Specified Clinical Cases 1-Acute Myocardial Infarction 2. Heart Failure 3. High BP 4. Cardiac Arrhythmia 5. Valvular Heart Disease 6. Lung cancer 7. COPD 8. Interstitial Lung Disease 9. Asthma 10. Pneumonia Clinical Case 1 - Acute Myocardial Infarction* Patient Initials: Date: What were the key presenting symptoms? How long had the patient had chest pain before arriving at hospital? What aspects of the patient’s history elevated their cardiovascular risk? List the other common cardiovascular risks? What were the patient’s clinical signs? What did the ECG show? What did the Chest X-ray demonstrate? What were the results of other immediate investigations? What was the ECG diagnosis? What is the difference between a ST elevation MI and a non-ST elevation MI? Explain the pathology of an acute MI? Was the patient given thrombolysis or undergo urgent primary angioplasty? What do you understand by the door to needle and call to needle times? What other therapies were administered? Did the patient undergo any invasive procedures such as coronary angiography if not on admission? If so, what were the reasons given? Did the patient have any complications as a result of his MI? What are the possible complications of acute myocardial infarction? What long-term treatment was initiated? What is the evidence for the use of -blockers post-MI? What arrangements have been made for the patient following discharge? What has the patient understood about his MI? Clinical Case 2 – Heart failure* Patient Initials: Date: What were the key presenting symptoms? What aspects of the patient’s history highlight the aetiology? What are the causes of heart failure? What is the difference between low output and high output heart failure? What was the patient’s drug history? What were the patient’s clinical signs? Why do patients with heart failure develop ankle oedema? What did the Chest X-ray demonstrate? What were the results of other investigations? Explain the Frank Starling Curve? What treatment was given to the patient? Explain how furosemide acts on the renal tubules? Why are ACE inhibitors used to treat patients with heart failure? What prognosis does the patient have? What is the role of palliative care in patients with severe heart failure? Clinical Case 3 – Hypertension* Patient Initials: Date: How did the patient present? What are the key questions to ask a patient with high blood pressure? What key clinical signs should be looked for? What are the causes of high BP? What is a normal BP? What is an abnormal BP? Why is hypertension known as the silent killer? Define the Korsatkov sounds? What are the features of hypertensive retinopathy? What are key investigations? Explain arteriosclerosis? What non-pharmacological advice should be considered? When should the patient be advised to consider drug therapy? What does the most recent evidence-based guidance (British Hypertension Society) suggest about drug therapy? What are the complications of untreated hypertension? Clinical Case 4 – Cardiac Arrhythmia* Patient Initials: Date: How did the patient present? What are the key clinical features to be assessed on arrival at hospital? What key questions would you ask a patient with palpitations? What did the ECG show? What is the difference between a supraventricular tachycardia (SVT) and ventricular tachycardia (VT)? What features of an ECG would suggest VT? What treatment did the patient receive? What would be the indications for electrical DC cardioversion? What would you explain to a patient requiring electrical DC cardioversion? What is Wolff-Parkinson-White syndrome? How does adenosine work and what indications are there for its use? What would you explain to a patient about to receive a dose of adenosine? What is the Vaughan-Williams classification of anti-arrhythmia drugs? What drugs are used in the long-term treatment of permanent Atrial Fibrillation (AF)? What are the indications for the use of warfarin in the management of AF? Clinical Case 5 – Valvular Heart Disease* Patient Initials: Date: How did the patient present? What aspects of the patient’s past medical history were relevant? Describe the clinical signs? What did the ECG show? What did the echocardiogram show? What valve(s) were diseased? What treatment did the patient receive? Was surgery considered? What are the clinical signs of aortic stenosis? What are the clinical signs of aortic regurgitation? What are the clinical signs of mitral stenosis? What are the clinical signs of mitral regurgitation? How might you distinguish between mitral and tricuspid regurgitation clinically? What are the causes of valvular heart disease? What are the complications of severe aortic stenosis? What is mitral valve prolapse? What are the indications for the use of Prophylactic antibiotics? What heart valves are most susceptible to infective endocarditis? What clinical signs would you look for if a patient presented with possible infective endocarditis? What are the common pathogens causing infective endocarditis? What initial antibiotic therapy is indicated if infective endocarditis is suspected but not microbiologically proven? Clinical Case 6 – Lung Cancer* Patient Initials: Date: What were the key presenting symptoms? What other symptoms may be associated with lung cancer? What aspects of the patient’s history highlight the aetiology? What co-morbid conditions may commonly be associated with lung cancer? What were the patient’s clinical signs? What did the CXR show? What did the staging CT thorax and upper abdomen demonstrate? What were the results of other investigations? What was the histopathological diagnosis? What sites do lung cancer commonly metastasise to? List some paraneoplastc syndromes. Explain the pathology of 2 of these paraneoplastic syndromes? What treatment was planned for this patient/did this patient receive? What other treatments may be available for patients with lung cancer? What did the patient understand about his/her diagnosis? Why is the prognosis for lung cancer generally so poor? Clinical Case 7 – COPD* Patient Initials: Date: What were the key presenting symptoms? What aspects of the patient’s history highlight the aetiology? What are the causes of COPD? What is COPD? What was the patient’s drug history? What were the patient’s clinical signs? Why may patients with COPD develop ankle oedema? What did the spirometry demonstrate? What were the results of other investigations? Explain the difference between asthma and COPD? Was treatment was given to the patient? What other treatments are available? Explain how salbutamol acts on the bronchi? What treatments alter prognosis for patients with COPD? Define type I and type II respiratory failure? Why may uncontrolled oxygen be potentially dangerous in someone with COPD? What is the role of pulmonary rehabilitation in patients with COPD? Clinical Case 8 – Interstitial lung disease* Patient Initials: Date: How did the patient present? What other questions are important to determine a possible aetiological cause for interstitial lung disease? What are the key clinical signs should be looked for? What are the causes of interstitial lung disease? What did the CXR show? What did the CT scan show? What is the difference between a standard CT thorax and a high resolution CT thorax? What did the pulmonary function tests show? What are the key differences in pulmonary function tests between interstitial lung disease and COPD? What other investigations may be appropriate? Was any treatment started? Why are many patients with interstitial lung disease taking diuretics at presentation? Clinical Case 9 – Asthma* Patient Initials: Date: How did the patient present? What key questions would you ask a patient with asthma? What was the patient’s drug history? What was the spirometry/peak flow? What are the key clinical features to be assessed on arrival at hospital? What were the patient’s clinical signs? What investigations were performed? What treatment did the patient receive? What are the definitions for acute severe, life threatening and near fatal asthma attacks? What investigations may be performed in patients with chronic asthma? What is Allergic Bronchopulmonary Aspergillosis? What are the principles for the British Thoracic Society guidelines for stepwise management of chronic asthma in adults? What is an asthma management plan? Clinical Case 10 – Pneumonia* Patient Initials: Date: How did the patient present? Describe the clinical signs? How does one assess the severity of community-acquired pneumonia? What was the patient’s score? What did the CXR show? What were the results of the other relevant investigations? What treatment did the patient receive? List some of the potential systemic complications of communityacquired pneumonia? What are the common pathogens associated with community acquired pneumonia? What is the differential diagnosis for a pleural effusion associated with community-acquired pneumonia? What diagnostic tests are available for determining a pleural effusion associated with community-acquired pneumonia? What features may help differentiate a community acquired pneumonia from pulmonary tuberculosis? What is hospital-acquired pneumonia? What are the common pathogens causing hospital-acquired pneumonia? How do the antibiotic treatments differ for community acquired pneumonia and hospital-acquired pneumonia? What follow up arrangements should be made for a patient with pneumonia? What is the difference between lower respiratory tract infection and pneumonia and why is it important to distinguish these two diagnoses? Activities Activity1 – Exercise Tolerance Test* Patient Initials: Date: Why was the patient having the test? What explanation was given to the patient before the procedure was started? What is being monitored during an ETT? What are the criteria for stopping the test? What would suggest a positive test? What was the outcome of the test for this patient? Activity2 – Echocardiography* Patient Initials: Date: Why was the patient having the test? What explanation was given to the patient before the procedure was started? Why is an ECG lead attached during the investigation? Why is it sometimes difficult to obtain a satisfactory ‘echo window’? What ‘echo’ view is best for identifying the overall LV function? What did this patient’s echocardiogram identify? What other investigations can be done by Echocardiography? Activity3 – Pulmonary Function Tests* Patient Initials: Date: You may wish to link this to the Task on Spirometry Why the patient having this procedure? Because the patient has asthma and she respiratory failure What explanation was given to the patient before the procedure was started? What measurements are made during the test? What information can be obtained from PFTs? Why is the Haemoglobin relevant to the interpretation of the results? What did the pulmonary function tests reveal? Activity 4: Coronary Angiography / Angioplasty Patient Initials: Date: Why the patient having this procedure? What explanation was given to the patient before the procedure was started? Why is it important to fully inform and consent a patient before undertaking any procedure? What is the role of the cardiac technician? What did the angiogram show? What is the next step in the patient’s management? Activity 5: Bronchoscopy Patient Initials: Date: Why the patient having this procedure? What explanation was given to the patient before the procedure was started? Was the patient given any drugs before the procedure? What information can be obtained from bronchoscopy? What did the bronchoscopy show? What is the next step in the patient’s management? Tasks Task1 – Performing an ECG* Patient Initials: Date: Signed by Staff Print Name: Why was the patient having an ECG? What explanation did you give to the patient before conducting the test? What are the surface markings for all the ECG leads? What leads represent the following territories? Inferior: Lateral: Anterior: Posterior: What did the ECG reveal? Did you leave the ECG electrodes on the patient? Why? Task2 :Electrocardiograph Reporting* ECG 1 Report: Patient Initials: Diagnosis: ECG 2 Report: Patient Initials: Diagnosis: ECG 3 Report: Patient Initials: Diagnosis: ECG 4 Report: Patient Initials: Diagnosis: Task3 – Managing an ECG monitor* Patient Initials: Date: Signed by Staff: Print Name: Why did the patient require continuous ECG monitoring? Was it fixed or telemetry? What differences were there between the application of the electrodes for the monitor compared to a 12-lead ECG? For how long was the patient expected to be monitored? List other indications for ECG monitoring What questions did the patient have regarding the monitoring and how were these answered? What did you learn from this task? Task4 – Asking a patient to do Peak Flow* Patient Initials: Date: Signed by Staff: Print Name: Why did the patient require a PEFR (peak flow)? What explanation did you give to the patient before conducting the test? What might cause the result of the test to be inaccurate? What is the PEFR – draw a graph to help explain this physiological function? What did the PEFR reveal? Task5 – Spirometry* Patient Initials: Date: Signed by Staff: Print Name: You may wish to link this to the Activity on Pulmonary Function Tests or alternatively this task can be completed on another patient. Why did the patient require this investigation? What explanation did you give to the patient before conducting the test? What parameters were collated? Copy the results below and give your interpretation Spirometry can be part of a more detailed assessment. What are the other paramenters collated? Task6 – Administration of a Nebuliser* Patient Initials: Date: Signed by Staff: Print Name: What was the indication for the nebuliser and what drug(s) What explanation did you give to the patient before administering the drug? What was the expected duration of the nebulised treatment? Why do some patients require oxygen-driven nebulised drugs? List 4 drugs that can be given via a nebuliser and the indication. What did you learn from this task? Task7- Chest X-Ray Reporting* Please make a report of 4 CXRs for your reflection CXR 1 Report: Patient Initials: Diagnosis: CXR 2 Report: Patient Initials: Diagnosis: CXR 3 Report: Patient Initials: Diagnosis: CXR 4 Report: Patient Initials: Diagnosis:
