blisters

Question 4

Infected eczema – which antibiotics are indicated? An update reflecting latest NICE guidance.: Infected eczema

4) Which statement regarding infected eczema is false

first choice topical antibiotic is Fusidic acid 2%:
Erythromycin is the alternative oral antibiotic if the person has a penicillin allergy or flucloxacillin is unsuitable, and the person is pregnant
routinely take a skin swab for microbiological testing in people with secondary bacterial infection of eczema at the initial presentation

Question 5

Management of HFrEF in newly diagnosed patients. A summary of an algorithm using evidence based therapies in HFrEF.: Proposed algorithm for chronic reduced ejection fraction heart failure (HFrEF) by McMurray and Packer 2020

5) Which statement regarding the proposed algorithm for chronic reduced ejection fraction heart failure (HFrEF) is false

Simultaneous initiation of a beta-blocker and an sodium glucose transporter 2 inhibitor is recommended at Step 1
Step 2 is addition of sacubitril/valsartan, within 1-2 weeks of Step 1
Therapy with all four drug classes should be achieved within 10 weeks

Question 6

Mirocytosis without anaemia – is this a potential marker of undiagnosed cancer?: Microcytosis without anaemia and cancer risk

6) Which statement regarding microcytosis without anaemia and cancer risk is false

Studies have previously identified microcytosis as a potential early risk marker for certain cancers including lymphoma
Studies have previously identified microcytosis as a potential early risk marker for certain cancers includin kidney cancer
Studies have previously identified microcytosis as a potential early risk marker for certain cancers including pancreatic cancer