QuestionSBA
QuestionChoice
You cannot increase the dose of salbutamol to 400 micrograms INH QDS, he is already on the max dose of 200 micrograms INH QDS.
50296
c
Increase the dose of salbutamol to 400 micrograms INH QDS
QuestionChoice
This patient has COPD that isn't controlled on his current medication. This treatment option is for a pneumonia/acute infective exacerbation of COPD which this gentleman doesn't have.
50298
e
Prescribe amoxicillin 500mg PO TDS
QuestionChoice
This patient has COPD that isn't controlled on his current medication. It wouldn't be the correct decision to stop his salbutamol as his condition isn't controlled on this - stopping this medication would make his condition worse.
50295
b
No change to his medication
QuestionChoice
This patient has COPD that isn't controlled on his current medication. This isn't an acute exacerbation as his observations are stable and his bloods are unremarkable. He has no signs of steroid responsiveness so should be stepped up the COPD treatment ladder to a LAMA + LABA.
50294
a
Prescribe a long acting muscarinic antagonist and a long acting beta agonist
QuestionChoice
This patient has COPD that isn't controlled on his current medication. This treatment option is for a pneumonia/acute infective exacerbation of COPD which this gentleman doesn't have.
50297
d
Admit to hospital with co-amoxiclav 1.2g IV TDS and clarithromycin 500mg IV BD
QuestionComment
What would signs of steroid responsiveness actually be?
61453
User
subscriber
Epidermis Benign
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3642
Moving up the treatment ladder in patients with COPD
Topic
9
Internal Medicine
10113
Case Presentation: A 68 year old man attends his GP for a COPD review as he is feeling breathless.


**PH** COPD, hypertension, hypercholesterolaemia

**DH** salbutamol 200 micrograms INH QDS, amlodipine 10mg PO OD, atorvastatin 20mg PO OD. NKDA

**On examination**

Temperature 37.4°C, HR 74, RR 22, BP 115/78, O2 96% RA.

Audible wheeze heard in all lung fields.

**Investigations**

Hb 126, WCC 8.3, Plts 303 x 10<sup>9</sup>, eosinophils 0.1 x 10<sup>9</sup>L, CRP 2

Question: Select the most appropriate management at this stage.
a