GP topics Flashcards
STEMI S+S
- Crushing chest pain
- Pallor
- Syncope
- Thready pulse
- Clammy
- Pain to left arm, neck, jaw
STEMI S+S
- Crushing chest pain
- Pallor
- Syncope
- Thready pulse
- Clammy
- Pain to left arm, neck, jaw
STEMI immediate Mx
- Morphine
- Oxygen
- Nitroglycerin (GTN)
- 300mg aspirin
- PCI within 120 minutes
- Prasugrel and aspirin if not already on anticoagulant
- Clopidogrel and aspirin if already on anticoagulant
- Fibrinolysis if PCI not in <120m
Secondary prevention MI
- ACEi
- Clopidogrel
- Aspirin and atorvastatin
- BB
ACAB
NSTEMI S+S
- male = chest pressure for several minutes with sweating
- Women = upper back pain and SOB
- ECG = ST depression, T wave inversion, transient ST elevation
NSTEMI Ix
- ECG
- Troponins = within 60 minutes, NSTEMI if above 99th percentile
NSTEMI Mx
- Initial same as STEMI
- GRACE score
- Low risk = ticagrelor and aspirin, PCI if indicated
- Med/high risk = angiography in 72hrs and PCI, prasugrel and aspirin
Stable angina
- Occurs with physical exertion or emotional stress
- Relieved by GTN spray or rest
Angina Ix
- Gold = CT coronary angiography
- ECG
Angina Mx
- Lifestyle advice
- GTN for symptomatic relief
- BB or CCB for longterm symptomatic relief
- 2nd line = long acting nitrate
- Aspirin or clopidogrel for secondary
- CABG or PCI if continued and on max therapy
Unstable angina
- New onset or abrupt deterioration in previously stable angina at rest
- Hospital = MONA and BB
HF
Inability of heart to deliver blood and oxygen to the bosy at the rate needed for metabolising tissues
HF
Inability of heart to deliver blood and oxygen to the bosy at the rate needed for metabolising tissues
S+S HF
- SOB
- Ankle swelling
- Fatigue
- Elevated JVP
- Creps
- Oedema
- Exertional dyspnoea
- PND
HF Ix
- BNP >100 = HF. >2000 = urgent referral, 400-2000 6 week referral
-Echocardiogtam - ECG
- CXR = Alveolar oedema, Kerley B lines, Cardiomegaly, dilated upper lobe, effusions
Mx HF
- ACEi
- BB
- Aldosterone antagonist (spironalactone)
- Loop diuretics
NYHA classification
1 = no limitation
2 = mild limitation = comfy at rest
3 = marked limitation = gentle activity triggers
4 = occur at rest
Atrial fibrillation
- Irregular disorganised electrical activity int he atria = irregular ventricular rhythm
- palpitations, chst pain, sob, dizzy
Causes AF
- Stroke or thromboembolism
- HF
- Tachy induced cardiomyopathy
- Reduced QOL
ECG AF
- No p waves
- chaotic baseline
- irregular ventricular rate
- qrs narrow
Mx AF
- CHADVASC to assess stroke
- Unstable = heparinisation and cardioversion
- Stable = BB, CCB or digoxin
Asthma Mx adults
- SABA
- ICS
- LTRA
- LABA
- MART
- Increase ICS
Ix asthma
- PEF
- FENO
- Spirometry with reversibility = FEV <80% or ration 0.7
acute asthma
- Moderate = PEF 50-75%
- Severe = PEF 33-50%, RR >25, HR >110. cant complete sentences
- Life threatening = PEF <33%, sate <92, tired, silent chest, shock
Mx acute asthma
OSHITME
- Oxygen
- Salbutamol
- Hydrocortisone
- Ipratropium
- Magnesium
-
COPD
- Chronic bronchitis = blue bloaters = cyanosed and fluid retention
- Emphysema = pink puffers = airway collapse on exhale = well perfused but hard to breathe
Ix COPD
- Spirometry = FEV1 <0.8, ratio 0.7
Mx COPD
- SABA or SAMA
- If no steroid response = LABA, LAMA
- If steroid response = LABA, ICS
- LTOT
CURB65
- Confusion
- Urea >7
- RR >30
- BP <90 systolic <60 diastolic
- > 65
0-1 = home
2 = hospital
3 = ICU
S+S pneumonia
- Bronchial breath sounds
- Coarse crackles
- Dull percussion
- Tachy
- Fever
- Hypoxia
Mx pneumonia
- Mild CAP = 5 days amox or macrolide
- Mod-severe = 7-10 dual
Paraneoplastic changes in lung cancer
- Increased PTH = hyperparathyroid
- Increased ADH = SIADH
- Increased ACTH = cushing
SCLC = SIADH, Cushings, LEMS, Cerebellar
Small cell lung cancer
- Can manifest as weakness thruogh lambert eaton myasthenic syndrome
Bronchiectasis
- Abnormal and permanently inflated airways
- Cough, sputum, haemoptysis, clubbing, creps, wheeze
- CXR = thickened bronchial walls
- Mx = postural drainage, ABx, corticosteroids
Causes PHT
- Primary or SLE
- 2 = LHF
- 3 = COPD
- 4 = pulmonary vascular disease
- 5 = misc
S+S Pulmonary HT
- syncope
- tachy
- raised jvp
- hepatomegaly
- peripheral oedema
Pulmonary
hypertension Ix
- RV hypertrophy
- right axis deviation
- RBBB
Mx Pulmonary hypertension
- IV prostanoids
- Endothelin receptor antagonists
- Phosphodiesterase
AKI criteria
- Rise in creatinine >25mm in 48hrs
- Rise in creatinine >50%/1.5X baseline 7days
- UO <0.5 for >6hrs
Ix AKI
- Leucocytes and nitrites = infection
- Protein and blood = acute nephritis
- Glucose = DM
G stages CKD
G1 = >90
G2 = 60-89
G3a = 45-59
G3b = 30-44
G4 = 15-29
G5 = <15
A score CKD
A1 = <3mg/mmol albumin
A2 = 3 - 30
A3 = >30
S+S CKD
- Pruritus
- Nausea
- Oedema
- Cramps
- PN
- HTN
Ix CKD
- EGFR
- urine albumin creatinine ratio
- Dipstick
- USS
Osteoarthritis XR
LOSS
- Loss joint space
- Osteophyte formation
- Subchondral sclerosis
- Subchondral cysts
Osteoarthritis S+S
- POM and crepitus
- Worse at end of day
- Stiff after resting
- Heberden’s and Bouchard’s
- Synovitis and limited movement
Mx osteoarthritis
- NSAIDs and paracetamol
- Steroid injections
- Joint replacement
Rheumatoid arthritis S+S
- Ulnar deviation
- Swan neck and boutonniere
- Worse in morning
- Improves with activity
- Nodules
- Symmetrical swollen painful small joints
RA XR
LESS
- Loss joint space
- Erosion
- Soft tissue swelling
- Soft bones
RA Mx
- XR = LESS = loss space, erosion, swelling, soft bone
- DMARDs (sulf, metho)
- Steroids
- NSAIDs
Gout S+S
- Rapid onset
- Stiff
- Pain, erithema, tender, warm
- Tophi
gout ix
- CRP and ESR
- Aspiration
- Negatively bifringent urate crystals, needle shaped
gout mx
- NSAID or colchicine
- Prednisolone
- Allopurinol if chronic
osteoporosis S+S
- Fractures = vertebral crush, colle’s
Ix OP
- DXA
- T score >-1 = normla
-1 to -2.5 = openia
<-2.5 = porosis
<-2.5 and fracture = severe porosis
Mx OP
- stop smoking
- AdCAL
- exercise
- Anabolic
- BPs if -2.5
- Denusomab
mx op
- stop smoking
- exercise
- adcal
- BPs = alendondronate (empty stomach 30mins pre eating)
- denusomab
polymyalgia rheumatica
Inflammatory condition causes pain and stiffness in shoulder, pelvic girdle and neck
- Related to GCA
- diagnosis by response to steroids
S+S PMR
- Bilateral shoulder pain may radiate to elbow
- Bialteral pelvic girdle pain
- Worse with movement
- Interferes with sleep
- Stiff for 45m in morning
- WL, fatigue, fever
- Upper arm tender
- oedema
Mx PR
- 15mg pred per day
- 1w = stop if no response
- 3-4w = start a reducing regime
GORD S+S
- heartburn
- belching
- nocturnal asthma
- chronic cough
- brash
GORD Mx
- lifestyle changes
- antacids
- PPIs
- H2 receptor antagonist e.g. cimetidine
- Nissen’s fundoplication
Diverticulitis vs diverticulosis
- Diverticulitis = inflammation of a divertuculum = outpouching git wall
- Diverticulosis = presence of diverticula
S+S diverticuitis
- LIF pain
- LIF mass
- Constipation
- Fever
- Tachycardia
- Asymptomatic = increase dietary fibre
- Acute = Severe LIF, fever, constiaption, tenderness, guarding
Mx diverticulitis
- Analgesia
- NBM
- IV fluids
- ABx = cipro, met
- Surgical resection
Ix diverticulitis
- Raised WCC, CRP
- CXR
- CTColonography = colonic wall thickening, diverticula and periocolic collections
Crohns patho
- skip lesions
- bowel to anus
- cobblestone = ulcers and fissures
- transmural
- non caseating granulomas
Crohns S+S
= oral ulcers
- Abdo tender = RIF (mass)
- Perianal abscess, fustulae, tags
- Clubbing
- Diarrhoea and weight loss
Ix crohns
- Stool sample
- Faecal calcoprotein
- Colonoscopy = granulomatous transmural inflammation
- pANCA -ve
mx crohns
- Mild = pred
- severe - IV hydrocortisone, metronidazole
- azathioprine to maintain remission
UC patho
- Mucosa and colon only
- Continuous and circumferential
- Crypt absesses and goblet cell depletion
- Punctuate ulcers
UC S+S
- diarrhoea blood and mucus
- Crampy pain
- Bowel frequency related to severity
- Systemic in attacks
UC ix
- stool sample
- pANCA +ve
- colonoscopy
UX mx
- Mild = <4/d = pred and mesalazine
- Moderate = 4-6/d = pred and mesalazine
- Severe = >6/d, IV fluids and hydrocortisone
IBS S+S
Abdo pain/discomfort associated with 2+ of
- relieved by poo
- altered stool form
- altered bowel frequency
IBS Ix
- FBC
- ESR and CRP
- Coeliac screen
- Faecal calcoprotein
IBS Mx
- education
- fibre
- mebeverine
- loperamide
- laxatives
Duodenal ulcer
- RF = HP, increased GA and gastric emptying
- S+S = epi before meals or at night, relieved by eating
- Epi tender
- Endoscopy
Gastric ulcer
- RF = HP, smoking, NSAIDs
- Epi pain related to meals and relieved by antacids
- Ix= endoscopy
mx ulcers
- avoid food that worsens
- stop smoking
- treat cause
- PPI
H pylori triple therapy
- clarithromycin
- amoxicillin
- omeprazole
LFTs with gallstones
- Raised ALP
- Normal bili
- Normal ALT
differentiating colic, chole and cholang
Colic = RUQ pain, no fever, no jaundice
Cholecystitis = RUQ pain, fever, no jaundice
Cholangitis = RUQ pain, Fever and jaundice
Cushings
- Prolonged elevation cortisol = syndrome
- Adenoma secreting ACTH = disease
- moon dace, central obesity, striae, hump, HTN, T2DM, bruising
- DST = dex at night and cortisol measured in morning = normal response = cortisol suppressed
Addisons disease
- Adrenal glands damaged so less cortisol and aldosterone
- fatigue, nausea, cramps, reduced libido, hyperpigmentation, hypotension
- Hypona, hyperk
- Short synacthen = synthetic acth given = failure of cortisol to rise = addisons
- Mx = hydrocortisone
TFT results
- Hyperthyroid = low TSH, high T3/4
- Hypothyroid = high TSH, low T3/4
- Secondary hypo = low both
hypercalcaemia
- Stones
- Bones
- Groans (abdo)
- Moans (psych)
Phaeochromocytoma
- Adrenaline secreted in bursts
- 24hr catecholamines and plasma free metanephrines
- S+S = anxiety,sweating, headache, HTN, palpitations
- Mx = alpha blockers, BB, adrenalectomy
hydrocele
- tunica vaginalis
- painless swelling
- irreducible
- transilluminated
- conservative, surgery if sx
varicocele
- veins swollen
- throbbing/dull pain or discomfort
- dragging sensation
- sub fertility
- bag of worms
- not there lying down
- asymmetry
- USS, conservative, surgery
epididymal cyst
- fluid filled sac
- asymptomatic
- transilluminate
RF for erectile dysfunction
- OBESITY
- HTN
- ENDOTHELIAL DYSFUNCTION
- LACK EXERCISE
SMOKING
mx erectile dysfunction
- PDE-5 inhibitors = afils
BPH
- LUTS
- Mx - alpha blockers (tamsulosin) for immediate sx and 5ARI (finasteride) for enlargement
- TURP, TUVP
prostatitis
- pelvic pain, LUTS, sexual dysfunction, tender and large
- dipstick, culture and C+G tests
- Oral abx, analgesia
complications prostatitis
- sepsis
- abscess
- urinary retention
- chronic prostatitis
blood results for ALD
- increased AST, increased ALT, AST:ALT 2:1
gout
- needle shaped negatively bifringent crystals
- XR = lytic lesions, punched out
- NSAIDs
- Colchicine
- Steroids
- Allopurinol prophylaxis
- Febuxostat if allopurinol not tolerated
Blood results for adults T1DM
- random plasma glucose >11
Pre DM2 bloods
- HbA1c 42-47
- Impaired fasting glucose 6.1 - 6.9
- IGT = 7.8 - 11.1 OGTT
DM2 diagnosis bloods
HbA1c = >48mmol
- Random glucose >11
- Fasting glucose >7
- OGTT >11
Primary hyperthyroidism
- due to thyroid pathology
secondary hyperthyroidism
- hypothalamus or pituitary pathology
Graves disease
- autoimmune
- TSH receptor antibodies cause primary hyperthyroidism
- Most common cause hyperthyroid
- Exopthalmos
- pretibial myxoedema
De quervains thyroiditis
- viral infection with fever, neck pain and tenderness
- Dysphagia
- Hyperthyroid phase followed by hypothyroid phase
- NSAID and BB
Mx hyperthyroid
- carbimazole
- propylthiouracil 2nd line
- iodine
- BB
Hashimoto thyroiditis
- commonest cause hypothyroid
- anti TPO antibodies
mx hypothyroid
levothyroxine
when are anti TPO antibodies present
- graves disease
- hashimoto
when are tsh receptor antibodies present
- graves disease
LVEF <40%
HFrEF
LVEF 41-49%
HF mrEF
LVEF >50
HRPEF
