GP High Yield Sheet PDF - RCSI Class of 2023

GP High Yield Sheet – Dr. Manar AlMansoor (RCSI Class of 2023) • • • • • • • • • • • When to consider referral in HTN? Resistant HTN, secondary HTN, severe end-organ damage (e.g., CVA, MI, DM, HF, CRF, hypertensive retinopathy, hypertensive encephalopathy). What is malignant HTN? BP 180/120 or...

GP High Yield Sheet – Dr. Manar AlMansoor (RCSI Class of 2023) • • • • • • • • • • • When to consider referral in HTN? Resistant HTN, secondary HTN, severe end-organ damage (e.g., CVA, MI, DM, HF, CRF, hypertensive retinopathy, hypertensive encephalopathy). What is malignant HTN? BP 180/120 or more, retinal hemorrhages and exudates or papilledema, could also have renal involvement. IT IS A MEDICAL EMERGENCY. What are the NICE guidelines for A-fib management? o Rate control: bisoprolol or diltiazem/verapamil. Consider digoxin if sedentary elderly. Not everyone needs rate control, but it is offered as a first-line strategy to those who need it. o Prevention of TE: use CHA2DS2VASc score to determine risk for anticoagulation. o Rhythm control: still sx despite rate control/unsuccessful. Options include electrical cardioversion and chemical cardioversion with drugs such as amiodarone. What is the NYHA classification for SOB in heart failure? o Class I: Asymptomatic with no limitations. o Class II: Slight limitation during ordinary activity. o Class III: Marked limitation during less than ordinary activity, such as walking for short distances. o Class IV: Symptoms are present at rest. AVOID BETA BLOCKERS IN THIS GROUP What is the GOLD classification of COPD? o Mild: FEV1 80% or more. o Moderate: FEV1 between 50 and 80% of predicted. Sx? Breathlessness on walking for a long time. o Severe: FEV1 between 30 and 50% of predicted. o Very severe: FEV1 less than 30%. What is the first-line management in COPD? Offer short-acting bronchodilator whether SABA (e.g., salbutamol) or SAMA (e.g., ipratropium) as needed/PRN. What is the second-line management in COPD? o FEV1 >50%: LABA (e.g., salmeterol, formoterol) OR LAMA (e.g., tiotropium). o FEV1 <50%: LABA AND ICS OR LAMA. What is the third-line management in COPD? Triple therapy LABA, LAMA, ICS. What are the common infecting organisms in UTIs? E. coli, proteus, pseudomonas, streptococci, staphylococci. What is the management of UTIs? Remember special management in children, pregnant women, and catharized patients. o Analgesia, increase fluid intake, oral antibiotics according to local guidelines (e.g., nitrofurantoin, trimethoprim). o Uncomplicated in females? 3 days, consider delayed prescription if mild symptoms. o Males, GU malformation, immunosuppression, relapse/recurrent UTI? 7-10 days. o Pyelonephritis? Ciprofloxacin for 7 days. How do we diagnose uncomplicated UTI in an otherwise healthy female? Urine dipstick for leucocyte and nitrite. Treat if positive. NO NEED FOR MSU unless