GP Flashcards
How is HTN diagnosed
140/90 on 2 separate occasions
stage 1 - 140/90
stage 2 - 160/100
severe - 180/110
AMBP - uses average of 14 measurements
Causes/RF of essential and secondary HTN
essestial (no underlying cause)
- low birth weight
- obesity
- XS alcohol
- XS salt
Secondary
- renal disease
- endocrine
- pre-eclampsia
- drugs (OOC, steriods, NSAIDS)
Step 4 of HTN medical management
+further diuretic
OR
+alpha blocker
OR
+beta blocker
Mechanism of action and 1 example of each diuretic type
- 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
CCB example and MoA
amlodipine, nifedipine
decrease myocardial contractility, relaxes vascular SM, reduces systemic VR and arterial BP
ACE-I example and MoA
Ramipril
decreases angiotensin II formation so decreased vasocontriction
blocks degradation of bradykinin (vasodilator)
ARB example and MoA
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
B blockers example and MoA
bisoprolol
blocks adrenaline and noradrenaline binders
Describe the link between ED and HTN
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
Effects of angiotensin II on body
IN REPSONSE TO LOW BP (decrease in renal perfusion JGA)
- increased sympathetic activity
- Tubular Na and Cl reabsorption and K excretion
- Aldosterone secretion (adrenal) -> contributes to 2
- arteriolar vasocontriction
- ADH secretion (pit gland) -> H20 absoption CD
Heart failure causes
10% of pt>65
- myocardial dysfunction
- cardiomyopathy
- factors increasing myocardial work (obesity, anaemia)
- HTN
- XS alcohol
Compensatory mechanisms for HF
- Sympathetic NS
- increases HR + SV (faster more forceful contractions)
- less effect after repeated action
- Increased Pre load
- ADH and aldosterone increase filling volume.
- increased Preload, higher pressure, higher SV
- need more 02 that isnt supplied -> muscle death
- Hypertrophy
- heart muscles enlarges to produce stronger contractions but needs more 02 that isnt supplied. Concentric hypertrophy reduces ventricle volume
Heart failure symptoms and signs
*SOB
*ankle swelling
*fatigue
+orthopnoea (SOB when flat)
Signs- peripheral oedema, pul crackles, tachy, increased JVP
Heart Failure diagnosis
- 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%)
CXR findings in Heart failure
Alveolar oedema
B lines
Cardiomegaly
Dilated prominent vessels
Effusion pleural
Medical management of Heart failure
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
Heart failure prognosis
30-40% die in first year
<10% mortality following
2/3rd pt die in 5 years
CVD primary, secondary, teritary prevention
1- lifestyle
2- medication, Q risk 2
3- rehab
Polypharmacy issues
Interactions
non adherence
NHS cost
Prescribing cascade
88% chance of adverse drug even if 5+ meds
Notifiable diseases
(6 in 1) Whooping Cough, Tetanus, Diphtheria
(MMR) Measles, Mumps, Rubella
Malaria
meningococcal septicaemia
Scarlet Fever
TB
Acute encephalitis
Describe assessment/ immediate management of an unwell child
ABCDE ?SEPSIS CONSCIOUSNESS
assessment: traffic light, vital signs, dehydration signs
Signs of dehydration in children
prolonget CRT
abnormal skin tugor
abnormal resp pattern
weak pulse
cool extremities
SEVERE: sunken fontanelle, dry mouth, sunken eyes, absence of tears
Management of red, amber and green features on traffic light
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)
PCB causes
vaginal - vaginitis, carcinoma
Cervical - cervicitis, carcinoma, polyps, trauma, ectopion
Abnormal discharge description and likely diagnosis
fishy - BV
cottage cheese - thrush
green, frothy - tri
thick green/yellow - gono
Blood stained - cancer, foreign body
Normal VD
no strong or unpleasant smell
clear or white
thick/sticky or slippery/wet
MoA and Efficacy for common methods of contraception
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
What is fraser competence
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*
Issues relating to teen pregnancy
- 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
Dementia screening tools
GPCOG
MMSE
6CIT (6 item cog impairment test)
IQCODE (informant questionnaire on cog decline in elderly)
Dementia Management
most medications treat Alzheimers - rivastigmine, memantine
Cognitive stimulation therapy
Cognitive rehab
community care for dementia patients
- have a needs assessment - determines help and support needed
- Care options - home, residential or care home, day care centres
- Admiral nurses
- Charities
Whats is DOLS
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
what is a IMCA
Independent mental capacity advocate
makes decisions about serious medical problems and represent people when no one else is able to
Core depression symptoms
- sadness or low mood
- Anhedonia
- fatigue
Additional depression symptoms
Physical - change in sleep, appetite, libido, psychomotor retardation or agitation
psycho - lack of confidence and conc, worthlessness and guilt, suicidal idealtion, numbnesss
Depression criteria
mild - 2 core 2/3 other
mod - 2 core 3 other
severe - 3 core 4+ other + psychotic sx
Suicide risk factors
SAD PERSONS
Sex male
Age <19 or >44
Depression
Previous attempts
Ethanol abuse
Rational reasoning lost
Social support lacking
Organised plan
No spouse
Sickness
Depression risk factors
- family/personal hx
- age 20-40
- substances
- unemployed
- divorced
- living alon
What is section 2 MHA
assessment: 28 days
What is section 3 MHA
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
who is involved in a section 3 detainment
- medical professional to prove medically fit
- 2 registered medical practitioners
What is section 5
holding powers
- 2 doctor: 72 hours
- 4: nurses 6 hours
what is section 136
72 hours
allows police officer to remove someone who appears to be suffering from mental health disorder to a place of safety
Depressio screening tools
PHQ-9
HAD (hospital anxiety and depression scale
ICD 10 (geriatric depression score)
Alcohol screening tools
- 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
Management of depression
mild: low intensity psychological intervention
mod: CBT or IPT + SSRI
severe: ECT
Tx continue 6 months after symptoms resolve
Differential diagnosis for patient with a cough
acute brochitis, URI, asthma, pneuomia, COPD, influenza,
TB risk factors
HIV
Diabetes
malnutrition
tobacco
harmful alcohol use
How to prevent TB outbreak
Identification and treatment of active TB (RIPE)
TB infection control:
BCG vaccine: provides children protection but more variable in adults
