Long term Flashcards
What is the blood pressure target of someone <80?
Clinic BP <140/90 mmHg
ABPM/HBPM <135/85 mmHg
What is the blood pressure target of someone >80?
Clinic BP <150/90 mmHg
ABPM/HBPM <145/85 mmHg
In diagnosing diabetes, what criteria are used for a fasting plasma glucose test, and what level indicates diabetes?
Fasting plasma glucose greater or equal to 7mmol.
Criteria include fasting for at least 8 hours.
In a patient with type 2 diabetes not achieving glycemic control on metformin, what oral antidiabetic agent may be considered as add-on therapy, particularly if there are cardiovascular considerations?
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, such as empagliflozin, have shown cardiovascular benefits and may be considered in this scenario.
Describe the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria for staging severity in COPD.
Staging is based on post-bronchodilator forced expiratory volume in one second (FEV1) as a percentage of predicted. Stages range from I (mild) to IV (very severe).
What is the stepwise approach in the management of asthma according to the Global Initiative for Asthma (GINA) guidelines?
GINA recommends a stepwise approach, starting with short-acting beta-agonists and progressing to inhaled corticosteroids with or without long-acting beta-agonists based on symptom severity.
In the context of stable angina, what role does beta-blocker therapy play, and when may it be contraindicated?
Beta-blockers are first-line for stable angina to reduce myocardial oxygen demand. They may be contraindicated in certain conditions like severe heart failure or bronchospastic diseases.
In the management of hyperlipidaemia, what is the primary target of statin therapy and when do you chase patients up?
NICE recommend we follow up patients at 3 months
repeat a full lipid profile
if the non-HDL cholesterol has not fallen by at least 40% concordance and lifestyle changes should be discussed with the patient
NICE recommend we consider increasing the dose of atorvastatin up to 80mg
For stroke prevention in non-valvular AF, what factors are considered in choosing between warfarin and direct oral anticoagulants (DOACs)?
Factors include age, renal function, bleeding risk, and patient preference. DOACs are often preferred due to their predictable pharmacokinetics and fewer interactions compared to warfarin.
In the management of heart failure with reduced ejection fraction (HFrEF), what neurohormonal antagonist is recommended, and when is it contraindicated?
ACE inhibitors or ARBs are recommended in HFrEF. Mineralocorticoid receptor antagonists (e.g., spironolactone) are also indicated, but they are contraindicated in severe renal dysfunction or hyperkalemia.
Explain the mechanisms of action of medications such as orlistat in the treatment of obesity.
Inhibits pancreatic lipase, reducing fat absorption.
What are two contra-indications to orlistat?
Cholestasis
Chronic malabsorption syndrome
Identify two specific preventive care measures that may be underutilized in a particular ethnic group within a local general practice. How can healthcare providers address this disparity?
Mammography and colorectal cancer screening. Strategies may include targeted community outreach, culturally sensitive educational materials, and providing these services in accessible community locations.
In a specific ethnic group, data shows lower rates of influenza vaccination compared to the general population. Provide three targeted interventions a general practice could implement to address this disparity, considering cultural and accessibility factors.
Interventions may include culturally tailored vaccination campaigns, offering vaccination at community events, and employing multilingual staff to provide education and administer vaccines.
In a practical exam scenario, a patient advocates for improved cultural competence within a general practice. Provide three measurable actions the patient can take to actively contribute to creating a more culturally competent healthcare environment.
Actions may include joining patient advisory councils, providing feedback on cultural competence training programs, and collaborating with the practice to develop culturally sensitive patient education materials.
Describe two key components of advanced care planning that are particularly relevant when managing end-of-life care for patients with heart failure. Provide examples of how these components can be applied in the context of heart failure.
Components may include identifying healthcare proxies (Trusted family)
Discussing treatment preferences. In heart failure, this could involve exploring preferences regarding aggressive interventions like resuscitation or the use of mechanical circulatory support devices.
What medication is given in COPD to loosen the phlegm?
Acetylcystine
What are the symptoms of diabetes?
Polyuria, polydipsia, unexplained weight loss (type 1), blurry vision, fatigue
What is the diagnostic criteria for type 2 diabetes if the patient is asymptomatic?
- You can use either a plasma glucose or a HbA1c sample
- If the patient is asymptomatic you must repeat the blood tests.
- Fasting glucose must be greater than or equal to 7.0mmol/L
- Random glucose greater than or equal to 11.1mmol/L (after 75g oral glucose tolerance test)
- HbA1c of greater than or equal to 48mmol/mol (6.5%) is diagnostic
Does an HbA1c of less than 48mmol/mol (6.5%) exclude diabetes?
No
It is not as sensitive as fasting samples for detecting diabetes
What is defined as pre-diabetes?
HbA1c is 42-47 mmol/mol
Or fasting glucose is
6.1-6.9 mmol/l
How do you diagnose type 2 diabetes?
Suspected T2DM?
Fasting glucose >7mmol/l or HBA1c >48 mmol/mol
Symptomatic?
Yes
Diagnosis confirmed
No
Repeat HbA1c/fasting glucose. If abnormal- diagnosis confirmed
Do you have to test for c-peptide and diabetes-specific autoantibodies if they have one or more of the following?
ketosis
rapid weight loss
age of onset below 50 years
BMI below 25 kg/m²
personal and/or family history of autoimmune disease
NO
Only plasma glucose tests. No need for further investigations
When should you add Metformin in type 1 diabetes?
IF the BMI is >25kg/m2
How often should you recommend self-monitoring of blood glucose in diabetes?
recommend testing at least 4 times a day, including before each meal and before bed
more frequent monitoring is recommended if frequency of hypoglycaemic episodes increases; during periods of illness; before, during and after sport; when planning pregnancy, during pregnancy and while breastfeeding
What is the insulin regime of choice for type 1 diabetes?
Twice-daily insulin detemir
Multiple daily injection basal-bolus insulin regimens
Describe a typical insulin regime for a type 1 diabetic?
Insulin regimes are initiated by a specialist in diabetes. Patients are usually initiated on a basal-bolus regime.
The basal part refers to an injection of a long acting insulin, such as “Lantus”, typically in the evening. This gives a constant background insulin throughout the day.
The bolus part refers to an injection of a short acting insulin, such as “Actrapid”, usually three times a day before meals. This is also injected according to the number of carbohydrates consumed every time the patient has a snack.
