GP + Misc Flashcards by Phoebe McCarthy

What is atopy?

A genetic tendency to develop allergies, with ↑IgE

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What is an allergy?

Disease caused by inappropriate immune response to ‘harmless’ antigen

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What is anaphylaxis?

Life-threatening type 1 allergic reaction

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What is an anaphylactoid reaction?

Clinical presentation like anaphylaxis, but not IgE mediated (mast cell damage)

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What is a type 1 allergic reaction?

IgE > mast cell degranulation

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What is a type 2 allergic reaction?

IgG > complement rxn and cell lysis

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What is a type 3 allergic reaction?

IgG > immune complexes deposit in tissues

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What is a type 4 allergic reaction?

Cell mediated > macrophages > B cell activation (delayed rxn)

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Symptoms of allergies?

Rash
Pruritis
Swelling/angioedema
Sneezing/rhinorrhoea
Dyspnoea, wheeze
N+V+D

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What are some investigations for allergies?

Skin prick testing
IgE testing (total IgE and specific IgE)
Challenge test (last resort)

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Management for urticaria?

Acute:
Consider PO corticosteroids

Long-term:
Antihistamines
Avoid triggers

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Management of allergic rhinitis?

Mild/intermittent = antihistamines

Severe/persistent:
Antihistamines
Nasal corticosteroids
Chromone eye drops

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What are the main priorities of palliative care?

Pain relief
Enhance quality of life
Neither hasten nor postpone death
Manage distressing symptoms

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How is pain managed in palliative care?

Follow WHO pain ladder

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What are the steps of the pain ladder?

Non-opioid (paracetamol, NSAID, aspirin)
Weak opioid (codeine, dihydrocodeine, tramadol)
Strong opioid (morphine, fentanyl)

+/- adjunct

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What are some adjunct options on the WHO pain ladder?

Neuropathic pain analgesics:
SSRI
TCAs
Gabapentin

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What is the breakthrough dose of morphine?

1/6th - 1/10th
of total daily dose

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Which strong opioid is preferred in palliative patients with mild-moderate renal impairment?

Oxycodone

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What should prescribed alongside all opioids?

Laxatives

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What are the 6 causes of nausea and vomiting in palliative care?

Reduced gastric motility
Chemically mediated
Raised ICP
Vestibular
Cortical
Visceral/serosal

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What are some of the first-line anti emetics used in palliative care?

Metoclopramide
Haloperidol
Cyclizine

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What is the mechanism of action of cyclizine?

Histamine receptor antagonist

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What is the mechanism of actions of metoclopramide and haloperidol?

Dopamine receptor antagonist

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What anticipatory medications should be prescribed in palliative care and what for?

SOB - morphine, midazolam
Secretions - hyoscine hydrobromide/butylbromide
Agitation - levomepromazine/midazolam

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What can be prescribed for hiccups in palliative care (3)?

Chlorpromazine Haloperidol Gabapentin

How to convert oral morphine does to subcut morphine and diamorphine (2)?

For SC morphine = dose÷2 For SC diamorphine = dose÷3

What is lasting power of attorney?

Someone appointed by a patient (when they had capacity) to make decisions on their behalf

What is an advanced decision to refuse treatment (ADRT)?

Legally binding document allowing a person to refuse specific medical treatments in the future (if they lose capacity)

What are advanced care plans?

Personalised documents which record patients wishes about future medical intervention (Not legally binding)

1st line laxative of choice for constipation in palliative care?

Stimulant = senna

What is 2nd line management of constipation in palliative care?

ADD osmotic laxative - lactulose or macrogol OR Surface wetting laxative - docusate

What is multiple organ dysfunction syndrome?

A hypometabolic, immunodepressed state w/: evidence of the failure of 2 or more organ systems

6 common causes of multiple organ dysfunction syndrome?

Sepsis Traumatic injury - burns/blood loss Pancreatitis MI Liver failure Toxic injury/poisoning

NICE definitions for stage 1 hypertension?

Clinic reading = 140/90 mmHg Ambulatory = 135/85mmHg

Possible causes of secondary hypertension (5)?

ROPED Renal disease Obesity Pregnancy induced Endocrine Drugs

Investigations following newly diagnosed hypertension (4)?

Fundoscopy Urine dip (ACR ratio) ECG Bloods - U&E, HbA1c, lipids

Hypertensive algorithm for <55y/o or T2DM?

1 - ACE/ARB 2 - ACE/ARB + CCB 3 - ACE/ARB + CCB + thiazide diuretic 4 - ACE/ARB + CCB + thiazide diuretic + spiro/alpha/beta

In step 4, when should spironolactone vs alpha/beta-blocker be used?

Spiro if K+ <4.5 Alpha/beta-blocker if K+ >4.5

Hypertensive algorithm if >55y/o or african-caribbean ethnicity?

1 - CCB 2 - CCB + ACE/ARB 3 - CCB +ACE/ARB + thiazide diuretic 4 - CCB + ACE/ARB + thiazide diuretic + spiro/alpha/beta

Blood pressure targets for those with HTN?

<80y = 140/90 (135/85 ABPM) >80y = 150/90 (145/85 ABPM)

Definitions of malignant hypertension/hypertensive emergency?

BP >180/120 WITH: Retinal haemorrhages or paplloedema

Management of malignant hypertension/hypertensive emergency (if persenting to primary care)?

Same-day referral

Who needs to be informed regarding notifiable diseases?

Local health protection team

Steps required for death confirmation?

Check patient ID (wristband) Assess response to verbal stimuli For a minimum of **five minutes** confirm the absence of: Central pulse on palpation Heart sounds on auscultation Resp sounds on auscultation Signs of life Confirm: Absence of pupillary reflexes Absence of corneal reflexes Absence of motor response to supraorbital pressure

What qualifies a death to be reported to the coroner (notifiable)?

Unexpected or sudden deaths Accidents/injuries Suicide Deaths results from ill treatment, starvation, or neglect Poisoning Industrial injury/disease e.g. asbestosis Stillbirths Prisoner/people in custody Service disability pensioners When attending doctor did not see them within 28 days before death

If a child is not considered competent under Gillick competence, who can consent on their behalf?

Parents Court can overrule parents if risk of death

Overview of refeeding syndrome (4)?

Sudden introduction in prolonged starvation In starvation cell metabolism has been slow Glucose introduced = insulin release = glucose into cells Causes demand for K+, phos, and Mg2+

How to convert oral codeine to oral morphine?

Divide dose by 10

What are the three types of organ transplant rejection?

Hyperacute Acute Chronic

When does hyperacute organ transplant rejection occur?

Minutes-hours

When does acute organ transplant rejection occur?

Within 6 months

When does chronic organ transplant rejection occur?

After 6 months

Management of hyperacute transplant rejection?

No treatment, graft must be removed

Management of acute transplant rejection?

May be reversible with steroids and immunosuppressants

How may acute renal transplant rejection be picked up?

Rising creatinine, pyuria and proteinuria with no reversible cause

Side effects of ciclosporin (4)?

Hypertension Hyperlipidaemia Nephrotoxicity Gingival hypertrophy

Side effects of tacrolimus (3)?

Tremor Neurotoxicity Nephrotoxicity

DVLA driving rules for seizures/epilepsy?

First seizure = 6months if normal ix Epilepsy = seizure free for 12m Withdrawal meds = until 6m after last dose MUST INFORM DVLA

DVLA driving rules for syncope?

Simple faint = no restriction 1 episode, explained/treated = 4w 1 episode, unexplained = 6m 2 or more = 12m

DVLA driving rules for stroke/TIA?

1 month Inform DVLA if residual deficit

DVLA driving rules for multiple TIAs over short period?

3 months Inform DVLA

How often to check blood sugars when driving in diabetes?

Up to 2 hours before and every 2 hours

Rules for HGV drivers with diabetes (3)?

Must inform DVLA No severe hypos in last 12m Full hypo awareness

When testing for coeliac disease, how long does gluten need to have been incorporated into the diet?

6 weeks

How long for the effects of finasteride to be seen/felt?

6 months

How long between inhaler doses in correct technique?

30 seconds

What should be considered if fever on alternating days in returning traveller?

Malaria

Out of COCP and HRT, which should be held before surgery and how long for?

Both 4 weeks

Which virus is associated with tonsillar cancer?

HPV

Precipitating factors for digoxin toxicity (3)?

Hypokalaemia Renal failure Dehydration

Signs of digoxin toxicity (4)?

Generally unwell Yellow-green vision Arrhythmias (AV block, bradycardia) Gynaecomastia

What disease can be reactivated in infliximab and adalimumab?

Tuberculosis

GP + Misc Flashcards

(72 cards)