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Year 4 things I forgot > CCC > Flashcards

CCC Flashcards

(55 cards)

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1
Q

What should all patients with CKD or T1DM for more than 10 years be offered

A

Atorvastatin 20mg

LFTs at 3 months - 3 times raise is acceptable

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2
Q

When should statins be increased

A

If non-HDL has not reduced by 40%

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3
Q

First line treatment for prolactinomas

A

Cabergoline (dopamine agonist)

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4
Q

Patients on Hydroxychloroquine (SLE) require what monitoring

A

Visual acuity

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5
Q

What should all patients over 5 with a ?asthma dx receive

A

FeNO
Spirometry (70% FEV1/FEVC?
BDR (improvement of 12% and 200ml FVC)

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6
Q

Wheeze heard in asthma

A

Bilateral polyphonic

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7
Q

In patients with diagnostic uncertainty in asthma, what can be performed

A

Peak flow variability chart

Direct bronchial challenge with histamine

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8
Q

Only diagnosis for an acute moderate asthma attack

A

Peak flow 50-75%

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9
Q

What variability must be seen in peak flow variation for asthma

A

Greater than 20%

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10
Q

When in the stage of the disease does COPD cause clubbing

A

It NEVER does

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11
Q

COPD scale and grading

A 
MRC 1-5
1 breathless on strenuous exercise
2 breathless walking up hill
3 breathless walking on flat
4 stop to catch breath after 100m
5 unable to leave house

FEV1 GOLD scale

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12
Q

How is a COPD diagnosis made

A

Clinical picture + spirometry (FEV1:FEVC less than 0.7)

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13
Q

How is severity of COPD graded

A

FEV1

1-4
4< 30% of expected

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14
Q

What advice should be given before a TLCO test

A

Stop smoking for 24 hours

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15
Q

What is FRC made up of

A

Residual volume
+
expiratory reserve volume

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16
Q

What is vital capacity (respiratory) made up of

A

IRV, TV and ERV

Everything but residual volume

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17
Q

What does second line treatment of COPD depend on?

A

Asthmatic or steroid responsive features

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18
Q

First line COPD treatment

A

SABA or SAM (ipatropium bromide)

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19
Q

Second line COPD treatment

A

Astmatic features: ICS + LABA

Non asthmatic features: LAMA +LABA

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20
Q

What does bipap stand for

A

Bilevel positive airway pressure

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21
Q

Main indication for bipap

A

pH less than 7.35
AND
CO2 > 6

(despite medical treatment)

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22
Q

What should all patients have before bipap

A

A CXR (looking for pneumothorax)

Pneumothorax and facial structure pathology are main contraindications

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23
Q

BiPAP starting pressures

Study These Flashcards
A

15 (insp)

5 (exp)

24
Q

Who should get pulmonary rehab in COPD

Study These Flashcards
A

All patients with MRC 3 or greater (breathless on flat)
AND
Those who feel it is disabling them

25
IECOPD management
Prednisolone 30mg 7-14 days Salbutamol and ipatropium (neb or inh) ABX (prulent sputum or clinical sings only) Physio IV aminophylline, NIV, doxapram
26
Steroid dose in IECOPD
pred 30mg 7-14 days
27
What do all patients with COPD get at second stage of management
LABA + Asthma features :ICS No asthmatic features: LAMA
28
Criteria for LTOT in COPD
PO2< 7.3 Or PO2 7.3-8 AND peripheral oedema, polysythemia, or pHTN
29
When do patients with an IECOPD get ABX
Pruelent sputum or clinical signs of pneumonia
30
ABX for IECOPD
Amoxicillin Claithromycin (long QT syndrome) Doxycycline
31
4 test results that diagnose T2DM
HbA1c >48 Random BM >11 Fasting BM >7 OGTT >11
32
Two T2DM hba1c targets
48 for new T2DM | 53 if risk of hypo
33
Key risk of metformin
Lactic acidosis
34
DM drug that increases risk of HF and bladder cancer
Piaglitazone
35
Second line T2DM drug for any one with CKD, CVD or QRIS>10
SGLT-2 inhib (flozin) UTIs and DKA risk
36
Who should get atorvastatin 20mg
All CKD pts | T1DM for more than 10 years
37
When starting statins what is the goal
Reduction in HDL of greater than 40% | check lipids at 3 months
38
When should pts with stable angina call 999
after 2 puffs (5 mins between)
39
When are q waves likely to appear during an MI
Late Hyper acute t -> STE -> TWI/ Q
40
Electrolyte side effect of loop diuretics
Hypokalaemia | Hyponaturemia
41
Electrolyte side effect of thiazide
Hypokalaemia Hyponatremia (increased uric acid) Same as loop diuretic
42
Electrolyte side effect of spironolactone
Hyperkalemia Hyponatermia (same as Addisons as blocks aldosterone)
43
Pattern of vomitting in a toxic cause
Nausea Very often Small amount Vommting does not relieve nausea
44
Pattern of N and V in gastric stasis
Early fullness infrequently Nausea improves after vomitting
45
1st and 2nd line treatment for NV due to toxins
1 haloperidol | 2 levopromazine
46
1st line NV due to vestibular cause
cyclizine
47
Alternative to metoclopramide in NV due to gastric stasis
Domperidone (dopamine antagonist)
48
When should CKD pts be referred to a specialist
eGFR<30 ACR?70 Decrease in eGFR of 15 or 25% in 1 year
49
What 3 drugs may be needed to treat CKD patients
Oral sodium bicarbonate to treat metabolic acidosis Iron/ depo injections for anaemia Vitamine D for renal bone disease
50
First line anti HTN in CKD
ACE inhibitors
51
Why should blood transfusions be limited in patients with CKD
May need a renal transplant | Transfusions causes allosensitisation why means transplanted organs more likely to be rejected
52
3 features of CKD bone disease (in terms of bone problems)
Osteomalacia (softening) Osteoporosis (brittle) Osteosclerosis (hardening)
53
xray changes seen in CKD bone disease
Sclerosis of both ends of vertebra Osteomalacia in centre of vertebra This is known as rugger jersey
54
Phosphate levels in CKD
High as cannot excrete
55
What CCB should be used in patients with HF
Amliodipine Nifedipine spesicialy can worsen symptoms

Year 4 things I forgot (7 decks)

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