the big conditions Flashcards
1
Q
progressive irreversible airway obstruction
A
COPD
2
Q
4 complications of COPD
A
cor pulmonale
type 2 resp failure
pneumothorax
lung cancer
3
Q
investigations for COPD?
A
spirometry
CXR
4
Q
what scale for COPD severity
A
GOLD scale
5
Q
what will spirometry show on COPD
A
obstructive
FEV <80%
FEV/FVC <0.7
6
Q
management of COPD?
A
stop smoking
pulmonary rehabilitation
improve health status and exercise tolerance
flu vaccine!!
bronchodilators, steroids, mucolytics
home o2
7
Q
when do you qualify for home oxygen in COPD?
A
if pao2 below 7.3
8
Q
as well as stopping smoking, doing pulm rehab, improving health status + exercise tolerance, getting flu vaccine…. what MEDICATIONS could you take for COPD?
A
bronchodilators, steroids, mucolytics
9
Q
symptoms on COPD exacerabtion?
A
increased SOB
increased purulent sputum
10
Q
STEPWISE MANAGEMENT OF COPD EXACERABATION
A
nebulized bronchodilators — controlled o2 therapy — steroids — antibiotics — invasive ventilation
11
Q
nebulized bronchodilators — controlled o2 therapy — steroids — antibiotics — invasive ventilation
= management for what?
A
COPD
12
Q
define asthma
A
dynamic reversible bronchial hyper-responsiveness
13
Q
two classes of drug that can make asthma worse
A
beta blockers
NSAIDs
14
Q
3 elements of asthma pathophys
A
inflammation
smooth muscle contraction
mucus
15
Q
how much variability in PEFR in 2 wks to diagnose asthma
A
> 15% variabillity in 2 wks
16
Q
what is in CURB65
A
Confusion
Urea >7
Resp rate >30
Blood pressure <90/<60
> 65
17
Q
treatment for pneumonia if CURB65 score 0-1
A
oral amox 5ds
18
Q
treatment for penumonia if CURB65 score 2
A
oral amox + clarith 5ds, ?admit
19
Q
treatment for pneumonia if CURB65 score >3
A
IV co-amox + clarith 5ds
20
Q
treatment for hospital acquired pneum?
A
ventilation + IV tazobactam
21
Q
give me 3 extra consequences of TB that arent pulm
A
meningitis
pott’s vertebrae
arthritis
22
Q
give me 6 risk factors for TB
A
IVDU prison homeless malnutrition overcrowding HIV
23
Q
how do you test for LATENT tb?
A
tuberculin skin test
interferon gamma release assay
24
Q
how do you test for active tb?
A
CXR
culture sputum
bronchoalveolar lavage
25
what stain do you use to look at tb sputum culture / bronchoalveolar lavage of TB?
ziehl-neelsen
26
what does CXR show in tb
consolidation cavitation upper lobes
27
how do you treat active tb?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
(R+I for 6 months)
(P+E for 2 months)
28
what is the P of RIPE for TB treatment?
Pyrazinamide
29
What is the E of RIPE for TB treatment?
Ethambutol
30
side effect of ethambutol?
optic neurities
31
side effect of pyrazinamide?
arthralgia, gout
32
side effect of rifampicin ?
red urine
33
side effect of isoniazid?
neuropathy
34
what three categories cause IBD
genes + env + immune
35
4 important things about crohns pathophys
transmural + granulomatous
skip lesion
mouth to anus
cobblestone mucosa
36
not inside the bowel things that can happen in crohns?
perianal tags/fissures/fistulae
enteropathic arthritis
apthous ulcers
fatty liver
37
investigation for crohn's in stool sample
faecal calprotectin
38
what is faecal calprotectin
stool sample crohn's
39
investigations for crohns?
stool sample
| conlonoscpy + biopsy
40
invesgations for uc?
stool sample
| colonoscopy + biopsy
41
treatment of crohn's?
mild - pred
| severe - admit, IV hydrocortisone + metronidazole
42
treatment of UC?
mild - sulfasalazine + pred
| severe - admit, IV hydrocortisone
43
4 features of UC pathophys
```
red mucosa
ulcers
pseudopolyps
crypt abscesses
(variably upfrom rectum)
```
44
definitive treatment for uc
colostomy can be curative
45
surgery for crohns
resection and temporary ileostomy
46
T cell autoimmune condition for genetically susceptible. 1 in 100. what's this condition?
coeliac
47
what protein causes the problem in coeliac?
gliadin
48
investigations for coeliac?
```
FBC
IgA serology (alpha gliadin, ttg, ema)
biopsy duodenum
```
49
what does FBC show in coeliac?
anaemia
50
what is ema test in coleic
anti-endomysial antibodies
51
what is ttg test in coeliac
tissue tranglutaminase
52
what cancers can coelaic cause
T cell lyhpoma
| SB cancer
53
3 findings on duodenal biopsy in coeliac
villous atrophy
crypt hyperplasia
intra-epithelial lymphocytes
54
treatment for IBS
ed, reassurance, diet
low fodmap
anti-spasmodics
laxatives if constip
loperamide if diarrhoea
tricylcics for pain
55
define heart failure
complex syndrome in which the ability of the heart to maintain circulation of the blood is IMPAIRED as a result of structural/functional impairment of VENTRICULAR filling or ejection
56
complex syndrome in which the ability of the heart to maintain circulation of the blood is IMPAIRED as a result of structural / functional impairment of VENTRICULAR filling / ejection
=?
heart failure
57
what is HF REF
<40% ejection fraction on echo
58
what is HF PEF
>40% ejection fraction on echo
59
new york heart association severity 4
cant physical activity
60
new york hear association severity 1
no limitation on physical activity
61
new york heart association severity 3
physical activity limited
62
new york heart association severity 2
physcial activity SLIGHTLY limited
63
cardiac causes of heart failure include CORONARY ARTERY DISEASE, hypertension, valve disease, arrhythmias, congenital heart disease, and cardiomyopathies. What are 4 other causes?
nephrotic syndrome
end stage CKD
alcohol + cocaine!
64
what is accelerated hypertension
>180/110 + retinal haemorrhages / papilloedema
same day referral to specialist centre!!
65
what is severe hypertension
>180 / >110
66
differential for hypertension
white coat hypertension!
67
90% of hypertension is primary, i.e. no identified cause. Name some secondary causes (clue: kidney, endocrine, drugs)
diabetic nephropathy
hyperthyroid, phaeochromocytoma, cushings
alcohol, cocaine, methylphenidate, venlafaxine
68
how do you confirm diagnosis of hypertension from clinic
ambulatory BP monitoring!!
| or home bp monitoring
69
apart from ambulatory BP monitoring, what other investigations do you want to do to rule out secondary causes of hypertension?
fundoscopy
12 lead ECG
urine - haematuria, protein:creatinine ratio, eGFR
70
what risk tool do you want to use when youve just diagnosed someone with hypertension?
QRISK3
| - 10yr risk of CVD
71
an 86yr old man is being treated for hypertension with amlodipine. what is his target blood pressure?
<150/90
72
a 54 yr old man is being treated for hypertension with enalapril. what is his target blood pressure?
<140/90
73
A 53 yr old Jamaican man hasn't tolerated the CCB you started for his hypertension. Give an example of a THIAZIDE you might try.
INDAPAMIDE
74
do you ever give ARB + ACEi together??
nooo
75
50 yr old woman with hypertension. ACE inhibitos havent worked. Whats step 2?
ACE-i + CCB
76
ACEi + CCB hasnt worked. What do you try now.
ACEi + CCB + thiazide
77
ACEi+CCB+thiazide hasnt worked. What do you try now ?
spironolactone / alphablocker / betablocker
78
what is the mortality rate of heart failure?
50% die within 5 yrs of diagnosis
79
what is end stage heart failure
likely to die within 6-12 months
80
3 complications of heart fialure
sexual dysfunction
depression
cachexia
81
which has a worse prognosis - HF-PEF or HF-REF?
HF-REF reduced ejection fraction is worse
82
give me 6 symptoms of heart failure
```
paroxsyaml nocturnal dyspnoea
orthopnoea
nocturnal cough
oedema
fatigue / decreased exercise tolerance
syncope
```
83
give me 6 signs of heart failure on examination
```
disaplaced apex beat
tachy
raised JVP
hepatomegaly
pleural effusion
oedema
```
84
two KEY investigation in diagnosing heart failure?
NTpro BNP!!!
| 12 lead ECG
85
NTpro BNP score of >2000 ....?
urgent referral to cardiology!! (2wk wait)
86
NTpro BNP score of 400-2000?
standard referral to cardiology
if <400, heart failure unlikely
87
NTpro BNP and 12 lead ECG are the mainstays of heart failure investigations. what else might you wanna check?
urine dip - blood + protein
U+Es, eGFR, TFTs, FBC, LFTs,
CXR!
peak flow, spirometry
88
treatment for HF-PEF?
LOOP - frusi, bumetanide
+ clopidogrel + statin
exercise rehab programme,
flu vaccine
89
treatment for HF-REF
LOOP - frusi, bumetanide
ACE-i or BETABLOCKER. (get stable on one before starting other)
+ clopidogrel + statin
exercise rehab programme
flu vaccine
90
give 3 indicators of end stage heart failure
lots of admissions
cardiac cachexia
SOB @ rest (NYHA stage 4)
91
management of end stage HF
MDT inc palliative care
symptomatic relief
advance care planning
92
give 3 indicators of end stage heart failure
lots of admissions
cardiac cachexia
SOB @ rest (NYHA stage 4)
93
management of end stage HF
MDT inc palliative care
symptomatic relief
advance care planning
94
man presents to GP saying he has chest pain on exercising, which lasts under 10 mins and is relieved by rest. is this likely to be stable or unstable angina?
stable
95
man with history of angina presents to GP saying he has got chest pain at rest which is lasting longer than usual
unstable angina
| ADMIT
96
what might you see on ECG in angina
pathological Q waves
left BBB
ST wave elevation / T wave inversion
97
three side effects of GTN
flushing
headache
light headedness
98
treatment for stable angina?
GTN spray
| beta blocker or CCB
99
you've tried treating a man's stable angina with GTN spray, a beta blocker, and then tried a CCB. He's not tolerating them well. What nex?
isosorbide mononitrate
| ivrabradine
100
ivrabradine acts on
funny channels
101
when do u get NHS health check
40-75 yrs, every 5 yrs.
| primary prevention of CVD
102
if QRISK >10%, what?
statin + lifestyle
103
if QRISK<10%, what?
just lifestyle
104
ECG, troponin, CK-MB and coronary angiography are all key investigations for MI. When will troponin T and I rise peak and fall?
rise - 3-12hrs
peak - 24-48hrs
fall - over 14ds
105
ECG, troponin, CK-MB and coronary angiopgraphy are all key investigations for MI. When will CK-MB rise, peak and fall?
rise - 3-12hrs
peak - 24hrs
fall - 48-72hrs
106
man having a heart attack in GP what do you give him?
ASPIRIN 300mg
107
ECG, troponin, CK-MB and angiopgraphy are all key investigations for MI. When will CK-MB rise, peak and fall?
rise - 3-12hrs
peak - 24hrs
fall - 48-72hrs
108
woman had a heart attack 15 minutes ago. been given aspirin 300mg. what now
PCI !!! percutaneous coronary intervention
109
what 2 tests do all MI patients need before discharge?
routine exercise ECG testing
| coronary angiography
110
there's no more alteplase in the cupboard and a patient needs fibrinolysis for MI which she had 3 hrs ago. what could you give instead
streptokinase
111
there's no more alteplase in the cupboard and a patient needs fibrinolysis for MI which she had 3 hrs ago. what could you give instead
streptokinase
112
what does PCI stand for
percuatneous coronary intervention
113
when do you have to do PCI
WITHIN 90 MINS!
114
what criteria are DIAGNOSTIC for heart failure (not severity)
framingham
115
what might you see on HF CXR
Alveolar oedema
kerley B lines
Cardiomegaly
Dilated upper lobe vessels
