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Year 4 things I forgot > CCC > Flashcards

CCC Flashcards

1
Q

What should all patients with CKD or T1DM for more than 10 years be offered

A

Atorvastatin 20mg

LFTs at 3 months - 3 times raise is acceptable

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2
Q

When should statins be increased

A

If non-HDL has not reduced by 40%

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3
Q

First line treatment for prolactinomas

A

Cabergoline (dopamine agonist)

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4
Q

Patients on Hydroxychloroquine (SLE) require what monitoring

A

Visual acuity

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5
Q

What should all patients over 5 with a ?asthma dx receive

A

FeNO
Spirometry (70% FEV1/FEVC?
BDR (improvement of 12% and 200ml FVC)

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6
Q

Wheeze heard in asthma

A

Bilateral polyphonic

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7
Q

In patients with diagnostic uncertainty in asthma, what can be performed

A

Peak flow variability chart

Direct bronchial challenge with histamine

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8
Q

Only diagnosis for an acute moderate asthma attack

A

Peak flow 50-75%

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9
Q

What variability must be seen in peak flow variation for asthma

A

Greater than 20%

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10
Q

When in the stage of the disease does COPD cause clubbing

A

It NEVER does

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11
Q

COPD scale and grading

A 
MRC 1-5
1 breathless on strenuous exercise
2 breathless walking up hill
3 breathless walking on flat
4 stop to catch breath after 100m
5 unable to leave house

FEV1 GOLD scale

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12
Q

How is a COPD diagnosis made

A

Clinical picture + spirometry (FEV1:FEVC less than 0.7)

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13
Q

How is severity of COPD graded

A

FEV1

1-4
4< 30% of expected

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14
Q

What advice should be given before a TLCO test

A

Stop smoking for 24 hours

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15
Q

What is FRC made up of

A

Residual volume
+
expiratory reserve volume

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16
Q

What is vital capacity (respiratory) made up of

A

IRV, TV and ERV

Everything but residual volume

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17
Q

What does second line treatment of COPD depend on?

A

Asthmatic or steroid responsive features

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18
Q

First line COPD treatment

A

SABA or SAM (ipatropium bromide)

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19
Q

Second line COPD treatment

A

Astmatic features: ICS + LABA

Non asthmatic features: LAMA +LABA

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20
Q

What does bipap stand for

A

Bilevel positive airway pressure

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21
Q

Main indication for bipap

A

pH less than 7.35
AND
CO2 > 6

(despite medical treatment)

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22
Q

What should all patients have before bipap

A

A CXR (looking for pneumothorax)

Pneumothorax and facial structure pathology are main contraindications

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23
Q

BiPAP starting pressures

A

15 (insp)

5 (exp)

24
Q

Who should get pulmonary rehab in COPD

A

All patients with MRC 3 or greater (breathless on flat)
AND
Those who feel it is disabling them

25
Q

IECOPD management

A

Prednisolone 30mg 7-14 days
Salbutamol and ipatropium (neb or inh)
ABX (prulent sputum or clinical sings only)
Physio

IV aminophylline, NIV, doxapram

26
Q

Steroid dose in IECOPD

A

pred 30mg 7-14 days

27
Q

What do all patients with COPD get at second stage of management

A

LABA
+
Asthma features :ICS
No asthmatic features: LAMA

28
Q

Criteria for LTOT in COPD

A

PO2< 7.3

Or PO2 7.3-8 AND peripheral oedema, polysythemia, or pHTN

29
Q

When do patients with an IECOPD get ABX

A

Pruelent sputum or clinical signs of pneumonia

30
Q

ABX for IECOPD

A

Amoxicillin
Claithromycin (long QT syndrome)
Doxycycline

31
Q

4 test results that diagnose T2DM

A

HbA1c >48
Random BM >11
Fasting BM >7
OGTT >11

32
Q

Two T2DM hba1c targets

A

48 for new T2DM

53 if risk of hypo

33
Q

Key risk of metformin

A

Lactic acidosis

34
Q

DM drug that increases risk of HF and bladder cancer

A

Piaglitazone

35
Q

Second line T2DM drug for any one with CKD, CVD or QRIS>10

A

SGLT-2 inhib (flozin)

UTIs and DKA risk

36
Q

Who should get atorvastatin 20mg

A

All CKD pts

T1DM for more than 10 years

37
Q

When starting statins what is the goal

A

Reduction in HDL of greater than 40%

check lipids at 3 months

38
Q

When should pts with stable angina call 999

A

after 2 puffs (5 mins between)

39
Q

When are q waves likely to appear during an MI

A

Late

Hyper acute t -> STE -> TWI/ Q

40
Q

Electrolyte side effect of loop diuretics

A

Hypokalaemia

Hyponaturemia

41
Q

Electrolyte side effect of thiazide

A

Hypokalaemia
Hyponatremia
(increased uric acid)

Same as loop diuretic

42
Q

Electrolyte side effect of spironolactone

A

Hyperkalemia
Hyponatermia

(same as Addisons as blocks aldosterone)

43
Q

Pattern of vomitting in a toxic cause

A

Nausea
Very often
Small amount

Vommting does not relieve nausea

44
Q

Pattern of N and V in gastric stasis

A

Early fullness
infrequently
Nausea improves after vomitting

45
Q

1st and 2nd line treatment for NV due to toxins

A

1 haloperidol

2 levopromazine

46
Q

1st line NV due to vestibular cause

A

cyclizine

47
Q

Alternative to metoclopramide in NV due to gastric stasis

A

Domperidone (dopamine antagonist)

48
Q

When should CKD pts be referred to a specialist

A

eGFR<30
ACR?70
Decrease in eGFR of 15 or 25% in 1 year

49
Q

What 3 drugs may be needed to treat CKD patients

A

Oral sodium bicarbonate to treat metabolic acidosis
Iron/ depo injections for anaemia
Vitamine D for renal bone disease

50
Q

First line anti HTN in CKD

A

ACE inhibitors

51
Q

Why should blood transfusions be limited in patients with CKD

A

May need a renal transplant

Transfusions causes allosensitisation why means transplanted organs more likely to be rejected

52
Q

3 features of CKD bone disease (in terms of bone problems)

A

Osteomalacia (softening)
Osteoporosis (brittle)
Osteosclerosis (hardening)

53
Q

xray changes seen in CKD bone disease

A

Sclerosis of both ends of vertebra
Osteomalacia in centre of vertebra

This is known as rugger jersey

54
Q

Phosphate levels in CKD

A

High as cannot excrete

55
Q

What CCB should be used in patients with HF

A

Amliodipine

Nifedipine spesicialy can worsen symptoms

Year 4 things I forgot (7 decks)

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