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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
Q

Describe the ECG findings of AF

A

irregular QRS

tachycardia

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26
Q

Which score is used to access stroke risk for AF?

A

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

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27
Q

how is AF managed?

A
  1. rate control
  2. rhythm control
  3. anti coagulation
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28
Q

Which medications are used for rate control in AF?

A

= reduce myocardial metabolic demands

beta blockers OR calcium channel blockers

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29
Q

Which medications are used for rhythm control in AF?

A

= restore sinus rhythm

amiodarone or flecainide

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30
Q

which anti coagulant is used in AF?

A

warfarin

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31
Q

When should you refer a patient with AF to cardiology?

A

fast rate
suitable for electrical cardioversion
symptoms uncontrollable
paroxysmal AF

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32
Q

What are the clinical features of stable angina?

A

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

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33
Q

What are the clinical features of unstable angina?

A

unpredictable and not related to stressors

acute event precede a MI

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34
Q

Outline the management plan for patients with stable angina

A
  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
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35
Q

When would you refer a patient to hospital with angina?

A

if recurrent chest pain in last 12 hours and abnormal ECG

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36
Q

Define COPD

A

chronic slowly progressive disease of airflow limitation caused by an inflammatory response of the lungs to noxious substances

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37
Q

How is COPD caused?

A

SMOKING!!!
coal mining
genetic e.g. alpha 1 trypsin deficiency

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38
Q

Describe the symptoms of COPD

A

Shortness of breath on exertion
chronic cough with sputum
wheeze
bronchitis

+ apnoea, weight loss, fatigue, recurrent infections

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39
Q

Describe the signs of COPD

A 
use of accessory muscles
hyperinflation
reduced chest expansion
resonant chest sounds
CO2 retention
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40
Q

Describe the spirometry findings indicating COPD

A

FEV1:FVC <70% predicted

irreversible with bronchodilators

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41
Q

Describe the early management and non drug therapy of COPD

A
  1. pulmonary rehab
  2. aim for BMI 20-25
  3. stop smoking!!
  4. vaccinations
  5. exercise
  6. nutrition
  7. screening for depression
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42
Q

How are acute attacks of COPD managed?

A
  1. increase bronchodilator use

2. steroids

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43
Q

How is COPD managed long term?

A
  1. SABA e.g. salbutamol or short acting anti-muscarinic e.g. ipratropium
    • LABA e.g. salmeterol or inhaled corticosteroids (LAMA) e.g. tiotropium
  3. long term oxygen therapy
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44
Q

How are infective exacerbations managed?

A 
S- steroids
H- heparin
O- oxygen
N- nebulized bronchodilators 
A- antibiotics
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45
Q

What are the 3 characteristic features of asthma?

A
  1. airway limitation - usually reversible
  2. airway hyper responsiveness
  3. inflammation of the bronchi- driven by T helper cells
46
Q

How does asthma present?

A 
wheeze
breathlessness
chest tightness
cough 
diurnal variation- worse at night and early morning
47
Q

What are the triggers for asthma symptoms?

A 
exercise
allergens 
cold air exposure
after beta blockers
house dust mite
48
Q

Describe the acute symptoms of severe asthma

A

tachypnoea
tachycardia
pulsus paradoxus
cor pulmonale

49
Q

How is asthma diagnosed?

A

spirometry
FEV1:FVC <70%
reversible with bronchodilators

50
Q

How is asthma managed conservatively?

A

smoking cessation
weight loss
allergen avoidance

51
Q

Describe the management plan for asthma

A
  1. SABA e.g. salbutamol
    • inhaled corticosteroid
    • LABA e.g. salmeterol
  4. increase inhaled steroid OR + leukotriene receptor agonist e.g. montelukast OR + theophylline
52
Q

What is the difference between type 1 and type 2 diabetes?

A

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
Q

What are the risk factors for type 2 diabetes?

A 
genetic
obesity 
high calorie intake
sedentary lifestyle
hypertension
cardiovascular group
ethnic group - south asia, afro caribbean
impaired glucose tolerance
54
Q

What is impaired glucose tolerance/ pre-diabetes?

A

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
Q

Describe the presenting symptoms of type 1 diabetes

A 
weight loss
polydipsia
polyuria
blurred vision
abdominal pain 
acutely unwell -DKA!
56
Q

Describe the presenting symptoms of type 2 diabetes

A
  1. incidental finding
  2. polydipsia
  3. polyuria
57
Q

What are the possible complications of diabetes?

A 
neuropathy
nephropathy 
arterial disease /CV disease
retinopathy 
skin changes
58
Q

How is a diagnosis of diabetes made?

A

fasting glucose >7.0 mmol/l
random glucose >11.1 mmol/l
HbA1c >48

59
Q

How is type 2 diabetes managed?

A
  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
Q

What is the first line medical management for type 2 diabetes?

A

METFORMIN

= increases insulin sensitivity, hepatic glujconeogeneis

used when HbA1c >48

61
Q

Describe the side effects of metformin

A

GI upset
risk of lactic acidosis
impaired renal function

62
Q

How does sulfonylureas work in treating type 2 diabetes?

A

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
Q

What are the side effects of sulphonylureas?

A

weight gain
hypoglycaemia
SIADH
peripheral neuropathy

64
Q

What are the mechanism of DPP4 inhibitors?

A

prevent GLP1 degradation and inhibits glucagon secretion, increased incretin levels

e.g. gliptains, sitagliptan

65
Q

what is the main cause of hyperthyroidism?

A

graves disease = autoimmune disorder causing overstimulation of the thyroid gland by autoantibodies

66
Q

List the symptoms of hyperthyroidism

A

GENERAL- weight loss, increased appetite, restlessness

CARDIAC- arrhythmias, AF, tachycardia

SKIN- sweating, clubbing

GI- diarrhoea

GYNAE- oligomenorrhoea

NEURO- tremor, anxiety

67
Q

What are the 3 main signs of graves disease?

A

eye disease- exophthalmos, ophthalmoplegia, photophobia

thyroid achopachy (clubbing)

pretibial myxoedema - erythematous oedematous lesions above lateral malleoli

68
Q

What are the complications with hyperthyroid disease?

A

thyroid storm

69
Q

What are the signs of a thyroid storm?

A 
tachycardia
sweating
high fever
agitation
confusion
70
Q

How is hyperthyroidism investigated?

A

free T3/T4 raised
low TSH
thyroid autoantibodies

71
Q

What are the 3 treatments for hyperthyroidism?

A

1st line= carbimazole

  1. beta blockers
  2. lubricant eye drops
72
Q

outline the mechanism of carbimazole

A

inhibits production of thyroid hormone say blocking thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin

73
Q

Side effect of carbimazole?

A

agranulocytosis

74
Q

How do beta blockers help in hyperthyroidism?

A

act to block increased circulating thyroxine

immediate relief of symptoms

75
Q

Outline the non pharmacological treatment for hyperthyroidism

A
  1. refer to ophthalmology for eyes
  2. stop smoking (worsens symptoms)
  3. follow up after medication
76
Q

What are the surgical options for hyperthyroidism?

A

radioiodine

thyroidectomy

77
Q

List the risk factors for a DVT?

A 
surgery - orthopaedic *
immobility
pregnancy
cancer 
increasing age 
previous DVT 
obesity
thrombophilia
synthetic oestrogen e.g. COP,P, HRT
78
Q

When is a DVT suspected?

A

calf warmth, tenderness, swelling, erythema
mild fever
pitting oedema

79
Q

What is a complication of DVT??

A

pulmonary embolism

80
Q

How is DVT scored?

A

wells score

81
Q

How should a patient be managed with a wells score over 2?

A

= 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
Q

How should a patient be managed with a wells score below 2?

A
  1. perform d-dimer
  2. if -ve, can exclude DVT
  3. if +ve, proximal leg vein ultrasound and LMWH
83
Q

Which investigations should be done on all patients with a DVT?

A
  1. Chest x-ray
  2. blood tests - FBC, serum calcium, LFT
  3. physical examination
  4. thrombophilia screening
84
Q

How should a patient with a DVT be managed?

A

low molecular weight heparin for 5 days or until INR 2-3

warfarin

85
Q

Describe the pathology of crohns disease?

A 
microscopic granulomas 
transmural inflammation (all layers)
goblet cell depletion
lymphocyte infiltration
deep ulcers
skip lesions - cobblestone appearance
86
Q

What are GI symptoms of crohns disease?

A 
weight loss 
lethargy 
diarrhoea **
abdo pain
perianal ulcers
anal skin tags 
fistulae 
strictures
87
Q

What are the extra intestinal symptoms of crohns?

A 
arthritis 
erythema nodosum 
uveitis 
clubbing 
mouth ulcers
88
Q

How is crohns investigated?

A

colonoscopy and biopsy

raised inflammatory markers

iron deficiency anaemia

low vitamin B12 and D

89
Q

How is crohns disease treated acutely?

A

1st line = glucocorticoids e.g. budesonide

enteral feeding with elemental diet

90
Q

How is crohns managed to maintain remission?

A

1st line = azathioprine

91
Q

Outline the GI symptoms of UC?

A

bloody diarrhoea
abdo pain
tenesmus

92
Q

What are the complications of UC?

A

colorectal carcinoma

primary sclerosing cholangitis

93
Q

What would you find on endoscopy in UC?

A

widespread ulceration
pseudopolyps
crypt abscesses

94
Q

How do you induce remission in UC?

A

1st line = rectal aminosalicylates or steroids e.g. mesalazine

95
Q

How do you maintain remission in UC?

A

oral aminosalicylates e.g. mesalazine

96
Q

Describe the mechanism of action of ACE-I?

A

inhibit angiotensin converting enzyme so less angiotensin 2 is made and causes vasodilation

97
Q

List examples of ACE-I and their side effects

A

e.g. ramipril, lisinopril

dry cough, low BP, dizziness, headache

98
Q

What is monitored when taking ACE-I?

A

renal function (U&E, eGFR, creatinine) as can cause renal failure

99
Q

how do calcium channel blockers work?

A

bind to L type calcium channels on the vascular smooth muscle which reduces pressure in the arteries

100
Q

List examples of calcium channel blockers and their side effects

A

e.g. amlodipine *, verapamil (heart selective)

dizziness, hypotension, oedema, constipation

101
Q

List examples of beta blockers and their side effects

A

e.g. bisoprolol (heart), propanolol (peripheral)

hypotension, dizziness, erectile dysfunction , weakness, headache

AVOID IN ASTHMA

102
Q

What is the mechanism of action of beta blockers?

A

bind to beta adrenoreceptors to block adrenaline binding

103
Q

List examples of alpha adrenoreceptor blocking drugs and side effects

A

e.g. doxazocin, trimazosin

dizziness, hypotension, retrograde ejaculation, headache

104
Q

Examples of thiazide like diuretic and how they work

A

indapromide, bendrofluoxide

inhibit reabsorption of Na and Cl from DCT in kidneys

105
Q

side effect of thiazide like diuretic

A

impotence in men, dehydration, dizziness, hypotension

106
Q

example of potassium sparing diuretic and how they work

A

e.g. spironolactone

competitive antagonist that competes with aldosterone and blocks Na channels in kidney to prevent Na reabsorption

107
Q

What are the contraindications for warfarin?

A

pregnancy - teratogenic
previous haemorrhagic stroke
bleeding disorder

108
Q

What advice is given to someone taking warfarin?

A

don’t miss a dose
take at same time each day
avoid foods such as spinach, kale, brocolli
limit alcohol consumption

109
Q

What are the contraindications for heparin?

A

peptic ulcer
haemophilia or bleeding disorder
severe HTN
epidural or spinal anaethesia

110
Q

What are the contraindications for apixiban?

A

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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