GP Key Conditions Flashcards
(113 cards)
Hypertension
Diabetes
Heart failure
Angina
Asthma
Fatigue
Polymyalgia
Fibromyalgia
COPD
Pneumonia
GORD
Crohn’s/UC/IBS
Osteoarthritis/rheumatoid/joint pain
Gout
Polymyalgia rheumatica
UTIs
MI/AF
DKA
ACS
S
What are the three stages of hypertension?
Stage 1- 140/90
Stage 2- 160/100
Stage 3- 180/120
What is defined as hypertension?
Over 140/90 in clinic
Over 135/85 outside of clinic
What are the investigations for hypertension?
Ambulatory blood pressure monitoring (ABPM)
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Home blood pressure monitoring (HBPM)
What is the management of hypertension?
Lifestyle- salt, exercise, smoking, drinking
1st ACEi/ARB in U55/DM or CCB in O55, african with no DM
Then both
Then thiazide diuretic- bendroflumethiazide
if potassium < 4.5 mmol/l add low-dose spironolactone
if potassium > 4.5 mmol/l add an alpha- or beta-blocker
Refer if not controlled with 4 drugs
Treat stage 2 whatever
General management of COPD?
Lifestyle changes- smoking cessation, flu vaccine
SABA or SAMA
Asthma features?
Yes- LABA+ICS
No- LABA+LAMA
SABA+LABA+LAMA+ICS
What is type 1 diabetes?
Autoimmune disorder where the insulin-producing beta cells of the islets of Langerhans in the pancreas are destroyed by the immune system
Signs of type 1 diabetes?
Weight loss
Polydipsia
Polyuria
May present with diabetic ketoacidosis
abdominal pain
vomiting
reduced consciousness level
Signs of type 2 diabetes?
Often picked up incidentally on routine blood tests
Polydipsia
Polyuria
Diagnostic thresholds for diabetes?
If the patient is symptomatic:
Fasting glucose greater than or equal to 7.0 mmol/l
Random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
HbA1c diabetes level?
Over 48 mmol/mol (6.5%)
T1DM management?
HbA1c monitored every 6 months
Self monitor glucose levels at least 4 times a day
offer multiple daily injection basal–bolus insulin regimens, rather than twice‑daily mixed insulin regimens, as the insulin injection regimen of choice for all adults
twice‑daily insulin detemir is the regime of choice. Once-daily insulin glargine or insulin detemir is an alternative
offer rapid‑acting insulin analogues injected before meals, rather than rapid‑acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes
Add metformin if BMI over 25
T2DM management?
Dietary/lifestyle advice
1st- Metformin
2nd- metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea- gliclazide
metformin + SGLT-2 inhibitor (if NICE criteria met)
DKA features?
Abdominal pain
Polyuria, polydipsia, dehydration
Kussmaul respiration (deep hyperventilation)
Acetone-smelling breath (‘pear drops’ smell)
Diabetes investigations?
Urine should be dipped for glucose and ketones
Fasting glucose and random glucose (see below for diagnostic thresholds)
HbA1c is not as useful for patients with a possible or suspected diagnosis of T1DM as it may not accurately reflect a recent rapid rise in serum glucose
Features of chronic heart failure?
dyspnoea
cough: may be worse at night and associated with pink/frothy sputum
orthopnoea
paroxysmal nocturnal dyspnoea
wheeze (‘cardiac wheeze’)
weight loss (‘cardiac cachexia’): occurs in up to 15% of patients. Remember this may be hidden by weight gained secondary to oedema
bibasal crackles on examination
signs of right-sided heart failure: raised JVP, ankle oedema and hepatomegaly
What is the investigation for heart failure?
N-terminal pro-B-type natriuretic peptide (NT‑proBNP) blood test first-line
if levels are ‘high’ arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are ‘raised’ arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks
Management of chronic heart failure?
1st- ACE-inhibitor and a beta-blocker
2nd- aldosterone antagonist- spironolactone
Treatment of acute heart failure?
IV loop diuretics- furosemide, bumetanide
Stable angina management?
All patients recieve aspirin and statin
Siblingual glyceral trinitrate to abort angina attacks
BB or calcium channel blocker first line
Asthma management adults?
SABA
SABA + low dose ICS
SABA + ICS + LTRA
SABA + ICS + LABA (can continue LTRA)
SABA+- LTRA + MART low dose ICS
SABA+- LTRA + MART med dose
SABA+- LTRA
and either
Increase to high dose ICS not as part of MART
Trial theophylline
Specialist help
Signs and symptoms of asthma?
Symptoms
cough: often worse at night
dyspnoea
‘wheeze’, ‘chest tightness’
Signs
expiratory wheeze on auscultation
reduced peak expiratory flow rate (PEFR)
How long for chronic fatigue to be diagnosed?
After 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms
Investigations of chronic fatigue syndrome?
NICE guidelines suggest carrying out a large number of screening blood tests to exclude other pathology e.g. FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening and also urinalysis