Chronic diseases

Question 1

Give the stages and values for HTN

Answer 1

HTN stages:
1 = >135/85
2=>150/95

Severe = systolic >180 and diastolic >110

Question 2

What are the Xray features that would be seen with cardiac failure?

Answer 2

ABCDE 
Alveoli oedema 
Kerley B lines, 
Cardiomegaly 
Dilated vessels 
Pleaural Effusion

Question 3

What are the causes of HF?

Answer 3

IHD
Idiopathic dilated cardiomyopathy
HTN
Mitral and aortic valve disease

Question 4

How would a patient in HF present?

Answer 4

Breathless, swollen ankles, fatigued
Paroxysmal nocturnal dyspnoea (PND), Orthopnea
Signs: cold peripheries, tachypnoea, crackles, displaced apex beat

Question 5

What are the first and second line treatment option for HF?

Answer 5

1st = ACE-I + BB 
2nd = spironolactone  

or

1st = Hydrazalazine and nitrates 
2nd = ARB

Question 6

A 78 year old smoking diabetic comes to you complaining of chest pain. The pain is tight and radiates to her jaw. It comes on when walking up a hill and eases when she rests.
Whats preventative measures would you take?

Answer 6

Sounds like angina
Lifestyles advise:
Stop smoking if they do, diet and weight advice, increase exercise, control DM

Start aspirin, ACE-I and statin

Question 7

A 78 year old smoking diabetic comes to you complaining of chest pain. The pain is tight and radiates to her jaw. It comes on when walking up a hill and eases when she rests. What medication could you give to help her next time this happens?

Answer 7

Sounds like angina

1st line = GTN spray = sublingual glyceryl trinitrate

2nd line = BB or CCB-Dihydrophine

3rd line = BB + CCB-Dihydrophine (LA modified release nifedipine)

4th line = Ivabradine

Question 8

What would patients have to also suffer with to have stage 1 HTN but to get treated as a stage 2?

Answer 8

Signs of end organ damage (ECG, U&Es, haematuria & fundoscopy)
CVD, DM, renal pathology,
10 year CVD risk of >20% according to Q risk score

Question 9

What is the first like treatment for HTN in a black 45 year old?

Answer 9

CCB = dihydropyridine = Amlodipine

Question 10

What is the first line treatment for HTN in a caucasian 86 year old?

Answer 10

CCB = dihydropyridine = Amlodipine

Question 11

Give the 2nd 3rd and 4th lines for the treatment of HTN

Answer 11

2nd = ACE-I + CCB
3rd line = ACI + CCB + Diuretic -thiazide like
4th line = dependant on potassium levels if <4.5 give spironolactone if >4.5 raise the dose of the diuretic

Question 12

Explain primary, secondary and tertiary prevention and give examples for each in relation to HF

Answer 12

1 = preventing them getting the disease - loosing weight, low salt diet, increasing exercise, stopping smoking, sugar tax 
2 = Early detection of the disease and stopping its progressions - statins, low-dose aspirin
3 = Reducing damage caused by the disease Anti HTNs, routine checks, medication reviews.

Question 13

Explain the difference between population and high risk approaches to prevention

Answer 13

Population - targets the whole population to shift the entire curve to the left, as events occur in the normal group too - mass change, with small benefit to the actual person -
High risk - targets those at risk and offers them treatments - But this fails to address a public health issue and has little impact on disease control