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Phase 3a Everything > gp_20231205142255 > Flashcards

gp_20231205142255 Flashcards

1
Q

What are the thresholds for diagnosis of hypertension?

A

140/90 clinic BP 135/85 ambulatory BP

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2
Q

What is the main cause of hypertension?

A

Essential hypertension - unknown cause

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3
Q

What are the secondary causes of hypertension?

A

ROPED R - renal failureO - obesity P - pre-eclampsiaE - endocrine D - drugs - NSAIDs, alcohol, steroids, oestrogen

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4
Q

What is the most common cause of secondary hypertension?

A

Renal failure

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5
Q

What are the risks of high blood pressure?

A

Increased risk of:- Stroke - IHD - Heart failure - Left ventricular hypertrophy - Hypertensive retinopathy - Kidney failure- Vascular dementia

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6
Q

What is stage 1 hypertension?

A

Clinic BP >140/90 Ambulatory BP > 135/85

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7
Q

What is stage 2 hypertension?

A

Clinic BP > 160/100Ambulatory BP > 150/95

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8
Q

What is stage 3 hypertension?

A

Clinic BP > 180/20

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9
Q

What investigations should all those with a new diagnosis of hypertension have?

A

Urine albumin:creatinine ratio Urine dipstick HbA1cRenal function LipidsFundoscopy ECGCalculate Q riskTFTs - check for secondary causes

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10
Q

What medications are used in the management of hypertension?

A

Under 55:- 1st line - ACE inhibitor - 2nd line - ARB Over 55:- 1st line - calcium channel blockerBlack or afro-carribean background:- 1st line - CCB Type 2 diabetes patients - 1st line - ACE inhibitor Alternative medications:- Beta blockers + potassium sparing diuretics - 4th line - Thiazide like diuretic - 3rd line

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11
Q

What is malignant hypertension?

A

Hypertension above 180/120 with papilloedema

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12
Q

What is the treatment of malignant hypertension?

A

Same day referral for IV antihypertensives:- Sodium nitroprusside - Labetolol- GTN - Nicardipine

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13
Q

What lifestyle changes can patients make to manage their hypertension?

A

Stop smoking Reduce alcohol intake Reduce caffeine intake Reducing dietary salt Diet and exercise

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14
Q

What should be monitored in patients on antihypertensives?

A

Serum electrolytes Kidney functionCheck blood pressure

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15
Q

Which thiazide like diuretic is most commonly used in hypertension?

A

Indapamide

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16
Q

What is heart failure?

A

Impaired heart function, usually of the left ventricle - blood can’t get out to the body

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17
Q

What is the pathophysiology of heart failure?

A

Impaired left ventricular function resulting in blood backing up into the left ventricle and the rest of the heart The left atrium, pulmonary vein and lungs are increased in volume and pressure This results in pulmonary oedema

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18
Q

What is a normal ejection fraction?

A

Above 50%

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19
Q

What is ejection fraction?

A

The proportion of blood in the left ventricle that is pumped out of the heart with each contraction

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20
Q

What are the causes of heart failure?

A

Ischaemic heart diseaseValvular heart disease - aortic stenosis Hypertension Arrhythmias - AFCardiomyopathy

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21
Q

What is the presentation of heart failure?

A

BreathlessnessCough with frothy pink/white sputumOrthopnoea Paroxysmal nocturnal dyspnoea Peripheral oedema Fatigue

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22
Q

What signs of heart failure would be seen on examination?

A

TachypnoeaTachycardia Hypertension Murmurs (if caused by valvulvar heart disease)3rd heart sound Bilateral basal cracklesRaised JVPPeripheral oedema

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23
Q

What investigations are used to diagnose heart failure?

A

ECGEchocardiogram BNP Bloods - LFT, TFT, U&E, FBC, lipids, HbA1c, inflammatory markersChest XR

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24
Q

What are the differentials of heart failure?

A

COPD
Pulmonary fibrosis
Pneumonia
Ageing/physical inactivity

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25
Q

What are the classes of heart failure?

A

Class 1 - no limitation of activity
Class 2 - comfortable at rest but symptomatic with normal activities
Class 3 - comfortable at rest but symptomatic with any activity
Class 4 - symptomatic at rest

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26
Q

What is the first line medical management of heart failure?

A

ACE inhibitor
Beta blocker
Aldosterone antagonist (if symptoms are not controlled by A+B)
Loop diuretics

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27
Q

What are haemorrhoids?

A

Enlarged anal vascular cushions

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28
Q

What are the risk factors for haemorrhoids?

A

Straining Constipation Pregnancy Obesity Increased age Increased intra-abdominal pressure

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29
Q

What is an anal cushion?

A

Submucosal tissue in the anus that contains connections between arteries and veins, making it very vascular

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30
Q

What is the classification of haemorrhoids?

A

Class 1 - no prolapse
Class 2 - prolapse on straining and return on relaxation
Class 3 - prolapse on straining with no return on relaxation, but that can be pushed back
Class 4 - prolapsed permenantly

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31
Q

What is the presentation of haemorrhoids?

A

Bright red bleeding upon wiping or after opening bowels Blood not mixed with stool Sore/itchy anus Intermittent protrusion

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32
Q

What are the differentials of haemorrhoids?

A

Anal fissure Crohn’s diseaseUlcerative colitis Bowel cancerAnal fistulaDiverticulosis

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33
Q

What is the first line investigation of haemorrhoids?

A

Inspection and PR exam

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34
Q

What other investigations may be performed in the diagnosis of haemorrhoids?

A

FBC Colonoscopy (to exclude other conditions)

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35
Q

What is the management of haemorrhoids?

A

Topical treatments - anusol Rubber band ligation Sclerotherapy Surgical treatment - haemorrhoidal artery ligation or haemorrhoidectomy

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36
Q

What is a thrombosed haemorrhoid?

A

Where there is strangulation at the base of the haemorrhoid which causes thrombosis in the haemorrhoid

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37
Q

What lifestyle advice should be given to someone with haemorrhoids?

A

More dietary fibre Good fluid intake Using laxatives where required Avoid straining

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38
Q

What is the most effective emergency contraception?

A

Copper IUD

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39
Q

How long after sex is a copper IUD effective for emergency contraception?

A

120 hours (5 days)

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40
Q

How does the copper IUD work?

A

It prevents implantation as it is toxic to both egg and sperm

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41
Q

How long can a copper IUD stay in place?

A

Up to 10 years

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42
Q

What are the contraindications to the copper IUD?

A

Up to 28 days postpartum Repeated history of STIs Current pelvic infection Distorted uterus Abnormal cervix Unexplained bleeding

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43
Q

What is the UKMEC criteria?

A

UKMEC1 - no restriction in use UKMEC2 - benefits outweigh risksUKMEC3 - risks outweigh benefits UKMEC4 - absolute contraindication

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44
Q

What contraception should women with breast cancer avoid?

A

Any hormonal contraception - Copper IUD or barrier methods are best choice

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45
Q

What contraception should women with Wilson’s disease avoid?

A

Copper IUD

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46
Q

What contraception should women with cervical or endometrial cancer avoid?

A

IUS

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47
Q

What are diaphragms and cervical caps?

A

Silicone caps that fit across the cervix to prevent semen from entering the uterus

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48
Q

How is a diaphragm/cervical cap used?

A

Fitted before sex, and left in for 6 hours after sexUsed alongside spermicide gel

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49
Q

How effective is the COCP?

A

99% with perfect use 91% with typical use

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50
Q

How does the COCP prevent pregnancy?

A

Prevents ovulation (primary method)Progesterone thickens cervical mucus Progesterone inhibits proliferation of the endometrium

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51
Q

How does the COCP prevent ovulation?

A

Oestrogen and progesterone have negative feedback on the release of GnRH from the hypothalamus In turn, less FH and LSH is released from the anterior pituitary, without which ovulation cannot occur

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52
Q

What are the first line choices of progesterone for the COCP?

A

Levonorgestrel or norethisterone

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53
Q

Why are levonorgestrel and norethisterone the first line choices of progesterone?

A

They have a lower VTE risk

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54
Q

What is the first line COCP for PMS?

A

Yasmin - containing drospirenone

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55
Q

Which is the first line COCP for acne and hirtruism?

A

Dianette - containing cyprotenone acetate

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56
Q

What are the three regimes for COCP use?

A

21 days on, 7 days off 63 days on, 7 days offContinuous use

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57
Q

What are the common side effects of the COCP?

A

Unscheduled bleeding in first 3 months Breast pain and tendernessMood changes and depression Headaches

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58
Q

What are the risks of the COCP?

A

Hypertension Small increase in risk of breast cancer, and cervical cancerVTE Small risk of MI and stroke

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59
Q

What are the contraindications to the COCP?

A

Over 35 and smoking more than 15 cigarettes per day Migraine with aura History of VTEUncontrolled hypertensionIshcaemic heart diseaseHistory of vascular disease or strokeLiver cirrhosis SLE

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60
Q

What extra protection is required when starting the COCP?

A

Up to day 5 - no extra protection requiredDay 5 onwards - condoms for the first 7 days of pill taking

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61
Q

What extra protection is required in the case of a missed pill?

A

If it is less than 72 hours since the last pill taken: - Take the missed pill as soon as possible - No extra action requried

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62
Q

What extra protection is required in the case of more than 1 missed pill?

A

Take the missed pill as soon as possible Additional contraception needed for 7 days Day 1-7 of packet - emergency contraception neededDay 8-14 - no emergency contraception neededDay 15-21 - no emergency contraception required, but skip 7 day pill free period

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63
Q

Can the COCP be used during a major operation?

A

No - the COCP should be stopped 4 weeks before a major operation

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64
Q

What is the only absolute contraindication to the POP?

A

Breast cancer

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65
Q

What are the two types of POP?

A

Traditional POPDesogestrel only pill

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66
Q

What is the time window for taking the traditional POP?

A

3 hours

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67
Q

What is the time window for taking the desogestrel only pill?

A

12 hours

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68
Q

What is the mechanism of action of the traditional POP?

A

Inhibits proliferation of the endometrium Thickens cervical mucus Reduces ciliary action in the fallopian tubes

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69
Q

What is the mechanism of action of the desogestrel only pill?

A

Inhibits ovulationInhibits proliferation of the endometrium Thickens cervical mucus Reduces ciliary action in the fallopian tubes

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70
Q

What extra protection is needed when starting the POP?

A

No extra protection needed if started on days 1-5Day 6 onwards - additional contraception required for 48 hours

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71
Q

What are the side effects of the POP?

A

Unscheduled bleeding during first three months Breast tendernessHeadaches Acne

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72
Q

What are the risks of the POP?

A

Increased risk of ovarian cystsRisk of ectopic pregnancy with traditional POPIncreased risk of breast cancer

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73
Q

What extra protection is required in the case of a missed POP pill?

A

Take the missed pill as soon as possible Use additional contraception for the next 48 hours

74
Q

How often is the progestogen-only injection given?

A

Every 12 to 13 weeks

75
Q

How long can it take for fertility to return after stopping the progestogen-only injection?

76
Q

What are the two types of progestogen-only injection given in the UK?

A

Depo-provera - IM injection
Sayana Press - self administered SC injection

77
Q

What are UKMEC3 contraindications to the POP?

A

Ischaemic heart disease and stroke
Liver disease
Unexplained vaginal bleeding

78
Q

What is the main mechanism of action of the depo injection?

A

Inhibits ovulation(also works by inhibiting proliferation of the endometrium and thickening cervical mucus)

79
Q

When is extra protection required when starting the depo injection?

A

No extra protection required before day 5 After day 5 - additional protection required for 7 days

80
Q

What are the side effects of the depo injection?

A

Weight gain Acne Reduced libidoMood changesHeadaches Flushes Hair lossSkin reactions at injection sites

81
Q

What is the most important side effect of the depo injection?

A

Reduced bone mineral density

82
Q

What is the progestogen only implant?

A

A small 4cm plastic rod that is inserted underneath the skin, above the subcutaneous fat

83
Q

How long does the implant last for?

84
Q

What is the only UKMEC4 criteria for the implant?

A

Active breast cancer

85
Q

How does the implant work?

A

Inhibits ovulation Makes the endometrium less accepting of implantation Thickens cervical mucus

86
Q

What are the two types of coils?

A

IUD - copper containing coil IUS - levenorgestrel containing coil

87
Q

What are the contraindications to the coil?

A

PID Immunosuppression Pregnancy Unexplained bleeding Pelvic cancerDistortion of the uterus by fibroids

88
Q

What are the risks relating to insertion of the coil?

A

Bleeding Pain on insertion Vasovagal reactions Uterine perforationPIDExpulsion

89
Q

How long can an IUD remain in place?

A

5-10 years

90
Q

How does the IUD work?

A

Copper is toxic to ova and spermAlso makes the endometrium less accepting of implantation

91
Q

When is the copper coil contraindicated?

A

In wilson’s disease

92
Q

What are the types of IUS and how long can they be used for?

A

Mirena - 5 years Levosert - 5 years Kyleena - 5 years Jaydess - 3 years

93
Q

What other uses is the mirena coil licensed for?

A

Contraception, menorrhagia and HRT

94
Q

What other uses is the levosert coil licensed for?

A

Contraception and menorrhagia

95
Q

How does the IUS work?

A

Thickens cervical mucus Makes the endometrium less accepting of implantation Inhibits ovulation in some women

96
Q

What are the side effects of the IUS?

A

Can cause spotting or irregular bleeding Pelvic pain Acne Headaches Breast tenderness

97
Q

What are the risks of the IUS?

A

Ectopic pregnancies Ovarian cysts

98
Q

What are the three types of emergency contraception?

A

Copper IUD Levonorgestrel (Levonelle)Ulipristal acetate (EllaOne)

99
Q

When can levonelle be taken?

A

Within 72 hours of unprotected sex

100
Q

When can EllaOne be taken?

A

Within 120 hours of unprotected sex

101
Q

What is the most effective form of emergency contraception?

A

Copper IUD

102
Q

What are the side effects of levonelle?

A

Nausea and vomiting Spotting and changes to the next menstrual period Diarrhoea Breast tendernessDizziness Depressed mood

103
Q

What are the side effects of EllaOne?

A

Nausea and vomiting Spotting and changes to the next menstrual period Back pain Mood changes Headache DizzinessBreast tenderness

104
Q

What is the Pearl Index?

A

The number of pregnancies that would be seen if 100 women used that form of contraception for one year

105
Q

At what age should a woman stop taking the COCP?

106
Q

When can the mirena coil or IUD be inserted after childbirth?

A

Within 48 hours of childbirth or after 4 weeks

107
Q

When can the COCP be started after childbirth?

A

After 21 daysor After 6 weeks if breastfeeding

108
Q

When can the progesterone only pill be started after childbirth?

A

Can be started at any time

109
Q

When can patients be given the copper IUD after 5 days post intercourse?

A

If the patient is up to 5 days after their earliest ovulation date

110
Q

Who should EllaOne not be given to?

A

Patients with severe asthma

111
Q

What is rheumatoid arthritis?

A

An autoimmune condition which causes chronic inflammation of the synovial lining of the joints

112
Q

Who is rheumatoid arthritis more common in?

A

3 times more common in women than in men

113
Q

What are the gene associations with rheumatoid arthritis?

A

HLA DR4HLA DR1

114
Q

What antibodies may be present in a patient with rheumatoid arthritis?

A

Rheumatoid factor Anti-CCP antibodies

115
Q

What are the key symptoms in rheumatoid arthritis?

A

Joint pain
Joint swelling
Morning stiffness < 30 minutes
Pain that gets better with exercise
Fatigue
Weight loss
Flu like illness

116
Q

Which joints are commonly affected in rheumatoid arthritis?

A

Proximal interphalangeal joints (PIP)Metacarpophalangeal joints (MCP)WristsAnklesCervical spine

117
Q

What hand signs may be present in someone with rheumatoid arthritis?

A

Z thumb Swan neck deformity Boutonnieres deformity Ulnar deviation

118
Q

What are the extra-articular manifestations of rheumatoid arthritis?

A

Pulmonary fibrosis Bronchiolitis obliterans Sjogren’s syndrome Anaemia of chronic diseaseCardiovascular diseaseEpiscleritis and scleritis Rheumatoid nodules

119
Q

What investigations may be carried out in the diagnosis of rheumatoid arthritis?

A

Rheumatoid factorAnti-CCP antibodies CRP and ESRXR hands and feetUltrasound to confirm synovitis

120
Q

What changes may be seen on XR in someon with rheumatoid arthritis?

A

Joint destruction and deformity Soft tissue swelling Periarticular osteopenia Bony erosions

121
Q

What factors are indicative of a worse prognosis?

A

Younger onset Male More joints and organs affectedPresence of RF and anti-CCP antibodies Erosions seen on XR

122
Q

What is the first line management of rheumatoid arthritis?

A

Monotherapy with methotrexate, leflunomide or sulfasalazine

123
Q

What is the second line management of rheumatoid arthritis?

A

Dual therapy with methotrexate, leflunomide or sulfasalazine

124
Q

What is the third line management of rheumatoid arthritis?

A

Methotrexate plus a biological therapy (usually a TNF inhibitor)

125
Q

What is the fourth line management of rheumatoid arthritis?

A

Methotrexate plus rituximab

126
Q

What anti-TNF medications are commonly used in the treatment of rheumatoid arthritis?

A

Infliximab Adalimumab Etanercept

127
Q

What is the treatment of an initial presentation or a flare up of rheumatoid arthritis?

A

A short course of glucocorticoids - prednisolone

128
Q

How is methotrexate taken for rheumatoid arthritis?

A

Methotrexate is taken orally or intramuscularlyFolic acid 5mg is given once a week, on a different day to the methotrexate

129
Q

What are the side effects of methotrexate?

A

Mouth ulcersLiver toxicity Leukopenia Teratogenic

130
Q

What are the differentials of rheumatoid arthritis?

A

Osteoarthritis SLEFibromyalgia Septic arthritis Psoriatic arthritis Polyarticular gout Reactive arthritis

131
Q

Which medications are safe for rheumatoid arthritis patients during pregnancy?

A

Sulfasalazine and hydroxychloroquine

132
Q

What is psoriasis?

A

A chronic inflammatory condition of the skin characterised by scaly erythematous and pruritic plaques

133
Q

What are the 5 types of psoriasis?

A

Chronic plaque psoriasis Flexural psoriasisGuttate psoriasis Pustular psoriasis Generalised psoriasis

134
Q

What is chronic plaque psoriasis?

A

Symmetrical plaques on the extensor surfaces of the limbs, scalp and back

135
Q

What is flexural psoriasis?

A

Smooth erythematous plaques without scale in flexures

136
Q

What is guttate psoriasis?

A

Multiple small, tear shaped lesions on the trunk after a streptococcal infection in children

137
Q

What is pustular psoriasis?

A

Multiple petechiae and pustules on the palms and soles

138
Q

What is generalised psoriasis?

A

Psoriasis with erythroderma and systemic illness

139
Q

What are the risk factors for psoriasis?

A

Skin trauma Withdrawal of steroids Drugs - NSAIDs- Beta blockers - Lithium - Anti-malarials Stress Alcohol Smoking Cold/dry weather

140
Q

What signs are specific to psoriasis?

A

Auspitz sign Koebner phenomenon Residual pigmentation after lesions resolve

141
Q

What is the auspitz sign?

A

Small points of bleeding when the plaques are scraped off

142
Q

What is the Koebner phenomenon?

A

The development or psoriatic lesions in an area of skin affected by trauma

143
Q

What is the first line topical treatment of psoriasis?

A

Topical corticosteroid and topical vitamin D applied at different times

144
Q

What is the second line topical treatment of psoriasis?

A

Stop the corticosteroid Apply topical vitamin D twice daily

145
Q

What is the third line topical treatment of psoriasis?

A

Stop topical vitamin DApply corticosteroid twice daily

146
Q

What is the first line systemic treatment of psoriasis?

A

Methotrexate

147
Q

What is the second line systemic treatment of psoriasis?

A

Ciclosporin

148
Q

What biologics can be used to treat psoriasis?

A

InfliximabEtanercept Adalimumab

149
Q

What nail changes are seen in psoriasis?

A

Nailbed pitting Onycholysis - separation of nail from nailbed Subungual hyperkeratosis - thickening of nailbed

150
Q

What is the action of metformin?

A

Increases peripheral glucose sensitivity and increases liver uptake of glucose

151
Q

What are the side effects of metformin?

A

Nause
Vomiting
Abdominal discomfort
Diarrhoea
Lactic acidosis

152
Q

What is the action of sulfonylureas?

A

Stimulate the pancreatic beta cells to release insulin

153
Q

What are the side effects of sulfonylureas?

A

Hypoglycaemia Weight gain Nausea and vomiting Diarrhoea Allergic reactions

154
Q

What is the action of thiazolidinediones?

A

Increase peripheral insulin sensitivity

155
Q

What are the side effects of thiazolidinediones?

A

Weight gain
Fluid retention and heart failure
Increased risk of fractures
Increased risk of bladder cancer

156
Q

What is the action of SLGT-2 inhibitors?

A

Increase urinary glucose excretion

157
Q

What are the side effects of SLGT2 inhibitors?

A

Fungal infections UTIsEuglycaemic diabetic ketoacidosis Increased risk of lower limb amputation

158
Q

What is the action of DPP-4 inhibitors?

A

Inhibits the enzyme DPP-4 which breaks down incretin hormones - this leads to an increase in production of insulin

159
Q

What is atrial flutter?

A

A short circuit in the heart causes the atria to pump rapidly

160
Q

What heart rate is seen in atrial flutter?

A

Atrial rate of 300 bpm Ventricular rate of 150 bpm (but can be variable)

161
Q

What appearance does atrial flutter given on an ECG?

A

Sawtooth appearance

162
Q

Why can the ventricular rate be variable in atrial flutter?

A

Dependant on how many impulses from the atria conduct through to the ventricles (a 2:1 ratio would result n 150bpm, a 3:1 ratio would result in 100bpm…)

163
Q

What are the causes of atrial flutter?

A

COPD Obstructive sleep apnoea Pulmonary emboli Pulmonary hypertension

164
Q

What are the symptoms of atrial flutter?

A

Palpitations LightheadednessSyncope Chest pain

165
Q

What is the treatment of atrial flutter in some haemodynamically unstable?

A

Direct current synchronised cardioversion + amiodarone

166
Q

What is the first line management of atrial flutter?

A

Beta blocker or calcium channel blocker

167
Q

What is the second line management of atrial flutter?

A

Cardioversion

168
Q

What is atrial fibrillation?

A

Irregular and uncoordinated atrial contraction at a rate of 300-600 bpm

169
Q

What are the causes of atrial fibrillation?

A

Ischaemic heart diseaseHypertension Rheumatic heart diseasePericarditis Myocarditis

170
Q

What are the symptoms of atrial fibrillation?

A

Palpitations Chest pain Shortness of breath Light headednessSyncope

171
Q

What are the signs of atrial fibrillation on ECG?

A

Irregularly irregular heartrateAbsent P waves

172
Q

What is the first line management of acute atrial fibrillation in a patient that is haemodynamically unstable?

A

Synchronised DC cardioversion and amiodarone

173
Q

What is the first line management of acute atrial fibrillation in a stable patient?

A

If onset < 48 hours ago - Rate and rhythm control If more than 48 hours ago- Rate control only

174
Q

What is the management of chronic AF?

A

Rate control - 1st line - beta blocker or calcium channel blocker- 2nd line - dual therapy- Digoxin Rhythm control - Electric cardioversion - Pharmacological cardioversion

175
Q

What joint aspiration results are seen in gout?

A

Negatively birefringent needles

176
Q

What joint aspiration results are seen in psuedogout?

A

Positively birefringent rhomboid crystals

177
Q

What is the presentation of pseudogout?

A

Acute monoarthritis - Shoulder and wrist most affected

178
Q

What is the treatment of pseudogout?

A

NSAIDs (colchicine if NSAIDs are contraindicated)

179
Q

What are the causes of megaloblastic anaemia?

A

B12 deficiency Folate deficiency

180
Q

What are the causes of non-megaloblastic anaemia?

A

Liver diseaseAlcohol Hypothyroidism Pregnancy

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