SOB case by mamun chowdhury

Definition

mrc_360 — 2021-06-02 22:00:33 UTC

Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

Main symptoms
- SOB (on exertion, cold weather, dust etc)
-Tight chest
-Wheeze

asthma

mrc_360 — 2021-06-02 22:02:54 UTC

Investigations

mrc_360 — 2021-06-02 22:07:54 UTC

FEV₁/FVC ratio
peak expiratory flow rate (PEFR)
CXR
FBC

management

mrc_360 — 2021-08-12 17:56:35 UTC

CKD

mrc_360 — 2021-08-12 17:57:28 UTC

Defintion

mrc_360 — 2021-08-12 17:58:54 UTC

Chronic kidney disease is defined as abnormalities of kidney structure or function, present for ≥3 months, with implications for health.
GFR < 60 mL/minute/1.73 m², or the presence of one or more of the following markers of kidney damage: albuminuria/proteinuria, urine sediment abnormalities (e.g., haematuria), electrolyte abnormalities due to tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging, or history of kidney transplantation

RF: >50 years, male sex, black or Hispanic ethnicity, family history, smoking, obesity, long-term analgesic use, diabetes, hypertension, and autoimmune disorders

Signs/symptoms
- Fatigue
- Oedema
- N&V
- Pruritus
- Loss of apetite

Investigations

mrc_360 — 2021-08-12 17:59:56 UTC

renal chemistry
estimation of GFR
serum cystatin C and cystatin C-based estimation of GFR
urinalysis

to consider:

Kidney Biopsy
Abdominal CT/MRI

management

mrc_360 — 2021-08-12 18:03:59 UTC

- Lifestyle
- Medications: ACEI, erythropoietin stimulating agent, iron, activated Vit D
- Dialysis: peritoneal/haemodialysis
- Surgical: renal transplant

osteoarthritis

mrc_360 — 2021-08-12 18:04:57 UTC

Defintion

mrc_360 — 2021-08-12 18:05:32 UTC

Degenerative joint disease that results from breakdown of joint cartilage and underlying bone. It is clinically characterised by

Signs/symptoms:
- joint pain
-Stiffness
-Reduced range of motion

most commonly involved joints are the two near the ends of the fingers (DIP & PIP) and the joint at the base of the thumbs; the knee and hip joints; and the joints of the neck and lower back

investigations

mrc_360 — 2021-08-12 18:06:53 UTC

x-ray of affected joints: joint space, subchondral sclerosis, and osteophyte
serum CRP
serum erythrocyte sedimentation rate (ESR)
Others (to consider): RF, anti-CCP, MRI

management

mrc_360 — 2021-08-12 18:09:10 UTC

Conservative- exercise programmes, physio
medical- Topical NSAIDS (first line), corticosteroid injection
surgical- joint replacement

Defintion

mrc_360 — 2021-08-12 18:17:14 UTC

_{neurological disorder characterised by recurrent seizures

Focal seizures}

_{these start in a specific area, on one side of the brain}
_{the level of awareness can vary in focal seizures.}
_{can be preceded by aura}

_Generalised

_{these engage or involve networks on both sides of the brain at the onset}
_{consciousness lost immediately.}
_{generalised seizures can be further subdivided into motor (e.g. tonic-clonic) and non-motor (e.g. absence).}
_{Postictal state}

Epilepsy

mrc_360 — 2021-08-12 18:19:18 UTC

investigations

mrc_360 — 2021-08-12 18:33:46 UTC

-EEG
-MRI/CT

management

mrc_360 — 2021-08-12 18:43:54 UTC

lifestyle- avoid triggers, ketogenic diet (questionable)
Pharmacological: anticonvulsants (sodium valporate, carbamazepine, phenytoin)
Surgery

Stroke

mrc_360 — 2021-08-12 18:45:11 UTC

Investigations

mrc_360 — 2021-08-12 18:45:32 UTC

non-contrast CT head (urgent, within an hour)
serum glucose (hypoglycaemia can mimic symptoms)
serum electrolytes
serum urea and creatinine

definition

mrc_360 — 2021-08-12 18:45:51 UTC

Stroke is defined as an acute neurological deficit lasting >24 hours and caused by cerebrovascular aetiology. It is subdivided into ischaemic stroke (87%, caused by vascular occlusion or stenosis) and haemorrhagic stroke (caused by vascular rupture, resulting in intra-parenchymal and/or subarachnoid haemorrhage, 13%).

Key signs/symptoms:

unilateral weakness or paralysis in the face, arm, or leg
sensory loss (numbness)
dysphasia
dysarthria
visual disturbance
headache
ataxia

RF- Hypertension, old age, alcohol, Fx, anticoagulant use

management

mrc_360 — 2021-08-12 18:45:58 UTC

Haemorrhagic:
1st line – supportive care plus monitoring

Plus –immediate referral for neurosurgery assessment

Consider – rapid blood pressure control

Consider – urgent reversal of anticoagulation

Ischaemic:
presentation within 4.5 hours AND thrombolysis not contraindicated

1st line – supportive care plus monitoring (GCS, blodo glucose,

Plus – alteplase

Consider – mechanical thrombectomy

Plus – antiplatelet agent

Consider – venous thromboembolism prophylaxis plus early mobilisation

Plus – high-intensity statin

presentation after 4.5 hours OR thrombolysis contraindicated

1st line – supportive care plus monitoring

Consider – mechanical thrombectomy

Plus – antiplatelet agent

Consider – venous thromboembolism prophylaxis plus early mobilisation

Plus – high-intensity statin

mrc_360 — 2021-08-26 16:55:46 UTC