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1
Q

Name some symptoms and signs of heart failure

A

SYMPTOMS
breathlessness, fatigue, ankle swelling

SIGNS
tachycardia, tachypnoea, pleural effusion, raised JVP, peripheral oedema, hepatomegaly, cardiomegaly, 3rd heart sound, cardiac murmurs

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2
Q

What biomarker will be raised in heart failure, and what level would indicate heart failure is unlikely?

A

Beta natriuretic peptide

heart failure unlikely if
<100pg/ml in men under 70yo
<150pg/ml in women under 70yo
<300pg/ml all over 70

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3
Q

What investigations should be carried out to investigate heart failure?

A

if PREVIOUS MI

  • doppler echocardiography
  • BNP if no obvious abnormality

if NO PREVIOUS MI

  • BNP
  • ECG
  • echocardiography
  • bloods- FBC, U+E, creatinine, LFTs, glucose, TFT, caridac enzymes
  • CXR
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4
Q

Signs of heart failure on CXR

A

ABCDE

Alveolar oedema
kerly B lines
Cardiomegaly
Dilated prominent upper lobe vessels
pleural Effusion
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5
Q

what classification system is used with heart failure?

A

New York Heart Association Classification

I- no symptoms on ordinary physical activity
II- slight limitiation
III- less than ordinary activity leads to symptoms
IV- inability to carry out any activity without symptoms

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6
Q

First line mangement of heart failure

A

1) Lifestyle advice
2) ACE-I for all with EF <40%
3) Diuretics for symptomatic relief
4) Beta blockers- symptomatic and lowers EF

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7
Q

Management of acute MI

A 
MONA
Morphine
Oxygen
Nitrates
Aspirin
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8
Q

Define clinical hypertension

A

Stage 1 >140/90

Stage 2 >160/100

Sever >180/110

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9
Q

Management of hypertension

A

Give antihypertensive treatment to

  • <80 yo + Stage 1 and signs/ risk of end organ damage
  • any age with stage 2

MANAGEMENT FOR <55yo

1) ACE-I (ARB if intollerant)
2) combination therapy- ACE-I + CCB/ thiazide
3) add more diuretic- spironolactone/ thiazide/ alphablocker/ beta blocker

MANAGEMENT FOR >55 OR AFROCARIBBEAN OF ANY AGE

1) CCB (or thiazide if evidence of heart failure)
2) combination therapy- ARB+CCB
3) add more diuretic- spironolactone/ thiazide/ alphablocker/ beta blocker

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10
Q

Example, side effect and contraindication of

1) ACE-I
2) CCB
3) thiazide
4) ARB

A

ACE-I
ramipril
SE: dry cough, hyperkalaemia, renal failure
CI: pregnant, breast feeding, renal artery stenosis

CCB
amlodipine/ nifedipine
SE: constipation, headache, flushes
CI: heart failure

THIAZIDE
Chlorthiazide
SE: hyponatraemia, dehydration, dizziness, impotence
CI: gout, diabetes

ARB
Candesartan
SE: dizziness, headache, flu like symptoms
CI: Pregnancy

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11
Q

Important advice to give to parents when deciding to vaccinate their child

A
  • immunisations protect from serious disease
  • reduces the risk, but should be aware of symptoms
  • vaccine inactivated or live but very low dose- will not cause disease in healthy child
  • important to have at right age
  • reduces spread of disease- herd immunity, protects whole community
  • vaccines are safe, they are rigorously tested. May be mild side effects
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12
Q

Name some notifiable diseases

A 
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
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13
Q

In the community, if meningitis is suspected, what should be given?

A

benzylpenicillin

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14
Q

What signs indicate an urgent hospital referral for children?

A

Red in traffic light guidance

  • fever >38 in <3months old
  • fever >39 3-6 months
  • pale, mottled, blue
  • drowsy, unresponsive
  • grunting, tachypnoea >60, chest indrawing
  • low skin turgot
  • non blanching rash
  • bulging fontanelle
  • stiff neck
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15
Q

Thrush presentation, organism, treatment

A

white cottage cheese discharge, vulval itching

candida albicans

oral single dose fluconazole/ pessary/ cream

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16
Q

Bacteria Vaginiosis presentation, treatment

A

thin grey/ white fishy discharge
Clue cells

Metronidazole/ clindamycin

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17
Q

trichomoniasis

A

yellow green frothy discharge, fishy odor, dysuria, bubbly, vaginitis

metronidazole

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18
Q

chlamydia treatment

A

azithromycin stat

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19
Q

Fraser competence guidelines

A

contraceptive advice or treatment can be given to under 16yo without parents if

  • can understand information
  • cant be persuaded to involve parents
  • likely to carry on having sex
  • physical or mental health at risk without advice/ treatment
  • young persons best interest
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20
Q

contraindication of COCP

A

migraine with aura

21
Q

Signs of dementia

A

Progressive
Memory loss
decline in cognition
difficulties with activities of daily living

22
Q

Name 3 cognitive impairment screening questionnaires

A

GO-Cog
Mini mental state examination
6-CIT

23
Q

Investigations to exclude reversible organic causes of dementia-like symptoms

A
  • Vision and hearing
  • infection screening, biochemistry, thyroid function, b12 and folate, MSU, CXR, ecg
  • Identify depression
  • Trauma and alcohol history
  • risk factors for vascular dementia
24
Q

Differentiating depression from dementia

A

depression more likely if

  • short length of time <6 months
  • global memory loss (rather than short term memory loss)
  • biological symptoms- sleep and apetite
  • worried about memory
25
Q

pathophysiology of alzheimers

A

Beta amyloid plaques
neurofibriallry tangles
Decreased ACh production

26
Q

Presentation of alzheimers

A

progressive global cognitive impairment
visio-spacial skills, memory, executive function
anosognosia- lack of insight
onset insidious

27
Q

Vascular dementia presentation

A

sudden onset and stepwise deterioration

Risk factors for CV disease

28
Q

Lewy body dementia presentation

A

fluctuating cognitive impairment
detailed visual hallucinations
sleep disorders
memory loss not usual initially

29
Q

frontotemporal dementia presentation

A

personality change, emotional blunting, apathy, dis-inhibition, carelessness, behavioural change,
progressive impairment of language function

30
Q

treatment of alzheimers disease

A

ACh-ASE INHIBITORS
eg donepezil, rivastigamine, galantamine
slows down progression
can also be used in Lewy Body dementia (NOT ftd/vascular)
SE: exacerbates peptic ulcer disease and heart block

ANTIGLUTAMATERGIC 
eg memantine
NMDA antagonist
effective in late stage disease
SE: hallucinations and confusion

for symptom control

  • folic acid and b12 vitamins- decreases mild cognitive impairment
  • antidepressants- depression common in dementia
  • sedation- violence and aggression, used if risk to self or others
31
Q

outline DOLS

A

Deprivation of liberty safeguard
-ensures people who cannot consent to their care (mental disorder lacking capacity) arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.
-Arrangements are assessed to check they are necessary and in the person’s best interests.
- if restraints and restrictions are used, they must be the least restrictive method possible and in the best interests of the patient
-liberty is a human right
Is the person subject to continuous supervision and control? and
Is the person free to leave?

32
Q

risk factors of suicide in those who are depressed

A 
Suicide plan/ ideas or hx of self harm
Unexplained guilt/ worthlessness
Inability to function- psychomotor retardation/ agitation
Concentration impaired
Impaired appetite
Decreased sleep
Energy low

Alcohol and drug use, history of menal illness, affairs in order, precise plan, male, concealing attempts, unemployment, isolation, single

33
Q

Differentiating

  • asthma
  • pneumonia
  • Bordetella pertussis
  • lung cancer
  • TB
A

ASTHMA
wheeze, tight chest, SOB, diurnal variation, FHx, atopy, exacerbated by irritants,
reversible obstructive pattern- FEV/FVC<80%

PNEUMONIA
fever, malaise, cough, chest pain, sputum
dullness to percussion, decreased breath sounds, CXR infiltrates

BORDETELLA PERTUSIS
paroxysmal coughing, inspiratory whooping sound

LUNG CANCER
Hx of smoking, change in character of chronic cough, haemoptysis, hoarseness, chest pain, weight loss, symptoms of metastases

TB
anorexia, malaise, weight loss, night sweats, chronic productive cough, occasional hameoptysis

34
Q

Risk factors for TB

A 
residence/ travel to high prevalence area
immunosuppressed- HIV/AIDS
poor nutrition, smoking, alcohol
poverty and homelessness
close contact with infected person
ethnic minorities
35
Q

Diagnosis of TB

A

latent- Mantoux test
active- CXR- lobar consolidation, cavitation, calcification, fibrosis,
Sputum sample- acid fast zheil neelsen stain
histology- caseating granuloma

36
Q

treatment of TB

A

RIPE
Rifampicin and isoniazid for 6 months with pyrazinamide and ethambutol for first 2 months

DoT- directly observed therapy to ensure compliance

37
Q

TB chest x ray signs

A

Consolidation, cavitation, fibrosis, and calcification.

38
Q

explain in laymans terms how ACE-I work and give 2 side effects

A

relax blood vessels and reduce amount of water body reabsorbs, making it easier for blood to be pumped round body

Dry cough, hypotension (so take before bed, and careful of waking up in the night), hyperkalaemia, worsen/ cause renal failure

39
Q

explain in laymans terms how angiotensin receptor blockers work, give an example and 2 side effects

A

Candesartan
To treat heart failure/ high BP- people with high BP may not feel unwell but if left untreated can damage heart and blood vessels
Works by allowing your blood vessels to relax and widen

SE: dizzy, hypotension, renal failure, avoid in pregnancy

40
Q

explain how aspirin works in laymans terms and give 2 side effetcs

A

Prevents unwanted blood clots from forming in body

Used to treat acute ischaemic stroke and long term prevention of thrombolytic arterial events (COX inhibitor- decreased platelet aggregation)

SE: GI irritation- GI ulcer and haemorrhage- take with food

41
Q

explain how Long term/ short term beta agonists work,

side effects

A

used in chronic asthma and to relieve breathlessness

relaxes muscle in lung to open airways

SE:tachycardia, palpitations, anxiety, tremor

42
Q

explain how beta blockers work

side effects

A

Treatment of ischaemic heart disease, decrease symptoms of angina, improve prognosis of chronic heart failure

Reduces how hard and fast the heart beats

SE: fatigue, cold extremities, headache, GI upset,
CI in asthma- causes bronchodilation

43
Q

explain how calcium channel blockers work

Side effects

A

Treatment of high blood pressure- relaxes walls of blood vessels and decreases how hard heart pumps and so makes it easier for heard to pump blood round body

SE: ankle swelling, flushing, headache, feeling tired

44
Q

explain how clopidogrel works

Side effects

A

Blood thinner- prevents blood clots so blood flows though vessels more easily

SE: bleeding more easily, nose blleds, heavier periods, bleeding gums, bruising

45
Q

diruetics- how they work and side effects

A

Water pills- make you wee more to prevent a build up of fluid in your body (dont take after 4pm as otherwise will need toilet in night)

SE: dehydration, hypotension, increased urinary frequency

46
Q

how insulin works and side effects

A

in type 1 diabetes body no longer makes insulin and so you have to inject it to help your body use sugar for energy

SE: hypoglycaemia–> coma and death–> watch out for dizziness, agitation, nausea, sweating, confusion.
Manage lifestyle factors too

47
Q

statins how they work and side effects

A

reduces bad cholesterol in body and so reduces narrowing and hardening of arteries

SE: headache, myopathy, rhabdomyalsis. Avoid grapefruit juice

48
Q

warfarin- how it works and side effects

A

prevents unwanted clots in body. Need to check INR regularly to check how long it takes for blood to clot

SE: increased bleeding, spontaneous haemorrhage

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