General GP Flashcards
TATT: investigations
In all: Urinalysis (DM, renal disease) FBC (anaemia, infection, malignancy) Random/fasting glucose LFTs and UEs
If indicated: TFTs Monospot test (glandular fever) Vitamin D Haematinics (iron, B12, folate) Coeliac antibodies HIV serology Cancer antigens?
PHQ-(DEPRESSION SCREEN)
Diabetes management
a) How often check HbA1c?
b) 1st line
c) If not below 48mmol/L - 1st line
d) Then add one of what 4 options (if HbA1c > 58) ?
(if BMI > 35, or would benefit from weight loss, may try what option before insulin?
e) If still not controlled…?
f) Other than diabetes drugs, also prescribe what classes in what cases? (difference in Afro-Caribbean)
g) Monitoring
a) Initially 3 monthly, then 6 monthly
b) Diet, exercise, etc.
c) Metformin
d) Dual therapy: Add in…sulfonylurea, gliptin (DPP-4 inhibitor), SGLT2 inhibitor or pioglitazone
e) Triple therapy: met + 2 2nd line drugs. If this fails, GLP-1, then insulin
f) ACE (+ diuretic or CCB if Afro-Car) if BP > 140/80 (or 130/80 if end-organ damage), statin if 10% QRISK2 score
g) renal, lipids, TFTs, eyes, feet, CV risk, neuropathic pain
Pre-diabetes
a) HbA1c
b) Fasting glucose
c) Impaired glucose tolerance
a) 42 - 47
b) 6.1 - 6.9
c) Fasting plasma glucose less than 7.0 mmol/L and OGTT 2-hour between 7.8 and 11.1 mmol/L
Angina: investigations
a) Initial
b) Follow-up:
- If CAD risk < 10%
- If CAD risk 10 - 29%
- If CAD risk 30 - 60%
- If CAD risk 60 - 90%
- If CAD risk > 90%
a) ECG, bloods (FBC, UEs, creatinine, glucose, lipids, TFTs, troponins, LFTs)
b)
< 10% - look for differentials
10 -29% - CT calcium scoring
30 - 60% - non-invasive coronary angiography
60 - 90% - invasive angiography
> 90% - treat without need for investigation
Angina: management
a) Symptomatic treatment (PRN)
b) Long-term treatment - 3 drugs (alternatives?)
c) If not controlled/contraindications - alternatives?
d) Surgical
e) Also advise…?
a) GTN
b) Beta-blocker (or CCB), statin, antiplatelet (aspirin)
c) Long-acting nitrate, ivabridine
d) Coronary revascularisation
e) Cardiac rehab, risk factor reduction, etc.
AF:
a) Rate control
b) Rhythm control
c) Other management
a) BB or CCB
b) Amiodarone, sotalol, fleicanide, electrical cardioversion
c) CHADSVASc - warfarin or NOAC (non-valvular)
COPD management
a) 1st line
b) If FEV1 > 50% -?
c) If FEV1 < 50% or not adequately controlled on above
a) SABA or SAMA
b) Add LABA or LAMA
c) Add ICS (combined inhaler with LABA/ICS = Fostair)
d) Add LAMA
CKD: stages
Stage 1: > 90 but signs of kidney damage Stage 2: 60-90 with signs of damage Stage 3A: 45-59 Stage 3B: 30-45 Stage 4: 15-30 Stage 5/ESRF: <15 (dialysis or transplant needed)
CKD: management
a) Monitoring
b) Drugs to presribe
c) Other possible meds
d) Avoid what?
a) CVD risk, urinalysis, eGFR, BP
b) Statin, antiplatelet,
c) Phosphate binders, vit D, bisphosponates, antihypertensive (if > 140/90 or lower in DM)
d) Nephrotoxins: NSAIDs, radio-contrast, aminoglycosides, metformin, cyclosporin, allopurinol
Heart failure: management
a) Routinely prescribe what 2 DMDs?
b) Add-in therapy?
c) If these fail - other options?
d) Surgery?
e) Offer what annual vaccines?
f) Symptomatic
a) ACE, BB
b) Spiro
c) Ivabradine, digoxin
d) Cardiac resynchronisation therapy
e) Flu and PCV
f) Furosemide
CCF: NYHA classification
- NYHA Class I: no symptoms
no limitation on ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations - NYHA Class II: mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea - NYHA Class III: moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms - NYHA Class IV: severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
