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Phase 3a > General Practice > Flashcards

General Practice Flashcards

1
Q

what type of drug is methotrexate

A

DMARD

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2
Q

what drug type is aspirin?

A

NSAID

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3
Q

when may you co-prescribe folic acid?

A

patient on methotrexate

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4
Q

what part of the kidney does ramipril dilate?

A

Efferant arteriole

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5
Q

what investigation may be needed for a patient on methotrexate?

A

FBC: marrow/wbc suppression
LFT: liver toxicity can occur
U&E

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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

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7
Q

risks of methotrexate medication

A
  • GI toxicity (diarrhoea)
  • liver toxicity
  • pulmonary toxicity (SOB)
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8
Q

what term is used to describe a high level Hb

A

polycythaemia

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9
Q

what can a raised ALT and GGT indicate?

A

liver damage - typically with GGT think alcohol consumption

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10
Q

causes of polycythaemia

A

primary = polycythaemia vera (JAK2 gene mutation)

secondary = sleep apnoea, COPD, chronic HD, anabolic steroids

apparent - diuretics, alcohol, obesity

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11
Q

causes of macrocytosis (name 2)

A
  • B12 folate def
  • alcohol
  • drugs - methotrexate
  • haem disorders - e.g. myeloma
  • liver disorder
  • smoking
  • obesity
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12
Q

causes of Hypocalcaemia - 2

A 
decreased PTH
- low vit D
CKD
- liver disease
- sclerotic bone metastasis
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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
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14
Q

what is the affect of alcohol on ferritin?

A

alcohol increases ferritin

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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

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16
Q

why is bisphosponate treatment limited

A

early reduction in bone resorption followed by later reduction = micro fractures

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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

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18
Q

what type of drug is naproxen

A

NSAID

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19
Q

a pt Bp is 142/61 what stage of hypertension is this?

A

stage 1

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20
Q

what may you assess/investigate if looking for end organ damage in a hypertensive pt (4)

A
  1. fundoscopy -> retinopathy
  2. urinalysis -> albumin:creatinine (how leaky kidneys are)
  3. 12-lead ECG (high bp=LVH?)
  4. QRISK3 (stroke risk)
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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

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22
Q

what murmur may be heard in severe anaemia

A

flow murmur

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23
Q

what is the bp reading for stage 3 HTN

A

> 180/120

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24
Q

list 3 target organ damages as a result of HTN

A
  • CKD
  • LVH
  • hypertensive retinopathy
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25
Q

1st line meds for pt with LHF and HTN

A

ramipril increased to 10mg

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26
Q

daniel,39 has a home bp reading of 138/82 what is the appropriate response from you, the gp?

A
  • refer to cardiology

daniel is <40 and hypertensive so appropriate for referral

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27
Q

doris, 81 has T2DM, you have diagnosed her with hypertension, what is the appropriate medication to prescribe?

A

ACEi/ARB

  • diabetes taken into account over age so ACEi more appropriate than CCB
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28
Q

what is the stepwise ladder for treating HTN in a pt under 55 not black or carribbean family origin or adult with T2DM (4)

A
  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
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29
Q

what is the stepwise ladder for a treating HTN for a patient that is black African or African-caribbean family origin and/or >55?

A
  1. CCB
  2. ACE-i or ARB or thiazide-like diuretic
  3. ACEi or ARB + CCB + thiazide like diuretic
  4. resistant hypertension
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30
Q

how does an ACE-i work?

A
  • interferes with RAAS= increased sodium urine secretion

- vasodilator (stops bradykinin breakdown)

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31
Q

common side effect of ramipril

A

cough

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32
Q

how do BB’s work?

A

work by blocking the effects of epinephrine (adrenaline) → slows heart rate and less force → lower BP

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33
Q

3 consequences of untreated HTN

A
  • hypertensive retinopathy
  • risk of cv event (HF/MI/LVH)
  • stroke risk increase (QRISK3)
  • vascular dementia
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34
Q

what class of drug is levetiracetam

A

anti-epileptic

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35
Q

A pt present with suspected Ovarian cancer, bloods are taken, what is the tumour marker for ovarian cancer?

A

Ca125

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36
Q

a patient presents with laryngitis, what symptoms need to be shown to make you wish to prescribe abx?(4)

A
  1. significant swelling
  2. white spots
  3. temperature
  4. struggle to swallow
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37
Q

what medication is used for breast cancer chemotherapy

A

aromatisei

  • examestone - can affect bone density
  • bisphospohonates can decrease bone mets
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38
Q

what is polymyalgia rheumatica and what is the associated condition it can lead to?

A

inflammation of the blood vessels -> temporal arteritis (giant cell arteritis) -> blindness

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39
Q

what is the common symptom of temporal arteritis

A

headache around the eyes

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40
Q

4 things we can use gabapentin for

A
  1. seizures
  2. menopause
  3. MS
  4. peripheral neuropathic pain
  5. MND
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41
Q

how can you assume an arthritis is RA?

A

RA is symmetrical

OA/psoriatic/gout are asymmetrical

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42
Q

what are the two components looked for in a semen analysis and what should the healthy percentage be?

A

speed (50%) and appearance (40%)

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43
Q

what are the first line medication for treating a UTI (2)

A
  • nitrofuritoin and trimethoprim

need decent renal function -> penicillin/amoxicillin

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44
Q

list 3 signs/symptoms of parkinsons disease

A
  1. resting tremor “pin-rolling tremor”
  2. lack of facial expression
  3. shuffling gait (festinant gait)
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45
Q

what tests can you do for parkinsons on an examination

A

glabellar tap (tapping forehead, parkinsons wont stop blinking, not parkinsons eventually stop)

test tone = cogwheeling

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46
Q

what medications are used for parkinsons disease

A

dopamine agonists

levodopa (l-dopa)

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47
Q

what is frozen shoulder

A

limitation of external rotation

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48
Q

what is the treatment for frozen shoulder

A

local steroid injection - pred/lidocaine

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49
Q

what treatment may be prescribed for a patient with intermittent self-catheterisation

A

nitrofuritoin for preventative

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50
Q

what is the action of anti-fibrinolytic drugs

A

prevent plasmin from breaking down fibrin

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51
Q

at what age should you expect a baby to be walking?

A

12-14 months (worry if nothing by 18m)

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52
Q

at what age should baby be on solid food?

A

6m

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53
Q

what does a BMI of 31 show?

A

obese

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54
Q

what is the average eGFR for a 65 year old man?

A

85

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55
Q

what value for preserved ejection fraction suggests HF?

A

preserved ejection fraction <40

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56
Q

what are the two types of left sided HF?

A
  1. systolic failure with reduced ejection fraction

2. diastolic failure with preserved ejection

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57
Q

define right sided- heart failure

A

loss of RV ability to pump blood from heart to lungs, blood backs into veins = oedema

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58
Q

list 5 signs/symptoms of HF

A
  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
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59
Q

list 3 risk factors for HF

A
  • male
  • CAD
  • previous MI
  • heart valve disease
  • HTN
  • arrhythmia
  • DM
  • meds - nsaids
    alcohol
    obesity
    etc
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60
Q

list 3 complications associated with heart failure?

A
  1. HF = less blood to the kidneys = kidney failure (dialysis)
  2. heart valve problems
  3. fluid build up in liver -> liver damage
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61
Q

what treatment may be considered for an ejection fraction <35% when treating HF?

A

consider implantable cardioverter defibrillator and cardiac resynchronisation therapy

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62
Q

when is pro-BNP released

A

response to pressure changes in the heart, higher in patients with HF

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63
Q

what stage of CKD is an GFR reading of 35 indicative of?

A

stage 3b

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64
Q

what stage of CKD is a GFR reading of 20 suggestive of?

A

stage 4

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65
Q

what medication is contra-indicated in renal failure?

A

loop diuretics (furosemide)

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66
Q

what hormone do BB’s block?

A

epinephrine (adrenaline)

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67
Q

why is furosemide prescribed in HF?

A

symptomatic relief for ankle oedema and difficulty breathing at night - improve symptoms

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68
Q

what is the survival rate of HF >5years >10years?

A

> 5 - 50%

> 10 - 10%

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69
Q

what two complications can furosemide cause?

A
  • hyponatraemia

- hypokalaemia

70
Q

what classification is used for HF?

A

new york HF classification

1 is good, 4 is bad

71
Q

what is measles?

A

highly contagious airborne virus

72
Q

list three main complications of measles

A
  • otitis media
  • pneumonia
  • convulsions, encephalitis, blindness
73
Q

list 3 symptoms of measles

A
  • maculopapular rash
  • conjunctivitis
  • cough
  • fever
74
Q

what are two differential’s for measles?

A
  • parovirus B19
  • strep infection (scarlet fever)
  • rubella
  • early meningococcal disease
75
Q

management for measles?

A
  • rest, fluids, para/ibru for symptom relief

- avoid contact with susceptible people/work/school 4 days

76
Q

what components make up the feverpain score?

A 
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
Q

what vaccines are given at 8 weeks?

A

6-in-1 rotavirus and menB

78
Q

how old is a child when they recieve their first flu vaccine?

A

2 years and 10 months

79
Q

list 5 notifiable diseases

A
  • covid-19
  • botulism
  • acute meningitis
  • acute encephalitis
  • cholera
  • food poisoning
  • infectious blood diarrhoea
  • measles
  • mumps
  • rubella
80
Q

give three examples of conditions which present with a maculopapular rash

A
  • EBV infection
  • measles
  • scarlet fever
  • hand,foot and mouth disease
  • herpes
  • hep b and c
  • zika virus
  • ebola virus
81
Q

list 5 signs of dehydration

A
  • sunken fontanelle
  • dry mouth
  • sunken eyes
  • absence of tears
  • poor overall appearance
82
Q

what two things are assessed when looking at a patients fitzpatrick skin type

A
  • skin features (colour/eyes)

- tanning ability

83
Q

what is the other term for “trigger finger”

A

stenosing tenosynovitis

84
Q

what is trigger finger?

A
  • finger struck in bent position

- inflammation narrows space between sheath that surrounds tendon in affected finger

85
Q

2 risk factors for trigger finger

A
  • women
  • diabetes
  • trauma
86
Q

treatment for trigger finger

A 
NSAIDS
rest
splint 
stretching exercises
if severe can have steroid inj
87
Q

define dupuytrens contracture

A

fascia of the hand becomes thickened and tight leading to finger contractions

88
Q

2 RF for dupuytrens contracture

A
  • age
  • epilepsy
  • family history
  • diabetes
  • smoking
  • alcohol
89
Q

what is the typical first sign of dupuytrens contracture

A

development of hard nodules on the palm

90
Q

what finger is most likely to be affected by dupuytrens contracture and what finger is least likely

A
  • ring finger most likely

- index least likely

91
Q

what test can be used when assessing dupuytrens contracture?

A

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
Q

management of dupuytrens contracture is to typically do nothing - what are the three surgical treatments that may be used

A
  1. needle fasciotomy
  2. limited fasciotomy
  3. dermofascietomy
93
Q

what is the most common cause of cellulitis

A

group A strep

94
Q

where is cellulitis most commonly seen?

A

feet and legs

95
Q

describe the appearance of cellulitis (5)

A 
red
hot
swollen
painful
orange-peel appearance
blisters
96
Q

2 RF for cellulitis

A
  • IVDU
  • injuries that break the skin
  • chickenpox and shingles
  • chronic skin conditions
97
Q

what is the treatment of cellulitis?

A

typically oral abx (fluclox)

if severe can be IV

98
Q

list 3 complications of cellulitis

A
  • bacteremia
  • suppurative arthritis
  • osteomyelitis
  • endocarditis
99
Q

at what age bracket does croup typically affect?

A

6m - 2yrs

100
Q

what type of infection is croup

A

upper respiratory tract infection (causing oedema in the larynx)

101
Q

what is the classic cause of croup (see it in exams)

A

parainfluenza virus

102
Q

how is croup treated

A

typically improves in <48hrs and responds well to steroids (dexamethasone)

103
Q

list 3 causes of croup

A
  • parainfluenza
  • influenza
  • adenovirus
  • RSC
104
Q

what type of cough may be heard in croup?

A

barking cough - clusters of coughing episodes

105
Q

how is croup managed

A
  • at home supportive
  • oral dexamethasone 150 mcg/kg
  • prednisolone
106
Q

what conditions make up “feltys syndrome”

A
  • rheumatoid arthritis
  • splenomegaly
  • neutropenia
107
Q

what condition is to be suspected after hearing a “crescendo-decrescendo” murmur (ejection systolic murmur)that radiates to the carotid arteries?

A

aortic stenosis

108
Q

what is the most common cause of aortic stenosis in developed countries

A

calcification of aortic valves

109
Q

what type of murmur is associated with mitral regurgitation

A

pansystolic murmur (heard loudest over mitral area and -> axilla)

110
Q

3 causes of mitral regurgitation

A
  • infective endocarditis
  • acute MI with papillary muscle rupture
  • rheumatic HD
  • congenital defects of mitral valve
  • cardiomyopathy
111
Q

what heart murmur may cause a hyperdynamic apex beat?

A

mitral regurgitiation

112
Q

what condition has an early diastolic murmur heard loudest at sternal edge associated with it?

A

aortic regurgitation

113
Q

2 causes of aortic regurgitation

A

congenital bicuspid aortic valve
rheumatic HD
infective endocarditis

114
Q

what pulse is to be expected from a pt with aortic regurgitation

A

collapsing pulse

115
Q

what murmur is associated with mitral stenosis

A

low-pitch, rumbling, mid-diastolic murmur heard loudest over apex

116
Q

what is the most common cause of mitral stenosis

A

rheumatic heart disease

117
Q

what type of arrthymia is associated with mitral stenosis

A

AF

118
Q

what fluid is located in the SA space

A

cerebrospinal fluid

119
Q

what is the typical cause of SAH

A

ruptured cerebral aneurysm

120
Q

what is the typical history of a SAH (5)

A
  • thunderclap headache
  • stiff neck
  • photophobia
  • vision change
  • neuro symptoms (LOC, weak, seizures)
121
Q

2 RF for SAH

A
  • HTN
  • smoking
  • excessive alcohol
  • cocaine
  • family history
122
Q

in what demographics is SAH more common

A
  • black
  • female
  • 45-70
123
Q

list 3 conditions associated with SAH

A
  • sickle cell anaemia
  • connective tissue disorders (marfans s)
  • neurofibromatosis
  • autosomal dom PKD
124
Q

what is the first line investigation for a suspected SAH

A

CT head

125
Q

how will the CSF of a patient with a SAH present?

A
  • high red cell count

- yellow coloured CSF - bilirubin

126
Q

list the two surgical procedures for SAH and one medication for vasospasm prevention

A
  • surgery = coiling and clipping

- meds = ccb = nimodipine

127
Q

what condition can occur in patients with chronic iron deficiency anaemia

A
  • 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
Q

what type of infection is pneumocystis jiroveci?

A

fungal infection

129
Q

what medical condition can increase your chances of having pneumocystis jiroveci

A

HIV (weakens immune system)

long term corticosteroid

130
Q

what is the most common type of medication for pneumocystis jiroveci?

A

trimethoprim/sulfamethoxazole

131
Q

what genetic type of condition is hereditary spherocytosis

A

autosomal dominant

132
Q

list 4 S/S of hereditary spherocytosis

A
  • jaundice
  • anaemia
  • gallstones
  • splenomegaly
133
Q

a patient with hereditary spherocytosis presents with anaemia, what is the causative agent?

A

parvovirus

134
Q

a pt presents with parvovirus and has developed anaemia and jaundice what is the underlying diagnosis?

A

hereditary spherocytosis

135
Q

how is hereditary spherocytosis diagnosed?

A
  • family history and clinical features
  • spherocytes on blood film
  • raised reticulocytes
136
Q

how is hereditary spherocytosis managed?

A

folate supplement and splenectomy

  • sometimes need cholecystectomy
  • transfusions in acute crisis
137
Q

what is the typical first sign of dementia in a pt with downs syndrome

A

loss of adaptive function (slowing of daily function/self-care)

138
Q

at what age should we be expected to take a baseline assessment for a pt with downs syndrome

A

age 30

>40 regular screen because increased prevelence

139
Q

life expectancy for downs syndrome pt

A

average = 60

140
Q

which blood tests are typically used in a confusion screen ? (9)

A
  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
Q

if a pt presents confused with focal neuro signs and head injury, what may you expect to see on CT (3)

A

subdural haematoma
extradural haematoma
extracranial bleed

142
Q

why is a urinalysis important in a confused pt?

A

differentials - dementia/UTI/delirium etc

143
Q

list 3 medications that can cause confusion

A
  • opioids
  • steroids
  • incontinence meds
  • SSRI
144
Q

what two risk factors are associated with the elderly and diazepam

A
  • increased falls risk

addiction

145
Q

when conducting a PSA in what scenario may you have to double the PSA level you recieve

A

pt on tamsulosin

146
Q

why is PSA not an accurate marker for prostate cancer

A

non specific i.e can increase in infection, bike riding etc

147
Q

at what level does the spinal cord terminate?

A

L1

148
Q

what is the most common cause of lumbar disc herniation at level L4/L5 and L5/S1

A

cauda equina syndrome

149
Q

list 3 symptoms of cauda equina syndrome

A
  • lower back pain with alternating or bilateral radicular pain
  • saddle anaesthesia
  • bladder/bowel disturbance
150
Q

investigation for cauda equina syndrome?

A

whole spine MRI

151
Q

in what time frame should the spinal cord be surgically decompressed in cauda equina

A

within 48hr

152
Q

define hirchsprungs disease

A

as baby develops in utero distal colon not innervated correctly = shrunken colon not distended and stool trapped in prox. colon

153
Q

3 presentations of hirchsprungs disease at birth

A
  • a delay in passing meconium (>48 hours)
  • a distended abdomen
  • forceful evacuation of meconium after digital rectal examination
154
Q

how is hirchsprungs disease diagnosis confirmed

A

rectal suction biopsy

155
Q

management of hirchsprungs disease

A

definitive - removal of section of anganglionic colon

156
Q

what type of genetic condition is gilberts syndrome

A

autosomal recessive

(decreased activity of the enzyme that conjugates bilirubin with glucuronic acid owing to a mutation in the UGT1A1 gene.)

157
Q

what may be seen as a symptom for gilberts syndrome

A
  • intermittent mild jaundice in relation to stress/fasting/infection/exercise
158
Q

what may be seen on bloods for gilberts syndrome

A

mildly increased bilirubin and normal fbc

159
Q

management for gilberts syndrome

A

no treatment as benign

160
Q

is sciatica unilateral or bilateral

A

unilateral

161
Q

list 3 differential diagnosis for anxiety

A
  1. substance and alcohol misuse/withdrawel
  2. medication-induced anxiety
  3. hyperthyroidism
162
Q

list 3 differential diagnosis fordepression

A
  1. grief reaction
  2. biopolar disorder
  3. dementia
163
Q

list an example of a screening tool for anxiety

A

GAD-7

164
Q

what is the recommended weekly alcohol intake?

A

<14 units a week

165
Q

what does the term macular damage mean?

A

collective term for several conditions causing damage to the retina

166
Q

what is the treatment for age related macular degeneration

A

no cure - can be slowed or halted with some cases by med treatment, drug therpy or laser treatment

167
Q

what is retinitis pigmentosa?

A

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
Q

define glaucoma

A

group of conditions affecting the optic nerve

169
Q

can diabetic retinopathy be cured?

A

if caught early progression can be halted with laser - wont restore vision loss (leading cause of blindness >65)

170
Q

what is charles bonnet syndrome?

A

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.

Phase 3a (4 decks)

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