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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
give a reversible cause of hypercholesterolaemia
hypothyroidism
26
what increases the risk of digoxin toxicity
quinine hypokalaemia so loop and thiazide CCB
27
how is digoxin toxicity managed
heart monitoring and FAB antibodies
28
target blood pressure in diabetics?
130/90
29
stage 2 hypertension?
clinically 160/100 | ABPM 150/95
30
what 3 things does asthma lead to
bronchial hyperresponsiveness leads to: airway remodelling increased secretions bronchoconstriction
31
what does 33,92 CHEST mean?
``` signs of severe asthma attack PEFR<33 predicted sats<92% Cyanosis Hypotension Exhaustion Silent chest Tachycardia ```
32
what is COPD?
bronchitis | emphysema
33
what investigations would you do in COPD and why?
``` FBC-polycythaemia CXR-changes and pneumonia ECG echo-cor pulmone diagnosis sputum cultures if infection signs ```
34
COPD management
``` smoking cessation, weight loss pneumococcal and influenza vaccination SABA or SAMA add LAMA and maybe LABA+ICS add the ICS SABA, LAMA, ICS+LABA ```
35
what would you do in someone having a severe COPD exacerbation?
ABCDE-after finding resus results CXR to exclude pneumothorax and ECG O2 and salbutamol nebs ABx
36
what organisms are likely to cause COPD exacerbations?
``` Moraxella catarrhalis H influenza S pneumoniae rhinovirus influenza ```
37
what is the difference between pharyngitis and tonsillitis?
tonsillitis has purulent discharge on top
38
what are the features of CURB65?
confusion urea over 7 resp rate over 30 blood pressure under 90/60
39
what do you do with a CURB65 of 3?
admit IV abx of cefuroxime or co amox+clary staph aureus>add fluclox MRSA>add vancomycin
40
what would you do with someone who's 70 coughing with SOB, fever, confused, urea=9 and BP is 100/50?
CURB is 4-consider ICU admission
41
what would HbA1c be if someone was diabetic?
over 48mmol/mol | 42-47 is prediabetic
42
what would blood glucose be if someone was diabetic
fasting>7 | random or OGTT>11.1mmol/L
43
management of diabetic who has been on metformin, gliclazide and sitagliptin and BMI>35?
exanetide (absolutely exsanguinate them of sugar)
44
what are the 4 features of metabolic obesity?
abdominal obesity hyperglycaemia dyslipidaemia hypertension
45
obese BMI?
30-34.9
46
why is glibenclamide and gliclazide more risky than metformin
can cause hypos
47
what is first line treatment for diabetes?
moderate exercise and calorie restriction, recheck HbA1c in 2 or 3 months for drug treatment
48
what diabetes medications can be used in pregnancy?
metformin and glibenclamide and insulin
49
what would you worry about in an ill diabetic on metformin if they developed stomach cramps, fatigue, vomiting and difficulty breathing?
lactic acidosis, doesn't happen if they're stable, only if precipitated by something
50
what common drugs cause renal impairment?
NSAIDs ACEi metformin diuretics
51
give drugs that increase glucose requirement
steroids
52
side effects of metformin
GI upset | lactic acidosis
53
what does HbA1c need to be over to intensify T2DM management?
58mmol/mol
54
first line treatment for obesity
600kcal/day diet | 30 min moderate exercise 5X per week
55
contraindications to orlistat use?
cholestasis | chronic malabsorption
56
SEs of orlistat
abdo distension/pain steatorrhoea hypoglycaemia ADEK deficiency
57
types of gastric surgery
sleeve gastrostomy gastric bypass gastric banding
58
what precaution must you take in someone with kidney disease who has hypertension?
eGFR must be over 30
59
causes of CKD?
``` vascular-HTN/stenosis/atherosclerosis autoimmune-SLE, HSP, GPA congenital metabolic-DM infection-pyonephritis ```
60
what would you do if you suspected amyloidosis?
congo red stain on biopsy
61
amyloidosis management?
pred chemo liver transplant
62
what is stage 3 renal failure defined as?
30-59
63
how do you manage chronic kidney disease until it's end stage?
BP control statin antiplatelet
64
what test do you use to calculate eGFR?
creatinine
65
what foods can coeliacs eat
potatoes and rice
66
what does a virus need to be for a pandemic spread?
novel virus susceptible ppln with a large pool means of sustainable transmission causes human illness
67
what ages get the annual flu vaccination
2-8
68
what is in the preschool booster?
MMR | DTap and IPV
69
what do you do if there's a notifiable disease/
notify proper officer at local council or health protection office within 3 days
70
what do you do if a child has red symptoms?
need to be assessed by a healthcare professional within 2 hours
71
why is codeine not used in children?
resp depression-can use oromorph
72
management of gonorrhoea
ceftrioxone (add azithromycin for chlamydia cover)
73
what are the signs of secondary syphilis?
fever, myalgia, hepatitis, rash on palms and soles, lymphadenopathy
74
when do you need to use contraception in pregnant women?
if exclusively breastfeeding-lactational amenorrhoea should last 6m, otherwise it can be 21d
75
what is the EllaOne
ulipristal-progesterone receptor modulator
76
what baseline things do you need to do before starting them on contraception
check BP, BMI, smoking status and history of migraines
77
what is oestrogen protective against?
osteoporosis ovarian cancer endometrial cancer
78
what does FSH act on?
granulosa cells
79
what are the medical uses of mirena?
endometriosis adenomyosis HRT with added oestrogen menorrhagia
80
what is the first stage of the menstrual cycle called
follicaular
81
what does the corpus luteum become
corpus albicans
82
what forms of contraception will you lose your periods on?
depo provera | mirena
83
where does VZV lie dormant
trigeminal ganglion geniculate root ganglion dorsal root ganglion
84
what is the treatment of shingles
oral aciclovir
85
what is Kaposi's sarcoma?
reactive hyperplasia tumour of endothelium of lymph nodes and vascular
86
how can malignant melanoma be staged?
Glasgow 7 point checklist | ABCDE (asymmetry, irregular borders, colour variation, diameter>6mm and evolving)
87
what is the prognosis of malignant melanoma based off?
depth of lesion
88
what skin problem can lead to damage of the vulva
lichen sclerosus
89
what causes ringoworm?
tinea corporis
90
what will happen if IM benzylpenicillin is given to someone with syphilis?
Jarisch-Herxheimer reaction
91
what is teenage pregnancy associated with?
``` less likely to finish education poverty poor housing infant mortality higher risk of post natal depression ```
92
define equity
what is fair and just
93
what are the 3 types of health related behaviour?
heatlh-preventing disease illness-seeking remedy (say im ill to doctor) sick role-aimed at getting better (say im sick to friends)
94
why do people engage in health impairing behaviours?
inaccurate perceptions of risk and susceptibility
95
what are the problems with dieting?
risk factor for an eating disorder disrupt normal appetite responses fat overshoot also reduces lean body mass
96
what is the externality theory?
normal weight people respond to internal homeostatic cues while overweight people respond to external cues
97
define health needs assessment
method for reviewing health issues leading to agreed priorities and resource allocation that will reduce inequalities, it's followed by planning, implementation, evaluation
98
what is the drawback to epidemiological health needs assessment?
doesn't consider felt need
99
define felt need
what the individual experiences
100
what are the 3 kinds of health needs assessment?
epidemiological corporate comparitive
101
what structure looks at what there is (places), what is done (services provided) and outcomes (death and disease)
Donebidean structure of evaluation
102
what are the 3 areas of duties of a dr
knowledge, skills and performance communication, partnership, teamwork safety and quality
103
define concordance
process by which patients and doctors come to an agreement about pt's care
104
give some barriers to patient concordance
poor communication patients want doctors to tell them what to do patients don't disclose all relevant information
105
define never event
serious, largely avoidable events which shouldn't occur if available, preventative measures have been implemented
106
how long can a refugee stay for?
5 years
107
why might homeless people not access services?
registration more imminent survival issues opening times percieved discrimination
108
what are the risk factors for inequality
``` Place of residence Race or ethnicity Occupation Gender Religion Education Socioeconomic status ```
109
what interview style might help with alcohol reduction?
``` FRAMES feedback-give risks responsibility-emphasise theirs advice menu of options empathise self efficacy-show them they can modify their behaviour ```
110
what are the features of dependence syndrome?
``` 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
second stage of hypertension?
160/100 or 150/95
112
when is hypertension treated with drugs
``` stage 1 if under 80 and QRISK>20% end organ damage established CVD renal failure DM stage 2+3>treat ```
113
what lifestyle advice should be offered to people with hypertension?
``` reduce salt to under 6g/day, aiming for 3 stop smoking exercise reduce caffeine intake reduce alcohol balanced diet ```
114
what diuretics should be added as third line in the treatment of hypertension
indapamide or chlorthalidone
115
define resistent hypertension
clinic bp of >140/90 after stage 3 treatment, expert advice or more diuretic (depends on potassium level, then alpha or beta blocker)
116
what is the aimed for blood pressure of someone under 80?
under stage 1 so 140/90
117
what is the aimed for blood pressure of someone over 80
150/90
118
what should you do before prescribing an ACEi?
U&Es
119
what investigations would you order if a patient was tired all the time?
``` FBC (anaemia, leukaemia) U&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
what are you testing for in a hep b screen
HBsAg and HBeAg-the antigens S>infected now! antibodies can imply past infection or vaccination has worked
121
what dietary advice should you give to someone with diabetes?
low glycaemic index carbs (pulses, wholegrain, rice, fruit and veg) high fibre stop trans fatty and sat fats
122
what do you give to a pregnant woman with hypertension?
CCB-not ACEi
123
management of T2DM?
1) lifestyle advice 2) metformin 3) sulfonylurea (gliben, glic) 4) BMI under 35-insulin, over-exanetide
124
what is exenatide?
glucagon like peptide receptor agonist-incretin mimetic (makes the body think it has glucagon)
125
when should HbA1c be checked?
every 3-6 months until stable then 6 monthly
126
what are the signs of diabetic neuropathy and peripheral arterial disease?
``` reduced ABPI absent pulses intermittent claudication ulcers cellulitis ```
127
how is diabetic neuropathy treated
amitriptyline, pregabalin, gabapentin, duloxetine | tramadol for rescue
128
what do you do with a patient who has had chest pain in the last 12 hours or is having it now?
emergency admission
129
FRAX score factors
``` women glucocorticosteroids female active cancer parent hip fracture previous hip fracture currently smoking weight height RA over 3 units secondary osteoporosis ```
130
ABCD2
``` 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
Well's score
``` 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
QRISK2
``` 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
CHA2DS2VASC
``` =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
what makes you want to choose BB or CCB rather than flecanide/sotalol/amiodarone in an AF pt
so rate rather than rhythm in less than 65, they're symptomatic, congestive HF, first presentation
135
HASBLED
``` htn>160 abnormal renal function stroke bleeding (history or tendency) labile INR elderly drugs >3 indicates high risk ```
136
what investigations would you do in a COPD patient?
spirometry, post bronchodilator CXR FBC to exclude 2ndary polycythaemia BMI
137
what is tertiary prevention?
lessening complications of a disease which has already happened
138
what is the disadvantage of screening?
overdetection of subclinical disease
139
cervical screening programme
25-49-every 3 years | 50-64-every 5 years
140
breast screening programme
47-73 every 3 years
141
bowel screening programme
50-74 every 2 years
142
what should be used in a penicillin allergic patient with sepsis?
IV vancomycin
143
what should thiazide diuretics be used for?
htn, loop are more for overload in heart failure
144
adverse effects of thiazides
gout postural hypotension hypokalaemia, hyponatraemia, hypercalcaemia
145
features of digoxin toxicity
lethargy, dizziness, n and v, gynaecomastia, arrythmia, anorexia
146
what do ACEi do in the kidneys?
constrict efferent arterioles
147
what is the plan when htn is newly diagnosed?
assess CVD risk (urine sample for albumin/creatinine, dip for haematuria, glucose, eGFR, cholesterol, fundoscopy, ECG) book for annual r/v
148
define malignant hypertension
200/130 with end organ damage
149
why are ACEi used in chronic renal failure?
protective long term but should be stopped if any contraindications or acute renal failure occurs
150
what are the types of high output heart failure?
pregnancy anaemia hyperthyroidism
151
what should be monitored in heart failure?
htn K Na
152
what is the secondary prevention of MI
``` reinforce lifestyle cardiac rehab aspirin+ticagrelor ACEi BB statin 5 drugs! ```
153
what time of day should statins be taken?
at night
154
what drugs increase life expectancy in pts with heart failure?
ACEi and BBs
155
side effects of omeprazole
loose stools osteoporosis hyponatraemia
156
steroids SEs
infection Cushings-easy bruising, weight gain, thin skin osteoporosis
157
SE co codamol
constipation
158
when should you be suspiscious of underage sex?
when U13 | when U16 and partner isn't
159
what are the CIs to metformin use?
hypoxic tissue injury (bc risk of lactic acidosis) so MI, sepsis, renal failure
160
SEs of gliclazide
weight gain | hypoglycaemia
161
SEs of pioglitazone
bladder cancer HF precipitation or exacerbation (Glitazone)
162
what are the gliptins?
DDP4 inhibitors such as sitagliptin weight gain and hypos
163
what are the risks with SLGT inhibitors like dapagloflozin?
increase sugar being weed out so UTI
164
what are the SEs of exanetide?
GLP1 inhibitor | pancreatitis and weight loss
165
what are the macrovascular complications of DM?
MI | stroke
166
what is the new asthma treatment pathway?
``` SABA ICS trial LT1 antagonist 4-8w LABA oral steroids ```
167
SEs of montelukast
diarrhoea fever GI discomfort
168
what 2 drugs should you co prescribe if youre giving long term steroids?
PPI inhibitor and bisphosphonates
169
what are cough red flags
weight loss, night sweats, rigors, haemoptysis, dyspnoea, nocturnal persistent cough
170
what defines a cough as chronic
over 6w
171
list the cardiac complications of MI
``` cardiac arrest cardiogenic shock arrythmias chronic heart failure pericarditis VSD acute mitral regurg ```
172
sequence of treatments in heart failure
BB and ACEi ARB or aldosterone antagonist or hydralazine with nitrate then consider ivabradine or digoxin
173
what is the outcome of case control studies?
odds ratio
174
what are IMCAs?
legal safeguards for people who lack capacity to make decisions about where they live and serious medical treatment
175
RFs for TB
immunosuppression (HIV, DM, kidney disease, low BMI, organ transplants) places with high prevalence
176
define concordance?
comes after compliance and adherence, the process by which patients and doctors come to an agreement on their care
177
what defines harmful drinking?
women-35+ | men-50+
178
what are the feautres of fetal alcohol syndrome?
``` low iq low set ears low nasal bridge microcephaly epicanthic folds microganthia ```
179
give some risk assessment tools for CVD?
Framingham score QRISK3 JBS3-for lifetime risk
180
how do you assess for end organ damage in a hypertensive patient?
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
what increases the risk of hyperlipidaemia?
``` smoking COCP BB steroids thiazides antipsychotics tamoxifen antiretrovirals XS alcohol pregnancy hypothyroidism renal failure HIV cholestasis cushings ```
182
how much exercise should you do per week?
30 mins moderate exercise 5X per week | and 2X strength exercises
183
what are the causes of AF
HTN cardiomyopathy coronary heart disease valvular heart disease
184
what kinds of domestic abuse are there?
``` psychological physical emotional financial sexual ```
185
define equality
equal shares for all
186
health problems faced by homeless adults
``` infectious diseases IVDU violence chronic disease worsened by lower access to healthcare mental illness poor nutrition poor dental health ```

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