GP Flashcards
(136 cards)
1
Q
Name three changes to the structure of the airways after asthma remodelling?
A
Goblet cell metaplasia
Thickened basement membrane
Smooth muscle hyperplasia
2
Q
Name 4 health conditions you would look for during the 8 week baby check?
A
- Congenital heart defects
- Spina bifida
- Cleft lip or palate
- Cryptochordism
- Ortalani Test - developmental dysplasia of the hip
3
Q
Name 5 red flag signs in a patient with a chronic cough?
A
- Haemoptysis
- Recurrent chest infections
- Night sweats
- Weight loss
- Pleuritic chest pain
- Hoarse voice
4
Q
Name 4 acute causes of cough and chest pain?
A
Asthma and COPD exacerbations
Pulmonary embolism
Pneumothorax
Pulmonary oedema
5
Q
Name 3 symptoms of asthma?
A
Wheeze
Intermittent dyspnoea
Cough (nocturnal)
6
Q
Name 5 precipitants of asthma?
A
Exercise Allergen (dust mites, fur) Cold Air Drugs eg BB or Aspirin Infection Smoking
7
Q
Name 4 signs of asthma?
A
- Tachypnoea
- Audible wheeze
- Hyperinflated chest
- Hyper-resonant percussion note
8
Q
How do you assess diurnal variation in asthma?
A
Peak flow meter, shows diurnal variation of >20% on ≥3 days a week for 2 weeks
9
Q
What are the results of spirometry in a patient with asthma?
A
Obstructive defect FEV1/FVC <0.7 and ≥15% increase post bronchodilator
10
Q
What are the RCP3 questions in assessing asthma?
A
Recent nocturnal wakening
Usual asthma symptoms in a day
Has your asthma interfered with usual activity
11
Q
What are the first 3 lines of drugs you would use in an asthma patient?
A
- SABA - salbutamol
- Inhaled corticosteroid - beclamethasone
- LABA - eg formeterol
12
Q
In step 4 of asthma medication management what would you consider?
A
Increased beclamethasone dose
Oral theophylline
Leukotriene receptor agonist rg monteleukast
13
Q
What would you use in step 5 of asthma management?
A
Oral prednisilone
14
Q
What are the risk factors for breast cancer?
A
Alcoholic drinks, oestrogren progesterone contraceptive , HRT< radiation, smoking
15
Q
Name 5 changes you would see in the breast in suspected breast cancer?
A
- Lump - fixed, rocky
- Skin changes - peau de orange
- Nipple inversion
- Nipple discharge
- Redness or rash
- Breast asymmetry
16
Q
Name 4 differential diagnosis of a breast lump?
A
- Fibroadenoma
- Breast cyst
- Breast abscess
- Duct ectasia
17
Q
What is the triple assessment for a breast lump?
A
- Clinical presentation
- Radiology, ultrasound >35, mammography <35
- Histology/cyology - ultrasound guided core biopsy is best
18
Q
When would you consider urgent referral (within 2 weeks) for breast lump?
A
> 30 with unexplained breast lump
>50 with either discharge or retraction in one nipple only
19
Q
What circumstance would you consider a referral in suspected breast cancer?
A
> 30 with unexplained axillary lump OR skin changes that suggest breast cancer
20
Q
What is a non-urgent referral for breast cancer?
A
<30 with unexplained breast lump
21
Q
In a patient who is BRCA1 or 2 positive (not got breast cancer) what are the three management options?
A
- Chemo-prevention or pre-prophylactic eg tamoxifen
- Surgical management - mastectomy
- Enhanced screening- MRI and mammography
22
Q
Which two drugs used in breast cancer management hormone therapy and how do they work?
A
- Tamoxifen - decrease oestrogen binding
2. Aromatase inhibitors eg Anastrozole to block oestrogen synthesis - usually used in post-menopausal women
23
Q
If a patient is HER2 positive which biological agent would you give them?
A
Herceptin
24
Q
Name 3 signs of heart failure?
A
Raised JVP, 3rd heart sounds, basal crepitation
25
Name 3 signs of acute coronary syndrome?
Pallor, 4th heart sound, tacypnoea, sweatiness
26
What are the ECG changes in an MI?
ST elevation, tall T waves or new LBBB in hours
| T wave inversion and pathological Q waves follow over hours to days
27
Name the acute MI management steps ?
MONA
1. Morphine eg diamorphine + anti-emetic
2. Oxygen- only if hypoxic (<94%)
3. Nitrates - GTN spray
4. Aspirin ( + ticagrelor/clopidogrel - P2Y12 inhibitors)
28
Which two drugs would you use in thrombolysis?
Streptokinase
| Tissue plasminogen activator ( tenectaplase)
29
When should you offer PCI?
Within <12 hour onset of symptoms and ST elevation on ECG
30
Which two drugs should a patient use for at least 12 months after vascular event?
Aspirin and a second anti-platlet eg clopidogrel
31
In a patient with chronic diarrhoea associated with weight loss, nocturnal diarrhoea or anaemia suggests what?
IBD
32
Give the 3 routes of administration for paracetamol?
Oral, intravenous and rectal
33
Which diseases would you find frank pus in the stool?
IBD, diverticulitis, abscess
34
Name 3 causes of explosive diarrhoea?
Giardia, cholera, rotavirus
35
Name 3 diseases you would find mucus in the stools?
IBS, colorectal cancer, polyps
36
How would you diagnose someone with IBS?
If recurrent abdominal pain associated with at least 2 of:
1. Relief by defecation
2. Altered stool form
3. Altered bowel frequency
37
Name 3 drugs you could use in the management of IBS?
Loperamide - for diarrhoea
Meberverine - antispasmodics
Tri-cyclic antidepressants for abdominal pain
38
Which drug is useful in UC but not Chron's?
5-ASA - eg mesalamine
39
In Moderate Chron's what drug would you use in a patient who is refractory to steroids?
Azathioprine
40
What is the name of the skin complication that arises as a result of coeliac?
Dermatatitis hepatiformis
| treat with dapsone
41
What are the voiding symptoms of LUTS (DDH SHIP)?
Dysuria, Dribbling, Hesitancy
| Straining, Haematuria, Incomplete emptying, Poor stream
42
What are the storage symptoms of LUTS? (FUUN)
Frequency, Urgency, Urgency incontinence, nocturne
43
What are the indications for surgery in LUTS? (RUSHES)
```
Retention
UTI
Stones
Haematuria
Elevated creatinine
Symptom deterioration
```
44
Give 5 causes of LUTS?
BPH, hydronephrosis, UTI, prostatitis, prostate cancer, bladder outflow obstruction
45
What is the first line drug treatment for BPH and how does it work?
Tamulosin - alpha blocker. Relax smooth muscle in bladder and prostate
46
What is the second line drug treatment for BPH and how does it work?
Finestaride. 5-alpha reductase inhibitor. Inhibits conversion of testosterone to dihydrotestosterone. Decreases prostate growth
47
What are the side effects of tamulosin?
Dizziness, drowsiness, hypotension and ejaculatory failure
48
What are the side effects of finestaride?
Impotence and decreased libido
49
Name 3 surgical methods to treat BPH?
TURP
| TUIP and retropubic prostatectomy
50
What is the name of the screening criteria?
Wilsons Criteria
51
Name 5 causes of a raised PSA?
```
Prostate cancer
Prostatitis
UTI
Surgery
Some drugs eg finesteride
Tall men, <25 BMI
```
52
Name 2 limitations of using PSA results?
1. Overtreatment - risk with invasive diagnosis and risk of radiation
2. False positives and false negatives - cause anxiety
53
Give 3 reasons why PSA is not used as in NHS screening?
1. Uncertain natural history
2. Morbidity of treatment
3. Risk of over treatment /overdiagnosis
54
What PSA level is generally regarded as abnormal?
>4mg/ml
55
What are the benefits of using PSA results?
Can detect early disease and early treatment
56
What is the Mayo prognostic score used to predict survival for?
Renal cell carcinoma
57
What is the GFR in stage 2 CKD?
89-60
58
What is the GFR in stage 4 CKD?
30-15
59
Give 6 causes of CKD?
1. Hypertension
2. Diabetes
3. High cholesterol
4. SLE
5. Lupus
6. NSAID use
7. Rheumatoid Arthritis
60
In CKD what do you aim to get the BP under?
<140/90
| <130/80 in diabetes
61
What 3 levels would you monitor in a patient with CKD?
Serum creatinine levels
Urine creatinine levels
Haematuria
Proteinuria
62
Name 4 complications of CKD and their treatment?
Anaemia - give erythropoietin
Acidosis - bicarbonate supplements
Oedema - furosemide
Bone mineral disorders - calcitriol of vit D supplements
63
What are the 2 types of asymmetrical polyarthritis (≥5 joints involved)?
Reactive and psoriatic
64
What do chondrocytes produce?
Proteoglycans and type 1 and 2 collagen
65
Name three differences between osteoarthritis and Rheumatoid?
1. OA- worsens on use, RA- better on use
2. OA- <30 min stiffness, RA >60mins stiffness
3. X-ray OA -LOSS , X-ray RA- LESS
66
Which examination is used in an MSK examination?
GALS - Gait, Arm, Legs, Spine
67
What two types of bony swellings do you see in OA and where are they located?
Bouchards - PIP
| Heberdens - DIP
68
Name 5 red flags of back pain?
1. Neurological disturbance
2. Bilateral or alternating leg pain
3. Worse pain on being supine
4. Nocturnal pain
5. Fever, sweats, weight loss
6. History of malignancy
69
Which antibody is highly specific for RA?
Anti-cyclic cirtullinated peptide
70
Name 3 hand deformities that occur as a result of RA?
Boutinnaires and swan neck deformity, ulnar deviation
71
Name 3 side effects of methotrexate?
Pneumonitis, oral ulcers, hepatotoxity
72
Which 3 DMARDS are used to treat RA?
Methotrexate, sulphalazine, hydroxychloroquine
73
What is the main side effect of DMARDS?
Immunosuppression - result in pancytopenia, increased likelihood of infections
74
Give 3 examples of biological agents used in RA?
Infliximab - TNF-alpha inhibitor
Rituximab- B cell depletion
Tociluzimab - IL1 and IL6 inhibition
75
Which drug is first line if methotrexate contraindicated in RA?
Infliximab - TNF alpha inhibitor
76
Name 3 drugs in step 1 of the analgesic ladder?
1. Paracetemol
2. NSAIDS
3. Aspirin
77
Name 3 drugs in step 2 of the analgesic ladder?
1. Codeine
2. Tramadol
3. Dihydrocodeine
78
Name 3 drugs in step 3 of the analgesic ladder?
1. Morphine
2. Fentanyl
3. Methadone
79
Name 3 adjuvants used in the analgesic ladder?
1. Carmazepine - neuropathic pain
2. Dexamethasone - bone pain
3. Zolendronic acid - bisphosphonate
4. Amiltryptaline - antidepressant used in neuropathic pain
80
How to NSAIDS cause renal impairment?
They stop production of prostaglandin which causes vasodilation and you need vasodilation for adequate renal perfusion
81
What are the 5 guiding principles when using the analgesic ladder?
1. By Mouth – oral forms of analgesics is preferred
2. By the Clock – analgesic should be given at regular intervals
3. By the Ladder – principles of the ladder
4. For the individual-Therapy based around the level of the patients pain
5. Attention to details - close monitoring of patients
82
Which 3 scales are used to assess activities of daily life?
1. Katz ADL
2. Barthel ADL
3. IADL
83
Name 3 components of Katz ADL?
Bathing, toilet use, dressing, transferring, urine and bowel continence, eating
84
Name 3 components of Barthel ADL?
Walking on flat, going up stairs, feeding, grooming, move wheelchair to bed, move to and from toilet, dressing, continence of bowel, continence of bladder, bathing
85
Name 3 components of IADL?
Use of telephone, travelling by car or public transport, food or clothes shopping, meal preparation, housework, medication use, management of money
86
What is a common side effect of codeine?
Constipation - give with laxative
87
What should you give when prescribing opioids?
Anti-emetic as cause nausea
88
Which two screening questionnaire's are used to assess the severity of depression/anxiety?
PHQ-9 and GAD-7
89
What are the 4 sections of the red book?
1. Child, family and birth information
2, Immunisations
3. Screening and routine reviews
4. Growth charts and other information
90
Give 4 different routes to administer drugs?
oral, rectal, subcutaneous, intra-muscular, rectal topical, sublingual, enteral feeding tubes
91
What is the 8 week immunisation and how is it administered?
5 in 1 vaccine - diphtheria, tetanus, whooping cough, polio and haemophilia influenza B- administered as single injection into thigh
92
What is meant by the term prophylaxis and which is used for asthma prophylaxis?
Treatment given or an action taken to prevent disease.
| Beclamethasone
93
How does breastfeeding work as a contraceptive?
Prolactin is released to stimulate lactation, which inhibits GnRH release and therefore the release of FSH and LH.
94
How should a patient take aledronic acid?
Take with plenty of water whilst sitting or standing, take on empty stomach and sit upright for at least 30 mins after taking tablet
95
What is the mechanism of alendronic acid?
oral Bisphosphonate and inhibits osteoclast mediated bone resorption
96
Give an example of 4 questions you would ask in a patient with chest pain?
1. What triggers the pain - worse on exercise?
2. Character of pain?
3. Where does it radiate t?
4. Is it relieved by GTN?
5. Associated symptoms?
97
Name 3 non-modifiable risks for IHD?
1. Increasing age
2. Male gender
3. Asian
4. Family History
98
Name 4 modifiable risks for IHD?
1. Hypertension
2. Smoking
3. Hypercholesterolamia
4. Type 2 diabetes
5. Obesity
99
Name 3 primary prevention steps for CVD?
1. QRISK2 score for CVD
2. Lifestyle changes - stop smoking, lose weight
3. Drugs eg aspirin and statins
100
Name 3 drugs you would prescribe post MI?
1. ACE inhibitors
2. Statins - control cholesterol
3. Antiplatelts - aspirin
101
What are the stages in the pathophysiology of MI?
1. Rupture of fibrous cap of coronary artery plaque --> arterial thrombosis
2. Thrombosis - formation of platelet rich clot
3. Platelts release thromboxane A2--> inflammation and vasoconstriction
4. Occludes coronary vessel - MI
102
Why is GTN not used orally?
GTN is metabolised in liver by first pass metabolism which reduces its bioavailability - hence sublingual and transdermal prefered
103
What are the non pharmacological management stages of IBS?
```
Dietary and lifestyle advice
Limit high fibre
Lots of fluids
Avoid caffeine
Don't skip meals and do regular exercise
```
104
In IBD which biologic drugs would you consider giving?
Infliximab
| Adalimumab
105
Name the dietary advice in a patient with coeliac?
1. Info on what foods contain gluten
2. Avoid cross contamination in home and accidental glucose
3. Role of national and local coeliac groups
106
How does the progesterone contraceptive pill prevent pregnancy?
Inhibits GnRH release
Thickens vaginal epithelium and cervical mucus
Inhibits ovulation
107
How does loperamide work?
Opiod-receptor agonist which reduces GI motility, increases time material stays in intestine so more water absorbed from fecal matter
108
Which 3 investigations would you do in a man with LUTS?
1. Examination of abdomen and external genitalia
2. Digital rectal examination
3. urine dipstick test to detect blood, glucose, proteins, leukocytes and nitrates
109
Give 3 treatment methods for localised prostate cancer?
1. Watchful waiting
2. Radical treatment - radical prostatectomy
3. Bracytherapy
110
Which receptor does doxazosin work on?
Alpha 1- adrenergic antagonist
111
What is the main side effect of tamulosin?
```
Postural hypotension
Retrograde ejaculation (30%)
```
112
What is the mechanism of action of cyclosporin?
Specific T-lymphocyte suppressor, acts in T-helper cells - inhibit IL-2
113
What is meant by a narrow therapeutic index?
Range of doses at which a medication is effective without adverse events. Drugs with a narrow TI have a narrow window between their effective doses and those at which they produce adverse toxic effects eg Warfarin, lithium, digoxin
114
Name 5 different investigations into joint swelling?
1. Aspirate the joint
2. X-Ray
3. Ultrasound Scan
4. Physical Inpecftion
5. Serum inflammatory markers - CRP, ESR
6. Blood cultures eg reactive arthritis
115
Give 3 non-pharmacological advice of rheumatoid arthritis?
Exercise more, relaxation, stress management, cognitive coping skills
116
What are the 3 steps in pharmacological management of rheumatoid arthritis?
1. Symptoms control - analgesics
2. DMARDS
3. Biologics eg etanercept and infliximab
117
Give 3 side effects of methotrexate?
Tetratogenic
Mouth ulcers
Diarrhoea
Hepatic and pulmonary fibrosis
118
What is given weekly to patients on methotrexate?
Folic acid - reduces toxic effects
119
What is the mechanism of Methotrexate?
Methotrexate prevents nucleic acid synthesis by causing cell death
120
What is a controlled drug?
Drugs which are dangerous or otherwise harmful and have potential for abuse or misuse
121
What is the definition of depression?
A state of persistent low mood, can affect thoughts, behaviours, feelings and physical health
122
Give 5 risk factors for depression?
1. Low socioeconomic status
2. Bereavement
3. Hypothyroidism
4. Personality factors eg low self esteem
5. Giving birth - post-natal
6. Lonliness
123
Give 4 psychological symptoms of depression?
Continuous low mood
Feeling guilty
Having no motivation or interest in things
Feeling anxious or worried
124
Give 4 physical symptoms of depression?
```
Change in apetite/weight
Disturbed sleep
Constipation
Lack of energy
Decreased libido
Changes to menstrual cycle
```
125
Give 3 social symptoms of depression?
Neglecting hobbies
Having difficulties at home
Not doing well at work
126
How do SSRI (selective serotonin reuptake inhibitor) work?
Precent re-uptake of serotonin from synapses so there is increased serotonin
127
How does amitryptilline work?
Raise levels of serotonin and noradrenaline in the brain by inhibiting reuptake
128
What is the WHO criteria in diabetes diagnosis?
Symptoms of hyperglycaemia (e.g. polyuria, polydipsia, unexplained weight loss, visual blurring, genital thrush, lethargy) PLUS
Random >= 11.1mmol/L
Fasting >= 7mmol/L
Oral glucose tolerance test >11.1mmol/L
HbA1c >= 48mmol/L
129
Give 5 risk factors of type 2 diabetes?
Obesity, smoking, intra-abdominal fat, hypertension, family history, history of MI,gestational diabetes
130
How does metformin work?
Up-regulates GLUT4 receptors in the peripheries =increased insulin sensitivity
131
Name 4 components of the diabetic review?
1. Vascular risks under control
2. Check eyes, feet and kidney function
3. Check if had hospital admissions
4. Check HbA1c
132
How does haemodialysis work?
Two needles into AV fistula remove blood into dialyser dialysate through semi permeable membrane back into person
133
Give examples of 5 drugs with a narrow therapeutic index?
Guys with large dicks make perfect inter- course
Gentamycin, warfarin, lithium, digoxin, methotrexate, phenytoin, insulin, cyclosporin
134
Give 4 questions you would ask the mother during the 8-week baby check?
1. Mental health and wellbeing
2. Any vaginal discharge or period
3. Stiches examined if C-section
4. Enquire about contraception
135
Which drug is used for the prophylaxis of asthma?
Beclamethasone
136
Give 3 reasons as to why stage 4 CKD- elderly patient may object to having dialysis?
1. Won't have good QOL with treatment
2. Don’t want inconvenience of having dialysis treatment
3. Advised against treatment as have other serious illness
