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CCC > GP > Flashcards

GP Flashcards

1
Q

What to advise on stopping COCP before surgery?

A

Stop pill 4 weeks before surgery and restart 2 weeks after, due to risk of VTE - advise alternative contraception

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2
Q

Asthma step by step guidelines in adults

A 
SABA
ICS
LTRA
LABA
(Theophyilline, tiotropium)
(Oral steroids)
(Omalizumab)
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3
Q

Routine investigations for COPD

A

CXR (exclude cancer, bronchiectasis)
Bloods (anaemia, polycythaemia)
Post-bronchodilator spirometery

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4
Q

FEV1/FVC ratio level for diagnosis of COPD

A

<0.7

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5
Q

1st line inhaler therapy for COPD

A

SABA + SAMA

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6
Q

2nd line inhaler therapy for COPD with asthmatic features

A

LABA + ICS

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7
Q

2nd line inhaler therapy for COPD without asthmatic features

A

LABA + LAMA

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8
Q

COPD triple therapy?

A

LAMA + LABA + ICS

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9
Q

GP management for exacerbation of COPD

A

Prednisolone 30mg OD for 5 days
+
Amoxicillin 500mg TDS 5 days (or doxycycline, clarithromycin)

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10
Q

Palliative management of COPD secretions?

A

Hyoscine Hydrobromide

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11
Q

Management options for COPD secretions?

A

Acapella device
Carbocistiene
Hyoscine bromide

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12
Q

FEV1, FVC and FEV1/FVC ratio picture in obstructive lung disease?

A

FEV1 = <80% predicted
FVC = (near) normal
FEV1/FVC ratio = <0.7

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13
Q

FEV1, FVC and FEV1/FVC ratio picture in restrictive lung disease?

A

FEV1: <80% predicted
FVC: <80% predicted
FEV1/FVC ratio: Normal or increased >0.7

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14
Q

FEV1 percentage of predicted for mild, moderate and severe COPD?

A

o Mild COPD = FEV1 >80% predicted
o Moderate COPD = FEV1 50-79% predicted
o Very severe COPD = FEV1 30-49% predicted

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14
Q

FEV1 percentage of predicted for mild, moderate and severe COPD?

A

o Mild COPD = FEV1 >80% predicted
o Moderate COPD = FEV1 50-79% predicted
o Very severe COPD = FEV1 30-49% predicted

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15
Q

Stage 1 hypertension

A

Clinic BP >140/90

HPBM >135/85 - 149/94

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16
Q

Stage 2 hypertension

A

Clinic BP >160/100 - <180-120

HPBM BP >150/95

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17
Q

Stage 3 (severe) hypertension

A

Clinic systole >180

Clinic diastole >120

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18
Q

Discrepancy of BP between clinic and HPBM in white coat effect?

A

> 20/10

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19
Q

Diagnosis of malignant hypertension

A

> 200/130mmHg with signs of end-organ damage

Pulmonary oedema, papilloedema, nephropathy

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20
Q

Phaeochromocytoma symptoms

A 
Labile/postural hypotension
Headache
Palpitations
Pallor
Profuse sweating
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21
Q

Cushing’s symptoms (hypercortisolism)

A 
Truncal obesity
Moon face
Bruises
Striae
Weakness in upper arms and thighs
Low libido
Depression, mood swings
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22
Q

Step 1 hypertension Tx

A

Age <55, non afro-caribbean: ACE-i (or ARB)

Age >55, afro-caribbean: CCB, TLD

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23
Q

Step 2 hypertension Tx

A

ACE-i / ARB + CCB/TLD

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24
Q

Step 3 hypertension Tx

A

ACEi/ARB + CCB + TLD

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25
Q

Step 4 hypertension Tx

A

Spironolactone (if K+ <4.5)
Beta blocker (if K+ >4.5)
Consider specialist referral

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26
Q

Annual HTN review?

A

Check BP
Check renal function (creation, U&E, eGFR, dipstick for proteinuria –> ACR)
QRISK assessment

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27
Q

Target BP age <80

A

<140/90 in clinic

<135/85 HBPM

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28
Q

Definition of CKD

A

Presence of kidney damage (albuminuria) OR decreased kidney function (eGFR <60ml/minute) for >3 months

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29
Q

Stage 1 CKD

A

eGFR >90 with other evidence of chronic kidney damage (microalbuminuria, proteinuria, haematuria, structural abnormality)

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30
Q

Stage 2 CKD

A

eGFR 60-80ml/minute with other evidence of chronic kidney (microalbuminuria, proteinuria, haematruia)

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31
Q

Stage 3a CKD

A

eGFR 45-59ml/minute

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32
Q

Stage 3b CKD

A

eGFR 30-44ml/minute

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33
Q

Stage 4 CKD

A

eGFR 15-29ml/minute

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34
Q

Stage 5 renal failure (ERF)

A

eGFR <15ml/minute

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35
Q

Nephrotoxic drugs

A 
Digoxin
Iodine
ACEi
Metformin
Opiates
NSAIDs
Diuretics
Lithium

(DIAMONDL)

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36
Q

CKD medication treatment

A

Atorvastatin 20mg OD
Antiplatelet
Folic acid and Vitamin B

If diabetes and ACR >3mg/mmol, HTN and ACR >30mg/mmol OR ACR >70mg/mmol –> ACE-I or ARB

Otherwise –> CCB if over 55 or afro-caribbean

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37
Q

Investigations for heart failure

A 
Nt-ProBNP (normal <100. Urgent referral >2000)
LFTs - liver failure due to backlog
U&Es
Renal function - eGFR, ACR
TFTs
HbA1C
FBC - infection
Echo
ECG
CXR - ABCDE
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38
Q

Findings on CXR suggestive of HF

A

ABCDE

A - Alveolar oedema (interstitial oedema - hazy)
B - Kerley B lines (fluid in lung fissures)
C - Cardiomegaly (increased cardiothoracic ratio)
D - Dilated prominent upper lobe vessels
E - Pleural effusion (reduced costophrenic angle)

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39
Q

Classes of heart failure

A

Class I: no Sx during ordinary physical activity
Class II: slight limitation of physical activity by Sx
Class III: less than ordinary activity causes Sx
Class IV: inability to carry out physical activity due to Sx

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40
Q

Long-term medical management of heart failure

A

ABAL

A + B –> ACE-i (ramipril 10mg OD) + Beta blocker (bisoprolol 10mg OD). Titrate upwards.

A –> Aldosterone antagonist (spironolactone)

L –> Loop diuretic (furosemide 40mg OD in morning)

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41
Q

Extra add on’s for HF management

A

Digoxin
Flu and pneumococcal vaccine
LVAD
Mental health management

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42
Q

What to do in a HF review?

A 
Medication review
BMI
Basic obs
U&Es
eGFR
ECG
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43
Q

3 features of typical angina (definition)

A
  1. Constricting/heavy discomfort to chest/jaw/neck/shoulders
  2. Brought on by exertion
  3. Relieved by rest or GTN
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44
Q

What is QRISK assessment tool?

A
  • Calculates 10 year estimated risk of someone having an adverse cardiac disease (includes stroke, peripheral artery disease etc)
  • Expressed as a percentage – 20% risk is 2 in 10 chance of developing cardiovascular disease within 10 years
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45
Q

Management of QRISK >10%

A

Lipid profile and FHx

Atorvastatin 20mg OD (check LFTs at 3 and 12 months)

46
Q

Difference between unstable angina and NSTEMI on investigation?

A

Tropononin

MI = raised, angina = normal

47
Q

Angina Primary Prevention

A

1st line: GTN Spray + Beta blocker

2nd line: CCB

48
Q

Unstable angina primary prevention

A

Aspirin + antithrombin (fondaparinux)

49
Q

Secondary prevention of ACS

A 
4 As
Aspirin (75mg) + (clopidogrel for first 12 months)
Atorvastatin 80mg
Atenolol 5mg 
ACE-i (ramipril 10mg)
49
Q

Secondary prevention of ACS

A 
4 As
Aspirin (75mg) + (clopidogrel for first 12 months)
Atorvastatin 80mg
Atenolol 5mg 
ACE-i (ramipril 10mg)
50
Q

Asthma steps in children

A 
SABA
ICS
LTRA/LABA (LTRA if under 5)
Thephylline/LAMA (tiotropium)
Refer
(monoclonal antibody - omalizumab) 
(oral steroids)
51
Q

Metformin mechanism of action

A

Increases sensitivity to insulin, and decreases liver production of glucose

52
Q

Metform SEs and contraindications

A 
Diarrhoea, abdo pain
Lactic acidosis (sick day rules - stop metformin)

Contraindication: renal failure

53
Q

Sulphonyl urea:
Mechanism of action
SEs
HbA1C target

A

MOA: increased insulation production and secretion
SE: weight gain (lots of sugar saved), hypos, CV disease
Target: 53mmol/mol

54
Q

SGLT-2 Inhibtiors (e.g. Gliflozin):
MOA
SEs
Contraindications

A

MOA: blocks glucose reabsorption in PCT, so glucose remains in urine
SE: weight loss, UTIs, thrush, ketacidosis
Contraindication: eGFR <60

55
Q

Gliptins (DDP-4 Inhibitors)
MOA
SEs
Contraindications

A

MOA: inhibits DPP-4 enzymes which stop incretin production to slow insulin production
SEs: GI upset, URTI symptoms

56
Q

GLP-1 Receptor agonists (Glutides)
MOA
SEs
Contraindications

A

MOA: increases insulin secretion, inhibits glucagon production, slows GI absorption. Subcut injection. most be BMI >35.
SE: weight loss, GI discomfort.
Contraindication: BMI <35

57
Q

What does CHA2DS2-VASc stand for and what does it mean?

A 
Congestive heart failure
Hypertension
A2 - age <75 (scores 2)
Diabetes
S2 - stroke/TIA (scores 2)

Vascular disease
Age 65-74
Sex (female)

If score >1 offer anticoagulation to patient with AF to prevent stroke risk (if score 1, consider)

58
Q

What does the HAS-BLED score stand for and what does it mean?

A

Hypertension
Abnormal renal and liver function
Stroke

Bleeding
Labile INRs (whilst on warfarin)
Elderly
Drugs/alcohol

59
Q

1st line treatment for AF

A

Lifestyle advice
+
Rate control: Beta-blocker (or CCB or digoxin)

60
Q

Rhythm control management for AF?

A

In first 48 hrs –> immediate cardioversion with flecainide/amiodarone (if structural heart disease)

If >48 hours –> anticoagulant for 3 weeks then do cardio version with flecainaide/amiodarone (if structural heart disease)

61
Q

Annual review for AF

A 
Check symptoms
HR
Review medications
Assess stroke risk
Assess bleeding risk
Assess CVD risk
62
Q

Causes of AF

A 
Sepsis
Mitral valve pathology (stenosis, regurgitation)
Ischaemic heart disease
Thryotoxicosis
Hypertension

Other: heart failure, diabetes, acute infection, hypokalaemia

63
Q

What does the Prisma-7 questionnaire assess for?

A

Frailty

64
Q

What to ask about when assessing multi-morbidity?

A
  • Establish disease burden
  • Mental health, wellbeing, QOL
  • Establish treatment burden
  • ICE
  • Social circumstance, health literacy, functional autonomy, coping strategies
  • ?Palliative acre needs
  • Assess for frailty
65
Q

What to ask about when assessing multi-morbidity?

A
  • Establish disease burden
  • Mental health, wellbeing, QOL
  • Establish treatment burden
  • ICE
  • Social circumstance, health literacy, functional autonomy, coping strategies
  • ?Palliative acre needs
  • Assess for frailty
66
Q

BMI grades for overweight and obesity

A
  • BMI 30-35kg/m2 = obesity grade I
  • BMI 35-40kg/m2 = obesity grade II
  • BMI >40/m2 = obesity grade III
67
Q

Drug used for obesity management and main SEs/risks.

A

Orlistat - lipase inhibitor (reduces absorption of dietary fat)

SE: abdo discomfort, faecal urgency
Monitoring: weight 3 months + 6 months

68
Q

Epilepsy history. What to ask?

A

ABC detail.
Video recording?

CBITE
Colour
Breathing
Incontinence
Tongue biting 
Eye rolling
69
Q

If a patient >55 is already taking a CCB + ARB but remains hypertensive, which drug should you add in?

A

Thiazide like diuretic (indapamide)

70
Q

HbA1C diagnostic levels

A 
Pre-diabetic = 42-47mmol/L
Diabetic = >48 mmol/L
SYMPTOMATIC = do test once
ASYMPTOMATIC = do test twice

CAN’T use in: pregnancy, kids, renal failure, acute illness

71
Q

Diabetes complications

A 
Macro = cardiovascular risk
Micro = nephropathy, neuropathy, retinopathy, erectile dysfunction
72
Q

Sick Day Rules for Metformin use and why

A

Reduce dose
Metformin increases chance of lactic acidosis (because it inhibits gluconeogenesis so promotes anaerobic respiration), which is exacerbated when combined with metabolic acidosis caused by sepsis = bad news

73
Q

When is urinary ACR classified as ‘raised’?

What are the levels for it?

A

> 3 mg/mmol = raised

<3 = normal
3-30 = moderately increased
>30 = severely increased
74
Q

For how long does someone have to have a change in eGFR for CKD to be diagnosed?

A

3 months

75
Q

SBA:
An 85 year old lady is recovering post hip fracture. She is struggling to get up the stairs and get to the toilet on time.
Which is the most appropriate HCP for her to be referred to?

A

Occupational Therapist

76
Q

SBA:

A 72 year old man lives alone, has multiple chronic conditions which affect his mental health. Which HCP should he see?

A

Social prescriber

77
Q

What level BNP is normal and what are the referral guidelines?

A

Normal = <100
400 - 2000 = refer for specialist assessment and echo within 6 weeks
>2000 = refer for specialist assessment and echo within 2 weeks

78
Q

23yo male. Constant localised pain left anterior chest wall. Anxious, feels has to catch breath sometimes. But able to run 5k without undue SOB.
Sats 99%.
HR 70.
Palpitation reproduces symptoms.

SBA: likely diagnosis?

A

Costochondritis

79
Q

What other conditions can increase BNP?

A

AF

80
Q

What scoring system can you use to monitor someones ability to live independently?

A

Barthel Index

81
Q

When initiating treatment on an ACEi, how frequently should you check U&Es?

A

Check in 1-2 weeks
Check after each increase
Check annually thereafter

82
Q

COPD inhaler stepladder

A

1st = SABA / SAMA
2nd without asthmatic features = LABA + LAMA
2nd line with asthmatic features = LABA + ICS
3rd line = triple therapy (LABA + LAMA + ICS)

83
Q

Medication for infective COPD exacerbation

A

Amoxicillin 500mg TDS 5/7 + Prednisolone 30mg OD 5/7

Consider osteoporosis prophylaxis if >3-4 courses of prednisolone in 1 year

84
Q

Initial drug treatment for someone with a new diagnosis of heart failure

A

1st line = A + B
Acei / ARB + beta-blocker

2nd line = A+L+Others
Aldosterone antagonist 
Loop diuretic 
(Flozin (SGLT2 inhibitors)
Digoxin
Valsartan)
85
Q

Drugs to stop in HF

A

NSAIDs (exacerbate HF)
Steroids (water retention)
Pioglitazone (water retention)

86
Q

How do you diagnose T2DM/pre-diabetes?

A 
Symptomatic = only 1 test needed
Asymptomatic = repeat test needed

Random blood glucose/OGTT = >11.1mmol/L (7.8-11.1 = pre-diabetes)
Fasting blood glucose = >7mmol/L
HBa1C = >48mmol/L (42-47mmol/L = pre-diabetes)

87
Q

T2DM treatment ladder

A

(Diet & lifestyle advice)

  1. Metformin
  2. Dual therapy (DPP4 inhibitors (gliptins), sulphonylurea (gliclazides), pioglitazone, SGLT2 inhibitors (flozins - use in HF).
  3. Insulin / GLP1 agonist (BMI >35)
87
Q

T2DM treatment ladder

A

(Diet & lifestyle advice)

  1. Metformin
  2. Dual therapy (DPP4 inhibitors (gliptins), sulphonylurea (gliclazides), pioglitazone, SGLT2 inhibitors (flozins - use in HF).
  3. Insulin / GLP1 agonist (BMI >35)
88
Q

Which TD2M drugs cause hypos

A

Sulphonylureas

Insulin

89
Q

SE of metformin

A 
GI upset (can give modified release)
Lactic adiposis (sick day rules! Stop taking)
Renally excreted - cannot give in eGFR<30, check U&Es before
90
Q

DPP4 inhibitors: type of drug, MOA, SE

A

Gliptins e.g. sitagliptin

MOA = stop breakdown of incretins, which increase insulin production

SE = GI upset, pancreatitis.

91
Q

Pioglitazone: MOA, SE, CI

A

MOA = similar to metformin, increases insulin sensitivity

SE = (lots!!) weight gain, fracture risk, fluid retention, bladder cancer association

CI = osteoporosis, HF, cancer

92
Q

Sulphonylureas: type of drug, MOA, SE

A

Gliclazides

MOA = increase insulin production/secretion from beta cells

SE = hypos, weight gain, SIADH (hyponatraemia), CV risk if used as monothearpy

93
Q

SGLT-2 inhibitors: type of drug, MOA, SE, CI

A

Flozins e.g. empagiflozin

MOA = prevent reabsorption of glucose into blood at PCT by inhibiting SGLT-2 protein = glucose excreted in urine

SE = weight loss, thrush/UTIs, DKA

CI = renal failure (eGFR <60)

94
Q

GLP-1 agonist = indication, type of drug, MOA, SE

A

Indication = 3rd line after dual therapy for T2DM. Can only be used in those >35 BMI who will benefit from weight loss.

MOA = increases insulin secretion and slows GI absorption.
SE = weight loss, GI upset, pancreatitis / pancreatic cancer
95
Q

Annual review for diabetes

A

HbA1c
BMI
BP (aim <140/80 or <130/80 in CKD)
Urinary ACR - >3 / urine dipstick positive for proteins then start ACE-i
Diabetic foot check
Diabetic retinopathy screen
Lifestyle discussion
QRISK score and start atorvastatin 20mg if >10%
Insulin user - check sites for lipodystrophy

96
Q

Losartan drug class

A

ARB

97
Q

Indapamide drug class

A

Thiazide like diuretic

98
Q

Lercanidipine drug class

A

CCB

99
Q

Lisinopril drug class

A

Ramipril

100
Q

School exclusion rules scarlet fever

A

24 hours after commencing abx

101
Q

Remoglifozin drug class

A

SGLT-2 inhibitors

Prevent glucose reabsorption in PCT - Increase flow of urine
SE = thrush, UTI, weight loss, DKA

102
Q

Gliclazides drug class

A

Sulphonyl urea
Increase insulin production/secretion

(SE: weight gain, hypos, SIADH)

103
Q

Sitgliptin drug class

A

DPP4 inhibitors

Inhibit breakdown of incretins - increases insulin resistance
SE: Pancreatitis, GI upset

104
Q

antihypertensive of choice for a patient age >55 with type 2 diabetes?

A

Ace-i (Better for kidneys- will probably need later on anyway)

105
Q

Treatment for primary hyperthyroidism

A

Carbimazole - SECONDARY CARE ONLY (Can cause agranulocytosis)
Propylthiouracil - Primary care for symptom management + refer (inhibits production of new thyroid hormone

106
Q

CURB 65 score cut offs and meaning

A 
Confusion
Urea >7
Resps >30
BP <90 or <60
Age 65
1 = OUTPATIENT (LOW RISK)
2/3 = INPATIENT (MODERATE RISK)
4/5 = HDU/ICU ADMISSION (HIGH RISK)
107
Q

CENTOR CRITERIA for tonsillitis and management

A

Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever (>38)
Absence of cough

0-3 = 17% likely bacteria
3-4 = 30-50% likely bacteria
108
Q

What follow up is needed after hospital admission for CAP?

A

CXR at 6 weeks

109
Q

Treatment of otitis externa

A

Topical neomycin + dexamethasone (Otomise spray)

Watch out for spread to temporal bone

110
Q

Migraine treatment

A

1st line = Topiramate (teratogenic)

2nd line = Propranolol

CCC (4 decks)

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