3a GP ILAs

Question 1

What is stage 1 hypertension in the clinic and then at home?

Answer 1

Clinic: 140/90mmHg to 159/99mmHg
ABPM: 135/85mmHg to 149/94mmHg

Question 2

What is stage 2 hypertension in the clinic and then at home?

Answer 2

Clinic: 160/100mmHg to 180/120 mmHg
Home: 150/95mmHg or higher

Question 3

What is stage 3 hypertension?

Answer 3

180/120mmHg

Question 4

What is the definition of malignant hypertension?

Answer 4

Over 180/120 mmHg with end organ damage (signs of retinal haemorrhage and papilloedema)

Question 5

If malignant hypertension is seen in GP what is the next course of action?

Answer 5

Same day referral to a specialist

Question 6

What lifestyle advice should you give to patients with hypertension?

Answer 6

Diet and exercise
Reduce caffeine
Lower salt intake
Stop smoking
Less alcohol

Question 7

What investigations should be carried out in a new case of hypertension?

Answer 7

Urine albulmin:creatinine ration
HbA1C
U&E
Lipids
12 lead ECG
Examine the eyes
Calculate Q risk

Question 8

In what age group would you suspect a secondary cause of hypertension?

Answer 8

Under 40 years

Question 9

What is the stepwise management of stage 1 hypertension?

Answer 9

Lifestyle advice
Consider antihypertensive drug treatment

Question 10

What is the treatment of Stage 2 hypertension?

Answer 10

Lifestyle advice
Antihypertensive treatment

Question 11

Patient who is white british male aged 47, which first line antihypertensive?

Answer 11

ACE inhibitor or ARB

Question 12

What is the first line antihypertensive in a 60 year old black female with T2DM?

Answer 12

ARB

Question 13

What is the first line antihypertensive in a 70 year old white british female with T2DM?

Answer 13

ACE inhibitor

Question 14

What is the first line antihypertensive in 62 year old caucasian male?

Answer 14

CCB

Question 15

Stepwise management of hypertension.

Answer 15

1. ACE inhibitor, ARB or CCB (dependent on the person)
2. Give the other one in addition, try CCB in those who had ACE inb to start.
3. Thiazide like diuretic
4. ACE Inhibitor, CCB, thiazide like diuretic, add small dose spironolactone

Question 16

When antihypertensive treatment has been started when should you review patients?

Answer 16

Monitor blood pressure every 4 weeks until within the expected range

Question 17

What blood tests before starting antihypertensive treatment?

Answer 17

U&E to check kidney function

Question 18

What are the common side effects a patient may experience from ace inhibitors?

Answer 18

Cough
Dizziness and headaches
Angiooedema

Question 19

What is the most common electrolyte disturbance in patients taking ACE inhibitors?

Answer 19

Hyperkalaemia

Question 20

What are the most common electrolyte disturbances seen in thiazide like diuretics?

Answer 20

Hyperglycaemia
Hypokalaemia
Hyponatraemia
Hypochloraemic alkalosis

Question 21

What are the common side effects in CCB’s?

Answer 21

Abdo pain, nausea and vomitting
Angio oedema
Dizziness
Peripheral oedema

Question 22

What are the typical symptoms seen in heart failure?

Answer 22

Breathlessness
Peripheral oedema
Paroxysmal nocturnal dyspnoea
Orthopnoea

Question 23

Pharmacological treatment of HF.

Answer 23

ACE inhibitor
Beta blocker
Loop diuretic for symptom control (furosemide or bumetanide)

Question 24

If symptoms of heart failure persist after ACE inhibitor and beta blocker which pharmacological treatment next?

Answer 24

Aldosterone antagonist such as spironolactone
Hydralazine

Question 25

What are the most common causes of Heart failure?

Answer 25

CAD, hypertension and valvular disease

Question 26

What blood test can be used to look for HF?

Answer 26

BNP

Question 27

next course of action if BNP > 2000?

Answer 27

Urgent 2-week referral to specialist

Question 28

Course of action if BNP is 400-2000?

Answer 28

6 week referral to specialist for assessment and ECHO

Question 29

What are the CXR findings in HF?

Answer 29

A - Alveolar oedema
B - Kerley B lines
C - Cardio megaly
D - Upper lobe blood vessel dilation
E - Pleural effusion
F - Fluid in horizontal fissure

Question 30

Side effects of spironolactone?

Answer 30

Hyperkalaemia
Renal impairment
Gynaecomastia
Breast tenderness
Hair growth
Changes in libido

Question 31

What is the fever pain score?

Answer 31

A score used to assess when patients with a sore throat and pharyngitis have strep infections

Question 32

What are the 5 criteria of the fever PAIN score?

Answer 32

Fever in past 24 hours
Abscence of cough
Symptom onset in the last 3 days
Purulent tonsils
Severe tonsil inflammation

Question 33

Name 5 of the most common notifiable diseases?

Answer 33

Measles
Rubella
Scarlet fever
Meningitis
Whooping cough
TB

Question 34

What is the definition of multimorbidity?

Answer 34

People with multiple health conditions which are often longterm

Question 35

What is the definition of polypharmacy?

Answer 35

Concurrent use of multiple medications in an individual

Question 36

What are the 7 main side effects of anticholinergic medications?

Answer 36

Blurred vision and dry eyes
Dry mouth
Drowsiness, dizziness and confusion
Rapid heart rate
Constipation
Skin flushing and overheating
Urine retention

Question 37

What are the 3 main opioid receptors in the body?

Answer 37

MOR
KOR
DOR

Question 38

Whereabouts are opioid receptors found?

Answer 38

Distributed throughout the CNS

Question 39

How should you treat chronic pain?

Answer 39

Non-pharmacological treatments first
Try non-opioid analgesia such as NSAIDS, paracetamol, Cox-2 inhibitors
Opioid analgesia to be used slow and low, intermittent use

Question 40

What are some signs of abuse and dependency on opioids?

Answer 40

Use of meds for stuff other than pain
Impaired control
Compulsive use of medication
Craving or escalation of medication use
Early refils