Community health/GP Flashcards
B symptoms
Unexplained fever
Unexplained weight loss
Drenching sweats (at night)
Indications for same-day referral for blood pressure to specialist assessment
Clinic BP >160/120 with:
- Signs of retinal haemorrhage/papilloedema OR
- Life-threatening symptoms e.g. confusion, chest pain etc
Suspected phaeochromocytoma e.g. labile or postural hypotension, headache, palpitations, pallor, abdominal pain
Stage 2 hypertension
Clinical BP >160/109mmHg, <180/120mmHg
with Ambulatory/Home BP of >150/95 mmHg
Management of stage 2 hypertension
Antihypertensive drug treatment in addition to lifestyle advice
Regardess of age
Clinical judgement used for frailty or multimorbidity
Stage 1 BP
Clinic BP 140/90 - 159/99mmHg
with Ambulatory/Home BP 135/85-149/94 mmHg
Management of stage 1 hypertension aged 60-80
Discuss antihypertensive drug treatment alongside lifestyle advice if:
- Persistent stage 1 hypertension
- One or more of: target organ damage, established CVD, renal disease, diabetes
or QRISK score >10%
Who should be investigated for secondary causes of hypertension
Adults aged under 40
Mangement of stage 1 hypertension aged 40-60
Consider antihypertensive drug treatment alongside lifestyle advice if:
- Persistent stage 1 hypertension
- Esimated 10-year CVD risk <10%
1st line management of hypertension in T2DM, or <55 and not of Afro-Caribbean heritage
ACEi or ARB
2nd line management of hypertension in T2DM, or <55 and not of Afro-Caribbean heritage
ACEi or ARB
+ CCB or thiazide-like diuretic
1st line management of hypertension without T2DM, aged >55 or Afro-Caribbean heritage
Calcium channel blocker
2nd line management of hypertension without T2DM, aged >55 or Afro-Caribbean heritage
CCB
+ ACEi/ARB or thiazide-like diuretic
3rd line management of hypertension
ACEi/ARB + CCB + Thiazide-like diuretic
4th step in management of hypertension
Confirm elevated BP with ABPM or HBPM
Check for postural hypotension
Discuss adherence
Low-dose spironolactone (if potassium <4.5)
Alpha or beta-blocker (if potassium >4.5)
Lifestyle advice in managing hypertension
Low sodium
Hgh fibre
Regular physical exercise
Reduction of alcohol intake
Smoking cessation
Weight reduction
Which joints are typically involved in osteoarthritis
Large joints e.g. knees + hips
Joints of the hands e.g. DIPJ, PIPJ
Sacro-iliac joints
Wrist
Cervical spine
Often asymmetrical
X-ray changes in osteoarthritis
LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis (increased density of bone along joint line)
X-ray changes in rheumatoid arthritis
LESS
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)
When to consider same-day referral for BP measurements
Clinic BP >180/120; and
Signs of retinal haemorrhage and/or papilloedenam or life-threatening symptos or suspected phaeochromocytoma
Genetic associations with rheumatoid arthritis
HLA DR4 - often present in RF positive patients
HLA DR1 - occasionally present
Antibodies in rheumatoid arthritis
Rheumatoid factor (RF) - present in about 70% patients; targets the Fc portion of the IgG antibody
Anti-CCP (cyclic citrullinated peptide) antibodies - more sensitive and specific to RA than RF; if RF negative, check anti-CCP antibodies
Features of rheumatoid arthritis
Symmetrical distal polyarthropathy
Pain, swelling + stiffness
Fatigue
weight loss
Flu like illness
Muscle aches + weakness
Rheumatoid arthritis hand signs
‘Boggy’ feeling to synovium of affected joints
Z-shaped deformity of the thumb
Swan neck deformity (hyperextended PIP with flexed DIP)
Boutonnieres deformity (hyperextended DIP, flexed PIP)
Ulnar deviation of fingers at the knuckle
Common joints affected with RA
PIPJ
MCPJ
Wrist
Ankle
Metatarsophalangeal joints
Cervical spine (atlantoaxial subluxation –> spinal cord compression)
Large joints can also be affected e.g. knee, hips and shoulders
