CCT - core notes

Question 1

Scale used to grade degree of breathlessness in a patient regarded to activity

Answer 1

MRC dyspnoea scale

1 - no breathlessness unless with strenuous exercise

2 - up a hill SOB

3 - walks slower, has to stop for breath

4 - hundred metres stops for breath

5 = too breathless to leave house

Question 2

Scale used to grade severity of functional limitations in a patient with heart failure

Answer 2

NYHA scale

1 = no limitation in activity

2= slight limitation in activity, comfortable at rest. Ordinary activity leads to fatigue, palpitations, shortness of breath or chest pain

3 = Marked limitation of physical activity, comfortable at rest. less than ordinary activity causes SOB or chest pain

4 = symptoms of heart failure at rest

Question 3

What investigations would you do in a patient with suspected heart failure?

Answer 3

1. if not has previous MI, measure BNP
2. ECG 12 lead
3. Echo - reserved or preserved ejection fraction

Other tests
4. CXR

5. U&Es, eGFR, TFT, LFTs, HbA1c and fasting lipids
6. Urine dipstick for blood and protein
7. weight
8. lung function tests (peak flow and/or spirometry)

Question 4

Management in primary care of a patient with a reduced ejection fraction

Answer 4

1. relieve symptoms of fluid over load –> diuretic
2. reduce mortality and morbidity –> ACE then BB , one at a time as patient tolerates
3. if still symptomatic even on ACEi and BB then ask for specialist

Question 5

If a patient has symptoms of community-acquired pneumonia, what scoring system would you use?

Answer 5

CURB-65

C-confusion

U- urea

R- RR (30 or more)

b- BP

65 age or more

score of 1 = home treatment
score of 2 = hospital admission
score of 3 = urgent hospital admission

Question 6

Management for Mild (CURB65 = 0-1) Community-acquired pneumonia

Answer 6

1st line = Amoxicillin

2nd line = clarithroymycin

Question 7

Management for MODERATE (CURB65 = 2) Community-acquired pneumonia

Answer 7

1st line = amoxicillin and clarithromycin

2nd line = doxycycline (avoid this in pregnancy)

Question 8

Management of severe community acquired pneumonia

Answer 8

1st line = benzylpenicillin and clarithromycin +/- gentamicin

2nd line = teicoplanin & clarithromycin +/- gentamicin

Question 9

What investigations might you consider for suspected Asthma?

Answer 9

1. spirometry (obstruction / reversibility)
2. peak flow
3. FBC - anaemia as cause of SOB, eosinophilia in asthma
4. CXR - exclude other diagnoses
5. FeNO - fractional nitric oxide, suggests eosinophilic inflammation

Question 10

what does FeNO suggest?

Answer 10

Eosinophillic inflammation

Question 11

Spirometry results in asthma?

Answer 11

FEV1/FVC ratio <0.7 is suggestive of obstruction and supportive of a diagnosis of Asthma

Question 12

Describe the management of Asthma in adults

Answer 12

1. SABA - relax bronchial smooth muscle
2. ICS - anti-inflammatory, decreases cytokines and eosinophils
3. LABA - relax bronchial smooth muscle
4. Montelukast - LTRA, reduce sputum eosinophilia, also mild bronchodilator effect
5. Theophylline - bronchodilator
6. Oral steroids

Question 13

The following describes what degree of asthma:

• increasing symptoms
• PEF >50-70% best or predicted
• no features of acute severe asthma

Answer 13

Moderate asthma

Question 14

The following describes what degree of asthma:

any one of:

• PEF 33-50% best or predicted
• RR > 25/min
• HR > 110bpm
• inability to complete sentences in one breath

Answer 14

severe asthma