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My General Practise > Oxford summary 6 > Flashcards

Oxford summary 6 Flashcards

1
Q

Acute Abdomen Hx & Exam

A 
SOCRATES 
Temperature, pulse, BP, anemia,
Jaundice 
Guarding/ rebound tenderness 
Rectal/ vaginal examination 
Urine dipstick/ finger prick blood glucose testing
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2
Q

Acute Abdomen DDx

A

Renal causes
Gynaecologic
GI
Other

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3
Q

Acute Abdomen

Ruptured spleen Hx

A

History of trauma
Blood loss: tachycardia, hypotension, pallor
Peritoneal irritation: guarding, rigidity, shoulder tip pain
Paralytic ileus: distention, no bowel sounds

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4
Q

RUQ pain DDx

A

liver
gallbladder
duodenum
right lung

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5
Q

R Flank pain DDx

A

R kidney
colon
ureter
MSK

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6
Q

RIF pain DDx

A 
caecum
appendix
R ovary
R fallopian tube
ureter
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7
Q

suprapubic pain DDx

A

bladder
uterus
rectum

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8
Q

epigastric pain DDx

A

oesophagus
stomach
duodenum
heart

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9
Q

LUQ pain DDx

A

stomach
spleen
L lung

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10
Q

L Flank pain DDx

A 
L kidney
colon 
ureter
AAA
MSK
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11
Q

Central pain DDx

A

small bowel
appendix
Meckel’s diverticulum

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12
Q

LIF pain DDx

A

colon
L ovary
L Fallopian tube
ureter

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13
Q

Abdominal Pain Hx + Exam

A

Hx: Socrates

Examination
• Temperature, pulse, BP, RR, anemia, jaundice signs
• Abdominal, rectal, genitalia exam
• Urine dipstick/ finger prick blood glucose testing

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14
Q

Anal/ perianal pain

A 
Fissue, haemorrhoids, naematoma, abscess, fistula 
Pilonidal sinus 
Skin infection 
FunRUQctional pain- proctalgia fugax 
Carcinoma
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15
Q

tenesmus DDx

A

IBS
Proctitis
IBD
tumour

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16
Q

Constipation Sx

A

Straining at defecation ≥25% of time
Tenesmus ≥25% of time
≤2 bowel movements / week
Lumpy/ hard stools ≥25% of time

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17
Q

Constipation Tx

A

o FBC, ESR, U&E, Cr, LFTs, TFTs, serum glucsose
o Colonoscopy or CT colography if >6weeks
o Lifestyle advice
o Osmotic or bulk- forming laxative- ispaghula, sterculia ± stimulant laxative
o Long- term stimulant laxative: c- danthrustate in very old
o If laxatives not working- try rectal measures. For soft stool- bisacodyl suppositories, if hard stool- glycerin suppositories

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18
Q

Organic causes of constipation

A

Colonic: cancer, diverticular disease, CD, stricture, intussuption, volvus

Anorectal: ant mucousal prolapse, fissure, abcess, proctitis

Pelvic: ovarian ca, uterine ca, endometriosis

Endocrine: Ca2+, hypothyroid, DM + autonomic neuropathy

Drugs: opioids, antacids + calcium/ aluminum, antidepressants, Fe2+, anti-PD, anticholinergic, anticonvulsants, antihistamine, calcium antagonists

Other: pregnancy, immobility, fluids

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19
Q

Dyspepsia causes

A

GORD, PU – both 15%
Stomach cancer- 2%
Non-ulcer dyspepsia aka “functiona”- 60%
Oseophagitis

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20
Q

Dyspepsia PC

A

Retrosternal or epigastric pain
heartburn

Fullness
bloating
wind
N &V

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21
Q

H pylori Tx

A

Healthy eating, weight loss
Stop smoking, alcohol, caffeine, chocolate, fatty food

omeprazole 20mg bd 4/52 + amoxicillin 1g bd + clarithromycin 500mg bd 1/52

Metronidazole 400mg bd can be used instead of amox

Endoscopy

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22
Q

H. Pylori Dx:

A

serology,
urea breast test,
faecal antigen test

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23
Q

Gastritis drug causes

A 
Ca antagonists 
Nitrates 
Theophyllines
Bisphosphonates 
Corticosteroids, NSAIDs 
SSRIs
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24
Q

Barret’s oesophagus

A

Metaplasia into intestinal cell type
Risk of adenocarcinoma
Tx: long-term omeprazole 20-40mg od ± laser ± resection

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25
Q

Acute gastritis
def
types
tx

A

Mucosal inflammation without ulcer
Type A: entire stomach, a/w pernicious anemia, pre-malignant
Type B: antrum ± duodenum, a/w H.pylori
Type c: due to irritants- NSAIDs, alcohol, bile reflux

Treat cause
Acid suppression with rantidine, nizatidine or PPI 4-8wk
Endoscopy

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26
Q

Gastro-esophageal malignancy upper 2/3

A

Squamous cell carcinoma
• Smoking, alcohol
• Low fruit and veggies

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27
Q

Gastro-esophageal malignancy lower 1/3

A

Adenocarcinoma
• Smoking
• Low fruits and veggies
• GORD, obesity

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28
Q

Gastro-esophageal malignancy risks

A

Previous mediastinal RT
Plummer- Vinson sundrome
Tylosis- inherited. Also hyperkertosis of palms

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29
Q

Gastro-esophageal malignancy PC

A

Short hx rapidly progressive dysphagia ± weight loss ± regurgitation of food and fluids, hoarsness, cough
Retrosternal pain is late feature

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30
Q

Gastro-esophageal malignancy Tx

A

endoscopy
CT
RT palliative with stenting tube

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31
Q 
Stomach cancer
95% what type  
age 
Risks
Px: 
Management:
A

adenocarcinoma
>55 yo

  • Japan, SES
  • Blood group A, smoking
  • Pernicious anemia, H.pylori, atrophic gastritis
  • Adenomatous polyps, previous partial gastrectomy

dyspepsia, weight loss, anorexia, early satiety, V, dysphagia ± GI bleed

endoscopy, total/ partial gastrectomy

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32
Q

Post gastrectomy syndromes

A 
•	Early satiety ± weight loss 
•	Bilious vomiting: 
o	Metoclopromide or domperidone 
•	Dumping: distention, colic and vasomotor disturbance after meal=  rapid gastric emptying. 
•	Diarrhea:  loperamide, codeine
•	Anaemia: B12 and iron deficiency 
•	Stomach cancer
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33
Q

Colorectal Cancer screening test

A

faecal occult blood test every 2 years to 60-74years

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34
Q

Colorectal Cancer FHx

A

risk 2-3x
Refer for colonscopy: 2x first degree or 1x first degree <45
FAP: cancer <40
Juvenile polyposis
Peutz- Jegher syndrome- AD. Benign intestinal polyps with dark freckes on lips, oral mucosa, face, palm and soles
HNPCC: ≥3 relatives with ≥2 generations and ≥1 developed <50
MMR oncogene

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35
Q

Previous hx colorectal cancer

A

colonoscopy 5 yearly until 70years

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36
Q

Colorectal cancer Risks

A 
Obesity, diet, alcohol, exercise 
Meds that : HRT, COCP, statins, aspririn
Hx gallbladder disease/ cholecystectomy 
T2DM 
UC/ Crohns Disease
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37
Q

Colorectal cancer Px:

A

Bowel habit: D ÷ mucous, constipation or alternating, Tenesmus
Obstruction: pain, distention, absolute constipation ± V
PR bleeding: occult or bright red
Perforation: generalized peritonitis  fistula
Systematic

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38
Q

Colorectal cancer Examination and investigation:

A

General: cachexia, jaundice, anemia
Abdominal mass, hepatosplenomegaly, ascites
Rectal exam

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39
Q

Colorectal cancer Tx:

A

resection ± chemotherapy

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40
Q

Hemorrhoids “piles”
Def
Risks:
Types

A

Distention of submucosal plexus of veins at 3,7, 11 o’clock

constipation, Fhx, VV, pregnancy,  anal tone, pelvic tumour, portal hypertension

1st degree: piles in anal canal
2nd degree: prolapse out of anal verge but spontaneously reduce
3rd degree: prolapse out of anus and need digital reduction
4th degree: permanently prolapsed

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41
Q

Hemorrhoids “piles”
Px:
Tx
Complications

A

Discomfort, discharge ± PR bleeding, Tenesmus, pruitius ani

Protoscopy ± sigmoidoscopy if >40 and not visable
Soften stool- bran ispaghula husk
Topical analgesia- lidocaine 5%

Strangulation –> intense pain + anal sphincter spasm
Thrombosis –> pain/ anal sphincter spasm

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42
Q

Perianal haematoma (thrombosed external pile)
Ruptured superficial perianal vein causing subcut haematoma
Px:
Tx:

A

sudden onset of severe perianal pain
Tender, 2-4mm “dark blueberry” under skin near anus

analgesia, spontaneously settles over 1 week

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43
Q

Rectal prolapse
Young or >60yrars
Px: mass coming from anus ± discharge
Types

A

Mucosal: 3rd degree- bowel musculature remains in position but redundant mucosa prolapses from anal canal

Complete: decent of upper rectum- weak pelvic floor fro childbirth. Bowel wall inverted and passed

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44
Q

Anal fissure
Torn anal mucosa- posteriorly>
Px:
Management:

A

Px: pain on defecation ± constipation, PR bleed
Visible as “sentile pile”= bunched up mucosa at base of tear
Rectal examination tender bc muscle spasm

Tx
ispaghula husk, lidocaine 5%, can add glycerol trinitrate 0.4% bd- pain and spasm but can cause headache or 2% topical diltiazem cream bd

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45
Q

Anal ulcers causes

A

Crohn
Syphilis
Tumour

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46
Q

Anal cancer SCC
Risks
Px:
Tx:

A

anal sex, syphilis, warts

PRB, pain, anal mass/ulcer, pruritus, stricture, BH change

RT ± CT- if fails then abdominoperineal resection

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47
Q

Irritable bowel syndrome def

A

Chronic relapsing and remitting condition. No cause. Symptoms: abdominal pain, bloating, change BH

48
Q

Irritable bowel syndrome dx

A

dx of exclusion

<40: FBC, ESR, TTG/ EMA- Ig to exclude coeliac
>40: exclude colorectal cancer

TFT, stool sample for infection, endocervical swab for chlamydia, colonoscopy, laproscopy for endometriosis

49
Q

Irritable bowel syndrome Sx

A

abdominal pain or discomfort that is relieved by defacation or altered bowel frequency/ form + ≥2:
Altered passage- straining, urgency, incomplete
Bloating, distention, tension, hardness
Passage of mucouse
Worse with eating

50
Q

Irritable bowel syndrome Tx

A

Diet:  water,  caffeine, alcohol, high-fibre food, for D- avoid sorbitol

Probiotics- 4week trial

Fibre/ bulking agent: ispaghula husk or laxatives if constipation

Antispasmodics- mebeverine, peppermint oil

Antidiarrhael loperamide- avoid codeine phosphate bc dependence

Antidepressants- low dose amitriptyline 10mg nocte, SSRI less effective

Psychotherapy and hypnosis

51
Q

Causes of SOB

Cardiac disease

A

Acute: LVF, arrythmis, shock
Subacute: arrhythmia, subacute bacterial endocarditis
Chronic: CCF, MS, AS, congenital heart disease

52
Q

Causes of SOB

Lung disease

A

Acute: pneumothorax, acute asthma, PE, pneumonitis
Subacute: asthma, infection, COPD exagerbation, effusion
Chronic: COPD, CF, ILD, mesothelioma, cancer

53
Q

Causes of SOB

Other causes

A

Hyperventilation
Foreign body inhalation
GB syndrome, MG, thyrotoxicosis, MND, MS, kyphoscoliosis
Polio
Anaemia, ketoacidosis, musculoskeletal chest pain

54
Q

Hyperventilation: >20 breaths/min or deep (TV)

A

Can result in palpitations, dizziness, faintness, tinnitus, chest pain, perioral and peripheral tingling due to Ca2+
Caused by: anxiety, PO, PE, hyperthyroid, fever, lymphangitis
Kaussmal respiration: deep, sighing seen in met acidosis
Neurogenic hyperventilation: due to stroke, tumour, CNS infection

55
Q

Hypoventilation causes:

A

Respiratory depression: opioid, anoxia, trauma
Neurological: GB disease, polio, MND, syringobulbia
Lung disease: pneumonia, collapse, pneumothorax, effusion
Resp muscle disease: MG, dermatomyositis
Limited chest movement: kyphoscoliosis

56
Q

Combined chest pain + SOB DDx

A

MI, pericarditis, chest infection, dissecting aneurysm
PE, pulmonary ca
Esophageal pain, MSK pain

57
Q

Increased RR causes

A
  • Lung- asthma, pneumona
  • Heart- LVF
  • Metabolic- ketoacidosis
  • Drugs- salicylate overdose
  • Psychiatric- hyperventilation
58
Q

Decreased RR causes

A

CNS- CVA

drugs- opioids

59
Q

Acute cough <3 weeks Tx

A

CXR if marked focal chest signs, foreign body, cancer
Abx- amoxicillin 500mg tds/ clarithromycin 500mg bd/ doxycycline 100mg od if:

Systemically unwell 
Co-morbidity high risk of complications
>65 with ≥2 of following or >80 with ≥1 of following:
•	Hospitalized in previous year
•	CCF 
•	Use of oral glucocorticoids 
•	DM
60
Q

Haemoptysis DDx

A
  • Infection, bronchiestasis, lung cancer, PE
  • Violent cough, foreign body, tubation, trauma
  • Cardiac: acute LVF, MS
  • Idiopathic, aspergillioma, good pastures, PAN, Wegners
61
Q

Haemoptysis Tx

A

Admit if bleeding/ shock
Urgent CXR
Cancer risk if: persistant with normal CXR, >40 + smoker, ex-smoker- if terminal tx with IV morphine + midazolam

62
Q

Chronic cough >3 weeks DDx

A
  • Post nasal drip, post viral, ear wax
  • COPD/ asthma, lung cancer, PPO, bronchiesctasis, smokers cough
  • Pertussis, TB
  • Foreign body, vocal cord palsy
  • GORD, LVF, ACEI
63
Q

Chronic cough management:

A

CXR

Treat cause

64
Q

Bronchiectasis: recurrent/ persistent infections –> dilated bronchi

Causes

Px mild:

Px severe:

A

Congenital: CF, kartagener syndrome
Post infection: TB, pertussis, measles, pneumonia
Obstruction, aspergillosis, hypogammaglobinaemia, aspiration

Px mild: asymptomatic with winter exagerbation- fever, cough, purulent sputum, pleuretic pain, SOB

Px severe: persistant cough + sputum, haemoptysis, clubbing, crackles and wheeze

65
Q

Bronchiectasis
Dx:

Tx:

A

CXR, sputum- M,C&S, spirometry, HR CT

respiratory referral, physio, aBx, bronchodilators, influnenza/ pneumo vaccine, surgery

66
Q

Pneumonia in Adults PC

A

Acute LRTO: cough ± purulent sputum ± pleurisy

New focal chest signs: consolidation, decreased air entry, coarse crackles, pleural rub

Systemic features: fever, sweating, shivers, aches, temp ≥38°C

67
Q

Pneumonia in Adults Causes

A

Pneumococcus
H. influenza- elderly
Influenza A and B- annual epidemics
M. pneumonia, gram –ve enterics

68
Q

Pneumonia in Adults prevention

A

influenza and pneumococcal vaccine

69
Q

Pneumonia in Adults Dx

A

Pulse oximetry: ≤92% saturation= need admission
CXR:
Sputum culture: not responding to tx, TB signs
Bloods: FBC, WCC, ESR, Ig titres

70
Q

CURB 65

A

Confusion
RR ≥30 breaths/ min
BP: systolic <90 or diastolic ≤60mmHg
≥65 years

0: likely for home treatment
1-2: consider hospital referral
3-4: urgent admission

71
Q

Pneumonia in Adults Management

A

Home vs admission
No smoking, rest, increase fluids
Amoxicillin 500mg-1g tds, doxycycline 100-200mg od or clarithromycin 500mg bd
Treat pleuritic pain with Paracetamol 1g qds
Review 48hrs- no improvement/ deterioration= CXR/ admit

72
Q

Pneumonia in Adults Comp

A

Pleural effusion, respiratory failure
Lung abscess: px with swinging fever + worsening pneumonia
Septicemia, jaundice
Metastatic infections

73
Q

Pneumonia in Adults Comp

A

Pleural effusion, respiratory failure
Lung abscess: px with swinging fever + worsening pneumonia
Septicemia, jaundice
Metastatic infections

74
Q

Common cold Complications

A

Exacerbation of asthma/ COPD

Secondary infection: bronchitis, pneumonia, conjunctivitis, OM, sinusitis, tonsillitis

75
Q

Common cold

A

acute, afebrile, RTI
Causes: Rhio, picorna, echo, coxsackie
Spread: droplet infections
Management: fluids, Paracetamol. Symptoms resolve <1.5wks

76
Q

Acute bronchitis

A

inflammation of major bronchi
Follows viral URTI
Symptoms: cough ± sputum, SOB, wheeze
Signs: wheeze and scattered coarse crepitations

77
Q

Acute bronchitis Tx

self limiting <3wks.

A

o Bronchodilators if wheeze hard
o Abx to shorten symptoms vs abx resistance, extra meds
 Systemically unwell
 Symptoms of serious illness/ complication- pneumonia
 Co-morbidity so risk of complications
 >65 + acute cough + ≥2 or >80y + acute cough +≥1: hospitalization in last year, CCF, oral steroids, DM

78
Q

Risk for severe disease with influenza

A

≥65 years or

≥1 of: chronic respiratory disease, CVD, immunosuppression, CRD, DM

79
Q

Influenza
Sporadic, during autumn and winter
Causes: influenza A, B, D
Spread: droplets, person- to person contact, contaminated items

Influenza Px

A

Common cold symptoms + myalgia, arthrylagia
Headache, sore throat, cough ± coryza
Acute symptoms last <5d- weakness, sweating, fatigue- longer
Secondary chest infection with S.aureus/ S.pneumonia

80
Q

Influenza Management

A

Rest, fluids, Paracetamol
Tx complications- penumona, exacerbation of asthma/ COPD
Antivirals: zanamivir 10mg bd 5/7 inhaled and oseltamivir 75mg bd 5/7- shorten symptoms and complications. Use when risk of complications and when prevalent in community

Zanamivir- can cause bronchospasm- avoid in asthma

81
Q

Influenza Prevention

Influenza vaccine

A

≥65, pregnant
Chronic renal, lung, liver, cardiovascular disease
Immunocompromised and DM
Health professionals, carers of patients with disabilities

Oseltamivir in high risk >13: 75mg od for 7- 10 days

82
Q

Lung Cancer urgent referral if

A

o Persistent haemoptysis
o CXR with pleural effusion, slowly resolving consolidation
o Asbestos exposure + SOB, pain, systemic symptoms

83
Q

Lung Cancer urgent CXR if

A

o Haemoptysis

o >3 wks: cough, chest/ shoulder pain, SOB, weight loss, chest signs, hoarseness, clubbing, lymphadenopathy, met?

84
Q

Lung Cancer types

A

Small cell lung cancer: ~25%
Disseminated on dx to liver, bones, brain, adrenals

NSCLC: adenocarcinoma or SCCC. Not always due to smoking

85
Q

Lung Cancer prevention

A

Smoking cessation- 90% lung cancers due to smoking

Diet: fruit, carrots, green veggies

86
Q

Lung Cancer PC

A 
>90% have symptoms 
Cough- 56% 
Chest/ shoulder pain- 37% 
Haemoptysis- 7% 
SOB, hoarseness
Weight loss, malaise, clubbing, met 
Incidental on CXR
87
Q

Lung Cancer Pancoast syndrome

A

Apical lung cancer + isilateral horners
Causes: invasion of cervical sympathetic plexus
Can have shoulder/ arm pain (invasion C8-T2), hoarseness, bovine cough- unilat recurrent laryngeal N palsy + VC paralysis

88
Q

Lung Cancer neoplastic syndrome

A 
SCLC
•	Ectopic ACTH 
•	SIADH 
•	Hypercalcaemia 
•	Hypercoagulability
89
Q

Asthma in Adults

Signs/ symptoms of severe attack

A

PEFR 33-50% predicted/ best
O2 saturation ≥92%, cant talk in sentences
Intercostal recession, RR ≥25 breaths/ min, HR ≥110bpm

90
Q

Asthma in Adults

Life-threatening signs

A

PEFR <33% predicted/ best
O2 saturation <92%
Arrhythmia, hypotension, cyanosis
Exhaustion, poor resp effort, silent chest, altered consciousness

91
Q

Asthma in Adults Definition

A

paroxysmal, reversible airway obstruction with:

  1. Airflow limitation- reversible spontaneously or with meds
  2. Airway hyper-responsiveness to wide range of stimuli
  3. Inflammation of bronchi
92
Q

Asthma in Adults Dx

A

symptoms/ sings in absence of alternative explanation
• Wheeze, SOB, chest tightness, cough
• Worse at night/ early morning, exercise, allergen/ cold air, after aspirin, β-blockers,
• PMH atopy, unexplained eosinophilia, Fhx
• Unexplained low FEV1 or PEFT
• Tests: spirometry*

93
Q

Asthma in Adults DDx

A

Airflow obstruction = FEV1/ FVC <0.7
• COPD, bronchiectasis, obliterative bronchiolitis
• Inhaled foreign body
• Large airway stenosis, lung cancer, Sarcoidosis

No airflow obstruction
• Chronic cough syndrome, hyperventilation syndrome
• Vocal cord dysfunction
• Rhinitis, GORD, HF, pulmonary fibrosis

94
Q

Asthma in Adults Tx

A
  1. Mild intermittent: inhaled short acting β2 as needed
  2. Regular preventer therapy: +inhaled steroid 200-800mcg
  3. Add- on therapy:
    o + LABA ±  inhaled steroid to 800mcg
    o LABA not working: stop, use only inhaled steroid 800mcg
    o Consider leukotriene R antagonist or SR theophylline
  4. Persistent poor control: inhaled steroid 800mcg
    o ± LRA, SR theophylline, β2 agonist tablet
  5. Continuous or frequent use of oral steroid
95
Q

Action based on probability of asthma

High:

A

inhaled beclometasone 200mcg bd for 6-8 weeks, review inhaler technique  doesn’t work try oral prednisolone 30mg od for 2 week

96
Q

Action based on probability of asthma

Intermediate:

A

o FEV1/ FVC <0.7: try trial of treatment/ reversibility testing
o c >0.7: further investigations

97
Q

Action based on probability of asthma

Low:

A

consider alternate dx
• Consider CXR if atypical/ additional symptoms
• Exhaled nitrous oxide testing, eosinophil count

98
Q

Reversibility testing: when suspect airflow obstruction

A

Check FEV1 or PEFR before + after 400mcg inhaled salbutamol via MDI and spacer

If uncertain/ no response to salbutamol: inhaled beclometasone 200mcg bd or oral prednisolone 30mg od for 14days

> 400mL in FEV1= asthma

99
Q

Asthma Tx

A

Inhaler device: try to use MDI. Educate on technique

Short- acting β2 agonist: salbutamol- quick and  SE. Use prm.
• Poor control: ≥2 cannisters/ month or >10-12puffs/day
• Budesonide/ formoterol combo as alternative

Inhaled corticosteroids
• Consider if exacerbation in last 2y needing steriords, βw agonist use ≥3x/wk or symptomatic ≥3x/wk or ≥1 night/wk

LABA: salmeterol- don’t use without inhaled steroids

Leukotriene receptor agonist: montelukast-  exacerbations

Theophylline: SE common

Onamlizumab: binds to IgE- subcut every 2-4 weeks
If allergy factor in asthma, on high-dose steroid + LABA and if frequent exacerbations

100
Q

COPD def

A

Slowly progressive disorder characterized by airflow obstruction

101
Q

COPD causes

A
  • Smoking
  • Genetic: bronchial hyperresonsiveness, α1α- antitrypsin def
  • Poor diet and LBW
102
Q

COPD Dx

A 
•	SOB on exertion- using MRC scale 
•	Chronic cough + regular sputum 
•	Frequent winter bronchitis 
•	Wheeze 
•	Spirometry shows airflow obstruction if:
a)	FEV1/ FVC <70% and 
b)	FEV1 <70% predicted and 
c)	<15% response to reversibility test 
* little variability in PEFR
103
Q

COPD signs

A

• Hyperinflated chest ± poor expansion on inspiration
•  cricosternal distance
• Hyperresonant chest with  dullness
• Wheeze/ quiet breath sounds
• Paradoxical movement of lower ribs
• Use of accessory muscles, tachypnea, pursed lips on expiration
Peripheral oedema, cyanosis,  JVP, cachexia

104
Q

COPD other investigations

A
  • CXR: exclude other dx
  • FBC: polycythaemia or anaemia
  • BMI
  • α1- antitrypsin- early onset COPD or fhx
  • ECG/ echo: if cor pulmonale suspected
  • Sputum culture
105
Q

COPD management

A 
Lifestyle: smoking cessation, vaccinations, exercise, weightloss 
Drug therapy
SABA
LABA
LAMA
106
Q

`MRC dysponea scale

A
  1. SOB on exertion
  2. SOB when hurrying or walking up hill
  3. SOB when flat or walking on own pace
  4. SOB after 100m or few minutes
  5. SOB on minimal effort
107
Q

Stage 1 COPD:

A

mild FEV1 ≥80%

Cough, little SOB, no abnormal signs

108
Q

Stage 2 COPD:

A

moderate FEV1 50-80% predicated
SOB, wheeze on exertion, cough ± sputum
Some abnormal signs

109
Q

Stage 3 COPD:

A

severe FEV1 30-49%
SOBOE, marked wheeze/ cough
Other signs, frequent exacerbations/ admissions

110
Q

Stage 4 COPD:

A

very severe FEV1 <30% or <50% + respiratory failure

Same as 3 but more SOB and severely restricted everyday

111
Q

COPDReversibility testing: when suspect airflow obstruction

A

Check FEV1 or PEFR before + after 400mcg inhaled salbutamol or beclometasone 200mcg bd or oral prednisolone 30mg od for 14days

If FEV1 and FEV1/FVC return to normal, not COPD

112
Q

COPD Long-term O2 therapy:

A

FEV1 <30%, O2 saturation ≤92% breathing air

Cyanosis, peripheral oedema, polycythaemia,  JVP

113
Q

COPD Acute exacerbation Px:
worsening of symptoms

COPD Acute exacerbation Causes

A

Infections: viral URTI/ LRTI and bacterial LRTI

Pollutants- nitrous oxide, sulphur dioxide, ozone

114
Q

COPD Acute exacerbation Investigations

A

Pulse oximetry to assess severity. ≤92%= hypoxemia- admit?
CXR
Sputum culture

115
Q

COPD Acute exacerbation

Management:

A

home vs admission
• Ability to cope at home, support
• SOB, general condition, level of activity
• Cyanosis, worsening peripheral oedema, level of consciousness
• LTOT, co-morbidity, change in CXR

116
Q

COPD Acute exacerbation

Home treatment

A

bronchodilators
broad spectrum abx- clarithromycin 500mg bd or doxyxycline 100mg od/bd if purulent sputum/ pneumonia signs/ consolidation on CXR
Oral corticosteroids: prednisolone 30-40mg/day for 1-2wks ± bisphosphonate

117
Q

COPD Acute exacerbation

Follow up:

A

Reassess: deterioration = admit. If >2 wks and no improvement = CXR and referral.
If discharged, assess ability to cope at home
Inhaler technique
Need to LTOT and/or home nebulizer
Check FEV1
Lifestyle modification

My General Practise (8 decks)

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