Clinical Seminars Flashcards
What is multi morbidity?
- 2 or more conditions.
What are the issues in elderly care?
- Mental health, polypharmacy, increased hospital utilisation, fragility, high treatment burden, poor quality of life.
What is the phenotype model?
- A group of conditions including reduce gait speed and unintentional weight loss.
What is cumulative deficit model?
- An accumulation of deficits that occur due to older age and lead to an increase in fragility index. Leading to increase risk of outcomes.
What is polypharmacy?
- 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.
What is appropriate polypharmacy?
- 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.
What is inappropriate polypharmacy?
- 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.
What types of polypharmacy are there?
- Minor ( 2- 4), major (>5) or hyper (>10).
What does compliance mean?
- Actions, transactions and processes are completed and promises are kept.
What does adherence mean?
- Shared decision making between individuals in regards to treatment decision.
What does concordance mean?
- Agreement between HCP and patient in regards to the patients belief in medication taking behaviours.
What does persistence mean?
- Taking full course of meals to make therapeutic.
What is ambulatory BP monitoring?
- Measures the BP of a patient every 30 mins, day and night for 24 hours.
What is home BP monitoring?
- 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.
What is the pathophysiology of diastolic heart failure?
- 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.
What is the pathophysiology of left ventricular heart failure?
- 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.
What is the pathophysiology of right ventricular heart failure?
- Caused by left ventricular heart failure
- Increased jugular venous pressure
- Peripheral oedema
What does BNP indicate?
- Myocardial stretch that is beyond the normal range.
What symptoms are due to overload and congestion?
- Weight gain, ascites, oedema, dyspnoea.
- Due to salt and water due to less efficient pumping.
- Symptoms lead to fluid accumulation.
What symptoms are due to reduced cardiac output?
- Later stage when heart muscles becomes super weak.
- Leads to muscle weakness, fatigue, muscle weakness
What symptoms are due to cardiac arrhythmias?
- Palpitations, lightheadness and syncope
- Due to AF
What is the categories of cough?
- Acute < 3 weeks
- Chronic > 8 weeks
- Subacute 3 - 8 weeks
What are common causes of chronic cough?
- COPD, asthma, upper airway cough syndrome, asthma and ACE inhibitors.
What is the assessment of cough?
- Onset, duration, severity, course, intermittent or continuous, precipitating or relieving factors.
What is the emergency admission for cough?
- 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
What are red flags for cough?
- Excessive sputum, systemic symptoms, haemoptysis, significant associated dyspnoea, chest pain, immunosuppression, abnormal chest or lung exam, elderly, risk of aspiration.
What is smoking cessation?
- Process of stopping/ discontinuing tobacco smoking.
What is nicotine replacement therapy?
- 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.
What is Bupropion?
- 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.
What is Vereniciline?
- Partial nicotine receptor agonists
- Works by relieving symptoms of cravings and withdrawal
What is pulmonary rehab?
- 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.
What is renal colic?
- 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.
What diseases can lead to symptoms with the prostate?
- 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.
What is the Gleason score?
- 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.
What are the red flags for prostate cancer?
- Males presenting with haematuria, erectile dysfunction or LUTs should be considered for DRE or PSA.
- If PSA is high or DRE abnormal then refer
What are the red flags for bladder cancer?
- 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
What are red flags for renal cancer?
- Patients over the age of 45 with visible haematuria without UTI or once UTI has resolved
What is haematuria?
- 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.
Investigations of haematuria?
- Urine dipstick
- Microscopic evaulation
What to do with patients who have recurrent UTI’s?
- Rule out red flags
- Antibiotic prophylaxis
- Good hygiene
- Vaginal oestrogen creams in post menopausal females.
