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Treatments > Respiratory, CVD, GI, Haematology, Renal > Flashcards

Respiratory, CVD, GI, Haematology, Renal Flashcards

1
Q

Asthma

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA (trial)
  4. SABA + ICS + LABA +/- LTRA
  5. refer
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2
Q

COPD

A
  1. SABA or SAMA
    If patient has features of atopy then: SABA + ICS +LTRA
    If patient has no atopy features then: SABA + LABA + LAMA
  2. SABA + LABA + LAMA + ICS
  3. Refer, may meet criteria for home oxygen therapy
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3
Q

Lung cancer

A

Surgery, chemo and/or radiotherapy - decide at MDT

  • Small cell = ACTH and SIADH and Lambert Eaton
  • Squamous cell = hyperparathyroidism and hyperthyroidism
  • Adenocarcinoma = gynaecomastia
  • Pancoast tumour = Horner’s syndrome and RLN palsy
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4
Q

Pneumonia

A 
Community acquired (CURB 1-2): amoxicillin or doxycycline
Community acquired (CURB 3-5): co-amoxiclav and doxycycline
Hospital acquired (CURB 1-2): amoxicillin or doxycycline
Hospital acquired (CURB 3-5): amoxicillin and gentamicin

Aspiration (non-severe): amoxicillin + metronidazole
Aspiration (severe): amoxicillin + metronidazole + gentamicin

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5
Q

Sleep apnoea

A

Weight loss + mouth guard to increase space in mouth
- NIV (CPAP)
- UPPP
(Assess using the Epworth Sleepiness score and polysomnography)

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6
Q

Hypertension

A

If <55yrs or DM:
1. ACE inhibitor or ARB
If >55yrs or African-Americas:
1. CCB (amlodipine)

  1. ACEi + CCB
  2. ACEi + CCB + thiazide-like diuretic (indapamide)
  3. add on spironolactone if K <4.5 OR add doxazosin or BB

If spironolactone and ACEi then risk of hyperkalaemia (monitor U+Es)

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7
Q

Stable angina

A
  1. GTN spray (sublingual)
    • CCB (nifedipine) or BB
  3. CCB + BB
  4. consider isosorbide mononitrate, nicorandil or ivabradine

CTCA to assess the degree of occlusion and consider surgery
Give secondary prevention (AABA)

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8
Q

AF (chronic)

A
  1. Beta-blockers to control rate
  2. Pill in pocket with flecainide
  3. Calculate CHADVASc score and if >1 then consider anticoagulation
  4. Digoxin can be used in patients who are sedentary
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9
Q

Peripheral arterial disease

A
  1. encourage exercise to the point of pain to increase perfusion of muscles
  2. Atorvastatin 80mg + clopidogrel
  3. If severe then angioplasty, stenting or bypass
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10
Q

Heart failure

A

ABAL:
ACEi + BB + Aldosterone antagonist (spironolactone) +/- loop diuretic

If patient also has AF then consider digoxin therapy. Beware of toxicity: N+V, anorexia, yellow-green vision, tremor
Fix any structural issues e.g. valve repair.

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11
Q

Wolf-Parkinson-White

A

Catheter ablation of accessory pathway is definitive treatment

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12
Q

Aortic Aneurysm

A

One off USS abdomen is offered to all men at 65yrs.
If 3.5cm - 4.5cm = yearly screening
If 4.6-5.5cm = 3monthly
If >5.5cm or growing at >1cm/year or symptomatic then refer for repair
If patient has a poor baseline health then defer repair until >6cm due to risk of procedure.

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13
Q

Aortic dissection

A

Type A - includes the root, give IV labetalol and surgery (graft containing branches)
Type B - affects the distal aorta, treat with IV labetalol, no surgery.

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14
Q

Primary and Secondary CVD prevention

A

Primary prevention: offered to patients with DM or CKD or 10yr risk of CV death >10%:
- atorvastatin 20mg

Secondary prevention: offered to all patients with disease affecting the CVD (angina, HTN, MI, stroke)

  • ACEi
  • Atorvastatin 80mg
  • Beta-blocker
  • Aspirin 75mg (after MI dual AP therapy is continued for 12M)
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15
Q

Acute alcohol withdrawal

A 
Chlordiazepoxide
Agitation and anxiety at 6-12hrs
Hallucinations at 12-24hrs
Seizures at 36hrs
Delirium tremens 24-72hrs (confusion, ataxia, hyperthermia)
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16
Q

Wernicke’s encephalopathy

A

Urgent pabrinex - is reversible.

- if untreated will progress to Korsakoff’s which is irreversible

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17
Q

Spontaneous bacterial peritonitis

A

Ciprofloxacin for prophylaxis

IV cefotaxime for treatment - most commonly caused by E.coli

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18
Q

Ascites

A

Spironolactone + low Na diet +/- paracentesis

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19
Q

Hepatitis

A

Hep A - has vaccine
Hep B - has vaccine
Hep C - cured by directed anti-virals

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20
Q

Hepatic encephalopathy

A

Laxatives (lactulose) + adequate fluid hydration + rifaximin

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21
Q

Wilson’s disease

A

Low caeruloplasmin + Low Cu

- treat with copper chelation (penicillamine)

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22
Q

Haemochromatosis

A

High Ferritin + High transferrin + Low TIBC

- treat with venesection weekly or iron chelation (desferroxamine)

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23
Q

GORD

A

H.pylori eradication: PPI + amoxicillin + metronidazole or clarithromycin
Modify diet and trial PPI (omeprazole)

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24
Q

Achalasia

A

Heller’s myotomy

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25
Q

Boerhaave’s syndrome

A

Urgent surgery thoracic washout and repair

26
Q

PUD and upper GI bleed

A

Supportive management and endoscopy - do not give PPI before endoscopy due to causing false negative results.

27
Q

Acute pancreatitis

A

Supportive management: lots of fluids and analgesia

- risk of third spacing and ARDS

28
Q

Biliary colic

A

Analgesia and refer for elective cholecystectomy

29
Q

Acute cholecystitis

A

IV antibiotics (amoxicillin + metronidazole + gentamicin) and emergency cholecystectomy

30
Q

Ascending cholangitis

A

IV antibiotics (A+M+G) and emergency cholecystectomy

31
Q

Coeliac

A

Gluten free diet

  • remember to always test IgA for deficiency if high suspicion and no positive anti-TTG (IgA). Can test IgG instead.
  • must have gluten in diet for 6W prior to testing - biopsy taken from the duodenum or jejunum
32
Q

UC

A

Flare: topical mesalazine +/- oral sulphasalazine
If acute severe: IV prednisolone +/- cyclosporin
Maintenance: topical mesalazine +/- oral sulphasalazine
- can also be considered for a panproctocolectomy to remove disease

33
Q

Crohn’s disease

A

Flare: prednisolone or elemental diet for kids
Maintenance: Azathioprine or mercaptopurine

34
Q

CRC

A 
Low rectal = AP resection
High rectal = Anterior resection
Sigmoid = Sigmoid colectomy
Splenic flexure = Left hemicolectomy
Transverse = transverse colectomy
Ascending = Right hemicolectomy

Hartmann’s colectomy is done in emergencies and is reversible - used in cases of peritonitis or perforation.

35
Q

Anal Fissure

A

Acute: topical analgesia, lubricants for defaecating
Chronic: GTN cream or diltiazem

36
Q

Haemorrhoids

A

Laxatives (lactulose) to improve constipation
Rubber band ligation if 1st or 2nd degree
Haemorrhoidal artery ligation if 2nd or 3rd degree
Haemorrhoidectomy

If thrombosed and <72hrs then consider excision. If >72hrs then offer conservative management and should settle in 10 days

37
Q

C.difficile infection

A

Mild: oral metronidazole for 10 days
Moderate - Severe: Oral metronidazole + oral vancomycin
Life-threatening: IV metronidazole and oral vancomycin.

38
Q

C.difficile infection

A

Mild: oral metronidazole for 10 days
Moderate - Severe: Oral metronidazole + oral vancomycin
Life-threatening: IV metronidazole and oral vancomycin.

39
Q

Grave’s disease

A
  1. Propanolol for symptomatic relief
  2. Carbimazole and levothyroxine (block and replace)
  3. Radioiodine treatment + thyroxine
40
Q

Sub-acute (DeQuervain’s) thyroiditis

A

In response to URTI and will settle so only give propranolol for symptomatic relief and NSAIDs for pain

41
Q

Toxic multi nodular goitre

A
  1. Propanolol for symptomatic
  2. Carbimazole + levothyroxine
  3. Radioiodine treatment + thyroxine
42
Q

Hashimoto’s thyroiditis

A

Levothyroxine

43
Q

Thyroid tumours

A 
Papillary = most common, spreads to LN but excellent prognosis, thyroidectomy + radio iodine treatment for remaining cells
Follicular = next common, slow growing, thyroidectomy + radio iodine treatment
Medullary = associated with MEN2a
Anaplastic = aggressive, older population, thydoidectomy plus radiotherapy
44
Q

Hyperparathyroidism

A

Primary: surgery to remove the tumour
Secondary: treat vitamin D deficiency and CKD
Tertiary: Surgically remove part of gland to return to normal function

45
Q

Hypoparathyroidism

A

Calcium and vitamin D supplementations

46
Q

Cushing’s Syndrome/Disease

A

Remove pituitary adenoma if disease

Gradually wean down exogenous steroids if syndrome

47
Q

Hyperaldosteronism

A

Spironolactone (is an aldosterone antagonist)

48
Q

Congenital adrenal hyperplasia

A

Give glucocorticoid and fludricortisone replacement.

- will have precocious puberty as adrenals pump out LOADS of testosterone

49
Q

Addison’s Disease

A

Replace hydrocortisone (cortisol) and fludrocortisone (aldosterone)

  • required lifelong to prevent crisis
  • double doses in illness or after surgery
50
Q

Phaeochromocytoma

A

Alpha-blockers: doxazosin or phenoxybenzamine
BB after established on AB
Adrenalectomy is definitive but will require lifelong replacement of adrenal hormones
- associated with MEN2a

51
Q

SIADH

A

Treat the underlying cause e.g. resect SCLC

Correct hyponatraemia very slowly due to risk of central pontine myelinolysis (<10mmol/24hrs)

52
Q

Diabetes insipidus

A

Cranial: response to desmopressin, give desmopresin therapy
Nephrogenic: no response to desmopressin, either just drink lots of give HIGH HIGH dose, also stop lithium if causing
Polydipsia: correct underlying behavioural issue

53
Q

Acromegaly

A

Somatostatin analogue and removal of pituitary adenoma

54
Q

Hypogonadotrophic hypogonadism

A

Pulsatile GnRH

55
Q

Androgen insensitivity

A

Bilateral orchiopexy
Oestrogen therapy
Vaginal dilation/lengthening

56
Q

PCOS

A

Weight loss + anti HTN + statin (QRISK >10%) + stop smoking
Mirena coil for endometrial protection (due to increased risk of endometrial cancer from infrequent ovulation)
Orlistat if BMI >30 and unable to lose weight naturally
If wanting to conceive: clomifene for ovarian stimulation or ovarian drilling

  • raised LH, raised FSH, raised testosterone
57
Q

Menopause

A

If >1yr since last period : combined continuous HRT
If >1yr since last period and no uterus: oestrogen HRT (no need for endometrial protection)
If <1yr since last period: combined cyclical HRT

If only local symptoms: oestrogen gel/pessaries, can also help with urinary incontinence
SSRI, clonidine and tibolene can all also be used if not wanting HRT
- Combined = risk of breast cancer
- Oestrogen only = risk of endometrial cancer

58
Q

Premature ovarian failure

A

Menopause <40yrs - High FSH and LH with low oestrogen on at least 2 occasions, 4 weeks apart.
Start combined cyclical HRT until normal age of menopause (51yrs).

59
Q

T1DM

A

Insulin + screening for complications e.g. retinopathy, renal function, neuropathy, HTN review, infections

60
Q

T2DM

A
  1. Metformin (if can’t tolerate then give MR)
  2. M + gliclazide (sulphonylurea) or pioglitazone
    • gliflozin if need weight loss and low risk of hypoglycaemia

Treatments (5 decks)

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