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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?

48
Q

investigations for coeliac?

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

what does FBC show in coeliac?

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?

72
Q

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

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??

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?

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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