GP ILA's Flashcards by Bethany Awdas

How does NICE define hypertension

-Clinic : >140/90
-Home : >135/85

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Give the 3 stages of hypertension

-1 : >140/90
-2 : >160/100
-3 : >180/120

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Give 4 causes of secondary hypertension

-ROPE

-R : Renal disease (most common)
-O : Obesity
-P : Pregnancy induced / pre-eclampsia
-E : Endocrine (e.g. hyperaldosteronism-Conns)

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Give the medical management for HTN (<55, white)

-Step 1 : ACE
-Step 2 : ACE + CCB
-Step 3 : ACE + CCB + Thiazide-Like diuretic
-Step 4 : ACE + CCB + Diuretic (indapapamide) + Spironolactone (if K+ <4.5mmol) OR alpha or beta blocker (if potassium >4.5mmol)

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Give the medical management of HTN (>55, black)

-Step 1 : CCB
-Step 2 : CCB + ARB or thiazide like diuretic
-Step 3 : CCB + ARB + Thiazide like diuretic

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What is the first line management of HTN in someone with T2DM despite age or family origin ?

-ACE or ARB

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What lifestyle advice can be given to someone with stage 1 HTN before medication is given ?

-Healthy diet
-Stop smoking
-Reduce alcohol, caffeine and salt intake
-Increase exercise

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What investigations should all patients with a new diagnosis of HTN receive ?

-Urine albumin : creatine ratio for proteinuria
-Dipstick : for microscopic haematuria to assess kidney damage
-Bloods : HbA1c, renal function and lipids
-Fundus examination : for HTN retinopathy
-ECG : for cardiac abnormalities

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Give 5 complications of HTN

-IHD
-Cerebrovascular accident (stroke, haemorrhage)
-Hypertensive retinopathy
-Hypertensive nephropathy
-Heart failure

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Give 3 complications of ACEI’s

-Cough
-Angioedema
-Hyperkalaemia

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Give 2 examples of an angiotensin II receptor blocker (ARB)

-Candesartan
-Losartan

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Give 5 SE of beta blockers

-Erectile dysfunction
-Bronchospasm
-Cold peripheries
-Fatigue
-Sleep disturbance

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Give 3 SE of CCB

-Constipation
-Flushing
-Ankle swelling
-Dizziness/Headache

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Give a side of an ARB

-Hyperkalaemia

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Give 3 SE of thiazide-like diuretics

-Hyponatraemia
-Hypokalaemia
-Dehydration

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Give HTN treatment targets

<80yrs : <140/90
>80 years : <150/90

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Give 5 key presentations of chronic heart failure

-Orthopnoea
-Paroxysmal Nocturnal Dyspnoea
-Breathlessness worsened by exertion
-Cough : white/pink sputum & worse at night
-Peripheral oedema

What investigations are used to diagnose chronic heart failure ?

-N-terminal-B-type natriuretic peptide (NT-proBNP)
-Echo
-ECG

Give 4 causes of HF

-IHD
-Valvular disease (e.g. aortic stenosis)
-HTN
-Arrhythmias (e.g. AF)

Give 4 medications used in chronic heart failure

-A : ACEI (lisinopril) -> reduce BP -> reduces work for heart and kidneys
-B : BB (bisoprolol) -> reduces HR
-A : Aldosterone antagonist -> spironolactone (used if reduced EF and Sx not controlled by A or B)
-L : Loop diuretics (furosemide) -> controls Sx

-Ensure listing for annual influenza vaccine

What are the signs/symptoms of acute HF

-Sudden onset SOB
-Wheeze
-Bibasal inspiratory crackles
-Third heart sound

How is acute heart failure managed (LVF) ?

POUR SOD

-POUR : away (stop) IV fluids
-S : Sit up
-O : oxygen
-D : diuretics (IV 40mg stat)

Give 3 signs more suggestive of right sided heart failuyre

-Raised JVP
-Ankle oedema
-Hepatomegaly

What investigations would you do in acute heart failure?

-ECG
-ABG
-CXR : cardiomegaly and upper lobe venous diversions
-Bloods : infection, kidney function, BNP, troponin if considering MI)

What would be seen on CXR if heart failure has caused fluid on the lungs ?

-Bilateral pleural effusions -Fluid in interlobar fissures -Kerley lines -> fluid in septal lines

What can be used in severe acute pulmonary oedema or cardiogenic shock as a result of HF?

-IV opiates (they act as vasodilators) -CPAP -Inotropes (e.g. noradrenalin infusion)

What is the fever pain score used for?

Used to determine in what children with a fever are more likely to have a sore throat caused by stretococcal bacterial = more beneficial with antibiotics

Give the 5 points in the fever pain score

-Fever in last 24 hrs -Purulence (pus on tongue) -Attend rapidly (within 3 days of onset) -Severely inflamed tonsils -No cough or corzya -4 or more = antibiotics

>60 Memory loss Varying changes in planning, reasoning, speech and orientation Progressess steadily

Alzheimer's

What is the most common form of dementia and what is its aetiology

-Alzheimer's -Amyloid plaques and neurofibrillary tangles

-Cognitive impairment following cerebrovascular infarct -Mood disturbance -Psychosis in later stages -HTN RF

Vascular dementia

what is the second most common type of dementia and its aetiology

-Vascular dementia -Multiple cerebrovascular infarcts

>50 -Rapidly progressing -Parkinson-like symptoms -Visual hallucinations -Cognitive decline : problems multi-tasking / performing complex cognitive actions

Lewy body dementia

<65 -Behavioural : altered personality -Semantic : decline in understanding of word meaning, difficulty with name retrieval -Non fluent : breakdown in output of language

Frontotemporal dementia

When can a child not consent to sex

-Adult of 18 or older -A child 12 and under cannot consent to sex -A child cannot consent to sex with an adult in a position of authority

What is the Fraser guidance that dictates a doctor can prescribe contraception to someone under 16

-If the girl will understand their advice -They cannot persuade her to inform her parents or allow him to inform the parents -She is likely to continue having sex with or without contraception -She receives the contraception advice/treatment or her physical or mental health or both are likely to suffer -Her best interests require him to give it

Define a refugee

-Someone forced to flee their home due to war, violence, or persecution and cross borders to seek safety in another country -They have been granted asylum and refugee status and has leave to remian for 5 years

Define a displaced person

-Same as a refugee but they remain within the borders of their native country

Define an asylum seeker

-Someone seeking international protection from dangers in his or her home country but whose claim for refugee status hasn't been determined legally

Define a migrant

Someone moving from place to place usually for economic reasons such as seasonal work

What is an unaccompanied asylum seeking child

-Crossed international border in search of safety and refugee status -Applying for asylum in his/her own right -Under 18 -Without adult family members or guardians in this country