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3a GP and public health > Common diseases > Flashcards

Common diseases Flashcards

COPD, asthma, heart failure, hypertension, angina, CKD, diabetes

1
Q

What are the dangers of overprescribing antibiotics?

A

unnecessary side effects
medicalise self limiting conditions
antibiotic resistance

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2
Q

When should you intervene for BP?

A

> 140/90 mmHg

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3
Q

Which factors intervene when taking BP measurement?

A 
"white coat syndrome"
stress
anxiety
size of cuff
exercise
smoking
caffeine
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4
Q

What is the main cause of hypertension?

A

PRIMARY = 90% = unknown aetiology!

multifactorial involving: genetics, socio economic factors, obesity, alcohol, high salt intake, age

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5
Q

Outline the secondary causes of hypertension?

A

elevated BP due to an identifiable cause:

  1. renal disease
    e. g. polycystic kidneys, chronic pyelonephritis
  2. adrenal disorders
    e. g. Cushings, pheochromocytoma
  3. endocrine disorders
    e. g. hypothyroidism, acromegaly, hyperparathyroidism
  4. CV disorders
    e. g. coarction of aorta
  5. drugs
    e. g. anabolic steroids, COCP, adrenaline
  6. pregnancy
    e. g. pre eclampsia
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6
Q

How is hypertension staged?

A

STAGE 1
clinical BP >140/90 and daytime average >135/85

STAGE 2
BP >150/95 or stage 1 plus: organ damaged, diabetes, Q risk >20%, renal pathology

STAGE 3
systolic >180 or diastolic >110

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7
Q

If BP reading is >140/90mmHg in a consolation, what should you do?

A
  1. take a 2nd measurement and record the lowest
  2. if BP still high, offer ambulatory BP monitoring or home BP monitoring
  3. if confirmed, manage hypertension
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8
Q

Outline the lifestyle modification advice given to patients with hypertension

A 
reduce salt intake <6g/day
reduce alcohol and caffeine intake
smoking cessation
exercise
improve diet 
weight loss
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9
Q

Describe the management plan for hypertension

A
  1. <55 y/o = ACE-I / >55 y/o or afro-caribbean = Calcium channel blocker
  2. add the other
  3. add thiazide like diuretic
  4. potassium <4.5 = spironolactone
    potassium >4.5 = increase thiazide like diuretic dose
  5. if still uncontrolled, refer to specialist!
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10
Q

What are the causes of left sided heart failure?

A

ischaemic heart disease
hypertension
valve disease
arrhythmias

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11
Q

List the symptoms of left sided heart failure

A 
dyspnoea
orthopnoea 
oedema
poor exercise tolerance 
nocturnal cough (pink frothy sputum)
wheeze
muscle wasting
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12
Q

Describe the pathology in left sided heart failure

A
  1. reduced output from left ventricle
  2. increased input pressure from left atrium
  3. pulmonary hypertension
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13
Q

What are the causes of right sided heart failure?

A

progression of left sided heart failure
chronic lung disease (cor pulmonale)
pulmonary embolism

(caused by R ventricle having to pump against increased resistance in pulmonary circulation)

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14
Q

List the symptoms of right sided heart failure

A 
raised JVP
ascites
peripheral oedema
splenomegaly
hepatomegaly
tricuspid regurgitation
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15
Q

Describe the NYHA classification system for heart failure

A
  1. no symptoms or limitation to daily activities
  2. mild symptoms and slight limitation of daily activities
  3. marked symptoms, limitation of daily activities, only comfortable at rest
  4. severe symptoms, uncomfortable at rest
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16
Q

Which investigations are necessary for heart failure?

A
  1. ECG
  2. Chest X-ray
  3. ECHO - assess ejection fraction
  4. Bloods
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17
Q

Describe the changes on a Chest Xray for heart failure

A 
A- Alveolar oedema
B- kerley B lines
C- cardiomegaly
D- upper lobe diffusion
E- pleural effusion
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18
Q

What is included in the regular review (every 6 months) for heart failure?

A
  1. clinical state
  2. screen for depression
  3. manage co-morbitides
  4. medication - review compliance and side effects
  5. bloods- U&E, creatinine, eGFR
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19
Q

List the lifestyle modification advice given to patients with heart failure

A
  1. educate - about disease, expected symptoms, discuss prognosis
  2. discuss ways to make life easier- benefits, aids
  3. diet- reduce salt intake, reduce weight, restrict alcohol, restrict fluid intake
  4. lifestyle measure- smoking cessation, regular exercise
  5. vaccinations
  6. advance care planning and palliative care options
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20
Q

describe the medication plan for left ventricular systolic dysfunction (reduced ejection fraction)

A

1st line = loop diuretic (furesomide) + ACE-I + beta blocker

2nd line= + spironolactone

3rd line= digoxin, ivabradine

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21
Q

What is the most common sustained tachyarrthymia?

A

atrial fibrillation

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22
Q

Define atrial fibrillation

A

irregularly irregular narrow QRS complex tachycardia with absence of P wanes (300-600 bpm)

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23
Q

What are the causes of atrial fibrillation?

A 
no cause (12%)
congestive heart failure
hypertension 
age >75 y/o
diabetes 
vascular disease 
valvular heart disease
thyrotoxicosis 
high caffeine intake
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24
Q

Describe the symptoms of atrial fibrillation

A 
asymptomatic *
palpitations
chest pain 
dyspnoea
dizziness
fatigue
syncope
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25
Describe the ECG findings of AF
irregular QRS | tachycardia
26
Which score is used to access stroke risk for AF?
CHADS2-VASC ``` C- congestive heart failure H- hypertension A- age >75 D- diabetes mellitus S2 - prior TIA or stroke V- vascular disease A- age 65-74 Sc- sex category (female =1pt) ``` >2 = high risk -> start oral anti coagulation
27
how is AF managed?
1. rate control 2. rhythm control 3. anti coagulation
28
Which medications are used for rate control in AF?
= reduce myocardial metabolic demands beta blockers OR calcium channel blockers
29
Which medications are used for rhythm control in AF?
= restore sinus rhythm amiodarone or flecainide
30
which anti coagulant is used in AF?
warfarin
31
When should you refer a patient with AF to cardiology?
fast rate suitable for electrical cardioversion symptoms uncontrollable paroxysmal AF
32
What are the clinical features of stable angina?
central chest tightness or heaviness precipitated by physical exertion (or cold weather, heavy meals, emotional stress) relieved by rest or GTN in 5 mins + dyspnoea, nausea, sweatiness, faintness
33
What are the clinical features of unstable angina?
unpredictable and not related to stressors | acute event precede a MI
34
Outline the management plan for patients with stable angina
1. short acting nitrates e.g. GTN spray for when symptomatic 2. beta blocker OR calcium channel blocker 3. aspirin 4. statin 5. control risk factors for CVD
35
When would you refer a patient to hospital with angina?
if recurrent chest pain in last 12 hours and abnormal ECG
36
Define COPD
chronic slowly progressive disease of airflow limitation caused by an inflammatory response of the lungs to noxious substances
37
How is COPD caused?
SMOKING!!! coal mining genetic e.g. alpha 1 trypsin deficiency
38
Describe the symptoms of COPD
Shortness of breath on exertion chronic cough with sputum wheeze bronchitis + apnoea, weight loss, fatigue, recurrent infections
39
Describe the signs of COPD
``` use of accessory muscles hyperinflation reduced chest expansion resonant chest sounds CO2 retention ```
40
Describe the spirometry findings indicating COPD
FEV1:FVC <70% predicted | irreversible with bronchodilators
41
Describe the early management and non drug therapy of COPD
1. pulmonary rehab 2. aim for BMI 20-25 3. stop smoking!! 4. vaccinations 5. exercise 6. nutrition 7. screening for depression
42
How are acute attacks of COPD managed?
1. increase bronchodilator use | 2. steroids
43
How is COPD managed long term?
1. SABA e.g. salbutamol or short acting anti-muscarinic e.g. ipratropium 2. + LABA e.g. salmeterol or inhaled corticosteroids (LAMA) e.g. tiotropium 3. long term oxygen therapy
44
How are infective exacerbations managed?
``` S- steroids H- heparin O- oxygen N- nebulized bronchodilators A- antibiotics ```
45
What are the 3 characteristic features of asthma?
1. airway limitation - usually reversible 2. airway hyper responsiveness 3. inflammation of the bronchi- driven by T helper cells
46
How does asthma present?
``` wheeze breathlessness chest tightness cough diurnal variation- worse at night and early morning ```
47
What are the triggers for asthma symptoms?
``` exercise allergens cold air exposure after beta blockers house dust mite ```
48
Describe the acute symptoms of severe asthma
tachypnoea tachycardia pulsus paradoxus cor pulmonale
49
How is asthma diagnosed?
spirometry FEV1:FVC <70% reversible with bronchodilators
50
How is asthma managed conservatively?
smoking cessation weight loss allergen avoidance
51
Describe the management plan for asthma
1. SABA e.g. salbutamol 2. + inhaled corticosteroid 3. + LABA e.g. salmeterol 4. increase inhaled steroid OR + leukotriene receptor agonist e.g. montelukast OR + theophylline
52
What is the difference between type 1 and type 2 diabetes?
type 1 = autoimmune destruction of insulin producing beta cells of pancreatic islets of Langerhans causing absolute insulin deficiency type 2= diminished effectiveness of endogenous insulin / insulin resistance
53
What are the risk factors for type 2 diabetes?
``` genetic obesity high calorie intake sedentary lifestyle hypertension cardiovascular group ethnic group - south asia, afro caribbean impaired glucose tolerance ```
54
What is impaired glucose tolerance/ pre-diabetes?
HbA1c= 42-47 mmol/mol OR fasting glucose 6.1-6.9 mmol/l ORAL glucose tolerance test used to confirmed diagnosis... 7.1- 11.1 mmol/l = IGT >11.1 = diabetes
55
Describe the presenting symptoms of type 1 diabetes
``` weight loss polydipsia polyuria blurred vision abdominal pain acutely unwell -DKA! ```
56
Describe the presenting symptoms of type 2 diabetes
1. incidental finding 2. polydipsia 3. polyuria
57
What are the possible complications of diabetes?
``` neuropathy nephropathy arterial disease /CV disease retinopathy skin changes ```
58
How is a diagnosis of diabetes made?
fasting glucose >7.0 mmol/l random glucose >11.1 mmol/l HbA1c >48
59
How is type 2 diabetes managed?
1. blood glucose control - finger prick, HbA1c 2. monitor and treat microvascular complications 3. modify risk factors e.g. BP, low sugar/fat diet, smoking cessation, start statin
60
What is the first line medical management for type 2 diabetes?
METFORMIN = increases insulin sensitivity, hepatic glujconeogeneis used when HbA1c >48
61
Describe the side effects of metformin
GI upset risk of lactic acidosis impaired renal function
62
How does sulfonylureas work in treating type 2 diabetes?
e.g. gliclazide = increases the amount of insulin produced by the pancreas (so only effective if some functioning beta cells present) used alongside metformin if HbA1c >58
63
What are the side effects of sulphonylureas?
weight gain hypoglycaemia SIADH peripheral neuropathy
64
What are the mechanism of DPP4 inhibitors?
prevent GLP1 degradation and inhibits glucagon secretion, increased incretin levels e.g. gliptains, sitagliptan
65
what is the main cause of hyperthyroidism?
graves disease = autoimmune disorder causing overstimulation of the thyroid gland by autoantibodies
66
List the symptoms of hyperthyroidism
GENERAL- weight loss, increased appetite, restlessness CARDIAC- arrhythmias, AF, tachycardia SKIN- sweating, clubbing GI- diarrhoea GYNAE- oligomenorrhoea NEURO- tremor, anxiety
67
What are the 3 main signs of graves disease?
eye disease- exophthalmos, ophthalmoplegia, photophobia thyroid achopachy (clubbing) pretibial myxoedema - erythematous oedematous lesions above lateral malleoli
68
What are the complications with hyperthyroid disease?
thyroid storm
69
What are the signs of a thyroid storm?
``` tachycardia sweating high fever agitation confusion ```
70
How is hyperthyroidism investigated?
free T3/T4 raised low TSH thyroid autoantibodies
71
What are the 3 treatments for hyperthyroidism?
1st line= carbimazole 2. beta blockers 3. lubricant eye drops
72
outline the mechanism of carbimazole
inhibits production of thyroid hormone say blocking thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin
73
Side effect of carbimazole?
agranulocytosis
74
How do beta blockers help in hyperthyroidism?
act to block increased circulating thyroxine immediate relief of symptoms
75
Outline the non pharmacological treatment for hyperthyroidism
1. refer to ophthalmology for eyes 2. stop smoking (worsens symptoms) 3. follow up after medication
76
What are the surgical options for hyperthyroidism?
radioiodine | thyroidectomy
77
List the risk factors for a DVT?
``` surgery - orthopaedic * immobility pregnancy cancer increasing age previous DVT obesity thrombophilia synthetic oestrogen e.g. COP,P, HRT ```
78
When is a DVT suspected?
calf warmth, tenderness, swelling, erythema mild fever pitting oedema
79
What is a complication of DVT??
pulmonary embolism
80
How is DVT scored?
wells score
81
How should a patient be managed with a wells score over 2?
= DVT likely 1. proximal leg vein ultrasound within 4 hours if -ve/ can't be carried out within 4 hours -> D-DIMER and LMWH
82
How should a patient be managed with a wells score below 2?
1. perform d-dimer 2. if -ve, can exclude DVT 3. if +ve, proximal leg vein ultrasound and LMWH
83
Which investigations should be done on all patients with a DVT?
1. Chest x-ray 2. blood tests - FBC, serum calcium, LFT 3. physical examination 4. thrombophilia screening
84
How should a patient with a DVT be managed?
low molecular weight heparin for 5 days or until INR 2-3 warfarin
85
Describe the pathology of crohns disease?
``` microscopic granulomas transmural inflammation (all layers) goblet cell depletion lymphocyte infiltration deep ulcers skip lesions - cobblestone appearance ```
86
What are GI symptoms of crohns disease?
``` weight loss lethargy diarrhoea ** abdo pain perianal ulcers anal skin tags fistulae strictures ```
87
What are the extra intestinal symptoms of crohns?
``` arthritis erythema nodosum uveitis clubbing mouth ulcers ```
88
How is crohns investigated?
colonoscopy and biopsy raised inflammatory markers iron deficiency anaemia low vitamin B12 and D
89
How is crohns disease treated acutely?
1st line = glucocorticoids e.g. budesonide | enteral feeding with elemental diet
90
How is crohns managed to maintain remission?
1st line = azathioprine
91
Outline the GI symptoms of UC?
bloody diarrhoea abdo pain tenesmus
92
What are the complications of UC?
colorectal carcinoma | primary sclerosing cholangitis
93
What would you find on endoscopy in UC?
widespread ulceration pseudopolyps crypt abscesses
94
How do you induce remission in UC?
1st line = rectal aminosalicylates or steroids e.g. mesalazine
95
How do you maintain remission in UC?
oral aminosalicylates e.g. mesalazine
96
Describe the mechanism of action of ACE-I?
inhibit angiotensin converting enzyme so less angiotensin 2 is made and causes vasodilation
97
List examples of ACE-I and their side effects
e.g. ramipril, lisinopril dry cough, low BP, dizziness, headache
98
What is monitored when taking ACE-I?
renal function (U&E, eGFR, creatinine) as can cause renal failure
99
how do calcium channel blockers work?
bind to L type calcium channels on the vascular smooth muscle which reduces pressure in the arteries
100
List examples of calcium channel blockers and their side effects
e.g. amlodipine *, verapamil (heart selective) dizziness, hypotension, oedema, constipation
101
List examples of beta blockers and their side effects
e.g. bisoprolol (heart), propanolol (peripheral) hypotension, dizziness, erectile dysfunction , weakness, headache AVOID IN ASTHMA
102
What is the mechanism of action of beta blockers?
bind to beta adrenoreceptors to block adrenaline binding
103
List examples of alpha adrenoreceptor blocking drugs and side effects
e.g. doxazocin, trimazosin dizziness, hypotension, retrograde ejaculation, headache
104
Examples of thiazide like diuretic and how they work
indapromide, bendrofluoxide inhibit reabsorption of Na and Cl from DCT in kidneys
105
side effect of thiazide like diuretic
impotence in men, dehydration, dizziness, hypotension
106
example of potassium sparing diuretic and how they work
e.g. spironolactone competitive antagonist that competes with aldosterone and blocks Na channels in kidney to prevent Na reabsorption
107
What are the contraindications for warfarin?
pregnancy - teratogenic previous haemorrhagic stroke bleeding disorder
108
What advice is given to someone taking warfarin?
don't miss a dose take at same time each day avoid foods such as spinach, kale, brocolli limit alcohol consumption
109
What are the contraindications for heparin?
peptic ulcer haemophilia or bleeding disorder severe HTN epidural or spinal anaethesia
110
What are the contraindications for apixiban?
creatinine clearance <15 or low eGFR bleeding risk of major bleed - not easily reversible prosthetic heart valve

3a GP and public health (3 decks)

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