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CCC > Primary Care > Flashcards

Primary Care Flashcards

1
Q

Main treatment of focal seizures?

A

1st line = carbemazepine

2nd line = lamotrigine or Na valproate

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2
Q

Driving rules following seizures?

A

Isolated seizure = 6m, or 5y if HGV
Dx of epilepsy = 1y seizure free
HGV = 10y seizure free

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3
Q

Tx of absence seizures?

A

1st line = Na val

If not tolerated = ethosuximide

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4
Q

What classifies paroxysmal AF?

A

2+ episodes of AF which terminate within 7days

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5
Q

What is persistent AF?

A

Continuous AF for >7d or which is cardioverted >48hr

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6
Q

What 2 things might you find when assessing pulse in AF?

A

Irregularly irreg pulse, and apex-radial pulse deficit

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7
Q

Where does AF normally originate from?

A

Pulmonary vein

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8
Q

Acute Mx of a stable pt in acute AF?

A

Chemical cardioversion with flecainide or amiodarone. Later start LMWH

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9
Q

CHA2DS2-VASc score of a 71 year old man, with a BP of 164/98, and a previous TIA?

A

4

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10
Q

What do the H and D stand for in HAS BLED?

A 
H = HTN >160 systolic
D = drugs (anti platelets/ NSAIDs) or alcohol (>8 drinks/ week)
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11
Q

Main steps in management of AF?

A
  1. anti-coagulation - Warfarin or NOAC
  2. Rate control - BB (bisoprolol) or CCB (verapamil/dilt) (2nd line)
  3. Rhythm control - BB or flecainide, DC cardioversion
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12
Q

What is a crash landing patient?

A

acute presentation of progressed CKD with no previous Sx

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13
Q

Signs of CKD?

A

pallor (lemon-tinge), pul/periph oedema, pleural effusion, pericarditis, metabolic flap, raised BP

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14
Q

What are the Dx tests for CKD?

A

Creatinine based eGFR (<60) and albumin:creatinine (3+)

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15
Q

Pt with eGFR 36 = what stage CKD?

A

3B

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16
Q

Mx of CKD?

A

BP control (ACD rule), statin, anti platelet (apixaban)

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17
Q

Complications of CKD?

A

Anaemia, bone metabolism & osteoporosis, metabolic acidosis

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18
Q

1st stage Tx in COPD?

A

Either SAMA or SABA

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19
Q

2nd stage Tx COPD?

A

If peak flow <50%: either LAMA or LABA+ICS (with SABA if already on)
Peak flow >50%: LABA or LAMA (with SABA if already on)

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20
Q

3rd stage Tx COPD?

A

LABA+ICS + LAMA (and SABA if already on)

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21
Q

Dx COPD?

A

FEV1/FVC <0.7 predicted , FEV1 <80%

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22
Q

CXR features COPD?

A

Hyperventilation (>6 ant ribs), flat hemidiaphragm, large central pul As, bull, decreased peripheral vascular markings

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23
Q

What are the features of a TACI stroke? What classifies a PACI?

A
  1. Homonymous hemianopia
  2. hemiplegia
  3. higher function loss, e.g. speech

TACI = all 3, PACI = 2/3

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24
Q

What screening tools/scales should be used to assess stroke & TIA?

A

Stroke - Rosier scale, score >0 = stroke liklely
TIA - ABCD2 score, score 4+ –> seen in stroke clinic within 24h. (score <4 –> seen within 1w)

ABCD2 is a prognostic score to identify people at high risk of having a stroke after a TIA.

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25
Q

What investigations must suspected stroke patients have and how quickly should it be done?

A

CT head within 1h

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26
Q

What is the management of a patient who had sudden onset left sided facial and arm weakness 3 hours ago? CT scan showed an area of dark tissue.

A

Alteplase to thrombolyse clot.

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27
Q

What long term medications are given for a stroke/TIA?

A
  1. BP control - e.g. ACEi
  2. Clopidogrel - 75mg OD
  3. Statin - start 48h after stroke
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28
Q

What non-medical Mx/advice must you give stroke pts?

A

Do not drive for at least 4 weeks.

Also offer physio, OT, limb splints/orthoses, SALT etc

29
Q

What is the Tx for TIA?

A

Aspirin 300mg OD for 2w
OR Clopidogrel 300mg OD –> then 75mg OD for 2w

Seen in specialist clinic within 24h

30
Q

A patient comes in with a clinic BP of 145/90, and a home reading of 131/84. Do they have HTN?

A

No - clinic BP is high but home reading is below cut off of 135/85

31
Q

What classifies stage 2 HTN?

A

> 160/100 and HBPM >150/95

32
Q

How is HTN diagnosed?

A

Clinic BP >140/90 –> do either ABPM or HBPM.

33
Q

What does the QRISK2 show?

A

Chance of having a heart attack or a stroke in next 10y.

34
Q

When suspecting HTN, what other things can/must you check before sending pt home with ABPM?

A 
QRISK2 score
Check for signs end organ damage:
- renal - ACR, U&amp;E, eGFR
- eyes - funding exam
cholesterol, ecg etc
35
Q

What can cause labile HTN results?

A

Phaeochromocytoma

36
Q

What lifestyle advice can you give to pts with HTN?

A

Smoking cessation, weight loss, reg exercise, fruit + veg, less salt, relaxation, less caffeine + alcohol

37
Q

When is Tx offered in stage 1 HTN?

A

If <80y and at least one of…

  • target organ damage
  • DM
  • 10y CV risk >20%
  • renal D
  • CVD
38
Q

What is the next option for treating a 65y old gentleman with a BP of 150/87 who is already taking 10mg OD of ramipril?

A

Add in a CCB, e.g. amlodipine 5mg OD

39
Q

A COPD patient needs to step up their medications. He is currently taking terbutaline, but is still having symptoms. His FEV1 was 60%. What would be the next step in his management?

A

Continue the terbutaline (SABA)

As PEFR >50% of expected, start either a LABA (e.g. salmeterol) or LAMA (e.g. tiotropium)

40
Q

A COPD patient is on salbutamol and salmeterol, however he is still having symptoms. What would be the next step?

A

Add in and inhaled corticosteroid, e.g. ipratropium.

41
Q

A COPD patient is taking fluticasone and salmeterol but still having Sx. What is the next step?

A

Add in a LAMA, e.g. tiotropium

42
Q

What is available to help pts stop smoking?

A

Nicotine replacement
Bupropion (helps w/ withdrawal & cravings)
Varenicline (helps with addiction to narcotic)

43
Q

What are the SEs of amlodipine that you must talk to patients about?

A

Flushing, headache, palpitations, ankle oedema,

44
Q

What diseases might cause an obstructive respiratory pattern on spirometry? What do you see?

A

Asthma, COPD, CF, bronchiectasis. Reduced FEV1/FVC.

FEV1 is lower as cannot get air out, however FVC remains the same.

45
Q

Which diseases cause a restrictive pattern on spirometry? What would you expect to see?

A

FEV1/FVC remains near normal or is >0.8.

Lungs have a decreased FEV1 & FVC, hence ratio stays the same (due to decreased compliance and elasticity of lungs)

46
Q

What % of predicted FEV1 classifies lung disease? What dose it mean if a symptomatic patient has a normal FEV1?

A

<80% = lung disease

If symptomatic but normal, Sx must be from another cause, e.g. PE, vasculitis

47
Q

What are the grades of COPD based upon FEV1?

A 
50-80% = mild
30-50% = moderate
<30% = severe
48
Q

Why is asthma not diagnosed using spirometry?

A

Would likely be near normal when asymptomatic. However, reversibility of >12% with SABA indicates diagnosis.

49
Q

Which test can help to differentiate T1DM from T2DM?

A

C-peptide. Will be negative in T1DM. However still some c-peptide present in T2DM

50
Q

A patient has been feeling more thirsty and needing to pass urine more recently. The GP checks their blood glucose level and it is 12.2. Is this sufficient to diagnose DM?

A

Yes - patient is symptomatic and has a high sugar.

If asymptomatic - must measure sugars on 2 separate days at approx same time. Or must have high HbA1c and a blood glucose on same day

51
Q

What are blood glucose aims for pre and post-meals?

A

Pre - 4-6

Post - 5-9

52
Q

Which diabetic medications are CI in renal failure?

A

Metformin, sitagliptin,

53
Q

What is the next step in a patient already on metformin + gliclazide?

A

Add a DPP-4i (sitagliptin), or a thiazolidine (pioglitazone), or exenatide

54
Q

What is the target HbA1c level? When might it be different?

A

Target is 48mmol/L, unless on sulphonylurea - aim 52 as risk of hypos

55
Q

Which diabetic agent can cause thrush?

A

SGLT-2 inhibitors - cause increased urination (wee out the glucose) –> thrush + weight loss

56
Q

What are the potential SEs of metformin?

A

GI upset - N/V/D, abdo pain, anorexia
Weight loss/neutral
rarely - lactic acidosis

57
Q

Which type of seizure is associated with lip smacking? and what is the term for this lip smacking movement?

A

Automatism - lip smacking, chewing, swallowing, hand movements
Assoc with complex partial seizures, also with absence seizures

58
Q

What alternative options are available for treatment of epilepsy? (non-pharmacological)

A

Ketogenic diet - high fat, low protein + carbs
Psychological interventions
Vagus N stimulation
Surgery

59
Q

A 19 year old girl suddenly stops what she is doing and stares into space for 1 minute. Afterwards she is unaware of what happened, but is alert and conscious. What treatment should she be offered? (1st + 2nd line)

A

1st line = Na val or ethosuximide

2nd line = lamotrigine

60
Q

Do epileptics need life long medication?

A

No. If seizure free for 2 years you can consider lowering dose then stopping meds

61
Q

What is the treatment for partial seizures?

A

1st line = carbamazepine

2nd line = lamotrigine/na val

62
Q

How is an acute seizure managed?

A
  1. put in recovery position, check nothing in mouth
  2. CALL FOR HELP. After 5 mins - IV lorazepam 4mg (slow IV infusion), or buccal midaz 10mg, or rectal diaz 10mg
  3. CALL ANAESTHETIST. Repeat dose in step 2 after another 10 mins
  4. IV phenytoin 15mg/kg, max 1g (slow IV infusion), or phenobarbital + CARDIAC MONITOR
63
Q

Which drug is assoc with alopecia and curly regrowth?

A

Na val

64
Q

A patient has started taking AED for epilepsy. Over a period of a few hours they develop angioedema, become hypotensive and a rash starts to develop. What is happening and what medicate might they be on?

A

Stephens-Johnson reaction assoc with lamotrigine

65
Q

What are the investigations for CKD?

A

Bloods –> creatinine based eGFR. If <60 –> repeat in 2w to confirm. Also check glucose, U+Es, LFTs, FBC, antibodies.
Urine: ACR of >3 = clinically significant. Also do dipstick & MC+S

66
Q

What acid-base balance might you see in CKD?

A

Metabolic acidosis

67
Q

What are the complications assoc with CKD?

A

HTN, met acidosis, high K, low Ca –> bone disease, anaemia, fluid retention

68
Q

What is the Tx options for CKD?

A
  1. Lifestyle changes - stop smoking, diet - lower salt & calories etc, exercise
  2. Avoid nephrotoxins - NSAIDs, radiological dye
  3. Control BP - ACEi, CCB, diuretics

Decrease CV risk - statins, anti platelets

Manage the complications

CCC (5 decks)

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