ILAs Flashcards
over what values is hypertension ?
> 140/90
confirmed with ambulatory/home: >135/85
most common cause of hypertension
primary (90%) high BP has developed on ownc
causes of secondary hypertension ? 2 most common ?
ROPED
- renal disease (common)
- cons disease/primary hyperaldosteronism (common)
- obesity
- pregnancy induced/pre eclampsia
- endocrine
- drugs (alcohol, steroids, NSAIDs, oestrogen)
If high BP is not responded to treatment, what should you consider ?
consider renal artery stenosis
(duplex US)
what ranges for stage 1/2/3 hypertension ?
- stage 1: >140/90 (>135/85)
- stage 2: >160/100 (>155/95)
- stage 3: > 180/120
what lifestyle advice for hypertension ?
- healthy diet
- smoking cessation
- reduce alcohol
- reduce caffeine
- reduce salt
- regular exercise
50 year old white man hypertension. what first line drug ? who else in the category ?
ACEI
(<55 or T2DM (any age))
50 year old black man with hypertension. what first line drug? who else in this category ?
CCB
(>55 or black African)
first line hypertension managment not enough, then add what ?
- consider ACEI or CCB (whichever they’re not already on)
OR - Thiazide-like diuretic
third line hypertension Mx ?
ACEI + CCB + thiazide like dietetic
what tests would you do in a newly diagnosed patient with hypertension to ensure they do not the any end-organ damage ? (3)
- fundoscopy (check for hypertensive retinopathy)
- urine dipstick (check for renal disease, either as a cause of consequence of hypertension)
- ECG (to check for LV hypertrophy of IHD)
ACEI SE ? (2)
- cough
- hyperkalaemia
CCB SE ? (3)
- headache
- flushing
- ankle oedema
BB SE ? (3)
- bronchospasm (especially in asthmatics)
- fatigue
- cold peripheries
bendoflumethiazide SE (4)
- gout
- hyppokalaemia
- hyponatraemia
- impaired glucose tolerance
what antihypertensive is first line in diabetic patients ?
ACEI/ARBS regardless of age
What drugs can contribute to idiopathic intracranial hypertension ? (5)
- COCP
- steroids
- tetracyclines
- retinoids
- lithium
what are the BP target ranges over a patient over 80 years ?
<150/90 (<145/85)
describe the antibodies associated with RA ? and what their sensitivity is ?
- RF (IgM): autoantibody that attacks IgG => inflam (70% of RA patients have it)
- Anti-CCP (more specific -80-90%)
what indicates a worse prognosis in RA ? (3)
- disease activity
- positive Ab (RF or anti-CCP)
- erosions on xray
- extra-acrituclar features (nodules)
RA RF ?
F:M (3:1)
middle age
smoking
obesity
FHx
RA presentation ? which joints affected ?
rapid of gradual: (triad) joint pain, stiffness swelling (worse with rest, improve with activity)
- MCP, PIP, wrist, MTP
RA hand OE ?
- synovial thickening => boggy feeling
- positive squeeze test
- z shaped deformity
- swan neck deformity
- boutineirs deformity
- ulnar deviation
name some extra articular manifestations of RA ?
- sjorgrens
- eye manifestations (keratoconjunctivitis sick - dry eyes)
- nodules
what would be seen on Xray of RA ? (5)
- periarticular osteopenia
- bony erosions
- soft tissue swelling
- loss of joint space
- subluxation
RA Mx ?
- short term steroids: at initial px or during flares
- DMARDS: methotrexate, hydroxychloroquine/sulfasalazine (safest during pregnancy)
when should methotrexate be stopped prior to conception ?
6 months before conception (in men and women)
what would post-bronchodilator spirometry show in COPD
obstruction: FEV1/FVC ration less than 70% (0.7)
What would be seen on CXR of patient with COPD ?
- hyperinflation
- bull
- flat hemidiaphragm
What general lifestyle managment is recommended to patients with COPD ?
- smoking cessation
- annula flu vaccine
- one-off pneumococcal vaccine
- pulmonary rehab
What is first line medical Mx of COPD ?
short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA)
COPD patient is not controlled on SABA. what would you consider next ? what does this depend on ?
depends on if asthmatic features suggestion steroid responsiveness
- no asthmatic features: add LABA and LAMA
- asthmatic features: add LABA + ICS
what are the features of cor pulmonale ?
- peripheral oedema
- raised JVP
- systolic parasternal heave
- Loud P2
which COPD patients should be considered for Long term oxygen therapy (LTOT) ?
- severe airflow obstruction: FEV1 < 30%)
- cynaosis
- polycythaemia
- raised JVP
- Oxy sats <92%
most common infective causes of COPD exacerbation ?
- haemophiliac influenza (most common)
Gout most commonly affects which joint ?
1st metatarsophalangeal joint (MTP joint)
describe the fluid analysis of the synovial fluid in gout ? when checked ?
needle shape negatively birefringent monosodium rate crystals under polarised light
- should be choked once the acne ep has settled down (2 weeks later)
pseudo gout joint aspiration description ?
weakly-positive birefringent rhomboid-shaped crystals
Gout acute managment ?
NSAIDs or colchicine
main colchicine side effect ?
diarrhoea
