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GP > the big conditions > Flashcards

the big conditions Flashcards

1
Q

progressive irreversible airway obstruction

A

COPD

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2
Q

4 complications of COPD

A

cor pulmonale
type 2 resp failure
pneumothorax
lung cancer

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3
Q

investigations for COPD?

A

spirometry

CXR

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4
Q

what scale for COPD severity

A

GOLD scale

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5
Q

what will spirometry show on COPD

A

obstructive
FEV <80%
FEV/FVC <0.7

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6
Q

management of COPD?

A

stop smoking
pulmonary rehabilitation
improve health status and exercise tolerance
flu vaccine!!

bronchodilators, steroids, mucolytics

home o2

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7
Q

when do you qualify for home oxygen in COPD?

A

if pao2 below 7.3

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8
Q

as well as stopping smoking, doing pulm rehab, improving health status + exercise tolerance, getting flu vaccine…. what MEDICATIONS could you take for COPD?

A

bronchodilators, steroids, mucolytics

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9
Q

symptoms on COPD exacerabtion?

A

increased SOB

increased purulent sputum

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10
Q

STEPWISE MANAGEMENT OF COPD EXACERABATION

A

nebulized bronchodilators — controlled o2 therapy — steroids — antibiotics — invasive ventilation

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11
Q

nebulized bronchodilators — controlled o2 therapy — steroids — antibiotics — invasive ventilation
= management for what?

A

COPD

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12
Q

define asthma

A

dynamic reversible bronchial hyper-responsiveness

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13
Q

two classes of drug that can make asthma worse

A

beta blockers

NSAIDs

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14
Q

3 elements of asthma pathophys

A

inflammation
smooth muscle contraction
mucus

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15
Q

how much variability in PEFR in 2 wks to diagnose asthma

A

> 15% variabillity in 2 wks

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16
Q

what is in CURB65

A

Confusion
Urea >7
Resp rate >30
Blood pressure <90/<60

> 65

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17
Q

treatment for pneumonia if CURB65 score 0-1

A

oral amox 5ds

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18
Q

treatment for penumonia if CURB65 score 2

A

oral amox + clarith 5ds, ?admit

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19
Q

treatment for pneumonia if CURB65 score >3

A

IV co-amox + clarith 5ds

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20
Q

treatment for hospital acquired pneum?

A

ventilation + IV tazobactam

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21
Q

give me 3 extra consequences of TB that arent pulm

A

meningitis
pott’s vertebrae
arthritis

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22
Q

give me 6 risk factors for TB

A 
IVDU
prison
homeless
malnutrition
overcrowding
HIV
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23
Q

how do you test for LATENT tb?

A

tuberculin skin test

interferon gamma release assay

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24
Q

how do you test for active tb?

A

CXR
culture sputum
bronchoalveolar lavage

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25
Q

what stain do you use to look at tb sputum culture / bronchoalveolar lavage of TB?

A

ziehl-neelsen

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26
Q

what does CXR show in tb

A

consolidation cavitation upper lobes

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27
Q

how do you treat active tb?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

(R+I for 6 months)
(P+E for 2 months)

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28
Q

what is the P of RIPE for TB treatment?

A

Pyrazinamide

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29
Q

What is the E of RIPE for TB treatment?

A

Ethambutol

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30
Q

side effect of ethambutol?

A

optic neurities

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31
Q

side effect of pyrazinamide?

A

arthralgia, gout

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32
Q

side effect of rifampicin ?

A

red urine

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33
Q

side effect of isoniazid?

A

neuropathy

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34
Q

what three categories cause IBD

A

genes + env + immune

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35
Q

4 important things about crohns pathophys

A

transmural + granulomatous
skip lesion
mouth to anus
cobblestone mucosa

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36
Q

not inside the bowel things that can happen in crohns?

A

perianal tags/fissures/fistulae
enteropathic arthritis
apthous ulcers
fatty liver

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37
Q

investigation for crohn’s in stool sample

A

faecal calprotectin

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38
Q

what is faecal calprotectin

A

stool sample crohn’s

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39
Q

investigations for crohns?

A

stool sample

conlonoscpy + biopsy

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40
Q

invesgations for uc?

A

stool sample

colonoscopy + biopsy

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41
Q

treatment of crohn’s?

A

mild - pred

severe - admit, IV hydrocortisone + metronidazole

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42
Q

treatment of UC?

A

mild - sulfasalazine + pred

severe - admit, IV hydrocortisone

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43
Q

4 features of UC pathophys

A 
red mucosa
ulcers
pseudopolyps
crypt abscesses
(variably upfrom rectum)
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44
Q

definitive treatment for uc

A

colostomy can be curative

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45
Q

surgery for crohns

A

resection and temporary ileostomy

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46
Q

T cell autoimmune condition for genetically susceptible. 1 in 100. what’s this condition?

A

coeliac

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47
Q

what protein causes the problem in coeliac?

A

gliadin

48
Q

investigations for coeliac?

A 
FBC
IgA serology (alpha gliadin, ttg, ema)
biopsy duodenum
49
Q

what does FBC show in coeliac?

A

anaemia

50
Q

what is ema test in coleic

A

anti-endomysial antibodies

51
Q

what is ttg test in coeliac

A

tissue tranglutaminase

52
Q

what cancers can coelaic cause

A

T cell lyhpoma

SB cancer

53
Q

3 findings on duodenal biopsy in coeliac

A

villous atrophy
crypt hyperplasia
intra-epithelial lymphocytes

54
Q

treatment for IBS

A

ed, reassurance, diet
low fodmap

anti-spasmodics
laxatives if constip
loperamide if diarrhoea
tricylcics for pain

55
Q

define heart failure

A

complex syndrome in which the ability of the heart to maintain circulation of the blood is IMPAIRED as a result of structural/functional impairment of VENTRICULAR filling or ejection

56
Q

complex syndrome in which the ability of the heart to maintain circulation of the blood is IMPAIRED as a result of structural / functional impairment of VENTRICULAR filling / ejection
=?

A

heart failure

57
Q

what is HF REF

A

<40% ejection fraction on echo

58
Q

what is HF PEF

A

> 40% ejection fraction on echo

59
Q

new york heart association severity 4

A

cant physical activity

60
Q

new york hear association severity 1

A

no limitation on physical activity

61
Q

new york heart association severity 3

A

physical activity limited

62
Q

new york heart association severity 2

A

physcial activity SLIGHTLY limited

63
Q

cardiac causes of heart failure include CORONARY ARTERY DISEASE, hypertension, valve disease, arrhythmias, congenital heart disease, and cardiomyopathies. What are 4 other causes?

A

nephrotic syndrome
end stage CKD
alcohol + cocaine!

64
Q

what is accelerated hypertension

A

> 180/110 + retinal haemorrhages / papilloedema

same day referral to specialist centre!!

65
Q

what is severe hypertension

A

> 180 / >110

66
Q

differential for hypertension

A

white coat hypertension!

67
Q

90% of hypertension is primary, i.e. no identified cause. Name some secondary causes (clue: kidney, endocrine, drugs)

A

diabetic nephropathy
hyperthyroid, phaeochromocytoma, cushings
alcohol, cocaine, methylphenidate, venlafaxine

68
Q

how do you confirm diagnosis of hypertension from clinic

A

ambulatory BP monitoring!!

or home bp monitoring

69
Q

apart from ambulatory BP monitoring, what other investigations do you want to do to rule out secondary causes of hypertension?

A

fundoscopy
12 lead ECG
urine - haematuria, protein:creatinine ratio, eGFR

70
Q

what risk tool do you want to use when youve just diagnosed someone with hypertension?

A

QRISK3

- 10yr risk of CVD

71
Q

an 86yr old man is being treated for hypertension with amlodipine. what is his target blood pressure?

A

<150/90

72
Q

a 54 yr old man is being treated for hypertension with enalapril. what is his target blood pressure?

A

<140/90

73
Q

A 53 yr old Jamaican man hasn’t tolerated the CCB you started for his hypertension. Give an example of a THIAZIDE you might try.

A

INDAPAMIDE

74
Q

do you ever give ARB + ACEi together??

A

nooo

75
Q

50 yr old woman with hypertension. ACE inhibitos havent worked. Whats step 2?

A

ACE-i + CCB

76
Q

ACEi + CCB hasnt worked. What do you try now.

A

ACEi + CCB + thiazide

77
Q

ACEi+CCB+thiazide hasnt worked. What do you try now ?

A

spironolactone / alphablocker / betablocker

78
Q

what is the mortality rate of heart failure?

A

50% die within 5 yrs of diagnosis

79
Q

what is end stage heart failure

A

likely to die within 6-12 months

80
Q

3 complications of heart fialure

A

sexual dysfunction
depression
cachexia

81
Q

which has a worse prognosis - HF-PEF or HF-REF?

A

HF-REF reduced ejection fraction is worse

82
Q

give me 6 symptoms of heart failure

A 
paroxsyaml nocturnal dyspnoea
orthopnoea
nocturnal cough
oedema
fatigue / decreased exercise tolerance
syncope
83
Q

give me 6 signs of heart failure on examination

A 
disaplaced apex beat
tachy
raised JVP
hepatomegaly
pleural effusion
oedema
84
Q

two KEY investigation in diagnosing heart failure?

A

NTpro BNP!!!

12 lead ECG

85
Q

NTpro BNP score of >2000 ….?

A

urgent referral to cardiology!! (2wk wait)

86
Q

NTpro BNP score of 400-2000?

A

standard referral to cardiology

if <400, heart failure unlikely

87
Q

NTpro BNP and 12 lead ECG are the mainstays of heart failure investigations. what else might you wanna check?

A

urine dip - blood + protein
U+Es, eGFR, TFTs, FBC, LFTs,
CXR!
peak flow, spirometry

88
Q

treatment for HF-PEF?

A

LOOP - frusi, bumetanide

+ clopidogrel + statin
exercise rehab programme,
flu vaccine

89
Q

treatment for HF-REF

A

LOOP - frusi, bumetanide
ACE-i or BETABLOCKER. (get stable on one before starting other)

+ clopidogrel + statin
exercise rehab programme
flu vaccine

90
Q

give 3 indicators of end stage heart failure

A

lots of admissions
cardiac cachexia
SOB @ rest (NYHA stage 4)

91
Q

management of end stage HF

A

MDT inc palliative care
symptomatic relief
advance care planning

92
Q

give 3 indicators of end stage heart failure

A

lots of admissions
cardiac cachexia
SOB @ rest (NYHA stage 4)

93
Q

management of end stage HF

A

MDT inc palliative care
symptomatic relief
advance care planning

94
Q

man presents to GP saying he has chest pain on exercising, which lasts under 10 mins and is relieved by rest. is this likely to be stable or unstable angina?

A

stable

95
Q

man with history of angina presents to GP saying he has got chest pain at rest which is lasting longer than usual

A

unstable angina

ADMIT

96
Q

what might you see on ECG in angina

A

pathological Q waves
left BBB
ST wave elevation / T wave inversion

97
Q

three side effects of GTN

A

flushing
headache
light headedness

98
Q

treatment for stable angina?

A

GTN spray

beta blocker or CCB

99
Q

you’ve tried treating a man’s stable angina with GTN spray, a beta blocker, and then tried a CCB. He’s not tolerating them well. What nex?

A

isosorbide mononitrate

ivrabradine

100
Q

ivrabradine acts on

A

funny channels

101
Q

when do u get NHS health check

A

40-75 yrs, every 5 yrs.

primary prevention of CVD

102
Q

if QRISK >10%, what?

A

statin + lifestyle

103
Q

if QRISK<10%, what?

A

just lifestyle

104
Q

ECG, troponin, CK-MB and coronary angiography are all key investigations for MI. When will troponin T and I rise peak and fall?

A

rise - 3-12hrs
peak - 24-48hrs
fall - over 14ds

105
Q

ECG, troponin, CK-MB and coronary angiopgraphy are all key investigations for MI. When will CK-MB rise, peak and fall?

A

rise - 3-12hrs
peak - 24hrs
fall - 48-72hrs

106
Q

man having a heart attack in GP what do you give him?

A

ASPIRIN 300mg

107
Q

ECG, troponin, CK-MB and angiopgraphy are all key investigations for MI. When will CK-MB rise, peak and fall?

A

rise - 3-12hrs
peak - 24hrs
fall - 48-72hrs

108
Q

woman had a heart attack 15 minutes ago. been given aspirin 300mg. what now

A

PCI !!! percutaneous coronary intervention

109
Q

what 2 tests do all MI patients need before discharge?

A

routine exercise ECG testing

coronary angiography

110
Q

there’s no more alteplase in the cupboard and a patient needs fibrinolysis for MI which she had 3 hrs ago. what could you give instead

A

streptokinase

111
Q

there’s no more alteplase in the cupboard and a patient needs fibrinolysis for MI which she had 3 hrs ago. what could you give instead

A

streptokinase

112
Q

what does PCI stand for

A

percuatneous coronary intervention

113
Q

when do you have to do PCI

A

WITHIN 90 MINS!

114
Q

what criteria are DIAGNOSTIC for heart failure (not severity)

A

framingham

115
Q

what might you see on HF CXR

A

Alveolar oedema
kerley B lines
Cardiomegaly
Dilated upper lobe vessels

GP (1 decks)

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