Community and Public Health Flashcards
All things GP and Public health
What should you do if you find a patient has a BP of over 140/90mmHg during a routine check up?
Take a second measurement, if different take a third measurement and record the lowest of the last 2 as their BP.
How many BPs are needed to give the average for a patient who is using an ambulatory BP monitor?
14
If a patient refuses ambulatory BP monitoring, what might you offer them?
Home BP monitoring
How does the process of home BP monitoring work?
2 readings per day for a week, discard the first day and then take an average of the remaining days to diagnose/exclude HTN.
When assessing a patient with a BP of over 180/100mmHg, what additional signs might lead you to refer to a specialist immediately?
- papilloedema
- retinal haemorrhages
- suggestion of phaeochromocytoma (labile/postural HTN, headaches, palpitations, pallor and diaphoresis)
Which risk score might you use for a patient with HTN and give 3 components of it.
QRISK2
Three from…
Age, gender, ethnicity, post code, smoking status, diabetes, SBP, cholesterol/HDL ratio, BMI, CKD, CVD in 1st degree relative, BP medication, RA
In a patient who is found to have hypertension, suggest 5 other investigations you might request?
- proteinuria, ACR and haematuria
- BM, U+E, creatinine, eGFR, serum total cholesterol and HDL
- fundoscopy (for retinopathy)
- 12 lead ECG
A 48 year old, white male has been diagnosed with hypertension. Which is the most appropriate anti-hypertensive to prescribe?
a) amlodipine
b) bisoprolol
c) indapamide
d) ramipril
d) spironolactone
d) ramipril
a 53 year old afro-Caribbean lady has been diagnosed with hypertension. Which is the most appropriate anti-hypertensive to prescribe?
a) amlodipine
b) bisoprolol
c) indapamide
d) ramipril
e) spironolactone
a) amlodipine
A 65 year old, white woman still has uncontrolled hypertension having been prescribed one anti-hypertensive, which additional medication should be added now?
a) amlodipine
b) bisoprolol
c) indapamide
d) ramipril
e) spironolactone
d) ramipril
n. b. over 65 on one anti-HTN means she is most likely on a CCB i.e. amlodipine already.
A 65 year old, afro-Caribbean woman still has uncontrolled hypertension having been prescribed one anti-hypertensive, which additional medication should be added now?
a) amlodipine
b) bisoprolol
c) candesartan
d) ramipril
e) spironolactone
c) Candesartan
Likely on a CCB already, in people of black ethnicity an ARB should be added instead of an ACE-I.
A patient has been prescribed 2 anti-hypertensive agents already however they require a third for optimum control. Which is the most appropriate?
a) amlodipine
b) bisoprolol
c) indapamide
d) ramipril
e) spironolactone
c) indapamide (thiazide-like diuretic)
If a patients BP is still over 140/90mmHg after the addition of a third anti-hypertensive to their prescription, which medication might you consider?
a) amlodipine
b) bisoprolol
c) candesartan
d) ramipril
d) spironolactone
d) spironolactone (at a low dose)
A patient requires a 4th anti-hypertensive agent. What blood test are will be most informative to guide your treatment choice?
a) sodium
b) potassium
c) calcium
d) HDLs
e) cholesterol
b) potassium
Patient likely needs spironolactone which can cause hyperkalaemia therefore should only be prescribed if potassium levels are under 4.5mmol/L.
A patient on spironolactone for HTN is found to have a low eGFR. What might you be concerned they will develop?
a) hyponatraemia
b) hypernatraemia
c) hypokalaemia
d) hyperkalaemia
e) hypercalcaemia
d) hyperkalaemia
Low GFR will increase a patients risk of this if they are on spironolactone
A patient requires a 4th anti-hypertensive to try and control their BP however they have a slightly raised potassium and low GFR. Which is the most appropriate choice?
a) high dose amlodipine
b) high dose bisoprolol
c) high dose inapamide
d) high dose ramipril
d) spironolactone
c) high dose indapamide
The tests suggest hyperkalaemia and so this is the most appropriate choice as unlike spironolactone it does not cause hyperkalaemia
You might consider a B-blocker after this stage however you should make a referral and not start on a high dose.
What QRISK Score indicates a patient should be prescribed a statin?
a) 5%>
b) 10%>
c) 15%>
d) 20%>
e) 25%>
b) 10%>
What metabolic abnormality might be caused by thiazide diuretics?
hyponatraemia
Why might an ACE-I cause hyperkalaemia and hyponatraemia?
Reduces the release of aldosterone and so increases potassium retention and sodium loss through the kidneys.
Which class of medications should not be prescribed with ACE-Is and why?
NSAIDs as can affect kidney function.
What three factors feed into behavioural change according to the Theory of Planned Behaviour?
Attitude, social pressure and perceived behavioural control.
In the Theory of planned behaviour, give 5 things you may do to help an individual bridge the intention behaviour gap.
1) perceived control: help a patient to take ownership of the behaviour
2) anticipated regret: reflect on when things better/bad
3) preparatory actions: break the task into manageable chunks
4) implementation intentions: ‘if and then plan’
5) relevance to self: more likely behaviours for the patient.
Give two positives and two negatives of the theory of planned behaviour.
+ve: effective across many behaviours, rational choice model, considers social and norm pressures + perceived control
-ve: no temporal/causal element, no affect or emotion considered, does not say how the 3 main aspects (attitude, social pressure and PBC) interact, habits and routines bypass cognitive deliberation, assumes 3 main aspects can be measured, relies on self-reported behaviour (at risk of patients lying).
Which of the following conditions when treated with warfarin, aims for an INR of over 3?
a) mitral stenosis
b) short-term DVT prophylaxis
c) Atrial fibrillation
d) post-femur fracture repair
e) Prosthetic heart valves
e) prosthetic heart valves
a, c and d all are 2-3
b is 2-2.5
