GP

Question 1

If someone presents with heart failure, who has a PMHx of MI, what referral need to do?

Answer 1

Urgent Transthoractic Echo (TTE)

Question 2

If someone has never had an MI, but present with BNP at 4000, what do you do?

Answer 2

Urgent TTE

Question 3

How long can you wait before needing a TTE if your BNP is <4000?

Answer 3

= 6 weeks

Question 4

What two things might you see on a HF ECG?

Answer 4

Hypertrophy

Ischaemia

Question 5

What would you see on a CXR of HF?

Answer 5

Alveolar oedema
B lines 
Cardiomegaly
Diversion of upper lobe
Effusion

Question 6

What is first line treatment for heart failure?

Answer 6

ACEi and Beta blocker

Question 7

What would you consider if 1st line treatment didn’t work for HF?

Answer 7

ARB (losartan, candesartan)

Question 8

What medication might you consider in Afro-Caribbean people with HF?

Answer 8

Hydralazine with Nitrate

Question 9

What is 3rd line for HF?

Answer 9

Digoxin

Question 10

What are the 3 symptoms of typical angina?

Answer 10

1. Constricting pain in chest, may radiate down arm and to jaw
2. Brought on by exercise
3. Relieved by GTN spray in 5 mins

Question 11

What are angina patients given for symptoms control?

Answer 11

GTN
Beta blockers
CCB

Question 12

What are angina patients given as preventative medicine?

Answer 12

Aspirin

Statins

Question 13

What CANNOT be prescribed with Verapamil?

Answer 13

Beta blockers

Heart block

Question 14

What type of drug is Ivabradine?

Answer 14

Anti-anginal

Question 15

How does Ivabradine work?

Answer 15

Slows heart rate, reduces cardiac pacemaker affect

Question 16

Side effects of Ivabradine?

Answer 16

Bradycardia
Headache
Visual problems

Question 17

Long term Mx of COPD?

Answer 17

SABA +/- short acting anti-muscarinic
LABA +/- long acting anti-muscarinic
Long term oxygen therapy

Question 18

What is the mechanism of Metformin?

Answer 18

Increases insulin sensitivity, hepatic gluconeogenesis and GI absorption of carbohydrates

Question 19

What is the criteria for Sulphonylureas to actually work?

Answer 19

Must be some working beta cells (as the bind to them to increase insulin production)

Question 20

What might you use in T2DM if metformin/gliclazide isn’t working?

Answer 20

SGLT2 - sodium glucose cotransporter 2

block renal absorption of glucose
e.g. canagliflozin

Question 21

What are some side effects of SGLT2?

Answer 21

Thrush
UTI
Euglycaemic ketoacidosis
Weight loss

Question 22

Give examples of dipeptidyl-peptidase 4 (DPP4) used in T2DM

Answer 22

Sitagliptin

Vildagliptin

Question 23

Name 2 types of T2DM medications that do not cause hypoglycaemia

Answer 23

1. Metformin

2. DDP4 - sitagliptin

Question 24

How many medications do you need to use before insulin is considered in T2DM?

Answer 24

3 (triple therapy)

Question 25

A patient of BMI 30 is non well controlled on triple therapy. What do you want to try next?

Answer 25

Glucagon-like-peptide 1 (GLP1)

Question 26

Give an example of a GLP1

Answer 26

Exenatide

Question 27

Name 3 side effects of insulin

Answer 27

Weight gain Hypoglycaemia Lipodystrophy

Question 28

Name 5 risk factors for chronic kidney disease

Answer 28

``` Hypertension Diabetes Polycystic kidney disease Renal artery stenosis Glomerulonephritis ```

Question 29

What foods must someone with CKD avoid?

Answer 29

Phosphate and potassium

Question 30

What reverses the action of warfarin?

Answer 30

Vitamin K

Question 31

What medication is mainly used in Alzheimer's?

Answer 31

Donepezil

Question 32

If a dementia patient has visual hallucinations, relatively preserved memory and fluctuations in cognition, what type of dementia might you suspect?

Answer 32

Lewy Body

Question 33

Which type of dementia can be preventable?

Answer 33

Vascular

Question 34

What condition is front-temporal dementia linked to?

Answer 34

Motor neurone disease