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Phase 3a ILA > GP > Flashcards

GP Flashcards

1
Q

How is HTN diagnosed

A

140/90 on 2 separate occasions
stage 1 - 140/90
stage 2 - 160/100
severe - 180/110

AMBP - uses average of 14 measurements

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2
Q

Causes/RF of essential and secondary HTN

A

essestial (no underlying cause)

  • low birth weight
  • obesity
  • XS alcohol
  • XS salt

Secondary

  • renal disease
  • endocrine
  • pre-eclampsia
  • drugs (OOC, steriods, NSAIDS)
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3
Q

Step 4 of HTN medical management

A

+further diuretic

OR

+alpha blocker

OR

+beta blocker

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4
Q

Mechanism of action and 1 example of each diuretic type

A
  • thiazide (indapamide) inhibits Na reabsorption and inhibits Na/Cl transporter in DCT
  • loop (furosemide) inhibit Na/Cl in ascending limb
  • Potassium sparing (triamterene) antagonise actions of aldosterone in DCT, more Na into collecting duct -> excreted. Na reabsorption inhibited so less K and H exchanged and lost in urine - K sparing
  • Aldosterone antagonist (spironolactone) helps loop/thiazide but antagonising aldosterone
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5
Q

CCB example and MoA

A

amlodipine, nifedipine

decrease myocardial contractility, relaxes vascular SM, reduces systemic VR and arterial BP

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6
Q

ACE-I example and MoA

A

Ramipril

decreases angiotensin II formation so decreased vasocontriction

blocks degradation of bradykinin (vasodilator)

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7
Q

ARB example and MoA

A

candesartan

block angiotensin II receptors, down regulates sympathetic adrenergic activity, promotes renal excretion Na and H20

dilates vessels reducing arterial pressure, preload and afterload on the heart

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8
Q

B blockers example and MoA

A

bisoprolol

blocks adrenaline and noradrenaline binders

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9
Q

Describe the link between ED and HTN

A

30-40% men with HTN also have ED

HTN stops penile arteries dilating and makes SM lose ability to relax (not enough blood to penis to cause erection and blood vessel damage)

Diuretics decrease force of blood to penis and zinc (needed to make testosterone)

BB dampen response to nerve impulses that lead to erection

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10
Q

Effects of angiotensin II on body

A

IN REPSONSE TO LOW BP (decrease in renal perfusion JGA)

  1. increased sympathetic activity
  2. Tubular Na and Cl reabsorption and K excretion
  3. Aldosterone secretion (adrenal) -> contributes to 2
  4. arteriolar vasocontriction
  5. ADH secretion (pit gland) -> H20 absoption CD
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11
Q

Heart failure causes

A

10% of pt>65

  • myocardial dysfunction
  • cardiomyopathy
  • factors increasing myocardial work (obesity, anaemia)
  • HTN
  • XS alcohol
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12
Q

Compensatory mechanisms for HF

A
  1. Sympathetic NS
    • increases HR + SV (faster more forceful contractions)
    • less effect after repeated action
  2. Increased Pre load
    • ADH and aldosterone increase filling volume.
    • increased Preload, higher pressure, higher SV
    • need more 02 that isnt supplied -> muscle death
  3. Hypertrophy
    • heart muscles enlarges to produce stronger contractions but needs more 02 that isnt supplied. Concentric hypertrophy reduces ventricle volume
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13
Q

Heart failure symptoms and signs

A

*SOB

*ankle swelling

*fatigue

+orthopnoea (SOB when flat)

Signs- peripheral oedema, pul crackles, tachy, increased JVP

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14
Q

Heart Failure diagnosis

A
  • BNP (increased LV dysfunction)
    • <100 normal
    • 100-400 refer echo 6/52
    • >400 refer echo 2/52
  • Echo (US waves look at pumping action and structure)
    • LVSD - decreased LVEF <40%
  • CXR
  • Bloods (eGFR normal 90-100%)
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15
Q

CXR findings in Heart failure

A

Alveolar oedema

B lines

Cardiomegaly

Dilated prominent vessels

Effusion pleural

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16
Q

Medical management of Heart failure

A

1st - ACE, BB (start low go slow)

2nd - Aldoserone antagonist, ARB (if pt doesnt tolerate ACEI)

Hydralazine and nitrate if pt black

Diuretics relieve symptoms

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17
Q

Heart failure prognosis

A

30-40% die in first year

<10% mortality following

2/3rd pt die in 5 years

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18
Q

CVD primary, secondary, teritary prevention

A

1- lifestyle

2- medication, Q risk 2

3- rehab

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19
Q

Polypharmacy issues

A

Interactions

non adherence

NHS cost

Prescribing cascade

88% chance of adverse drug even if 5+ meds

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20
Q

Notifiable diseases

A

(6 in 1) Whooping Cough, Tetanus, Diphtheria

(MMR) Measles, Mumps, Rubella

Malaria

meningococcal septicaemia

Scarlet Fever

TB

Acute encephalitis

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21
Q

Describe assessment/ immediate management of an unwell child

A

ABCDE ?SEPSIS CONSCIOUSNESS

assessment: traffic light, vital signs, dehydration signs

22
Q

Signs of dehydration in children

A

prolonget CRT

abnormal skin tugor

abnormal resp pattern

weak pulse

cool extremities

SEVERE: sunken fontanelle, dry mouth, sunken eyes, absence of tears

23
Q

Management of red, amber and green features on traffic light

A

red -> urgently (w/in 2 hours) assessed face to face by specialist

amber -> assessed face to face if necessary, safety net (warning symptom info, arrange follow up)

green -> care at home with appropriate advice (manage temp, regular fluids, rash and dehydration checks)

24
Q

PCB causes

A

vaginal - vaginitis, carcinoma

Cervical - cervicitis, carcinoma, polyps, trauma, ectopion

25
Q

Abnormal discharge description and likely diagnosis

A

fishy - BV

cottage cheese - thrush

green, frothy - tri

thick green/yellow - gono

Blood stained - cancer, foreign body

26
Q

Normal VD

A

no strong or unpleasant smell

clear or white

thick/sticky or slippery/wet

27
Q

MoA and Efficacy for common methods of contraception

A

LARC - long activing resersible contraception

Condom - barrier - 85% depends on user

COC - prevents ovulation, thickens mucus in neck of womb/ thins lining of womb - 91% depends on user

POP - thickens cervical mucus and thins endometrium - 92% depends on user

PO implants - releases progestogen, thickens cervical mucus and thins endometrium - >99% lasts 3 years

Cu-IUD - copper alters cervical mucus - >99% stays 5-10 years

Minera - releases levonorgestrel (progestin) into uterus - >99% stays 3-5 years

28
Q

What is fraser competence

A

used to see whether child has maturity to make own decisions with regards to contraception only

Gillick competency

  • child able to understand advice
  • cannot persuaed child to inform competent adult
  • child likely to continue having sex with or without contraception
  • without contraceptive advice/tx -> physical/mental health could suffer
  • best interests require advice/tx without consent

*sexual activity with child <13 illegal and should always result in child protection*

29
Q

Issues relating to teen pregnancy

A
  • lack of prenatal care
  • higher risk of pre-eclampsia
  • infant mortality higher
  • 40% teenage mums drop out of school -> no quals -> increased risk of poverty
30
Q

Dementia screening tools

A

GPCOG

MMSE

6CIT (6 item cog impairment test)

IQCODE (informant questionnaire on cog decline in elderly)

31
Q

Dementia Management

A

most medications treat Alzheimers - rivastigmine, memantine

Cognitive stimulation therapy

Cognitive rehab

32
Q

community care for dementia patients

A
  • have a needs assessment - determines help and support needed
  • Care options - home, residential or care home, day care centres
  • Admiral nurses
  • Charities
33
Q

Whats is DOLS

A

only for care homes, hopitals and hospices

set of checks that aim to make sure any care that restricts a persons liberty is both appropriate and in theirh best interests

34
Q

what is a IMCA

A

Independent mental capacity advocate

makes decisions about serious medical problems and represent people when no one else is able to

35
Q

Core depression symptoms

A
  1. sadness or low mood
  2. Anhedonia
  3. fatigue
36
Q

Additional depression symptoms

A

Physical - change in sleep, appetite, libido, psychomotor retardation or agitation

psycho - lack of confidence and conc, worthlessness and guilt, suicidal idealtion, numbnesss

37
Q

Depression criteria

A

mild - 2 core 2/3 other

mod - 2 core 3 other

severe - 3 core 4+ other + psychotic sx

38
Q

Suicide risk factors

A

SAD PERSONS

Sex male

Age <19 or >44

Depression

Previous attempts

Ethanol abuse

Rational reasoning lost

Social support lacking

Organised plan

No spouse

Sickness

39
Q

Depression risk factors

A
  • family/personal hx
  • age 20-40
  • substances
  • unemployed
  • divorced
  • living alon
40
Q

What is section 2 MHA

A

assessment: 28 days

41
Q

What is section 3 MHA

A

Treatment: 6 months

  • suffering from mental disorder of a nature or degree which makes it appropriate to receive medical tx in hospital
  • necessary for health of pt OR safety of pt OR safety of others
  • appropriate tx available
  • tx cannot be given under other circumstances
42
Q

who is involved in a section 3 detainment

A
  • medical professional to prove medically fit
  • 2 registered medical practitioners
43
Q

What is section 5

A

holding powers

  1. 2 doctor: 72 hours
  2. 4: nurses 6 hours
44
Q

what is section 136

A

72 hours

allows police officer to remove someone who appears to be suffering from mental health disorder to a place of safety

45
Q

Depressio screening tools

A

PHQ-9

HAD (hospital anxiety and depression scale

ICD 10 (geriatric depression score)

46
Q

Alcohol screening tools

A
  • AUDIT -1 (shortened version of below, first 3 questions, do full qu if
    • score 3+
    • drank more than 6 drinks on one occasion in last year
  • AUDIT
  • FAST - ED
  • CAGE
47
Q

Management of depression

A

mild: low intensity psychological intervention
mod: CBT or IPT + SSRI
severe: ECT

Tx continue 6 months after symptoms resolve

48
Q

Differential diagnosis for patient with a cough

A

acute brochitis, URI, asthma, pneuomia, COPD, influenza,

49
Q

TB risk factors

A

HIV

Diabetes

malnutrition

tobacco

harmful alcohol use

50
Q

How to prevent TB outbreak

A

Identification and treatment of active TB (RIPE)

TB infection control:

BCG vaccine: provides children protection but more variable in adults

Phase 3a ILA (4 decks)

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