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key GP knowledge Flashcards

1
Q

ACS symptoms
ST elevation or LBBB

A

STEMI

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2
Q

ACS symtoms
No ST elevation
BUT raised troponin and other ECG changes (ST depression, T wave inversion, pathological Q waves)

A

NSTEMI

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3
Q

ACS symptoms
No ST elevation or LBBB
Normal troponin and nothing on ECG
SOB at rest

A

Unstable angine

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4
Q

Central crushing chest pain
N&V
Sweating and clamminess
Feeling of impending doom
SOB
Palpitations
Pain radiates to jaw or arms

A

MI

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5
Q

what is the acute management in a STEMI

A

M : morphine
O : oxygen
N : GTN
A : aspirin (300mg PO)

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6
Q

what can be done surgically for a STEMI

A
  • Primary PCI (within 2 hrs)
  • Thromoblysis with alteplase (>2 hrs)
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7
Q

what is given as secondary prevention of a STEMI

A

A : aspirin (75mg)
A : another antiplatelet (clopidogrel)
A : atorvostatin (80mg)
A : ACEI (ramipril)
A : atenolol (or other BB)
A : aldosterone antagonist in HF (eplererone)

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8
Q

acute NSTEMI treatment

A

B : BB
A : aspirin (300mg)
T : Ticagrolr (180mg)
M : morphine
A : anticoagulant (fondaparinux)
N : Nitrates (GTN)

-> O2 if sats dropping

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9
Q

give 5 alternative causes of raised troponin

A

CKD
sepsis
myocarditis
aortic dissection
PE

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10
Q

Palpitations
SOB
Syncope

A

AF

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11
Q

what is seen on an ECG in AF

A

Absent P waves
Narrow QRS complex tachycardia
Irregularly irregular ventricular rhythm

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12
Q

Give 5 causes of AF

A

S : sepsis
M : mitral valve pathology (stenosis or regurg)
I : IHD
T : thyrotoxicosis
H : HTN

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13
Q

what are the rate control options for AF

A
  1. BB (atenolol)
  2. CCB
  3. Digoxin
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14
Q

when would rhythm control be offered first line AF

A

-Reversible cause of AF
-AF is new onset (<48 hrs)
-AF is causing HF

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15
Q

what are the 2 options for rhythm control in AF

A

-Cardioversion
-Long term medical rhythm control

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16
Q

what are the 2 options for cardioversion

A

-> 1st = Pharmacological : flecanide. Amiodarone if structural heart disease
-> Electrical

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17
Q

what 3 medications can be used for long term medical rhythm control

A
  1. BB
  2. Dronedarone
  3. Amiodarone
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18
Q

what is used to determine stroke in AF and what is given if score >1

A

CHADs2VASc
>1 = anticoagulation (warfarin or DOAC - apixaban)

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19
Q

what is the gold standard investigations for stable angina

A

-CT coronary angiography

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20
Q

what is used for immediate symptom relief in angina

A

GTN spray
-> Repeat after 5 minutes. If still in pain after 5 minutes, repeat the dose

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21
Q

What is used for long term symptomatic relief of angina

A
  • BB (e.g. bisoprolol 5mg OD)
  • CCB (amlodipine 5mg OD)
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22
Q

What is used in the secondary prevention of angina ?

A

A : aspirin (75mg)
A : Atorvostatin (80mg)
A : ACEI
a ; already on bb for symptom relief

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23
Q

what can be given to patients with angina that have proximal or extensive disease on CT coronary angiography

A

Percutaneous coronary intervention

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24
Q

What can be offered to patients with angina and severe stenosis

A

CABG

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25
- Long term smoker - Chronic : SOB, cough, wheeze, sputum production, recurrent resp infections
COPD
26
Explain the MRC dyspnoea scale
1 : strenuous exercise 2 : Uphill 3 : flat 4 : 100 metres 5 : can't leave the house
27
How is COPD diagnosed
-Clinical diagnosis + spirometry -FEV1/FVC <0.7
28
How is the severity of spirometry in COPD determined
Stage 1 : > 80% Stage 2 : 50-79% Stage 3 : 30-49% Stage 4 : <30%
29
What can cause earlier and more severe COPD
Alpha 1 antitrypsin deficiency
30
what is step one in the management of COPD
-Salbutamol -> beta-2-agonist OR -Ipratropium bromide -> short acting antimuscarinics
31
What is step 2 of the management of COPD if the pt is NOT steroid responsive
-> LABA + -> LAMA
32
What is step 2 in the management of COPD if the pt is steroid responsive
-> LABA + -> ICS
33
How is COPD exacerbation managed at home
-> Prednisolone (30mg, OD for 7-14 days)
34
What are the first line treatment options for COPD exacerbation in hospital
-> Nebulised bronchodilators (salbutamol and ipratropium -> Steroids
35
Give 6 causes of a raised PSA
Prostate cancer BPH Prostatitis UTI Vigorous exercise Recent ejaculation / prostate stimulation
36
Give 2 medical management options for BPH
-> Alpha blockers (e.g. tamsulosin) : relaxes smooth muscle -> 5-alpha reductase inhibitors (e.g. finasteride) : gradually reduces the size of the prostate.
37
How does finasteride work in BPH
-> 5-alpha reductase converts testosterone to dihydrotestosterone (DTH) -> Finasteride prevents this, this reduces the amount of DTH leading to a reduction in prostate size.
38
What is a notable side event of tamulosin
Postural hypotension
39
what is most common surgical management of BPH
-TURP
40
Symmetrical distal polyarthropathy Worse after rest, improves with activity Morning stiffness >60 mins Fatigue, weight loss, muscel aches and weakness
Rheumatoid arthritis
41
what joints are typically affected in RA
Small joints of hands and feet Hands : wrist, MCP, PIP (never DIP) Feet : ankle
42
Give 4 signs of RA in the hand
-Thumb : z shaped deformity - Swan neck : -Boutonnieres -Ulnar deviation of fingers at MCP joint
43
what 2 antibodies are involved in RA
-RF -Anti-CCP (more sensitive and specific)
44
4 changes on X ray in RA
L : Loss of joint space E : erosions (bont) S : Soft bones (periarticular osteopenia) S : Soft tissue swelling
45
what are the 4 steps to the management of RA
1st : DMARD : methotexate, leflunomide, sulfasalazine. 2nd : two in combination 3rd : Methotrexate + biologic (e.g. TNF inhibitor) 4th : Methotrexate + rituximab
46
4 x ray changes in OA
L : loss of joint space O : osteophyte S : subchondral sclerosis S : Subchondral cyst
47
Joint pain and stiffness (<30 mins) Worsened by activity
OA
48
What joints are involved in OA
Hips Kness Sacro-iliac DIPs CMC Wrist Cervical spine
49
Give 5 signs of OA in the hands
-Herberden's : DIP -Bouchard's : PIP -Squaring at base of thumb (CMC) -Weak grip -Reduced ROM
50
what is the stepwise analgesia control of OA
1. Oral paracetamol / topical NSAID (capsaicin) 2. Oral NSAID + PPI 3. Opiates
51
what is the step wise management of T2DM
1st : metformin 2nd : add either DPP-4 inhibitor or sulfonyurea Tell DVLA and car insurance
52
Skin traffic light system
-Green : normal -Amber : pallor reported by parent -Red : pale, mottled blud
53
Activity traffic light systme
-Green : Responds normally, alert, crying, smiling -Amber : decreased activity, no smile, wakes with prolonged stimulation -Red : not responsive, weak and high pitched cry, not staying awake
54
Resp traffic light system
-Green : normal -Amber : flaring, >50 (6-12mnths), >40 (>12mnths), O2 under 95, crackles -Red : grunting, >60, subcostal recession
55
Circulation traffic light system
-Green : moist mucus membranes -Amber : tachy, CRT > 3, dry membranes, poor feeding, reduced urine output -red : reduced skin tugor
56
Other amber traffic light
- Temp over 39 in 3-6mnths - Fever > 5 days - Rigor - Swelling of limb/joint - Not weight-bearing
57
Other red traffic light
- <3mnths and temp over 38 - Non blanching rash - Bulging fontanelle - Neck stiffness - Status epilepticus - Focal seizure - Neurological signs
57
Other red traffic light
- <3mnths and temp over 38 - Non blanching rash - Bulging fontanelle - Neck stiffness - Status epilepticus - Focal seizure/neurological signs
58
what is seen as tachycardic in <12mnths , 12-24 mnths and 2-5 yrs
< 12 mnths = >160 bpm 12-24 mnths = >150 bpm 2-5 yrs = >140bpm
59
what is seen as tachycardic in <12mnths , 12-24 mnths and 2-5 yrs
< 12 mnths = >160 bpm 12-24 mnths = >150 bpm 2-5 yrs = >140bpm
60
when would u admit for IV abx in an unwell chid
temp >38 in <3mnths temp >39 in 3-6mnths
61
what abx for otitis media and when would u prescribe them in an unwell child
Amoxicillin Bilateral and <2 years
62
What Abx for sinusitis in an unwell child
Amoxicillin or Doxycycline
63
What Ab for LRTI in an unwell child
Amoxicillin
64
What Abx for UTI in an unwell child
Trimethoprim Nitrofurantoin

3a (45 decks)

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