Round Up Email April 2021

Question 1

Update in acute otitis externa section on GPnotebook. What are the common pathogens in acute otitis externa? Are oral antibiotics the usual treatment of choice for acute otitis externa?: Otitis externa

1) Which statement about acute otitis externa is false

in the vast majority of cases of acute otitis externa the cause is bacterial infection
oral antibiotics are the antibiotic preparation of choice in the majority of cases of acute otitis externa
acute otitis externa can mimic the appearance of acute otitis media (AOM) because of erythema involving the tympanic membrane

Question 2

A GP colleague discussed with me about a diabetic patient with markedly raised GAD antibodies and generalised muscle stiffness. Could this be "stiff person syndrome"? I have updated the page about this condition on GPnotebook to provide more information: Stiff person syndrome (original term, Stiff man syndrome)

2) Which statement regarding stiff person syndrome is false?

stiff person syndrome is a rare neurological disorder, which is an autoimmune disorder frequently associated with the presence of serum anti-glutamic acid decarboxylase (GAD) antibody
electromyographic (EMG) findings are supportive of the diagnosis of Stiff person syndrome showing continuous motor activity
stiff person syndrome affects men twice as often as women

Question 3

What is type 3 c diabetes? An update of this condition on GPnotebook: Diabetes of the exocrine pancreas (DEP)

3) Which statement regarding Type 3c diabetes is false?

the majority of type 3 diabetes are misdiagnosed as Type 2 diabetes
the most common cause of Type 3c diabetes is chronic pancreatitis
patients with Type 3c diabetes are less likely to require early insulin therapy than patients with Type 2 diabetes

Question 4

Antidepressants in neuropathic pain – what is the evidence? Which antidepressants are first line based on the evidence?: Antidepressants for neuropathic pain (antidepressant therapy for neuropathic pain)

4) Which statement regarding the use of medication in neuropathic pain is false?

when comparing antidepressants, SSRIs have the most evidence of benefit in the treatment of neuropathic pain
carbamazepine (CBZ) and oxcarbazepine (OXC) are the first-choice drugs in treatment of trigeminal neuralgia
evidence suggests that tertiary amines (e.g. amitriptyline) are somewhat more effective than the secondary amines (e.g. nortriptyline) in the management of neuropathic pain

Question 5

DAPA-HF – more evidence of benefit of use of SGLT2 inhibitors in heart failure with reduced ejection fraction.: DAPA HF - analysis reveals evidence of benefit of dapagliflozin apparent 28 days post-initiation

5) Which statement regarding the use of SGLT2 inhibitors in heart failure with reduced ejection fraction (HFrEF) is false?

there is evidence of benefit of SGLT2 inhibitors (versus placebo) from 14 days post-initiation in HFrEF
the use of SGLT2 inhibitors in HFrEF patients reduced the incidence of new onset Type 2 diabetes
in DAPA-HF over a median of just over 18 months, there was a relative risk reduction of the primary endpoint of cardiovascular death or worsening heart failure of 22% in the dapagliflozin treated patient group - a NNT of 21

Question 6

Hyperthyroidism in pregnancy – an update regarding the evidence base for the use of antithyroid drugs in pregnancy.: Pregnancy and thyrotoxicosis

6) Which statement regarding hyperthyroidism in pregnancy is false

evidence suggests that the risk of birth defects is lesser with propylthiouracil than with carbimazole
the risk of birth defects for carbimazole in pregnancy is similar to that if the mother had untreated hyperthyroidism
there is a suggested association between use of carbimazole with neonatal aplasia cutis