ILAs

Question 1

over what values is hypertension ?

Answer 1

> 140/90
confirmed with ambulatory/home: >135/85

Question 2

most common cause of hypertension

Answer 2

primary (90%) high BP has developed on ownc

Question 3

causes of secondary hypertension ? 2 most common ?

Answer 3

ROPED
- renal disease (common)
- cons disease/primary hyperaldosteronism (common)
- obesity
- pregnancy induced/pre eclampsia
- endocrine
- drugs (alcohol, steroids, NSAIDs, oestrogen)

Question 4

If high BP is not responded to treatment, what should you consider ?

Answer 4

consider renal artery stenosis
(duplex US)

Question 5

what ranges for stage 1/2/3 hypertension ?

Answer 5

• stage 1: >140/90 (>135/85)
• stage 2: >160/100 (>155/95)
• stage 3: > 180/120

Question 6

what lifestyle advice for hypertension ?

Answer 6

• healthy diet
• smoking cessation
• reduce alcohol
• reduce caffeine
• reduce salt
• regular exercise

Question 7

50 year old white man hypertension. what first line drug ? who else in the category ?

Answer 7

ACEI
(<55 or T2DM (any age))

Question 8

50 year old black man with hypertension. what first line drug? who else in this category ?

Answer 8

CCB
(>55 or black African)

Question 9

first line hypertension managment not enough, then add what ?

Answer 9

• consider ACEI or CCB (whichever they’re not already on)
  OR
• Thiazide-like diuretic

Question 10

third line hypertension Mx ?

Answer 10

ACEI + CCB + thiazide like dietetic

Question 11

what tests would you do in a newly diagnosed patient with hypertension to ensure they do not the any end-organ damage ? (3)

Answer 11

• fundoscopy (check for hypertensive retinopathy)
• urine dipstick (check for renal disease, either as a cause of consequence of hypertension)
• ECG (to check for LV hypertrophy of IHD)

Question 12

ACEI SE ? (2)

Answer 12

• cough
• hyperkalaemia

Question 13

CCB SE ? (3)

Answer 13

• headache
• flushing
• ankle oedema

Question 14

BB SE ? (3)

Answer 14

• bronchospasm (especially in asthmatics)
• fatigue
• cold peripheries

Question 15

bendoflumethiazide SE (4)

Answer 15

• gout
• hyppokalaemia
• hyponatraemia
• impaired glucose tolerance

Question 16

what antihypertensive is first line in diabetic patients ?

Answer 16

ACEI/ARBS regardless of age

Question 17

What drugs can contribute to idiopathic intracranial hypertension ? (5)

Answer 17

• COCP
• steroids
• tetracyclines
• retinoids
• lithium

Question 18

what are the BP target ranges over a patient over 80 years ?

Answer 18

<150/90 (<145/85)

Question 19

describe the antibodies associated with RA ? and what their sensitivity is ?

Answer 19

• RF (IgM): autoantibody that attacks IgG => inflam (70% of RA patients have it)
• Anti-CCP (more specific -80-90%)

Question 20

what indicates a worse prognosis in RA ? (3)

Answer 20

• disease activity
• positive Ab (RF or anti-CCP)
• erosions on xray
• extra-acrituclar features (nodules)

Question 21

RA RF ?

Answer 21

F:M (3:1)
middle age
smoking
obesity
FHx

Question 22

RA presentation ? which joints affected ?

Answer 22

rapid of gradual: (triad) joint pain, stiffness swelling (worse with rest, improve with activity)
- MCP, PIP, wrist, MTP

Question 23

RA hand OE ?

Answer 23

• synovial thickening => boggy feeling
• positive squeeze test
• z shaped deformity
• swan neck deformity
• boutineirs deformity
• ulnar deviation

Question 24

name some extra articular manifestations of RA ?

Answer 24

• sjorgrens
• eye manifestations (keratoconjunctivitis sick - dry eyes)
• nodules

Question 25

what would be seen on Xray of RA ? (5)

Answer 25

- periarticular osteopenia - bony erosions - soft tissue swelling - loss of joint space - subluxation

Question 26

RA Mx ?

Answer 26

- short term steroids: at initial px or during flares - DMARDS: methotrexate, hydroxychloroquine/sulfasalazine (safest during pregnancy)

Question 27

when should methotrexate be stopped prior to conception ?

Answer 27

6 months before conception (in men and women)

Question 28

what would post-bronchodilator spirometry show in COPD

Answer 28

obstruction: FEV1/FVC ration less than 70% (0.7)

Question 29

What would be seen on CXR of patient with COPD ?

Answer 29

- hyperinflation - bull - flat hemidiaphragm

Question 30

What general lifestyle managment is recommended to patients with COPD ?

Answer 30

- smoking cessation - annula flu vaccine - one-off pneumococcal vaccine - pulmonary rehab

Question 31

What is first line medical Mx of COPD ?

Answer 31

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

Question 32

COPD patient is not controlled on SABA. what would you consider next ? what does this depend on ?

Answer 32

depends on if asthmatic features suggestion steroid responsiveness - no asthmatic features: add LABA and LAMA - asthmatic features: add LABA + ICS

Question 33

what are the features of cor pulmonale ?

Answer 33

- peripheral oedema - raised JVP - systolic parasternal heave - Loud P2

Question 34

which COPD patients should be considered for Long term oxygen therapy (LTOT) ?

Answer 34

- severe airflow obstruction: FEV1 < 30%) - cynaosis - polycythaemia - raised JVP - Oxy sats <92%

Question 35

most common infective causes of COPD exacerbation ?

Answer 35

- haemophiliac influenza (most common)

Question 36

Gout most commonly affects which joint ?

Answer 36

1st metatarsophalangeal joint (MTP joint)

Question 37

describe the fluid analysis of the synovial fluid in gout ? when checked ?

Answer 37

needle shape negatively birefringent monosodium rate crystals under polarised light - should be choked once the acne ep has settled down (2 weeks later)

Question 38

pseudo gout joint aspiration description ?

Answer 38

weakly-positive birefringent rhomboid-shaped crystals

Question 39

Gout acute managment ?

Answer 39

NSAIDs or colchicine

Question 40

main colchicine side effect ?

Answer 40

diarrhoea