management of core conditions

Question 1

asthma

Answer 1

1) SABA as required - if 3 X a week, go UP
2) low dose ICS
3) + LABA
4) + medium ICS or add LTRA
(if LABA no help, remove)
5) refer to patient for specialist

Question 2

asthma emergency

33, 92 chest

Answer 2

Sit them UP!
O - 15 L NON REBREATHE mask HIGH FLOW
S- Salbutamol nebulised 5MG - give them back to back!!! CHECK K cos can lower potassium. - hypo K
H- help!! Call for help!!!!! REG/ICU critical care.
IPRATROPIUM 6-8 L to nebuliser solution. (can only be given 4-6 hourly).
Theopylline
M- Magnesium sulphate 1.2g-2g over 20 mins IV. Or IV aminophylline or IV salbutamol.
Escalalte
STEROID.- 100mg hydrocortisone IV. Or prednisolone 40-50mg tablets if can manage them.

Question 3

Diabetes

Answer 3

HBA1C 48 = diabetic
RBG: >11+ diabetic
FBG: >7 diabetic

48–> 52 –> 58
1) metformin or sulfonylurea if metformin not tolerated

2) metformin + sulfonylrea
3) 2 drugs + statglliptin / pioglitazone
4) INSULIN

Question 4

Coronary Heart Disease

Answer 4

ivx: coronary angioplasty
- atorvostatin 20mg daily if Qrisk 10%+ (se joint pain, nause, nose bleeds)

• decrease BP with Ace
• B blocker for coronar arteries HTN
• Nitrates
• Low dose aspirin 75mg

Question 5

Heart Failure

Answer 5

LV systolic dysfunction - poor lv contraction
- LOOP DIURETIC
- ACE + B
statin and antiplatelet

Impared LV RELAXATION - EF preserved

• LOOP DIURETIC fuoresemide
• antiplatelet + statin

(LV dysfunction = same + Ace and B)

Question 6

Stroke

Answer 6

ischaemic
- thombolysis (within 4.5 hours onset = alteplase)
aspirin 300mg
- mechanical thrombectomy within 6hrs onset
- DOAC rivaroxiban
Decompression craniectomy if < 60

LONG TERM:  
- aspirin 2 weeks 300mg 
Clopidogrel 75mg 
Stain 80mg secondary prevention 
manage BP

haemorrhagic

• reverse anticoagulation
• surgical referral if CSF incresing- burn bleed to stem

Question 7

TIA

Answer 7

suspected TIA
- ABCD2 score

Treat
- 300mg aspirin

Question 8

Chronic kidney disease

Answer 8

• sustained decrease egfr 25% frmo baseline and change in CKD category in 12 months

TX:

• ACE INHIBITOR (BP)
• STATIN
• antiplatelets
• when eGfr <10
• -> dialysis or transplant

Question 9

Atrial Fibrillation

Answer 9

ACUTE + HAEMODYNAMICALLY UNSTABLE

• Emergency cardioversion
• rhythm control amiodarone or Flecanide

Chronic

• Rate control B blocker or Ca channel blocker
• Digoxin if non paroxysmal and sedentry
• cardiovert electrically

Question 10

frailty

Answer 10

• recognise risk patients
• dementia
• postural hypotension
• delerium
• osteoprosis
• infection

Question 11

Obesity

Answer 11

• BMI + 25 overweight
  + 30 obese
  +35 morbidly obese

Question 12

Depression

Answer 12

• mild: CBT
• moderate : 2 core + 2 extra - SSRI + CBT
• severe: 3 core + 4 extra SSRI + CBT
• resistant and catatonic / risk to life from cachexia = ECT