key GP knowledge Flashcards
ACS symptoms
ST elevation or LBBB
STEMI
ACS symtoms
No ST elevation
BUT raised troponin and other ECG changes (ST depression, T wave inversion, pathological Q waves)
NSTEMI
ACS symptoms
No ST elevation or LBBB
Normal troponin and nothing on ECG
SOB at rest
Unstable angine
Central crushing chest pain
N&V
Sweating and clamminess
Feeling of impending doom
SOB
Palpitations
Pain radiates to jaw or arms
MI
what is the acute management in a STEMI
M : morphine
O : oxygen
N : GTN
A : aspirin (300mg PO)
what can be done surgically for a STEMI
- Primary PCI (within 2 hrs)
- Thromoblysis with alteplase (>2 hrs)
what is given as secondary prevention of a STEMI
A : aspirin (75mg)
A : another antiplatelet (clopidogrel)
A : atorvostatin (80mg)
A : ACEI (ramipril)
A : atenolol (or other BB)
A : aldosterone antagonist in HF (eplererone)
acute NSTEMI treatment
B : BB
A : aspirin (300mg)
T : Ticagrolr (180mg)
M : morphine
A : anticoagulant (fondaparinux)
N : Nitrates (GTN)
-> O2 if sats dropping
give 5 alternative causes of raised troponin
CKD
sepsis
myocarditis
aortic dissection
PE
Palpitations
SOB
Syncope
AF
what is seen on an ECG in AF
Absent P waves
Narrow QRS complex tachycardia
Irregularly irregular ventricular rhythm
Give 5 causes of AF
S : sepsis
M : mitral valve pathology (stenosis or regurg)
I : IHD
T : thyrotoxicosis
H : HTN
what are the rate control options for AF
- BB (atenolol)
- CCB
- Digoxin
when would rhythm control be offered first line AF
-Reversible cause of AF
-AF is new onset (<48 hrs)
-AF is causing HF
what are the 2 options for rhythm control in AF
-Cardioversion
-Long term medical rhythm control
what are the 2 options for cardioversion
-> 1st = Pharmacological : flecanide. Amiodarone if structural heart disease
-> Electrical
what 3 medications can be used for long term medical rhythm control
- BB
- Dronedarone
- Amiodarone
what is used to determine stroke in AF and what is given if score >1
CHADs2VASc
>1 = anticoagulation (warfarin or DOAC - apixaban)
what is the gold standard investigations for stable angina
-CT coronary angiography
what is used for immediate symptom relief in angina
GTN spray
-> Repeat after 5 minutes. If still in pain after 5 minutes, repeat the dose
What is used for long term symptomatic relief of angina
- BB (e.g. bisoprolol 5mg OD)
- CCB (amlodipine 5mg OD)
What is used in the secondary prevention of angina ?
A : aspirin (75mg)
A : Atorvostatin (80mg)
A : ACEI
a ; already on bb for symptom relief
what can be given to patients with angina that have proximal or extensive disease on CT coronary angiography
Percutaneous coronary intervention
What can be offered to patients with angina and severe stenosis
CABG
- Long term smoker
- Chronic : SOB, cough, wheeze, sputum production, recurrent resp infections
COPD
Explain the MRC dyspnoea scale
1 : strenuous exercise
2 : Uphill
3 : flat
4 : 100 metres
5 : can’t leave the house
How is COPD diagnosed
-Clinical diagnosis + spirometry
-FEV1/FVC <0.7
How is the severity of spirometry in COPD determined
Stage 1 : > 80%
Stage 2 : 50-79%
Stage 3 : 30-49%
Stage 4 : <30%
What can cause earlier and more severe COPD
Alpha 1 antitrypsin deficiency
what is step one in the management of COPD
-Salbutamol -> beta-2-agonist
OR
-Ipratropium bromide -> short acting antimuscarinics
What is step 2 of the management of COPD if the pt is NOT steroid responsive
-> LABA
+
-> LAMA
What is step 2 in the management of COPD if the pt is steroid responsive
-> LABA
+
-> ICS
How is COPD exacerbation managed at home
-> Prednisolone (30mg, OD for 7-14 days)
What are the first line treatment options for COPD exacerbation in hospital
-> Nebulised bronchodilators (salbutamol and ipratropium
-> Steroids
Give 6 causes of a raised PSA
Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise
Recent ejaculation / prostate stimulation
Give 2 medical management options for BPH
-> Alpha blockers (e.g. tamsulosin) : relaxes smooth muscle
-> 5-alpha reductase inhibitors (e.g. finasteride) : gradually reduces the size of the prostate.
How does finasteride work in BPH
-> 5-alpha reductase converts testosterone to dihydrotestosterone (DTH)
-> Finasteride prevents this, this reduces the amount of DTH leading to a reduction in prostate size.
What is a notable side event of tamulosin
Postural hypotension
what is most common surgical management of BPH
-TURP
Symmetrical distal polyarthropathy
Worse after rest, improves with activity
Morning stiffness >60 mins
Fatigue, weight loss, muscel aches and weakness
Rheumatoid arthritis
what joints are typically affected in RA
Small joints of hands and feet
Hands : wrist, MCP, PIP (never DIP)
Feet : ankle
Give 4 signs of RA in the hand
-Thumb : z shaped deformity
- Swan neck :
-Boutonnieres
-Ulnar deviation of fingers at MCP joint
what 2 antibodies are involved in RA
-RF
-Anti-CCP (more sensitive and specific)
4 changes on X ray in RA
L : Loss of joint space
E : erosions (bont)
S : Soft bones (periarticular osteopenia)
S : Soft tissue swelling
what are the 4 steps to the management of RA
1st : DMARD : methotexate, leflunomide, sulfasalazine.
2nd : two in combination
3rd : Methotrexate + biologic (e.g. TNF inhibitor)
4th : Methotrexate + rituximab
4 x ray changes in OA
L : loss of joint space
O : osteophyte
S : subchondral sclerosis
S : Subchondral cyst
Joint pain and stiffness (<30 mins)
Worsened by activity
OA
What joints are involved in OA
Hips
Kness
Sacro-iliac
DIPs
CMC
Wrist
Cervical spine
Give 5 signs of OA in the hands
-Herberden’s : DIP
-Bouchard’s : PIP
-Squaring at base of thumb (CMC)
-Weak grip
-Reduced ROM
what is the stepwise analgesia control of OA
- Oral paracetamol / topical NSAID (capsaicin)
- Oral NSAID + PPI
- Opiates
what is the step wise management of T2DM
1st : metformin
2nd : add either DPP-4 inhibitor or sulfonyurea
Tell DVLA and car insurance
Skin traffic light system
-Green : normal
-Amber : pallor reported by parent
-Red : pale, mottled blud
Activity traffic light systme
-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
Resp traffic light system
-Green : normal
-Amber : flaring, >50 (6-12mnths), >40 (>12mnths), O2 under 95, crackles
-Red : grunting, >60, subcostal recession
Circulation traffic light system
-Green : moist mucus membranes
-Amber : tachy, CRT > 3, dry membranes, poor feeding, reduced urine output
-red : reduced skin tugor
Other amber traffic light
- Temp over 39 in 3-6mnths
- Fever > 5 days
- Rigor
- Swelling of limb/joint
- Not weight-bearing
Other red traffic light
- <3mnths and temp over 38
- Non blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal seizure
- Neurological signs
Other red traffic light
- <3mnths and temp over 38
- Non blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal seizure/neurological signs
what is seen as tachycardic in <12mnths , 12-24 mnths and 2-5 yrs
< 12 mnths = >160 bpm
12-24 mnths = >150 bpm
2-5 yrs = >140bpm
what is seen as tachycardic in <12mnths , 12-24 mnths and 2-5 yrs
< 12 mnths = >160 bpm
12-24 mnths = >150 bpm
2-5 yrs = >140bpm
when would u admit for IV abx in an unwell chid
temp >38 in <3mnths
temp >39 in 3-6mnths
what abx for otitis media and when would u prescribe them in an unwell child
Amoxicillin
Bilateral and <2 years
What Abx for sinusitis in an unwell child
Amoxicillin or Doxycycline
What Ab for LRTI in an unwell child
Amoxicillin
What Abx for UTI in an unwell child
Trimethoprim
Nitrofurantoin
