COVID19

Question 1

What labs may be indicative of COVID? (2)

Answer 1

Leukopenia

Lymphopenia

Question 2

Name 4 physiological effects of angiotensin 2

Answer 2

• vasoconstriction - hypertension
• inflammation - ards
• fibrosis - cardiac fibrosis
• thrombosis
• proliferation

Question 3

What imaging features may be indicative of COVID? (3)

Answer 3

• Bilateral
• ground glass opacities
• Peripheral distribution

Question 4

Name and describe the 3 phases of COVID

Answer 4

• Stage 1: early infection- mild constitutional symptoms, fever, dry cough, diarrhoea, headache
• stage 2: pulmonary phase- sob, hypoxia
• stage 3: hyperinflammation- ARDS, sirs/shock, cardiac failure

Question 5

Name 3 clinical signs of stage 1 covid infection

Answer 5

• Lymphopenia
• increased prothrombin time PT
• increased D dimer and LDH (lactate dehydrogenase) (mild)

Question 6

Name 3 clinical signs of stage 2 covid infection

Answer 6

• abnormal chest imaging: bilateral ground glass opacities etc
• transaminitis ( hyper transaminases- synthesise amino acids)
• low to normal procalcitonin (calcium homeostasis)

Question 7

Name 3 clinical signs of stage 3 covid infection

Answer 7

• Elevated inflammatory markers: CRP, LDL, il-6, D dimer, ferritin
• elevated troponin (cardiac damage)
• nt-proBNP elevated (heart failure)

Question 8

Name 3 important SARS cov 2 variants

Answer 8

• B.1.1.7 variant or variant of concern voc 202012 / 01 or 20i/501y.V1 found in uk late 2020. More transmissible and cause more severe disease
• b.1.351 variant or 20H/501Y.V2 found late 2020 sa. More transmissable and evade immune responses but does not impact severity
. P.1 variant or 20J/501Y.V3. Found in Japan in travellers from Brazil late 2020. Several mutations with potential to increase transmissibility and impact immunity.

Question 9

What are the major thrombotic complications in COVID?

Answer 9

Hypercoagulation
• vTE including DVT and pe
• arterial thrombosis: stroke, mi, limb ischaemia
Higher risk in ICU

Question 10

What are the major coagulation abnormalities in Covid? (4)

Answer 10

• High fibrinogen
• high D dimer
• mild prolongation pt
• Prolongation aptt

Question 11

Which drug may have mortality benefit COVID?

Answer 11

Dexamethasone

Question 12

Which drug may be useful for hospitilised COVID patients with hypoxia not yet on oxygen?

Answer 12

Remdesivir (nucleoside analogue)

Avoid dexamethasone

Question 13

Which 3 drugs may be useful for hospitilised COVID patients with hypoxia receiving low flow oxygen?

Answer 13

• remdesivir
• dexamethasone
• if inflammatory markers still high, add tocilizumab (immunosuppressant)

Question 14

Which 3 drugs may be useful for hospitilised COVID patients with hypoxia receiving high flow oxygen Or non invasive ventilation?

Answer 14

• Low dose dexamethasone
• add tocilizumab if being transferred to or are in ICU
. Add remdesivir but reserve for low-flow patients if short supply

Question 15

Which 2 drugs may be useful for hospitilised COVID patients with severe disease requiring mechanical ventilation or extracorporeal membrane oxygenation?

Answer 15

• Low dose dexamethasone
• ICU: add tocilizumab
• avoid remdesivir

Question 16

Preferred antipyretics Covid?

Answer 16

Paracetamol

Avoid NSAIDs unless clinically indicated