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1
Q

Name some symptoms and signs of heart failure

A

SYMPTOMS
breathlessness, fatigue, ankle swelling

SIGNS
tachycardia, tachypnoea, pleural effusion, raised JVP, peripheral oedema, hepatomegaly, cardiomegaly, 3rd heart sound, cardiac murmurs

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2
Q

What biomarker will be raised in heart failure, and what level would indicate heart failure is unlikely?

A

Beta natriuretic peptide

heart failure unlikely if
<100pg/ml in men under 70yo
<150pg/ml in women under 70yo
<300pg/ml all over 70

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3
Q

What investigations should be carried out to investigate heart failure?

A

if PREVIOUS MI

  • doppler echocardiography
  • BNP if no obvious abnormality

if NO PREVIOUS MI

  • BNP
  • ECG
  • echocardiography
  • bloods- FBC, U+E, creatinine, LFTs, glucose, TFT, caridac enzymes
  • CXR
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4
Q

Signs of heart failure on CXR

A

ABCDE

Alveolar oedema
kerly B lines
Cardiomegaly
Dilated prominent upper lobe vessels
pleural Effusion
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5
Q

what classification system is used with heart failure?

A

New York Heart Association Classification

I- no symptoms on ordinary physical activity
II- slight limitiation
III- less than ordinary activity leads to symptoms
IV- inability to carry out any activity without symptoms

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6
Q

First line mangement of heart failure

A

1) Lifestyle advice
2) ACE-I for all with EF <40%
3) Diuretics for symptomatic relief
4) Beta blockers- symptomatic and lowers EF

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7
Q

Management of acute MI

A 
MONA
Morphine
Oxygen
Nitrates
Aspirin
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8
Q

Define clinical hypertension

A

Stage 1 >140/90

Stage 2 >160/100

Sever >180/110

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9
Q

Management of hypertension

A

Give antihypertensive treatment to

  • <80 yo + Stage 1 and signs/ risk of end organ damage
  • any age with stage 2

MANAGEMENT FOR <55yo

1) ACE-I (ARB if intollerant)
2) combination therapy- ACE-I + CCB/ thiazide
3) add more diuretic- spironolactone/ thiazide/ alphablocker/ beta blocker

MANAGEMENT FOR >55 OR AFROCARIBBEAN OF ANY AGE

1) CCB (or thiazide if evidence of heart failure)
2) combination therapy- ARB+CCB
3) add more diuretic- spironolactone/ thiazide/ alphablocker/ beta blocker

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10
Q

Example, side effect and contraindication of

1) ACE-I
2) CCB
3) thiazide
4) ARB

A

ACE-I
ramipril
SE: dry cough, hyperkalaemia, renal failure
CI: pregnant, breast feeding, renal artery stenosis

CCB
amlodipine/ nifedipine
SE: constipation, headache, flushes
CI: heart failure

THIAZIDE
Chlorthiazide
SE: hyponatraemia, dehydration, dizziness, impotence
CI: gout, diabetes

ARB
Candesartan
SE: dizziness, headache, flu like symptoms
CI: Pregnancy

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11
Q

Important advice to give to parents when deciding to vaccinate their child

A
  • immunisations protect from serious disease
  • reduces the risk, but should be aware of symptoms
  • vaccine inactivated or live but very low dose- will not cause disease in healthy child
  • important to have at right age
  • reduces spread of disease- herd immunity, protects whole community
  • vaccines are safe, they are rigorously tested. May be mild side effects
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12
Q

Name some notifiable diseases

A 
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
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13
Q

In the community, if meningitis is suspected, what should be given?

A

benzylpenicillin

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14
Q

What signs indicate an urgent hospital referral for children?

A

Red in traffic light guidance

  • fever >38 in <3months old
  • fever >39 3-6 months
  • pale, mottled, blue
  • drowsy, unresponsive
  • grunting, tachypnoea >60, chest indrawing
  • low skin turgot
  • non blanching rash
  • bulging fontanelle
  • stiff neck
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15
Q

Thrush presentation, organism, treatment

A

white cottage cheese discharge, vulval itching

candida albicans

oral single dose fluconazole/ pessary/ cream

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16
Q

Bacteria Vaginiosis presentation, treatment

A

thin grey/ white fishy discharge
Clue cells

Metronidazole/ clindamycin

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17
Q

trichomoniasis

A

yellow green frothy discharge, fishy odor, dysuria, bubbly, vaginitis

metronidazole

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18
Q

chlamydia treatment

A

azithromycin stat

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19
Q

Fraser competence guidelines

A

contraceptive advice or treatment can be given to under 16yo without parents if

  • can understand information
  • cant be persuaded to involve parents
  • likely to carry on having sex
  • physical or mental health at risk without advice/ treatment
  • young persons best interest
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20
Q

contraindication of COCP

Study These Flashcards
A

migraine with aura

21
Q

Signs of dementia

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A

Progressive
Memory loss
decline in cognition
difficulties with activities of daily living

22
Q

Name 3 cognitive impairment screening questionnaires

Study These Flashcards
A

GO-Cog
Mini mental state examination
6-CIT

23
Q

Investigations to exclude reversible organic causes of dementia-like symptoms

Study These Flashcards
A
  • Vision and hearing
  • infection screening, biochemistry, thyroid function, b12 and folate, MSU, CXR, ecg
  • Identify depression
  • Trauma and alcohol history
  • risk factors for vascular dementia
24
Q

Differentiating depression from dementia

Study These Flashcards
A

depression more likely if

  • short length of time <6 months
  • global memory loss (rather than short term memory loss)
  • biological symptoms- sleep and apetite
  • worried about memory
25
pathophysiology of alzheimers
Beta amyloid plaques neurofibriallry tangles Decreased ACh production
26
Presentation of alzheimers
progressive global cognitive impairment visio-spacial skills, memory, executive function anosognosia- lack of insight onset insidious
27
Vascular dementia presentation
sudden onset and stepwise deterioration | Risk factors for CV disease
28
Lewy body dementia presentation
fluctuating cognitive impairment detailed visual hallucinations sleep disorders memory loss not usual initially
29
frontotemporal dementia presentation
personality change, emotional blunting, apathy, dis-inhibition, carelessness, behavioural change, progressive impairment of language function
30
treatment of alzheimers disease
ACh-ASE INHIBITORS eg donepezil, rivastigamine, galantamine slows down progression can also be used in Lewy Body dementia (NOT ftd/vascular) SE: exacerbates peptic ulcer disease and heart block ``` ANTIGLUTAMATERGIC eg memantine NMDA antagonist effective in late stage disease SE: hallucinations and confusion ``` for symptom control - folic acid and b12 vitamins- decreases mild cognitive impairment - antidepressants- depression common in dementia - sedation- violence and aggression, used if risk to self or others
31
outline DOLS
Deprivation of liberty safeguard -ensures people who cannot consent to their care (mental disorder lacking capacity) arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. -Arrangements are assessed to check they are necessary and in the person’s best interests. - if restraints and restrictions are used, they must be the least restrictive method possible and in the best interests of the patient -liberty is a human right Is the person subject to continuous supervision and control? and Is the person free to leave?
32
risk factors of suicide in those who are depressed
``` Suicide plan/ ideas or hx of self harm Unexplained guilt/ worthlessness Inability to function- psychomotor retardation/ agitation Concentration impaired Impaired appetite Decreased sleep Energy low ``` Alcohol and drug use, history of menal illness, affairs in order, precise plan, male, concealing attempts, unemployment, isolation, single
33
Differentiating - asthma - pneumonia - Bordetella pertussis - lung cancer - TB
ASTHMA wheeze, tight chest, SOB, diurnal variation, FHx, atopy, exacerbated by irritants, reversible obstructive pattern- FEV/FVC<80% PNEUMONIA fever, malaise, cough, chest pain, sputum dullness to percussion, decreased breath sounds, CXR infiltrates BORDETELLA PERTUSIS paroxysmal coughing, inspiratory whooping sound LUNG CANCER Hx of smoking, change in character of chronic cough, haemoptysis, hoarseness, chest pain, weight loss, symptoms of metastases TB anorexia, malaise, weight loss, night sweats, chronic productive cough, occasional hameoptysis
34
Risk factors for TB
``` residence/ travel to high prevalence area immunosuppressed- HIV/AIDS poor nutrition, smoking, alcohol poverty and homelessness close contact with infected person ethnic minorities ```
35
Diagnosis of TB
latent- Mantoux test active- CXR- lobar consolidation, cavitation, calcification, fibrosis, Sputum sample- acid fast zheil neelsen stain histology- caseating granuloma
36
treatment of TB
RIPE Rifampicin and isoniazid for 6 months with pyrazinamide and ethambutol for first 2 months DoT- directly observed therapy to ensure compliance
37
TB chest x ray signs
Consolidation, cavitation, fibrosis, and calcification.
38
explain in laymans terms how ACE-I work and give 2 side effects
relax blood vessels and reduce amount of water body reabsorbs, making it easier for blood to be pumped round body Dry cough, hypotension (so take before bed, and careful of waking up in the night), hyperkalaemia, worsen/ cause renal failure
39
explain in laymans terms how angiotensin receptor blockers work, give an example and 2 side effects
Candesartan To treat heart failure/ high BP- people with high BP may not feel unwell but if left untreated can damage heart and blood vessels Works by allowing your blood vessels to relax and widen SE: dizzy, hypotension, renal failure, avoid in pregnancy
40
explain how aspirin works in laymans terms and give 2 side effetcs
Prevents unwanted blood clots from forming in body Used to treat acute ischaemic stroke and long term prevention of thrombolytic arterial events (COX inhibitor- decreased platelet aggregation) SE: GI irritation- GI ulcer and haemorrhage- take with food
41
explain how Long term/ short term beta agonists work, | side effects
used in chronic asthma and to relieve breathlessness relaxes muscle in lung to open airways SE:tachycardia, palpitations, anxiety, tremor
42
explain how beta blockers work side effects
Treatment of ischaemic heart disease, decrease symptoms of angina, improve prognosis of chronic heart failure Reduces how hard and fast the heart beats SE: fatigue, cold extremities, headache, GI upset, CI in asthma- causes bronchodilation
43
explain how calcium channel blockers work Side effects
Treatment of high blood pressure- relaxes walls of blood vessels and decreases how hard heart pumps and so makes it easier for heard to pump blood round body SE: ankle swelling, flushing, headache, feeling tired
44
explain how clopidogrel works Side effects
Blood thinner- prevents blood clots so blood flows though vessels more easily SE: bleeding more easily, nose blleds, heavier periods, bleeding gums, bruising
45
diruetics- how they work and side effects
Water pills- make you wee more to prevent a build up of fluid in your body (dont take after 4pm as otherwise will need toilet in night) SE: dehydration, hypotension, increased urinary frequency
46
how insulin works and side effects
in type 1 diabetes body no longer makes insulin and so you have to inject it to help your body use sugar for energy SE: hypoglycaemia--> coma and death--> watch out for dizziness, agitation, nausea, sweating, confusion. Manage lifestyle factors too
47
statins how they work and side effects
reduces bad cholesterol in body and so reduces narrowing and hardening of arteries SE: headache, myopathy, rhabdomyalsis. Avoid grapefruit juice
48
warfarin- how it works and side effects
prevents unwanted clots in body. Need to check INR regularly to check how long it takes for blood to clot SE: increased bleeding, spontaneous haemorrhage

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