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GP topics Flashcards

1
Q

STEMI S+S

A
  • Crushing chest pain
  • Pallor
  • Syncope
  • Thready pulse
  • Clammy
  • Pain to left arm, neck, jaw
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2
Q

STEMI S+S

A
  • Crushing chest pain
  • Pallor
  • Syncope
  • Thready pulse
  • Clammy
  • Pain to left arm, neck, jaw
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3
Q

STEMI immediate Mx

A
  • Morphine
  • Oxygen
  • Nitroglycerin (GTN)
  • 300mg aspirin
  • PCI within 120 minutes
  • Prasugrel and aspirin if not already on anticoagulant
  • Clopidogrel and aspirin if already on anticoagulant
  • Fibrinolysis if PCI not in <120m
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4
Q

Secondary prevention MI

A
  • ACEi
  • Clopidogrel
  • Aspirin and atorvastatin
  • BB
    ACAB
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5
Q

NSTEMI S+S

A
  • male = chest pressure for several minutes with sweating
  • Women = upper back pain and SOB
  • ECG = ST depression, T wave inversion, transient ST elevation
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6
Q

NSTEMI Ix

A
  • ECG
  • Troponins = within 60 minutes, NSTEMI if above 99th percentile
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7
Q

NSTEMI Mx

A
  • Initial same as STEMI
  • GRACE score
  • Low risk = ticagrelor and aspirin, PCI if indicated
  • Med/high risk = angiography in 72hrs and PCI, prasugrel and aspirin
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8
Q

Stable angina

A
  • Occurs with physical exertion or emotional stress
  • Relieved by GTN spray or rest
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9
Q

Angina Ix

A
  • Gold = CT coronary angiography
  • ECG
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10
Q

Angina Mx

A
  • Lifestyle advice
  • GTN for symptomatic relief
  • BB or CCB for longterm symptomatic relief
  • 2nd line = long acting nitrate
  • Aspirin or clopidogrel for secondary
  • CABG or PCI if continued and on max therapy
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11
Q

Unstable angina

A
  • New onset or abrupt deterioration in previously stable angina at rest
  • Hospital = MONA and BB
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12
Q

HF

A

Inability of heart to deliver blood and oxygen to the bosy at the rate needed for metabolising tissues

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13
Q

HF

A

Inability of heart to deliver blood and oxygen to the bosy at the rate needed for metabolising tissues

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14
Q

S+S HF

A
  • SOB
  • Ankle swelling
  • Fatigue
  • Elevated JVP
  • Creps
  • Oedema
  • Exertional dyspnoea
  • PND
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15
Q

HF Ix

A
  • BNP >100 = HF. >2000 = urgent referral, 400-2000 6 week referral
    -Echocardiogtam
  • ECG
  • CXR = Alveolar oedema, Kerley B lines, Cardiomegaly, dilated upper lobe, effusions
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16
Q

Mx HF

A
  • ACEi
  • BB
  • Aldosterone antagonist (spironalactone)
  • Loop diuretics
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17
Q

NYHA classification

A

1 = no limitation
2 = mild limitation = comfy at rest
3 = marked limitation = gentle activity triggers
4 = occur at rest

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18
Q

Atrial fibrillation

A
  • Irregular disorganised electrical activity int he atria = irregular ventricular rhythm
  • palpitations, chst pain, sob, dizzy
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19
Q

Causes AF

A
  • Stroke or thromboembolism
  • HF
  • Tachy induced cardiomyopathy
  • Reduced QOL
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20
Q

ECG AF

A
  • No p waves
  • chaotic baseline
  • irregular ventricular rate
  • qrs narrow
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21
Q

Mx AF

A
  • CHADVASC to assess stroke
  • Unstable = heparinisation and cardioversion
  • Stable = BB, CCB or digoxin
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22
Q

Asthma Mx adults

A
  • SABA
  • ICS
  • LTRA
  • LABA
  • MART
  • Increase ICS
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23
Q

Ix asthma

A
  • PEF
  • FENO
  • Spirometry with reversibility = FEV <80% or ration 0.7
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24
Q

acute asthma

A
  • Moderate = PEF 50-75%
  • Severe = PEF 33-50%, RR >25, HR >110. cant complete sentences
  • Life threatening = PEF <33%, sate <92, tired, silent chest, shock
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25
Mx acute asthma
OSHITME - Oxygen - Salbutamol - Hydrocortisone - Ipratropium - Magnesium -
26
COPD
- Chronic bronchitis = blue bloaters = cyanosed and fluid retention - Emphysema = pink puffers = airway collapse on exhale = well perfused but hard to breathe
27
Ix COPD
- Spirometry = FEV1 <0.8, ratio 0.7
28
Mx COPD
- SABA or SAMA - If no steroid response = LABA, LAMA - If steroid response = LABA, ICS - LTOT
29
CURB65
- Confusion - Urea >7 - RR >30 - BP <90 systolic <60 diastolic - >65 0-1 = home >2 = hospital >3 = ICU
30
S+S pneumonia
- Bronchial breath sounds - Coarse crackles - Dull percussion - Tachy - Fever - Hypoxia
31
Mx pneumonia
- Mild CAP = 5 days amox or macrolide - Mod-severe = 7-10 dual
32
Paraneoplastic changes in lung cancer
- Increased PTH = hyperparathyroid - Increased ADH = SIADH - Increased ACTH = cushing SCLC = SIADH, Cushings, LEMS, Cerebellar
33
Small cell lung cancer
- Can manifest as weakness thruogh lambert eaton myasthenic syndrome
34
Bronchiectasis
- Abnormal and permanently inflated airways - Cough, sputum, haemoptysis, clubbing, creps, wheeze - CXR = thickened bronchial walls - Mx = postural drainage, ABx, corticosteroids
35
Causes PHT
- Primary or SLE - 2 = LHF - 3 = COPD - 4 = pulmonary vascular disease - 5 = misc
36
S+S Pulmonary HT
- syncope - tachy - raised jvp - hepatomegaly - peripheral oedema
37
Pulmonary hypertension Ix
- RV hypertrophy - right axis deviation - RBBB
38
Mx Pulmonary hypertension
- IV prostanoids - Endothelin receptor antagonists - Phosphodiesterase
39
AKI criteria
- Rise in creatinine >25mm in 48hrs - Rise in creatinine >50%/1.5X baseline 7days - UO <0.5 for >6hrs
40
Ix AKI
- Leucocytes and nitrites = infection - Protein and blood = acute nephritis - Glucose = DM
41
G stages CKD
G1 = >90 G2 = 60-89 G3a = 45-59 G3b = 30-44 G4 = 15-29 G5 = <15
42
A score CKD
A1 = <3mg/mmol albumin A2 = 3 - 30 A3 = >30
43
S+S CKD
- Pruritus - Nausea - Oedema - Cramps - PN - HTN
44
Ix CKD
- EGFR - urine albumin creatinine ratio - Dipstick - USS
45
Osteoarthritis XR
LOSS - Loss joint space - Osteophyte formation - Subchondral sclerosis - Subchondral cysts
46
Osteoarthritis S+S
- POM and crepitus - Worse at end of day - Stiff after resting - Heberden's and Bouchard's - Synovitis and limited movement
47
Mx osteoarthritis
- NSAIDs and paracetamol - Steroid injections - Joint replacement
48
Rheumatoid arthritis S+S
- Ulnar deviation - Swan neck and boutonniere - Worse in morning - Improves with activity - Nodules - Symmetrical swollen painful small joints
49
RA XR
LESS - Loss joint space - Erosion - Soft tissue swelling - Soft bones
50
RA Mx
- XR = LESS = loss space, erosion, swelling, soft bone - DMARDs (sulf, metho) - Steroids - NSAIDs
51
Gout S+S
- Rapid onset - Stiff - Pain, erithema, tender, warm - Tophi
52
gout ix
- CRP and ESR - Aspiration - Negatively bifringent urate crystals, needle shaped
53
gout mx
- NSAID or colchicine - Prednisolone - Allopurinol if chronic
54
osteoporosis S+S
- Fractures = vertebral crush, colle's
55
Ix OP
- DXA - T score >-1 = normla -1 to -2.5 = openia <-2.5 = porosis <-2.5 and fracture = severe porosis
56
Mx OP
- stop smoking - AdCAL - exercise - Anabolic - BPs if -2.5 - Denusomab
57
mx op
- stop smoking - exercise - adcal - BPs = alendondronate (empty stomach 30mins pre eating) - denusomab
58
polymyalgia rheumatica
Inflammatory condition causes pain and stiffness in shoulder, pelvic girdle and neck - Related to GCA - diagnosis by response to steroids
59
S+S PMR
- Bilateral shoulder pain may radiate to elbow - Bialteral pelvic girdle pain - Worse with movement - Interferes with sleep - Stiff for 45m in morning - WL, fatigue, fever - Upper arm tender - oedema
60
Mx PR
- 15mg pred per day - 1w = stop if no response - 3-4w = start a reducing regime
61
GORD S+S
- heartburn - belching - nocturnal asthma - chronic cough - brash
62
GORD Mx
- lifestyle changes - antacids - PPIs - H2 receptor antagonist e.g. cimetidine - Nissen's fundoplication
63
Diverticulitis vs diverticulosis
- Diverticulitis = inflammation of a divertuculum = outpouching git wall - Diverticulosis = presence of diverticula
64
S+S diverticuitis
- LIF pain - LIF mass - Constipation - Fever - Tachycardia - Asymptomatic = increase dietary fibre - Acute = Severe LIF, fever, constiaption, tenderness, guarding
65
Mx diverticulitis
- Analgesia - NBM - IV fluids - ABx = cipro, met - Surgical resection
66
Ix diverticulitis
- Raised WCC, CRP - CXR - CTColonography = colonic wall thickening, diverticula and periocolic collections
67
Crohns patho
- skip lesions - bowel to anus - cobblestone = ulcers and fissures - transmural - non caseating granulomas
68
Crohns S+S
= oral ulcers - Abdo tender = RIF (mass) - Perianal abscess, fustulae, tags - Clubbing - Diarrhoea and weight loss
69
Ix crohns
- Stool sample - Faecal calcoprotein - Colonoscopy = granulomatous transmural inflammation - pANCA -ve
70
mx crohns
- Mild = pred - severe - IV hydrocortisone, metronidazole - azathioprine to maintain remission
71
UC patho
- Mucosa and colon only - Continuous and circumferential - Crypt absesses and goblet cell depletion - Punctuate ulcers
72
UC S+S
- diarrhoea blood and mucus - Crampy pain - Bowel frequency related to severity - Systemic in attacks
73
UC ix
- stool sample - pANCA +ve - colonoscopy
74
UX mx
- Mild = <4/d = pred and mesalazine - Moderate = 4-6/d = pred and mesalazine - Severe = >6/d, IV fluids and hydrocortisone
75
IBS S+S
Abdo pain/discomfort associated with 2+ of - relieved by poo - altered stool form - altered bowel frequency
76
IBS Ix
- FBC - ESR and CRP - Coeliac screen - Faecal calcoprotein
77
IBS Mx
- education - fibre - mebeverine - loperamide - laxatives
78
Duodenal ulcer
- RF = HP, increased GA and gastric emptying - S+S = epi before meals or at night, relieved by eating - Epi tender - Endoscopy
79
Gastric ulcer
- RF = HP, smoking, NSAIDs - Epi pain related to meals and relieved by antacids - Ix= endoscopy
80
mx ulcers
- avoid food that worsens - stop smoking - treat cause - PPI
81
H pylori triple therapy
- clarithromycin - amoxicillin - omeprazole
82
LFTs with gallstones
- Raised ALP - Normal bili - Normal ALT
83
differentiating colic, chole and cholang
Colic = RUQ pain, no fever, no jaundice Cholecystitis = RUQ pain, fever, no jaundice Cholangitis = RUQ pain, Fever and jaundice
84
Cushings
- Prolonged elevation cortisol = syndrome - Adenoma secreting ACTH = disease - moon dace, central obesity, striae, hump, HTN, T2DM, bruising - DST = dex at night and cortisol measured in morning = normal response = cortisol suppressed
85
Addisons disease
- Adrenal glands damaged so less cortisol and aldosterone - fatigue, nausea, cramps, reduced libido, hyperpigmentation, hypotension - Hypona, hyperk - Short synacthen = synthetic acth given = failure of cortisol to rise = addisons - Mx = hydrocortisone
86
TFT results
- Hyperthyroid = low TSH, high T3/4 - Hypothyroid = high TSH, low T3/4 - Secondary hypo = low both
87
hypercalcaemia
- Stones - Bones - Groans (abdo) - Moans (psych)
88
Phaeochromocytoma
- Adrenaline secreted in bursts - 24hr catecholamines and plasma free metanephrines - S+S = anxiety,sweating, headache, HTN, palpitations - Mx = alpha blockers, BB, adrenalectomy
89
hydrocele
- tunica vaginalis - painless swelling - irreducible - transilluminated - conservative, surgery if sx
90
varicocele
- veins swollen - throbbing/dull pain or discomfort - dragging sensation - sub fertility - bag of worms - not there lying down - asymmetry - USS, conservative, surgery
91
epididymal cyst
- fluid filled sac - asymptomatic - transilluminate
92
RF for erectile dysfunction
- OBESITY - HTN - ENDOTHELIAL DYSFUNCTION - LACK EXERCISE SMOKING
93
mx erectile dysfunction
- PDE-5 inhibitors = afils
94
BPH
- LUTS - Mx - alpha blockers (tamsulosin) for immediate sx and 5ARI (finasteride) for enlargement - TURP, TUVP
95
prostatitis
- pelvic pain, LUTS, sexual dysfunction, tender and large - dipstick, culture and C+G tests - Oral abx, analgesia
96
complications prostatitis
- sepsis - abscess - urinary retention - chronic prostatitis
97
blood results for ALD
- increased AST, increased ALT, AST:ALT 2:1
98
gout
- needle shaped negatively bifringent crystals - XR = lytic lesions, punched out - NSAIDs - Colchicine - Steroids - Allopurinol prophylaxis - Febuxostat if allopurinol not tolerated
99
Blood results for adults T1DM
- random plasma glucose >11
100
Pre DM2 bloods
- HbA1c 42-47 - Impaired fasting glucose 6.1 - 6.9 - IGT = 7.8 - 11.1 OGTT
101
DM2 diagnosis bloods
HbA1c = >48mmol - Random glucose >11 - Fasting glucose >7 - OGTT >11
102
Primary hyperthyroidism
- due to thyroid pathology
103
secondary hyperthyroidism
- hypothalamus or pituitary pathology
104
Graves disease
- autoimmune - TSH receptor antibodies cause primary hyperthyroidism - Most common cause hyperthyroid - Exopthalmos - pretibial myxoedema
105
De quervains thyroiditis
- viral infection with fever, neck pain and tenderness - Dysphagia - Hyperthyroid phase followed by hypothyroid phase - NSAID and BB
106
Mx hyperthyroid
- carbimazole - propylthiouracil 2nd line - iodine - BB
107
Hashimoto thyroiditis
- commonest cause hypothyroid - anti TPO antibodies
108
mx hypothyroid
levothyroxine
109
when are anti TPO antibodies present
- graves disease - hashimoto
110
when are tsh receptor antibodies present
- graves disease
111
LVEF <40%
HFrEF
112
LVEF 41-49%
HF mrEF
113
LVEF >50
HRPEF

Phase 3a (23 decks)

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