ILA/GP Flashcards

Question

Signs of raised ICP?

Answer 1

- Papilloedema - Headache (non-specific and diffuse) - Nausea - Pulsatile tinnitus - Transient visual loss - Visual disturbance (visual field defects, photophobia)

Answer 2

- Endothelial injury - Entry of LDL and cholesterol into tunica intima - Injured endothelial cells express adhesion molecules on surface = diapadesis of WBCs into tunica intima - FOAM CELLS FORM (macrophages ingest oxidised LDL) - many foam cells appear as a fatty streak - Foam cells BURST = releases LDL and cholesterol = triggers further inflammatory response - Smooth muscle cells from artery wall migrate into the fatty streak = produce collagen = FIBROUS CAP over the fatty streak = known as fibrous plaque ** PLAQUE RUPTURE = thrombus formation, or can embolise.

Answer 3

High blood pressure Chemical irritants (smoking) High levels of cholesterol and triglycerides

Answer 4

INFORMED patients having an active role in treatment decisions. Respects the beliefs and wishes of a patient in determining whether, when and how medicines are to be taken.

Answer 5

PASSIVE behaviour, following a list of instructions from the doctor

Answer 6

The active choice of patients to follow through with the prescribed treatment, while taking responsibility for their own well-being

Answer 7

A - AUGMENTED B - BIZARRE C - CHRONIC USE D - DELAYED E - END OF USE (WITHDRAWAL) F - FAILURE OF TREATMENT G - GENETIC

Answer 8

Exaggerated effect at recommended dose - reversible upon withdrawing the drug i.e bradycardia with beta blockers / bleeding with anti-coagulants

Answer 9

ADR continues even after the drug has stopped

Answer 10

ADR becomes apparent after stopping the drug

Answer 11

ADR develops after the drug has been stopped i.e. insomnia with benzodiazepines / rebound tachycardia w beta blockers

Answer 12

Unexpected treatment failure due to drug-drug interaction, drug-food interaction or poor compliance

Answer 13

Drug causing irreversible changes to genome (thalidomide)

Answer 14

Do - dose relatedness (ADRs can occur at either subtherapeutic doses, therapeutic doses or supratherapeutic doses) T - timing (ADRs can be time-dependent or independent) S - susceptibility (age, gender, disease state, physiological state like pregnancy)

Answer 15

Green social prescribing - supporting people to engage in nature-based interventions to improve physical and mental wellbeing. - Local walking schemes - Community gardening projects - Conservation volunteering - Open water swimming - Arts and cultural activities

Answer 16

Blue social prescribing - supporting people to engage in water-based activities to improve physical and mental wellbeing. Examples: swimming, sailing, surfing + canoeing

Answer 17

- All necessary vitamins, minerals and fats for first 6 months. - Antibodies - Also reduces risk of breast cancer, endometrial cancer, ovarian cancer, CV diseease and T2DM in mothers. - Convenient and quickly available - Cheaper than formula milk - Emotional bond between baby and mother

Answer 18

HARK H – Humiliation A – Afraid R – Rape K – Kick

Answer 19

Sick - do you make yourself sick Control over food - do you worry you've lost control One stone - lost more than one stone in a 3-month period? Fat - do you believe yourself to be fat when others say you're too thin? Food - would you say food dominates your life?

Answer 20

- Age - Sedentary lifestyle - Corticosteroid use - Hormonal (diabetes, hyper/hypothyroid) - Dietary deficiencies (vit D, calcium, excess protein, excess alcohol, ANOREXIA)

Answer 21

Normal: more than -1 Osteopenia: -1 to -2.5 Osteoporosis: less than -2.5 Severe Osteoporosis: less than -2.5 plus a fracture

Answer 22

Number of standard deviations the patient is from an average healthy young adult.

Answer 23

Number of standard deviations the patient is from the average for their age, sex and ethnicity.

Answer 24

- Pre-contemplation - Contemplation - Planning - Action - Maintenance - Relapse

Answer 25

- Foot check - Changes in lifestyle or any side effects? - Hypoglycaemic awareness + check injection sites (if on insulin) - BMI - Blood pressure - Cholesterol - HbA1c - LFTs (due to inc risk of NAFLD) - Kidney function (eGFR + ACR albumin:creatinine ratio) - Eye screening for retinopathy

Answer 26

DAFNE - skills-based education programme in which adults with T1DM learn how to adjust insulin to suit their free choice of food, rather than having to work their life around their insulin doses Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is a structured group education programme for adults with type 2 diabetes. Supports people in identifying their own health risks and responding to them by setting their own specific behavioural goals.

Answer 27

Weight loss Polyuria Polydipsia

Answer 28

42-47 mmol/mol

Answer 29

SMITH Sepsis Mitral valve pathology (stenosis or regurgitation) Ischaemic heart disease (restricted blood flow = arrhythmia) Thyrotoxicosis Hypertension - LIFESTYLE CAUSES: caffeine + alcohol - Smoking - 20/day = 1 pack year (pro-rata it) - FAMILY HISTORY

Answer 30

- ECG - ECHO - 24-hour ambulatory ECG (Holter monitor) - Cardiac event recorder - 1-2 weeks

Answer 31

- REGULAR rhythms: (300) / (count large squares between R-R) - IRREGULAR rhythms: (count QRS complexes in 10 secs) x (6)

Answer 32

- Absent P waves - Narrow QRS complex tachycardia - Irregularly irregular ventricular rhythm

Answer 33

1) GASTROENTERITIS (norovirus, C.diff, food poisoning, E.coli) 2) IMMUNE-MEDIATED (lactose intolerance, IBD, coeliac) 3) MEDICATION (Abx, SSRIs, PPIs, chemo) 4) PARASITE (guardia, amoebiasis)

Answer 34

Stoma made from an opening in the colon (large bowel)

Answer 35

Stoma made from an opening in the ileum (small bowel)

Answer 36

APIESAC - Aphthous ulcers (mouth) - Pyoderma gangrenosum (rapidly enlarging, painful skin ulcers) - Iritis (eye issues; episcleritis, scleritis and anterior uveitis) - Erythema nodosum (tender, red nodules on the shins) - Sclerosing cholangitis (PSC - ulcerative colitis) - Arthritis (enteropathic) - Clubbing of fingers

Answer 37

● Age 65 years or over ● Chronic kidney disease (eGFR < 60 ml/min/1.73 m2) ● Heart failure ● Liver disease ● Sepsis ● Diabetes - glomerular damage, renal arteriosclerosis, and atherosclerosis are the contributing factors in diabetic patients, leading to the progression of kidney damage ● Oliguria (< 0.5 ml/kg/hour) ● Neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer ● Use of iodine-based contrast media within the past week (e.g., used during CT scans) ● Symptoms or history of urological obstruction, or conditions that may lead to obstruction (i.e. prostate enlargement, ovarian or bladder tumour, or kidney stones) ● Use of drugs that can cause or exacerbate kidney injury (Table 1)

Answer 38

- ACEi/ARBs - NSAIDs - Aminoglycosides (gentamicin) - Rifampicin - Aciclovir - Ampicillin

Answer 39

- PROSTATE CANCER - BPH * Prostatitis * Urine Infections * Vigorous exercise * Ejaculation * Anal sex / prostate stimulation - DRE * Certain medicines * Urinary catheters

Answer 40

- Tamsulosin (alpha blocker - relaxes smooth muscle) = may cause postural hypotension - Finasteride (5a-reductase inhibtior)

Answer 41

FUNI SHID STORAGE SYMPTOMS: *FUNI* - Frequency - Urgency - Nocturia - Incontinence VOIDING SYMPTOMS: *SHID-C* - Weak stream - Hesitancy - Incomplete bladder emptying - Dribbling (post-micturition) - Chronic retention

Answer 42

1st line: urine dipstick (nitrates, leucocytes, blood) Gold standard: MSU/CSU microscopy, culture and sensitivity testing

Answer 43

- RA - OA - Ankylosing spondylitis - Gout - Septic arthritis - SLE - Psoriatic arthritis

Answer 44

CARDIOVASCULAR * Arrhythmias * Orthostatic Hypotension * Bradycardia * Valvular Heart Disease NEUROLOGICAL * Stroke * Epilepsy * Peripheral Neuropathy GENITOURINARY * Incontinence * UTI ENDOCRINE * Hypoglycaemia MUSCULOSKELETAL * Arthritis * Disuse Atrophy ENT * Benign Paroxysmal Positional Vertigo

Answer 45

You must stop driving immediately and tell the DVLA if you have a seizure, even if you have not been diagnosed with epilepsy yet. You will only be able to apply for a license again if: * You've been seizure free for 12 months. * You've had an awake seizure in the past and in the last 3 years you've only had sleep seizures. * You've never had an awake seizure, and in the last 12 months you've only had sleep seizures.

Answer 46

Sudden loss of consciousness, stiffening of muscles (tonic phase), followed by rhythmic jerking of limbs (clonic phase). Prolonged post-ictal period

Answer 47

- Isolated area of brain Simple focal seizures - person remains conscious but experiences unusual sensations or feelings (aura) that may involve emotions, sensory changes, or distorted perceptions. Complex focal seizures - alterations in consciousness or awareness. The person may exhibit repetitive behaviours like lip-smacking, fumbling with objects, or walking in circles.

Answer 48

Start in one area of the brain (focal onset) but then spread to involve both sides of the brain, leading to a tonic-clonic seizure.

Answer 49

- Last only a few seconds, or at most a few minutes. - Sudden onset of increased muscle tone - entire body stiffens. - This results in a fall if the patient is standing, usually backwards.

Answer 50

Loss of muscle tone

Answer 51

In children <5 years Tonic-clonic seizures due to HIGH FEVER

Answer 52

Diptheria, tetanus, polio Pertussis (whooping cough) Haemophilus influenzae type B + hepatitis B

Answer 53

FBC, U&E’s and LFTs – there is a risk of leucopenia, thombocytopenia, hyponatraemia and hepatic dysfunction. Carbamazepine levels 1-2 weeks after starting the drug. Repeated every 1-2 weeks until therapy stabilised, thereafter patients should be monitored every 2-3 months. Patient/carer needs to be warned to report immediately the onset of any feature of blood disorders (e.g. sore throat, bruising, and mouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort, and dark urine), and respiratory effects (e.g. shortness of breath).

Answer 54

Different formulations of Carbamazepine may vary in bioavailability. Patients being treated for epilepsy should be maintained on a specific manufacturer's product. If Maria is taking Tegretol as a named brand then she should continue on that brand.

Answer 55

FOLATE ANTAGONIST Inhibits dihydrofolate reductase (DHFR) ⇒ reduced thymine, adenine and guanine production ⇒ impaired nucleic acid synthesis ⇒ cell death **(*T CELL APOPTOSIS) = immunosuppression***

Answer 56

Methotrexate can cause normocytic megaloblastic anaemia. Folic acid supplementation during methotrexate therapy can reduce the risks of adverse effects including nausea, vomiting, abdominal pain, mouth ulcers, raised liver enzymes and bone marrow toxicity. FOLIC ACID NEEDED FOR HEALTHY RBCs = can cause megaloblastic anaemia without

Answer 57

- **eGFR** (estimated glomerular filtration rate) - most commonly used - single blood test and therefore simplest and cheapest. - Creatinine clearance should be used in preference when using toxic drugs, in elderly patients and in patients with very low or very high muscle mass. A creatinine clearance test uses both a blood and urine sample in order to see how well the kidneys are functioning. Creatinine is created as a waste byproduct of normal muscle activity.

Answer 58

Aminosalicylate

Answer 59

asthma COPD HF Low BP Peripheral vasc disease Diabetes mellitus People who wear contact lenses (reduced secretion of lacrimal fluid).

Answer 60

Where a patient with paroxysmal (intermittent) atrial fibrillation takes their antiarrhythmic medication when they experience an episode of palpitations, rather than taking regular medication every day. The idea is to terminate the suspected episode of AF without having to present to a medical facility. The ‘prn’ method of use avoids side effects from taking tablets on days when they may not be necessary and is helpful for patients who are averse to taking regular medications.