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Phase 3a topics > Core GP conditions > Flashcards

Core GP conditions Flashcards

1
Q

Management of hypertension

<55, T2DM, not black african or african caribbean family origin

A
  1. ACEi such as ramipril or Angiotensin II receptor blocker (ARB) such as losartan,olmesartan?
  2. Add CCB or thiazide-like diuretic such as indapamide

3.ACEi or ARB + CCB + thiazide-like diuretic

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2
Q

Management of hypertension

> 55,black-african or african-caribbean family origin

A
  1. CCB such as amlodipine
  2. Add ACEi or ARB or thiazide diuretic (chlorthalidone (12.5–25.0 mg once daily) or indapamide (1.5 mg modified-release once daily or 2.5 mg once daily)
  3. ACEi or ARB + CCB + thiazide-like diuretic
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3
Q

What to do if hypertension not controlled by all 3

A
  1. confirm resistant HTN, discuss adherence, if blood potassium < 4.5
    consider spironolactone,alpha blocker or beta blocker
  2. seek expert help if uncontrolled on optimum tolerated doses of 4 drugs
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4
Q

what is stage 1 hypertension

A

Clinical >140/90 ABPM > 135/85

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5
Q

what is stage 2 hypertension

A

clinical>160/100 ABPM 150/95

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6
Q

what is stage 3 hypertension

A

> 180/120* *with organ damage

malignant HTN - medical emergency.

Refer for same-day specialist assessment if there are: signs of retinal haemorrhage and or papilloedema on fundoscopy or life threatening symptoms such as : new-onset confusion, chest pain, signs of HF or aki

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7
Q

Calcium channel blocker side effects

A

Constipation on toilet
Flushed doing a poo
Ankles swell up coz sat down for so long
Get dizzy when you stand up

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8
Q

Side effects ACE inhibitors

A

dry cough

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9
Q

rampiril

A

ACE inhibitor

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10
Q

losartan

A

ARB

Angiotensin 2 receptor blocker

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11
Q

olmesartan

A

ARB

Angiotensin 2 receptor blocker

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12
Q

indapamide

A

thiaside like diuretic

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13
Q

amlodipine

A

calcium channel blocker

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14
Q

chlorthalidone

A

thiazide like duretic

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15
Q

what is MEN

A

Multiple endocrine neoplasia, also called pheochromocytoma, causes the classic triad of headache,sweating,tachycardia. also associated with medullary thyroid carcinoma (resection history)

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16
Q

stages of hypertensive retinopathy

A

1) arteriolar narrowing 2) arteriovenous nipping 3) flame haemorrhages and cotton wool spots 4) papilloedema

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17
Q

What may ramipril cause on an ECG?

A

tall tented T waves due to hyperkalemia as it is an ACEi so leads to potassium retention

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18
Q

what is pheochromocytoma

A

Palpitations
Headache
Episodic sweating
ochromocytoma

a small vascular tumour of the adrenal medulla, causing irregular secretion of adrenalin and noradrenaline leading to attacks of raised blood pressure, palpitations, and headache.

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19
Q

Management acute heart failure

haemodynamically unstable : hypotensive or other signs of cardiogenic shock

A
  1. Vasoactive drug (inotrope/vasopressor) - only administered in cardiac care unit or HDU 00. resp support

eg adrenaline/vasopressin

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20
Q

Management acute heart failure

haemodynamically unstable: hypertensive

A
  1. Vasodilator IV eg glyceryl trinitrate (GTN)

1b. loop diuretic IV

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21
Q

Management acute heart failure

haemodynamically stable

A
  1. Loop diuretic
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22
Q

Ongoing management heart failure episode stabilised LVEF >40

A

ACE inhibitor or ARB

Beta blocker eg bisoprolol

Aldosterone antagonist (spironolcatone, eplerenone)

Loop diuretic (furosemide)

Sodium-glucose co-transporter 2 (SGLT2) inhibitor eg canagliflozin

Specialist Drugs: Ivabradine, digoxin

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23
Q

Ongoing management heart failure

LVEF <35% no LBBB

A
  1. ICD (implantable cardioverter defib)
  2. mechanical circulatory support
  3. cardiac transplantation
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24
Q

Ongoing management heart failure

LVEF < 35% with LBBB

A
  1. Cardiac resynchronisation therapy with biventricular pacemaker (CRT/P)/cardiac resynchronisation therapy-defibrillator (CRT-D)
  2. Left ventricular assist device (LVAD)
  3. Cardiac transplantation
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25
Q

X-ray congestive heart failure

A

Alveolar oedema (bat wing opacities)

Kerley B lines

Cardiomegaly (cardiothoracic ratio > 0.5

upper lobe blood Diversion

pleural Effusions (bilateral blunting of costophrenic angles)

fluid in the horizontal Fissure

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26
Q

Pulse sign associated with left sided heart failure?

A

pulsus alternans (alternating strong and weak pulse)

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27
Q

Investigations ?heart failure

A

Echo (for LVEF)
ECG (for causes)
CXR
BNP/Pro-BNP (good to rule out)
FBC (for anaemia)
Troponin if ?MI
U&E
Glucose and HbA1c
LFTs
TFTs

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28
Q

What is diagnostic for diabetes?

A

HbA1c > 48 mmol/mol
Random Glucose > 11 mmol/l
Fasting Glucose > 7 mmol/l
OGTT 2 hour result > 11 mmol/l

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29
Q

HbA1c treatment targets T2DM

A

48 mmol/mol for new type 2 diabetics
53 mmol/mol for diabetics that have moved beyond metformin alone

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30
Q

Management of T2DM

A
  1. metformin (biguanides)
  2. add one of: sulfonylurea (gliclazide) , thiazolidinediones (pioglitazone), DPP-4 inhibitor (sitagliptin,) or SGLT-2 inhibitor (canagliflozin)
  3. Add another of: sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor
  4. Metformin plus insulin
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31
Q

Side effects metformin

A

Diarrhoea and abdominal pain. This is dose dependent and reducing the dose often resolves the symptoms
Lactic acidosis

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32
Q

side effects thiazolidinediones (pigolitazone)

A

Weight gain
Fluid retention
Anaemia
Heart failure
Extended use may increase the risk of bladder cancer

33
Q

Side effects sulfonylurea eg gliclazide

A

Weight gain
Hypoglycaemia
Increased risk of cardiovascular disease and myocardial infarction when used as monotherapy

34
Q

Antibodies graves

A

TSH receptor antibodies (TRAB): antibodies often present in the serum of patients with Graves’ disease that are directed against the TSH receptor

35
Q

Antibodies hashimotos

A

antithyroid peroxidase (anti-TPO) antibodies and antithyroglobulin antibodies (anti-Tg)

36
Q

What is levothyroxine

A

Levothyroxine is synthetic T4, and metabolises to T3 in the body.

37
Q

Medications which may cause hypothyroidism

A

lithium
amiodarone

38
Q

Pathophysiology graves

A

autoimmune condition where TSH receptor antibodies cause a primary hyperthyroidism. These TSH receptor antibodies are abnormal antibodies produced by the immune system that mimic TSH and stimulate the TSH receptors on the thyroid. This is the most common cause of hyperthyroidism.

39
Q

unique features graves

A

Diffuse goitre (without nodules)
Graves eye disease
Bilateral exophthalmos
Pretibial myxoedema

40
Q

Management hyperthyroid

A

propanolol for symptom relief then for actual treatment:

  1. Carbimazole
  2. Propylthiouracil
  3. Radioactive Iodine
  4. Surgery –> levothyroxine

propanolol for symptomatic/thyroid storm/dequervains

41
Q

CURB-65

A

Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.

Confusion
Blood urea nitrogen >19 (urea>7)
Respiratory rate > 30
BP < 90, or diastolic < 60
Age > 65

0-1: Probably suitable for home treatment; low risk of death.
2: Consider hospital supervised treatment.
3: Manage in hospital as severe pneumonia; high risk of death

42
Q

ORBIT score

A

predicts bleeding risk in patients on anticoagulation for atrial fibrilation

43
Q

Investigation ACS

A
  1. ECG - if ST elevation or new LBBB = STEMI
  2. Troponin - if raised/other ECG changes = NSTEMI
  3. If both negative = unstable angina
44
Q

MAnagement STEMI

A

Patients with STEMI presenting within 12 hours of onset should be discussed urgently with local cardiac centre for either:

Primary PCI (if available within 2 hours of presentation)
Thrombolysis (if PCI not available within 2 hours)

45
Q

Left coronary artery leads

A

I, aVL, V3-6

46
Q

Right coronary artery leads

A

II, III, aVF

47
Q

Diagnostic investigation angina

A

CT Coronary Angiography

48
Q

How to treat atypical pneumonias

A

macrolides eg clarithromycin

49
Q

pneumonia and target lesions

A

mycoplasma –> erythema multiforme

(atypical pneumonia)

50
Q

Management fungal pneumonia eg Pneumocystis jiroveci (PCP)

A

co-trimoxazole

51
Q

Obstructive spirometry

A

FEV1/FVC ratio <0.7

52
Q

Management COPD

A
  1. SABA or SAMA
  2. IF not responsive: SABA + LABA + LAMA
  3. IF steroid responsive/asthmatic features: LABA + ICS,
  4. LABA, LAMA, ICS
53
Q

Bicarbonate and COPD

A

Raised bicarbonate indicates they chronically retain CO2 and their kidneys have responded by producing more bicarbonate to balance the acidic CO2 and maintain a normal pH. In an acute exacerbation, the kidneys can’t keep up with the rising level of CO2 so they become acidotic despite having a higher bicarbonate than someone without COPD.

54
Q

type 1 respiratory failure

A

Normal pCO2 with low pO2

55
Q

Type 2 respiratory failure

A

Raised pCO2 with low pO2

56
Q

COPD oxygen therapy

A

If retaining CO2 aim for oxygen saturations of 88-92% titrated by venturi mask

If not retaining CO2 and their bicarbonate is normal (meaning they do not normally retain CO2) then give oxygen to aim for oxygen saturations > 94%

57
Q

managemnet acute exacerbation copd

A

Steroids, bronchodilators, antibiotics

58
Q

xray oestoarthritis

A

L – Loss of joint space
O – Osteophytes
S – Subchondral sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone, aka geodes)

59
Q

Activity related pain and has no morning stiffness or stiffness lasting less than 30 minutes.

A

oestoarthritis

60
Q

MAnagement osteoarthritis

A
  1. Oral paracetamol and topical NSAIDs or topical capsaicin (chilli pepper extract).
  2. Add oral NSAIDs and consider also prescribing a proton pump inhibitor (PPI) to protect their stomach such as omeprazole.
  3. Consider opiates such as codeine and morphine but not long term

Intra-articular steroid injections

61
Q

Genetic associations and antibodies rheumatoid

A

HLA DR4 (a gene often present in RF positive patients)
HLA DR1 (a gene occasionally present in RA patients)

Rheumatoid Factor (RF) present in 70%
Cyclic citrullinated peptide antibodies (anti-CCP antibodies) more sensitive and more specific

62
Q

DMARDs rheumatoid

A
  1. methotrexate, leflunomide or sulfasalazine. Hydroxychloroquine if mild
  2. use 2
  3. methotrexate plus a biological therapy, usually a TNF inhibitor (adalimumab, infliximab, etanercept, golimumab and certolizumab pegol)
  4. methotrexate plus rituximab
63
Q

what type of drug is rituximab

A

Anti-CD20

64
Q

adverse effects methotrexate

A

Bone marrow suppression and leukopenia and highly teratogenic

65
Q

assessing severity of LUTS

A

international prostate symptom score (IPSS)

66
Q

Management BPH

A

Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms

5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate

67
Q

Side effect tamsulosin

A

postural hypotension

68
Q

Side effect finasteride

A

sexual dysfunction

69
Q

Most common type of lung cancer

A

Adenocarcinoma (around 40%)

70
Q

lung cancer hoarse voice

A

Recurrent laryngeal nerve palsy

71
Q

Horners syndrome

A

partial ptosis, anhidrosis and miosis

72
Q

lung cancer with hyponautraemia

A

Syndrome of inappropriate ADH (SIADH) caused by ectopic ADH secretion by a small cell lung cancer

73
Q

lung cancer asbestos

A

mesothelioma

74
Q

sign in lambert eaton syndrome

A

post-tetanic potentiation

normal reflexes after sustained muscle contraction

75
Q

what cancer causes lambert eaton

A

small cell lung cancer

76
Q

Presentation lambert eaton

A

Weakness, particularly in the proximal muscles but can also affect intraocular muscles causing diplopia (double vision), levator muscles in the eyelid causing ptosis and pharyngeal muscles causing slurred speech and dysphagia (difficulty swallowing). Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction.

77
Q

First line investigation for ?lung cancer

A

CXR

78
Q

what diabetes drug can cause hypoglycaemia

A

gliclazide (sulfonurea)

79
Q

GP NT-proBNP deciding course of action

A

Levels >2000 ng/L: urgent specialist referral for echocardiogram (within 2 weeks)
400-2000 ng/L: specialist referral for echocardiogram within 6 weeks
<400 ng/L: normal, consider alternative diagnoses

Phase 3a topics (39 decks)

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