GP ILA's Flashcards
How does NICE define hypertension
-Clinic : >140/90
-Home : >135/85
Give the 3 stages of hypertension
-1 : >140/90
-2 : >160/100
-3 : >180/120
Give 4 causes of secondary hypertension
-ROPE
-R : Renal disease (most common)
-O : Obesity
-P : Pregnancy induced / pre-eclampsia
-E : Endocrine (e.g. hyperaldosteronism-Conns)
Give the medical management for HTN (<55, white)
-Step 1 : ACE
-Step 2 : ACE + CCB
-Step 3 : ACE + CCB + Thiazide-Like diuretic
-Step 4 : ACE + CCB + Diuretic (indapapamide) + Spironolactone (if K+ <4.5mmol) OR alpha or beta blocker (if potassium >4.5mmol)
Give the medical management of HTN (>55, black)
-Step 1 : CCB
-Step 2 : CCB + ARB or thiazide like diuretic
-Step 3 : CCB + ARB + Thiazide like diuretic
What is the first line management of HTN in someone with T2DM despite age or family origin ?
-ACE or ARB
What lifestyle advice can be given to someone with stage 1 HTN before medication is given ?
-Healthy diet
-Stop smoking
-Reduce alcohol, caffeine and salt intake
-Increase exercise
What investigations should all patients with a new diagnosis of HTN receive ?
-Urine albumin : creatine ratio for proteinuria
-Dipstick : for microscopic haematuria to assess kidney damage
-Bloods : HbA1c, renal function and lipids
-Fundus examination : for HTN retinopathy
-ECG : for cardiac abnormalities
Give 5 complications of HTN
-IHD
-Cerebrovascular accident (stroke, haemorrhage)
-Hypertensive retinopathy
-Hypertensive nephropathy
-Heart failure
Give 3 complications of ACEI’s
-Cough
-Angioedema
-Hyperkalaemia
Give 2 examples of an angiotensin II receptor blocker (ARB)
-Candesartan
-Losartan
Give 5 SE of beta blockers
-Erectile dysfunction
-Bronchospasm
-Cold peripheries
-Fatigue
-Sleep disturbance
Give 3 SE of CCB
-Constipation
-Flushing
-Ankle swelling
-Dizziness/Headache
Give a side of an ARB
-Hyperkalaemia
Give 3 SE of thiazide-like diuretics
-Hyponatraemia
-Hypokalaemia
-Dehydration
Give HTN treatment targets
<80yrs : <140/90
>80 years : <150/90
Give 5 key presentations of chronic heart failure
-Orthopnoea
-Paroxysmal Nocturnal Dyspnoea
-Breathlessness worsened by exertion
-Cough : white/pink sputum & worse at night
-Peripheral oedema
What investigations are used to diagnose chronic heart failure ?
-N-terminal-B-type natriuretic peptide (NT-proBNP)
-Echo
-ECG
Give 4 causes of HF
-IHD
-Valvular disease (e.g. aortic stenosis)
-HTN
-Arrhythmias (e.g. AF)
Give 4 medications used in chronic heart failure
-A : ACEI (lisinopril) -> reduce BP -> reduces work for heart and kidneys
-B : BB (bisoprolol) -> reduces HR
-A : Aldosterone antagonist -> spironolactone (used if reduced EF and Sx not controlled by A or B)
-L : Loop diuretics (furosemide) -> controls Sx
-Ensure listing for annual influenza vaccine
What are the signs/symptoms of acute HF
-Sudden onset SOB
-Wheeze
-Bibasal inspiratory crackles
-Third heart sound
How is acute heart failure managed (LVF) ?
POUR SOD
-POUR : away (stop) IV fluids
-S : Sit up
-O : oxygen
-D : diuretics (IV 40mg stat)
Give 3 signs more suggestive of right sided heart failuyre
-Raised JVP
-Ankle oedema
-Hepatomegaly
What investigations would you do in acute heart failure?
-ECG
-ABG
-CXR : cardiomegaly and upper lobe venous diversions
-Bloods : infection, kidney function, BNP, troponin if considering MI)
What would be seen on CXR if heart failure has caused fluid on the lungs ?
-Bilateral pleural effusions
-Fluid in interlobar fissures
-Kerley lines -> fluid in septal lines
What can be used in severe acute pulmonary oedema or cardiogenic shock as a result of HF?
-IV opiates (they act as vasodilators)
-CPAP
-Inotropes (e.g. noradrenalin infusion)
What is the fever pain score used for?
Used to determine in what children with a fever are more likely to have a sore throat caused by stretococcal bacterial = more beneficial with antibiotics
Give the 5 points in the fever pain score
-Fever in last 24 hrs
-Purulence (pus on tongue)
-Attend rapidly (within 3 days of onset)
-Severely inflamed tonsils
-No cough or corzya
-4 or more = antibiotics
> 60
Memory loss
Varying changes in planning, reasoning, speech and orientation
Progressess steadily
Alzheimer’s
What is the most common form of dementia and what is its aetiology
-Alzheimer’s
-Amyloid plaques and neurofibrillary tangles
-Cognitive impairment following cerebrovascular infarct
-Mood disturbance
-Psychosis in later stages
-HTN RF
Vascular dementia
what is the second most common type of dementia and its aetiology
-Vascular dementia
-Multiple cerebrovascular infarcts
> 50
-Rapidly progressing
-Parkinson-like symptoms
-Visual hallucinations
-Cognitive decline : problems multi-tasking / performing complex cognitive actions
Lewy body dementia
<65
-Behavioural : altered personality
-Semantic : decline in understanding of word meaning, difficulty with name retrieval
-Non fluent : breakdown in output of language
Frontotemporal dementia
When can a child not consent to sex
-Adult of 18 or older
-A child 12 and under cannot consent to sex
-A child cannot consent to sex with an adult in a position of authority
What is the Fraser guidance that dictates a doctor can prescribe contraception to someone under 16
-If the girl will understand their advice
-They cannot persuade her to inform her parents or allow him to inform the parents
-She is likely to continue having sex with or without contraception
-She receives the contraception advice/treatment or her physical or mental health or both are likely to suffer
-Her best interests require him to give it
Define a refugee
-Someone forced to flee their home due to war, violence, or persecution and cross borders to seek safety in another country
-They have been granted asylum and refugee status and has leave to remian for 5 years
Define a displaced person
-Same as a refugee but they remain within the borders of their native country
Define an asylum seeker
-Someone seeking international protection from dangers in his or her home country but whose claim for refugee status hasn’t been determined legally
Define a migrant
Someone moving from place to place usually for economic reasons such as seasonal work
What is an unaccompanied asylum seeking child
-Crossed international border in search of safety and refugee status
-Applying for asylum in his/her own right
-Under 18
-Without adult family members or guardians in this country
