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Everything Flashcards

1
Q

cause of angina

A

mostly atheroma

mismatch of o2 demand and supply

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2
Q

why are cold fingers a side effect of beta blockers?

A

they dilate coronary arteries but constrict skin and muscle ones –> cold fingers

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3
Q

what does negatively chronotropic mean?

A

decrease in heart rate

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4
Q

what does negatively inotropic mean?

A

decrease in LV contractility (force of contraction)

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5
Q

Side effects of beta blockers

A

erectile dysfunction, cold hands + feet, bradycardia

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6
Q

How do nitrates work?

A

they are ventilators

increase venous capacity –> reduction in preload

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7
Q

how does aspirin work?

A

cyclo-oxygenase inhibitor
reduces prostaglandin synthesis, results in decreased platelet aggregation.
Is antipyretic, anti-inflammatory, analgesic

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8
Q

what does angiotensin II do?

A

increased sympathetic activity
release of aldosterone
vasoconstriction. ACEi block the conversion of angiotensin I to angiotensin II

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9
Q

what are the most sensitive + specific markers of MI?

A

cardiac troponin levels (T and I)

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10
Q

1st line management for ACS (pre-hospital)

A

MONA

morphine, oxygen, nitrate, aspirin

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11
Q

what do anticoagulants target?

A

formation and/or activity of thrombin

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12
Q

Medical treatment after MI

A 
primary angioplasty/thrombolysis
BBs (atenolol)
ACE-i (lisinopril) or ARB (candesartan)
Statin
Dual anti platelet therapy: aspirin and a P2Y12 inhibitor (clopidogrel)
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13
Q

LT rx angina

A

CCB/B-blocker/long acting nitrate e.g. amlodipine, atenolol, nicorandil

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14
Q

Post MI what should pts do

What is contraindicated

A

Attend cardiac rehab – advice on activity etc.
Lifestyle changes
NSAIDS absolute CI for 2/12 post STEMI

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15
Q

Ix AF

A

ECG, echo

CHADS-2-VASC

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16
Q

CHADS-2-VASC

rx level?

what rx?

A 
CHF
HTN
Age 65-74 – 1
DM
Stroke/TIA/VTE -2
Vascular disease
Age >75 2 point
Sex – female - 1

Low risk – men 0, women 1 –> not for AC
Moderate risk – men 1 ?AC
High risk – 2 or above –> AC

Can give warfarin or NOAC

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17
Q

target inr

A

2-3

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18
Q

HAS-BLED

A

Risk of major bleeding in AF with oral anticoagulation:
HTN (Uncontrolled)
Abnormal renal/liver function (up to 2pts)
Stroke history
Bleeding predisposition/history
Labile INR
Elderly >65
Drugs (anti plts) or alcohol (up to 2 pts)
≥3 high risk – use AC with caution

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19
Q

Rx AF

A

New onset – consider cardioversion (AC 4/52 first)
Rate control – B-blocker or rate limiting CCB (diltiazem), digoxin
OR…
Rhythm control – amiodarone, or flecainide (not if IHD)
Do not do both

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20
Q

the 3 aspects to atrial fibrillation management

A

a. rate control
b. rhythm control
c. thromboprophylaxis

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21
Q

SABA

A

salbutamol

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22
Q

LABA

A

salmeterol

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23
Q

SAMA

A

Ipratropium bromide

short acting muscarinic antagonist (anticholinergic)

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24
Q

LAMA

A

Tiotropium bromide

long acting muscarinic antagonist (anticholinergic)

Adverse effects are mainly related to its antimuscarinic effects. Common adverse drug reactions (≥1% of patients) associated with tiotropium therapy include: dry mouth and/or throat irritation. Rarely (<0.1% of patients) treatment is associated with:urinary retention,

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25
Q

Inhaled corticosteroid

A

beclametasone, budesonide, fluticasone

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26
Q

Leukotriene antagonist

A

montelukast

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27
Q

4 key Qs to assess asthma severity

A

In the last four weeks..

  1. How many days did you have daytime asthma symptoms?
  2. How often did you need to use your reliever?
  3. How many days were activities limited by asthma?
  4. How often did asthma symptoms occur at night or on waking?
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28
Q

Asthma rx pathway in adults

A
  1. inhaled SABA PRN
  2. Inhaled corticosteriod 200-800
  3. inhaled LABA. Up steroid to 800
  4. Increase ICS to 2000/d. Add montelukast
  5. daily oral steroids
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29
Q

Stage 1 COPD

A

Mild

FEV1>80%

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30
Q

Stage 2 COPD

A

Mod

FEV1 50-79%

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31
Q

Stage 3 copd

A

severe

fev1 30-49%

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32
Q

Stage 4 copd

A

v severe

fev1 <30%

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33
Q

type 1 resp failure

A

pink puffers
low o2
norm co2

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34
Q

type 2 resp failure

A

blue bloaters
low o2
high co2

become unresponsive to high co2 drive and only breathe in response to hypoxia

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35
Q

mx of COPD

A
  1. SABA + SAMA e.g. salbutamol and ipratropium bromide
  2. ICS e.g. beclametasone/budesonide
  3. If SAMA used QDS  change to LAMA once a day e.g. tiptropium bromide
  4. If unstable consider LABA or LAMA
  5. Combined inhaler with LABA and ICS e.g. seretide/symbicort
  6. If still symptomatic add LAMA
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36
Q

other mx of copd

A

Smoking cessation
Pneumococcal vaccine and yearly influenza vaccine
Prompt abx for infective exacerbations
Pulmonary rehabilitation

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37
Q

T1 DM mx

A

Insulin – mixture of short and long acting insulin e.g. Novorapid boluses and Detemir BD
Individual care plan
Review annually – includes BP, renal function, eye check, foot check
If poor control refer to Diabetologist
Target HbA1c <48 mmols/mol

38
Q

T2 DM mx stepwise

A
  1. Lifestyle Modifications – recheck HbA1c in 2-3 months
  2. Biguanide e.g. Metformin – titrate upwards to max. dose as needed (monitor renal function)
  3. If HbA1c still >58 add second agent - sulphonylurea (gliclazide, glibenclamide), pioglitazone or DPP4 inhibitor (e.g. sitagliptin)
  4. Add a third agent (another of those listed in step 3)
  5. BMI <35 = commence insulin therapy
    BMI >35 = GLP1 agonist e.g.exenatide

T2 diabetics require the same annual review as type 1 diabetics

39
Q

what is the target hba1c for t2dm

A

48

If on an oral hypoglycaemic agent target = 53 to avoid hypos.

40
Q

BP targets in someone with htn

A

Aim clinic BP >140/90 in people <80
Aim 150/90 if ≥80
Aim 130/80 if diabetic

41
Q

drug for obesity

A

orlistat

if bmi >50 proceed to surgery immediately

42
Q

bariatric surgery criteria

A
  • BMI >35 and recent dx of T2DM
  • Asian and recent dx of T2DM with BMI >25
  • BMI >40 or BMI >35 with sig. assoc. disease + all non surgical methods failed + seen by specialist + fit for anaesthetic and surgery + patient commits to long term follow up
43
Q

bariatric surgery

A

Gastric banding
Gastric bypass
Sleeve gastrectomy

44
Q

53yr old Jamaican, BP in clinic 152/97, and APBM of 140/80, eGFR 100, T1DM. Does he need treatment? If so what is first line?

A

CCB e.g. amlodipine, lifestyle changes

45
Q

73yr old lady, currently on lisinopril and felodipine, her clinic and ABPM are consistently >150/90. What should be added next?

A

Thiazide like diuretic e.g. bendroflumethiazide

46
Q

Stage 1 HTN

A

BP (clinic) ≥140/90 & ABPM ≥135/85

47
Q

Stage 2 HTN

A

BP (clinic) ≥160/100 & ABPM ≥150/95

48
Q

Severe HTN

A

BP (clinic) Systolic ≥180 or Diastolic ≥110

49
Q

After establishing someone has high blood pressure what should be done next

A

Assess CV risk e.g. QRISK2

Assess target end organ damage: Urine AC ratio, U&E, plasma glucose, serum cholesterol, fundoscopy ?HTN retinopathy, ECG

50
Q

HTN mx

A
  1. Lifestyle advice
  2. Offer antihypertensives if <80 with stage 1 HTN if at least 1 of:
    - Target organ damage
    - Established CVD
    - CKD
    - T1/T2DM
    - QRISK 2 ≥20%
  3. Offer antihypertensives to anyone with stage 2 or severe HTN
51
Q

BP meds

A

STEP 1
over 55y or black - C
under 55 - A

STEP 2
C + A

STEP 3
C + A + D (thiazide like)

STEP 4
consider further diuretic or alpha/beta blocker
consider expert advice

52
Q

example of CCB

A

amlodipine

53
Q

example of ACEi

A

lisinopril

54
Q

example of thiazide like diuretic

A

bendroflumethiazide

55
Q

SE ACEi

A

dry cough

56
Q

SE CCB

A

swollen ankles

57
Q

SE thaizide like diuretic

A

hypokalaemia / sexual dysfunction

58
Q

what do thiazides do?

A

block reabsorption of sodium at distal convoluted tubule of kidney

59
Q

name 4 medications every patient should be on post-MI?

A

B blocker, aspirin, ACE/ARB (e.g. candesartan), statin e.g. atorvastatin, ?warfarin

60
Q

What agent reverses warfarin? give an example of a NOAC?

A

VIT K, Beriplex

61
Q

What should be considered when deciding between warfarin and NOAC?

A

Risk of fall/bleeding, how easy it will be to monitor, dietary changes

62
Q
  1. Name two groups of medications that can be used in the rate control of AF and an example of each?
  2. Which drug is contraindicated for rhythm control in AF if the patient has IHD?
A
  1. B blocker , Rate limiting CCB (non-dihydropyridine) e.g. diltiazem, cardiac glycoside e.g. digoxin
  2. Flecainide
63
Q

Two examples of an inhaled corticosteroid

A

Beclametasone, budesonide, fluticasone

64
Q

33 yr old with uncontrolled asthma. Currently taking terbutaline PRN, beclametasone 400mcg/day and they have recently completed a trial of formeterol which provided some relief. What is the next step?

A

Continue formeterol and increase ICS to 800mcg/day. Then add 4th drug or increase to 2000.

65
Q 
Intepret this ABG:
65 yr old gentlemen brought into A&amp;E with COPD exacerbation. On 28% oxygen via simple facemask. 
pH 7.35
PaO2 7.3
PaCO2 11.2
HCO3 36.0
A

Type 2 resp failure. Chronic – as bicarbonate has increased

66
Q

What oxygen saturations are the target for COPD patients on oxygen therapy?

A

88-92%

67
Q

69 yr old pt with COPD on salbutamol and ipratropium bromide, they take both at least 4 times a day. What is the next step in management?

A

Change ipratropium bromide to tiotropium (LAMA) and add ICS

68
Q

Three things that require annual review in a diabetic?

A

Renal function, hba1c, bp, eyes, feet

69
Q

If an asymptomatic patient has an incidental random plasma glucose test done with a result of 12.0 what does the result of his glucose tolerance test have to be to be diagnosed as diabetic?

A

> 11.1

70
Q

If a 68 year old morbidly obese lady has a HbA1c of 60 and is been considered for insulin therapy. What medications should they have already tried?

A

Metformin, 2 others (sulphonylurea/glitazone/gliptin) and GLP1 agonist e.g. exanatide

71
Q

If a 76 yr old gentlemen is found to have an eGFR of 38, what stage CKD does he have?

A

3B

72
Q

Following lifestyle changes which treatment option is the most appropriate next step for a patient with BMI 52?

A

Surgery

73
Q

paget’s disease of the nipple

A 
sign of intraductal breast cancer
unilateral, red, scaly, crusted nipple
dx: biopsy. 
DDx: eczema
Surgery: mastectomy or lumpectomy + surgery
74
Q

ABCDE of malignant melanoma

A 
A - asymmetry
B - borders irregular
C - colour change
D - diameter >6mm
E - evolving quickly. bleeding bad
75
Q

rx malignant melanoma

A

excision with margin of normal skin

76
Q

pathology of psoriasis

A 
epidermal proliferation
inflammatory infiltration (T-cell driven in the dermis &amp; epidermis)
77
Q

what is the signal for hyperprofliferation in psoriasis?

A

tumour necrosis factor

which is why infliximab is a logical therapy

78
Q

signs psoriasis

A

symmetrical well defined red plaques with silvery scale on the extensor surfaces
nail changes - pitting, onycholysis (separation from nail bed)
generalised psoriasis = systemic symptoms eg fever, inc WCC, dehydration

79
Q

systemic signs in psoriasis

A

7% develop athropathy

80
Q

Dds psoriasis

A

eczema

fungal infection

81
Q

mx psoriasis

A
  • EDUCATION
  • remove possible triggers - strep infection, drugs, stress, alcohol
  • potent corticosteroid applied once daily plus vitamin D
    e. g. betamethasone + calcipotriol (Dovobet)
82
Q

mx severe psoriasis

A

methotrexate - helps athropathy

infliximab (anti tnf)

83
Q

cause of cellulitis

A

strep infection - B haemolytic strep

84
Q

px cellulitis

A

systemic upset and lymphadenopathy, badly defined and affecting the legs

85
Q

rx cellulitis

A

benzylpenicillin + flucloxacillin

86
Q

what rx for cellulitis if penicillin allergic

A

erythromycin

87
Q

cause of acne vulgaris

A

abnormality of keratinisation within the follicle = blockage of secretions = blackhead and white heads (comedones)

increased sebum production (regulated by androgens and CRH)

88
Q

what is the ddx for acne

A

acne rosacea - no comedones, diffusely red nose, cheeks, chin - flushing. Eye involvement. rx - topical metronidazole

89
Q

signs & rx moderate acne

A 
signs = inflammatory lesions, face +/- chest and back
rx = erythromycin PO with topical benzoyl peroxide
90
Q

signs & rx mild acne

A

signs = mainly comedones on face

rx = topical benzoyl peroxide

91
Q

signs & rx severe acne

A

signs = nodules, cysts, scarring

rx = the synthetic retinoid isotretinoin - v teratogenic so good contraception needed. High success rates but psychosis and depression.

GP (2 decks)

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