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Fifth Year Medicine > GP > Flashcards

GP Flashcards

1
Q

After how many days do you give a sick note?

A

6 days

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2
Q

Who should be treated for hypertension?

A

BP over 160/100

Or over 140/90 with:
Diabetes
End organ damage: past stroke, MI, angina, peripheral vascular disease, LVH
Cardiovasc risk

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3
Q

What indicates end organ damage in hypertension?

A

Rx if BP over 140/90 if
Heart: LVH, past MI or angia
Vessels: stroke, TIA, peripheral vascular disease
Kidney disease

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4
Q

45 year old man has BP of 165/103 and low K+.

Likely cause?

A

Secondary hypertension due to Conn’s

Hyperaldoesteronism from adrenals

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5
Q

What are the grades of hypertensive retinopathy?

A

1- silver wiring (tortuous thick walled arteries)
2- AV nipping
3- flame haemorrhage + cotton wool spots
4- papilloedema

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6
Q

What is considered stage 1 and stage 2 HTN with ambulatory BP?

A

Take off 5/5 from clinic readings so
Stage 1 > 135/85
Stage 2 > 150/95

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7
Q

What viruses can cause a LRT symptoms along side the common cold?
Particularly in children and older adults

A

Respiratory syncytial virus + parainfluenza (bronchiolitis + croup)
= bronchitis (phlegm + wheeze), bronchiolitis or pneumonia

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8
Q

Commonest cause of URTI?

Common cold

A

Rhinovirus

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9
Q

How can you investigate a patient with the flu to confirm your clinical diagnosis?

A

Serology- takes 2 weeks
Culture- nasopharyngeal swab takes 1 week
PCR- quick

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10
Q

What can you give to children with the flu?

A

Oseltamivir PO

Can cause GI upset, stevens-Johnson
Given if symptoms started in last 48 hours

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11
Q

When might you consider giving Oseltamivir prophylactically for someone coming into contact with the flu?

A

If

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12
Q

HLA associated with type 1 diabetes?

A

DR3

3 Little Pigs + a Straw Shack
liver- autoimmune hepatitis
pancreas- type 1 DM
Sjogrens, SLE

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13
Q

Which is more associated with progression to diabetes:
Impaired fasting glucose (between 6-7)
Or Impaired glucose tolerance (between 7.8-11)

A

Impaired glucose tolerance

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14
Q

Drug causes of diabetes?

A

Steroids
Anti-HIV drugs
Anti-psychotics- clozapine, atypicals
Thiazides

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15
Q

Which auto-antibodies may be found in type 1 diabetes?

A

Islet cell antibodies

Glutamic acid decarboxylase

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16
Q

BP target if stroke, MI, retinopathy or microalbuminaemia?

A

130/80

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17
Q

Patient is on metformin, but HbA1c is above 53 after 16 weeks of it, how do you decide the next medication to add in?

A

BMI below 35: gliclazide
BMI above 35 or hypoglycaemia is an issue: gliptins (DPP4 inhibitors)

DPP4 breaksdown GLP1, a hormone that augments insulin release

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18
Q

Patient is taking metformin, gliclazide and after 6 months, HbA1c is still >57mmol
What are the options now?

A

Insulin

Or glitazone

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19
Q

How do you decide whether to give PCI or thrombolysis to someone with MI?

A

If patient can be at a PCI centre within 2 hours of first medical contact

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20
Q

After how long is fibrinolysis no longer worth giving to someone following an MI?

A

CI after 24 hours

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21
Q

CI to thrombolysis?

A

PC: Aortic dissection, cerebral malignancy or AV malformation,
LP or liver biopsy in last 24 hours

PMH: brain bleed, GI bleed (

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22
Q

If giving thrombolysis what should be given after the tissue plasminogen activator?

A

After alteplase/ reteplase/ tenecteplase

Unfractionated heparin infusion

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23
Q

What features should be present to warrant giving clopidogrel in suspected NSTEMIs?

A

Chest pain with ECG changes- ST depression or raised troponin

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24
Q

What features in a patient would make you opt for an invasive approach in treating an NSTEMI? Aka that make them high risk so conservative approach won’t work?

A
  1. Rise in troponin
  2. Dynamic ST or T waves changes
  3. PMH: diabetes, CKD, angina post MI, LVEF
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25
Q

Rx of high risk patients with suspected NSTEMI?

A

Aspirin + clopidogrel
Fondaparinux
IV nitrate
High risk: GPIIb/IIIa infusion (tirofiban) + inpatient angiography

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26
Q

How soon should angiography be delivered in someone with ongoing pain and an NSTEMI?

A
  1. URGENT: if ongoing angina + evolving ST changes or signs of shock/life threatening arrhythmias = within 2 hours
  2. EARLY: if high risk patient with GRACE score >140 = within 24 hours
  3. If lower risk patient = within 72 hours
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27
Q

Which features are associated with the worst prognosis in NSTEMI?

A

Age > 70
PC: ST depression or widespread T wave inversion
Raised troponin
PMH: unstable angina, previous MI, poor LV function, DM

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28
Q

Causes of angina that are not from atheroma?

A

Aortic stenosis, HOCM
Arteritis
Anaemia
Tachyarrhythmias

29
Q

How does management differ between Prinzmetal angina (due to coronary artery spasm) and angina pectorus?

A

Prinzmetal- aggravated by aspirin, treat with calcium channel blockers ± long acting nitrates

30
Q

CI to beta-blockers in angina?

A

Asthma, COPD
LVF, bradycardia
Coronary artery spasm (variant Prinzmetal angina)

Give diltiazem or verapamil instead

31
Q

What can be given as prophylaxis against angina?

A

Regular oral nitrate or slow-release nitrate

32
Q

What are the pro’s and cons of stenting vs percutaneous transluminal coronary angioplasty Vs medical therapy?

A

PTCA controls symptoms better than drugs but has a higher rate of cardiac events (MI)
Stenting reduces restenosis rates and need for CABG compared to PTCA

33
Q

How can the risk of coronary artery disease (CAD) be used to stratify choice of imaging to confirm diagnosis?

A

> 90% assume CAD
60-90% angiography (aka women over 70, without RFs)
30-60% functional imaging (stress echo, MRI, scintigraphy)
10-30% CT- coronary artery calcification score

34
Q

Which types of troponin are most sensitive and specific for myocardial necrosis?

A

T and I

35
Q

Someone has had an NSTEMI, when would you give Fondaparinux and when LMWH?

A

Low bleeding risk, no angiography planned for 24 hours: fondaparinux

High bleeding risk or angiography planned within 24 hours: LMWH

36
Q

In patients with an anterior MI what additional medication should be considered?

A

Warfarin to protect against a LV mural thrombus causing a thromboembolism

37
Q

Patient with an MI is taking statin, ACEi, b-blocker and clopidogrel. On an ECG you notice the PR interval is 6 squares long and occasionally a dropped beat, what should you change?

A

Stop b-blocker = 2nd degree AV block

38
Q

After MI’s some patients develop ventricular tachycardia, how long does it need to go on for to be sustained vs non-sustained?

A

30 seconds
Non-sustained: do electrophysiological studies if after 48 hours of MI
Sustained: DC shock or amiodarone if stable

39
Q

Rx for pericarditis?

A

NSAIDs

Saddle shaped ST elevation

40
Q

After an MI a patient presents with angina and persistent St elevation. Likely diagnosis and Rx?

A

LV aneurysm

Anticoagulate + consider excision

41
Q

Rx for Dressler’s syndrome: pericarditis, fever, pleural effusions 1-3 weeks post MI

A

NSAIDs + steroids if severe

42
Q

IHx for a patient who has an MI and develops a raised JVP and low cardiac output/failure?

A

Echo

Can diagnose RV failure, ventricular septal defect, cardiac tamponade

43
Q

Name for oesophageal rupture caused by vomiting?

A

Boerhaave syndrome

44
Q

During an endoscopy a patient becomes short of breath and BP drops, a crackling sensation is felt on palpation of the neck. Diagnosis + Rx?

A

Oesophageal rupture- surgical emphysema

As iatrogenic cause, conservative management of:
Antibiotics, PPIs + NG tube

45
Q

Primary sclerosing cholangitis predisposes you to what kind of cancer?

A

Adenocarcinoma of bile duct + gallbladder

Associated with ulcerative colitis

46
Q

What would prompt an ABG in asthma?

A

When sats drop below 92%

47
Q

What rx do you add in for asthma treatment in adults if life-threatening?

A

More regular salbutamol (check ECG for arrhythmias)
Ipratropium NEB
Magnesium sulphate IV

48
Q

What features indicate asthma on a peak flow diary?

A

Diurnal variation of >20% (between morning and evening) on 3 days a week for 2 weeks

49
Q

What change in spirometry results would you expect in someone taking b2 agonists who was asthmatic?

A

15% improvement in FEV1

50
Q

Which vasculitis are associated with asthma?

Name 2

A
  1. Churg Strauss (eosinophilia + vasculitis- looks like sepsis)
  2. Polyarteritis nodosum (rash + ulcers + renal disease)
51
Q

Kawasaki is a version of which vasculitis?

A

Polyarteritis nodosum

52
Q

Signs of aminophylline toxicity (used for asthma)?

A

Fits
GI upset
Arrhythmia

53
Q

Clinical definition of chronic bronchitis?

A

Cough + sputum most days of 3 months for 2 successive years

54
Q

Which are the different dangers faced by being a pink puffer with COPD or a blue bloater?

A

Pink puffer- breathless not cyanosed, risk type 1 respiratory failure (low O2)

Blue bloater- cyanosed not breathless, risk cor pulmonale from CO2 retention + polycythaemia

55
Q

What is the pKa of oxygen that makes someone eligible for long term oxygen therapy in COPD, assuming they are not currently smoking?

A

7.3pKa
Despite O2 therapy
Measurements taken 3 weeks apart

56
Q

When can someone have long term oxygen therapy (15hr a day for benefit) for their COPD if their pO2 is between 7.3-8kPa?

A 
If they also have: 
pulmonary hypertension (RVH, loud S2)
Polycythaemia
Peripheral oedema
Nocturnal hypoxia
57
Q

Patient is on long term oxygen therapy and hypercapnic. What might you consider?

A

Non-invasive ventilation

58
Q

How many pack years makes COPD less likely?

A

Under 10

59
Q

What parameters of a patient’s COPD would make air travel risky?

A

FEV1

60
Q

Which organisms occur commonly in hospital acquired pneumonia? (Within 48 hours)

A

G -ve enterobacteria or staph aureus

Pseudomonas, klebsiella, bacteroides, clostridia

61
Q

A patient has a pneumonia, what features would prompt you to do an CXR to see if it is persisting at all?

A

CRP or persistent symptoms

62
Q

Which conditions require re-vaccination with the pneumococcal vaccine after 6 years?

A

Conditions where pneumococcus could be fatal:
Nephrotic syndrome, post renal transplant
Asplenia, sickle cell

63
Q

What type of influenza is responsible for avian flu?

A

H5N1 strain of Influenza A

64
Q

When would you think about transferring a patient with pneumonia to ITU?

A

If O2 sats not improving with O2

If kPa of CO2 rose above 6kPa (type 2 resp failure)

65
Q

Patient with resolving pneumonia develops recurrent fevers, what would you expect you might drain on pleural fluid aspiration and the features of this aspirate?

A

Empyema-
Yellow turbid fluid
Low pH

66
Q

Why do people get bronchiectasis?

Permanent dilatation of airways from chronic infection

A

Congenital: CF, primary ciliary dyskinesia etc

Post infection: measles, pertussis, penumonia, TB

67
Q

Patient has wet cough for a long time, haemoptysis, coarse creps. Likely diagnosis and IHx?

A

Bronchiectasis (secondary to post-infection, obstruction or congenital)
IHx: sputum culture
CXR
Definitive: High res CT chest
Additional: bronchoscopy to look for obstruction, get culture samples and find haemoptysis site

68
Q

In patients with cystic fibrosis what easy and non-invasive test can be used to screen for exocrine pancreatic dysfunction?

A

Faecal elastase

Fifth Year Medicine (32 decks)

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