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Phase 3a > GP ILAs > Flashcards

GP ILAs Flashcards

1
Q

A patient has a BP of 140/90 in the practice, what do you do?

A

Commence home/ambulatory monitoring

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2
Q

Home BP monitoring results average over 160/100. What is this? What do you do?

A

Type 2 hypertension is a clinic BP of >160 or a home/ambulatory average of 150. Treat according to ABCD guidelines

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3
Q

Home BP monitoring results average over 140/90 but less than 160. When would you treat this person’s BP?

A

Type 1 - HTN. Treat if patient also has one of the target organs damage. CVR disease. Renal disease. Diabetes.

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4
Q

What lifestyle advice would you give to someone with high BP?

A

control weight, increase exercise, IMPROVE DIET, esp reduce salt, reduce smoking, reduce alcohol & caffience intake, consider relaxation exercises.

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5
Q

What medication would you offer to everyone with high BP?

A

Statin - atorvastatin 20 mg once daily. SE - headache, muscle pain, diarrhoea. NNT = 50

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6
Q

What’s the first like treatment for someone with a high BP under 55?

A

ACE-inhibitor or ARB Calcium channel blocker (if Afro-Caribbean)

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7
Q

A patient has an average home blood pressure of 155 and renal disease. They’re 60. What medication do you use to control BP?

A

Calcium Channel Blocker. amlopdine

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8
Q

What precaution do you need to make when starting someone on an ACE-inhibitor?

A

requires U+E blood test two weeks after start/adjustment date to monitor renal function

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9
Q

What is the mode of action for statins? and what are common SE?

A
  • reducing LDL levels
  • Stabilisation of atherosclerotic plaques
  • Muscle pain, increased DM risk, abnormal LFTs.
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10
Q

What is the main principles of treating acute or chronic heart failure?

A
  1. Treat the cause (arrhythmias, valve disease)
  2. Treat exacerabting factors (anaemias, thryoid disease, infection, HTN)
  3. Avoid other exacerbating factors (NSAIDs, verapamil)
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11
Q

What is the drug management for heart failure?

A

ACE-i + Beta blocker

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12
Q

What drug would you swap to if a patient presents with a cough after starting an ACE-i?

A

Angiotensin-II Receptor Blocker (ARB)

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13
Q

What drug would you add on if a patient remained symptomatic of heart failure after having started on ACE-i + BB?

A

Spironalactone - aldosterone antagonists

requires close creatinie, GFR & potasium monitoring

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14
Q

After treating a heart failure patient with first and second line Tx - what would you prescribe next?

A

Digoxin - slows heart rate

improves exercise tolerance and reduces hospitalisaiton but doesn’t decrease mortalitiy.

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15
Q

What is the definition of polypharmacy?

A

Someone taking 5 or more drugs

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16
Q

Descirbe the type of vaginal discharge suspective of Bacterial Vaginosis and other associated symptoms that may be present.

A
  • thin with offensive fishy odour coating the vagina and vestibule
  • no itch
  • > 4.5 pH
17
Q

What are issues related to polypharmacy?

A

Inappropirate polypharmacy

  • benefits of extra medication not realised
  • medicines used to treat other drug side effects where dose reduction would have been more appropriate
  • increasing number of medications increases the likelihood of errors medication administration
18
Q

Describe the prognosis of HF.

A

mortality rate highest in the first year: 30-40% mortality rate

if requires admission 5 year mortality rate goes up

Trend of mortality rate has been decreasing over time

19
Q

What are some primary preventions for heart disease?

A

NHS health check programme (risk assessment in 40-74 yrs)

education and healthy lifestyle (diet, exercise, smoking and alchol advice/recommendations)

stress management and reduction

20
Q

What are some secondary preventions for heart disease?

A
  • regular ECHOs and BP checks following first MI/onset of Sx
  • daily low-dose aspirin
  • Diet and exercise advice following a MI
  • BP meds
  • Statins
  • Diabetes screening and management
  • suitably modified work
21
Q

What are tertiary preventions for heart disease?

A
  • cardiac rehabilitation programmes
  • community support groups allowing people to share stratergies for wellbeing
22
Q

What are the common causes of vaginal discharge?

A
  • Phsyiological
  • infection (sexually transmitted or not)
  • Vaginal candasis
  • Bacertial vaginosis
23
Q

What is normal physiological vaginal discharge like?

A
  • produce 1-4mls daily
  • varying in consistency depending on point in menstrual cycle because of differeing levels of oestrogen
  • thick and stick to think, clear and slippery
24
Q

Describe the type of vaginal discharge suggestive of Candiasis and any associated symptoms.

A
  • thin white, ordorless
  • vulva itch
  • soreness, dysuria, superficial duspareunia
  • may be normal visble findings OR vulva erthema, odema, fissuring or satellite lesions
  • pH <= 4.5
25
Q

What is the sort of vaginal discharge suggestiv of Trichomoniasis?

A
  • varying levels of volume from a little to a lot, frothy yellow
  • offensive ordour
  • vulva itch
  • dysuria. lower abdomen pain
  • vulvitis, vaginitis, cervicitis, strawberry cervix.
  • pH >4.5
26
Q

What investigations could you perform in primary care for a patient with suspected dementia?

A
  • 6CIT (cognitive impairment test)
  • MMSE
  • rule out UTI
  • Bloods: TFTs, FBC, glucose
  • Hx + collateral Hx
27
Q

What are the main types of dementia?

A
  • Alzheimer’s disease
  • lewy body dementia (Parkinson’s type dementia)
  • vascular dementia
  • frontotemporal dementia
28
Q

What is the pathophysiological difference between lewy body dementia and alzhiemer’s?

A
  • LBD characterised by the presence of lewy bodies subcortically
  • Alzheimer’s characterised by the presence of tau tangles
29
Q

What’s the similarities between LBD and alzheimer’s?

A
  • progressive decline in thinking abilities that lead to an impairment of daily functioning
  • likely changes in mood
  • eventual loss of insight and independence
30
Q

What clinical characteristics would direct you to think a person had LBD?

A
  • prominent halluciantions - animals and people
  • fluctuations in cognitive functioning
  • onset of parkinsonian Sx within a year
31
Q

What clinical characteristics would make you think a patient had Alzhiemer’s rather than any other sort of dementia?

A
  • Amnesic episodic type memory problems - can’t remember lists even with prompting
  • head tilt sign - looks to carer for help remembering things
  • getting lost - first sign
  • continence problems
  • APATHY
  • behvaioural problems usually sign of later stage disease (think FTD if these present first)
32
Q

What autosomal dominant genes can cause Alzheimer’s disease?

A

APOE4

APP

PSEN 1 & 2

33
Q

What are some risk factors for alzheimer’s diseasE?

A
  • loneliness
  • depression/poor mental health
  • lack of exercise
  • obestiy
  • diabetes
  • HTN
  • FHx + presence of causative genetic mutations
34
Q

What medical treatments can you offer to someone with alzheimer’s?

A
  • memantine -NMDAr agonist - prevents excess stimulation of the glutamate system
  • Rivastigmine - anti-acetylcholinesterase inhibitor - increase ACh in synaptic cleft
35
Q

What are the main characteristic of vascular dementia?

A
  • stepwise deterioration of mental functioning
  • intial presentation more likely to be mental slowing and attentional deficit i.e. inability to follow a recipe
  • may have focal neurological signs due to strategic infarcts
36
Q

What is the pathophysiology of vascular dementia?

A
  • happens post vascular insult
  • mutlifocal subcortical infarcts
  • can contribute to cases of earlier onset AD
37
Q

What are some reversible causes of dementia like symptoms?

A
  • folate/B12 deficiencies
  • hypothyroidism
  • alcohol related dementia
  • syphilis
  • depressive psuedodementia
  • normal pressure hyrocephalus - dementia, gait distrubance + urinary incontinence

Phase 3a (15 decks)

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