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Phase 3a AW > GP ILAs > Flashcards

GP ILAs Flashcards

1
Q

What are the causes of hypertension?

A 
Essential/primary hypertension
Secondary hypertension-
- Cushings Disease
- Conns Syndrome
-Renal artery stenosis
- Coarctation of the aorta
- Phaeochromatoma- postural HT, headache, palpitations, pallor, sweating
- Renal disease (PKD, glomerulonephritis)
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2
Q

How is hypertension diagnosed?

A

Suspect if clinical BP >140/90

Confirm it with ABPM >135/85

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3
Q

What are the stages in severity of hypertension?

A

Stage 1- Clinic BP >140/90 or ABPM >135/85
Stage 2- Clinic BP >160/100 or ABPM >150/95
Severe- Systolic >180 or >110

(all =< rather than 20% = Stage 2

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4
Q

What is the management of hypertension?

A

Stage 1: Lifestyle modification- weight, salt, exercise, alcohol, stress

Stage 2:
<55 = ACEi or ARB
>55 or Afro-Caribbean = CCB (amlodipine or verapamil)
Then combine
Then add thiazide- like diuretic e.g. indapamide
Then refer for expert advice and add spironolactone if potassium <4.5, or a-blocker or BB if above >4.5

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5
Q

What investigations would you do in hypertension?

A

End organ damage (12 lead ECG, U&Es, eGFR and urine dip, renal USS)
CVD risk- BG, fasting lipids

Secondary causes- dexamethasone suppression, 24 urinary metanephrines

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6
Q

What is target BP in

a) >80 year old
b) under 80
c) diabetes with signs of end-organ damage

A

a) <150/85
b) <140/85
c) <135/85

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7
Q

What are the causes of chronic heart failure?

A

High output and low output

High output means the needs of the body have increased beyond that which the heart can supply e.g. hyperthyroidism, anaemia, Paget’s, AV malformation

Low output means decreased heart function. This can either be:

  • Increased pre-load (mitral regurg, fluid overload such as CKD)
  • Pump failure (cardiac muscle disease, decreased expansion of the heart)
  • Chronic excessive overload or aortic stenosis
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8
Q

What are the symptoms of heart failure?

A

Breathlessness, fluid retention, fatigue, syncope, orthopnoea, PND

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9
Q

What are the signs of heart failure?

A

Tachycardia, hypertension, tachypnoea, basal creps, oedema, displaced apex beat, raised JVP, hepatomegaly, ascites

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10
Q

What is the classification system for HF?

A

NYHA

Talks about limitations to physical activity

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11
Q

What are the investigations for acute HF?

A

ECG, CXR
Bloods- U&Es, eGFR, TFTs, LFTs, fasting glucose, FBC, fasting lipids
Diagnosis by BNP or NT-pro-BNP

> 400pg/ml- urgent TTE (trans-thoracic echo)
100-400- TTE within 2 weeks

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12
Q

What are the investigations for chronic HF?

A

Same as acute

Except refer to cardiology and organise ECHO within 2 weeks if no history of MI

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13
Q

What can reduce BNP?

A 
Obesity
Diuretics
ACEi
BBs/ ARBs
Aldosterone antagonists
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14
Q

What else can raise BNP?

A 
LVH
Ischaemia
Tachycardia
Sepsis
COPD
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15
Q

What does an ECG show for HF?

A

Ischaemia or hypertrophy

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16
Q

What does a CXR show for HF?

A 
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper vessels/ upper lobe diversion
Pleural effusion
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17
Q

When would you refer HF to an MDT?

A

1st diagnosis, severe case, failure to manage in primary care, comorbid vascular disease

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18
Q

Who is involved in the management of HF in primary care?

A

GP, ANPs, district nurses, third sector (BHF), family, counselling services, palliative care, CMHTs

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19
Q

What are non-pharmacological measures of HF?

A

Educate, diet and exercise, stop smoking, reduce alcohol intake, restrict fluid intake, vaccination- annual flu and once-only pneumococcal

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20
Q

What are the pharmacological measures in HF?

A

1st line- ACEi and BB, loop diuretic for symptomatic relief
2nd line- Refer
If NYHA 3/4 or MI in last month, begin spironolactone
Consider hydralazine with nitrate for Afro-Caribbean patients

3rd line-
Digoxin
Ivabradine- decrease HR (AEs= luminous phenomena, visual effects)

Other drugs to consider- anticoagulation (if AF), aspirin (if athersclerotic arterial disease), statins (anti-cholesterol), amlodipine (treatment for angina and hypertension)

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21
Q

What diuretic is used in HF? How do they work?

A

Furosemide 20-40 mg or bumetanide 1-2mg OD
It is loop diuretic, that works by inhibiting the Na/K/Cl co-transporter
AEs- dehydration, hypotension, low electrolyte statue, hearing loss and tinnitus
CIs- Hypovolaemia or dehydration, hepatic encephalopathy, severe hypokalaemia, severe hyponatraemia, worsen gout

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22
Q

What is an example of a thiazide-like diuretic?

A

Bendroflumethazide

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23
Q

Name an example of an ACEi and an ARB?

A

ACEi- Ramipril

ARB- Candersartan

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24
Q

How do ACE inhibitors work?

A

They inhibit ACE in the lungs

  1. Blood pressure is decreased due to reduced blood volume, peripheral resistance and cardiac load
  2. They inhibit vasoconstriction and release of aldosterone which inhibits the retention of sodium and water
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25
Q

What are the side effects of ACE inhibitors?

A

Persistent dry cough (due to increased bradykinin), hypotension, angiooedema, hyperkalaemia, worsen renal failure (esp renal artery stenosis)

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26
Q

What are contraindications of ACE inhibitors?

A

Renal artery stenosis, AKI, pregnant and/or breastfeeding

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27
Q

What needs to be monitored when increasing dose of ACE inhibitors?

A

Serum urea, creatinine, electrolytes and eGFR at initiation and with every increase in dose

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28
Q

How do beta blockers work?

A

Reduce the force of contraction and speed of conduction of the heart. This relieves myocardial ischaemia by reducing cardiac work and O2 demand, and increasing myocardial perfusion

They also lower BP by reducing renin secretion from the kidneys.

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29
Q

What are B1 selective, non-selective and a and B blockers?

A

B1 selective- atenolol, metoprolol, bisoprolol
Non-selective- Proanolol, nadolol, carteolol
a and B- blockers- Labetolol, carvediolol

30
Q

What conditions except HF are beta blockers used in?

A 
Peripheral vascular disease
Erectile dysfunction
Diabetes Mellitus
Interstitial pulmonary disease
COPD
31
Q

What needs to be observed after every titration of beta blockers?

A

HR, BP, clinical status after each titration

32
Q

What are the adverse effects of beta blockers?

A

Fatigue, cold extremities, headaches, GI disturbance e.g. Nausea

33
Q

What are the contraindications for beta blockers?

A

Asthma (bronchospasm), heart block, haemodynamically unstable, significant hepatic failure

34
Q

Which services/ healthcare professionals would be involved in a patient with heart failure?

A 
Named GP
ANP
District nurses
Third sector (BHF)
Family
Counselling
Palliative services
CMHT
35
Q

What is the treatment of HF under a cardiologist?

A

Amiodarone

Medical devices: Implantable cardioverter difibrillator or cardiac resynchronsation therapy

36
Q

What is the prognosis in HF?

A
  • Progressive deterioration to death
  • Approx 50% die suddenly- probably due to arrhythmias
  • Mild/moderate HF- 20-30% 1 year mortality
  • Severe HF- 50% 1 year mortality
37
Q

What is in the 6-in-1 vaccine?

When is it given?

A

Diphtheria, tetanus, pertussis (whooping cough), polio, HiB, hepatitis B

2 months, 3 months, 4 months

38
Q

When is the MMR given?

A

1 year, 3 years 4 months

39
Q

When is pneumococcal vaccine given?

A

2 months, 4 months, 1 year, age 65

40
Q

What are the factors that reduce immunisation uptake?

A 
Other children in household
Single parent
Mother is <20 or >34
Mother is more highly education, not employed or self-employed
Live in a deprived area
41
Q

What is the protocol for non-urgent and urgent notifiable diseases?

A

Notify the ‘proper office’- local council or health protection team

Written notification within 3 days if non-urgent
Verbal notification within 24 hours in urgent

42
Q

When is fever a red flag in an unwell child?

A

temperature >38 degrees in a child 0-3

43
Q

What are the signs of meningococcal disease?

A

Fever and non-blanching rash

44
Q

When should meningitis be suspected in a child?

A

Neck stiffness, bulging fontanelle, LOC, status epilepticus

GP- IM BenPem
Hospital- IV Cefotaxime

45
Q

When should herpes simplex encephalitis be suspected in a child?

A

Fever with neurological signs and seizures, or decreased consciousness

46
Q

When should pneumonia be suspected in a child?

A

Fever, tachypnoea, chest crackles, nasal flaring

47
Q

When should a UTI be suspected?

A

<3 months- fever

>3 months- vomiting, poor feeding, lethargy, irritability, abdo pain, urinary symptoms

48
Q

What are the ‘red’ signs of an unwell child?

A 
Pale skin
No response to social cues
Grunting, tachypnoea >60
Reduced skin turgour
Age <3 months with temp >38
Non- blanching rash
Bulging fontanelle
Status epilepticus
49
Q

What is safety netting?

What safety netting advice would be given to an unwell child’s parents?

A

It allows identification of a deteriorating child and ensures direct access to healthcare if a child needs it.

  • Encourage regular fluid intake
  • Calpol for temperature of 38 degrees
  • Observe for signs of dehydration- sunken fontanelle, dry mucous membranes, no tears, dry nappies etc
  • Monitor for rash
  • Contact medical professional if unsure
50
Q

What advice should you give to parents of a child with febrile seizures?

A

Place child on their side and a soft surface
Ring ambulance if >5 mins
>10 mins= status epilepticus- give rectal diazepam

51
Q

What are the ‘triple swabs’ for STI screen?

A

High vaginal swab- from posterior fornix. For bacterial vaginosis, trichomas vaginalis, candida

Endocervical swab- gonorrhoea
Endocervical swab- chlamydia

52
Q

How can you differentiate between normal and abnormal vaginal discharge?

A

pH <4.5:
White, curdy discharge- candida- emperical therapy
No other symptoms- physiological- reassurance

pH >4.5:
Thin, grey/white homogenous discharge coating the vaginal walls. Fishy odour. Not Sore- Bacterial vaginosis- emperical Rx

Yellow/green frothy fishy discharge- Trichomas vaginalis- Refer to GUM/send HSV

Physiological
Foreign body
STIs
Strep/staph infections

53
Q

What are the risks of the COCP?

CIs?

A

VTE, MI stroke, breast cancer

Migraine with aura, smoking, obesity, hypertension

54
Q

What are the fraser guidelines?

A

A doctor can prescribe contraceptives to a girl under 16 without parents consent if:

1) She understands his advice
2) She cannot be persuaded to tell her parents
3) She is likely to continue having sexual intercourse
4) Her physical or mental health is likely to suffer
5) It is in her best interests to receive contraceptive or treatment

55
Q

What age does a child not have capacity to consent to sex?

A

Under 13

56
Q

How can you investigate dementia in primary care?

A

MMSE, GPCOG, 6CIT

Bloods- FBC, U&E, LFTs, TFTs, glucose, calcium, serum B12 and folate

MSU if delirium is suspected

57
Q

What is dementia?

A

A syndrome caused by a number of brain disorders which causes memory loss, decline in cognition (memory, language, attention, problem-solving) and difficulties with ADLs

58
Q

What are the treatments for Alzheimer’s disease?

A

AChE inhibitors- Donepezil, galantamine, rivastigmine

NMDA antagonist- Memantine

59
Q

What are the 3 core features of depression and some other symptoms?

A

Major symptoms- Low mood, anhedonia, fatigue

  • Change in appetite or weight
  • Insomnia or hypersomnia
  • Poor concentration
  • Psychomotor retardation or retardation
    -Worthlessness
    SAD PERSONS
60
Q

What are the organic differential diagnoses for low mood?

A

MEANI
Malignancy
Endocrine- thyroid, PT disorders, cushings, addisons
Autoimmune- SLE, RA
Neurological- MS, PD, Stroke, Cerebral tumour
Infection- Hepatitis, HSV, syphilis, HIV

61
Q

Name some drugs causing low mood

A 
Antihypertensives- BB, methyldopa
Steroids
OCP
Neuro drugs- L-dopa, carbamazepine
Analgesics- opioids
62
Q

What is the first line treatment for depression?

A

Fluoxetine (SSRIs) or citalopram

63
Q

What are some side effects of SSRIs?

A

Dyspepsia, bleeding, sweating, sexual dysfunction

64
Q

What is an example of a TCA? Side effects?

A

Lofepramine

SEs: Drowsiness, dry mouth, blurred vision, constipation, urinary retention, sweating

65
Q

Name an example of an MAOI?

A

Phenylzine

66
Q

What are some screening questions for depression?

A

1) During the last month, have you been feeling down, depressed or hopeless?
2) During the last month, have you often been bothered by having little interest or pleasure in doing things?

67
Q

What are some tools for depression?

A

PHQ9
HAD
Becks depression inventory

68
Q

What are the acute causes of a cough in an adult (<3 weeks)?

A 
URTI
Croup
Acute bronchitis
Pneumonia
Acute exacerbation of asthma
Inhaled foreign body
69
Q

What are the chronic causes of a cough in an adult (>3 weeks)?

A 
Post-nasal drip
TB
COPD/asthma
Post viral
Lung cancer
Bronchiectasis
GORD
Pulmonary oedema
70
Q

How can TB be prevented?

A

BCG vaccination
All infants where incidence of TB is >40:100,000 or infants whose parents or grandparents were born in a country of >40:100,000
New immigrants
Occupational workers at risk

Phase 3a AW (7 decks)

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