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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
X-ray congestive heart failure
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
26
Pulse sign associated with left sided heart failure?
pulsus alternans (alternating strong and weak pulse)
27
Investigations ?heart failure
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
28
What is diagnostic for diabetes?
HbA1c > 48 mmol/mol Random Glucose > 11 mmol/l Fasting Glucose > 7 mmol/l OGTT 2 hour result > 11 mmol/l
29
HbA1c treatment targets T2DM
48 mmol/mol for new type 2 diabetics 53 mmol/mol for diabetics that have moved beyond metformin alone
30
Management of T2DM
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 3. Metformin plus insulin
31
Side effects metformin
Diarrhoea and abdominal pain. This is dose dependent and reducing the dose often resolves the symptoms Lactic acidosis
32
side effects thiazolidinediones (pigolitazone)
Weight gain Fluid retention Anaemia Heart failure Extended use may increase the risk of bladder cancer
33
Side effects sulfonylurea eg gliclazide
Weight gain Hypoglycaemia Increased risk of cardiovascular disease and myocardial infarction when used as monotherapy
34
Antibodies graves
TSH receptor antibodies (TRAB): antibodies often present in the serum of patients with Graves' disease that are directed against the TSH receptor
35
Antibodies hashimotos
antithyroid peroxidase (anti-TPO) antibodies and antithyroglobulin antibodies (anti-Tg)
36
What is levothyroxine
Levothyroxine is synthetic T4, and metabolises to T3 in the body.
37
Medications which may cause hypothyroidism
lithium amiodarone
38
Pathophysiology graves
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
unique features graves
Diffuse goitre (without nodules) Graves eye disease Bilateral exophthalmos Pretibial myxoedema
40
Management hyperthyroid
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
CURB-65
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
ORBIT score
predicts bleeding risk in patients on anticoagulation for atrial fibrilation
43
Investigation ACS
1. ECG - if ST elevation or new LBBB = STEMI 2. Troponin - if raised/other ECG changes = NSTEMI 3. If both negative = unstable angina
44
MAnagement STEMI
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
Left coronary artery leads
I, aVL, V3-6
46
Right coronary artery leads
II, III, aVF
47
Diagnostic investigation angina
CT Coronary Angiography
48
How to treat atypical pneumonias
macrolides eg clarithromycin
49
pneumonia and target lesions
mycoplasma --> erythema multiforme (atypical pneumonia)
50
Management fungal pneumonia eg Pneumocystis jiroveci (PCP)
co-trimoxazole
51
Obstructive spirometry
FEV1/FVC ratio <0.7
52
Management COPD
1. SABA or SAMA 2. IF not responsive: SABA + LABA + LAMA 2. IF steroid responsive/asthmatic features: LABA + ICS, 3. LABA, LAMA, ICS
53
Bicarbonate and COPD
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
type 1 respiratory failure
Normal pCO2 with low pO2
55
Type 2 respiratory failure
Raised pCO2 with low pO2
56
COPD oxygen therapy
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
managemnet acute exacerbation copd
Steroids, bronchodilators, antibiotics
58
xray oestoarthritis
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
Activity related pain and has no morning stiffness or stiffness lasting less than 30 minutes.
oestoarthritis
60
MAnagement osteoarthritis
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
Genetic associations and antibodies rheumatoid
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
DMARDs rheumatoid
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
what type of drug is rituximab
Anti-CD20
64
adverse effects methotrexate
Bone marrow suppression and leukopenia and highly teratogenic
65
assessing severity of LUTS
international prostate symptom score (IPSS)
66
Management BPH
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
Side effect tamsulosin
postural hypotension
68
Side effect finasteride
sexual dysfunction
69
Most common type of lung cancer
Adenocarcinoma (around 40%)
70
lung cancer hoarse voice
Recurrent laryngeal nerve palsy
71
Horners syndrome
partial ptosis, anhidrosis and miosis
72
lung cancer with hyponautraemia
Syndrome of inappropriate ADH (SIADH) caused by ectopic ADH secretion by a small cell lung cancer
73
lung cancer asbestos
mesothelioma
74
sign in lambert eaton syndrome
post-tetanic potentiation normal reflexes after sustained muscle contraction
75
what cancer causes lambert eaton
small cell lung cancer
76
Presentation lambert eaton
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
First line investigation for ?lung cancer
CXR
78
what diabetes drug can cause hypoglycaemia
gliclazide (sulfonurea)
79
GP NT-proBNP deciding course of action
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

GP stacks (3 decks)

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