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Phase 3a > GP topics > Flashcards

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
Q

Mx acute asthma

A

OSHITME
- Oxygen
- Salbutamol
- Hydrocortisone
- Ipratropium
- Magnesium
-

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26
Q

COPD

A
  • Chronic bronchitis = blue bloaters = cyanosed and fluid retention
  • Emphysema = pink puffers = airway collapse on exhale = well perfused but hard to breathe
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27
Q

Ix COPD

A
  • Spirometry = FEV1 <0.8, ratio 0.7
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28
Q

Mx COPD

A
  • SABA or SAMA
  • If no steroid response = LABA, LAMA
  • If steroid response = LABA, ICS
  • LTOT
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29
Q

CURB65

A
  • Confusion
  • Urea >7
  • RR >30
  • BP <90 systolic <60 diastolic
  • > 65
    0-1 = home
    2 = hospital
    3 = ICU
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30
Q

S+S pneumonia

A
  • Bronchial breath sounds
  • Coarse crackles
  • Dull percussion
  • Tachy
  • Fever
  • Hypoxia
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31
Q

Mx pneumonia

A
  • Mild CAP = 5 days amox or macrolide
  • Mod-severe = 7-10 dual
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32
Q

Paraneoplastic changes in lung cancer

A
  • Increased PTH = hyperparathyroid
  • Increased ADH = SIADH
  • Increased ACTH = cushing
    SCLC = SIADH, Cushings, LEMS, Cerebellar
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33
Q

Small cell lung cancer

A
  • Can manifest as weakness thruogh lambert eaton myasthenic syndrome
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34
Q

Bronchiectasis

A
  • Abnormal and permanently inflated airways
  • Cough, sputum, haemoptysis, clubbing, creps, wheeze
  • CXR = thickened bronchial walls
  • Mx = postural drainage, ABx, corticosteroids
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35
Q

Causes PHT

A
  • Primary or SLE
  • 2 = LHF
  • 3 = COPD
  • 4 = pulmonary vascular disease
  • 5 = misc
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36
Q

S+S Pulmonary HT

A
  • syncope
  • tachy
  • raised jvp
  • hepatomegaly
  • peripheral oedema
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37
Q

Pulmonary
hypertension Ix

A
  • RV hypertrophy
  • right axis deviation
  • RBBB
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38
Q

Mx Pulmonary hypertension

A
  • IV prostanoids
  • Endothelin receptor antagonists
  • Phosphodiesterase
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39
Q

AKI criteria

A
  • Rise in creatinine >25mm in 48hrs
  • Rise in creatinine >50%/1.5X baseline 7days
  • UO <0.5 for >6hrs
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40
Q

Ix AKI

A
  • Leucocytes and nitrites = infection
  • Protein and blood = acute nephritis
  • Glucose = DM
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41
Q

G stages CKD

A

G1 = >90
G2 = 60-89
G3a = 45-59
G3b = 30-44
G4 = 15-29
G5 = <15

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42
Q

A score CKD

A

A1 = <3mg/mmol albumin
A2 = 3 - 30
A3 = >30

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43
Q

S+S CKD

A
  • Pruritus
  • Nausea
  • Oedema
  • Cramps
  • PN
  • HTN
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44
Q

Ix CKD

A
  • EGFR
  • urine albumin creatinine ratio
  • Dipstick
  • USS
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45
Q

Osteoarthritis XR

A

LOSS
- Loss joint space
- Osteophyte formation
- Subchondral sclerosis
- Subchondral cysts

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46
Q

Osteoarthritis S+S

A
  • POM and crepitus
  • Worse at end of day
  • Stiff after resting
  • Heberden’s and Bouchard’s
  • Synovitis and limited movement
47
Q

Mx osteoarthritis

A
  • NSAIDs and paracetamol
  • Steroid injections
  • Joint replacement
48
Q

Rheumatoid arthritis S+S

A
  • Ulnar deviation
  • Swan neck and boutonniere
  • Worse in morning
  • Improves with activity
  • Nodules
  • Symmetrical swollen painful small joints
49
Q

RA XR

A

LESS
- Loss joint space
- Erosion
- Soft tissue swelling
- Soft bones

50
Q

RA Mx

A
  • XR = LESS = loss space, erosion, swelling, soft bone
  • DMARDs (sulf, metho)
  • Steroids
  • NSAIDs
51
Q

Gout S+S

A
  • Rapid onset
  • Stiff
  • Pain, erithema, tender, warm
  • Tophi
52
Q

gout ix

A
  • CRP and ESR
  • Aspiration
  • Negatively bifringent urate crystals, needle shaped
53
Q

gout mx

A
  • NSAID or colchicine
  • Prednisolone
  • Allopurinol if chronic
54
Q

osteoporosis S+S

A
  • Fractures = vertebral crush, colle’s
55
Q

Ix OP

A
  • DXA
  • T score >-1 = normla
    -1 to -2.5 = openia
    <-2.5 = porosis
    <-2.5 and fracture = severe porosis
56
Q

Mx OP

A
  • stop smoking
  • AdCAL
  • exercise
  • Anabolic
  • BPs if -2.5
  • Denusomab
57
Q

mx op

A
  • stop smoking
  • exercise
  • adcal
  • BPs = alendondronate (empty stomach 30mins pre eating)
  • denusomab
58
Q

polymyalgia rheumatica

A

Inflammatory condition causes pain and stiffness in shoulder, pelvic girdle and neck
- Related to GCA
- diagnosis by response to steroids

59
Q

S+S PMR

A
  • 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
Q

Mx PR

A
  • 15mg pred per day
  • 1w = stop if no response
  • 3-4w = start a reducing regime
61
Q

GORD S+S

A
  • heartburn
  • belching
  • nocturnal asthma
  • chronic cough
  • brash
62
Q

GORD Mx

A
  • lifestyle changes
  • antacids
  • PPIs
  • H2 receptor antagonist e.g. cimetidine
  • Nissen’s fundoplication
63
Q

Diverticulitis vs diverticulosis

A
  • Diverticulitis = inflammation of a divertuculum = outpouching git wall
  • Diverticulosis = presence of diverticula
64
Q

S+S diverticuitis

A
  • LIF pain
  • LIF mass
  • Constipation
  • Fever
  • Tachycardia
  • Asymptomatic = increase dietary fibre
  • Acute = Severe LIF, fever, constiaption, tenderness, guarding
65
Q

Mx diverticulitis

A
  • Analgesia
  • NBM
  • IV fluids
  • ABx = cipro, met
  • Surgical resection
66
Q

Ix diverticulitis

A
  • Raised WCC, CRP
  • CXR
  • CTColonography = colonic wall thickening, diverticula and periocolic collections
67
Q

Crohns patho

A
  • skip lesions
  • bowel to anus
  • cobblestone = ulcers and fissures
  • transmural
  • non caseating granulomas
68
Q

Crohns S+S

A

= oral ulcers
- Abdo tender = RIF (mass)
- Perianal abscess, fustulae, tags
- Clubbing
- Diarrhoea and weight loss

69
Q

Ix crohns

A
  • Stool sample
  • Faecal calcoprotein
  • Colonoscopy = granulomatous transmural inflammation
  • pANCA -ve
70
Q

mx crohns

A
  • Mild = pred
  • severe - IV hydrocortisone, metronidazole
  • azathioprine to maintain remission
71
Q

UC patho

A
  • Mucosa and colon only
  • Continuous and circumferential
  • Crypt absesses and goblet cell depletion
  • Punctuate ulcers
72
Q

UC S+S

A
  • diarrhoea blood and mucus
  • Crampy pain
  • Bowel frequency related to severity
  • Systemic in attacks
73
Q

UC ix

A
  • stool sample
  • pANCA +ve
  • colonoscopy
74
Q

UX mx

A
  • Mild = <4/d = pred and mesalazine
  • Moderate = 4-6/d = pred and mesalazine
  • Severe = >6/d, IV fluids and hydrocortisone
75
Q

IBS S+S

A

Abdo pain/discomfort associated with 2+ of
- relieved by poo
- altered stool form
- altered bowel frequency

76
Q

IBS Ix

A
  • FBC
  • ESR and CRP
  • Coeliac screen
  • Faecal calcoprotein
77
Q

IBS Mx

A
  • education
  • fibre
  • mebeverine
  • loperamide
  • laxatives
78
Q

Duodenal ulcer

A
  • RF = HP, increased GA and gastric emptying
  • S+S = epi before meals or at night, relieved by eating
  • Epi tender
  • Endoscopy
79
Q

Gastric ulcer

A
  • RF = HP, smoking, NSAIDs
  • Epi pain related to meals and relieved by antacids
  • Ix= endoscopy
80
Q

mx ulcers

A
  • avoid food that worsens
  • stop smoking
  • treat cause
  • PPI
81
Q

H pylori triple therapy

A
  • clarithromycin
  • amoxicillin
  • omeprazole
82
Q

LFTs with gallstones

A
  • Raised ALP
  • Normal bili
  • Normal ALT
83
Q

differentiating colic, chole and cholang

A

Colic = RUQ pain, no fever, no jaundice
Cholecystitis = RUQ pain, fever, no jaundice
Cholangitis = RUQ pain, Fever and jaundice

84
Q

Cushings

A
  • 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
Q

Addisons disease

A
  • 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
Q

TFT results

A
  • Hyperthyroid = low TSH, high T3/4
  • Hypothyroid = high TSH, low T3/4
  • Secondary hypo = low both
87
Q

hypercalcaemia

A
  • Stones
  • Bones
  • Groans (abdo)
  • Moans (psych)
88
Q

Phaeochromocytoma

A
  • Adrenaline secreted in bursts
  • 24hr catecholamines and plasma free metanephrines
  • S+S = anxiety,sweating, headache, HTN, palpitations
  • Mx = alpha blockers, BB, adrenalectomy
89
Q

hydrocele

A
  • tunica vaginalis
  • painless swelling
  • irreducible
  • transilluminated
  • conservative, surgery if sx
90
Q

varicocele

A
  • veins swollen
  • throbbing/dull pain or discomfort
  • dragging sensation
  • sub fertility
  • bag of worms
  • not there lying down
  • asymmetry
  • USS, conservative, surgery
91
Q

epididymal cyst

A
  • fluid filled sac
  • asymptomatic
  • transilluminate
92
Q

RF for erectile dysfunction

A
  • OBESITY
  • HTN
  • ENDOTHELIAL DYSFUNCTION
  • LACK EXERCISE
    SMOKING
93
Q

mx erectile dysfunction

A
  • PDE-5 inhibitors = afils
94
Q

BPH

A
  • LUTS
  • Mx - alpha blockers (tamsulosin) for immediate sx and 5ARI (finasteride) for enlargement
  • TURP, TUVP
95
Q

prostatitis

A
  • pelvic pain, LUTS, sexual dysfunction, tender and large
  • dipstick, culture and C+G tests
  • Oral abx, analgesia
96
Q

complications prostatitis

A
  • sepsis
  • abscess
  • urinary retention
  • chronic prostatitis
97
Q

blood results for ALD

A
  • increased AST, increased ALT, AST:ALT 2:1
98
Q

gout

A
  • needle shaped negatively bifringent crystals
  • XR = lytic lesions, punched out
  • NSAIDs
  • Colchicine
  • Steroids
  • Allopurinol prophylaxis
  • Febuxostat if allopurinol not tolerated
99
Q

Blood results for adults T1DM

A
  • random plasma glucose >11
100
Q

Pre DM2 bloods

A
  • HbA1c 42-47
  • Impaired fasting glucose 6.1 - 6.9
  • IGT = 7.8 - 11.1 OGTT
101
Q

DM2 diagnosis bloods

A

HbA1c = >48mmol
- Random glucose >11
- Fasting glucose >7
- OGTT >11

102
Q

Primary hyperthyroidism

A
  • due to thyroid pathology
103
Q

secondary hyperthyroidism

A
  • hypothalamus or pituitary pathology
104
Q

Graves disease

A
  • autoimmune
  • TSH receptor antibodies cause primary hyperthyroidism
  • Most common cause hyperthyroid
  • Exopthalmos
  • pretibial myxoedema
105
Q

De quervains thyroiditis

A
  • viral infection with fever, neck pain and tenderness
  • Dysphagia
  • Hyperthyroid phase followed by hypothyroid phase
  • NSAID and BB
106
Q

Mx hyperthyroid

A
  • carbimazole
  • propylthiouracil 2nd line
  • iodine
  • BB
107
Q

Hashimoto thyroiditis

A
  • commonest cause hypothyroid
  • anti TPO antibodies
108
Q

mx hypothyroid

A

levothyroxine

109
Q

when are anti TPO antibodies present

A
  • graves disease
  • hashimoto
110
Q

when are tsh receptor antibodies present

A
  • graves disease
111
Q

LVEF <40%

A

HFrEF

112
Q

LVEF 41-49%

A

HF mrEF

113
Q

LVEF >50

A

HRPEF

Phase 3a (23 decks)

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