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4th Year > Primary Care > Flashcards

Primary Care Flashcards

1
Q

FEV1:FVC ratio of what indicates COPD

A

< 70% or 0.7

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2
Q

Stages of COPD based on predicted FEV1 %

A

Stage 1: >80%
Stage 2: 50-79%
Stage 3: 30-49%
Stage 4: < 30%

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3
Q

MRC Dyspnoea Scale Grade 1

A

Not troubled by SOB except on strenuous exercise

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4
Q

MRC Dyspnoea Scale Grade 2

A

SOB when walking quickly or uphill

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5
Q

MRC Dyspnoea Scale Grade 3

A

Walks slower than contemporaries

Has to stop due to SOB

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6
Q

MRC Dyspnoea Scale Grade 4

A

Stops for breath after 100m

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7
Q

MRC Dyspnoea Scale Grade 5

A

Too breathless to leave home

Breathless when dressing

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8
Q

Target PaO2 for COPD patients

A

8KPa

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9
Q

Requirements for long-term O2 therapy in COPD?

A

Non-smokers with a PaO2 < 7.3KPa

OR

Secondary polycythaemia, Peripheral oedema, Pulmonary Hypotension

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10
Q

Prophylactic antibiotics for COPD

A

Azithromycin 250mg 3x weekly

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11
Q

Paroxysmal AF

A

2+ episodes lasting 30 seconds to 7 days

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12
Q

Persistent AF

A

Continuous for 7+ days

Long standing persistent AF if 12+ months

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13
Q

Permanent AF

A

Long-standing persistent and resistant to treatment

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14
Q

When should Amiodarone be used following electrical cardioversion in AF?

A

4 months before, and for 12 months afterwards

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15
Q

What level of NT-proBNP in heart failure requires a referral?

A

400-2000ng/L

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16
Q

What factors may decrease NT-proBNP?

A

Obesity
Afro-Caribbean ethnicity
Diuretics, ACEi, Beta Blocker use

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17
Q

NYHA Classification of Heart Failure

A
  1. No limitations
  2. Slight physical limitations
  3. Marked limitations
  4. Symptoms at rest
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18
Q

When should electrical cardioversion be offered in AF?

A

Patients who have had AF persisting for 48 hours of longer

Transoesophageal echocardiography-guided cardioversion OR conventional cardioversion deemed equally efficacious

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19
Q

Indications for pharmacological rate control in AF (Beta blocker/ digoxin/ Diltiazem)

A

AF with a reversible cause
Patient has heart failure caused by AF
New onset AF
Atrial flutter suitable for ablation

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20
Q

Risks of AF with stroke

A 
Larger infarcts
Increased disability
Death
Long-term care
Impaired cognitive function
Dementia
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21
Q

Anti-arrhythmic drugs for AF

A

Beta-blockers
Flecainide, propafenone (pill in the pocket vs regular)
Sotalol, dronedarone, amiodarone

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22
Q

When to cardiovert in an emergency AF presentation

A

Acute new onset AF with haemodynamic instability

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23
Q

Principles of lifestyle management in heart failure

A 
Food- salt restriction, fluid restriction if hyponatraemic, alcohol intake
Smoking
Yearly influenza vaccinations
Driving e.g. LGV, minibus licenses
Air travel- may be affected
Pregnancy and contraception
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24
Q

Which Heart failure patients should be offered a loop diuretic?

A

Those with preserved LVEF ( greater than 40%)

e.g. Furosemide 80mg OD

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25
Q

Secondary causes of hypertension

A 
Renal disease (mostly intrinsic)
Endocrine (Cushing's, Conn's Phaeochromocytoma, Acromegaly, Hyperparathyroidism
Pregnancy
Coarctation of the aorta
Steroids
MAOIs
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26
Q

Stage 1 Hypertension and management

A

BP 140/90 mmHg
(5 less for ambulatory monitoring)

Lifestyle management alone initially

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27
Q

Stage 2 Hypertension

A

BP 160/100 mmHg
(5 less for ambulatory monitoring)

Start with ACEi or CCB therapy

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28
Q

Indications for pharmacological management of Stage 1 hypertension

A

Under 80 with:

  • Target organ damage
  • Diabetes
  • Renal disease
  • QRISK2 20% +
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29
Q

Thiazide like diuretics

A

e.g. Bendroflumethiazide, Indapamide, Chlortalidone

Best taken in the morning as this has best diuretic effect

Avoid in gout, hypokalaemia, hyponatraemia

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30
Q

ECG changes that may be seen in stable angina

A

Pathological Q waves
ST depression
T wave inversion
LBBB

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31
Q

Initial treatment for Stable Angina

A

GTN spray +

Beta blocker or CCB

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32
Q

Additional drug treatments for Stable Angina

A

Long acting nitrates
Ivabradine (cardiotonic agent)
Nicorandil (vasodilator)
Ranolazine

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33
Q

First line imaging for stable angina

A

64 slice CT coronary angiography

34
Q

Indications for CABG in stable angina patients

A

Imaging identifies left main stem or triple vessel disease

35
Q

For how long may Ticagrelor or Clopidogrel be continue following a STEMI or a NSTEMI?

How long may aspirin be continued for?

A

12 months

Aspirin 75mg is continued indefinitely

36
Q

What is the dose of statins to be used in primary prevention (patients with a QRISK2 > 10%)?

A

Atorvastatin 20mg

37
Q

Which patients should receive a low dose statin as a primary prevention regardless of QRISK2 score?

A

T1DM patients over 40 or with diabetes for 10+ years or with nephropathy
CKD patients

38
Q

What is the dose of statin used in secondary prevention?

A

Atorvastatin 80mg

39
Q

Driving after a heart attack

A

Don’t have to notify DVLA

Should stop for around 4 weeks

40
Q

GTN spray advice in stable angina

A
  • Use before exercise
  • If needed, repeat dose after 5 minutes
  • Call an ambulance after 2 doses
41
Q

How is type 1 DM diagnosed?

A

Random CBG of 11mmol/L
OR
Fasting plasma glucose 7mmol/L on 2 occasions

Plus:
Polyuria, polydipsia, weight loss, increasing tiredness

42
Q

How is Type 2 DM diagnosed?

A

HbA1c >48mmol/mol (6.5%) on 2 occasions
OR
HbA1c >48mmol/mol (6.5%) + blood glucose diagnosis

43
Q

In which patients may HbA1c measurement be unreliable?

A 
Under 18s
Pregnancy
Chronic Kidney Disease
HIV
Pancreatic disease
44
Q

How often are clinic HbA1c levels measured in T1DM

A

3-6 monthly

45
Q

1st line insulin therapy for adults

A

Multiple basal bolus insulin injection

46
Q

2nd line insulin therapy for adults

A

Twice daily Insulin Detemir

47
Q

Glucose targets in Type 1 Diabetes

A

Fasting Plasma Glucose (waking):
5-7mmol/L

Fasting Plasma Glucose (before meals):
4-7mmol/L

Post-meals (90 minutes):
5-9 mmol/L

48
Q

What does DAFNE stand for?

A

Dose Adjustment for Normal Eating

Diet regimes in normal eating

49
Q

What is the target blood pressure in Type 1 Diabetes and what is the first line treatment?

A

135/85mmHg
130/80 mmHg if albuminuria/ metabolic syndrome

1st Line: ACEi or ARB

50
Q

4 stages of Diabetic Eye disease and features

A

1 (Mild): Microaneurysms
2 (Moderate): Haemorrhages, cotton wool spots
3 (Severe): Hard exudates
4 (Proliferative): New vessel formation near optic disc

51
Q

Monitoring in Type 1 Diabetes

A

Retinopathy (3 months initially; then review annually)
Neuropathy/ Foot Care (annual review)
Nephropathy (Measure Albumin: Creatinine annually)
Erectile Dysfunction (offer Sildenafil)
Gastroparesis advice
Cardiovascular risk (lipids, BP)

52
Q

Rapid Acting Insulins

A

Lispro
Actrapid
Aspart
Glulisine

53
Q

Intermediate Acting Insulins

A

Isophane

54
Q

Long Acting Insulins

A

Glargine, Detemir

55
Q

Blood Pressure targets in T2DM

A

140/80 mmHg

56
Q

When should statins be stopped in Non-Alcoholic Fatty Liver Disease (in context of T2DM)?

A

If liver enzyme levels double in 3 months

57
Q

HbA1c target for T2DM patients controlled by lifestyle/ diet or a single drug (metformin)?

A

48mmol/mol (6.5%)

58
Q

HbA1c target for TD2m patients controlled by any drug associated with hypoglycaemia?

A

53mmol/mol (7%)

59
Q

At what point should therapy of T2DM be intensified, and what is the new target HbA1c?

A

When HbA1c reaches 58mmol/mol (7.5%)

New target HbA1c is 53mmol/mol (7%)

60
Q

2nd Line intensification therapies in T2DM after Metformin?

A

DDP4 Inhibitors- Gliptins
Pioglitazone
Sulfonylureas (gliclazide, glimepiride)

61
Q

Contra-indications to Metformin

A 
Renal Impairment (eGFR <30)
Alcohol intake high
62
Q

Side effects of Metformin

A 
Weight Loss (reduced weight gain)
Cardioprotective
Abdominal pain, nausea and vomiting
63
Q

Important facts on Sulfonylureas

A

Can cause Hypoglycaemia

Increases risk of weight gain

64
Q

Contra-indications to Pioglitazone in T2DM

A 
Bladder cancer
Heart failure
Diabetic Ketoacidosis
Macroscopic haematuria
Caution in elderly
65
Q

Important features on SGLT2 Inhibitors (e.g. Canagliflozin)

A

Well tolerated
Increased urine output
Increased infection risk

66
Q

Important features on DDP4 Inhibitors e.g. Sitagliptin

A

Generally well tolerated
Weight neutral
May be effective only for a short period

67
Q

Indications for GLP-1 Mimetics in T2DM

A

BMI 35+

can be offered in BMI under 35 if insulin would be detrimental, or weight loss beneficial to other health problems

68
Q

Which patients should be screened for CKD?

A 
Diabetes
Hypertension
Recurrent UTIs
CV Disease
Structural renal disease
Family History of End Stage Kidney Disease
Patients on Nephrotoxic drugs
69
Q

Most common identifiable cause of CKD

A

Type 2 Diabetes

70
Q

Basis of CKD Diagnosis- investigative tests

A

Serum Creatinine Measurement (eGFR)
Proteinuria (Albumin: Creatinine Ratio)
Haematuria
Renal USS

71
Q

When does CKD normally become symptomatic

A

Stage 4

72
Q

Serum Creatinine Measurement in CKD

A

Don’t eat meat 12 hours before the test

Repeat within 2 weeks if <60

73
Q

Preferred test for proteinuria in CKD

A

Albumin: Creatinine Ratio (is more sensitive to lower levels than Protein:Creatinine Ratio)

74
Q

Action to take upon ACR results in CKD

A

3-70 mg/mmol: Repeat test in 3 months

70 mg/mmol: Refer to nephrology

75
Q

Which two investigations are used to stratify risk in CKD

What would not count as CKD?

A

eGFR and ACR

If eGFR is Stage 1/2; and ACR is under 3, then there is no CKD in absence of other markers of kidney damage

76
Q

Common blood test findings in CKD

A 
Hypocalcaemia
Raised phosphate
Raised Alk Phos
Raised Parathyroid Hormone
Anaemia
77
Q

Blood pressure target in CKD

A

140/90 mmHg

130/80 if ACR is greater than 70

78
Q

First line treatment for Hypertension in CKD

A

ACEi or ARB

79
Q

Dietary advice in CKD

A

Moderate protein consumption
Restrict potassium
Avoid high Phosphate foods (milk, cheese, eggs)

80
Q

When should oral Sodium Bicarbonate be offered in CKD

A

GFR < 30

Serum Bicarbonate < 20 mmol/L

81
Q

Management of restless legs/ cramps in CKD

A

Check ferritin levels

Can prescribe Clonazepam/ Gabapentin

82
Q

What may affect HbA1c readings?

A

Haemglobinopathies- abnormally short RBC lifespans

4th Year (7 decks)

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