General Practice Flashcards
1
Q
what type of drug is methotrexate
A
DMARD
2
Q
what drug type is aspirin?
A
NSAID
3
Q
when may you co-prescribe folic acid?
A
patient on methotrexate
4
Q
what part of the kidney does ramipril dilate?
A
Efferant arteriole
5
Q
what investigation may be needed for a patient on methotrexate?
A
FBC: marrow/wbc suppression
LFT: liver toxicity can occur
U&E
6
Q
what is the risk of long term aspirin and what medication should be offered?
A
risk of gastric ulcers, offer patient a PPI
7
Q
risks of methotrexate medication
A
- GI toxicity (diarrhoea)
- liver toxicity
- pulmonary toxicity (SOB)
8
Q
what term is used to describe a high level Hb
A
polycythaemia
9
Q
what can a raised ALT and GGT indicate?
A
liver damage - typically with GGT think alcohol consumption
10
Q
causes of polycythaemia
A
primary = polycythaemia vera (JAK2 gene mutation)
secondary = sleep apnoea, COPD, chronic HD, anabolic steroids
apparent - diuretics, alcohol, obesity
11
Q
causes of macrocytosis (name 2)
A
- B12 folate def
- alcohol
- drugs - methotrexate
- haem disorders - e.g. myeloma
- liver disorder
- smoking
- obesity
12
Q
causes of Hypocalcaemia - 2
A
decreased PTH - low vit D CKD - liver disease - sclerotic bone metastasis
13
Q
causes of raised GGT and/or ALT (2 for each)
A
-GGT
alcohol
- obesity
-pancreatic disease
ALT - statins - NSAID - hep B&C - coeliac a1at defificiency haemachromatosis
14
Q
what is the affect of alcohol on ferritin?
A
alcohol increases ferritin
15
Q
what must be checked before starting a patient on a bisphosophonate
A
- can they sit up and take medication
- calculate the creatinine clearance make sure good enough
16
Q
why is bisphosponate treatment limited
A
early reduction in bone resorption followed by later reduction = micro fractures
17
Q
what class of drug is metoclopramide
A
anti-emetic - speeds up gastric motility/output and acts on dopamine receptors = less feeling of sickness
18
Q
what type of drug is naproxen
A
NSAID
19
Q
a pt Bp is 142/61 what stage of hypertension is this?
A
stage 1
20
Q
what may you assess/investigate if looking for end organ damage in a hypertensive pt (4)
A
- fundoscopy -> retinopathy
- urinalysis -> albumin:creatinine (how leaky kidneys are)
- 12-lead ECG (high bp=LVH?)
- QRISK3 (stroke risk)
21
Q
why must you re-assess a HTN pt’s Bp 2 weeks after prescribing an ACEi for their HTN
A
increase in AKI symptoms - suggestive of renal artery stenosis as cause of HTN
22
Q
what murmur may be heard in severe anaemia
A
flow murmur
23
Q
what is the bp reading for stage 3 HTN
A
> 180/120
24
Q
list 3 target organ damages as a result of HTN
A
- CKD
- LVH
- hypertensive retinopathy
25
1st line meds for pt with LHF and HTN
ramipril increased to 10mg
26
daniel,39 has a home bp reading of 138/82 what is the appropriate response from you, the gp?
- refer to cardiology
| daniel is <40 and hypertensive so appropriate for referral
27
doris, 81 has T2DM, you have diagnosed her with hypertension, what is the appropriate medication to prescribe?
ACEi/ARB
- diabetes taken into account over age so ACEi more appropriate than CCB
28
what is the stepwise ladder for treating HTN in a pt under 55 not black or carribbean family origin or adult with T2DM (4)
1. ACE-i or ARB
2. CCB or thiazide-like diuretic
3. ACE-i or ARB + CCB + thiazide-like diuretic
4. = resistant hypertension, check K+ levels and then low-dose spironolactone +bb
29
what is the stepwise ladder for a treating HTN for a patient that is black African or African-caribbean family origin and/or >55?
1. CCB
2. ACE-i or ARB or thiazide-like diuretic
3. ACEi or ARB + CCB + thiazide like diuretic
4. resistant hypertension
30
how does an ACE-i work?
- interferes with RAAS= increased sodium urine secretion
| - vasodilator (stops bradykinin breakdown)
31
common side effect of ramipril
cough
32
how do BB's work?
work by blocking the effects of epinephrine (adrenaline) → slows heart rate and less force → lower BP
33
3 consequences of untreated HTN
- hypertensive retinopathy
- risk of cv event (HF/MI/LVH)
- stroke risk increase (QRISK3)
- vascular dementia
34
what class of drug is levetiracetam
anti-epileptic
35
A pt present with suspected Ovarian cancer, bloods are taken, what is the tumour marker for ovarian cancer?
Ca125
36
a patient presents with laryngitis, what symptoms need to be shown to make you wish to prescribe abx?(4)
1. significant swelling
2. white spots
3. temperature
4. struggle to swallow
37
what medication is used for breast cancer chemotherapy
aromatisei
- examestone - can affect bone density
- bisphospohonates can decrease bone mets
38
what is polymyalgia rheumatica and what is the associated condition it can lead to?
inflammation of the blood vessels -> temporal arteritis (giant cell arteritis) -> blindness
39
what is the common symptom of temporal arteritis
headache around the eyes
40
4 things we can use gabapentin for
1. seizures
2. menopause
3. MS
3. peripheral neuropathic pain
4. MND
41
how can you assume an arthritis is RA?
RA is symmetrical
| OA/psoriatic/gout are asymmetrical
42
what are the two components looked for in a semen analysis and what should the healthy percentage be?
speed (50%) and appearance (40%)
43
what are the first line medication for treating a UTI (2)
- nitrofuritoin and trimethoprim
need decent renal function -> penicillin/amoxicillin
44
list 3 signs/symptoms of parkinsons disease
1. resting tremor "pin-rolling tremor"
2. lack of facial expression
3. shuffling gait (festinant gait)
45
what tests can you do for parkinsons on an examination
glabellar tap (tapping forehead, parkinsons wont stop blinking, not parkinsons eventually stop)
test tone = cogwheeling
46
what medications are used for parkinsons disease
dopamine agonists
| levodopa (l-dopa)
47
what is frozen shoulder
limitation of external rotation
48
what is the treatment for frozen shoulder
local steroid injection - pred/lidocaine
49
what treatment may be prescribed for a patient with intermittent self-catheterisation
nitrofuritoin for preventative
50
what is the action of anti-fibrinolytic drugs
prevent plasmin from breaking down fibrin
51
at what age should you expect a baby to be walking?
12-14 months (worry if nothing by 18m)
52
at what age should baby be on solid food?
6m
53
what does a BMI of 31 show?
obese
54
what is the average eGFR for a 65 year old man?
85
55
what value for preserved ejection fraction suggests HF?
preserved ejection fraction <40
56
what are the two types of left sided HF?
1. systolic failure with reduced ejection fraction
| 2. diastolic failure with preserved ejection
57
define right sided- heart failure
loss of RV ability to pump blood from heart to lungs, blood backs into veins = oedema
58
list 5 signs/symptoms of HF
1. SOB lying down/activity
2. peripheral oedema
3. arrhythmia
4. persistant cough/wheeze + mucus
5. nausea
6. chest pain
7. increased JVP
8. pulmonary crackles/oedema
59
list 3 risk factors for HF
- male
- CAD
- previous MI
- heart valve disease
- HTN
- arrhythmia
- DM
- meds - nsaids
alcohol
obesity
etc
60
list 3 complications associated with heart failure?
1. HF = less blood to the kidneys = kidney failure (dialysis)
2. heart valve problems
3. fluid build up in liver -> liver damage
61
what treatment may be considered for an ejection fraction <35% when treating HF?
consider implantable cardioverter defibrillator and cardiac resynchronisation therapy
62
when is pro-BNP released
response to pressure changes in the heart, higher in patients with HF
63
what stage of CKD is an GFR reading of 35 indicative of?
stage 3b
64
what stage of CKD is a GFR reading of 20 suggestive of?
stage 4
65
what medication is contra-indicated in renal failure?
loop diuretics (furosemide)
66
what hormone do BB's block?
epinephrine (adrenaline)
67
why is furosemide prescribed in HF?
symptomatic relief for ankle oedema and difficulty breathing at night - improve symptoms
68
what is the survival rate of HF >5years >10years?
>5 - 50%
| > 10 - 10%
69
what two complications can furosemide cause?
- hyponatraemia
| - hypokalaemia
70
what classification is used for HF?
new york HF classification
| 1 is good, 4 is bad
71
what is measles?
highly contagious airborne virus
72
list three main complications of measles
- otitis media
- pneumonia
- convulsions, encephalitis, blindness
73
list 3 symptoms of measles
- maculopapular rash
- conjunctivitis
- cough
- fever
74
what are two differential's for measles?
- parovirus B19
- strep infection (scarlet fever)
- rubella
- early meningococcal disease
75
management for measles?
- rest, fluids, para/ibru for symptom relief
| - avoid contact with susceptible people/work/school 4 days
76
what components make up the feverpain score?
```
fever (during past 24hr)
purulence (pus on tonsils)
attend rapid (within 3 days)
severely inflammed tonsils
no cough or coryza (inflammed mucus membrane in
nose)
```
(score is 1 = low to 5 - high)
77
what vaccines are given at 8 weeks?
6-in-1 rotavirus and menB
78
how old is a child when they recieve their first flu vaccine?
2 years and 10 months
79
list 5 notifiable diseases
- covid-19
- botulism
- acute meningitis
- acute encephalitis
- cholera
- food poisoning
- infectious blood diarrhoea
- measles
- mumps
- rubella
80
give three examples of conditions which present with a maculopapular rash
- EBV infection
- measles
- scarlet fever
- hand,foot and mouth disease
- herpes
- hep b and c
- zika virus
- ebola virus
81
list 5 signs of dehydration
- sunken fontanelle
- dry mouth
- sunken eyes
- absence of tears
- poor overall appearance
82
what two things are assessed when looking at a patients fitzpatrick skin type
- skin features (colour/eyes)
| - tanning ability
83
what is the other term for "trigger finger"
stenosing tenosynovitis
84
what is trigger finger?
- finger struck in bent position
| - inflammation narrows space between sheath that surrounds tendon in affected finger
85
2 risk factors for trigger finger
- women
- diabetes
- trauma
86
treatment for trigger finger
```
NSAIDS
rest
splint
stretching exercises
if severe can have steroid inj
```
87
define dupuytrens contracture
fascia of the hand becomes thickened and tight leading to finger contractions
88
2 RF for dupuytrens contracture
- age
- epilepsy
- family history
- diabetes
- smoking
- alcohol
89
what is the typical first sign of dupuytrens contracture
development of hard nodules on the palm
90
what finger is most likely to be affected by dupuytrens contracture and what finger is least likely
- ring finger most likely
| - index least likely
91
what test can be used when assessing dupuytrens contracture?
table top test
(The patient tries to position their hands flat on a table. If the hand cannot rest completely flat, the test is positive, indicating Dupuytren’s contracture.)
92
management of dupuytrens contracture is to typically do nothing - what are the three surgical treatments that may be used
1. needle fasciotomy
2. limited fasciotomy
3. dermofascietomy
93
what is the most common cause of cellulitis
group A strep
94
where is cellulitis most commonly seen?
feet and legs
95
describe the appearance of cellulitis (5)
```
red
hot
swollen
painful
orange-peel appearance
blisters
```
96
2 RF for cellulitis
- IVDU
- injuries that break the skin
- chickenpox and shingles
- chronic skin conditions
97
what is the treatment of cellulitis?
typically oral abx (fluclox)
| if severe can be IV
98
list 3 complications of cellulitis
- bacteremia
- suppurative arthritis
- osteomyelitis
- endocarditis
99
at what age bracket does croup typically affect?
6m - 2yrs
100
what type of infection is croup
upper respiratory tract infection (causing oedema in the larynx)
101
what is the classic cause of croup (see it in exams)
parainfluenza virus
102
how is croup treated
typically improves in <48hrs and responds well to steroids (dexamethasone)
103
list 3 causes of croup
- parainfluenza
- influenza
- adenovirus
- RSC
104
what type of cough may be heard in croup?
barking cough - clusters of coughing episodes
105
how is croup managed
- at home supportive
- oral dexamethasone 150 mcg/kg
- prednisolone
106
what conditions make up "feltys syndrome"
- rheumatoid arthritis
- splenomegaly
- neutropenia
107
what condition is to be suspected after hearing a "crescendo-decrescendo" murmur (ejection systolic murmur)that radiates to the carotid arteries?
aortic stenosis
108
what is the most common cause of aortic stenosis in developed countries
calcification of aortic valves
109
what type of murmur is associated with mitral regurgitation
pansystolic murmur (heard loudest over mitral area and -> axilla)
110
3 causes of mitral regurgitation
- infective endocarditis
- acute MI with papillary muscle rupture
- rheumatic HD
- congenital defects of mitral valve
- cardiomyopathy
111
what heart murmur may cause a hyperdynamic apex beat?
mitral regurgitiation
112
what condition has an early diastolic murmur heard loudest at sternal edge associated with it?
aortic regurgitation
113
2 causes of aortic regurgitation
congenital bicuspid aortic valve
rheumatic HD
infective endocarditis
114
what pulse is to be expected from a pt with aortic regurgitation
collapsing pulse
115
what murmur is associated with mitral stenosis
low-pitch, rumbling, mid-diastolic murmur heard loudest over apex
116
what is the most common cause of mitral stenosis
rheumatic heart disease
117
what type of arrthymia is associated with mitral stenosis
AF
118
what fluid is located in the SA space
cerebrospinal fluid
119
what is the typical cause of SAH
ruptured cerebral aneurysm
120
what is the typical history of a SAH (5)
- thunderclap headache
- stiff neck
- photophobia
- vision change
- neuro symptoms (LOC, weak, seizures)
121
2 RF for SAH
- HTN
- smoking
- excessive alcohol
- cocaine
- family history
122
in what demographics is SAH more common
- black
- female
- 45-70
123
list 3 conditions associated with SAH
- sickle cell anaemia
- connective tissue disorders (marfans s)
- neurofibromatosis
- autosomal dom PKD
124
what is the first line investigation for a suspected SAH
CT head
125
how will the CSF of a patient with a SAH present?
- high red cell count
| - yellow coloured CSF - bilirubin
126
list the two surgical procedures for SAH and one medication for vasospasm prevention
- surgery = coiling and clipping
| - meds = ccb = nimodipine
127
what condition can occur in patients with chronic iron deficiency anaemia
- plummer-vinson syndrome
People with this condition have problems swallowing due to small, thin growths of tissue that partially block the upper food pipe (esophagus).
128
what type of infection is pneumocystis jiroveci?
fungal infection
129
what medical condition can increase your chances of having pneumocystis jiroveci
HIV (weakens immune system)
long term corticosteroid
130
what is the most common type of medication for pneumocystis jiroveci?
trimethoprim/sulfamethoxazole
131
what genetic type of condition is hereditary spherocytosis
autosomal dominant
132
list 4 S/S of hereditary spherocytosis
- jaundice
- anaemia
- gallstones
- splenomegaly
133
a patient with hereditary spherocytosis presents with anaemia, what is the causative agent?
parvovirus
134
a pt presents with parvovirus and has developed anaemia and jaundice what is the underlying diagnosis?
hereditary spherocytosis
135
how is hereditary spherocytosis diagnosed?
- family history and clinical features
- spherocytes on blood film
- raised reticulocytes
136
how is hereditary spherocytosis managed?
folate supplement and splenectomy
- sometimes need cholecystectomy
- transfusions in acute crisis
137
what is the typical first sign of dementia in a pt with downs syndrome
loss of adaptive function (slowing of daily function/self-care)
138
at what age should we be expected to take a baseline assessment for a pt with downs syndrome
age 30
| >40 regular screen because increased prevelence
139
life expectancy for downs syndrome pt
average = 60
140
which blood tests are typically used in a confusion screen ? (9)
1. fbc (infection, anaemia, leukaemia)
2. U&E (hyper/ponatraemia, high urea, aki)
3. LFT (liver failure secondary to encephalopathy)
4. coagulation/inr (intracranial bleeding)
5. TFT (hypo/perthyroidism)
6. calcium (hypercalcaemia)
7. B12 and folate (def.)
8. glucose/HbA1c
9. blood cultures (sepsis)
141
if a pt presents confused with focal neuro signs and head injury, what may you expect to see on CT (3)
subdural haematoma
extradural haematoma
extracranial bleed
142
why is a urinalysis important in a confused pt?
differentials - dementia/UTI/delirium etc
143
list 3 medications that can cause confusion
- opioids
- steroids
- incontinence meds
- SSRI
144
what two risk factors are associated with the elderly and diazepam
- increased falls risk
| addiction
145
when conducting a PSA in what scenario may you have to double the PSA level you recieve
pt on tamsulosin
146
why is PSA not an accurate marker for prostate cancer
non specific i.e can increase in infection, bike riding etc
147
at what level does the spinal cord terminate?
L1
148
what is the most common cause of lumbar disc herniation at level L4/L5 and L5/S1
cauda equina syndrome
149
list 3 symptoms of cauda equina syndrome
- lower back pain with alternating or bilateral radicular pain
- saddle anaesthesia
- bladder/bowel disturbance
150
investigation for cauda equina syndrome?
whole spine MRI
151
in what time frame should the spinal cord be surgically decompressed in cauda equina
within 48hr
152
define hirchsprungs disease
as baby develops in utero distal colon not innervated correctly = shrunken colon not distended and stool trapped in prox. colon
153
3 presentations of hirchsprungs disease at birth
- a delay in passing meconium (>48 hours)
- a distended abdomen
- forceful evacuation of meconium after digital rectal examination
154
how is hirchsprungs disease diagnosis confirmed
rectal suction biopsy
155
management of hirchsprungs disease
definitive - removal of section of anganglionic colon
156
what type of genetic condition is gilberts syndrome
autosomal recessive
(decreased activity of the enzyme that conjugates bilirubin with glucuronic acid owing to a mutation in the UGT1A1 gene.)
157
what may be seen as a symptom for gilberts syndrome
- intermittent mild jaundice in relation to stress/fasting/infection/exercise
158
what may be seen on bloods for gilberts syndrome
mildly increased bilirubin and normal fbc
159
management for gilberts syndrome
no treatment as benign
160
is sciatica unilateral or bilateral
unilateral
161
list 3 differential diagnosis for anxiety
1. substance and alcohol misuse/withdrawel
2. medication-induced anxiety
3. hyperthyroidism
162
list 3 differential diagnosis fordepression
1. grief reaction
2. biopolar disorder
3. dementia
163
list an example of a screening tool for anxiety
GAD-7
164
what is the recommended weekly alcohol intake?
<14 units a week
165
what does the term macular damage mean?
collective term for several conditions causing damage to the retina
166
what is the treatment for age related macular degeneration
no cure - can be slowed or halted with some cases by med treatment, drug therpy or laser treatment
167
what is retinitis pigmentosa?
This is a disease of the retina which leads to a gradual reduction in vision; night and peripheral vision being the first to be affected followed by difficulties in reading and colour vision
168
define glaucoma
group of conditions affecting the optic nerve
169
can diabetic retinopathy be cured?
if caught early progression can be halted with laser - wont restore vision loss (leading cause of blindness >65)
170
what is charles bonnet syndrome?
When people lose their sight, their brains are not receiving as many pictures as they used to sometimes, new fantasy pictures or old pictures stored in our brains are released and experienced as though they were seen.
This condition can affect people with serious sight loss. Generally these are people who have lost their sight later in life but may affect people of any age.
