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4th Year > Primary Care > Flashcards

Primary Care Flashcards

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1
Q

FEV1:FVC ratio of what indicates COPD

A

< 70% or 0.7

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2
Q

Stages of COPD based on predicted FEV1 %

A

Stage 1: >80%
Stage 2: 50-79%
Stage 3: 30-49%
Stage 4: < 30%

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3
Q

MRC Dyspnoea Scale Grade 1

A

Not troubled by SOB except on strenuous exercise

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4
Q

MRC Dyspnoea Scale Grade 2

A

SOB when walking quickly or uphill

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5
Q

MRC Dyspnoea Scale Grade 3

A

Walks slower than contemporaries

Has to stop due to SOB

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6
Q

MRC Dyspnoea Scale Grade 4

A

Stops for breath after 100m

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7
Q

MRC Dyspnoea Scale Grade 5

A

Too breathless to leave home

Breathless when dressing

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8
Q

Target PaO2 for COPD patients

A

8KPa

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9
Q

Requirements for long-term O2 therapy in COPD?

A

Non-smokers with a PaO2 < 7.3KPa

OR

Secondary polycythaemia, Peripheral oedema, Pulmonary Hypotension

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10
Q

Prophylactic antibiotics for COPD

A

Azithromycin 250mg 3x weekly

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11
Q

Paroxysmal AF

A

2+ episodes lasting 30 seconds to 7 days

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12
Q

Persistent AF

A

Continuous for 7+ days

Long standing persistent AF if 12+ months

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13
Q

Permanent AF

A

Long-standing persistent and resistant to treatment

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14
Q

When should Amiodarone be used following electrical cardioversion in AF?

A

4 months before, and for 12 months afterwards

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15
Q

What level of NT-proBNP in heart failure requires a referral?

A

400-2000ng/L

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16
Q

What factors may decrease NT-proBNP?

A

Obesity
Afro-Caribbean ethnicity
Diuretics, ACEi, Beta Blocker use

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17
Q

NYHA Classification of Heart Failure

A
  1. No limitations
  2. Slight physical limitations
  3. Marked limitations
  4. Symptoms at rest
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18
Q

When should electrical cardioversion be offered in AF?

A

Patients who have had AF persisting for 48 hours of longer

Transoesophageal echocardiography-guided cardioversion OR conventional cardioversion deemed equally efficacious

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19
Q

Indications for pharmacological rate control in AF (Beta blocker/ digoxin/ Diltiazem)

A

AF with a reversible cause
Patient has heart failure caused by AF
New onset AF
Atrial flutter suitable for ablation

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20
Q

Risks of AF with stroke

A 
Larger infarcts
Increased disability
Death
Long-term care
Impaired cognitive function
Dementia
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21
Q

Anti-arrhythmic drugs for AF

A

Beta-blockers
Flecainide, propafenone (pill in the pocket vs regular)
Sotalol, dronedarone, amiodarone

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22
Q

When to cardiovert in an emergency AF presentation

A

Acute new onset AF with haemodynamic instability

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23
Q

Principles of lifestyle management in heart failure

A 
Food- salt restriction, fluid restriction if hyponatraemic, alcohol intake
Smoking
Yearly influenza vaccinations
Driving e.g. LGV, minibus licenses
Air travel- may be affected
Pregnancy and contraception
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24
Q

Which Heart failure patients should be offered a loop diuretic?

A

Those with preserved LVEF ( greater than 40%)

e.g. Furosemide 80mg OD

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25
Secondary causes of hypertension
``` Renal disease (mostly intrinsic) Endocrine (Cushing's, Conn's Phaeochromocytoma, Acromegaly, Hyperparathyroidism Pregnancy Coarctation of the aorta Steroids MAOIs ```
26
Stage 1 Hypertension and management
BP 140/90 mmHg (5 less for ambulatory monitoring) Lifestyle management alone initially
27
Stage 2 Hypertension
BP 160/100 mmHg (5 less for ambulatory monitoring) Start with ACEi or CCB therapy
28
Indications for pharmacological management of Stage 1 hypertension
Under 80 with: - Target organ damage - Diabetes - Renal disease - QRISK2 20% +
29
Thiazide like diuretics
e.g. Bendroflumethiazide, Indapamide, Chlortalidone Best taken in the morning as this has best diuretic effect Avoid in gout, hypokalaemia, hyponatraemia
30
ECG changes that may be seen in stable angina
Pathological Q waves ST depression T wave inversion LBBB
31
Initial treatment for Stable Angina
GTN spray + Beta blocker or CCB
32
Additional drug treatments for Stable Angina
Long acting nitrates Ivabradine (cardiotonic agent) Nicorandil (vasodilator) Ranolazine
33
First line imaging for stable angina
64 slice CT coronary angiography
34
Indications for CABG in stable angina patients
Imaging identifies left main stem or triple vessel disease
35
For how long may Ticagrelor or Clopidogrel be continue following a STEMI or a NSTEMI? How long may aspirin be continued for?
12 months Aspirin 75mg is continued indefinitely
36
What is the dose of statins to be used in primary prevention (patients with a QRISK2 > 10%)?
Atorvastatin 20mg
37
Which patients should receive a low dose statin as a primary prevention regardless of QRISK2 score?
T1DM patients over 40 or with diabetes for 10+ years or with nephropathy CKD patients
38
What is the dose of statin used in secondary prevention?
Atorvastatin 80mg
39
Driving after a heart attack
Don't have to notify DVLA Should stop for around 4 weeks
40
GTN spray advice in stable angina
- Use before exercise - If needed, repeat dose after 5 minutes - Call an ambulance after 2 doses
41
How is type 1 DM diagnosed?
Random CBG of 11mmol/L OR Fasting plasma glucose 7mmol/L on 2 occasions Plus: Polyuria, polydipsia, weight loss, increasing tiredness
42
How is Type 2 DM diagnosed?
HbA1c >48mmol/mol (6.5%) on 2 occasions OR HbA1c >48mmol/mol (6.5%) + blood glucose diagnosis
43
In which patients may HbA1c measurement be unreliable?
``` Under 18s Pregnancy Chronic Kidney Disease HIV Pancreatic disease ```
44
How often are clinic HbA1c levels measured in T1DM
3-6 monthly
45
1st line insulin therapy for adults
Multiple basal bolus insulin injection
46
2nd line insulin therapy for adults
Twice daily Insulin Detemir
47
Glucose targets in Type 1 Diabetes
Fasting Plasma Glucose (waking): 5-7mmol/L Fasting Plasma Glucose (before meals): 4-7mmol/L Post-meals (90 minutes): 5-9 mmol/L
48
What does DAFNE stand for?
Dose Adjustment for Normal Eating Diet regimes in normal eating
49
What is the target blood pressure in Type 1 Diabetes and what is the first line treatment?
135/85mmHg 130/80 mmHg if albuminuria/ metabolic syndrome 1st Line: ACEi or ARB
50
4 stages of Diabetic Eye disease and features
1 (Mild): Microaneurysms 2 (Moderate): Haemorrhages, cotton wool spots 3 (Severe): Hard exudates 4 (Proliferative): New vessel formation near optic disc
51
Monitoring in Type 1 Diabetes
Retinopathy (3 months initially; then review annually) Neuropathy/ Foot Care (annual review) Nephropathy (Measure Albumin: Creatinine annually) Erectile Dysfunction (offer Sildenafil) Gastroparesis advice Cardiovascular risk (lipids, BP)
52
Rapid Acting Insulins
Lispro Actrapid Aspart Glulisine
53
Intermediate Acting Insulins
Isophane
54
Long Acting Insulins
Glargine, Detemir
55
Blood Pressure targets in T2DM
140/80 mmHg
56
When should statins be stopped in Non-Alcoholic Fatty Liver Disease (in context of T2DM)?
If liver enzyme levels double in 3 months
57
HbA1c target for T2DM patients controlled by lifestyle/ diet or a single drug (metformin)?
48mmol/mol (6.5%)
58
HbA1c target for TD2m patients controlled by any drug associated with hypoglycaemia?
53mmol/mol (7%)
59
At what point should therapy of T2DM be intensified, and what is the new target HbA1c?
When HbA1c reaches 58mmol/mol (7.5%) New target HbA1c is 53mmol/mol (7%)
60
2nd Line intensification therapies in T2DM after Metformin?
DDP4 Inhibitors- Gliptins Pioglitazone Sulfonylureas (gliclazide, glimepiride)
61
Contra-indications to Metformin
``` Renal Impairment (eGFR <30) Alcohol intake high ```
62
Side effects of Metformin
``` Weight Loss (reduced weight gain) Cardioprotective Abdominal pain, nausea and vomiting ```
63
Important facts on Sulfonylureas
Can cause Hypoglycaemia | Increases risk of weight gain
64
Contra-indications to Pioglitazone in T2DM
``` Bladder cancer Heart failure Diabetic Ketoacidosis Macroscopic haematuria Caution in elderly ```
65
Important features on SGLT2 Inhibitors (e.g. Canagliflozin)
Well tolerated Increased urine output Increased infection risk
66
Important features on DDP4 Inhibitors e.g. Sitagliptin
Generally well tolerated Weight neutral May be effective only for a short period
67
Indications for GLP-1 Mimetics in T2DM
BMI 35+ | can be offered in BMI under 35 if insulin would be detrimental, or weight loss beneficial to other health problems
68
Which patients should be screened for CKD?
``` Diabetes Hypertension Recurrent UTIs CV Disease Structural renal disease Family History of End Stage Kidney Disease Patients on Nephrotoxic drugs ```
69
Most common identifiable cause of CKD
Type 2 Diabetes
70
Basis of CKD Diagnosis- investigative tests
Serum Creatinine Measurement (eGFR) Proteinuria (Albumin: Creatinine Ratio) Haematuria Renal USS
71
When does CKD normally become symptomatic
Stage 4
72
Serum Creatinine Measurement in CKD
Don't eat meat 12 hours before the test Repeat within 2 weeks if <60
73
Preferred test for proteinuria in CKD
Albumin: Creatinine Ratio (is more sensitive to lower levels than Protein:Creatinine Ratio)
74
Action to take upon ACR results in CKD
3-70 mg/mmol: Repeat test in 3 months | 70 mg/mmol: Refer to nephrology
75
Which two investigations are used to stratify risk in CKD What would not count as CKD?
eGFR and ACR If eGFR is Stage 1/2; and ACR is under 3, then there is no CKD in absence of other markers of kidney damage
76
Common blood test findings in CKD
``` Hypocalcaemia Raised phosphate Raised Alk Phos Raised Parathyroid Hormone Anaemia ```
77
Blood pressure target in CKD
140/90 mmHg 130/80 if ACR is greater than 70
78
First line treatment for Hypertension in CKD
ACEi or ARB
79
Dietary advice in CKD
Moderate protein consumption Restrict potassium Avoid high Phosphate foods (milk, cheese, eggs)
80
When should oral Sodium Bicarbonate be offered in CKD
GFR < 30 | Serum Bicarbonate < 20 mmol/L
81
Management of restless legs/ cramps in CKD
Check ferritin levels | Can prescribe Clonazepam/ Gabapentin
82
What may affect HbA1c readings?
Haemglobinopathies- abnormally short RBC lifespans

4th Year (7 decks)

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