GP

Question 1

asthma bronchodialator improvement diagnosis

Answer 1

imrpovement in FEV1 of 12% or more

Question 2

asthma FEV1

Answer 2

<80%

Question 3

asthma FEV1:FVC

Answer 3

<0.7

Question 4

what age can you use peak flow and diagnose asthma

Answer 4

> 5

Question 5

PERF diary over 4 week improvement diagnosis

Answer 5

> 20% variability is positive

Question 6

who cant you use HBA1C with?

Answer 6

T1DM
chidden
pregnancy

Question 7

Metformin

Answer 7

Incr sensitivity to glucose

GI: N&V, lactic acidosis

Question 8

Sulphonylurea

Answer 8

e.g. gliclazide – incr production of insulin - SE: hypo’s – DVLA

Question 9

DPP-IV inhibibitor = gliptins

Answer 9

e.g. sitagliptin – incr incretin which stimates insulin – SE: pancreatitis

Question 10

SGLT-2 inhibitor EG Gliflozin

Answer 10

E.g. gliflozin – Na/glucose transporter stop absorbing glucose so wee it out

SE: UTI, Thrush, diabetic symptoms, hypoglycaemic/dka risk

Question 11

Thiazolidenedione = Glitazone

Answer 11

e.g. Pioglitazone – prevserves B cell function – can’t use if PMHx, SE: weight gain
Triple therapy/ insulin

Question 12

DKA presentation

Answer 12

Nausea, Vomiting, Abdominal pain, Decreased conscious level, ‘Pear drop’ smell,

Question 13

DKA diagnosis

Answer 13

Blood glucose >11mmol/L (or known diabetes)
Blood Ketones >3mmol/L or urinary >2+
Venous pH <7.3 or venous bicarb <15

Question 14

HHS syx

Answer 14

Thirst, polyuria, freq, tired, vomiting, SOB

Question 15

HHS diagnosis

Answer 15

BM > 30 mmol, Plasma osmolarity >340

Question 16

HHS treatment

Answer 16

ABCDE –> 1L 0.9% saline over 30 mins, sliding scale of insulin

Question 17

Qrisk

Answer 17

Percentage risk of CVD event over the next 10 years
Use in people aged 40-85 every 5 years (prevention)
>10% risk = atorvastatin 20mg (80mg if previous CHD/DM/ACS symptoms)

Question 18

Statin tests, SE and CI

Answer 18

LFTs before starting stains (& @ 3m + 12m) + cholesterol levels (aim <5mmol)

SEs: Headache, GI disturbance, muscle aches, myopathy, rhabdomyolysis

CI: pregnancy, erythromycin/other Cyt p450 inhibitors (AO DEVICES)

Question 19

Stable angina diagnosis

Answer 19

clinical, exercise ECG (ST depression, T wave inversion)

Question 20

stable angina treatment

Answer 20

B blocker/CCB + GTN for symptom relief
Long acting nitrate e.g. ivabradine

Secondary prevention:
Antiplatelet (aspirin 75mg), statin, ACEi + lifestyle advice
Surgery: revascularisation stents (PTCA)/CABG – coronary artery bypass graft

Question 21

NSTEMI treatment

BATMAN

Answer 21

B – Beta blockers unless contraindicated
• A – Aspirin 300mg stat dos
• T – Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative)
• M – Morphine titrated to control pain
• A – Anticoagulant: Low Molecular Weight Heparin (LMWH) at treatment dose (e.g. enoxaparin 1mg/kg twice daily for 2-8 days) or fondaparinux 2.5mg SC
• N – Nitrates (e.g. GTN) to relieve coronary artery spasm

Question 22

MI complications - DREAD

Answer 22

D – Death

R – Rupture of the heart septum or papillary muscles

E – “Edema” (Heart Failure)

A – Arrhythmia and Aneurysm

D – Dressler’s Syndrome
It usually occurs around 2-3 weeks after an MI. It is caused by a localised immune response and causes pericarditis

Question 23

secondary prevention MI

6 As

+ lifestyle too

Answer 23

Aspirin 75mg once daily
Another antiplatelet: e.g. clopidogrel or ticagrelor for up to 12 months
Atorvastatin 80mg once daily
ACE inhibitors (e.g. ramipril titrated as tolerated to 10mg once daily)
Atenolol (or other beta blocker titrated as high as tolerated)
Aldosterone antagonist for those with clinical heart failure (i.e. eplerenone titrated to 50mg once daily

Question 24

HF treatment

ABAL

Answer 24

ACE inhibitor (e.g. ramipril titrated as tolerated up to 10mg once daily)
Beta Blocker (e.g. bisoprolol titrated as tolerated up to 10mg once daily)
Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone) (2nd line add on)
Loop diuretics improves symptoms (e.g. furosemide 40mg once daily)
Measure U&Es

Question 25

CKD Definition

Answer 25

eGFR <60 on 2 occasions 90 days apart

eg over 3 months

Question 26

CKD management

Answer 26

1. ACE INHIBITOR <140 OR <130 Systolic f DM
2. Atorvastatin 20mg (Primary prevention of CVD)
3. Lifestyle changes: Exercise, maintain a healthy weight and stop smoking. Special dietary advice about phosphate, sodium, potassium and water intake
   Optimise Diabetic control
4. Oral sodium bicarbonate to treat metabolic acidosis
5. Iron supplementation and erythropoietin to treat anaemia
6. Vitamin D to treat renal bone disease
7. Dialysis in end stage renal failure
8. Renal transplant in end stage renal failure

Question 27

CKD complications and management

Answer 27

Hypertension –> ACEi (monitor K+)
Anaemia -> Iron supplementation and erythropoietin
Renal Bone Disease –> Vitamin D
Dialysis in end stage renal failure
Renal transplant in end stage renal failure