Round Up Email October 2019

Question 1

Gynaecomastia update – this section in GPn has been updated with reference to the excellent Association of Breast Surgery Summary. Updated criteria for investigation and referral of gynaecomastia reflect this guidance.: Gynaecomastia

1) Which of the criterion below is not an indication to investigate gynaecomastia?

Recent onset in lean men >20 years
Elderly men with senile gynaecomastia
Persistent gynaecomastia in adolescents, duration > 18-24 months

Question 2

Palmoplantar pustular psoriasis – this section on GPnotebook has been updated with a focus on the management and referral from primary care: Psoriasis (pustular, palmoplantar)

2) Which statement regarding palmoplantar psoriasis is false?

This condition is more common in men than women
a strong association with current or past smoking
dermovate ointment at night under polythene occlusion is a suggested management in primary care

Question 3

The DAPA-HF (dapagliflozin in heart failure) trial revealed the use of dapagliflozin in heart failure (in both diabetic and non-diabetic patients) led to a 22% relative risk reduction (NNT 21) in the primary endpoint of cardiovascular death or worsening heart failure – even though patients were already on evidence based optimal therapies. This is first of the planned trials of SGLT2s in heart failure but could see increasing use of these drugs by cardiologists: Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF)

3) Which statement regarding the DAPA-HF study is true?

Major hypoglycaemic events were significantly more common in the dapaglflozin arm of the study
renal dysfunction was significantly more common in the dapagliflozin arm of the study
all-cause death was reduced in the dapagliflozin group compared to the placebo group

Question 4

How to investigate an asymptomatic raised ALT – this is summarised in GPnotebook.: Algorithm for the evaluation of asymptomatic raised ALT in an adult

4) Which statement regarding the investigation of an asymptomatic raised ALT is true?

if asymptomatic raised ALT is > 80 IU/L on initial sample, then some guidance suggests this per se is sufficient to consider immediate seeking of expert advice or referral
an increase in polyclonal immunoglobulin suggests primary biliary cirrhosis
serum caeruloplasmin levels: decreased levels suggest Wilson's disease

Question 5

pes anserine bursitis – this cause of medial knee pain is summarised in a key facts format on GPn.: Pes anserine bursitis

5) Which statement regarding pes anserine bursitis is true?

Presents with lateral knee pain that is particular noted with rising from a seated position, going upstairs, or sitting with their legs crossed.
Tenderness may be palpated along the medial tendinous structures of the pes anserine group as they travel to insert along the medial tibial region
Swelling over the medial aspect of the knee is present in the vast majority of cases

Question 6

BRCA2 and prostate cancer - men with BRCA2 who develop prostate cancer, in general, have a more aggressive disease with an earlier onset. This page on GPn has been updated to reflect recent changes in evidence base relating to BRCA2 and prostate cancer: BRCA2 and prostate cancer

6) Which statement regarding BRCA2 and prostate cancer is true?

PSA testing for prostate cancer is more sensitive in men with BRCA2 mutations
BRCA2-mutant tumours also exhibit a reduced frequency of intraductal prostate carcinoma
BRCA2 related prostate cancer has a lesser tendency to metastatic disease than non-BRCA2 prostate cancer