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Phase 1 Exam > Clinical Seminars > Flashcards

Clinical Seminars Flashcards

1
Q

What is multi morbidity?

A
  • 2 or more conditions.
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2
Q

What are the issues in elderly care?

A
  • Mental health, polypharmacy, increased hospital utilisation, fragility, high treatment burden, poor quality of life.
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3
Q

What is the phenotype model?

A
  • A group of conditions including reduce gait speed and unintentional weight loss.
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4
Q

What is cumulative deficit model?

A
  • An accumulation of deficits that occur due to older age and lead to an increase in fragility index. Leading to increase risk of outcomes.
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5
Q

What is polypharmacy?

A
  • Concordent use of multiple items by one individual.
  • Usually medications but can be dressings, appliances or sometimes blood testing equipment.
  • More common in the elderly and those with multiple chronic conditions.
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6
Q

What is appropriate polypharmacy?

A
  • Where all the drugs prescribed are to reach a therapeutic effect.
  • The drugs have reached this or will reach it in the near future.
  • Optimised for minimal ADRS.
  • Patient motivated and can take all the medication.
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7
Q

What is inappropriate polypharmacy?

A
  • Where one or more of the drugs is no longer needed because there is no evidence based indication for it, it isn’t reaching therapeutic effects or their is unacceptable ADRS.
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8
Q

What types of polypharmacy are there?

A
  • Minor ( 2- 4), major (>5) or hyper (>10).
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9
Q

What does compliance mean?

A
  • Actions, transactions and processes are completed and promises are kept.
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10
Q

What does adherence mean?

A
  • Shared decision making between individuals in regards to treatment decision.
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11
Q

What does concordance mean?

A
  • Agreement between HCP and patient in regards to the patients belief in medication taking behaviours.
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12
Q

What does persistence mean?

A
  • Taking full course of meals to make therapeutic.
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13
Q

What is ambulatory BP monitoring?

A
  • Measures the BP of a patient every 30 mins, day and night for 24 hours.
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14
Q

What is home BP monitoring?

A
  • Taken morning and evening for 7 days.

- Used for patients that can’t tolerate ABPM such as those with disabilities, the elderly, obese patients etc.

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15
Q

What is the pathophysiology of diastolic heart failure?

A
  • Low cardiac output due to ventricular hypertrophy meaning the left ventricle can’t be filled adequately leading to reduced stroke volume but normal ejection fraction.
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16
Q

What is the pathophysiology of left ventricular heart failure?

A
  • The left ventricle can’t pump blood adequately from the left ventricle into the ascending aorta and therefore leads to a backlog of blood into left atrium, the pulmonary vessels and the lungs.
  • Leads to blood pooling in the vessels causing engorgement and fluid to build up in the vessels leading to pulmonary oedema.
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17
Q

What is the pathophysiology of right ventricular heart failure?

A
  • Caused by left ventricular heart failure
  • Increased jugular venous pressure
  • Peripheral oedema
18
Q

What does BNP indicate?

A
  • Myocardial stretch that is beyond the normal range.
19
Q

What symptoms are due to overload and congestion?

A
  • Weight gain, ascites, oedema, dyspnoea.
  • Due to salt and water due to less efficient pumping.
  • Symptoms lead to fluid accumulation.
20
Q

What symptoms are due to reduced cardiac output?

A
  • Later stage when heart muscles becomes super weak.

- Leads to muscle weakness, fatigue, muscle weakness

21
Q

What symptoms are due to cardiac arrhythmias?

A
  • Palpitations, lightheadness and syncope

- Due to AF

22
Q

What is the categories of cough?

A
  • Acute < 3 weeks
  • Chronic > 8 weeks
  • Subacute 3 - 8 weeks
23
Q

What are common causes of chronic cough?

A
  • COPD, asthma, upper airway cough syndrome, asthma and ACE inhibitors.
24
Q

What is the assessment of cough?

A
  • Onset, duration, severity, course, intermittent or continuous, precipitating or relieving factors.
25
Q

What is the emergency admission for cough?

A
  • Resps less than 30 per minute
  • Tachycardic - BPM more 130
  • BP less than 90/60
  • Oxygen sats less than 92%
  • Altered level of consciousness
  • Use of accessory muscles for resp
26
Q

What are red flags for cough?

A
  • Excessive sputum, systemic symptoms, haemoptysis, significant associated dyspnoea, chest pain, immunosuppression, abnormal chest or lung exam, elderly, risk of aspiration.
27
Q

What is smoking cessation?

A
  • Process of stopping/ discontinuing tobacco smoking.
28
Q

What is nicotine replacement therapy?

A
  • Preparations include gum, inhalers, nasal spray, oral spray, lozengers, sublinguial tablet or transdermal patch
  • Should be prescribed by brand
  • Duration of 8 to 12 weeks, with gradual reduction at the end
  • Can be used in under 18’s but up to a maximum of 12 weeks.
  • Contraindicated in patients with GI conditions, diabetics, moderate to severe hepatic dysfunction and uncontrolled hypothyroidism
  • Side effects include headache, dizziness, nausea, vomiting, rash and uticaria.
29
Q

What is Bupropion?

A
  • Relatively weak
  • A selective noradrenaline and dopamine reuptake inhibitor
  • Should be commenced 1 to 2 weeks before smoking is stopped.
  • Can’t be used in under 18s or those with certain neurological conditions and medications.
30
Q

What is Vereniciline?

A
  • Partial nicotine receptor agonists

- Works by relieving symptoms of cravings and withdrawal

31
Q

What is pulmonary rehab?

A
  • Physical activity programme designed for patients specific to their condition and gives them advice in terms of lung health and general health/wellbeing.
  • Decreases symptoms, increased quality of life and increases emotional and physical participation.
  • Used in those with severe breathlessness.
32
Q

What is renal colic?

A
  • Acute and severe loin to groin pain.
  • Peak incidence is between 40 to 60 for men and late 20’s for women.
  • Investigations: mid stream urine, plain abdo XR, CT scan, detailed history.
  • Management: Strong analgesics through IV, lithroscopy, urotheroscopy and open surgery.
33
Q

What diseases can lead to symptoms with the prostate?

A
  • The prostate produces prosthatic fluid and proteolytic enzymes which breaks down clotting factors in ejaculate.
  • Benign prostate hypertrophy - most common due to increase in cells themselves rather than cell size and occurs in the transitional zone. In a carcinoma, it occurs in the peripheral zone.
  • The narrowing of the urethra leads to weak flow, increased in frequency, difficulty empyting or starting to urinate.
34
Q

What is the Gleason score?

A
  • Used to grade and access the stage of prostate cancers.
  • 10 to 12 cores are taken from the prostate and the most two similar analysis are taken and used to grade from low to high.
  • Less than 6 = low, 7 = intermideate and between 8 and 10 is high.
  • Helps to determine treatment of the patient.
35
Q

What are the red flags for prostate cancer?

A
  • Males presenting with haematuria, erectile dysfunction or LUTs should be considered for DRE or PSA.
  • If PSA is high or DRE abnormal then refer
36
Q

What are the red flags for bladder cancer?

A
  • If patients over the age of 45 present with visible haematuria without UTI or once UTI has resolved.
  • Patients over 60 with non visible haematuria with dysuria or high WBC count.
  • Patients over 60 with recurrent or persistant UTIs
37
Q

What are red flags for renal cancer?

A
  • Patients over the age of 45 with visible haematuria without UTI or once UTI has resolved
38
Q

What is haematuria?

A
  • Visible = appearance of blood in the urine - can be dark/red or frank blood.
  • Non visible = microscopic - RBC count more than or equal to 3.
39
Q

Investigations of haematuria?

A
  • Urine dipstick

- Microscopic evaulation

40
Q

What to do with patients who have recurrent UTI’s?

A
  • Rule out red flags
  • Antibiotic prophylaxis
  • Good hygiene
  • Vaginal oestrogen creams in post menopausal females.

Phase 1 Exam (25 decks)

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