Community and Palliative Flashcards
Chronic fatigue syndrome diagnosis and management
At least 4 months of disabling fatigue affecting physical and mental function at least 50% of the time in absence of any other disease which may explain symptoms
CBT
Graded exercise therapy
Pacing (organising activities to avoid tiring)
Levels of non-alcoholic fatty liver disease
Steatosis - fat in liver
Steatohepatitis - fat with inflammation
Liver cirrhosis
What metabolic syndrome is related to fatty liver
Insulin-resistance
Investigations following incidental finding of fatty liver on ultrasound
Enhanced liver fibrosis blood test
ALT > AST
FIB4 or NAFLD fibrosis score + FibroScan (liver stiffness with transient elastography)
Specialist referral - liver biopsy gold standard
Management of fatty liver disease
Lifestyle changes e.g. weight loss Gastric banding Metformin Manage co-morbidities Annual review and education
Blood pressure target in T2 diabetes and what BP drug
140/80
130/80 if end-stage organ failure present
ACE-inhibitors
HbA1C target if only lifestyle management or metformin
48mmol/mol
When to add second drug to metformin
58mmol/mol
What drugs can you add to metformin in T2 diabetes
Sulfonylurea Gliptin Pioglitazone SGLT-2 inhibitor OR insulin therapy
What insulin therapy should be started in T2 diabetes
Human NPH insulin (isophane, intermediate acting) at bedtime or twice daily
When should you offer a statin to a T2 diabetic?
if QRISK-2 score is >10%
What statin should be offered in T2 diabetes?
Atorvastatin 20mg od (80mg if existing CVD)
When to use a glucagon-like peptide mimetic in T2 diabetes?
Triple therapy contraindicated or not effective
> 35 BMI and psychological or medical problems associated with obesity
<35 BMI and can’t have insulin therapy
35 year old female with chronic pain all over her body, feels lethargic, with ongoing headaches and sleep disturbances - what management approach would you take?
Explanation
Aerobic exercises
CBT
Medication (amitriptyline, duloxetine, pregabalin)
How many tender points do you need for a diagnosis of fibromyalgia to be likely?
At least 11 out of 18
Risk factors and symptoms suggesting diverticular disease
Age, lack of fibre, obesity, sedentary, smoking, NSAIDs
Change in bowel habit
Blood in stool
Abdominal pain
What complications could arise from diverticular disease?
Haemorrhage Diverticulitis Fistula Perforation and fecal peritonitis Perforation and abscess development Diverticular phelgmon
Diverticular disease investigations and management
CT cologram
Increase dietary fibre intake
ABx for diverticulitis
Diverticulitis signs and symptoms
Nausea, vomiting and fever Constipation or diarrhoea Severe abdominal pain in left lower quadrant Guarding and rigidity Frequency, urgency or dysuria PR bleeding
Causes of PR bleeding
Haemorrhoids Anal fissure Carcinoma Colorectal polyps IBD Rectal prolapse Diverticular disease (elderly)
Causes of diarrhoea in children
Acute: gastroenteritis (rotavirus) - fever and vomiting for first two days, lasts a week. Treat with rehydration
Chronic: Cow’s milk intolerance, coeliac, Toddler’s diarrhoea (with undigested food and varying consistency )
Chronic bronchitis antibiotic
Amoxicillin, tetracycline or clarithromycin
Uncomplicated community-acquired pneumonia antibiotic
Amoxicillin (doxycycline or clarithromycin if pen allergy. Add flucloxacillin if staph)
Atypical pneumonia antibiotic
Clarithromycin
Hospital-acquired pneumonia antibiotic
Within 5 days of admission: co-amoxiclav or cefuroxime
Management of eczematous lesions on scalp, nasolabial folds, auricular and peri-orbital areas
Seborrheic dermatitis
Face and body:
topical antifuncal e.g. ketoconazole
Topical steroids
Scalp:
Head and Shoulder shampoo
Treatment of cradle cap in children (erythematous rash with coarse yellow scales)
Baby shampoo and oils
Topical hydrocortisone if severe
Reflux red flags (ALARMS)
Anorexia Loss of weight Anaemia Recent onset Melena/haematemesis Swallowing problems
Reflux medication ladder
Antacid (Gaviscon)
(H2 blocker (ranitidine))
PPI (lansoprazole)
Test for H.pylori
Breath and stool test
Difference between HDLs and LDLs
HDLs take cholesterol to the liver to be expelled
LDLs deposit cholesterol in the arteries
What is a normal cholesterol
5 and under
What dose of statin is used for primary prevention?
20mg
What dose of statin is used for secondary prevention
80mg
Three uses of calcium channel blockers
- First or second line for hypertension
- Symptom control in stable angina
- Supraventricular arrhythmias - controls heart rate (supraventricular tachy, AF, atrial flutter)
Main side effects of amlodipine and nifedipine
Ankle swelling, flushes, headache, palpitations due to vasodilation and tachycardia
How should GTN be taken in angina?
If prophylactic, spray sublingually prior to starting an activity
Sit and rest for 5 mins
If pain is still there then spray another
Wait 5 mins
If pain still there, call 999
What side effects should be expected from GTN spray use
Headaches, flushing, light-headedness and hypotension
Sustained use can lead to tolerance
ABCD2 score in strokes
Age >60 (1) Blood pressure >140/90 (1) Clinical features: unilateral weakness (2); speech impairment without weakness (1) Duration >60 (2), 10-59 (1) Diabetes (1)
Asymptomatic T2 diabetes investigation
Two HbA1c on different days (only one if symptomatic) - if >48mmol/L
When can you test for gestational diabetes and what do you do?
24 - 28 weeks
Fast overnight, blood test in morning
Given glucose drink
Blood test 2 hours later
What is the cut off for 2 hour plasma glucose for gestational diabetes?
5.6mmol/L (7.6 if fasting glucose)
Management for gestational diabetes?
Lifestyle
Insulin
HbA1c for pre-diabetes
41-47
Fasting blood glucose for pre-diabetes
5.5-6.9
2 hour blood glucose for pre-diabetes
7.8-11.1
What do you monitor before putting on metformin?
Kidney function
Who should you not investigate diabetes with HbA1c?
Children
Pregnant women
People on corticosteroids
Symptoms of less than 2 months
Diagnosis of diabetes with fasting and 2 hour
Fasting - 7
2 hour - 11
What are purpura?
Small, raised areas of bleeding under the skin
Henloch-Schonlein purpura presentation
Areas of palpable purpura over extensor surfaces of arms and legs and buttocks
Polyarthralgia
IgA nephropathy e.g. haematuria and renal failure
Abdominal pain
HSP management
Analgesia for arthralgia
Supportive treatment of nephropathy (steroids and immunosuppressants)
Self-limiting
