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Phase 3A Revision > Community health/GP > Flashcards

Community health/GP Flashcards

1
Q

B symptoms

A

Unexplained fever
Unexplained weight loss
Drenching sweats (at night)

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2
Q

Indications for same-day referral for blood pressure to specialist assessment

A

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

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3
Q

Stage 2 hypertension

A

Clinical BP >160/109mmHg, <180/120mmHg
with Ambulatory/Home BP of >150/95 mmHg

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4
Q

Management of stage 2 hypertension

A

Antihypertensive drug treatment in addition to lifestyle advice
Regardess of age
Clinical judgement used for frailty or multimorbidity

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5
Q

Stage 1 BP

A

Clinic BP 140/90 - 159/99mmHg
with Ambulatory/Home BP 135/85-149/94 mmHg

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6
Q

Management of stage 1 hypertension aged 60-80

A

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%

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7
Q

Who should be investigated for secondary causes of hypertension

A

Adults aged under 40

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8
Q

Mangement of stage 1 hypertension aged 40-60

A

Consider antihypertensive drug treatment alongside lifestyle advice if:
- Persistent stage 1 hypertension
- Esimated 10-year CVD risk <10%

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9
Q

1st line management of hypertension in T2DM, or <55 and not of Afro-Caribbean heritage

A

ACEi or ARB

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10
Q

2nd line management of hypertension in T2DM, or <55 and not of Afro-Caribbean heritage

A

ACEi or ARB
+ CCB or thiazide-like diuretic

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11
Q

1st line management of hypertension without T2DM, aged >55 or Afro-Caribbean heritage

A

Calcium channel blocker

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12
Q

2nd line management of hypertension without T2DM, aged >55 or Afro-Caribbean heritage

A

CCB
+ ACEi/ARB or thiazide-like diuretic

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13
Q

3rd line management of hypertension

A

ACEi/ARB + CCB + Thiazide-like diuretic

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14
Q

4th step in management of hypertension

A

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)

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15
Q

Lifestyle advice in managing hypertension

A

Low sodium
Hgh fibre
Regular physical exercise
Reduction of alcohol intake
Smoking cessation
Weight reduction

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16
Q

Which joints are typically involved in osteoarthritis

A

Large joints e.g. knees + hips
Joints of the hands e.g. DIPJ, PIPJ
Sacro-iliac joints
Wrist
Cervical spine
Often asymmetrical

17
Q

X-ray changes in osteoarthritis

A

LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis (increased density of bone along joint line)

18
Q

X-ray changes in rheumatoid arthritis

A

LESS
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)

19
Q

When to consider same-day referral for BP measurements

A

Clinic BP >180/120; and
Signs of retinal haemorrhage and/or papilloedenam or life-threatening symptos or suspected phaeochromocytoma

20
Q

Genetic associations with rheumatoid arthritis

A

HLA DR4 - often present in RF positive patients
HLA DR1 - occasionally present

21
Q

Antibodies in rheumatoid arthritis

A

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

22
Q

Features of rheumatoid arthritis

A

Symmetrical distal polyarthropathy
Pain, swelling + stiffness
Fatigue
weight loss
Flu like illness
Muscle aches + weakness

23
Q

Rheumatoid arthritis hand signs

A

‘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

24
Q

Common joints affected with RA

A

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

25
Q

Extra-articular manifestations of RA

A

Pulmonary fibrosis with pulmonary nodules (Caplan’s syndrome)
Bronchiolitis obliterans
Felty’s syndrome (RA, neutropenia, splenomegaly)
Secondary Sjogren’s syndrome
Anaemia of chronic disease
CVD
Episcleritis + scleritis
Rheumatoid nodules
Lymphadenopathy
Carpal tunnel syndrome
Amyloidisis

Phase 3A Revision (12 decks)

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