Chronic Phase 1

Question 1

Topics

Answer 1

Cardio
Resp
Rheumatology
Chronic gynaecology

Question 2

Breast triple assessment

Answer 2

• Clinical Examination: Includes inspection and palpation of both breasts and the axilla.
• Imaging: Mammography and ultrasound are the mainstays for initial assessment. MRI may be considered for further evaluation.
• Biopsy: Core needle biopsy (preferably under ultrasound or mammographic guidance) is essential for histological diagnosis.

Question 3

Asthma

Answer 3

Acute exacerbation: Administer oxygen, inhaled bronchodilators (e.g., salbutamol), corticosteroids (oral or IV), and consider magnesium sulfate in severe cases.
Long-term: Inhaled corticosteroids, long-acting beta agonists, leukotriene receptor antagonists, and monitoring with peak flow meters.

Question 4

COPD

Answer 4

Acute exacerbation: Oxygen therapy (target SpO2 88-92%), nebulized bronchodilators (salbutamol and ipratropium), systemic corticosteroids (prednisolone), and antibiotics if indicated.
Long-term: Smoking cessation, inhaled bronchodilators, corticosteroids, pulmonary rehabilitation, and vaccinations (influenza, pneumococcal).

Question 5

Bronchiectasis

Answer 5

Acute exacerbation: Antibiotics, airway clearance techniques, and bronchodilators.
Long-term: Physiotherapy, prophylactic antibiotics, and management of underlying conditions.

Question 6

ILD

Answer 6

Acute exacerbation: Oxygen therapy, corticosteroids, and treating underlying cause.
Long-term: Antifibrotic agents (e.g., pirfenidone, nintedanib), pulmonary rehabilitation, and oxygen therapy.

Question 7

Cystic fibrosis

Answer 7

Acute exacerbation: Antibiotics (oral, IV, or nebulized), chest physiotherapy, and nutritional support.
Long-term: Enzyme replacement, high-calorie diet, regular physiotherapy, and prophylactic antibiotics.

Question 8

Pulmonary hypertension

Answer 8

Acute management: Oxygen therapy, diuretics, and vasodilators (e.g., sildenafil).
Long-term: Disease-specific treatments (endothelin receptor antagonists, phosphodiesterase inhibitors, prostacyclins), anticoagulation, and diuretics.

Question 9

Chronic HF

Answer 9

Acute exacerbation: Diuretics (e.g., furosemide), oxygen, nitrates (if indicated), and consider inotropes.
Long-term: ACE inhibitors/ARBs, beta-blockers, aldosterone antagonists, lifestyle modification, and monitoring with echocardiography.

Question 10

Ischaemic heart disease

Answer 10

Acute exacerbation (unstable angina/MI): MONA (Morphine, Oxygen, Nitrates, Aspirin), antiplatelets (clopidogrel), beta-blockers, and consider revascularization (PCI/CABG).
Long-term: Antiplatelets, statins, beta-blockers, ACE inhibitors, lifestyle changes.

Question 11

AF

Answer 11

Acute management: Rate control (beta-blockers, calcium channel blockers), rhythm control (amiodarone, cardioversion), anticoagulation (warfarin, NOACs).
Long-term: Anticoagulation, rate/rhythm control, and regular monitoring.

Question 12

Hypertension

Answer 12

Acute severe hypertension: IV antihypertensives (e.g., labetalol, nitroprusside).
Long-term: Lifestyle changes, antihypertensives (ACE inhibitors, ARBs, calcium channel blockers, diuretics).

Question 13

Valvular heart disease

Answer 13

Acute exacerbation: Symptom management (diuretics for heart failure), treatment of arrhythmias.
Long-term: Regular monitoring, valve repair/replacement if indicated.

Question 14

Rheumatoid arthritis

Answer 14

Acute flare: NSAIDs, corticosteroids (oral or intra-articular), DMARDs (methotrexate, sulfasalazine).
Long-term: DMARDs, biologics (TNF inhibitors), regular monitoring, physiotherapy

Question 15

Osteoarthritis

Answer 15

Acute exacerbation: NSAIDs, corticosteroid injections, pain management.
Long-term: Lifestyle modifications, physiotherapy, analgesics, joint replacement surgery if severe.

Question 16

Systemic lupus erythematosus

Answer 16

Acute flare: High-dose corticosteroids, immunosuppressants (e.g., cyclophosphamide).
Long-term: Hydroxychloroquine, corticosteroids, immunosuppressants, regular monitoring.

Question 17

Ankylosing spondylitis

Answer 17

Acute flare: NSAIDs, corticosteroids.
Long-term: NSAIDs, TNF inhibitors, physiotherapy.

Question 18

Gout

Answer 18

Acute attack: NSAIDs, colchicine, corticosteroids.
Long-term: Uric acid-lowering therapy (allopurinol, febuxostat), lifestyle modifications.

Question 19

Psoriatic arthritis

Answer 19

Acute flare: NSAIDs, corticosteroids, DMARDs.
Long-term: DMARDs, biologics, physiotherapy.

Question 20

Rheumatology examination

Answer 20

Joint examination (swelling, tenderness, deformity)
Range of motion assessment
Functional status evaluation (e.g., grip strength)
Skin examination (rash, nodules)
Blood tests (ESR, CRP, rheumatoid factor, anti-CCP)
Imaging (X-ray, MRI, ultrasound of joints)

Question 21

Endometriosis

Answer 21

Acute flare: NSAIDs, hormonal therapy (e.g., oral contraceptives, GnRH agonists).
Long-term: Hormonal therapy, surgery (laparoscopy), pain management.

Question 22

PCOS

Answer 22

Acute symptoms: Metformin for insulin resistance, hormonal contraceptives for menstrual irregularities.
Long-term: Lifestyle modifications, management of associated conditions (e.g., diabetes, infertility).

Question 23

PID

Answer 23

Acute management: Broad-spectrum antibiotics (e.g., ceftriaxone, doxycycline, metronidazole).
Long-term: Regular screening for STIs, partner notification and treatment, contraception advice.

Question 24

Chronic pelvic pain

Answer 24

Acute flare: Analgesics (NSAIDs), hormonal therapy if related to menstrual cycle.
Long-term: Multidisciplinary approach (pain management, physiotherapy, psychological support).

Question 25

Memorrhagia

Answer 25

Acute management: Tranexamic acid, NSAIDs, hormonal therapy (e.g., oral contraceptives).
Long-term: Hormonal therapy, endometrial ablation, surgical options (e.g., hysterectomy).

Question 26

Fibroids

Answer 26

Acute symptoms: NSAIDs, hormonal therapy (e.g., GnRH agonists).
Long-term: Myomectomy, uterine artery embolization, hysterectomy if indicated.

Question 27

Nice guidelines asthma

Answer 27

Oxygen Therapy: Target SpO2 94-98%.
Bronchodilators: Nebulized salbutamol and ipratropium.
Corticosteroids: Oral prednisolone (40-50 mg) or IV hydrocortisone.
Magnesium Sulfate: IV in severe cases.
Monitoring: Peak flow, ABGs if severe.
Long-term Management:
Inhaled Corticosteroids (ICS): Beclometasone, fluticasone.
Long-acting Beta Agonists (LABA): Salmeterol, formoterol.
Leukotriene Receptor Antagonists: Montelukast.
Patient Education: Personalized asthma action plan, trigger avoidance.

Question 28

COPD Nice guidelines

Answer 28

Oxygen Therapy: Target SpO2 88-92%.
Bronchodilators: Nebulized salbutamol and ipratropium.
Corticosteroids: Oral prednisolone (30 mg for 7-14 days).
Antibiotics: If increased sputum purulence (e.g., amoxicillin, doxycycline).
Non-invasive Ventilation (NIV): For acute respiratory failure.
Long-term Management:
Smoking Cessation: Support and pharmacotherapy.
Inhaled Bronchodilators: LABA, LAMA (e.g., tiotropium).
Inhaled Corticosteroids: In combination with bronchodilators if frequent exacerbations.
Pulmonary Rehabilitation: Exercise and education programs.
Vaccinations: Influenza, pneumococcal.

Question 29

Bronchiectasis Nice guidelines

Answer 29

Acute Exacerbation:
Antibiotics: Based on recent sputum culture (e.g., ciprofloxacin, amoxicillin).
Airway Clearance Techniques: Physiotherapy, postural drainage.
Bronchodilators: If there is concurrent airflow obstruction.
Long-term Management:
Regular Physiotherapy: Daily airway clearance.
Prophylactic Antibiotics: For frequent exacerbations.
Monitoring: Regular lung function tests, sputum cultures.

Question 30

Interstitial lung disease

Answer 30

Acute Exacerbation:
Oxygen Therapy: To manage hypoxia.
Corticosteroids: High-dose for acute inflammation.
Treat Underlying Cause: E.g., infection, drug-induced.
Long-term Management:
Antifibrotic Agents: Pirfenidone, nintedanib.
Immunosuppressive Therapy: For autoimmune causes (e.g., methotrexate, azathioprine).
Pulmonary Rehabilitation: Exercise training, education.
Oxygen Therapy: Long-term for chronic hypoxia.

Question 31

Cystic fibrosis NICE

Answer 31

Acute Exacerbation:
Antibiotics: Targeted based on sputum culture (e.g., IV tobramycin, ceftazidime).
Chest Physiotherapy: Intensified to clear secretions.
Nutritional Support: High-calorie diet, pancreatic enzyme supplements.
Long-term Management:
Enzyme Replacement Therapy: Pancreatic enzymes with meals.
Regular Chest Physiotherapy: To maintain airway clearance.
Prophylactic Antibiotics: To prevent recurrent infections.
Multidisciplinary Care: Regular follow-up with CF team.

Question 32

Asthma doses

Answer 32

Oxygen Therapy: Target SpO2 94-98%.
Bronchodilators:
Salbutamol: 5 mg via nebulizer every 20 minutes initially, then as required.
Ipratropium Bromide: 500 mcg via nebulizer every 4-6 hours.
Corticosteroids:
Prednisolone: 40-50 mg orally daily for 5-7 days.
Hydrocortisone: 100 mg IV every 6 hours if unable to take oral medication.
Magnesium Sulfate: 1.2-2 g IV infusion over 20 minutes in severe cases.

Question 33

Prophylactic antibiotics with cystic fibrosis

Answer 33

Azithrozycin 250mg three times per week