Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GP 3b > gp 3B > Flashcards

gp 3B Flashcards

1
Q

list some risk factors for non alcoholic fatty liver disease

A

METABOLIC SYNDROME- obesity, hypertension, diabetes, hypertriglyceridaemia, hyperlipidaemia

secondary to drugs (NSAIDS, corticosteroids, methotrexate), PCOS, hypothyroidism, hep C virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the stages of non alcoholic fatty liver disease

A

steatosis–> steatohepatitis–> fibrosis–> cirrhosis

insulin resistance leads to build up of fat in liver cells, causes inflammation (steatohepatitis), stellate cells lay down fibrous tissue, and eventually whole architecture of liver is changed (cirrhosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

signs and symptoms NAFLD

Typical blood test pattern

A

often asymptomatic and picked up incidentally on blood tests

fatigue and malaise. significant damage- hepatomegaly, jaundice, RUQ pain, ascites

LFTs- AST and ALT raised persistently for 3 months
Bigger rise in ALT (L= liver, L=lipids)
(in alcoholic hepatitis AST more raised (s= shit loads of alcohol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

management of NAFLD

A

steatosis and steatohepatits reversible

  • reverse factors causing insulin resistance- diet, exercise, medication to control blood glucose
  • optimise hypertension, hyperlipidaemia, diabetes management

fibrosis and cirrhosis irreversible

  • need for specialist surveillance for hepatocellular cancer (ultrasound scans and AFP
  • liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

diagnosis of NAFLD

A

LFTs
ultrasound scan
biopsy and fibroscan (transient elastography)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

complications of NAFLD

A

direct liver complications- portal hypertension, variceal haemorrhage, liver failure, hepatocellular carcinoma, sepsis

metabolic complications- hypertension, CKD, impaired glucose regulation, diabetes type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

likely cause of LTF results:

raised AST> ALT

A

AST- Cirrhosis or alcohol (Shit loads of alcohol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

likely cause of LTF results:

Raised ALT> AST

A

ALT- acute or chronic liver disease (L=liver specific)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

likely cause of LTF results:

raised ALP> ALT

A

ALP- cholestasis (plug)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

likely cause of LTF results:

raised ALT> ALP

A

ALT - hepatocellular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

likely cause of LTF results:

ALP raised, GGT normal

A

ALP, normal GGT- likely bone cause (bp, no GGT in bone)
check calcium

bony mets, primary bone tumour, vit d deficiency, recent bone fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

likely cause of LTF results:

ALP and GGT raised

A

ALP and GGT- likely liver cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

causes of acute hepatocellular injury

A

paracetamol overdose
infection- hep a, hep B
liver ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

causes of chronic hepatocellular injury

A

alcoholic fatty liver disease
NAFLD
chronic infection (hep B/ C)
primary biliary cirrhosis

(alpha 1 antitrypsin deficiency, wilsons disease haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the BMI cut off points

A 
Healthy weight- 18.5-24.9
overweight 25-29.9
obesity 1- 30-34.9
obesity 2 35-39.9
obesity 3- 40 or more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the recommended amount of exercise people should do a week

A

30 mins 5 days a week. activities can be in 10 min bursts. 2x weight bearing sessions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

summarise the management of type 1 diabetes

A
  • INSULIN- 2x daily background medium acting insulin and pre-meal quick acting insulin
  • monitor blood glucose to determine pre-meal insulin
  • measure carbohydrate intake
  • awareness of blood glucose lowering effect of exercise
  • DAFNE- insulin treatment education programme- dose adjustment for normal eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

summarise the management of type 2 diabetes

A

lifestyle- exercise, diet, weight loss
medication to conrol BP< blood glucose, lipids
identification and prevention of long term microvascular complications

1st line drug treatment- metformin

  • opposes insulin resistance
  • modest improvement in HbA1c
  • no weight gain
  • reduces cardiovascular risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

side effects and risk of metformin

A

diarrhoea, N+V, abdo pain

risk of lactic acidosis if renal function impaired- do not prescribe if eGFR < 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

routine clinical investigations for tired all the time

A 
FBC
ESR and CRP
LFTs
U+E
TFT
glucose/ HbA1c
IgA TTB (coeliac)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the risk of using sulphonylurea to treat DM type II

A

hypoglycaemia

weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how should pain management be stepped up in a dying patient

A

WHO analgesic pain ladder

1) non opioid analgesics- NSAIDs, paracetamol
2) weak opioids- cocodamol, codeine, tramadol
3) strong opioids-morphine, fentanyl, methadone, oxycodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what should be prescribed with an opioid

A

laxatives
softening- docusate
stimulant- senna, bisacodyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

opioid toxicity signs

A

drowsiness, myoclonic jerks, itching, pinpoint pupils, confusion, agitation, cognitive impairment, hallucinations, vivid dreams, respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
main symptoms to control in dying patient
``` N+V breathlessness respiratory secretions pain agitation ```
26
what anti-emetic should be used in a patient with parkinsons
domperidone- doesn't cross BBB so cant cause extrapyramidal side effects
27
5 reversible/ treatable causes of nausea and vomiting
drugs- opioids, PPIs, NSAIDs, SSRIs, antibiotics (stop drug) pain- analgesia anxiety- explore fears, anxiolytic- lorazepam constipation- laxatives raised ICP- dexamethasone electrolyte disturbances infection- antibiotic bowel obstruction- surgery, steroids, antiemetics
28
Suitable antiemetic for chemical/ drug causes of N+V
haloperidol- inhibits chemoreceptor trigger centre
29
suitable antiemetic for gastric stasis
metoclopramide (pro-kinetic agent)
30
antiemetic used in chemotherapy
ondansetron
31
what is the DS1500 form?
form for immediate release of certain funds eg disability living allowance, incapacity benefts etc, for a patient with a terminal illness fast track to certain welfare benefits
32
pre- emptive medication prescribed for 'death rattle'
hyoscine butylbromide
33
main locations lung cancer metastases to
``` bone brain liver lymph nodes adrenal glands ```
34
4 main features of CXR suggesting lung cancer
hilar enlargement peripheral opacity (visible lesion in lung field pleural effusion- usually unilateral lobar collapse
35
presentation of AF
``` asymptomatic irregularly irregular pulse syncope/ dizziness breathlessness palpitations chest discomfort TIA/ stroke ```
36
pathology of AF
irregular atrial rhythm between 300-600bpm. The AV node is unable to transmit beats as quickly as this, and thus does so intermittently, resulting in an irregular ventricular rhythm. This irregular stimulation of the ventricles reduces cardiac output by up to 20%, as well as allowing stasis of blood in the heart chambers.
37
causes of AF
cardiac- hypertension, heart failure, MI, valve disease, congenital heart disease pulmonary- PE, pneumonia, bronchocarcinoma other- alcohol, hyperthyroidism, sepsis, hypokalaemia, hypermagnesaemia
38
ECG findings in AF
irregular QRS complexes/ R-R intervals | absent P waves
39
investigations of AF
ECG bloods- U+Es, TFTs, cardiac enzymes echo- structural abnormalities
40
management of acute AF
emergency electro-cardioversion if haemodynamically unstable if haemodynamically stable -rate control- betablockers, then digoxin -rhythm control- pharmalogical cardioversion (amiodarone, flecainide) anticoagulation- heparin
41
management of chronic AF
rate control - betablocker (CCB if asthma) 1st line - digoxin monotherapy only if sedentary - combination therapy (betablocker, digoxin, diltaziem) if uncontrolled rhythm control - if symptoms continue after rate control - cardioversion- electrical/amiodarone pace and ablate strategy - left atrial ablation - if permanent atrial fibrillation with symptoms or left ventricular dysfunction thought to be caused by high ventricular rates. assess stroke and bleeding risk stop smoking, limit caffeine and alcohol
42
how to assess stroke risk in AF
CHA2DS2 VASc 1 year risk of stroke ``` congestive heart failure hypertension age >75 diabetes stroke/ TIA/ TE Vascular disease age 65-75 sex (female) ``` 1- low- moderate risk, consider antiplatelet or anticoagulation 2+ moderate-high risk- start anticoagulant
43
how to assess the risk of bleeding in those starting anticoagulation for AF
HASBLED risk of major bleeding for patients on anticoagulant ``` Hypertension abnormal liver/ renal function stroke bleeding history/ predisposition labile INR elderly >65 drugs/ alcohol ``` 3+ high risk of bleeding
44
if patients were at a high risk of stroke, how could this be managed?
anticoagulation | apixaban, rivaroxaban, warfarin, dabigatran
45
risk of stroke following TIA
ABCD2 score ``` age >60 BP > 140/90 clinical features- unilateral weakness (2), speech difficulties (1) duration (>60 mins (2), 10-59 min (1) ) diabetes ```
46
definition of CKD
reduction in kidney function or structural damage (or both) present for more than 3 months, with associated health implications. - eGFR <60mL/min - > 3 months - evidence of structural/ functional abnormalities: proteinuria, ultrasound, biopsy, U+Es
47
risk factors of CKD
``` diabetes hypertension smoking AKI chronic use of NSAIDS Cardiovascular disease ```
48
causes of CKD
diabetes pre-renal- renal artery stenosis renal- diabetic nephropathy, hypertension, glomerulonephritis, myeloma, polycystic kidney disease post renal- urinary obstruction (enlarged prostate, stone, neurogenic bladder, constipation)
49
presentation of CKD
asymptomatic ``` Ureamic state: anorexia loss of appetite nausea oedema muscle cramps peripheral neuropathy pallor hypertension nocturia and polyuria restless legs amenorrhoea ```
50
who to screen for CKD
``` diabetes hypertension cardiovascular disease structural renal disease recurrent UTIs SLE FHx ```
51
investigations of CKD
UEs --> eGFR eGFr- 2 tests 3 months apart urine dipstick- haematuria/ proteinuria FBC- normochromic, normocytic anaemia- anaemia oc CKD (decreased erythropoietin production early morning urine sample- albumin creatine ratio BMI, glucose, lipid, BP profile renal tract ultrasound kidneys often small
52
CKD complications
ABCDEF Anaemia blood pressure calcium phosphate loading + cardiovascular disease vit D- poor bone metabolism- renal bone disease electrolyte derangements- acidosis, hyperkalaemia fluid overload- pulmonary oedema
53
management of CKD
identify and treat reversible causes limit progression/ complications -BP- ACE-I -renal bone disease- check PTH, vit D analogues and calcium supplements -cardiovascular risk- statin, aspirin -diet- mdt involvement symptom control -anaemia- give iron/ b12/ folate and human epo -acidosis- give sodium barcarbonate -oedema- loop diuretics, fluid and sodium restriction renal replacement therapy
54
red flags of a vomiting child
not keeping down any food- pyloric stenosis, intestinal obstruction -projectile vomiting- pyloric stenosis -bile stained vomit- intestinal obstruction -haematemesis or melaena- peptic ulcer, oesophagitis -abdo distension- intestinal obstruction -reduced consciousness, bulging fontanelle, neurologic signs- meningitis -respiratory symptoms- aspiration, infection blood in stool- gastroenteritis, cow milk protein allergy -rash, angioedema- cows milk protein allergy
55
common causative agents of gastroenteritis
norovirus, rotavirus, ecoli, salmonella
56
signs and electrolyte disturbance of pyloric stenosis
projectile vomiting, no bowel movements olive shaped mass RUQ, peristaltic waves L-R dehydration metabolic alkalosis- hypochloraemic, hypokalaemic management: correct electrolyte disturbances. Pylomyotomy
57
premature baby, distended stomach, vomited, temperature, refusing feeds, green vomit, fresh blood in stools likely diagnosis
nec- necrotising enterocolitis diagnosis: transilumination of abdo AXR: distended loops of bowel, thickened bowel wall, intramural gas, gas in portal venous tract
58
signs of appendicitis
``` colicky pain getting worse vomiting pain moving across abdo pain relieved by lying still pyrexic tenderness and guarding ``` abdo ultrasound- thickened non-compressible appendix with increased blood flow
59
management of GORD
small frequent meals burping regularly to help milk settle not over feeding keep baby upright after feeding if problematic cases (chronic cough, hoarse cry, distress, reluctance to feed, poor weight gain - Gaviscon mixed with feeds - thickened milk formula - ranitidine- histamine 2 blocker- recued amount of acid stomach produces
60
risk factors of cows milk protein allergy
atopy formula fed <1yo
61
clinical features of IgE mediated cows milk protein allergy
symptoms within 2 hrs of milk consumption • Skin reactions including itching, erythema, urticaria and acute angioedema • Colicky abdominal pain, nausea, vomiting and diarrhoea • Nasal itching, sneezing, rhinorrhoea and congestion • Cough, chest tightness and wheeze • Anaphylaxis can occur but is extremely rare
62
clinical features of non- igE mediated cow milk protein allergy
symptoms up to a week after ingestion • Atopic eczema, itching and erythema • Colicky abdominal pain, reflux, blood or mucus in stool, constipation or diarrhoea • Cough, wheeze, breathlessness or chest tightness • Tiredness, weight loss and faltering growth
63
management of cows milk protein allergy
-skin prick/ blood test for IgE -trial exclusion of cows milk (exclude from mums diet of breast fed) -hydrolysed milk formula -paediatric dietician -remission rate high- challenge every 6-12 months milk alternatives- avoid soya (common allergen), others can be used age 2yo+
64
what is lactose intolerance
inability to digest lactose due to lack of enzyme lactase. problem of older childhood and adults bloating, diarrhoea, gas not an allergy
65
presentation of cluster headache management
``` disabling, rapid onset excruciating pain around one eye blood shot, lid swelling, miosis, ptosis, lacrimation unilateral pain worse at night can wake person up attacks last 15-90 mins, can have several in day bouts can go on for months, then relapse ``` management ACUTE- 200% o2 and sumitriptans prophylaxis- verapamil
66
presentation of trigeminal neuralgia
``` Asian male >50 paroxysms of intense stabbing pain, lasting seconds unilateral face screws up with pain electric shock in jaw/teeth/gums triggers eg washing hair, brushing teeth ``` management: carbamazepine
67
presentation of migraine management
``` vomiting photophobia aura triggers FHx ``` management - acute- triptans, nsaids, paracetamol, anti emetics - chronic- propranolol, topiramate
68
presentation of GCA
>50 headache, lasting a few weeks tender thickened pulseless temporal arteries jaw claudication ESR >40 treatment: steroids
69
metabolic causes of itch
chronic renal failure and dialysis, liver disease, cholestasis -uraemic pruritic
70
haematological causes of itch
iron deficiency anaemia- do FBC (glossitis, angular cheilitis) polycythaemia rubravera- itching after hot bath. Red face, splenomegaly, burning sensation in fingers and toes, dizziness tinnitus (JAK2 mutation)
71
endocrine causes of itch
graves disease | diabetes mellitus- increased risk of candida infection
72
paraneoplastic causes of itch
lymphoma (not usually leukaemia) | especially hodgkins lymphoma
73
Presentation of seborrheic dermatitis management
chronic relapsing remitting scalp, face and trunk oily skin, psoriasis, immunosuppression, stress oily and dry skin, scaly patches, scaly red eyelid margins (blephitis), flaky patches around hair line, salmon pink think scaly patches Mx- antifungal- ketoconazole
74
investigating systemic causes of itch
``` fbc esr serum ferritin WCC FBC LFTs renal function and electrolytes thyroid function tests ```
75
signs of drug dependency syndrome
craving difficulty controlling substance use withdrawal state tolerance progressive neglect of pleasures and interests persistent use despite clear evidence of harmful consequences guilt, keeping drug use secret, arguments

GP 3b (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions