GP

Question 1

step1 management of patients ≥ 12 years with newly diagnosed asthma

Answer 1

a low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler to be taken as needed for symptom relief
this is termed anti-inflammatory reliever (AIR) therapy

Question 2

what is tx in patients ≥ 12 years with newly diagnosed asthma if patient presents highly symptomatic (for example, regular nocturnal waking) or with a severe exacerbation?

Answer 2

start treatment with low-dose MART (maintenance and reliever therapy, see below)
treat the acute symptoms as appropriate (e.g. a course of oral corticosteroids may be indicated)

Question 3

step 2 management of patients ≥ 12 years with newly diagnosed asthma

Answer 3

a low-dose MART
MART describes using an inhaled corticosteroid (ICS)/formoterol combination inhaler for daily maintenance therapy and the relief of symptoms as needed, i.e. regularly and as required

Question 4

step 3 management of patients ≥ 12 years with newly diagnosed asthma

Answer 4

a moderate-dose MART

Question 5

step 4 management of patients ≥ 12 years with newly diagnosed asthma

Answer 5

check the fractional exhaled nitric oxide (FeNO) level if available, and the blood eosinophil count NICE
if either of these is raised, refer to a specialist in asthma care
if neither FeNO nor eosinophil count is raised, consider a trial of either a leukotriene receptor antagonist (LTRA) or a long-acting muscarinic receptor antagonist (LAMA) used in addition to moderate-dose MART
if control has not improved, stop the LTRA or LAMA and start a trial of the alternative medicine (LTRA or LAMA)

Question 6

step 5 management of patients ≥ 12 years with newly diagnosed asthma

Answer 6

refer people to a specialist in asthma care when asthma is not controlled despite treatment with moderate-dose MART, and trials of an LTRA and a LAMA

Question 7

Sulfonylureas - side-effects

Answer 7

hypoglycaemia, weight gain and hyponatraemia

Question 8

meds causing hyperkalaemia

Answer 8

ACE inhibitors
angiotensin II receptor blockers
spironolactone
heparin
ciclosporin
amiloride

Question 9

most common s/e of metformin

Answer 9

GI disturbance

Question 10

meds causing bradycardia

Answer 10

verapamil
amiodarone
diltiazem
ivabradine

Question 11

meds causing lethargy/drowsiness

Answer 11

antipsychotics
tricyclic antidepressants
beta-blockers
carbamazepine
chlorpheniramine
phenytoin

Question 12

Lethargy, weight gain, cold intolerance?

Answer 12

• hypothyroidism

Question 13

Second degree heart block (Mobitz II)

Answer 13

an ECG shows a constant PR interval but the P wave is often not followed by a QRS complex

Question 14

Second degree heart block (Mobitz I)

Answer 14

an ECG shows progressive prolongation of the PR interval until a dropped beat occurs

Question 15

Metformin - contraindicated by

Answer 15

CKD (eGFR < 30ml/min/1.73m2)

Question 16

Insulin - side-effects

Answer 16

hypoglycaemia, weight gain and lipodystrophy

Question 17

COPD general mx?

Answer 17

Question 18

COPD - 1st line mx?

Answer 18

a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA)

Question 19

COPD - for patients who remain breathless or have exacerbations despite using short-acting bronchodilators?

Answer 19

is the patient has ‘asthmatic features/features suggesting steroid responsiveness’

Question 20

how do you determine whether a patient has asthmatic/steroid responsive features?

Answer 20

Question 21

COPD mx if No asthmatic features/features suggesting steroid responsiveness

Answer 21

add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA)
if already taking a SAMA, discontinue and switch to a SABA

Question 22

COPD mx if Asthmatic features/features suggesting steroid responsiveness

Answer 22

Question 23

COPD - when is oral theophylline given?

Answer 23

Question 24

COPD - prophylactic abx?

Answer 24

Question 25

COPD - short course oral steroids when?

Answer 25

Question 26

COPD - cor pulmonale features + mx?

Answer 26

Question 27

Factors which may improve survival in patients with stable COPD?

Answer 27

Question 28

what inflammatory marker is raised in subacute thyroiditis?

Answer 28

ESR

Question 29

exacerbating factors of psoriasis?

Answer 29

trauma alcohol drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab withdrawal of systemic steroids

Question 30

what are indications for verapamil?

Answer 30

Angina, hypertension, arrhythmias Highly negatively inotropic Should not be given with beta-blockers as may cause heart block

Question 31

s/e and cautions for verapamil?

Answer 31

Heart failure, constipation, hypotension, bradycardia, flushing

Question 32

indications for diltizaem?

Answer 32

Angina, hypertension Less negatively inotropic than verapamil but caution should still be exercised when patients have heart failure or are taking beta-blockers

Question 33

s/e and cautions for diltiazem?

Answer 33

Hypotension, bradycardia, heart failure, ankle swelling

Question 34

indications for Nifedipine, amlodipine, felodipine (dihydropyridines)?

Answer 34

Hypertension, angina, Raynaud's Affects the peripheral vascular smooth muscle more than the myocardium and therefore do not result in worsening of heart failure but may therefore cause ankle swelling Shorter acting dihydropyridines (e.g. nifedipine) cause peripheral vasodilation which may result in reflex tachycardia

Question 35

s/e and cautions for Nifedipine, amlodipine, felodipine (dihydropyridines)?

Answer 35

Flushing, headache, ankle swelling

Question 36

complete heart block ECG?

Answer 36

The ECG shows no association between the P waves and QRS complexes - complete heart block

Question 37

what is this?

Answer 37

Treponema pallidum

Question 38

what is seen on scan of thyroid in subacute thyroiditis?

Answer 38

Globally reduced uptake on iodine-131 scan

Question 39

what does coxsackie virus cause?

Answer 39

hand, foot, mouth disease

Question 40

meds causing impaired glucose tolerance?

Answer 40

antipsychotics thiazides ciclosporin loop diuretics corticosteroids

Question 41

moderate asthma features?

Answer 41

PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm

Question 42

severe asthma features?

Answer 42

PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm

Question 43

life-threatening asthma features?

Answer 43

PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma

Question 44

clinic BP in <80yo?

Answer 44

140/90 mmHg

Question 45

clinic BP in >80yo?

Answer 45

150/90 mmHg

Question 46

ABPM / HBPM in <80yo?

Answer 46

135/85 mmHg

Question 47

ABPM / HBPM in >80yo?

Answer 47

145/85 mmHg

Question 48

features of secondary syphilis?

Answer 48

painless, warty lesions on the genitalia rash on palms and soles buccal ulceration condylomata lata

Question 49

features of dengue fever?

Answer 49

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

Question 50

pneumonia caused by what is assoc with cold sores?

Answer 50

strep pneumoniae

Question 51

features of PDA?

Answer 51

left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat

Question 52

how does myxoedema coma present?

Answer 52

Myxoedema coma typically presents with confusion and hypothermia.

Question 53

which anaesthetic agent may result in adrenal suppression?

Answer 53

Etomidate

Question 54

features of lithium toxicity?

Answer 54

coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion polyuria seizure coma

Question 55

pulsus paradoxes can be a feature in what level of asthma?

Answer 55

severe asthma