Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GP > Diabetes, COPD & CKD > Flashcards

Diabetes, COPD & CKD Flashcards

1
Q

What’s COPD?

A

Chronic obstructive pulmonary disease

Damage to lungs (commonly by cigarettes) resulting in a mixture of bronchitis and emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical features of COPD? Signs too!

A

SOBOE
Chronic cough, clear sputum
Wheeze
Apnoea

Fatigue, weight loss

Recurrent chest infections

Hyper-resonance (due to hyperinflation)
Wheeze
Reduced air entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for COPD?

A

SMOKING

Occupational: working with dust, flour, fumes etc.

Genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology of COPD?

A

Bronchitis: inflammation of bronchi causing oedema, mucus, obstruction. Air can’t get down to alveoli as easily

Emphysema: alveoli lose elasticity, they can’t expel air as well, air stagnant in alveoli, so poor oxygen exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigation of COPD? What results would you see?

A

Spirometry would show obstructive pattern

CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What spirometry results would you expect to see in COPD?

A

Obstructive pattern

FEV1 80% or less than predicted

FEV1: FVC ratio less than 0.7 (because they have full lungs but can’t expel it quickly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are FEV1 and FVC?

What’s the normal range of FEV1: FVC ratio?

If its too low what does it mean?

A

FEV1: forced expiratory volume in 1 second
FVC: forced vital capacity (full volume you can breathe out)

0.75-0.85

Obstructive lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is COPD staged?

A

Gold criteria

1 - Mild: FEV1 > 80%
2 - Moderate: FEV1 50-80%
3 - Severe: FEV1 30-50%
4 - V severe: FEV1 < 30%

MRC: based on how breathlessness impacts function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of COPD long term?

A

Non-medical:
Pulmonary rehab
Stop smoking
Flu and pneumococcal vaccine every year

  1. SABA or SAMA

Decide if asthmatic features or not

No asthmatic features:
2. LABA + LAMA

Asthmatic features:

  1. LABA + ICS
  2. LABA + ICS + LAMA

Extras:

  • mucolytics if productive cough
  • theophylline if struggles with inhalers
  • if cor pulmonale, loop diuretic
  • LTOT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of an exacerbation of COPD?

A

ABCDE
High flow oxygen

Neb salbutamol 2.5-5.0mg
Neb ipratropium 500mg

Oral prednisolone 30mg
Or IV hydrocortisone 100mg

If this not working call for help
Amninophylline, BiPAP

Antibiotics if positive sputum sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What infections commonly cause exacerbations of COPD?

A

H. influenzae
S. pneumoniae

Maroxella catarrhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe pathophysiology of type 1 and 2 diabetes?

A
  1. Autoimmune destruction of beta cells in islets of Langerhans in pancreas
    they stop producing insulin
  2. insulin resistance and reduced effectiveness of endogenous insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical features of diabetes?

A 
Type 1:
Weight loss
Polydipsia
Polyuria
Fatigue
Or in DKA

Type 2 often found incidentally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What’s DKA and how does it present?

A

Diabetic ketoacidosis

Lack of insulin means the person is unable to convert glucose into glycogen to store it. Cell mitochondria have to break down fatty acids to generate energy. The product of this reaction is ketones

High levels of ketone in the blood leads to acidosis and is very serious

Presents:

  • abdo pain
  • vomiting
  • reduced consciousness
  • poly dipsia and uria
  • dehydration (tachyC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for diabetes? And what would the results be?

A

Fasting glucose > 7mmol/l

Random blood glucose > 11.1mmol/l

HbA1c > 48% (6.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What’s pre-diabetes?

A

Stage before diabetes 2

When blood glucose is higher than it should be but not high enough to classify as diabetes yet

Reversible, with lifestyle change

17
Q

Management of type 1 diabetes?

A

Insulin: short and long acting

Annual review of renal function, eyes, feet, BP

Education and support from GP, ANP, dietician, counselling

18
Q

Management of type 2 diabetes?

A

Lifestyle changes: diet, smoking, alcohol, exercise

Annual review of renal function, eyes, feet, BP

Drugs:
1. Metformin

  1. Add either a Sulfonylurea, SGLT2 inhibitor, DPP-4 inhibitor (-gliptins) or pioglitazone
  2. Insulin
19
Q

Give an example of a sulfonylurea. How do they work?

A

Gliclazide

Bind to beta cell receptors and stimulate insulin release, only effective if you have some beta cells left

20
Q

Give an example of a DPP-4 inhibitor? How do they work?

A

-gliptins, sitagliptin

Inhibits glucagon secretion

21
Q

How does pioglitazone work?

A

Improves insulin sensitivity, increases adipogenesis

22
Q

Give an example of a SGLT2 inhibitor? How do they work?

A

-fozins, dapaglifozin

Block renal reabsorption of glucose, so more is lost in urine

23
Q

What type of drugs are these?

  • dapaglifozin
  • gliclazide
  • sitagliptin
  • pioglitazone
  • metformin

Which ones have weight gain as a side effect?

A

SGLT2 inhibitor
Weight LOSS

Sulfonylurea
Weight GAIN

DPP4 inhibitor
Weight neutral

Pioglitazine
Weight GAIN

Metformin
Weight neutral

24
Q

How does metformin work?

Side effects?

A

Increases insulin sensitivity, hepatic gluconeogenesis and GI absorption of carbohydrates

GI upset

25
Q

What is CKD?

A

Chronic Kidney Disease

Gradual loss of kidney function over time (months, years)

26
Q

Clinical features of CKD? What’s the cause of most of these symptoms?

A 
Anorexia
Vomiting
Restless legs
Fatigue, weakness
Bone pain
Oedema
Pruritus

Men: impotence
Women: amenorrhoea

Caused by uraemia

27
Q

Risk factors of CKD?

A

Hypertension
Diabetes
Age

Glomerulonephritis
SLE
Polycystic kidney disease

28
Q

What are the stages of CKD?

A
  1. No CKD
  2. Mild
    3a. Moderate
    3b. Moderate
  3. Severe
  4. Kidney failure

Determined by GFR

29
Q

Complications of CKD?

A 
Anaemia
HTN
Hyperkalaemia
Hyperparathyroidism
Dyslipidaemia
30
Q

Management of CKD?

A

Limit progression: treat HTN

Symptom control: iron for anaemia, diuretics for oedema

Diet: avoid high potassium and phosphate foods

If very severe, dialysis

31
Q

What reverses warfarin and NOACs?

A

Warfarin: Vit K

NOAC: beriplex

32
Q

After you’ve done spirometry with your COPD patient, what other investigation would you do that would help figure out prognosis and management?

A

BODE

Body-mass index
(Airflow) Obstruction
Dyspnoea
Exercise

A multidimensional scoring system and capacity index to help predict outcomes

33
Q

What should you measure before starting LMWH?

A

Weight
LFTs
Platelet count
U+E

34
Q

How does warfarin work?

A

Vitamin K antagonist

Prevents formation of factor 2, 7, 9, 10

35
Q

How does unfractionated heparin work?

A

Activates anti-thrombin III

36
Q

How does LMWH work?

A

Enhances action of antithrombin

To help it antagonise factor Xa quicker and better

GP (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions