Areas for recap Flashcards
Investigations used for the diagnosis of asthma
When is investigation required?
REMEMBER there is no direct test for the diagnosis of asthma and hence requires clinical judgement
Investigation is required for patients with an intermediate probability of asthma (have only some of the characteristic features of asthma) or who do not respond to initial therapy (beta blocker and ICS)
Investigations:
- FeNO - 40 ppb is regarded as positive
Objective testing to assess airway obstruction when the pt is symptomatic:
- Spirometry - FEV1:FVC > 70
- Bronchodilator reversibility - > 12 % or increase of 200mL in lung volume in adults in response to a bronchodilator or steroid
- PEF readings - 20% variability after 2-4 weeks of twice daily monitoring is regarded as a positive result
BTS/SIGN Treatment of Asthma in adults
SABA → + ICS → + LABA → Increase ICS or + LTRA → specialist referral
BTS/SIGN Treatment of Asthma in Children
SABA → + very low dose ICS or LTRA (< 5) → Very low dose ICS + LTRA/LABA (>5) or LTRA (<5) → increase ICS (low dose) + LTRA/LABA (>5) → Specialist referral
Key questions in annual asthma review
- Assess inhaler technique
- Frequency of reliever use
- > x3 a week indicates need to progress to the next step for treatment
- Check adherance to treatment
- Assess severity of symptoms
- Any symptoms been experienced?
- Any nocturnal symptoms?
- Have symptoms interfered with activities?
- Any asthma attacks in the past year?
- Smoking status
- Occupational irritants ?occupational asthma
- Check for any adverse effects of long term steroid use: Hba1C, bone health, blood pressure, cholesterol, vision (catarracts and glaucoma)
Findings of cardiovascular examination in COPD
Elevated JVP, apex displacement, parasternal heave, cor pulmonale
Pharmacological treatment of COPD
Treatment of an acute exacerbation of COPD
- Increase dose or frequency of IHD bronchodilator
- Use of a NEB may be considered for those with extreme fatigue
- Add oral corticosteroid if there is interference with daily activities
- Add antibiotics if there is purulent sputum
Risk factors for dyspepsia
- Obesity
- Smoking
- Excessive alcohol intake
- Pregnancy
- Iatrogenic - medications (including NSAIDs)
- Consumption of certain foods (spicy, citrus)
- Eating late/close to going to bed
Key features of medical Hx to assess in dyspepsia
- Medications: Certain medications may exacerbate symptoms
- ALARMS55 symptoms
- SHx: Smoking and alcohol comsumption
Features of conservative management for reflux
- Weight loss
- Avoidance of exacerbating foods
- Smaller, more frequent meals
- Do not eat close to bed time
- Smoking cessation
- Reduction in alcohol intake
Diagnostic criteria for IBS
Ddx to rule out
At least 6 months of abdominal pain or bloating or change in bowel habit.
RULE OUT - Coeliac disease (anti-tTG, EMA), IBD (ESR/CRP), infective cause (recent travel or systemic illness)
Lifestyle advice for IBS
Dietary modifications: FODMAPS
Adequate fluid intake (8 glasses a day)
4 week trial of a pro-biotic
Identify and try to reduce stress
Maintain an active lifestyle
Smoking cessation and reduce alcohol intake
Diagnostic criteria for diabetes mellitus
Symptomatic patients: Symptoms + 1 elevated HbA1c/FPG readings
Asymptomatic patients: 2 elevated HbA1c/FPG readings
HbA1c, Fasting Plasma Glucose (FPG), OGTT and random blood glucose values for diabetes diagnosis
(values for GDM diagnosis)
HbA1c: 48 or above
FPG: > 7.0 mmol/L
OGTT: > 11 mmol/L
Random blood glucose: > 11 mmol/L
Gestational diabetes diagnosis:
FPG: > 5.6 mmol/L
OGTT: > 7.8 mmol/L
Limitation of HbA1c values in the diagnosis of diabetes mellitus
HbA1c is not suitable for all groups, with the following groups unsuitable for diagnosis via HbA1c value (FPG should instead be used):
- ALL children and young people (under 18 years of age)
- patients of any age suspected of having Type 1 diabetes
- patients with symptoms of diabetes for less than 2 months
- patients at high risk who are acutely ill (e.g. those requiring hospital admission)
- patients taking medication that may cause rapid glucose rise e.g. steroids, antipsychotics
- patients with acute pancreatic damage, including pancreatic surgery
- in pregnancy or 2 months post-partum
- presence of genetic, haematologic and illness-related factors that influence HbA1c and its measurement
REMEMBER HbA1c tests glycosylation of RBCs, with each RBC having a lifespan of 120 days. Therefore, conditions/events which interfere with RBC lifespan/number can effect HbA1c results.
