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3a > GP > Flashcards

GP Flashcards

1
Q

why might someone with DKA have a fever?

A

infection can trigger it

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2
Q

what should you give someone with pneumonia who is allergic to penicillin?

A

doxycycline or clarithromycin

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3
Q

what genes contribute to obesity

A

BMIQ1, BMIQ2, POMC

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4
Q

give 3 ways the domains of public health can be used in smoking

A

improving health services-stopping smoking services, advice for GPs
health promotion: increasing tax on tobacco, making packages less appealing
health protection: laws against smoking in public places

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5
Q

4 causes of AF?

A

drugs and alcohol
hyperthyroidism
ischaemic heart disease
valvular heart disease

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6
Q

what are the ECG findings of AF?

A

lack of p waves

irregularly irregular rhythm

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7
Q

2 first line options for AF?

A

propranolol

verapamil

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8
Q

side effects of beta blockers

A

postural hypotension
sleep disturbance
cold peripheries
ED

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9
Q

what is normative need?

A

when a professional determines what the patient needs

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10
Q

what is the mechanism behind increasing blood pressure with age?

A

increased preload-ageing kidneys

increased afterload-renin

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11
Q

how is blood pressure controlled?

A

sensed by baroreceptors in the aortic arch and carotid sinus-mediated with vagal tone

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12
Q

how do you calculate mean arterial pressure?

A

2X diastolic
+systolic
/3

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13
Q

where is aldosterone released from?

A

adrenals

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14
Q

what is QRISK

A

assessment of CVD risk

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15
Q

secondary causes of hypertension

A 
renal artery stenosis
SIADH
Cushing's
phaechromocytoma
Conn's
drugs-COCP, steroids, NSAIDs
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16
Q

what is first line in the management of hypertension?

A

lifestyle advice!

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17
Q

what is the blood pressure target if over 80?

A

150/90

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18
Q

how high does QRISK need to be to start a statin

A

over 10

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19
Q

what kind of CCBs do you use in hypertension?

A

hydropyrodine like amlodipine and nifedipine

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20
Q

what are non dihydropyrodines used for

A

stable angina

CAD

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21
Q

what can you use for hypertension in someone with renal artery stenosis

A

angiotensin receptor blockers-sartans (different to aldosterone antagonists)

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22
Q

what should you use in a black man with hypertension who has heart failure?

A

diuretics

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23
Q

what could hypercholesterolaemia be caused by?

A

familial
Cushing’s
cholestasis
hypothyroidism

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24
Q

what is the mechanism of statins?

A

HMG coA reductase inhibitor

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25
Q

give a reversible cause of hypercholesterolaemia

A

hypothyroidism

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26
Q

what increases the risk of digoxin toxicity

A

quinine
hypokalaemia so loop and thiazide
CCB

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27
Q

how is digoxin toxicity managed

A

heart monitoring and FAB antibodies

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28
Q

target blood pressure in diabetics?

A

130/90

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29
Q

stage 2 hypertension?

A

clinically 160/100

ABPM 150/95

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30
Q

what 3 things does asthma lead to

A

bronchial hyperresponsiveness leads to:
airway remodelling
increased secretions
bronchoconstriction

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31
Q

what does 33,92 CHEST mean?

A 
signs of severe asthma attack
PEFR<33 predicted
sats<92%
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia
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32
Q

what is COPD?

A

bronchitis

emphysema

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33
Q

what investigations would you do in COPD and why?

A 
FBC-polycythaemia
CXR-changes and pneumonia
ECG
echo-cor pulmone diagnosis
sputum cultures if infection signs
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34
Q

COPD management

A 
smoking cessation, weight loss
pneumococcal and influenza vaccination
SABA or SAMA
add LAMA and maybe LABA+ICS
add the ICS
SABA, LAMA, ICS+LABA
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35
Q

what would you do in someone having a severe COPD exacerbation?

A

ABCDE-after finding resus results
CXR to exclude pneumothorax and ECG
O2 and salbutamol nebs
ABx

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36
Q

what organisms are likely to cause COPD exacerbations?

A 
Moraxella catarrhalis
H influenza
S pneumoniae
rhinovirus
influenza
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37
Q

what is the difference between pharyngitis and tonsillitis?

A

tonsillitis has purulent discharge on top

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38
Q

what are the features of CURB65?

A

confusion
urea over 7
resp rate over 30
blood pressure under 90/60

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39
Q

what do you do with a CURB65 of 3?

A

admit
IV abx of cefuroxime or co amox+clary
staph aureus>add fluclox
MRSA>add vancomycin

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40
Q

what would you do with someone who’s 70 coughing with SOB, fever, confused, urea=9 and BP is 100/50?

A

CURB is 4-consider ICU admission

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41
Q

what would HbA1c be if someone was diabetic?

A

over 48mmol/mol

42-47 is prediabetic

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42
Q

what would blood glucose be if someone was diabetic

A

fasting>7

random or OGTT>11.1mmol/L

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43
Q

management of diabetic who has been on metformin, gliclazide and sitagliptin and BMI>35?

A

exanetide (absolutely exsanguinate them of sugar)

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44
Q

what are the 4 features of metabolic obesity?

A

abdominal obesity
hyperglycaemia
dyslipidaemia
hypertension

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45
Q

obese BMI?

A

30-34.9

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46
Q

why is glibenclamide and gliclazide more risky than metformin

A

can cause hypos

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47
Q

what is first line treatment for diabetes?

A

moderate exercise and calorie restriction, recheck HbA1c in 2 or 3 months for drug treatment

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48
Q

what diabetes medications can be used in pregnancy?

A

metformin and glibenclamide and insulin

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49
Q

what would you worry about in an ill diabetic on metformin if they developed stomach cramps, fatigue, vomiting and difficulty breathing?

A

lactic acidosis, doesn’t happen if they’re stable, only if precipitated by something

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50
Q

what common drugs cause renal impairment?

A

NSAIDs
ACEi
metformin
diuretics

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51
Q

give drugs that increase glucose requirement

A

steroids

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52
Q

side effects of metformin

A

GI upset

lactic acidosis

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53
Q

what does HbA1c need to be over to intensify T2DM management?

A

58mmol/mol

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54
Q

first line treatment for obesity

A

600kcal/day diet

30 min moderate exercise 5X per week

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55
Q

contraindications to orlistat use?

A

cholestasis

chronic malabsorption

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56
Q

SEs of orlistat

A

abdo distension/pain
steatorrhoea
hypoglycaemia
ADEK deficiency

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57
Q

types of gastric surgery

A

sleeve gastrostomy
gastric bypass
gastric banding

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58
Q

what precaution must you take in someone with kidney disease who has hypertension?

A

eGFR must be over 30

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59
Q

causes of CKD?

A 
vascular-HTN/stenosis/atherosclerosis
autoimmune-SLE, HSP, GPA
congenital
metabolic-DM
infection-pyonephritis
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60
Q

what would you do if you suspected amyloidosis?

A

congo red stain on biopsy

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61
Q

amyloidosis management?

A

pred
chemo
liver transplant

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62
Q

what is stage 3 renal failure defined as?

A

30-59

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63
Q

how do you manage chronic kidney disease until it’s end stage?

A

BP control
statin
antiplatelet

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64
Q

what test do you use to calculate eGFR?

A

creatinine

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65
Q

what foods can coeliacs eat

A

potatoes and rice

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66
Q

what does a virus need to be for a pandemic spread?

A

novel virus
susceptible ppln with a large pool
means of sustainable transmission
causes human illness

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67
Q

what ages get the annual flu vaccination

A

2-8

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68
Q

what is in the preschool booster?

A

MMR

DTap and IPV

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69
Q

what do you do if there’s a notifiable disease/

A

notify proper officer at local council or health protection office within 3 days

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70
Q

what do you do if a child has red symptoms?

A

need to be assessed by a healthcare professional within 2 hours

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71
Q

why is codeine not used in children?

A

resp depression-can use oromorph

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72
Q

management of gonorrhoea

A

ceftrioxone (add azithromycin for chlamydia cover)

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73
Q

what are the signs of secondary syphilis?

A

fever, myalgia, hepatitis, rash on palms and soles, lymphadenopathy

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74
Q

when do you need to use contraception in pregnant women?

A

if exclusively breastfeeding-lactational amenorrhoea should last 6m, otherwise it can be 21d

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75
Q

what is the EllaOne

A

ulipristal-progesterone receptor modulator

76
Q

what baseline things do you need to do before starting them on contraception

A

check BP, BMI, smoking status and history of migraines

77
Q

what is oestrogen protective against?

A

osteoporosis
ovarian cancer
endometrial cancer

78
Q

what does FSH act on?

A

granulosa cells

79
Q

what are the medical uses of mirena?

A

endometriosis
adenomyosis
HRT with added oestrogen
menorrhagia

80
Q

what is the first stage of the menstrual cycle called

A

follicaular

81
Q

what does the corpus luteum become

A

corpus albicans

82
Q

what forms of contraception will you lose your periods on?

A

depo provera

mirena

83
Q

where does VZV lie dormant

A

trigeminal ganglion
geniculate root ganglion
dorsal root ganglion

84
Q

what is the treatment of shingles

A

oral aciclovir

85
Q

what is Kaposi’s sarcoma?

A

reactive hyperplasia tumour of endothelium of lymph nodes and vascular

86
Q

how can malignant melanoma be staged?

A

Glasgow 7 point checklist

ABCDE (asymmetry, irregular borders, colour variation, diameter>6mm and evolving)

87
Q

what is the prognosis of malignant melanoma based off?

A

depth of lesion

88
Q

what skin problem can lead to damage of the vulva

A

lichen sclerosus

89
Q

what causes ringoworm?

A

tinea corporis

90
Q

what will happen if IM benzylpenicillin is given to someone with syphilis?

A

Jarisch-Herxheimer reaction

91
Q

what is teenage pregnancy associated with?

A 
less likely to finish education
poverty
poor housing
infant mortality
higher risk of post natal depression
92
Q

define equity

A

what is fair and just

93
Q

what are the 3 types of health related behaviour?

A

heatlh-preventing disease
illness-seeking remedy (say im ill to doctor)
sick role-aimed at getting better (say im sick to friends)

94
Q

why do people engage in health impairing behaviours?

A

inaccurate perceptions of risk and susceptibility

95
Q

what are the problems with dieting?

A

risk factor for an eating disorder
disrupt normal appetite responses
fat overshoot
also reduces lean body mass

96
Q

what is the externality theory?

A

normal weight people respond to internal homeostatic cues while overweight people respond to external cues

97
Q

define health needs assessment

A

method for reviewing health issues leading to agreed priorities and resource allocation that will reduce inequalities, it’s followed by planning, implementation, evaluation

98
Q

what is the drawback to epidemiological health needs assessment?

A

doesn’t consider felt need

99
Q

define felt need

A

what the individual experiences

100
Q

what are the 3 kinds of health needs assessment?

A

epidemiological
corporate
comparitive

101
Q

what structure looks at what there is (places), what is done (services provided) and outcomes (death and disease)

A

Donebidean structure of evaluation

102
Q

what are the 3 areas of duties of a dr

A

knowledge, skills and performance
communication, partnership, teamwork
safety and quality

103
Q

define concordance

A

process by which patients and doctors come to an agreement about pt’s care

104
Q

give some barriers to patient concordance

A

poor communication
patients want doctors to tell them what to do
patients don’t disclose all relevant information

105
Q

define never event

A

serious, largely avoidable events which shouldn’t occur if available, preventative measures have been implemented

106
Q

how long can a refugee stay for?

A

5 years

107
Q

why might homeless people not access services?

A

registration
more imminent survival issues
opening times
percieved discrimination

108
Q

what are the risk factors for inequality

A 
Place of residence
Race or ethnicity
Occupation
Gender
Religion
Education
Socioeconomic status
109
Q

what interview style might help with alcohol reduction?

A 
FRAMES
feedback-give risks
responsibility-emphasise theirs
advice
menu of options
empathise
self efficacy-show them they can modify their behaviour
110
Q

what are the features of dependence syndrome?

A 
physiological withdrawal
tolerence
neglect of other areas of life
lots of time spent using and obtaining
continue use despite having problems because of it
111
Q

second stage of hypertension?

A

160/100 or 150/95

112
Q

when is hypertension treated with drugs

A 
stage 1 if under 80 and 
QRISK>20%
end organ damage
established CVD
renal failure
DM
stage 2+3>treat
113
Q

what lifestyle advice should be offered to people with hypertension?

A 
reduce salt to under 6g/day, aiming for 3
stop smoking
exercise
reduce caffeine intake
reduce alcohol
balanced diet
114
Q

what diuretics should be added as third line in the treatment of hypertension

A

indapamide or chlorthalidone

115
Q

define resistent hypertension

A

clinic bp of >140/90 after stage 3 treatment, expert advice or more diuretic (depends on potassium level, then alpha or beta blocker)

116
Q

what is the aimed for blood pressure of someone under 80?

A

under stage 1 so 140/90

117
Q

what is the aimed for blood pressure of someone over 80

A

150/90

118
Q

what should you do before prescribing an ACEi?

A

U&Es

119
Q

what investigations would you order if a patient was tired all the time?

A 
FBC (anaemia, leukaemia)
U&amp;E (renal disease)
TFTs
LFTs (liver disease)
ESR/CRP (chronic inflammation)
coeliac screen
BM (DM)
outdoors>Lyme
sex>hep B and HIV
snoring>sleep study
housebound/Asain>vit D
120
Q

what are you testing for in a hep b screen

A

HBsAg and HBeAg-the antigens
S>infected now!
antibodies can imply past infection or vaccination has worked

121
Q

what dietary advice should you give to someone with diabetes?

A

low glycaemic index carbs (pulses, wholegrain, rice, fruit and veg)
high fibre
stop trans fatty and sat fats

122
Q

what do you give to a pregnant woman with hypertension?

A

CCB-not ACEi

123
Q

management of T2DM?

A

1) lifestyle advice
2) metformin
3) sulfonylurea (gliben, glic)
4) BMI under 35-insulin, over-exanetide

124
Q

what is exenatide?

A

glucagon like peptide receptor agonist-incretin mimetic (makes the body think it has glucagon)

125
Q

when should HbA1c be checked?

A

every 3-6 months until stable then 6 monthly

126
Q

what are the signs of diabetic neuropathy and peripheral arterial disease?

A 
reduced ABPI
absent pulses
intermittent claudication
ulcers
cellulitis
127
Q

how is diabetic neuropathy treated

A

amitriptyline, pregabalin, gabapentin, duloxetine

tramadol for rescue

128
Q

what do you do with a patient who has had chest pain in the last 12 hours or is having it now?

A

emergency admission

129
Q

FRAX score factors

A 
women
glucocorticosteroids
female
active cancer
parent hip fracture
previous hip fracture
currently smoking
weight
height
RA
over 3 units
secondary osteoporosis
130
Q

ABCD2

A 
age>60
BP>140/90
Characteristics slurred speech then unilateral weakness
Duration over 10 min then over 1hr
Diabetes
over 4 image and refer
131
Q

Well’s score

A 
active cancer
calf swelling 3cm+
non varicose superficial veins
bedridden recently
plaster cast
pitting oedema
prev DVT
paresis
paralysis
0-2 D dimer
3+ USS
132
Q

QRISK2

A 
Age
Bangladeshi/Pakistani/Indian
Male
Postcode
Smoking
Diabetes
Angina or MI in first degree relative
RA, AF
antihypertensive medication
BMI
CKD 4/5
BP
if over 10% consider atorvastatin
133
Q

CHA2DS2VASC

A 
=stroke in AF patient
congestive heart failure
hypertension
age>75 or over 65
angina
diabetes
stroke/TIA/VTE
sex-female
vascular disease
over 1 then anticoagulation but 2 for females
134
Q

what makes you want to choose BB or CCB rather than flecanide/sotalol/amiodarone in an AF pt

A

so rate rather than rhythm in less than 65, they’re symptomatic, congestive HF, first presentation

135
Q

HASBLED

A 
htn>160
abnormal renal function
stroke
bleeding (history or tendency)
labile INR
elderly
drugs
>3 indicates high risk
136
Q

what investigations would you do in a COPD patient?

A

spirometry, post bronchodilator
CXR
FBC to exclude 2ndary polycythaemia
BMI

137
Q

what is tertiary prevention?

A

lessening complications of a disease which has already happened

138
Q

what is the disadvantage of screening?

A

overdetection of subclinical disease

139
Q

cervical screening programme

A

25-49-every 3 years

50-64-every 5 years

140
Q

breast screening programme

A

47-73 every 3 years

141
Q

bowel screening programme

A

50-74 every 2 years

142
Q

what should be used in a penicillin allergic patient with sepsis?

A

IV vancomycin

143
Q

what should thiazide diuretics be used for?

A

htn, loop are more for overload in heart failure

144
Q

adverse effects of thiazides

A

gout
postural hypotension
hypokalaemia, hyponatraemia, hypercalcaemia

145
Q

features of digoxin toxicity

A

lethargy, dizziness, n and v, gynaecomastia, arrythmia, anorexia

146
Q

what do ACEi do in the kidneys?

A

constrict efferent arterioles

147
Q

what is the plan when htn is newly diagnosed?

A

assess CVD risk (urine sample for albumin/creatinine, dip for haematuria, glucose, eGFR, cholesterol, fundoscopy, ECG)
book for annual r/v

148
Q

define malignant hypertension

A

200/130 with end organ damage

149
Q

why are ACEi used in chronic renal failure?

A

protective long term but should be stopped if any contraindications or acute renal failure occurs

150
Q

what are the types of high output heart failure?

A

pregnancy
anaemia
hyperthyroidism

151
Q

what should be monitored in heart failure?

A

htn
K
Na

152
Q

what is the secondary prevention of MI

A 
reinforce lifestyle
cardiac rehab
aspirin+ticagrelor
ACEi
BB
statin
5 drugs!
153
Q

what time of day should statins be taken?

A

at night

154
Q

what drugs increase life expectancy in pts with heart failure?

A

ACEi and BBs

155
Q

side effects of omeprazole

A

loose stools
osteoporosis
hyponatraemia

156
Q

steroids SEs

A

infection
Cushings-easy bruising, weight gain, thin skin
osteoporosis

157
Q

SE co codamol

A

constipation

158
Q

when should you be suspiscious of underage sex?

A

when U13

when U16 and partner isn’t

159
Q

what are the CIs to metformin use?

A

hypoxic tissue injury (bc risk of lactic acidosis) so MI, sepsis, renal failure

160
Q

SEs of gliclazide

A

weight gain

hypoglycaemia

161
Q

SEs of pioglitazone

A

bladder cancer
HF precipitation or exacerbation
(Glitazone)

162
Q

what are the gliptins?

A

DDP4 inhibitors
such as sitagliptin
weight gain and hypos

163
Q

what are the risks with SLGT inhibitors like dapagloflozin?

A

increase sugar being weed out so UTI

164
Q

what are the SEs of exanetide?

A

GLP1 inhibitor

pancreatitis and weight loss

165
Q

what are the macrovascular complications of DM?

A

MI

stroke

166
Q

what is the new asthma treatment pathway?

A 
SABA
ICS
trial LT1 antagonist 4-8w
LABA
oral steroids
167
Q

SEs of montelukast

A

diarrhoea
fever
GI discomfort

168
Q

what 2 drugs should you co prescribe if youre giving long term steroids?

A

PPI inhibitor and bisphosphonates

169
Q

what are cough red flags

A

weight loss, night sweats, rigors, haemoptysis, dyspnoea, nocturnal persistent cough

170
Q

what defines a cough as chronic

A

over 6w

171
Q

list the cardiac complications of MI

A 
cardiac arrest
cardiogenic shock
arrythmias
chronic heart failure
pericarditis
VSD
acute mitral regurg
172
Q

sequence of treatments in heart failure

A

BB and ACEi
ARB or aldosterone antagonist or hydralazine with nitrate
then consider ivabradine or digoxin

173
Q

what is the outcome of case control studies?

A

odds ratio

174
Q

what are IMCAs?

A

legal safeguards for people who lack capacity to make decisions about where they live and serious medical treatment

175
Q

RFs for TB

A

immunosuppression (HIV, DM, kidney disease, low BMI, organ transplants)
places with high prevalence

176
Q

define concordance?

A

comes after compliance and adherence, the process by which patients and doctors come to an agreement on their care

177
Q

what defines harmful drinking?

A

women-35+

men-50+

178
Q

what are the feautres of fetal alcohol syndrome?

A 
low iq
low set ears
low nasal bridge
microcephaly
epicanthic folds
microganthia
179
Q

give some risk assessment tools for CVD?

A

Framingham score
QRISK3
JBS3-for lifetime risk

180
Q

how do you assess for end organ damage in a hypertensive patient?

A

examination: apex beat for cardiomegaly/hypertrophy, heart sounds; fundoscopy (papilloedema, flame haemorrhages, cotton wool spots)
blood tests: creatinine, UE, eGFR, glucose, HbA1c, lipid profile
urine: dip for protein and RBC then lab for al:cr
CVD risk strat
ECG and echo if LVH suspected

181
Q

what increases the risk of hyperlipidaemia?

A 
smoking
COCP
BB
steroids
thiazides
antipsychotics
tamoxifen
antiretrovirals
XS alcohol
pregnancy
hypothyroidism
renal failure
HIV
cholestasis
cushings
182
Q

how much exercise should you do per week?

A

30 mins moderate exercise 5X per week

and 2X strength exercises

183
Q

what are the causes of AF

A

HTN
cardiomyopathy
coronary heart disease
valvular heart disease

184
Q

what kinds of domestic abuse are there?

A 
psychological
physical
emotional
financial
sexual
185
Q

define equality

A

equal shares for all

186
Q

health problems faced by homeless adults

A 
infectious diseases
IVDU
violence
chronic disease worsened by lower access to healthcare
mental illness
poor nutrition
poor dental health

3a (11 decks)

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