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

Respiratory, CVD, GI, Haematology, Renal Flashcards

(60 cards)

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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
Boerhaave's syndrome
Urgent surgery thoracic washout and repair
26
PUD and upper GI bleed
Supportive management and endoscopy - do not give PPI before endoscopy due to causing false negative results.
27
Acute pancreatitis
Supportive management: lots of fluids and analgesia | - risk of third spacing and ARDS
28
Biliary colic
Analgesia and refer for elective cholecystectomy
29
Acute cholecystitis
IV antibiotics (amoxicillin + metronidazole + gentamicin) and emergency cholecystectomy
30
Ascending cholangitis
IV antibiotics (A+M+G) and emergency cholecystectomy
31
Coeliac
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
UC
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
Crohn's disease
Flare: prednisolone or elemental diet for kids Maintenance: Azathioprine or mercaptopurine
34
CRC
``` 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
Anal Fissure
Acute: topical analgesia, lubricants for defaecating Chronic: GTN cream or diltiazem
36
Haemorrhoids
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
C.difficile infection
Mild: oral metronidazole for 10 days Moderate - Severe: Oral metronidazole + oral vancomycin Life-threatening: IV metronidazole and oral vancomycin.
38
C.difficile infection
Mild: oral metronidazole for 10 days Moderate - Severe: Oral metronidazole + oral vancomycin Life-threatening: IV metronidazole and oral vancomycin.
39
Grave's disease
1. Propanolol for symptomatic relief 2. Carbimazole and levothyroxine (block and replace) 3. Radioiodine treatment + thyroxine
40
Sub-acute (DeQuervain's) thyroiditis
In response to URTI and will settle so only give propranolol for symptomatic relief and NSAIDs for pain
41
Toxic multi nodular goitre
1. Propanolol for symptomatic 2. Carbimazole + levothyroxine 3. Radioiodine treatment + thyroxine
42
Hashimoto's thyroiditis
Levothyroxine
43
Thyroid tumours
``` 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
Hyperparathyroidism
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
Hypoparathyroidism
Calcium and vitamin D supplementations
46
Cushing's Syndrome/Disease
Remove pituitary adenoma if disease | Gradually wean down exogenous steroids if syndrome
47
Hyperaldosteronism
Spironolactone (is an aldosterone antagonist)
48
Congenital adrenal hyperplasia
Give glucocorticoid and fludricortisone replacement. | - will have precocious puberty as adrenals pump out LOADS of testosterone
49
Addison's Disease
Replace hydrocortisone (cortisol) and fludrocortisone (aldosterone) - required lifelong to prevent crisis - double doses in illness or after surgery
50
Phaeochromocytoma
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
SIADH
Treat the underlying cause e.g. resect SCLC | Correct hyponatraemia very slowly due to risk of central pontine myelinolysis (<10mmol/24hrs)
52
Diabetes insipidus
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
Acromegaly
Somatostatin analogue and removal of pituitary adenoma
54
Hypogonadotrophic hypogonadism
Pulsatile GnRH
55
Androgen insensitivity
Bilateral orchiopexy Oestrogen therapy Vaginal dilation/lengthening
56
PCOS
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
Menopause
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
Premature ovarian failure
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
T1DM
Insulin + screening for complications e.g. retinopathy, renal function, neuropathy, HTN review, infections
60
T2DM
1. Metformin (if can't tolerate then give MR) 2. M + gliclazide (sulphonylurea) or pioglitazone 3. + gliflozin if need weight loss and low risk of hypoglycaemia

Treatments (5 decks)

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