GP ILA Flashcards
What are some complications of HTN?
- ischeamic heart disease.
- strokes.
- heart failure.
- peripheral arterial disease.
- aortic aneurysms.
- kidney disease.
- vascular dementia.
What further investigations should you do after diagnosing HTN
- Urine - haematuria, albumin:creatinine ratio
- HbA1c
- CKD - electrolytes, creatinine, eGFR
- Examine fundi - hypertensive retinopathy
- 12 lead ECG - LV hypertrophy
- Lipids
- Thyroid function tests - hyperthyroidism
- Auscultation - renal and carotid bruri
What are some lifestyle changes to help manage HTN
- Smoking cessation
- Weight loss
- Regular exercise
- Healthy diet
- Low dietary sodium
- Reduce alcohol consumption
- Decrease stress
What are some ACE inhibitor side effects
- Persistent dry cough
- Dizziness
- Renal - check U&Es within 2 weeks
- Angioedema (swollen face)
- Hyperkalaemia
What are some calcium channel blocker side effects
- Facial flushing
- Headache
- Swollen ankles
- Constipation
- Increased by grapefruit
What are some thiazide like diuretics side effects
- Postural hypotension
- Polydipsia
- Polyuria
- Low sodium and potassium with long term use
What is malignant hypertension?
Very high blood pressure, acute onset, signs of early organ damage, medical emergency
What drugs can cause drug induced impotence
Caused by central acting, beta blockers and diuretics whilst calcium antagonists, ACEi and ARBs have neutral or beneficial effects on sexual function.
How would you measure decline in HF?
- Frailty score
- Exercise tolerance
- MRC SOB scale
- New York Heart Association SOB scale
- Weight loss
- Hospital admissions
What does ABCDE stand for in HF CXR
A - Alveolar oedema
B - Kerley B lines
C - Cardiomyopathy
D - Dilated upper lobe vessels
E - Effusion
How would you diagnose HF?
- History
- CXR ABCDE
- BNP
- ECG
- Bloods - FBC, TFT, LFT, HbA1c
What are the symptoms of end stage HF?
- SOB
- Chest pain
- Oedema
- Fatigue
- Constipation
- Depression + anxiety
- Cognitive impairment
What is the difference between palliative and terminal care
Paliative:
- Can have with curative treatment
- Incorporates family help
- Can be 6-12 months
Terminal:
- Final weeks/days of life
- Purely focussed on making patient comfortable
- Not with curative treatment
What are some differential diagnoses for anxiety
- Situational anxiety - relating to life events
- Adjustment disorder - temporary anxiety in response to life stressor for no more than 6 months
- Panic disorder - sudden onset anxiety in absence of multi-themed worry
- Social phobia - anxiety in social situations
- OCD
- PTSD
- Substance or drug induced anxiety disorder
- Withdrawal - alcohol, opioids, sedatives
- Cardiac disease - palpitations
What is the DSM 5 criteria for anxiety?
- Excessive anxiety and worry more days than not over 6 months about a number of events and activities
- The individual finds it difficult to control the worry
- Associated with three (or more) of the following six symptoms: restlessness or feeling ‘keyed up’ or on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the psychological effects of a substance, and cannot be explained by another mental disorder.
