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3B > GP > Flashcards

GP Flashcards

1
Q

AF risk factors

A 
HTN
CCF 
Coronary artery disease 
Valvular disease 
Arrhythmias 
Age 
DM 
Alcohol 
Male 
Smoking
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2
Q

AF presenting features

A 
Palpitations 
Tachycardia 
Irregular pulse 
Stroke 
Dyspnoea 
Fatigue 
Chest pain 
Dizziness
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3
Q

AF investigations

A

ECG
TFTs
Echo

Before starting medication:
U+Es
CHA2DS2-VASc

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4
Q

AF ECG findings

A

Absent P waves

Irregularly irregular rate

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5
Q

AF echo findings

A

Valvular regurgitation or stenosis
LV or LA enlargement
PHTN
LV thickening and dysfunction

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6
Q

CHA2DS2-VASc

A 
CHF - 1 
HTN - 1 
Age > 75 - 2 
DM - 1
Stroke/TIA - 2 
Vascular disease - 1 
Age 65-74 - 1 
Sex - Female
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7
Q

AF management

A

Anticoagulation - DOAC

  • Factor 10a inhibitor
  • CI in mitral stenosis or prosthetic valves
  • Maintain INR 2-3

?Warfarin - HASBLED

Rate control - B-blocker

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8
Q

HASBLED

A 
HTN - 1 
Abnormal renal/liver function - 2 
Stroke - 1 
Bleeding history - 1 
Labile INRs - 1 
Elderly > 65 - 1 
Drugs predisposing bleeding - 1
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9
Q

HTN definition

A

Clinical reading > 140/90

Ambulatory reading > 135/85

Primary hypertension = 90-95% of cases

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10
Q

Secondary HTN causes

A

Renal

  • Glomerulonephritis
  • Chronic pyelonephritis
  • PKD
  • Renal artery stenosis

Endocrine

  • Primary hyperaldosteronism
  • Phaeochromocytoma
  • Cushing’s
  • CAH
  • Acromegaly

Other causes

  • Glucocorticoids
  • NSAIDs
  • Pregnancy
  • CoA
  • COCP
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11
Q

HTN features

A

Usually asymptomatic

Headaches
Visual disturbances
Seizures

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12
Q

HTN investigations

A

24-hour BP monitoring

U+E - Check for cause or consequence 
HbA1c 
Lipids 
ECG 
Urine dip
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13
Q

HTN management

< 55 or DM2

A
  1. A
  2. A + D
  3. A + C + D

K+ < 4.5 - Spironolactone
K+ > 4.5 - A/B-blocker

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14
Q

HTN management

> 55 or Afro-Caribbean

A
  1. C
  2. C + A
  3. C + A + D

K+ < 4.5 - Spironolactone
K+ > 4.5 - A/B-blocker

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15
Q

ACE

A

Inhibits conversion of AT1 to AT2

Side effects

  • Cough
  • Angioedema
  • Hyperkalaemia

Considerations

  • CI in pregnancy
  • Check renal function 2/3 weeks after starting
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16
Q

CCB

A

Block voltage-gated Ca channels

  • Causes smooth muscle relaxation
  • Reduces force of myocardial contraction

Side effects

  • Flushing
  • Ankle swelling
  • Headache
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17
Q

Thiazide diuretics

A

Inhibit sodium absorption at the beginning of the DCT

Side effects

  • Hyponatraemia
  • Hypokalaemia
  • Dehydration
18
Q

A2RB

A

Block the effects of AT2 at the AT1 receptor

Side effects - Hyperkalaemia

Used if ACE is not tolerated

19
Q

Adrenal cortex layers

A

Great Friday routines
Salt, sugar, sex
The deeper you go, the sweeter it gets

GFR-ACD

Glomerulosa - Mineralocorticoids - Aldosterone
Fasciculata - Glucocorticoids - Cortisol
Reticularis - Androgens - DHEA

20
Q

R-A-S

A

Low BP detected by baroreceptors in aortic arch…

Stimulates SNS…

  • Vasoconstriction
  • Increased water and sodium reabsorption
  • Increased potassium excretion
21
Q

Renin

A

Released by renal juxtaglomerular cells…

In response to…

  • Reduced renal perfusion
  • Hyponatraemia
  • SNS

Hydrolyses angiotensinogen to AT1

22
Q

AT2

A

ACE converts AT1 to AT2

AT2 acts to increase BP…

  • Vasoconstriction of efferent arteriole
  • Increased filtration fraction to preserve GFR
  • Stimulates thirst via hypothalamus
  • Stimulates aldosterone and ADH release
  • Increases proximal tubule Na+/H+ activity
23
Q

Aldosterone

A

Released by zona glomerulosa in response to raised AT2, K+ and ACTH

Acts on DCT and collecting ducts

Stimulates…

  • Na+ reabsorption
  • K+ excretion
  • H2O reabsorption
24
Q

ADH

A

Increases BP

  • Synthesised by hypothalamus
  • Secreted by PP in response to decreased BP
  • Acts on collecting ducts
  • Increases water reabsorption
25
Q

ANP

A

Atrial natriuretic peptide
Decreases BP

Released by atrial myocytes in response to…

  • Cardiac distension
  • SNS stimulation
  • AT2

Inhibits RAS and causes vasodilation

26
Q

CKD definition and staging

A

GFR < 60

Stage 1 - GFR > 90 + Evidence of kidney damage on investigation 
Stage 2 - GFR 60-89
Stage 3a - GFR 45-59
Stage 3b - GFR 30-44
Stage 4 - GFR 15-29
Stage 5 - GFR < 15
27
Q

CKD risk factors

A

Age > 50
DM
HTN
Childhood kidney disease

Long-term steroid use 
Male 
Black/Hispanic 
FH 
Smoking 
Obesity 
AI disorders
28
Q

CKD signs and symptoms

A 
Anaemia 
Oedema 
Nausea 
Pruritus 
Arthralgia 
Enlarged prostate
29
Q

CKD investigations

A 
Creatinine-based estimate of GFR 
Albumin:Creatinine ratio
Creatinine ^ 
Urinalysis - Haematuria and proteinuria 
Microalbuminaemia 
Renal USS 
Biopsy
30
Q

Complications

A

Anaemia
Renal osteodystrophy
CVD

Protein malnutrition
Metabolic acidosis
Hyperkalaemia
Pulmonary oedema

31
Q

CKD stage 1-2

Management

A
  1. ACE-I or ARB

Measure serum K+ and GFR before starting and 1/2 weeks after

K+ > 5 - Do not offer RAS inhibitor

  1. CCB - Verapamil

+++ Statin

32
Q

CKD stage 3-4

Management

A
  1. ACE-I or ARB

Measure serum K+ before starting and 1/2 weeks after

K+ > 5 - Do not offer RAS inhibitor

  1. CCB - Verapamil

+++ Statin
+++ B-blocker

33
Q

CKD additional treatments

A

CONSIDER ANTICOAGULATION

EPO stimulating agent 
Ferrous sulphate 
Calcium carbonate 
Ergocalciferol 
Calcitriol 
Sodium bicarbonate
34
Q

CKD stage 5

Management

A

Dialysis
Kidney transplant

Calcium carbonate
Calcitriol
Ergocalciferol

35
Q

HF risk factors

A 
MI 
DM 
Dyslipidaemia 
Age ^ 
Male 
HTN 
Valvular heart disease 
FH 
AF
Thyroid disease
36
Q

HF symptoms

A 
Dyspnoea 
Chest pain 
Fatigue 
Orthopnoea 
Tachycardia
37
Q

HF signs

A 
Raised JVP 
S3 gallop 
Cardiomegaly 
Hepatojugular reflux 
Rales 
Hepatosplenomegaly
Pitting oedema
38
Q

HF diagnosis

A

Framingham criteria

1 major + 2 minor

39
Q

Framingham criteria

A

Major - Acute pulmonary oedema, cardiomegaly, hepatojugular reflux, neck vein distension , orthopnoea, pulmonary rales, S3 gallop

Minor - Ankle oedema, dyspnoea on exertion, hepatomegaly, nocturnal cough, pleural effusion, tachycardia > 120

40
Q

HF investigations

A 
Echo 
CXR 
BNP ^^^ 
FBC 
Serum electrolytes - Sodium LOW 
Creatinine and urea ^ 
BM - Check for DM 
LFTs ^
TFTs 
Lipids ^
Ferritin or transferrin saturation
41
Q

HF management

A 
ACE-I or ARB 
B-blocker 
Loop diuretic or thiazide diuretic 
Digoxin 
Aldosterone antagonist - Spironolactone

3B (23 decks)

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