Chronic Phase 1 Flashcards
Topics
Cardio
Resp
Rheumatology
Chronic gynaecology
Breast triple assessment
- 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.
Asthma
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.
COPD
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).
Bronchiectasis
Acute exacerbation: Antibiotics, airway clearance techniques, and bronchodilators.
Long-term: Physiotherapy, prophylactic antibiotics, and management of underlying conditions.
ILD
Acute exacerbation: Oxygen therapy, corticosteroids, and treating underlying cause.
Long-term: Antifibrotic agents (e.g., pirfenidone, nintedanib), pulmonary rehabilitation, and oxygen therapy.
Cystic fibrosis
Acute exacerbation: Antibiotics (oral, IV, or nebulized), chest physiotherapy, and nutritional support.
Long-term: Enzyme replacement, high-calorie diet, regular physiotherapy, and prophylactic antibiotics.
Pulmonary hypertension
Acute management: Oxygen therapy, diuretics, and vasodilators (e.g., sildenafil).
Long-term: Disease-specific treatments (endothelin receptor antagonists, phosphodiesterase inhibitors, prostacyclins), anticoagulation, and diuretics.
Chronic HF
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.
Ischaemic heart disease
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.
AF
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.
Hypertension
Acute severe hypertension: IV antihypertensives (e.g., labetalol, nitroprusside).
Long-term: Lifestyle changes, antihypertensives (ACE inhibitors, ARBs, calcium channel blockers, diuretics).
Valvular heart disease
Acute exacerbation: Symptom management (diuretics for heart failure), treatment of arrhythmias.
Long-term: Regular monitoring, valve repair/replacement if indicated.
Rheumatoid arthritis
Acute flare: NSAIDs, corticosteroids (oral or intra-articular), DMARDs (methotrexate, sulfasalazine).
Long-term: DMARDs, biologics (TNF inhibitors), regular monitoring, physiotherapy
Osteoarthritis
Acute exacerbation: NSAIDs, corticosteroid injections, pain management.
Long-term: Lifestyle modifications, physiotherapy, analgesics, joint replacement surgery if severe.
Systemic lupus erythematosus
Acute flare: High-dose corticosteroids, immunosuppressants (e.g., cyclophosphamide).
Long-term: Hydroxychloroquine, corticosteroids, immunosuppressants, regular monitoring.
Ankylosing spondylitis
Acute flare: NSAIDs, corticosteroids.
Long-term: NSAIDs, TNF inhibitors, physiotherapy.
Gout
Acute attack: NSAIDs, colchicine, corticosteroids.
Long-term: Uric acid-lowering therapy (allopurinol, febuxostat), lifestyle modifications.
Psoriatic arthritis
Acute flare: NSAIDs, corticosteroids, DMARDs.
Long-term: DMARDs, biologics, physiotherapy.
Rheumatology examination
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)
Endometriosis
Acute flare: NSAIDs, hormonal therapy (e.g., oral contraceptives, GnRH agonists).
Long-term: Hormonal therapy, surgery (laparoscopy), pain management.
PCOS
Acute symptoms: Metformin for insulin resistance, hormonal contraceptives for menstrual irregularities.
Long-term: Lifestyle modifications, management of associated conditions (e.g., diabetes, infertility).
PID
Acute management: Broad-spectrum antibiotics (e.g., ceftriaxone, doxycycline, metronidazole).
Long-term: Regular screening for STIs, partner notification and treatment, contraception advice.
Chronic pelvic pain
Acute flare: Analgesics (NSAIDs), hormonal therapy if related to menstrual cycle.
Long-term: Multidisciplinary approach (pain management, physiotherapy, psychological support).
Memorrhagia
Acute management: Tranexamic acid, NSAIDs, hormonal therapy (e.g., oral contraceptives).
Long-term: Hormonal therapy, endometrial ablation, surgical options (e.g., hysterectomy).
Fibroids
Acute symptoms: NSAIDs, hormonal therapy (e.g., GnRH agonists).
Long-term: Myomectomy, uterine artery embolization, hysterectomy if indicated.
Nice guidelines asthma
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.
COPD Nice guidelines
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.
Bronchiectasis Nice guidelines
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.
Interstitial lung disease
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.
Cystic fibrosis NICE
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.
Asthma doses
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.
Prophylactic antibiotics with cystic fibrosis
Azithrozycin 250mg three times per week
