Week 4

Question 1

COPD

Answer 1

Consider dx in patients > 35 who are smokers / ex smokers and have symptoms such as exertional dyspnoea, chronic cough or regular sputum production

Post bronchodilator spirometry - obstruction (FEV1/FVC < 0.7)
CXR
FBC - exclude secondary polycythaemia
BMI

Question 2

COPD Severity - categorised using FEV1

Answer 2

Stage 1 (mild) - > 80%
Stage 2 (moderate) - 50-79%
Stage 3 (severe) - 30-49%
Stage 4 (very severe) - < 30%

Question 3

Rescue pack

Answer 3

Steroids - if SOB affects ADLs
ABx - if discoloured sputum

Exacerbations can be divided into:
Mild - controllable with increased usual meds
Moderate - requires systemic corticosteroids and / or abx
Severe - requires hospitalisation

Question 4

Causes of COPD exacerbations

Answer 4

Bacterial - Haemophilis influenza, S pneuminiae, Staph aureus

Viral - RSV, influenza, rhinovirus, parainfluenza

Pollutants - sulphur dioxide, nitrogen dioxide

Question 5

Assess pt for LTOT - ABG on at least 2 occasions 3 weeks apart

Answer 5

Very severe / severe 
Cyanosis
Polycythaemia
Peripheral oedema
Raised jugular venous pressure
Oxygen sats 92% or below on room air

Question 6

Offer LTOT to:

Answer 6

PO2 of < 7.3 kPa
PO2 of 7.3-8 kPa plus one of: 
Secondary polycythaemia
Nocturnal hypoxaemia 
Peripheral oedema 
Pulmonary HTN

Question 7

Furosemide SE

Answer 7

Common - mild GI disturbances, postural hypotension, electrolyte disturbances (hyponat / kal / calc / chlor / mag), hypersensitivity reactions

Less common - pancreatitis, hepatic encephalopathy, acute urinary retention, metabolic alkalosis, tinnitus, deafness, hyperglycaemia…

Question 8

Behavioural Problems DDx

Answer 8

ADHD
ASD
Developmental delay
Neglect

Question 9

SENCO (special educational needs coordinator)

Answer 9

Coordinates provision in schools for children with special educational needs
Liaises with other HCP
Works closely with headteacher to develop school SEN policy
Liaises with parents / carers for a consistent approach at home and school

Question 10

Methylphenidate

Answer 10

CNS stimulant
Controlled drug - prescribed by hospital initially and then by GP under ‘shared care protocol’ (clinical responsibility still with specialist)
SE - abdo pain, nausea, dyspepsia
Growth not usually affected but monitor for first 6 months normally
BNF advises monitoring for psychiatric disorders and checking BP / pulse every 6 months

Question 11

ADHD

Answer 11

Characterised by:
Extreme restlessness
Poor concentration
Uncontrolled activity 
Impulsiveness

Question 12

ADHD Management

Answer 12

Specialist assessment required in all cases
Unless a food diary has shown link between diet and behaviour don’t make changes
Methylphenidate
Atomoxetine