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Year 3 - GP Block > 15&17 - Chronic Diseases > Flashcards

15&17 - Chronic Diseases Flashcards

1
Q

What is the test in lower limb ischaemia?

A
  1. Buerger’s Test
  2. Elevate leg to 30 degress for 30-60 seconds
  3. Observe any colour change
  4. Colour change below 20 degrees indicates severe ischaemia
  5. Slow return of colour, or blueness indicates hyperaemia
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2
Q

CKD

- Seven medications groups?

A
  1. ACEi (protective)
  2. SGLT2
  3. Atorvastatin 20mg (CHD)
  4. Vit D/Colecalciferol
  5. EPO
  6. RRT
  7. Vaccination
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3
Q

CKD

- Six safety-net flags?

A
  1. Oliguria
  2. Flank pain
  3. Pruritis
  4. Muscle pains
  5. Oedema
  6. Palpitations
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4
Q

What are the sick day rules for CKD and what qualifies?

A
  1. When vommitting and/or diarrhoea

2. Stop ACEi, NSAIDs, Diuretics

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5
Q

What investigations are indicated in HTN for organ end-damage?

A
  1. Fundoscopy
  2. eGFR
  3. Bloods and ECG
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6
Q

HTN

- Three main drug groups

A
  1. ACEi/ARB
  2. CCB
  3. Thiazide-like diuretics
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7
Q

What safety-netting is indicated in HTN?

A
  1. Visual disturbance
  2. Sensory change
  3. BP > 180/90
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8
Q

What is the criteria for Hyperlipidaemia?

A
  1. Total Cholesterol >5.18mmol/L
  2. LDL cholesterol > 2.49mmol/L
  3. HDL cholesterol <1.04 mmol/L
  4. Triglycerides > 1.7mmol/L
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9
Q

Six hyperlipidaemia management options?

A
  1. Lifestyle modification
  2. 10% QRISK - Moderate intensity statin
    Atorvastatin 20mg
  3. High risk of ASCVD (atherosclerotic cardiovascular disease)
    Atorvastatin 40-80mg
  4. LDL-cholesterol remains >1.8mmol/L
    Ezetimibe 10mg PO
  5. LDL-c remains >1.8 at step 4
    Alirocumab 75-150mg (PCSK9 inhibitor - prevents LDLR antagonism)
  6. LDL-c >4.9 without DM and <75yo
    Colestyramine 4g PO (bile acid sequestrant)
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10
Q

Followup from commencing statin therapy?

A
  1. 3 Month lipid profile
    • Aim for 40% reduction
  2. Check CK levels
    - Watch for muscle pain
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11
Q

Tests for DM

A
  1. HbA1c
  2. Fasting glucose
  3. Fructosamine
  4. OGTT
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12
Q

DM 9 Processes of Care

A
  1. Screen before
    Retinopathy
    Peripheral vascular
    Albuminuria
  2. Lifestyle now
    Smoking
    BMI
    BP
  3. Monitor later
    Lipids
    HbA1c
    Creatinine
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13
Q

Statin Dosing in DM

A

QRISK >10%

Primary prevention - 20mg Atorvastatin
Secondary prevention - 80mg Atorvastatin + 75mg Aspirin

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14
Q

DM with microvascular changes/microalbuminuria

- BP Target

A

DM target with changes:

  • 130/80
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15
Q

DM Drugs and Targets

A

Metformin 500-2000mg
Liver
Muscles

  1. Gliclazide 40-320mg
    Pancreatic insulin (NB Hypos)
    Very potent - not for elderly
  2. GLP-1 eg Semaglutide 0.25-1mg once weekly
    Pancreatic action
  3. DPP-4
    Indirect/mild impact
    Sitagliptin 100mg oD
    Linagliptin
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16
Q

How to test the reversibility of a pulmonary disorder?

A
  1. Baseline spirometry
  2. Bronchodilation
    • Salbutamol (2 x 200mcg puffs)
      - Large volume spacer
  3. Pause for 30 minutes
  4. Repeat spirometry
    • FEV/FVC ration
17
Q

Example SABA inhalers?

A
  1. Salbutamol MDI (100mcg)
    • Ventolin
    • Salamol
    • Airomir
  2. Salbutamol DPI (200mcg)
    • Ventolin
  3. Terbutaline (500mcg)
    • Bricanyl
18
Q

ICS MDIs

A

ICS MDIs

  1. Clenil modulite
    • 50mcg Beclometasone
  2. QVAR
    • 50mcg Beclometasone
  3. Flixotide
    • 50 mcg Fluticasone
19
Q

ICS/LABAs

A

ICS/LABAs

  1. Seretide 250
    • 250mcg Fluticasone
    • 25mcg Salmeterol
  2. Symbicort 200
    • 200mcg Budesonide
    • 6 mcg Formoterol
  3. Fostair 200
    • 200mcg Beclometasone
    • 6 mcg Formoterol
20
Q

LABAs

A

Serevent MDI
- Salmeterol 25 mcg

Serevent Accuhaler
- Salmeterol 50 mcg

Formoterol Easyhaler
- 12 mcg formoterol

Oxis 6 turbohaler
- 6mcg formoterol

21
Q

LAMAs

A

LAMAs

  1. Spiriva Respimat SMI (soft mist)
    • 2.5 mcg Tiotropium bromide
  2. Spiriva MDI
    • 18 mcg Tiotropium Bromide
22
Q

Spacers

  1. Advantages
  2. Designs
A

Spacers

  1. Pros
    • Waste less
    • Fewer ADRs
  2. Designs
    • Volumatic
    • Aerochamber
23
Q

Asthma Prevention Plan

Three key components

A

Asthma Prevention Plan

  1. Everyday
  2. Exacerbation
  3. Attack
24
Q

Asthma Prevention Plan

  1. Everyday
A
  1. Everyday Asthma Prevention
    • Preventer inhaler regime
    • Reliever inhaler regime
    • Others
25
Q

Asthma Prevention Plan

  1. Exacerbation
A
  1. Asthma Exacerbation plan
    • Symptom relief
    • Reliever use
    • Check PEFR levels
    • Step up medication
26
Q

Asthma Prevention Plan

  1. Attack
A
  1. Asthma attacks response
    • Manage Sx
    • PEFR
    • Medications
    • Follow-up
27
Q

Childhood asthma

  1. DDs
  2. Natural history
A

Childhood asthma

  1. DDs
    • Viral wheeze
    • Foreign body
  2. Natural history
    • 80% will outgrow
    • Atopy is RF for adult asthma
28
Q

Asthma diagnosis follow up?

A
  1. Lots of follow up (lots of information - RAPRIOP)
    • Reassure
      Reversible + not a lung pathology
    • Reliever
      Opens up muscle spasm
    • Preventer
      Reduces inflammation and mucus
  2. Asthma nurse reviews
  3. Medication reviews
29
Q

COPD Rehab

A

COPD

  1. Lecture on disease
  2. Gym/exercise
  3. CBT
  4. Nicotine Patches COPD
30
Q

COPD Doctor Role

A

COPD Doctor Role

  1. Symptom management
    • eg. Inhalers
  2. Slow progression
    • Eg. Smoking cessation
31
Q

COPD Baseline History

A
  1. Smoking
    • History
    • Current
    • Factors
  2. Obesity
    • Risk Factor
  3. Lifestyle
    • Occupation
    • ICE
32
Q

Metformin

  1. Indication
  2. Dosing regimen
A

Metformin

  1. Indication
    - 6.5% HbA1C for six months
  2. Dosing regimen
    - 1 Week 500mg OD
    - 2 Weeks 500mg BD
    - 3 weeks tds/qds
33
Q

GLP1 indications

A

GLP1 indications

  1. BMI>30
  2. CHD (Empa)
  3. CKD (Dapa)
34
Q

What are the stages of Buerger’s Test?

A

Buerger’s Test

  1. Supine patient
    • Elevate legs to 45
    • Palor = Ischaemia
  2. Sit patient up
    • Hang legs at 90 flexion
    • Blue then red reveals post-hypoxic vasodilation
35
Q

What is Buerger’s angle and what does it indicate?

A

Buerger’s Angle

  1. 20 degrees
  2. Indication of severe ischaemia
36
Q

Limb ischaemia

- Dx

A

Limb ischaemia drugs
- For prevention of vascular disease

  1. Statin
  2. Aspirin
37
Q

Two broad causes of eosinophilia?

A

Eosinophilia?

  1. Parasite
  2. Asthma (responsive to steroids)
    - Allergies
    - Drug reactions

Year 3 - GP Block (13 decks)

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