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Phase 3a ILA > GP > Flashcards

GP Flashcards

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1
Q

How is HTN diagnosed

A

140/90 on 2 separate occasions
stage 1 - 140/90
stage 2 - 160/100
severe - 180/110

AMBP - uses average of 14 measurements

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2
Q

Causes/RF of essential and secondary HTN

A

essestial (no underlying cause)

  • low birth weight
  • obesity
  • XS alcohol
  • XS salt

Secondary

  • renal disease
  • endocrine
  • pre-eclampsia
  • drugs (OOC, steriods, NSAIDS)
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3
Q

Step 4 of HTN medical management

A

+further diuretic

OR

+alpha blocker

OR

+beta blocker

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4
Q

Mechanism of action and 1 example of each diuretic type

A
  • thiazide (indapamide) inhibits Na reabsorption and inhibits Na/Cl transporter in DCT
  • loop (furosemide) inhibit Na/Cl in ascending limb
  • Potassium sparing (triamterene) antagonise actions of aldosterone in DCT, more Na into collecting duct -> excreted. Na reabsorption inhibited so less K and H exchanged and lost in urine - K sparing
  • Aldosterone antagonist (spironolactone) helps loop/thiazide but antagonising aldosterone
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5
Q

CCB example and MoA

A

amlodipine, nifedipine

decrease myocardial contractility, relaxes vascular SM, reduces systemic VR and arterial BP

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6
Q

ACE-I example and MoA

A

Ramipril

decreases angiotensin II formation so decreased vasocontriction

blocks degradation of bradykinin (vasodilator)

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7
Q

ARB example and MoA

A

candesartan

block angiotensin II receptors, down regulates sympathetic adrenergic activity, promotes renal excretion Na and H20

dilates vessels reducing arterial pressure, preload and afterload on the heart

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8
Q

B blockers example and MoA

A

bisoprolol

blocks adrenaline and noradrenaline binders

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9
Q

Describe the link between ED and HTN

A

30-40% men with HTN also have ED

HTN stops penile arteries dilating and makes SM lose ability to relax (not enough blood to penis to cause erection and blood vessel damage)

Diuretics decrease force of blood to penis and zinc (needed to make testosterone)

BB dampen response to nerve impulses that lead to erection

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10
Q

Effects of angiotensin II on body

A

IN REPSONSE TO LOW BP (decrease in renal perfusion JGA)

  1. increased sympathetic activity
  2. Tubular Na and Cl reabsorption and K excretion
  3. Aldosterone secretion (adrenal) -> contributes to 2
  4. arteriolar vasocontriction
  5. ADH secretion (pit gland) -> H20 absoption CD
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11
Q

Heart failure causes

A

10% of pt>65

  • myocardial dysfunction
  • cardiomyopathy
  • factors increasing myocardial work (obesity, anaemia)
  • HTN
  • XS alcohol
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12
Q

Compensatory mechanisms for HF

A
  1. Sympathetic NS
    • increases HR + SV (faster more forceful contractions)
    • less effect after repeated action
  2. Increased Pre load
    • ADH and aldosterone increase filling volume.
    • increased Preload, higher pressure, higher SV
    • need more 02 that isnt supplied -> muscle death
  3. Hypertrophy
    • heart muscles enlarges to produce stronger contractions but needs more 02 that isnt supplied. Concentric hypertrophy reduces ventricle volume
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13
Q

Heart failure symptoms and signs

A

*SOB

*ankle swelling

*fatigue

+orthopnoea (SOB when flat)

Signs- peripheral oedema, pul crackles, tachy, increased JVP

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14
Q

Heart Failure diagnosis

A
  • BNP (increased LV dysfunction)
    • <100 normal
    • 100-400 refer echo 6/52
    • >400 refer echo 2/52
  • Echo (US waves look at pumping action and structure)
    • LVSD - decreased LVEF <40%
  • CXR
  • Bloods (eGFR normal 90-100%)
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15
Q

CXR findings in Heart failure

A

Alveolar oedema

B lines

Cardiomegaly

Dilated prominent vessels

Effusion pleural

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16
Q

Medical management of Heart failure

A

1st - ACE, BB (start low go slow)

2nd - Aldoserone antagonist, ARB (if pt doesnt tolerate ACEI)

Hydralazine and nitrate if pt black

Diuretics relieve symptoms

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17
Q

Heart failure prognosis

A

30-40% die in first year

<10% mortality following

2/3rd pt die in 5 years

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18
Q

CVD primary, secondary, teritary prevention

A

1- lifestyle

2- medication, Q risk 2

3- rehab

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19
Q

Polypharmacy issues

A

Interactions

non adherence

NHS cost

Prescribing cascade

88% chance of adverse drug even if 5+ meds

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20
Q

Notifiable diseases

A

(6 in 1) Whooping Cough, Tetanus, Diphtheria

(MMR) Measles, Mumps, Rubella

Malaria

meningococcal septicaemia

Scarlet Fever

TB

Acute encephalitis

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21
Q

Describe assessment/ immediate management of an unwell child

Study These Flashcards
A

ABCDE ?SEPSIS CONSCIOUSNESS

assessment: traffic light, vital signs, dehydration signs

22
Q

Signs of dehydration in children

Study These Flashcards
A

prolonget CRT

abnormal skin tugor

abnormal resp pattern

weak pulse

cool extremities

SEVERE: sunken fontanelle, dry mouth, sunken eyes, absence of tears

23
Q

Management of red, amber and green features on traffic light

Study These Flashcards
A

red -> urgently (w/in 2 hours) assessed face to face by specialist

amber -> assessed face to face if necessary, safety net (warning symptom info, arrange follow up)

green -> care at home with appropriate advice (manage temp, regular fluids, rash and dehydration checks)

24
Q

PCB causes

Study These Flashcards
A

vaginal - vaginitis, carcinoma

Cervical - cervicitis, carcinoma, polyps, trauma, ectopion

25
Abnormal discharge description and likely diagnosis
fishy - BV cottage cheese - thrush green, frothy - tri thick green/yellow - gono Blood stained - cancer, foreign body
26
Normal VD
no strong or unpleasant smell clear or white thick/sticky or slippery/wet
27
MoA and Efficacy for common methods of contraception
LARC - long activing resersible contraception Condom - barrier - 85% depends on user COC - prevents ovulation, thickens mucus in neck of womb/ thins lining of womb - 91% depends on user POP - thickens cervical mucus and thins endometrium - 92% depends on user PO implants - releases progestogen, thickens cervical mucus and thins endometrium - \>99% lasts 3 years Cu-IUD - copper alters cervical mucus - \>99% stays 5-10 years Minera - releases levonorgestrel (progestin) into uterus - \>99% stays 3-5 years
28
What is fraser competence
used to see whether child has maturity to make own decisions with regards to contraception only Gillick competency * child able to understand advice * cannot persuaed child to inform competent adult * child likely to continue having sex with or without contraception * without contraceptive advice/tx -\> physical/mental health could suffer * best interests require advice/tx without consent \*sexual activity with child \<13 illegal and should always result in child protection\*
29
Issues relating to teen pregnancy
* lack of prenatal care * higher risk of pre-eclampsia * infant mortality higher * 40% teenage mums drop out of school -\> no quals -\> increased risk of poverty
30
Dementia screening tools
GPCOG MMSE 6CIT (6 item cog impairment test) IQCODE (informant questionnaire on cog decline in elderly)
31
Dementia Management
most medications treat Alzheimers - rivastigmine, memantine Cognitive stimulation therapy Cognitive rehab
32
community care for dementia patients
* have a needs assessment - determines help and support needed * Care options - home, residential or care home, day care centres * Admiral nurses * Charities
33
Whats is DOLS
only for care homes, hopitals and hospices set of checks that aim to make sure any care that restricts a persons liberty is both appropriate and in theirh best interests
34
what is a IMCA
Independent mental capacity advocate makes decisions about serious medical problems and represent people when no one else is able to
35
Core depression symptoms
1. sadness or low mood 2. Anhedonia 3. fatigue
36
Additional depression symptoms
Physical - change in sleep, appetite, libido, psychomotor retardation or agitation psycho - lack of confidence and conc, worthlessness and guilt, suicidal idealtion, numbnesss
37
Depression criteria
mild - 2 core 2/3 other mod - 2 core 3 other severe - 3 core 4+ other + psychotic sx
38
Suicide risk factors
SAD PERSONS Sex male Age \<19 or \>44 Depression Previous attempts Ethanol abuse Rational reasoning lost Social support lacking Organised plan No spouse Sickness
39
Depression risk factors
* family/personal hx * age 20-40 * substances * unemployed * divorced * living alon
40
What is section 2 MHA
assessment: 28 days
41
What is section 3 MHA
Treatment: 6 months - suffering from mental disorder of a nature or degree which makes it appropriate to receive medical tx in hospital - necessary for health of pt OR safety of pt OR safety of others - appropriate tx available - tx cannot be given under other circumstances
42
who is involved in a section 3 detainment
- medical professional to prove medically fit - 2 registered medical practitioners
43
What is section 5
holding powers 5. 2 doctor: 72 hours 5. 4: nurses 6 hours
44
what is section 136
72 hours allows police officer to remove someone who appears to be suffering from mental health disorder to a place of safety
45
Depressio screening tools
PHQ-9 HAD (hospital anxiety and depression scale ICD 10 (geriatric depression score)
46
Alcohol screening tools
* AUDIT -1 (shortened version of below, first 3 questions, do full qu if * score 3+ * drank more than 6 drinks on one occasion in last year * AUDIT * FAST - ED * CAGE
47
Management of depression
mild: low intensity psychological intervention mod: CBT or IPT + SSRI severe: ECT Tx continue 6 months after symptoms resolve
48
Differential diagnosis for patient with a cough
acute brochitis, URI, asthma, pneuomia, COPD, influenza,
49
TB risk factors
HIV Diabetes malnutrition tobacco harmful alcohol use
50
How to prevent TB outbreak
Identification and treatment of active TB (RIPE) TB infection control: BCG vaccine: provides children protection but more variable in adults

Phase 3a ILA (4 decks)

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