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3a > key GP knowledge > Flashcards

key GP knowledge Flashcards

1
Q

ACS symptoms
ST elevation or LBBB

A

STEMI

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2
Q

ACS symtoms
No ST elevation
BUT raised troponin and other ECG changes (ST depression, T wave inversion, pathological Q waves)

A

NSTEMI

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3
Q

ACS symptoms
No ST elevation or LBBB
Normal troponin and nothing on ECG
SOB at rest

A

Unstable angine

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4
Q

Central crushing chest pain
N&V
Sweating and clamminess
Feeling of impending doom
SOB
Palpitations
Pain radiates to jaw or arms

A

MI

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5
Q

what is the acute management in a STEMI

A

M : morphine
O : oxygen
N : GTN
A : aspirin (300mg PO)

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6
Q

what can be done surgically for a STEMI

A
  • Primary PCI (within 2 hrs)
  • Thromoblysis with alteplase (>2 hrs)
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7
Q

what is given as secondary prevention of a STEMI

A

A : aspirin (75mg)
A : another antiplatelet (clopidogrel)
A : atorvostatin (80mg)
A : ACEI (ramipril)
A : atenolol (or other BB)
A : aldosterone antagonist in HF (eplererone)

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8
Q

acute NSTEMI treatment

A

B : BB
A : aspirin (300mg)
T : Ticagrolr (180mg)
M : morphine
A : anticoagulant (fondaparinux)
N : Nitrates (GTN)

-> O2 if sats dropping

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9
Q

give 5 alternative causes of raised troponin

A

CKD
sepsis
myocarditis
aortic dissection
PE

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10
Q

Palpitations
SOB
Syncope

A

AF

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11
Q

what is seen on an ECG in AF

A

Absent P waves
Narrow QRS complex tachycardia
Irregularly irregular ventricular rhythm

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12
Q

Give 5 causes of AF

A

S : sepsis
M : mitral valve pathology (stenosis or regurg)
I : IHD
T : thyrotoxicosis
H : HTN

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13
Q

what are the rate control options for AF

A
  1. BB (atenolol)
  2. CCB
  3. Digoxin
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14
Q

when would rhythm control be offered first line AF

A

-Reversible cause of AF
-AF is new onset (<48 hrs)
-AF is causing HF

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15
Q

what are the 2 options for rhythm control in AF

A

-Cardioversion
-Long term medical rhythm control

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16
Q

what are the 2 options for cardioversion

A

-> 1st = Pharmacological : flecanide. Amiodarone if structural heart disease
-> Electrical

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17
Q

what 3 medications can be used for long term medical rhythm control

A
  1. BB
  2. Dronedarone
  3. Amiodarone
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18
Q

what is used to determine stroke in AF and what is given if score >1

A

CHADs2VASc
>1 = anticoagulation (warfarin or DOAC - apixaban)

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19
Q

what is the gold standard investigations for stable angina

A

-CT coronary angiography

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20
Q

what is used for immediate symptom relief in angina

A

GTN spray
-> Repeat after 5 minutes. If still in pain after 5 minutes, repeat the dose

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21
Q

What is used for long term symptomatic relief of angina

A
  • BB (e.g. bisoprolol 5mg OD)
  • CCB (amlodipine 5mg OD)
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22
Q

What is used in the secondary prevention of angina ?

A

A : aspirin (75mg)
A : Atorvostatin (80mg)
A : ACEI
a ; already on bb for symptom relief

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23
Q

what can be given to patients with angina that have proximal or extensive disease on CT coronary angiography

A

Percutaneous coronary intervention

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24
Q

What can be offered to patients with angina and severe stenosis

A

CABG

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25
Q
  • Long term smoker
  • Chronic : SOB, cough, wheeze, sputum production, recurrent resp infections
A

COPD

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26
Q

Explain the MRC dyspnoea scale

A

1 : strenuous exercise
2 : Uphill
3 : flat
4 : 100 metres
5 : can’t leave the house

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27
Q

How is COPD diagnosed

A

-Clinical diagnosis + spirometry
-FEV1/FVC <0.7

28
Q

How is the severity of spirometry in COPD determined

A

Stage 1 : > 80%
Stage 2 : 50-79%
Stage 3 : 30-49%
Stage 4 : <30%

29
Q

What can cause earlier and more severe COPD

A

Alpha 1 antitrypsin deficiency

30
Q

what is step one in the management of COPD

A

-Salbutamol -> beta-2-agonist

OR

-Ipratropium bromide -> short acting antimuscarinics

31
Q

What is step 2 of the management of COPD if the pt is NOT steroid responsive

A

-> LABA

+

-> LAMA

32
Q

What is step 2 in the management of COPD if the pt is steroid responsive

A

-> LABA

+

-> ICS

33
Q

How is COPD exacerbation managed at home

A

-> Prednisolone (30mg, OD for 7-14 days)

34
Q

What are the first line treatment options for COPD exacerbation in hospital

A

-> Nebulised bronchodilators (salbutamol and ipratropium
-> Steroids

35
Q

Give 6 causes of a raised PSA

A

Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise
Recent ejaculation / prostate stimulation

36
Q

Give 2 medical management options for BPH

A

-> Alpha blockers (e.g. tamsulosin) : relaxes smooth muscle
-> 5-alpha reductase inhibitors (e.g. finasteride) : gradually reduces the size of the prostate.

37
Q

How does finasteride work in BPH

A

-> 5-alpha reductase converts testosterone to dihydrotestosterone (DTH)
-> Finasteride prevents this, this reduces the amount of DTH leading to a reduction in prostate size.

38
Q

What is a notable side event of tamulosin

A

Postural hypotension

39
Q

what is most common surgical management of BPH

A

-TURP

40
Q

Symmetrical distal polyarthropathy
Worse after rest, improves with activity
Morning stiffness >60 mins
Fatigue, weight loss, muscel aches and weakness

A

Rheumatoid arthritis

41
Q

what joints are typically affected in RA

A

Small joints of hands and feet
Hands : wrist, MCP, PIP (never DIP)
Feet : ankle

42
Q

Give 4 signs of RA in the hand

A

-Thumb : z shaped deformity
- Swan neck :
-Boutonnieres
-Ulnar deviation of fingers at MCP joint

43
Q

what 2 antibodies are involved in RA

A

-RF
-Anti-CCP (more sensitive and specific)

44
Q

4 changes on X ray in RA

A

L : Loss of joint space
E : erosions (bont)
S : Soft bones (periarticular osteopenia)
S : Soft tissue swelling

45
Q

what are the 4 steps to the management of RA

A

1st : DMARD : methotexate, leflunomide, sulfasalazine.
2nd : two in combination
3rd : Methotrexate + biologic (e.g. TNF inhibitor)
4th : Methotrexate + rituximab

46
Q

4 x ray changes in OA

A

L : loss of joint space
O : osteophyte
S : subchondral sclerosis
S : Subchondral cyst

47
Q

Joint pain and stiffness (<30 mins)
Worsened by activity

A

OA

48
Q

What joints are involved in OA

A

Hips
Kness
Sacro-iliac
DIPs
CMC
Wrist
Cervical spine

49
Q

Give 5 signs of OA in the hands

A

-Herberden’s : DIP
-Bouchard’s : PIP
-Squaring at base of thumb (CMC)
-Weak grip
-Reduced ROM

50
Q

what is the stepwise analgesia control of OA

A
  1. Oral paracetamol / topical NSAID (capsaicin)
  2. Oral NSAID + PPI
  3. Opiates
51
Q

what is the step wise management of T2DM

A

1st : metformin
2nd : add either DPP-4 inhibitor or sulfonyurea
Tell DVLA and car insurance

52
Q

Skin traffic light system

A

-Green : normal
-Amber : pallor reported by parent
-Red : pale, mottled blud

53
Q

Activity traffic light systme

A

-Green : Responds normally, alert, crying, smiling
-Amber : decreased activity, no smile, wakes with prolonged stimulation
-Red : not responsive, weak and high pitched cry, not staying awake

54
Q

Resp traffic light system

A

-Green : normal
-Amber : flaring, >50 (6-12mnths), >40 (>12mnths), O2 under 95, crackles
-Red : grunting, >60, subcostal recession

55
Q

Circulation traffic light system

A

-Green : moist mucus membranes
-Amber : tachy, CRT > 3, dry membranes, poor feeding, reduced urine output
-red : reduced skin tugor

56
Q

Other amber traffic light

A
  • Temp over 39 in 3-6mnths
  • Fever > 5 days
  • Rigor
  • Swelling of limb/joint
  • Not weight-bearing
57
Q

Other red traffic light

A
  • <3mnths and temp over 38
  • Non blanching rash
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal seizure
  • Neurological signs
57
Q

Other red traffic light

A
  • <3mnths and temp over 38
  • Non blanching rash
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal seizure/neurological signs
58
Q

what is seen as tachycardic in <12mnths , 12-24 mnths and 2-5 yrs

A

< 12 mnths = >160 bpm
12-24 mnths = >150 bpm
2-5 yrs = >140bpm

59
Q

what is seen as tachycardic in <12mnths , 12-24 mnths and 2-5 yrs

A

< 12 mnths = >160 bpm
12-24 mnths = >150 bpm
2-5 yrs = >140bpm

60
Q

when would u admit for IV abx in an unwell chid

A

temp >38 in <3mnths
temp >39 in 3-6mnths

61
Q

what abx for otitis media and when would u prescribe them in an unwell child

A

Amoxicillin
Bilateral and <2 years

62
Q

What Abx for sinusitis in an unwell child

A

Amoxicillin or Doxycycline

63
Q

What Ab for LRTI in an unwell child

A

Amoxicillin

64
Q

What Abx for UTI in an unwell child

A

Trimethoprim
Nitrofurantoin

3a (45 decks)

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