GP/ILA Flashcards

Question

What are the causes of HF with reduced ejection fraction?

Answer 1

1. Reduced contractility due to MI or myocarditis 2. Reduced blood supply to the heart due to CAD 3.Increased afterload due to hypertension 4.Impaired mechanical function due to valve disease

Answer 2

Diastolic HF - filling dysfunction

Answer 3

1. Restrictive cardiomyopathy due to sarcoidosis 2. Valve disease 3. Hypertension 4. Ventricles noncompliant and unable to fill during diastole

Answer 4

1. Biventricular heart failure 2. Cor pulmonale- HF secondary to any cause of pulmonary arterial hypertension 3.Left-sided HF = impaired ability of left ventricle to maintain adequate cardiac output without an increase in left sided filling pressures 4. Right sided HF= Impaired ability of the right ventricle to deliver of blood flow to the pulmonary circulation and increased right atrial pressure

Answer 5

- cardiac disorders- IHD, valvular heart disease, HTN, LV hypertrophy - Other chronic disease = diabetes, obesity, chronic lung disease -Toxins- smoking, illicit drugs

Answer 6

- Cardiogenic shock -Arrhythmias -AF - Biventricular failure -End of organ damage -CKD

Answer 7

- orthopnoea -Paroxysmal nocturnal dyspnoea -Breathless -Ankle swelling -Fatigue -Tachycardic -Raised JVP -Ascites

Answer 8

Has the patient had a previous MI? Yes -> Urgent Transthoracic Echo (TTE) No -> measure serum BNP > Above 4000pg/ml -> urgent TTE > 100 - 4000pg/ml -> TTE within 6 weeks

Answer 9

12 lead ECG CXR Bloods Urinalysis Peak flow / spirometry

Answer 10

Alveolar oedema (Bat’s wings) Kerley B lines Cardiomegaly Pleural effusion

Answer 11

FBC U+Es LFTs TFTs eGFR Lipid profile Glucose

Answer 12

No symptoms or limitation to daily activities

Answer 13

Mild symptoms and slight limitation of daily activities

Answer 14

Marked symptoms, limitation on daily activities, only comfortable at rest

Answer 15

Severe symptoms, uncomfortable at rest

Answer 16

ACEi + Beta blocker > When starting ACEi, measure U+Es, eGFR

Answer 17

Loop diuretic- furosemide = for breathgless/oedema

Answer 18

- spironolactone - if symptoms persist -Digoxin -Hydralazine with Nitrate may be of particular use in Afro-Caribbean patients

Answer 19

GP ANPs District Nurses Third sector (BHF) Family Counselling Palliative services Community Mental Health Teams

Answer 20

50% die within 5 years of diagnosis 40% die or are re-admitted in 1 year

Answer 21

- Reduced EF -Comorbidities -Smoker - Previous MI - Obesity

Answer 22

Palliative = can be provided at any stage of serious illness that is impacting their daily life- focuses on improving their quality of life. Relieving pain for the patient. Terminal care = Care us more about giving support to those who have 6 months or less to live due to a terminal illness

Answer 23

- Family of joint disorders that classically include Ankylosing spondylitis, psoriatic arthritis, IBD and reactive arthritis. - They typically include: - axial skeleton, peripheral asymmetric joint involvement, enthesitis, extra articular features and HLA B27 antigen

Answer 24

- An inflammatory arthropathy affecting both large and small joints. - Belongs to a group of seronegative inflammatory spondyloarthropathies - HLA- B27 - Immune mediated inflammatory response that affects the skin, joints and periarticular structures

Answer 25

- Personal history of psoriasis - First degree relative with psoriasis or PsA - History of joint trauma

Answer 26

- Joint pain - Morning stiffness and improves through the day. - Fatigue, malaise, low grade fevers

Answer 27

- Swelling and tenderness of affected joints - Reduced range of motion - Dactylitis - Skin psoriasis - Nail changing

Answer 28

- Uveitis - Urethritis - Aortic regurgitation - Mitral valve prolapse - IBD - Achilles tendonitis

Answer 29

- Absence of Rheumatoid factor and anti-ccp - ESR and CRP normal or elevated - X-ray of affected joints – may show erosion of the small joints (erosion in DIP) or soft tissue swelling - MRI of sacroiliac joints

Answer 30

- Mainly clinical based of history and clinical examination – aided by CASPAR criteria

Answer 31

The aim is to control the symptoms and prevent damage and complications. - NSAIDS - DMARDs - Intraarticular glucocorticoid injection - Biologics – TNF alpha inhibitors, interleukin inhibitors - Physiotherapy

Answer 32

- CVD - Joint erosion

Answer 33

- Chronic inflammatory skin condition - Demarcated red, scaly plaques - Can be precipitated by infections or hormonal changes - Smoking and alcohol worsen symptoms - Sun light is a relieveing factor

Answer 34

- Pruritic lesions - Pain or burning sensation around lesions - Joint pain and stiffness - Family history of psoriasis

Answer 35

Psoriatic lesions are: - Well demarcated, erythematous plaques - Generally, symmetrically distributed – scalp/ elbows/ knees Nail changes: - Pitting - Onycholysis - Yellowing and ridging

Answer 36

- Chronic plaque psoriasis – most common - Guttate psoriasis- multiple, small scaly plaques across trunk. Onset often acute following an infection. - Erythrodermic psoriasis – rare but severe- hospital admission

Answer 37

- Diagnosed clinically – clinical test: gentle scraping and removal of scale causes pinpoint capillary bleeding.

Answer 38

- Topical corticosteroids - hydrocortisone, eumovate - Tar preparations. - Calcipotriol - Methotrexate - Acitretin - Cyclosporin

Answer 39

a person who has been forced to leave their country in order to escape war, persecution, or natural disaster.

Answer 40

Someone who has submitted an application to be recognised as a refugee + is waiting for their claim to be decided by the Home Office.

Answer 41

Anyone has the right to apply for asylum in the UK + remain until a final decision on their application has been made.

Answer 42

When a person is granted full refugee status + given permanent residence in the UK. they have all the rights of a UK citizen. they are eligible for family reunion (one spouse, and any child of that marriage under the age of 18) .

Answer 43

Entitled to Money: £35 / week Entitled to housing: no choice dispersal Entitled to NHS care > if under 18, are allocated a social services key worker + can go to school Asylum seekers are not allowed to work; are not entitled to any other form of benefit. failed asylum seekers are not entitled to any of the above.

Answer 44

Language / culture / communication barriers Lack of knowledge re: where to get help Health is not a priority.

Answer 45

A person who has made an application for refugee status ii) A person granted asylum + refugee status. Usually means leave to remain for 5 years, then reapply. iii) Failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3 years, then reapply.

Answer 46

To give permission or an agreement

Answer 47

16- This is the age when young people of any sex, gender or sexual orientation can legally consent to taking part in sexual activity.

Answer 48

oHow close in age and maturity levels those involved are. oThe relationship of those involved. oWhether the person under 16 consented oWhether the person under 16 was aged 12 or under (under the age of 13 children are seen as being less capable of consenting than those aged 13 or over)

Answer 49

1.Establish whether the child is already sexually active, in what circumstance is the sexual activity occurring and with who. 2. Exclude rape 3.If there is a potential sexual crime = referral to police is obligated 4.Fraser guidance if contraception is needed

Answer 50

oHave you ever stayed out overnight or longer without permission from your parent or guardian? oHow old is your partner or the person you have sex with? (is the age gap 4 or more years?) oDoes your partner stop you from doing things you want to do? oThinking about where you go to hang out, or to have sex. Do you feel unsafe there or are your parents or guardian worried about your safety?

Answer 51

oApplies specifically to advice and treatment about contraception and sexual health. You can prescribe contraception if: oThe girls will understand the advice. oThey cannot persuade her to inform her parents or to allow the Dr to inform the parents that she is seeking contraceptive advice. oShe is very likely to continue having sexual intercourse with or without contraception. oHer best interest requires the Dr to give her contraceptive advice, treatment or both without parental consent.

Answer 52

- Assesses whether the child has the maturity to make their own decisions -Factors that need to be considered:o The child’s age, maturity, and mental capacity oTheir understanding of the issue and what it involves. oTheir understanding of the risks oHow well they understand the advice been given. oTheir understanding of alternative options oTheir ability to explain a rationale around their reasoning

Answer 53

- Understand information given to them - Retain that information long enough to be able to make the decision - Weigh up the information available to make the decision Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

Answer 54

- seek consent from their parents or carers -Can seek opinion from a colleague -child protection concerns can be shared to CPS or police or safeguarding

Answer 55

* copper-bearing intrauterine device (Cu-IUD) * levonorgestrel-releasing intrauterine system (LNG-IUS) * progestogen-only: o implant (IMP) o injectable (DMPA) o pill (POP) * combined hormonal contraception (CHC) * Vaginal ring * Patch * Pill * Barrier methods (external/internal condoms)

Answer 56

oAny new medications or health supplements? oDiagnosed with new health conditions? oAny headaches or migraines? oEver had a blood clot – DVT/PE? oImmediate family ever had a blood clot? oHas any immediate family ever had breast cancer? oSmoking status? oBMI?

Answer 57

- All women under the age of 16 are encouraged to involve their parents -Doctors can offer an abortion if they are confident that you can give valid consent and that it is in their best interest -If staff suspect risk of sexual abuse they are obliged to involve social services

Answer 58

oChange of colour oConsistency oVolume oOdour oAssociated Sx like itch, sores

Answer 59

BV and vaginal candidiasis. Other causes can be STD, contraceptive use, age, polyps etc.

Answer 60

- HIV -Chlamydia -Gonorrhoea -Trichomonas -Syphilis

Answer 61

- 2 weeks for chlamydia and Gonorrhoea -4 weeks for HIV and syphilis - 3-7 days for trichomoniasis

Answer 62

An infectious disease caused by streptococcus progenies also known as group A streptococcus.

Answer 63

- Highly contagious - Transmitted when a person's mouth, throat or nose comes into contact with infected saliva or mucus by aerosol transmission or by direct contact

Answer 64

- very young or very old - immuni compromised - IVDU

Answer 65

- initial sore throat - Fever - Headache - Fatigue - Nausea -Vomiting -Sandpaper like blanching rash that develops on the trunk 12-48 hours after initial symptoms -strawberry tongue

Answer 66

Throat swabs and blood tests are not routinely indicated for the diagnosis

Answer 67

- If severe hospital admission - 10 day course of phenoxymethylpenicillin - If allergic to penicillin - azithromycin for 5 days for children aged 6months to 17 - or birth to 6 months is clarithromycin

Answer 68

- Exclusion from nursery, school for 24 hours after treatment - Frequent handwashing, don't share utensils

Answer 69

- 6in1 - Rotavirus - MenB

Answer 70

- 6in1 second dose - Pneumococcal vaccine - Rotavirus second dose

Answer 71

- 6in1 vaccine 3rd dose - MenB vaccine 2nd dose

Answer 72

- Hib/MenC 1st dose - MMR vaccine 1st dose - Pneumococcal 2nd dose - MenB 3rd dose

Answer 73

children's flu vaccine

Answer 74

- MMR 2nd dose - 4in1 pre school booster

Answer 75

HPV vaccine

Answer 76

- 3in1 teenage booster - MEnACWY

Answer 77

- roseola infantum, - parvovirus B19 - Kawasaki disease - measles - rubella - viral urticaria - septicaemia and meningitis

Answer 78

- Generalised anxiety disorder is characterised by excessive worry about everyday issues that is disproportionate to any inherent risk. - It is a chronic condition that may fluctuate in severity.

Answer 79

- Female sex - Comorbid anxiety disorders - Family history of anxiety - Childhood adversity - History of sexual or emotional trauma - Sociodemographic factors

Answer 80

- Restlessness/ nervousness - Easily fatigues. - Poor concentration - Irritability - Muscle tension - Sleep disturbance

Answer 81

The criteria for GAD is: - Excessive anxiety and worry occurring more days that not for 6months< - Individual finds it difficult to control the worry - Have 3 or more of the symptoms - Causing impairment in social, occupational or other areas

Answer 82

- The nature, severity and duration of symptoms - Current physical or emotional stress - History of trauma - History of mental health disorders including FH - Comorbid conditions - History of alcohol and substance abuse - Use of OTC remedies - Availability of social and emotional support

Answer 83

Tools such as GAD-2 or GAD-7 questionnaires should be considered to determine the severity

Answer 84

- Treat the comorbidities if present. - If the anxiety symptoms are mild – A periods of active monitoring. - Therapy/ CBT - Drug therapy – SSRI or SNRI

Answer 85

- this means having regular or frequent panic attacks without a clear cause or trigger. Experiencing panic disorder can mean that you feel constantly afraid of having another panic attack, to the point that this fear itself can trigger your panic attacks.

Answer 86

this diagnosis means you experience extreme fear or anxiety triggered by social situations (such as parties, workplaces, or everyday situations where you have to talk to another person).

Answer 87

- you may be given this diagnosis if your anxiety problems involve having repetitive thoughts, behaviours or urges.

Answer 88

this is a diagnosis you may be given if you develop anxiety problems after going through something you found traumatic. PTSD can involve experiencing flashbacks or nightmares which can feel like you're re-living all the fear and anxiety you experienced at the time of the traumatic events.

Answer 89

- Alcohol is a depressant. It slows down processes in your brain and CNS and can initially make you feel less inhibited. In the short term it may make you feel more relaxed but these effects wear off quickly.

Answer 90

- Depression is characterised by the absence of a positive affect, low mood and a range of associated emotional cognitive, physical and behaviour symptoms. - There is less severe depression and more severe depression

Answer 91

- Discuss the onset, duration, pattern and severity of symptoms, including impact on daily functioning at work, and on relationships. - Current lifestyle including diet, exercise, sleep , alcohol, substances - Any current or past mental health conditions - Any risk factors: Family history, suicide, self-harm, Physical health conditions - Any supportive relationships - Any current or previous trauma - Ask bout thoughts of self harm and suicide

Answer 92

- Assess the person’s level of social support and awareness of sources of help - Arrange help appropriate to their level of need - Advise the person to seek further help if their situation deteriorates

Answer 93

- Use a depression questionnaire - PHQ-9 - HADS – hospital anxiety and depression scale - BDI-II – Beck depression Inventor-II

Answer 94

- Provide advice on the nature and course of depression - Provide advice on how to improve sense of wellbeing - Offer social support - If significant risk of suicide, or to harm others – refer to specialist mental health services - Offer a SRRI or SNRI – Amitriptyline/ fluoxetine or duloxetine - CBT - Arrange a review 2-4 weeks after stating treatment

Answer 95

Refer to GMC and senior colleagues

Answer 96

Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop

Answer 97

can follow up rare exposure allows identification of risk factors - can sow causation Less chance of bias

Answer 98

Large sample size required Impractical for rare diseases Expensive People drop out

Answer 99

Snapshot data of those with and without disease to find associations at a single point in time

Answer 100

- Quick and cheap - Few ethical issues

Answer 101

- prone to bias -No time reference

Answer 102

Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease

Answer 103

- good for rare diseases -Inexpensive

Answer 104

- Can only show association not causation - Unreliable due to recall bias

Answer 105

Similar participants randomly controlled to intervention or control groups to study the effect of the intervention Gold standard

Answer 106

- can infer causality -Less risk of bias/ confounders

Answer 107

- time consuming and expensive - Ethical issues can interfere

Answer 108

A systematic error that results in a deviation from the true effect of an exposure on an outcome

Answer 109

The possibility there is a random error

Answer 110

Selection bias Information bias Publication bias

Answer 111

Discrepancy of who is involved

Answer 112

- Measurement bias - Observation bias - Recall bias (doesn’t remember or recall correctly) - Reporting bias (don’t report truth because they feel judged)

Answer 113

Some trials are more likely to be published than others

Answer 114

When an apparent association between an exposure and an outcome is actually the result of another factor.

Answer 115

Number of new cases in a population during a specific time period.

Answer 116

Number of existing cases at a specific point in time.

Answer 117

The percentage of people correctly identified with the disease

Answer 118

The percentage of people correctly excluded as ‘disease free’

Answer 119

Correctly identifies everyone with the disease as having the disease, but may cause false positives.

Answer 120

Correctly excludes everyone without the disease, but may miss people who do have the disease

Answer 121

%age of those with a positive test who actually have the disease

Answer 122

%age of those with a negative test who are actually disease free

Answer 123

Important disease Natural history of the disease must be understood (detectable risk factors, disease markers) Simple, safe, precise and validated test Acceptable to the population Effective treatment from early detection with better outcomes than late detection Policy of who should receive treatment.

Answer 124

a serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented

Answer 125

Medical: wrong route chemo Surgical: wrong site or retained object Mental health: escape of transfer patient

Answer 126

The Swiss Cheese Model demonstrates how, generally, a failure cannot be traced back to a single root cause; accidents are often the result of a combination of factors

Answer 127

1. organisational influences 2. unsafe supervision 3. preconditions for unsafe acts 4. Unsafe acts

Answer 128

- self -context -task

Answer 129

medical error is a “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.

Answer 130

An adverse event is a type of injury that most frequently is due to an error in medical or surgical treatment rather than the underlying medical condition of the patient.