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Primary Care Flashcards

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1
Q

Main treatment of focal seizures?

A

1st line = carbemazepine

2nd line = lamotrigine or Na valproate

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2
Q

Driving rules following seizures?

A

Isolated seizure = 6m, or 5y if HGV
Dx of epilepsy = 1y seizure free
HGV = 10y seizure free

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3
Q

Tx of absence seizures?

A

1st line = Na val

If not tolerated = ethosuximide

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4
Q

What classifies paroxysmal AF?

A

2+ episodes of AF which terminate within 7days

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5
Q

What is persistent AF?

A

Continuous AF for >7d or which is cardioverted >48hr

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6
Q

What 2 things might you find when assessing pulse in AF?

A

Irregularly irreg pulse, and apex-radial pulse deficit

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7
Q

Where does AF normally originate from?

A

Pulmonary vein

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8
Q

Acute Mx of a stable pt in acute AF?

A

Chemical cardioversion with flecainide or amiodarone. Later start LMWH

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9
Q

CHA2DS2-VASc score of a 71 year old man, with a BP of 164/98, and a previous TIA?

A

4

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10
Q

What do the H and D stand for in HAS BLED?

A 
H = HTN >160 systolic
D = drugs (anti platelets/ NSAIDs) or alcohol (>8 drinks/ week)
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11
Q

Main steps in management of AF?

A
  1. anti-coagulation - Warfarin or NOAC
  2. Rate control - BB (bisoprolol) or CCB (verapamil/dilt) (2nd line)
  3. Rhythm control - BB or flecainide, DC cardioversion
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12
Q

What is a crash landing patient?

A

acute presentation of progressed CKD with no previous Sx

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13
Q

Signs of CKD?

A

pallor (lemon-tinge), pul/periph oedema, pleural effusion, pericarditis, metabolic flap, raised BP

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14
Q

What are the Dx tests for CKD?

A

Creatinine based eGFR (<60) and albumin:creatinine (3+)

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15
Q

Pt with eGFR 36 = what stage CKD?

A

3B

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16
Q

Mx of CKD?

A

BP control (ACD rule), statin, anti platelet (apixaban)

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17
Q

Complications of CKD?

A

Anaemia, bone metabolism & osteoporosis, metabolic acidosis

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18
Q

1st stage Tx in COPD?

A

Either SAMA or SABA

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19
Q

2nd stage Tx COPD?

A

If peak flow <50%: either LAMA or LABA+ICS (with SABA if already on)
Peak flow >50%: LABA or LAMA (with SABA if already on)

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20
Q

3rd stage Tx COPD?

A

LABA+ICS + LAMA (and SABA if already on)

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21
Q

Dx COPD?

A

FEV1/FVC <0.7 predicted , FEV1 <80%

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22
Q

CXR features COPD?

A

Hyperventilation (>6 ant ribs), flat hemidiaphragm, large central pul As, bull, decreased peripheral vascular markings

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23
Q

What are the features of a TACI stroke? What classifies a PACI?

A
  1. Homonymous hemianopia
  2. hemiplegia
  3. higher function loss, e.g. speech

TACI = all 3, PACI = 2/3

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24
Q

What screening tools/scales should be used to assess stroke & TIA?

A

Stroke - Rosier scale, score >0 = stroke liklely
TIA - ABCD2 score, score 4+ –> seen in stroke clinic within 24h. (score <4 –> seen within 1w)

ABCD2 is a prognostic score to identify people at high risk of having a stroke after a TIA.

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25
What investigations must suspected stroke patients have and how quickly should it be done?
CT head within 1h
26
What is the management of a patient who had sudden onset left sided facial and arm weakness 3 hours ago? CT scan showed an area of dark tissue.
Alteplase to thrombolyse clot.
27
What long term medications are given for a stroke/TIA?
1. BP control - e.g. ACEi 2. Clopidogrel - 75mg OD 3. Statin - start 48h after stroke
28
What non-medical Mx/advice must you give stroke pts?
Do not drive for at least 4 weeks. | Also offer physio, OT, limb splints/orthoses, SALT etc
29
What is the Tx for TIA?
Aspirin 300mg OD for 2w OR Clopidogrel 300mg OD --> then 75mg OD for 2w Seen in specialist clinic within 24h
30
A patient comes in with a clinic BP of 145/90, and a home reading of 131/84. Do they have HTN?
No - clinic BP is high but home reading is below cut off of 135/85
31
What classifies stage 2 HTN?
>160/100 and HBPM >150/95
32
How is HTN diagnosed?
Clinic BP >140/90 --> do either ABPM or HBPM.
33
What does the QRISK2 show?
Chance of having a heart attack or a stroke in next 10y.
34
When suspecting HTN, what other things can/must you check before sending pt home with ABPM?
``` QRISK2 score Check for signs end organ damage: - renal - ACR, U&E, eGFR - eyes - funding exam cholesterol, ecg etc ```
35
What can cause labile HTN results?
Phaeochromocytoma
36
What lifestyle advice can you give to pts with HTN?
Smoking cessation, weight loss, reg exercise, fruit + veg, less salt, relaxation, less caffeine + alcohol
37
When is Tx offered in stage 1 HTN?
If <80y and at least one of... - target organ damage - DM - 10y CV risk >20% - renal D - CVD
38
What is the next option for treating a 65y old gentleman with a BP of 150/87 who is already taking 10mg OD of ramipril?
Add in a CCB, e.g. amlodipine 5mg OD
39
A COPD patient needs to step up their medications. He is currently taking terbutaline, but is still having symptoms. His FEV1 was 60%. What would be the next step in his management?
Continue the terbutaline (SABA) | As PEFR >50% of expected, start either a LABA (e.g. salmeterol) or LAMA (e.g. tiotropium)
40
A COPD patient is on salbutamol and salmeterol, however he is still having symptoms. What would be the next step?
Add in and inhaled corticosteroid, e.g. ipratropium.
41
A COPD patient is taking fluticasone and salmeterol but still having Sx. What is the next step?
Add in a LAMA, e.g. tiotropium
42
What is available to help pts stop smoking?
Nicotine replacement Bupropion (helps w/ withdrawal & cravings) Varenicline (helps with addiction to narcotic)
43
What are the SEs of amlodipine that you must talk to patients about?
Flushing, headache, palpitations, ankle oedema,
44
What diseases might cause an obstructive respiratory pattern on spirometry? What do you see?
Asthma, COPD, CF, bronchiectasis. Reduced FEV1/FVC. | FEV1 is lower as cannot get air out, however FVC remains the same.
45
Which diseases cause a restrictive pattern on spirometry? What would you expect to see?
FEV1/FVC remains near normal or is >0.8. | Lungs have a decreased FEV1 & FVC, hence ratio stays the same (due to decreased compliance and elasticity of lungs)
46
What % of predicted FEV1 classifies lung disease? What dose it mean if a symptomatic patient has a normal FEV1?
<80% = lung disease | If symptomatic but normal, Sx must be from another cause, e.g. PE, vasculitis
47
What are the grades of COPD based upon FEV1?
``` 50-80% = mild 30-50% = moderate <30% = severe ```
48
Why is asthma not diagnosed using spirometry?
Would likely be near normal when asymptomatic. However, reversibility of >12% with SABA indicates diagnosis.
49
Which test can help to differentiate T1DM from T2DM?
C-peptide. Will be negative in T1DM. However still some c-peptide present in T2DM
50
A patient has been feeling more thirsty and needing to pass urine more recently. The GP checks their blood glucose level and it is 12.2. Is this sufficient to diagnose DM?
Yes - patient is symptomatic and has a high sugar. If asymptomatic - must measure sugars on 2 separate days at approx same time. Or must have high HbA1c and a blood glucose on same day
51
What are blood glucose aims for pre and post-meals?
Pre - 4-6 | Post - 5-9
52
Which diabetic medications are CI in renal failure?
Metformin, sitagliptin,
53
What is the next step in a patient already on metformin + gliclazide?
Add a DPP-4i (sitagliptin), or a thiazolidine (pioglitazone), or exenatide
54
What is the target HbA1c level? When might it be different?
Target is 48mmol/L, unless on sulphonylurea - aim 52 as risk of hypos
55
Which diabetic agent can cause thrush?
SGLT-2 inhibitors - cause increased urination (wee out the glucose) --> thrush + weight loss
56
What are the potential SEs of metformin?
GI upset - N/V/D, abdo pain, anorexia Weight loss/neutral rarely - lactic acidosis
57
Which type of seizure is associated with lip smacking? and what is the term for this lip smacking movement?
Automatism - lip smacking, chewing, swallowing, hand movements Assoc with complex partial seizures, also with absence seizures
58
What alternative options are available for treatment of epilepsy? (non-pharmacological)
Ketogenic diet - high fat, low protein + carbs Psychological interventions Vagus N stimulation Surgery
59
A 19 year old girl suddenly stops what she is doing and stares into space for 1 minute. Afterwards she is unaware of what happened, but is alert and conscious. What treatment should she be offered? (1st + 2nd line)
1st line = Na val or ethosuximide | 2nd line = lamotrigine
60
Do epileptics need life long medication?
No. If seizure free for 2 years you can consider lowering dose then stopping meds
61
What is the treatment for partial seizures?
1st line = carbamazepine | 2nd line = lamotrigine/na val
62
How is an acute seizure managed?
1. put in recovery position, check nothing in mouth 2. CALL FOR HELP. After 5 mins - IV lorazepam 4mg (slow IV infusion), or buccal midaz 10mg, or rectal diaz 10mg 3. CALL ANAESTHETIST. Repeat dose in step 2 after another 10 mins 4. IV phenytoin 15mg/kg, max 1g (slow IV infusion), or phenobarbital + CARDIAC MONITOR
63
Which drug is assoc with alopecia and curly regrowth?
Na val
64
A patient has started taking AED for epilepsy. Over a period of a few hours they develop angioedema, become hypotensive and a rash starts to develop. What is happening and what medicate might they be on?
Stephens-Johnson reaction assoc with lamotrigine
65
What are the investigations for CKD?
Bloods --> creatinine based eGFR. If <60 --> repeat in 2w to confirm. Also check glucose, U+Es, LFTs, FBC, antibodies. Urine: ACR of >3 = clinically significant. Also do dipstick & MC+S
66
What acid-base balance might you see in CKD?
Metabolic acidosis
67
What are the complications assoc with CKD?
HTN, met acidosis, high K, low Ca --> bone disease, anaemia, fluid retention
68
What is the Tx options for CKD?
1. Lifestyle changes - stop smoking, diet - lower salt & calories etc, exercise 2. Avoid nephrotoxins - NSAIDs, radiological dye 3. Control BP - ACEi, CCB, diuretics Decrease CV risk - statins, anti platelets Manage the complications

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