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Flashcards in NICE guidelines Deck (122)
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1
Q

ASTHMA: how can you use PEFR to diagnose?

A

PEFR improves after administration of a SABA

2
Q

ASTHMA - adult: first line treatment (symptom relief)

A

SABA

3
Q

ASTHMA - adult: first line treatment + prevention

A

SABA + low-dose ICS

4
Q

ASTHMA - adult: next step from SABA + low-dose ICS

A

+ LTRA

5
Q

ASTHMA - adult: next step from SABA + low-dose ICS + LTRA

A

+ LABA (keep or take away LTRA)

6
Q

ASTHMA - adult: next step from SABA + low-dose ICS + LTRA + LABA

A

incorporate MART routine

7
Q

ASTHMA - adult: next step from SABA + low-dose ICS + LTRA + LABA (MART routine)

A

increase ICS to medium dose

8
Q

ASTHMA - adult: next step from SABA + med-dose ICS + LTRA + LABA (+/-MART routine)

A

increase ICS to high dose

9
Q

ASTHMA - adult: next step from SABA + high-dose ICS + LTRA + LABA (+/-MART routine)

A

+ 4th drug theophylline/oral beta agonist/anti-muscarinic

10
Q

ASTHMA - adult: next step from SABA + high-dose ICS + LTRA + LABA (+/-MART routine OR 4th drug)

A

oral corticosteroid (also keep high dose ICS)

11
Q

ASTHMA - 5-16yo: first line treatment (symptom relief)

A

SABA

12
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS

A

+ LTRA

13
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS + LTRA

A

+ LABA (consider stopping LTRA)

14
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS + LABA (+ LTRA)

A

incorporate MART routine

15
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS + LABA (+ LTRA; +/- MART routine)

A

increase to medium dose ICS

16
Q

ASTHMA - 5-16yo: next step from SABA + paed med dose ICS + LABA (+ LTRA; +/- MART routine)

A

refer to specialist paed clinic + consider increasing to high dose ICS

17
Q

ASTHMA - 5-16yo: next step from SABA + paed med dose ICS + LABA (+ LTRA; +/- MART routine)

A

refer to specialist paed clinic + consider increasing to high dose ICS

18
Q

ASTHMA - <5yo: first line treatment (symptom relief)

A

SABA

19
Q

ASTHMA - <5yo: first line treatment with maintenance therapy

A

SABA + 8-week trial of paed mod-dose ICS

20
Q

ASTHMA - <5yo: after 8 week paed mod-dose ICS trial if symptoms recur within 4 weeks

A

low dose ICS and SABA

21
Q

ASTHMA - <5yo: after 8 week paed mod-dose ICS trial if symptoms recur within & after 4 weeks

A

med dose ICS and SABA

22
Q

COPD FVC <0.7, FEV1 >80%

mild, mod, severe, v severe?

A

mild

23
Q

COPD FVC <0.7, FEV1 50-79%

mild, mod, severe, v severe?

A

moderate

24
Q

COPD FVC <0.7, FEV1 30-49%

mild, mod, severe, v severe?

A

severe

25
Q

COPD FVC <0.7, FEV1 <30%

mild, mod, severe, v severe?

A

v severe

26
Q

MRC dyspnoea scale 1 = not troubled by breathlessness OR too breathless to leave house?

A

not troubled by breathlessness

27
Q

MRC dyspnoea scale 5 = not troubled by breathlessness OR too breathless to leave house?

A

too breathless to leave house

28
Q

name 2 lifestyle management things for COPD

A

smoking cessation
vaccinations
pulmonary rehab

29
Q

COPD - inhaled meds - step-up if no improvement FEV1 >/=50% (already on SABA/SAMA + LABA)

A

LABA + ICS

30
Q

COPD - inhaled meds - short acting relief

A

SABA salbutamol or

SAMA ipatropium bromide

31
Q

COPD - inhaled meds - long acting if FEV 1 >/=50%

A

LABA (salmeterol) or LAMA (tiotropium bromide)

remove SAMA if using LAMA

32
Q

COPD - inhaled meds - long acting if FEV 1 <50%

A

LABA + ICS combi inhaler or LAMA

33
Q

COPD - inhaled meds - second line if no improvement for both FEV1 measurements

A

LABA + ICS combo AND LAMA

34
Q

COPD - combined inhaled and oral therapy

A

beta-2 agonist + theophylline OR

anticholinergic + theophylline

35
Q

COPD - if chronic cough

A

mucolytic (carbocristine)

36
Q

COPD - abx for purulent sputum

A

amoxicillin
doxycycline
erythromycin

37
Q

COPD - when would you give PO corticosteroids?

A

increased dyspnoea or reduced ADLs

38
Q

DM classic triad

A

polyuria
polydipsia
weight loss

39
Q

DM2 - HbA1c target if not on hypoglycaemics

A

<48

40
Q

DM2 - HbA1c target if on hypoglycaemics

A

53

41
Q

DM1 routes of insulin

A

SC injections - short acting before meals, long acting in the evening
SC pump - continuous/regular

42
Q

DM2 - first line meds

A

metformin

43
Q

DM2 - metformin SEs

A

reduced appetite + weight, cardio protective, reduced risk of hypo

44
Q

DM2 - metformin CI

A

cannot be used if eGFR <30

45
Q

DM2 - what to add to metformin if HbA1c >58

A

DPP4 (sitagliptin) OR
sulfonylurea (gliclazide) OR
pioglitazone

46
Q

DM2 - out of sitagliptin, gliclazide and pioglitazone, which is best in kidney impairment?

A

sitagliptin

47
Q

DM2 - sulfonylurea SEs

A

increased weight, increased risk of hypo

48
Q

DM2 - pioglotazone CIs

A

HF, DKA, bladder ca, haematuria

49
Q

DM2 - third line treatment

A

metformin + sulfonylurea + DPP4(sitagliptin)/pioglitazone

50
Q

DM2 - 4th line treatment

A

insulin

51
Q

DM2 - if metformin resistant…

A

skip metformin and use one of the other adjuncts

52
Q

DM2 - when to measure HbA1c

A

3 monthly until stable then 6 monthly

53
Q

DM2 - non glycaemic treatments

A

statin (reduce CVD risk)

antihypertensives if >140/90

54
Q

DM2 - annual check

A
weight + BMI
serum creatinine
BP
smoking
HbA1c
cholesterol
urinary ACR
eye exam
foot exam
55
Q

DM - microalbuminuria - ACR ratio over ?

A

> 3

+ urine dip + for protein

56
Q

DM - microalbuminuria management

A

ACE-i or ARB even if BP normal - protects kidneys

57
Q

CHD - what type of angina?

induced by effort, relieved by rest

A

stable

58
Q

CHD - what type of angina?

caused by coronary artery spasm

A

variant

59
Q

CHD - what type of angina?

increasing in freq or severity, after minimal exertion/at rest, high risk of MI

A

unstable/crescendo

60
Q

CHD - what type of angina?

precipitated by lying flat

A

decubitus

61
Q

QRISK2 score - what does it calculate?

A

10 year risk of having MI or stroke (based on RFs and demographics)

62
Q

CHD - step 0 - symptom relief

A

inhaled GTN

63
Q

CHD - step 1 - regular medicines

A

BB or CHB
amlodipine, felodipine
OR diltiazem + verapamil (rate limiting)

64
Q

CHD - step 2 - monotherapy

A

long acting nitrate (isorbide mononitrate)

specific anti-angina drugs (ivabrandine, nicorandil, ranolazine)

65
Q

CHD - when step 2 monotherapy insufficient

A

combine with BB or CCB

then can add GTN

66
Q

CHD - secondary prevention in stable angina

A

aspirin 75mg to all
statin to all
ace-i if also have DM

67
Q

CHD - secondary prevention after an MI

A
BRA-AC
bisoprolol
ramipril
aspirin
atorvostatin
clopidogrel
68
Q

HF - investigations

A

BNP
echo
ECG
CXR

69
Q

HF - acute management

A

diuretics - frusemide or bendroflumethiazide if already on loop
do not offer opiates or nitrates

70
Q

HF - first line chronic management

A

ACE-i and BB
ARB if ACE-i intolerant
hydralazine + nitrate if afro-caribbean

71
Q

HF - second line chronic management

A

aldosterone antagonist (spironolactone), ARB or hydralazine + nitrate
OR
sacubitril valsartan

72
Q

HF - 3rd line management

A

digoxin or ivabradine

implantable cardiac defib

73
Q

investigation in suspected AF

A

ambulatory ECG

74
Q

AF - acute management

A

cardioversion

flecainide or amiodarone

75
Q

AF - management - anti-coagulation

A

CHADSVASC or HASBLED
if anti-coag
warfarin or NOAC

76
Q

AF - management - rate control

A

beta blocker or rate limiting CCB
digoxin if sedentary
next stage is to combine 2 of the above

77
Q

AF - management - rhythm control

A

only if rate control has been unsuccessful

cardioversion + amiodarone

78
Q

score for stroke prevention in AF

A
CHA2DS2VASC
stroke risk based on 
congestive heart failure
HF
age
diabetes
stroke
sex (female)
vascular disease
if score >/= 7 = 10% stroke risk
79
Q

score for predicting risk of bleed on anti-coags in AF

A

hasbled

80
Q

FAST screen for stroke

A

face
arms
legs
TIME TO CALL 999 muvafuka

81
Q

acute stroke management - thrombolysis

A

alteplase thrombolysis in <4.5hrs

82
Q

acute stroke management - pharmacological

A

antiplatelets
aspirin 300mg for 2 weeks
then clopidogrel 75mg long term
warfarin if AF

83
Q

acute stroke management - possible surgical interventions

A

carotid artery imaging <1 week to see if there is carotid artery narrowing
carotid endarectomy

84
Q

stroke management longterm

A

clopidogrel 75mg
warfarin if AF
statin

85
Q

score for TIA

A
ABCD2
age
BP
clinical features (unilateral weakness or speech disturbance)
duration of symptoms
86
Q

TIA - ABCD2 score meanings

A
>/= 4 - urgent 24hr see neurologist
<4 - 1 week referral
ALSO hospitalise if...
persistant signs/sx
<45yo
crescendo TIA
patient has AF
87
Q

TIA - management

A

ABCD2 score >/=4 (or <45, crescendo or AF)
aspirin 300mg & urgent neurologist appt in 24hrs
ABCD2 score <4
aspirin 300mg within 1 week

88
Q

DVLA rules post stroke or TIA

A

1 month

89
Q

what classification system used for stroke

A

oxford

90
Q

CKD investigations

A

creatinine based eGFR
urine ACR
renal USS + biopsy

91
Q

CKD - microalbuminaemia

A

raised ACR

92
Q

CKD - stages

A
1 = eGFR >90 (review annually)
2 = 60-90 (review annually)
3 = 30-60 (review 6 monthly)
4 = 15-30 (review 3 monthly)
5 (end stage) = <15 (review 6 weekly)
93
Q

CKD - managment

A
BP control (aim <140)
ACE-I or ARB
94
Q

CKD - end stage management

A

haemodialysis / some form of dialysis

95
Q

CKD - prevention of CVD

A

statin

antiplatelet (apixiban or warfarin)

96
Q

epilepsy - initial investigation for all

A

ECG

97
Q

epilepsy - when to start treatment

A

after diagnosis confirmed (usually 2nd seizure)

98
Q

epilepsy - absent/tonic clonic or atonic management

A

sodium val

lamotrigine

99
Q

epilepsy - myoclonic management

A

sodium valproate

leviteracetam, topiramate

100
Q

epilepsy - focal management

A

carbamazepine

lamotrigine

101
Q

epilepsy - non-pharma management

A

surgery
vagal stimulation
ketogenic diet
deep brain stimulation

102
Q

epilepsy - coming off anti-epileptics

A

wean down over 3 months

103
Q

epilepsy - annual review

A

seizures
medications
bloods
lifestyle/eduction

104
Q

epilepsy - DVLA

A

can drive car/bike if seizure free for over a year

can drive lorry/bus if seizure free for 10 years

105
Q

epilepsy - sodium val side effects

A

weight gain, N+V

106
Q

epilepsy - lamotrigine side effects

A

anti-cholinergic

107
Q

epilepsy - carbemazapine side effects

A

headache, blurred vision, dizzy drowsy ataxic

108
Q

HT - diagnosis

A

blood pressure in GP

ambulatory blood pressure

109
Q

HT - score for risk of cardiac event

A

qrisk2

% risk of heart attack or stroke in 10 years

110
Q

HT - first line management - non-pharmacological

A

lifestyle and diet

111
Q

HT - first line - pharmacological

A

<55yo
ACE-i (ARB if not tolerated)
>55 or afro-caribbiean
CCB (thiazide diuretic if not tolerated)

112
Q

HT - second line pharma treatment

A

ACE-i + CCB

113
Q

HT - third line pharma treatment

A

ACE-i + CCB + thiazide diuretic

114
Q

HT - 4th line pharma treatment

A

add:
a blocker (tamusolin)
diuretic (spironolactone or indapamide)
beta blocker

115
Q

HT - ACE-i side effets

A

postural HT
dry cough
can’t use in pregnancy

116
Q

HT - ARB Side effects

A

dizzy

can’t use in pregnancy/breast feeding

117
Q

HT - CCB side effects

A

ankle oedema
headaches
palpitations
N+V

118
Q

HT - thiazides side effects

A

hypokalaemia

headache

119
Q

HT - K+ sparing diuretics side effects

A

gynaecomastia
impotence
menstrual irregular

120
Q

HT - annual review

A

BP, weight, height BMI

medicines

121
Q

COPD - exacerbation management in the community

A

oral prednisolone for 2 weeks

abx if needed

122
Q

COPD - what is in a rescue pack?

A

corticosteriods, bronchodilator, abx