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Year 4 COMP 2 > Primary Care > Flashcards

Primary Care Flashcards

1
Q

What are the four options for antihypertensive medications?

A

ABCD:

  • ACE inhibitor OR Angiotensin II inhibitor
  • Beta-blocker
  • Calcium channel antagonist (dihydropyridine type)
  • Diuretic (thiazides)
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2
Q

What antihypertensive is 1st line in those age > 55 years or black of any age?

A

Calcium channel blocker (e.g. amlodipine)

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3
Q

Which antihypertensive medication you would give to a black 37 year old male?

A

Amlodipine (a calcium channel blocker)

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4
Q

Name the drug you would choose to give to a 64 year old welsh man with hypertension?

A

Amlodipine ( a calcium channel blocker)

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5
Q

A 50 year old welsh man is found to be hypertensive. What medication are you going to start him on?

A

Ramipril (an ACEi)

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6
Q

The 50 year old welsh man you started on ramipril has developed an annoying persistent cough. Which medication might you replace the ramipril with?

A

Candesartan (ARB)

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7
Q

The 50 year old welsh man who is taking candesartan come back to see you as the nurses checked his BP and its still high. What other drugs do you have the option of adding?

A

C or D

  • calcium channel blocker (amlodipine)
    OR
  • diuretic (e.g. indapamide)
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8
Q

What two antihypertensives should not be combined due to increased risk of diabetes?

A

Beta-blocker + thiazide diuretic

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9
Q

A gentleman started on ramipril needs an additional drug to control his high BP. Is candesartan a suitable option?

A

No. You must not combine ACE inhibitor and angiotensin II receptor blockers (ARBs).

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10
Q

What diuretic might you start in a hypertensive patient who has had an MI?

A

Indapamide 1.5mg m/r

Chlortalidone 12.5 to 25mg

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11
Q

Beta-blockers are fourth line therapy for hypertension except in certain circumstances. In what situations would you consider a beta blocker sooner?

A
  • For those with established cardiovascular disease
  • In women of child bearing potential
  • Young patients who are unable to tolerate ACE inhibitors
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12
Q

What are the contraindications to thiazide like diuretics?

A

Gout, dyslipidaemia, urinary incontinence

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13
Q

What are the contraindications to beta blockers?

A

Asthma, heart block, peripheral vascular disease, dyslipidaemia

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14
Q

What are the contraindications to ACE inhibitors?

A

Pregnancy, renovascular disease

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15
Q

What are the contraindications to calcium channel antagonists?

A

Myocardial infarction

Heart failure

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16
Q

What are the possible side effects of thiazide like diuretics e.g indapamide?

A 
Hypokalaemia
Hyponatraemia
Sexual dysfunction
Gout
Glucose intolerance
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17
Q

What are the possible side effects of beta blockers?

A

Fatigue
Insomnia
Cold peripheries
Bradycardia

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18
Q

What are the possible side effects of ACE inhibitors? e.g. ramipiril

A

Cough
First dose hypotension
Taste disturbance
Angio-oedema

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19
Q

What are the possible side effects of calcium channel antagonists e.g. amlodipine

A

Constipation
Peripheral oedema
Flushing
Headache

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20
Q

What type of drug is atorvastatin?

A

An HMG CoA reductase inhibitor i.e. a statin

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21
Q

What do NICE recommend about statins as primary prevention for CV disease?

A

Atorvastatin 20mg od should be given to all those with a QRISK2 score of 10% or more

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22
Q

What do the guidelines state on statins for people with type I diabetes?

A

People with type I diabetes should be offered a statin if:

  • they are over 40
  • they have had diabetes for more than 10 years
  • or if they have had any complications from diabetes
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23
Q

What is the aim when starting a statin?

A

To achieve a 40% reduction in the level on non-HDL cholesterol. (Measurement should be taken 3 months after starting the statin to see if this has been achieved).

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24
Q

What is the commonest side effect of statins?

A

GI upset

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25
Q

If a patient has muscle pains, what should you do before starting a statin?

A

Measure serum CK.
If more than 5 times the ULN you should check it again in 7 days. If still more than 5 times ULN, do not start a statin.
If baseline CK is less than 5 times ULN, start statin with caution, using a lower dose (10mg).

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26
Q

What blood tests should you do before starting someone on a statin?

A

Measure ALT and AST. You should then check them again 3 months after starting the statin and then at one year.

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27
Q

What level rise in AST/ALT should prompt you to stop a statin?

A

3 times ULN

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28
Q

What four drugs should all patients who have had an MI be taking for life?

A

ASBA

1) Aspirin 75mg
2) Statin - 80mg daily for secondary prevention
3) Beta blocker
4) ACE inhibitor

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29
Q

Describe the management of angina

A

Lifestyle SAN!?

1) Lifestyle modification
2) Statin (if cholesterol >4mmol/L)
3) Aspirin 75mg daily decreases mortality by 34%
4) Nitrates GTN for symptomatic control

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30
Q

When is it safe to drive after an MI?

A

Patients should not drive for at least 4 weeks after having an MI.

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31
Q

You started a 57 year old man on amlodipine. His BP is still not controlled. What drug might you consider adding?

A

Add Ramipril.

He’s already taking a calcium channel blocker (since >55yrs) so add an ACEi.

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32
Q

What are the three most common causes of chronic breathlessness seen in GP?

A

LVF, COPD & anaemia

33
Q

What drugs cause breathlessness?

A

B-blockers, amiodarone, drugs affecting the immune response, local radiotherapy & recreation drugs

34
Q

Why might amiodarone cause breathlessness?

A

Risk of interstitial fibrosis or pneumonitis

35
Q

What cause of chest pain is relieved by leaning forward?

A

Pericarditis

36
Q

What cause of chest pain is tearing & mid scapular?

A

Aortic dissection

37
Q

What are the common causes of post operative breathlessness?

A

PE, pulmonary atelectasis, bronchopneumonia, LVF, pneumothorax

38
Q

What investigations should you carry out if you suspect heart failure?

A

ECG and measure BNP levels (markedly raised in HF)

If either are abnormal send for echo

39
Q

How often on average will a full time GP with 2000 patients see:

a) Breast cancer
b) Lung cancer
c) Colorectal cancer
d) Prostate cancer
e) Ovarian cancer

A

a) Every 8 months
b) Every 9 months
c) Every 12 months
d) Every 15 months
e) Every 5 years

40
Q

Who is breast cancer screening offered to? how often?

A

Women aged 50-70 years old, every 3 years

41
Q

Who is colorectal screening offered to and how often?

A

Men and women aged 60-69 - those over 70 can request if they wish. Home FOB (faecal occult blood) testing.

42
Q

What % have with positive FOB test have been found to have cancer in studies?

A

11%

43
Q

What is the sensitivity of FOB? (as a %)

A

60%

44
Q

What are the symptoms of bowel cancer, stated in order of increasing risk

A 
constipation (0.4%)
diarrhoea (0.9%)
weight loss (1.2%)
abdominal pain (1.1%)
Rectal bleeding (2-5%)
Anaemia (up to 13%)
45
Q

Risk of underlying cancer with rectal bleeding in those:

a) Under 60?
b) Over 80?

A

a)

46
Q

A 35 year old man comes to see you as he has been experiencing rectal bleeding for 6 weeks but no other symptoms. Should you refer him under 2 week urgent referral?

A

No. In those age

47
Q

What examination findings would lead you to consider a 2 week urgent referral for suspected colorectal cancer?

A

-Any patient with a rectal mass/ RL abdo mass

48
Q

What would warrant an urgent referral for suspected colorectal cancer in those age 60 or older?

A
  • Any patient aged 60 years and older, with rectal bleeding persisting for 6 weeks
  • Any pt aged 60 and older with change in bowel habit to looser stools/and or increased stool frequency for 6 weeks
49
Q

What would warrant an urgent referral for suspected colorectal cancer in those age 40 or older?

A

-Any patient aged 40 years and older, reporting rectal bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting for 6 weeks or more

50
Q

What risk of lung cancer does haemoptysis confer at first presentation and at second presentation?

A

2.4% at first presentation rising to 17% if reported again

51
Q

What action should you take if a patient presents with haemoptysis?

A

Urgent referral for CXR.

If peristent in 40 years or older and smoker/ex-smoker urgent CXR and REFERRAL

52
Q

What action should be taken for unexplained/persistent (>3 weeks) symptoms associated with lung cancer?

A

CXR

53
Q

List the symptoms lung cancer might present with

A

Haemoptysis, cough, weight loss, fatigue, cervical/supraclavicular lymphadenopathy, chest pain/shoulder pain, dyspnoea, finger clubbing, hoarseness

54
Q

What are the NICE recommendations for urgent referral to a chest physician for suspected cancer?

A

1) CXR suspicious/suggestive of lung cancer - including slow resolving consolidation and pleural effusion
2) Persistent haemoptysis in ex-smokers/smoker aged 40 years or older.

55
Q

What signs of lung cancer require immediate referral/emergency admission?

A
  • Stridor, or

- Signs of superior vena cava obstruction (swelling of neck/face with fixed elevation of jugular venous pressure)

56
Q

What should lead you to postpone testing PSA levels?

A

UTI - for at least one month after proven UTI

PR exam - postpone until one week after

57
Q

What are the indications for urgent referral of suspected prostate cancer?

A
  • Hard, irregular prostate
  • Normal prostate but rising or raised age-specific PSA even if asymptomatic.
  • Symptoms and high age specific PSA levels
58
Q

What should you do if borderline PSA?

A

Repeat at 1-3 months

59
Q

What are the age- specific PSA levels that should warrant referral if associated with symptoms at:

a) Aged 50-59
b) Aged 60-69
c) Aged 70 and over

A

a) 3.0 ng/ml
b) 4.0 ng/ml
c) 5.0ng/ml

60
Q

What are the two emergency contraceptive pills?

A

Levonegestrel

Ulipristal acetate

61
Q

What is 1st line treatment of scabies?

A

Permethrin cream
- all bed linen and clothes should be washed simultaneously in hot water and household contact should also be treated even if asymptomatic

62
Q

How long after unprotected sex can high dose levonorgestrel (levonelle-1) be taken?

A

Up to 72 hours

63
Q

How effective is the emergency contraceptive pill levonorgestrel at:
a) 24 hours?
b) 25-48 hours?
c) 49-72 hours?
(what % of pregnancies would you expect to prevent?)

A

a) 95%
b) 85%
c) 58%

64
Q

What dose of levonorgestrel is given for emergency contraception?

A

1.5mg

65
Q

What advice must you give any woman taking emergency contraceptive pill about sickness?

A

If they vomit within 3 hours they need to repeat the dose or consider having the copper coil fitted.

66
Q

What antiemetic is safe and effective to be co-prescribed with levonorgestrel?

A

Domperidone 10mg

67
Q

How long after unprotected sex can ulipristal acetate (ellaone) be given?

A

120 hours

68
Q

What type of drug is ulipristal acetate?

A

A selective progesterone receptor modulator (SPRM)

69
Q

What is the primary mechanism of action of ulipristal acetate?

A

Inhibits/delays ovulation

may also have effect on the endometrium and inhibit implantation

70
Q

What should you say to the patient regarding immediate contraception after they have been prescribed the emergency contraceptive pill levonorgestrel?

A

Abstain from sex/ use barrier methods until:

  • she has begun bleeding
  • contraceptive cover has been resumed: for the POP after taking again for 2 consecutive days; for COCP after taking again for 7 consecutive days
71
Q

What should you say to the patient regarding immediate contraception after they have been prescribed the emergency contraceptive pill ulipristal acetate?

A

If taking hormonal contraception need to abstain from sex or use barrier methods until after the next period or withdrawal bleed as ulipristal acetate can reduce the effectiveness of contraceptive pill

72
Q

What emergency contraceptive pill is 1st line?

A

Levonorgestrel is 1st line up to 72 hours

72 hrs to 120 hours - ulipristal acetate

73
Q

Which form of emergency contraception is most effective?

A

Copper coil (IUD)

74
Q

What are the contraindications to copper coil?

A 
Suspected pregnancy
Pelvic inflammatory disease
Distorted uterine cavity/uterine abnormality
Cervical or endometrial carcinoma
Trophoblastic disease
75
Q

What must you ask and tell the patient about the IUCD when fitting for emergency contraception?

A

Ask about any contraindications?
Does she want to use it for ongoing contraception?
Inform about risks:
-Likelihood of heavier bleed
-Risk of PID
-Very rare risk of uterine perforation
Tell patient she must have a check up at 6 weeks

76
Q

What things should you be asking about or considering when a patient requests emergency contraception?

A

-How long since first episode of unprotected sex?
-How important not to get pregnant?
-How will pt. access sexual health services in future?
-Is there a need for ongoing contraception? (can be started at the same time as emergency contraception)
-Risk of STIs - offer testing!!
GIVE LEAFLET

77
Q

What drugs can cause symptoms of depression?

A

Beta blockers

78
Q

Chronic sub-threshold depression is also known as?

A

Dysthymia

Year 4 COMP 2 (3 decks)

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