GP ILAs Flashcards
A patient has a BP of 140/90 in the practice, what do you do?
Commence home/ambulatory monitoring
Home BP monitoring results average over 160/100. What is this? What do you do?
Type 2 hypertension is a clinic BP of >160 or a home/ambulatory average of 150. Treat according to ABCD guidelines
Home BP monitoring results average over 140/90 but less than 160. When would you treat this person’s BP?
Type 1 - HTN. Treat if patient also has one of the target organs damage. CVR disease. Renal disease. Diabetes.
What lifestyle advice would you give to someone with high BP?
control weight, increase exercise, IMPROVE DIET, esp reduce salt, reduce smoking, reduce alcohol & caffience intake, consider relaxation exercises.
What medication would you offer to everyone with high BP?
Statin - atorvastatin 20 mg once daily. SE - headache, muscle pain, diarrhoea. NNT = 50
What’s the first like treatment for someone with a high BP under 55?
ACE-inhibitor or ARB Calcium channel blocker (if Afro-Caribbean)
A patient has an average home blood pressure of 155 and renal disease. They’re 60. What medication do you use to control BP?
Calcium Channel Blocker. amlopdine
What precaution do you need to make when starting someone on an ACE-inhibitor?
requires U+E blood test two weeks after start/adjustment date to monitor renal function
What is the mode of action for statins? and what are common SE?
- reducing LDL levels
- Stabilisation of atherosclerotic plaques
- Muscle pain, increased DM risk, abnormal LFTs.
What is the main principles of treating acute or chronic heart failure?
- Treat the cause (arrhythmias, valve disease)
- Treat exacerabting factors (anaemias, thryoid disease, infection, HTN)
- Avoid other exacerbating factors (NSAIDs, verapamil)
What is the drug management for heart failure?
ACE-i + Beta blocker
What drug would you swap to if a patient presents with a cough after starting an ACE-i?
Angiotensin-II Receptor Blocker (ARB)
What drug would you add on if a patient remained symptomatic of heart failure after having started on ACE-i + BB?
Spironalactone - aldosterone antagonists
requires close creatinie, GFR & potasium monitoring
After treating a heart failure patient with first and second line Tx - what would you prescribe next?
Digoxin - slows heart rate
improves exercise tolerance and reduces hospitalisaiton but doesn’t decrease mortalitiy.
What is the definition of polypharmacy?
Someone taking 5 or more drugs
Descirbe the type of vaginal discharge suspective of Bacterial Vaginosis and other associated symptoms that may be present.
- thin with offensive fishy odour coating the vagina and vestibule
- no itch
- > 4.5 pH
What are issues related to polypharmacy?
Inappropirate polypharmacy
- benefits of extra medication not realised
- medicines used to treat other drug side effects where dose reduction would have been more appropriate
- increasing number of medications increases the likelihood of errors medication administration
Describe the prognosis of HF.
mortality rate highest in the first year: 30-40% mortality rate
if requires admission 5 year mortality rate goes up
Trend of mortality rate has been decreasing over time
What are some primary preventions for heart disease?
NHS health check programme (risk assessment in 40-74 yrs)
education and healthy lifestyle (diet, exercise, smoking and alchol advice/recommendations)
stress management and reduction
What are some secondary preventions for heart disease?
- regular ECHOs and BP checks following first MI/onset of Sx
- daily low-dose aspirin
- Diet and exercise advice following a MI
- BP meds
- Statins
- Diabetes screening and management
- suitably modified work
What are tertiary preventions for heart disease?
- cardiac rehabilitation programmes
- community support groups allowing people to share stratergies for wellbeing
What are the common causes of vaginal discharge?
- Phsyiological
- infection (sexually transmitted or not)
- Vaginal candasis
- Bacertial vaginosis
What is normal physiological vaginal discharge like?
- produce 1-4mls daily
- varying in consistency depending on point in menstrual cycle because of differeing levels of oestrogen
- thick and stick to think, clear and slippery
Describe the type of vaginal discharge suggestive of Candiasis and any associated symptoms.
- thin white, ordorless
- vulva itch
- soreness, dysuria, superficial duspareunia
- may be normal visble findings OR vulva erthema, odema, fissuring or satellite lesions
- pH <= 4.5
What is the sort of vaginal discharge suggestiv of Trichomoniasis?
- varying levels of volume from a little to a lot, frothy yellow
- offensive ordour
- vulva itch
- dysuria. lower abdomen pain
- vulvitis, vaginitis, cervicitis, strawberry cervix.
- pH >4.5
What investigations could you perform in primary care for a patient with suspected dementia?
- 6CIT (cognitive impairment test)
- MMSE
- rule out UTI
- Bloods: TFTs, FBC, glucose
- Hx + collateral Hx
What are the main types of dementia?
- Alzheimer’s disease
- lewy body dementia (Parkinson’s type dementia)
- vascular dementia
- frontotemporal dementia
What is the pathophysiological difference between lewy body dementia and alzhiemer’s?
- LBD characterised by the presence of lewy bodies subcortically
- Alzheimer’s characterised by the presence of tau tangles
What’s the similarities between LBD and alzheimer’s?
- progressive decline in thinking abilities that lead to an impairment of daily functioning
- likely changes in mood
- eventual loss of insight and independence
What clinical characteristics would direct you to think a person had LBD?
- prominent halluciantions - animals and people
- fluctuations in cognitive functioning
- onset of parkinsonian Sx within a year
What clinical characteristics would make you think a patient had Alzhiemer’s rather than any other sort of dementia?
- Amnesic episodic type memory problems - can’t remember lists even with prompting
- head tilt sign - looks to carer for help remembering things
- getting lost - first sign
- continence problems
- APATHY
- behvaioural problems usually sign of later stage disease (think FTD if these present first)
What autosomal dominant genes can cause Alzheimer’s disease?
APOE4
APP
PSEN 1 & 2
What are some risk factors for alzheimer’s diseasE?
- loneliness
- depression/poor mental health
- lack of exercise
- obestiy
- diabetes
- HTN
- FHx + presence of causative genetic mutations
What medical treatments can you offer to someone with alzheimer’s?
- memantine -NMDAr agonist - prevents excess stimulation of the glutamate system
- Rivastigmine - anti-acetylcholinesterase inhibitor - increase ACh in synaptic cleft
What are the main characteristic of vascular dementia?
- stepwise deterioration of mental functioning
- intial presentation more likely to be mental slowing and attentional deficit i.e. inability to follow a recipe
- may have focal neurological signs due to strategic infarcts
What is the pathophysiology of vascular dementia?
- happens post vascular insult
- mutlifocal subcortical infarcts
- can contribute to cases of earlier onset AD
What are some reversible causes of dementia like symptoms?
- folate/B12 deficiencies
- hypothyroidism
- alcohol related dementia
- syphilis
- depressive psuedodementia
- normal pressure hyrocephalus - dementia, gait distrubance + urinary incontinence
