GP Flashcards by RK Splendid

In the mx of hypertension, when do we give medication?

Immediately if BP > 180/120

If between 140/90-179/119 -> confirm another reading w/ambulatory or home BP

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How do we decide whether to give statins or not?

Calculate QRISK2 score.

If overr 10% discuss statins

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With constipation what is quite important to rule out?

Obstruction;

ask about abdominal distension, passing flatus

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Name an anti-emetic safe when there is GI pathology?

Cyclizine

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what might we give as prophylaxis for migraines (aftere treatment of an acute episode with triptans)?

Propanolol

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Patient with RhA gets a sore throat. Differentials?

Strep throat

Agranulocytosis - due to methotrexate

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How do we treat sinusitis/ acute otitis media

Viral Sinusitis - supportive care, nasal decongestant

Bacterial - supportive. Delayed antibiotic prescribing (co-amoxiclav)

Otitis media - pain relief. Abx

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Patient has a chest infection. How are we treating them?

Kids - amoxicillin. Dose depends on age

Adults - amoxicillin 500mg

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Why don’t we stop steroids suddenly?

When patients have been on steroids for a while eg months to years,
This suppresses the body’s normal cortisol production
Stopping the steroid can then swing them into an adrenal crisis - BP crashes, blood sugars crash

They must be weaned off

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How do you treat conjunctivitis in kids?

Chloramphenicol (eye drops)

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What are some causes of subconjunctival haemorrhage?

Trauma
High pressure eg high blood pressure
Clotting disorders, Low platelets

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How do we manage vertigo?

prochlorperazine 2.5mg - anti sickness and vestibular suppressant

Treat underlying cause - eg bacterial infections like syphilis, otitis media, or HIV

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60 year old man comes in shoulder pain bilateral and hip pain. Worse in morning improves in day. Limited extension and external rotation arms. Dfx?

Important as to ask?

Polymyalgia rheumatic a - not muscle pain, they get joint pain!

Ask about temporal tenderness, headache, jaw claudication as people with gca can get pmr

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What does of prednisolone do we start with for Polymyalgia Rheumatica?

15mg OD

Then reduce gradually weeks after first to 12.5 etc

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How do we Mx infective exacerbation of copd?

Prednisolone 30mg for 5 days
Inhalers: increase dose or frequency

3.Antibiotics:
Amoxicillin 500mg TDS
For H. Influenza doxycycline
Clarithromycin if one allergic

4.Afterwards:
Repeat post bronchodilator spirometry
Optimise inhalers

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What are the signs of steroid responsiveness in copd?

Diurnal variation in peak flow
Previous asthma responsive to steroid
- 3rd one

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What is the management of COPD?

Acute:

SABA
LABA + ICS (if asthmatic features/steroid responsive) OR LABA + LAMA (if not)
Triple therapy (laba, lama, ics)

Prevention of infective exacerbation:
- pneumococcal vaccines
- stop smoking, education
- rescue packs of antibiotics and steroid?
Etc

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Differentials for tingling in whole left arm?

Metabolic: B12, diabetes peripheral neuropathy
Central; Migraine with aura, SOL,
Neuro; Stroke/TIA, spinal radiculopathy, poly and mononeuropathies

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What is the GP work up for multiple sclerosis

Bloods:
FBC
UEs, LFT, B12 HBA1c
TFT

To rule out other causes of the parasthrsias

Neurology referral

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How do we treat peripheral vascular disease/claudication in GP?

Anti BP drug eg ACEI
Statins - high dose eg 80mg
Clopidogrel 75mg (or aspirin)

Lifestyle advice; stop smoking, lose weight, good diet
(Can refer for supervised exercise programme and vascular surgery)

If don’t want surgery - 5ht2 receptor blocker
Safetynet- if they get 6Ps on leg!!

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What is the dose of amoxicillin prescribed?

500mg TDS

How do we treat insomnia in the community?

Zopiclone 7.5mg OD

Less worry about overdose
Careful with benzos - dependency

How do you differentiate a viral from bacterial laryngitis?

Difference in treatment?

Exudative tonsillopharyngitis with fever and anterior cervical lymphadenitis is highly suggestive of a bacterial origin.

Viral would just be the normal symptoms of sore throat, vocal hoarseness etc.

Mx:
Viral - supportive care eg paracetamol and anti-tussives, voice rest and hydration.
For bacterial causes, antibiotics (phenoxymethylpen) are used along with supportive measures. Vocal strain is managed with voice therapy and vocal hygiene.

Main side effect of ACEIs eg ramipril?

CVS - palpitations, arrhythmia, angioedema (black pts)
Resp - SOB
CNS - syncope, headache, vertigo
GI - discomfort

Dry cough - ACEis

Hyperkalaemia

What are the positives and negatives of warfarin vs rivaroxaban?

Warfarin - give to old and frail with tendency to fall because can reverse easily - lots of monitoring needed Rivaroxaban - give to young as less monitoring - cannot reverse!

How do we treat chronic sinusitis?

Lifestyle advice eg avoid smoking Admission if needed Consider nasal saline irrigation Consider intranasal corticosteroid eg budesonide nasal

Side effects of CCBs?

Ankle swelling (peripheral oedema) CVS - Palpitations CNS - headache GI - nausea, abdo pain

Elderly woman taking many meds gets postural hypotension. Potential cause?

Antihypertensives!!

Elderly woman taking zopiclone and promethazine, what are potential SEs?

They can cause falls due to sedative effect!

What are target hba1cs in t2dm?

53 - mono therapy | 48 - dual therapy

Ace inhibitor, nsaids, bendroflumethiazide drugs together can cause what? Monitoring?

AKI Monitor UEs Be careful about ACE in patients with diabetes!! - proteinuria etc

When a patient becomes unwell with diarrhoea vomiting, fever sweats, shakes (sepsis) what do we need to consider?

Push oral rehydration Consider stopping these DAMN drugs (or reducing dose for a few days until better to prevent an AKI); Diuretics Ace/Arb Metformin and sulphunylurea NSAIDs If diarrhoea vomiting not stopping or can’t keep down fluids, go to AnE

How is a hiatus hernia managed?

The problem in this condition is acid reflux so; Omeprazole 40mg Lifestyle modifications such as losing weight, elevating the head of the bed, and avoiding large meals, meals just before bedtime, alcohol, and acidic foods.

If someone comes in with asymptomatic atrial fibrillation, how would you go about treating them?

Calculate the CHADsVASC score!! Just having AF alone is not enough indication for treatment If score is 0, No treatment is needed if score is 1+ antiplatelet or anticoagulant (Apixaban, warfarin) heart rate: 90+ should make you consider giving 1 point hence rate control

Which antihypertensives can cause hyponatraemia?

Thiazide diuretics (Bendroflumethiazide)

A patient with HTN comes in with hyperkalaemia and normalish blood pressure. they are taking ramipril. how do we proceed?

Isolated hyperkalaemia could be due to rhabdomyolisis with venepuncture, ESPECIALLY in the face of normal U&Es -> next step is to repeat U&Es

epigastric pain radiates to back worse at night and on empty stomach better after eating ddx?

Duodenal ulcer differentiated from gastric ulcer because gastric ulcer pain worse after eating because of acid release when eating which irritates stomach lining upon eating, alkaline juices secreted into duodenum which relieves pain

what does the following mean; visual acuity left 6/24 right 6/12

poorer vision in left

painful red eye, decreasing visual acuity, halos. name a different?

Angle closure glaucoma rx: Urgent referal to Opthalmology department

what is the normal upper limit of BP at home meeasurement?

135 / 85

Woman is type 1 diabetic. 56 yo. Has developed primary HTN. Albumin:creatinine ratio is high egfr is 43 -> so low what Antihypertensive to give?

ACE Inhibitor because it is Reno-protective (??) and because her ACR and eGFR are distorted -> ONCE you start them on this, monitor renal function soon! if renal function is is deteriorating STOP ACE inhibitor - risk of underlying renal artery stenosis?

Mass that is superior to the testis - well defined. transilluminates. differentials?

epididymal cyst - well defined and superficial to testis - can be painful or painless hydrocele - not well defined as fluid surrounds whole testis - painless

woman gets episodes where her heart feels as though its skipping a beat 2-3 times a week, with pounding sensation, occurs around bedtime ECG is normal; sinus rhythm ddx?

1. Supraventricular premature beats - comes on suddenly 2. Paroxysmal AF: - There isnt pounding - Has to be irregular - the ECG will be normal IF you do not catch them in the episode (so would need ie a 48 hours tape)

how do we manage a superficial thrombophlebitis?

If there is a risk factor for DVT/clot then anticoagulant; Rivaroxaban if not; NSAID 1st line - Naproxen

Which meds are recommended first line in Constipation? exceptions?

Bulk-forming laxatives: Ispaghula husk - 1 sachet PO 2x a day Methylcellulose. Sterculia. (act by retaining fluid within the stool and increasing faecal mass, stimulating peristalsis; also have stool-softening properties) exception - opiod induced constipation (give macrogol)

what is thee target blood pressure for patients including diabetics?

Non-diabetic: 140/85 Diabetic: 130/80 (even with target organ damage)

what is the threshold for treatment of hypertension?

160/100

are beta blockers contraindicateed in heart failure?

NO especially the newer cardioselective ones

Lisit complications of Beta blockers

Asthma Bradyarrthmias Complete heart block Hypotension Cardiogenic shock Severe peripheral arterial disease

What is the scoring system used to predict chances of pulmonary embolism?

PERC score

what are the uses of the different types of diuretics?

Thiazides are used to relieve oedema due to chronic heart failure and, in lower doses, to reduce blood pressure. Loop diuretics (furosemide) are used in pulmonary oedema due to left ventricular failure and in patients with chronic heart failure. Potassium sparing: - Spironolactone is of value in the treatment of oedema and ascites caused by cirrhosis of the liver - Amiloride hydrochloride; used as adjunct to retain potassium