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GI + Other Conditions Flashcards

1
Q

What is the management for GORD?

A

Over the counter medication - antacids

Lowest possible does of PPI

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2
Q

What investigations can be performed in GORD?

A

Endoscopy - Savary-Miller grading system

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3
Q

What are the complications of GORD?

A

PUD
Perforation
Barretts oesophageus - oesophageal cancer
Oesophageal stricture

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4
Q

What are the some medications that may exacerbate symptoms of GORD?

A 
Alpha-blockers 
Anticholinergics 
Benzodiazepines
Beta-blockers 
Bisphosphonates 
CCB
Corticosteroid 
TCA
Nitrates 
Theophyllines
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5
Q

What is required for diagnoses of diabetes?

A

Symptoms + raised HBA1C

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6
Q

What is the multi factorial treatment of diabetes?

A

HBA1C, Lipids and BP

Lifestyle

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7
Q

When is HBA1C affected other then in diabetes?

A

Variants e.g. HbS
Haemodilution in pregnancy
Severe anaemia
Bone marrow disease

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8
Q

What are the guidelines for the prescription of aspirin and statins in people with diabetes?

A

Pts with type 1 or type 2 diabetes should be offered 20mg Atorvastain primary prevention of CVD, as this is increased in diabetics

Anti-platelet therapy (aspirin or clopidogrel) should not be offered to type 2 diabetes pts without CVD.

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9
Q

What BP readings should T2DM Pt be aiming for?

A

<80 yrs: clinic BP - <140/90, Home BP - <135/85

> 80 yrs: clinic BP - <150/90, Home BP - <145/85

If known CKD: <130/80

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10
Q

What is the first line drug offered to T2DM pts for hypertension, after lifestyle modifications?

A

ACEi or ARB

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11
Q

What are some micro vascular complications of diabetes?

A

Diabetic retinopathy
Diabetic neuropathy - diabetic foot
Diabetic nephropathy

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12
Q

What are the macrovasular complications of diabetes?

A

Strokes
MI
Peripheral arterial disease

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13
Q

When is screening offered for diabetic retinopathy?

A

Everyone with diabetes (12 or older) is invited for annual eye screening. This is because diabetic retinopathy is asymptomatic in the early stages, so if picked up early can be reversed.

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14
Q

What are the three stages of diabetic retinopathy?

A

Background retinopathy- tiny bulges develop in the blood vessels - bleed slightly but don’t affect vision

Pre-proliferative retinopathy - more severe/widespread change affect the blood vessels plus moe significant bleeding

Proliferate retinopathy - scar tissue and new blood vessels on retina - weak and bleed easy resulting in some vision loss

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15
Q

What can the diabetic neuropathy screening involve?

A

Filament test - sensitivity to touch
Sensory test - vibration and temp
Nerve conductions studies
Muscle response test (electromyography) - electrical discharges in pts muscle
Autonomic testing - BP changes in different positions and if sweat normally

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16
Q

What are the two tests done to measure kidney function in diabetes?

A

Urine sample - check for protiens

Bloods - eGRF/ACR

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17
Q

What are the complications of diabetic nephropathy?

A 
Fluid retention 
Hyperkalemia 
CVD/Stroke 
Diabetic retinopathy 
Anaemia
Foot sores, ED, diarrhoea and other issues related to nerves and blood vessels 
Pregnancy complications 
Irreversible kidney damage
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18
Q

What safety netting should someone with diabetes be given?

A

Signs of hypoglycaemia - confusion, drowsiness, feeling light-headed, feeling hungry, shaking, palpations

Check feet

Changes in vision

Risk of infections - e.g. thrush

Symptoms of diabetic nephropathy - frothy urine, oedema

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19
Q

Give an example of a diabetic education programme?

A

DESMOND

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20
Q

What is management of someone with newly diagnosed CKD?

A
  1. Lifestyle advice - including vaccinations
  2. Aim or BP <140/90 - SGLT2i first line. ACEi/ARB used with caution as may reduce eGFR further
  3. Statins considered but use with caution

Avoid NSAIDS

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21
Q

What safety netting should someone with CKD be given?

A

AKI presentations:

  • feeling sick
  • diarrhoea
  • dehydration
  • peeing less then usual
  • confusion
  • drowsiness
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22
Q

What blood test other then HDL levels need to be done before and after 3 months of prescribing statins?

A

LFTs and eGFR. - liver inflammation and kidney damage

23
Q

What investigations should be done for suspected stable angina?

A

ECG
FBC, lipid and triglycerides, BP, eGFR
Q-risk

24
Q

What is the management of stable angina?

A

Lifestyle advise

GTN spray

Optimise BP and lipid lowering therapy

Beta-blockers and aspirin for long term prevention may be considered

Socially prescribe to support groups

Cardiology referral if symptoms can’t be managed in primary care

25
Q

When should a follow up be arranged if stable angina?

A

2-4 weeks and then 6 months

26
Q

What are the side effects of GTN spray?

A

Dizziness
N/V
Drowsiness

27
Q

What safety netting should be given to pts with stable angina?

A

MI symptoms

If symptoms get worse to come back

28
Q

What are the diffentials for irregularly irregular pulse?

A

AF and Ventricular ectopics

29
Q

What are the different types of AF?

A

Paroxysmal AF - episodes come and go within 48 hrs without treatment
Persistent - each episode lasts longer then 7 days
Long standing - over a year
Permanent

30
Q

What are some of the symptoms of AF?

A

Dizziness, SOB, syncope, tiredness, chest discomfort, reduced exercise tolerance, palpitations

But can be symptomless

31
Q

What are the common cause of AF?

A

SMITH

Stroke 
Mitral valve pathology 
Ischaemic heart disease 
Thyrotoxicosis (hyperthyroidism)
Hypertension

+ diabetes, cancer and alcohol misuse

32
Q

What are the complications of AF?

A

Stoke, thromboembolism, HF, tachycardia-induced cardiomyopathy and critical cardia ischaemia

Reduced quality of life

33
Q

Which tool is used to assess stroke risk?

A

CHA2DS2VASc

34
Q

Which tool is used to asses bleeding risk?

A

ORBIT

35
Q

What rate controlling drugs can be used in AF?

A

Beta-blockers - Atenolol
CCB - Diltiazem

Digoxin?

Do not combine as can cause heart block

36
Q

What can be offered in reversible AF?

A

AF is reversible if new onset in lat 48hrs, AF causing HF, remain symptomatic despite rate control

Cardioversion

37
Q

What anti-coagulation should be prescribed in AF?

A

DOAC e.g. apixaban

If contradicted the warfarin

38
Q

What are the two types of cardio version?

A

Immediate - AF present for less then 48hrs or they are haemodnamically unstable

Delayed - if AF present for more then 48hrs and are stable

39
Q

What are the forms of cardioversion?

A

Pharmacological - first line flecanide or amiodarone (pts with structural heart disease)

Electrical cardioversion

Risk of embolisation so require anticoagulation

40
Q

What follow up should be arranged for AF?

A

1 week to review if medications working if not then try dual therapy

If still no result the refer to cardiology

41
Q

What is the management for UTIs?

A

Uncomplicated: nitrofurantoin or trimethoprim for 3 days

Complicated: urine sampled obtained and trimethoprim for 7 days or amoxicillin

Reccurent - prophylaxis of nitrofurantoin or trimethoprim and second line is cefalexin

Children over 3 months - nitrofurantoin or trimethoprim for 7 days or if upper urinary symptoms then co-amoxiclav or cefalexin

Children under 3months - refer to paediatric specialist

42
Q

What is the treatment for pyelonephritis?

A

Ciprofloxacin - 500mg twice a day for 7 days
Trimethoprim- 200mg twice a day for 14 days
Co-amoxicalv - three times a day for 7-10 days
Cefalexin 500mg twice or three times a day for 7-10days

43
Q

What cause oral thrush?

A

Candida albicans

44
Q

What are the different types of thrush?

A

Oral thrush
Denture stomatitis- denture wearers
Chronic-plaque candidiasis - older men over 30 and smokers

45
Q

What is the management for oral thrush?

A

Miconazole oral gel - 1st line - 4 times a day and continue for 7 days after healed

2nd line - nystatin suspension - 4 times a day for 7 days and continue for 48 hrs after lesions resolve

Oral fluconazole - review after 7 days

46
Q

When should you refer someone to dermatology in oral thrush?

A

Systemically unwell

Oseophageal candidiasis characterised by pain on swallowing or retrosternal pain

Treatment fails, severe infection, immunocompromised, Recurrent episodes

47
Q

What is the treatment for uncomplicated vulvovaginal thrush?

A

Short course of intravaginal antifungal (clotrimazole) or oral antifungal (fluconazole or itraconazole)

48
Q

What make vuvulovaginal thrush complicated?

A

Reccurent (4 or more in a year)
Severe infection
Infection during pregnancy
Infection in diabetes or immunocompromised
Infection from other organism other then candida

49
Q

What is the treatment of severe vulvovaginal thrush?

A

Two does of fluconazole 150mg 3 days apart or if contraindicated two doses of clotrimazole 500mg vaginal pessary 3 days apart

50
Q

What is the treatment for Reccurent vulvovaginal thrush?

A

Treat as require prescription

6 months maintenance regime with oral or intravaginal antifungal

51
Q

What is the treatment of vulvovaginal thrush in diabetes or immunocompromised?

A

Oral antifungal 7 days
Intravaginal antifungal - 6-14 days

Optimise diabetic control

52
Q

What is the treatment in pregnant women with vulvovaginal thrush?

A

Intravaginal antifungal for 7 days

Avoid oral antifungals

53
Q

What is vasovagal syncope?

A

Absence of feature suggesting alternative diagnosis
Uncomplicated faint (3ps):
-posture - prolonged standing
-provoking factors - such as pain or medical procedure
-prodromal symptoms - such as sweating out feeling warm/hot before blackout

54
Q

What is diagnostic of orthostatic hypotension?

A

Symptoms get worse on standing and relived by sitting or lying down

A fall in systolic BP of 20mmHg or 30mmHg in hypertension or fall of 10mmHg of diastolic BP within 3 mins of standing

GP (6 decks)

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