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Yr3 - GP > Long Term Conditions > Flashcards

Long Term Conditions Flashcards

1
Q

Define diabetes mellitus

A

Metabolic disorder group

Persistent hyperglycemia is caused by deficient insulin secretion =/- resistance to insulin

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2
Q

Define type 1 diabetes

A

Absolute insulin deficiency causes persistent hyperglycaemia

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3
Q

Define type 2 diabetes

A

Insulin resistance and a relative insulin deficiency result in persistent hyperglycaemia

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4
Q

Define gestational diabetes

A

Hyperglycaemia develops during pregnancy

- usually resolves after delivery

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5
Q

Causes of type 1 diabetes

A

Destruction of beta-cells in pancreatic islets of Langerhans

- autoimmunity

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6
Q

Complications of type 1 diabetes

A 
Microvascular
- nephropathy
- retinopathy
- chronic painful neuropathy
- autonomic neuropathy
Macrovascular
- CVD
Metabolic
- DKA
- dyslipidaemia
Increased risk for other autoimmune conditions
Reduced QoL
Skin complications
Infections
Reduced life expectancy
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7
Q

Presentation of type 1 diabetes

A 
Ketosis
Rapid weight loss
Under 50 years
BMI below 25
Personal/FH of autoimmune disease
Random plasma glucose over 11
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8
Q

Precipitating factors of DKA

A 
Infection
Physiological stress
Inadequate insulin or non-adherence
Drugs
- corticosteroids
- diuretics
- salbutamol
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9
Q

Presentation of DKA

A 
Increased thirst and urinary frequency
Weight loss
Inability to tolerate fluids
Persistent vomiting +/-diarrhoea
Abdominal pain
Lethargy/confusion
Fruity smell of acetone on breath
Acidotic breathing - deep sighing respiration
Dehydration
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10
Q

Treatment targets for type 1 diabetics

A

HbA1c at 48 mmol/mol (6.5%) or lower
Advise routine self-monitoring of blood glucose
- fasting 5-7 mmol/L
- random of 4-9 mmol/L

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11
Q

Causes of type 2 diabetes

A

Insulin resistance/insensitivity and insulin deficiency

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12
Q

Risk factors for type 2 diabetes

A

Obesity and inactivity
FH
Ethnicity - Asian, African and Black communities at greater risk
History of gestational diabetes
Poor dietary habits - low fibre, high GI diet
Drug treatments - statins, corticosteriods
PCOS
Metabolic syndrome
Low birth weight for gestational age

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13
Q

Complications of type 2 diabetes

A 
Macrovascular
- CVD
Microvascular
- nephropathy
- retinopathy
- chronic painful neuropathy
- autonomic neuropathy
Metabolic
- dyslipidaemia
Psychological
Reduced QoL
Infections
Reduced life expectancy
Dementia
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14
Q

Drug management of type 2 diabetes

A 
Metformin
- gradually increase dose over several weeks to reduce GI side effects
- monitor renal function
If metformin contrindicated or not-tolerated
- gliptin
- pioglitazone
- sulfonylurea
- SLGT-2i
Statin - reduce CVS risk
ACEi/ARB if hypertensive
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15
Q

Lifestyle management of type 2 diabetes

A 
Emphasise importance of healthy balanced diet
- high fibre
- low GI index
- low-fat dairy 
- oily fish
Regular exercise - lowers blood glucose levels
- reduced CVS risk
- help with weight management
Max 14 units alcohol a week
- may exacerbate hypoglycaemic effects of drugs
Smoking
- CVS risk
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16
Q

Risk factors for diabetic foot

A 
Neuropathy
Limb ischaemia
Ulceration
Callus formation
Infection/inflammation
Deformity
Gangrene
Charcot arthropathy
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17
Q

Define COPD

A

Chronic Obstructive Pulmonary Disease

  • emphysema = loss of parenchymal lung texture
  • chronic bronchitis = cough and sputum production for at least 3 months for 2 consecutive years
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18
Q

Risk factors for COPD

A 
Tobacco smoking
Occupational exposure
- dusts - coal, grains, silica
- fumes or chemicals - welding fume, dyes
Air pollution
Genetics
- alpha1-antitrypsin deficiency
Lung development
- maternal smoking
- pre-term birth
Asthma
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19
Q

Complications of COPD

A 
Reduced QoL 
Increased morbidity and mortality
Depression and anxiety
Cor pulmonale
Frequent chest infections
Secondary polycythaemia - overproduction of RBCs
Respiratory failure - increased airway resistance
Pneumothorax - bulla
Lung cancer
Muscle wasting and cachexia
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20
Q

Clinical presentation of COPD

A

Breathlessness - persistent, progressive over time, worse on exertion
Chronic/recurrent cough
Regular sputum production
Frequent lower respiratory tract infections
Wheeze
Cyanosis
Raised JVP
Cachexia
Hyperinflation of chest
Use of accessory muscles/pursed lip breathing

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21
Q

Features of spirometry of COPD

A

Post bronchodilator FEV1/FVC less than 0.7

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22
Q

Clinical features of cor pulmonale

A 
Peripheral oedema
Raised JVP
Systolic parasternal heave
Loud pulmonary second heart sound
Hepatomegaly
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23
Q

Investigations for COPD

A

Chest x-ray
Full blood count - anaemia, polycythaemia
Spirometry

24
Q

MRC dyspnoea scale

A

1 - not troubled by breathlessness except during strenuous exercise
2 - short of breath when hurrying or walking up slight hill
3 - walks slower than contemporaries on level because of breathlessness, has to stop for breath
4 - stops for breath after 100m or few mins on level
5 - too breathless to leave house

25
Q

Differential diagnosis of COPD

A 
Asthma
Bronchiectasis
Heart failure
Lung cancer
ILD
Anaemia
TB
Cystic fibrosis
Upper airway obstruction
26
Q

Define acute exacerbation of COPD

A

Sustained worsening of person’s symptoms from usual stable state
- acute in onset

27
Q

Causes of acute exacerbations of COPD

A

Respiratory tract infections
- commonly rhinovirus
Smoking
Enviromental pollutants

28
Q

Clinical presentation of acute exacerbations of COPD

A

Increased breathlessness
Increased cough
Increased sputum production and change in colour

29
Q

Differential diagnosis of acute exacerbations of COPD

A 
Pneumonia
PE
Pneumothorax
Acute heart failure
Pleural effusion
Cardiac ischemia/arrhythmia
Lung cancer
Upper airway obstruction
30
Q

Management of COPD

A 
Stop smoking
Pneumococcal and influenza vaccinations
Pulmonary rehabilitation
SABA or SAMA to increase exercise tolerance
LABA or LAMA
31
Q

Management of acute exacerbations of COPD

A 
Increase dose or frequency of SABA
Oral corticosteroids - 30mg oral prednisolone
Antibiotics
- amoxicillin
- doxycycline
- clarithromycin
32
Q

Define asthma

A

Chronic respiratory condition associated with airway inflammation and hyper-responsiveness

33
Q

Risk factors for asthma

A 
PMH/FH of atopic disease
Male sex for pre-pubertal asthma
Female sex for persistence of asthma from childhood to adulthood
Respiratory infections in infancy
Exposure to tobacco smoke
Premature birth and low birth weight
Obesity
Social deprivation
Exposure to inhaled particles
Workplace exposure
34
Q

Complications of asthma

A 
Death
Respiratory complications
- irreversible airway changes
- pneumonia
- pulmonary collapse
- respiratory failure
- pneumothorax
Imparied QoL
- fatigue
- underperformance and time off school/work
35
Q

Clinical presentation of asthma

A 
Wheeze - expiratory polyphonic
Cough
Breathlessness
Chest tightness
Episodic, diurnal and triggered/exacerbated by exercise, viral infections or exposure to cold air or allergens
36
Q

Spirometry of asthma

A

FEV1/FVC greater than 70%
Bronchodilator reversibility
Variable peak expiratory flow readings

37
Q

Differential diagnosis of asthma

A 
Bronchiectasis
COPD
Ciliary dyskinesia
Cystic fibrosis
Dysfunctional breathing
Foreign body aspiration
GORD
Heart failure
ILD
Lung cancer
Pertussis
PE
TB
Upper airway cough syndrome
Vocal cord dysfunction
38
Q

Definition of complete control of asthma

A 
No daytime symptoms
No night-time waking
No need for rescue medication
No asthma attacks
No limitations on exercise
Normal lung function
Minimal side effects from medication
39
Q

Management of asthma

A 
Personalised asthma plan
Routine vaccinations
Inhaler technique
Inhaled SABA - reliever
ICS - preventer
LTRA
40
Q

Define MI

A

Necrosis of section of myocardial tissue due to ischaemia

41
Q

Risk factors for MI

A 
Male sex
Advancing age
Socioeconomic status
Geographical location - highest in scotland, lowes in england
Obesity
Smoking
Hyopetesnion
Hypercholesterolaemia
DM
FH
42
Q

Complications of MI

A 
Acute heart failure
Chronic heart failure
Post-infarction angina
Stroke
Depression
Anxiety
Sudden death
43
Q

Secondary prevention of previous MI

A 
Relevant lifestyle changes reduce risk
- stop smoking
- cardioprotective diet
- physically active
- weight loss
- alcohol less than 14 units
Cardiac rehabilitation programme
Medications
- ACEi
- aspirin + clopidogrel/ticagrelor
- beta-blocker
- statin
44
Q

Definition of hypetension

A

Systolic over 140

Diastolic over 90

45
Q

Stages of hypertension

A

1 - 140/90 to 159/99
2 - 160/100 to 180/120
3 - over 180/120

46
Q

Risk factors for hypertension

A 
Age
Sex
Ethnicity
Social deprivation
Lifestyle
Anxiety and emotional stress
47
Q

Complications of hypertension

A 
HF
Coronary artery disease
Stroke
Chronic kidney disease
Peripheral arterial disease
Vascular dementia
48
Q

Investigations for target organ damage due to hypertension

A 
Haematuria
Urine albumin:creatinine ratio
HbA1c
Electrolytes, creatinine and eGFR
12-lead ECG
Serum total cholesterol and HDL cholesterol - CVS risk
49
Q

Secondary causes of hypertension

A 
Renal disorders
- chronic pyelonephritis
- diabetic nephropathy
- glomerulonephritis
- PCKD
- obstructive uropathy
- renal cell carcinoma
Vascular
- coarctation of aorta
- renal artery stenosis
Endocrine
- primary hyperaldosteronism
- phaeochromocytoma
- cushing's syndrome
- acromegaly
- hypothyroidism
- hyperthyroidism
Drugs
- alcohol
- ciclosporin
- COCP
- corticosteroids
- erythropoietin
- NSIADs
50
Q

Management of hypertension

A 
Lifestyle advice
- diet and exercise
- reduce caffeine
- reduce dietary sodium
- smoking cessation
- reduce alcohol consumption
Drug management
- ACEi/ARB
- CCB - over 55 or black African/Afro-Caribbean
- thiazide-like diuretic
51
Q

Define heart failure

A

Ability of heart to maintain the circulation of blood is impaired as a result of structural or functional impairment of ventricular filling or ejection

52
Q

Classification of heart failure

A 
Ejection fraction
- heart failure with reduced ejection fraction (HR-REF)
- heart failure with preserved ejection fraction (HR-PEF)
Time course
- acute
- chronic
Symptomatic severity
- 1-4
53
Q

Causes of heart failure

A 
Myocardial disease
- coronary artery disease
- hypertension
- cardiomyopathies
Valvular heart disease
Pericardial disease
Congestive heart disease
Arrhythmias
High output states
- anaemia
- thyrotoxicosis
- phaeochromocytoma
- septicaemia
- liver failure
- thiamine deficiency
Volume overload
- end-stage chronic kidney disease
- nephrotic syndrome
Obesity
Drugs
- alcohol
- cocaine
- NSAIDs
54
Q

Complications of heart failure

A 
Cardiac arrhythmias
- AF
- ventricular arrhythmias
Depression
Cachexia
CKD
Sexual dysfunction
Sudden cardiac death
55
Q

Clinical features of chronic heart failure

A

Breathlessness
Fluid retention
Fatigue, decreased exercise tolerance, increased recovery time after exercise
Light headedness or history of syncope
Tachycardia
Laterally displaced apex beat, heart murmurs or 3rd/4th heart sounds
Raised JVP
Enlarged liver
Tachypnoea, basal crepitations, pleural effusions

56
Q

Management of heart failure

A

Relive fluid overload - loop diuretic
ACEi
Beta-blocker
Consider statin and antiplatelet

Yr3 - GP (8 decks)

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