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D TO REVISE - PHASE 3A > TO REVISE GP > Flashcards

TO REVISE GP Flashcards

1
Q

HTN
What is malignant HTN?

A

Rapid rise in BP –
- Fibrinoid necrosis
- Retinal haemorrhages
- Papilloedema
- Exudates
Severe HTN ≥180/120

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2
Q

HTN
What are the side effects of ACEi?

A

Dry cough + rash (bradykinin),
hypotension,
hyperkalaemia,
AKI (check renal function 1-2w after starting)
teratogenic

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3
Q

COPD
What are steps 1 and 2 of the COPD management?

A
  • 1 = SABA or SAMA
  • 2:
    – FEV1>50% = LABA and/or LAMA
    – FEV1 <50% LABA + ICS and/or LAMA (also offered in those with asthma/atopic features)
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4
Q

ARRHYTHMIAS
Give 2 effects of hypokalaemia on an ECG

A
  1. Flat T waves
  2. QT prolongation
  3. ST depression
  4. Prominent U waves
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5
Q

ARRHYTHMIAS
Give an effect of hypocalcaemia on an ECG

A
  1. QT prolongation
  2. T wave flattening
  3. Narrowed QRS
  4. Prominent U waves
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6
Q

ARRHYTHMIAS
Give an effect of hypercalcaemia on an ECG

A
  1. QT shortening
  2. Tall T wave
  3. No P waves
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7
Q

HTN
What are the side effects of CCB?

A

Oedema,
headache,
flushing
palpitations

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8
Q

HTN
What are the side effects of beta-blocker?

A

Headache,
hypotension,
erectile dysfunction

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9
Q

T2DM
How does HHS present?
How is it diagnosed?
Management?

A
  • Marked dehydration (polydipsia, polyuria, hypovolaemia) + impaired consciousness
  • Plasma glucose >30mmol/L, plasma osmolality >320mOsm
  • IV fluid replacement, infuse insulin, LMWH prophylaxis as hyperviscous blood
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10
Q

T2DM
What is the mechanism of action of…

i) metformin?
ii) gliclazide?
iii) sitagliptin?

A

i) Increased insulin sensitivity, reduced gluconeogenesis in liver + helps weight
ii) Stimulates beta cells to secrete insulin
iii) Increases incretin levels which inhibit glucagon production

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11
Q

T2DM
What are some side effects of…

i) metformin?
ii) gliclazide?
iii) sitagliptin?
iv) empagliflozin?
v) glitazone?
vi) GLP-1 mimetics?

A

i) GI upset (D+V, abdo pain), lactic acidosis
ii) Hypoglycaemia + weight gain
iii) GI upset, pancreatitis
iv) Glucosuria, weight loss + UTI risk
v) Weight gain, fluid retention, heart failure
vi) Weight loss, N+V, pancreatitis

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12
Q

HYPERTHYROIDISM
What are the Graves’ disease specific features?

A
  • Diplopia, ophthalmoplegia, increased tears
  • Exophthalmos, lid lag + retraction
  • Thyroid acropachy (clubbing, painful digits)
  • Pretibial myxoedema
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13
Q

OSTEOARTHRITIS
What would plain radiograph show in osteoarthritis?

A

LOSS –
- Loss of joint space
- Osteophytes
- Subarticular sclerosis (increased density of bone along joint line)
- Subchondral cysts (fluid filled holes in the bone)

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14
Q

B12/PERNICIOUS ANAEMIA
What are the B12 specific features of the anaemia?

A
  • Peripheral neuropathy with numbness or paraesthesia
  • Loss of vibration sense or proprioception
  • Visual, mood or cognitive changes
  • Glossitis = beefy-red sore tongue
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15
Q

ARRHYTHMIAS
Give 3 effects hyperkalaemia on an ECG

A

GO - absent P wave
GO TALL - tall T wave
GO long - prolonged PR
GO wide - wide QRS

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16
Q

TYPE 2 DIABETES
Describe the treatment pathway for T2DM

A
  1. Lifestyle changes - lose weight, exercise, healthy diet and control of contributing conditions
  2. Metformin
  3. Metformin and sulfonylurea (GLICLAZIDE)
  4. Metformin + sulfonylurea (GLICLAZIDE) + insulin
  5. metformin +sulonylurea (GLICLAZIDE) + insulin +PIOGLITAZONE
  6. Increase insulin dose as required
17
Q

TYPE 2 DIABETES
How does metformin work in treating T2DM?

A

Increase insulin sensitivity and inhibits glucose production

18
Q

REACTIVE ARTHRITIS
What investigations might you do in someone you suspect to have reactive arthritis?

A

ESR + CRP - raised
ANA - negative
RF - negative
X-ray - sacroiliitis or enthesopathy
Joint aspirate - negative (exclude septic arthritis + gout)

19
Q

FIBROMYALGIA
What is the diagnostic criteria for fibromyalgia?

A

Chronic widespread pain lasting for > 3 months with other causes excluded
Pain is at 11/18 tender point sites for 6 months

20
Q

FIBROMYALGIA
Give 3 disease that might be included in the differential diagnosis for fibromyalgia

A
  1. Hypothyroidism
  2. SLE
  3. Low vitamin D
21
Q

GOUT
Describe the pathophysiology of gout

A

Purine –> (by xanthine oxidase) xanthine –> uric acid –> monosodium rate crystals OR excreted by kidneys
Urate blood/tissue imbalance –> rate crystal formation –> inflammatory response through phagocytic activation

Overproduction/under excretions of uric acid causes build up and precipitated out in joints

22
Q

GOUT
Give 3 causes of gout

A

= Hyperuricaemia

  1. Impaired excretion - CKD, diuretics, hypertension
  2. Increased production - hyperlipidaemia
  3. Increased intake - high purine diet = red meat, seafood, fructose, alcohol
23
Q

PSEUDOGOUT
What can cause pseudogout?

A
  1. Hypo/hyperthyroidism
  2. Haemochromatosis
  3. Diabetes
  4. Magnesium levels
24
Q

PSEUDOGOUT
What kind of crystals do you see in pseudogout?

A

Positive birefringent calcium pyrophosphate rhomboid crystals

25
Q

GOUT
What kind of crystals do you see in gout?

A

Monosodium urate crystals = negatively birefringent

26
Q

BPH
What are some investigations for BPH?

A
  • DRE = smooth but enlarged prostate
  • U+Es, serum PSA (rise)
  • Urine dip + MC&S
  • International prostate symptom score (I-PSS) looks at LUTS + how much affect day-to-day life
  • Transrectal USS ± biopsy
  • Flexibly cystoscopy
27
Q

BPH
What 2 medications can be used in BPH and what is their mechanism of action?

A
  • Alpha blockers 1st line (doxazosin, tamsulosin) to relax prostate smooth muscle
  • 5-alpha reductase inhibitor (finasteride) which decreases prostate size by less conversion of testosterone into dihydrotestosterone
28
Q

BPH
What are the side effects of…

i) alpha blockers?
ii) 5-alpha reductase inhibitors?

A

i) Postural hypotension (vasodilation), dizziness, dry mouth
ii) Erectile dysfunction, reduced libido, ejaculation issues

29
Q

CKD
Name 4 cause of CKD

A
  1. DM - 24% of patients
  2. Hypertension
  3. Glomerulonephritis
  4. Congenital - polycystic kidney disease
  5. Urinary tract obstruction
  6. drugs - NSAIDs, ACEi, antidepressants, many antibiotics
30
Q

PROSTATE CANCER
What investigations might you do in someone who you suspect has prostate cancer?

A

Digital Rectal Exam and PSA are done in community,
Transrectal USS and biopsy = DIAGNOSTIC
Gleason grading system - higher the score the worse the prognosis

31
Q

UTI
Give 4 risk factors of UTI’s

A
  1. Catheter
  2. Female
  3. Prostatic hypertrophy (obstructs)
  4. Low urine volume
  5. Urinary tract stones
  6. Pregnancy
32
Q

LYME DISEASE
what are the investigations?

A
  • diagnosed clinically if erythema migrans is present
  • ELISA test
  • immunoblot for lyme disease
33
Q

LYME DISEASE
what is the management?

A
  • doxycycline (amoxicillin if pregnant)
  • ceftriaxone in disseminated disease
34
Q

CKD
What are the different stages of CKD?

A

Stage 1 = <90
Stage 2 = 60-89
Stage 3a = 45-59
Stage 3b = 30-44
Stage 4 = 15-29
Stage 5 = <15

D TO REVISE - PHASE 3A (9 decks)

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