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Community and public health > Community health > Flashcards

Community health Flashcards

1
Q

What is the primary cause of polycythaemia?

A

Polycythaemia vera - JAK2 gene mutation

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2
Q

What are the secondary causes of polycythaemia?

A

Obstructive sleep apnoea
COPD
Chronic heart disease
EPO/anabolic steroids

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3
Q

What can cause apparent polycythaemia?

A

Diuretics
Alcohol
Obesity

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4
Q

What is polycythaemia?

A

High concentration of red blood cells
Makes blood thicker and less able to travel through blood vessels

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5
Q

What are the causes of macrocytosis?

A

B12 folate deficiency
Alcohol
Drugs
Haematological disorders
Liver disorder
Smoking
Pregancy

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6
Q

What drugs may cause macrocytosis?

A

Methotrexate
Azathioprine

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7
Q

What haematological disorders may cause macrocytosis?

A

Myelodysplastic syndrome
Aplastic anaemia
Myeloma

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8
Q

What are the potential causes of hypocalcaemia?

A

Decreased PTH
Low Vit D
CKD
Liver disease
Sclerotic (blastic) bone metastases

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9
Q

What are the potential causes of raised GGT?

A

Alcohol
Obesity
Pancreatic disease
MI
Renal failure
Diabetes

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10
Q

Which 2 liver enzymes may demonstrate cholesystitis?

A

ALP and GGT

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11
Q

What are the potential causes of raised ALT?

A

Statins
NSAIDs
Hep B&C
Coeliac disease
Alcohol
Fatty liver disease
Haemochromotosis
Alpha-1 antitrypsin deficiency

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12
Q

What are the causes of low phosphate?

A

GI - reduced absorption/intake (anorexia)
Alcoholism
DKA
Hyperparathyroidism
Renal disease - increased excretion

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13
Q

What are bisphosphonates?

A

Analogues of pyrophosphate
Potent inhibitors of osteoclast medicated bone resorption

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14
Q

What are bisphosphonates used for?

A

Paget’s disease
Hypercalcaemia
Osteolytic bone disease of malignancy
Primary and secondary hyperparathyroidism
Osteoporosis

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15
Q

What must you look out for in someone on bisphosphonates?

A

Osteonecrosis of the jaw

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16
Q

What BP range is a stage 1 hypertension?

A

130-139 systolic
80-89 diastolic

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17
Q

What BP range is a stage 2 hypertension?

A

140 of higher systolic
90 or higher diastolic

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18
Q

What BP range is a stage 3 hypertension?

A

Higher than 180 systolic
Higher than 110 diastolic

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19
Q

Name 5 risk factors of hypertension

A

Heart disease/angina
MI
Strokes
HF
PAD
Aortic aneurysms
Kidney disease
Vascular dementia
Aortic valve disease
Vision loss/choroidopathy
Sexual dysfunction
Brain aneurysms
Arrhythmias
Arterial thrombosis

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20
Q

How does hypertension damage blood vessels?

A

Increased shearing pressure due to increased BP
Therefore damage to arterial walls, then plaque formation and athlerosclerosis

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21
Q

What is choroidopathy?

A

Build up of fluid in eye due to burst blood vessels

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22
Q

Name 3 methods of lifestyle management for hypertension

A

Weight loss
Making sure weight not carried around abdomen
Regular exercise
Healthy diet - lots of fruit and veg
Reduce salt intake
Reduce alcohol consumption
Quit smoking

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23
Q

What examination may you do in an initial consultation for someone newly diagnosed with hypertension?

A

BP
Fundoscopy
Auscultate heart

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24
Q

What further investigations may you do for someone newly diagnosed with hypertension?

A

Urine albumin:creatinine
HbA1c
Electrolytes
Fundoscopy
ECG
Ambulatory blood pressure (if not already done for diagnosis)
Further tests to identify secondary cause of hypertension if signs

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25
Q

Which 3 further investigations are the most important for someone with a new diagnosis of hypertension?

A

Urine albumin:creatinine
Fundoscopy
ECG

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26
Q

Why do you need further tests for someone recently diagnosed with hypertension?

A

Checking for signs of end organ damage

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27
Q

Name 3 secondary causes of hypertension

A

Renal disease
Conn’s disease
Phaeochromocyotoma
Cushing’s disease
Acromegaly
Hyperthyroidism
Alcohol
Corticosteroids
NSAIDs

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28
Q

Name 2 renal causes of hypertension

A

Chronic pyelonephritis
Diabetic nephropathy
Glomerulonephritis
PKD
Obstructive uropathy
Renal cell carcinoma

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29
Q

Name 3 types of antihypertensives available

A

ACEi
ARBs
Diuretics
CCBs
Beta-blockers
Alpha-blockers

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30
Q

Name an ACEi

A

Ramipril

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31
Q

Name 3 S/E of an ACEi

A

Bradykinin cough
Hyperkalaemia (ramipril)
Angioedema

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32
Q

What is a benefit of ACEis?

A

Protective for kidneys

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33
Q

What should you look out for with kidneys in using ACEis?

A

Some may get damage if atherosclerosis in renal arteries so do U&E 2 weeks after starting

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34
Q

Name 2 S/E of ARBs

A

Dizziness
Headaches
Fatigue

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35
Q

Name an ARB

A

Candesartan

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36
Q

Name a loop diuretic

A

Furosemide

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37
Q

Name 3 S/E of loop diuretics

A

Hyperuricaemia
Hypomagnesaemia
Hypocalcaemia
Hypokalaemia
Alkalosis
Urinating a lot

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38
Q

Name a thiazide like diuretic

A

Indapamide

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39
Q

Name 3 S/E of thiazide like diuretics

A

Hypokalaemia
Alkalosis
Hypercalcaemia
Hyperuricaemia
Hyperglycaemia
Hyperlipidaemia

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40
Q

Name a potassium sparing diuretic

A

Spironolocatone

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41
Q

Name 2 S/E of spironolactone

A

Hyperkalaemia
Gynaecomastia

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42
Q

Name a CCB

A

Amlodipine

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43
Q

What are the S/E of CCBs?

A

FIGHTED
Fatigue/flushing
Increase in glucose levels and uric acid
GI upset (nausea/constipation), gingival hyperplasia
Headache
Tachycardia, palpitation, angina
Edema (pedal, peripheral, facial) - dose dependent
Dizziness

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44
Q

Name a beta-blocker

A

Bisoprolol

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45
Q

Why may bisoprolol be preferable in the treatment of hypertension?

A

Cardio selective - less likely to get some of the S/E

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46
Q

What are the S/E of beta-blockers?

A

BALD FISH
Bronchoconstriction/bradycardia
Arrythmias
Lethargy
Disturbance in glucose metabolism
Fatigue
Insomnia
Sexual dysfunction
Hypotension

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47
Q

Name an alpha blocker

A

Doxazocin

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48
Q

What are the S/E of alpha blockers?

A

Postural hypotension
Nausea
Drowsiness/fatigue
Swollen ankles/legs

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49
Q

What tests might you do for someone with erectile dysfunction?

A

History - psychological?
External genitalia exam
PSA and prostate
Bloods - testosterone, LH if low testosterone, diabetes, cholesterol, FBC

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50
Q

What combination of 4 drugs is classically given to patients post-MI?

A

ACEi
Amlodipine/beta-blocker
Aspirin
Statin

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51
Q

Name 5 risk factors for heart failure

A

Coronary heart disease
MI
Hypertension
Valvular heart disease
Infection
Myocarditis
Heavy alcohol usage
Illegal drug usage
Chemotherapy
Congential heart defects
Arrythmias
Hyperthyroidism
Phaeochromocytoma
NSAIDs
Sleep opnoea
Smoking
Obesity
Family history - cardiomyopathies, hyperlipidaemia
Chronic lung disease
Pregnancy
Anaemia
Sarcoidosis

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52
Q

What are the different types of heart failure?

A

Left sided heart failure
- Reduced EF
- Preserved EF
RHF
Congestive HF

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53
Q

What is the difference between reduced EF and preserved EF left sided HF?

A

Reduced - ventricle not contracting properly
Preserved - ventricle not relaxing properly

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54
Q

What is BNP?

A

Made by heart and tends to be raised in HF
Used to diagnose/rule out HF

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55
Q

What is a normal BNP?

A

< 400

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56
Q

What is eGFR?

A

Estimated glomerular filtration rate

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57
Q

What is a healthy eGFR?

A

90ml/min

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58
Q

What does an eGFR of 60-90 mean?

A

G2

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59
Q

What does an eGFR of 45-59 mean?

A

Ga3

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60
Q

What does an eGFR of 30-44 mean?

A

G3b

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61
Q

What does an eGFR of 15-29 mean?

A

G4

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62
Q

What does an eGFR of <15 mean?

A

G5

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63
Q

What is the prognosis of heart failure?

A

50% die within 5 years

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64
Q

How does a loop diuretic work in heart failure?

A

Inhibits Na-K-Cl cotransporter in the thick ascending limp of loop of henle
Helps kidneys remove excess water and salt so that your heart has less fluid to pump around the body

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65
Q

What is a loop diuretic used for in heart failure?

A

Symptomatic relief

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66
Q

Which is the only medication used in preserved EF HF?

A

Loop diuretic

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67
Q

What is the second line diuretic for HF?

A

Spironalactone

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68
Q

What are the S/E of loop diuretics?

A

Needing to wee more often
Electrolyte imbalances

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69
Q

How does an ACEi work?

A

Prevents the formation of angiotensin II
Angiotensin II causes narrowing of blood vessels therefore raising BP and resistance within arteries

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70
Q

How does an ACEi help in HF?

A

Reduces pressure so heart doesn’t have to work as hard

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71
Q

How do beta-blockers help in HF?

A

Slows down HR to prevent heart from overworking
Prevents heart responding to stress hormones therefore preventing the heart from overworking

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72
Q

What monitoring do you need to do for someone with HF?

A

Annual ECG
BP - BB
HR - BB
U&Es - diuretics

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73
Q

What might you see on a chest x-ray in someone with HF?

A

Alveolar oedema (bat wings when acute)
Kerley B lines - interstitial oedema
Cardiomegaly - >50% oedema
Dilated upper lobe vessels - pulmonary venous hypertension
Pleural effusion

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74
Q

What bloods should you do for someone with suspected HF?

A

FBC
U&E
TFT
LFT
Lipid profile
HbA1c
NT-proBNP

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75
Q

What is the gold standard investigation for HF diagnosis?

A

ECHO

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76
Q

What LVEF suggests HF?

A

< 50%

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77
Q

What are the symptoms of measles?

A

CCCK
- Cough
- Coryza
- Conjunctivitis
- Koplik spots

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78
Q

What does the fever pain score assess and ?

A

The likelihood of an infection being caused by strep and when to prescribe antibiotics

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79
Q

What answers on the fever pain score would suggest strep?

A

Fever in past 24 hours - yes
Absence of cough or coryza - yes
Symptoms of onset

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80
Q

When is strep less likely?

A

As you get older. Much more common in children

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81
Q

What is the centor score?

A

Likelihood of a fever being strep

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82
Q

What answers would suggest that an infection is strep on the centor score?

A

Exudate or swelling on tonsils - yes
Tender/swollen anterior cervical lymph nodes - yes
Temp > 38 - yes
Cough - no

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83
Q

What is the NICE traffic light guidance?

A

Guidance that you can use to assess how serious an infection is

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84
Q

What is assessed in the NICE traffic light guidance?

A

Colour, activity, respiratory, hydration and circulation, other

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85
Q

What colour would a child be if they were green on the NICE traffic light guidance?

A

Normal colour of skin, lips and tongue

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86
Q

What would the activity of a child be like if they were green NICE traffic light guidance?

A

Responding normally to social cues, content, smiling, stays awake or awakens quickly, strong normal cry/not crying

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87
Q

What respiratory symptoms would a child have if they were green on the NICE traffic light guidance?

A

None

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88
Q

What hydration and circulation symptoms would a child have if they were green on the NICE traffic light guidance?

A

Normal skin turgor and eye, moist mucus membranes

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89
Q

What is also important to note in order for a child to be green on the NICE traffic light guidance?

A

None of amber or red S&S

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90
Q

What colour might a child be if they are amber on the NICE traffic light guidance?

A

Pallor of skin, lips, or tongue reported by parent or carer

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91
Q

What activity might a child be showing if they are amber on the NICE traffic light guidance?

A

Not responding normally to social cues, waking only with prolonged stimulation, decreased activity, not smiling

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92
Q

What respiratory symptoms would a child have if they are amber on the NICE traffic light guidance?

A

Nasal flaring
Tachypnoea
6-12m RR > 50
>12m RR > 40
O2 < 95% in air
Crackles on chest auscultation

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93
Q

What hydration and circulation symptoms might a child have if they are amber on the NICE traffic light guidance?

A

Poor feeding
Dry mucous membranes
CRT > 3s
Reduced urine output
Tachycardia
< 1 yr > 160
1-2 yrs > 150
2-5 yrs > 140

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94
Q

What other symptoms may be present if a child is amber on the NICE traffic light guidance?

A

Fever for 5 days or more
Rigors
Temp > 39 if 3-6m
Swelling of limb/joint
Non-weight bearing/not using a limb

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95
Q

What colour may a child be if they are red on the NICE traffic light guidance?

A

Pale, mottled, ashen, blue skin, lips, or tongue

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96
Q

What activity level may a child be at if they are red on the NICE traffic light guidance?

A

No response to social cues
Appears ill to a healthcare professional
Unable to rouse, of if roused doesn’t stay awake
Weak, high-pitched or continuous crying

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97
Q

What respiratory symptoms may a child have if they are red on the NICE traffic light guidance?

A

Grunting
Tachypnoea RR > 60
Moderate/severe chest indrawing

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98
Q

What hydration and circulation symptoms may a child have if they are red on the NICE traffic light guidance?

A

Reduced skin turgor

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99
Q

What other symptoms may children have if they are red on the NICE traffic light guidance?

A

Temperature > 38 in 0-3m
Non-blanching rash
Bulging fontanelle
Focal neurological signs
Focal seizures
Status epilepticus

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100
Q

What safety netting may you give a parent of a child that presents with a fever?

A

Breathless, drowsy, stop drinking, don’t pass urine for more than 6 hours, fever for more than 5 days, or if worried about anything or think they’re worse - bring them back or A&E

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101
Q

How many stages are there to delivery vaccines in babies under 1?

A

3

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102
Q

When do babies under the age of 1 get vaccines?

A

8 weeks
12 weeks
16 weeks

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103
Q

What vaccines do babies get at 8 week?

A

6-in-1 vaccine
Rotavirus
MenB

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104
Q

What vaccines do babies get at 12 weeks?

A

6-in-1 vaccine (2nd)
Pneumococcal
Rotavirus (2nd)

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105
Q

What vaccines do babies get at 16 weeks?

A

6-in1 vaccine (3rd)
MenB (2nd)

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106
Q

How many times are primary children given vaccines?

A

2 times

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107
Q

When are primary school children vaccinated?

A

1 year
3 years 4 months

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108
Q

What vaccines are 1 year olds given?

A

HiB (4th)/MenC (1st)
MMR (1st)
Pneumococcal (2nd)
MenB (3rd)

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109
Q

What vaccines are 3 year olds given?

A

MMR (2nd)
4-in-1 pre-school booster

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110
Q

How many times are teenagers vaccinated?

A

Twice

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111
Q

When are teenagers vaccinated?

A

12/13
14

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112
Q

What vaccines do 12/13 year olds get?

A

HPV

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113
Q

What vaccines do 14 year olds get?

A

3-in-1 teenage booster
MenACWY

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114
Q

What is given in the 6-in-1 vaccine?

A

DPT - diptheria, tetanus, polio
HepB
HiB
Whooping cough

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115
Q

What is in the 4-in-1 vaccine?

A

DTP
Whooping cough
(lose the two H’s)

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116
Q

What is in the 3-in-1 vaccine?

A

DTP

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117
Q

What are the risk factors for developing dementia?

A

Hypertension
Smoking
Diabetes
Obesity
Sedentary life
Poor diet
Lots of alcohol
Low levels of cognitive engagement
Depression
Traumatic brain injury
Hearing loss
Social isolation
Air pollution
Increasing age
Female
Down’s syndrome and other learning disabilities
Hypothyroidism

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118
Q

Which dementia is more common in down’s syndrome?

A

Alzheimers - higher levels of Tau in Downs

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119
Q

How can the presentation of dementia differ in those with learning disabilities?

A

Earlier onset
Reduced interest in being sociable
Decreased enthusiasm for usual activities
Decline in ability to pay attention
Sadness, fearful, anxiety
Irritability, uncooperative, aggression
Restlessness, sleep disturbances
Sleeping a lot

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120
Q

How can you diagnose dementia?

A

Needs referral to memory clinic
Demonstrate decline in baseline cognition, functioning, and changes in personality across 3 longitudinal assessments
Confusion screen

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121
Q

How can you diagnose dementia in individuals with learning disabilities?

A

Screen for dementia from 30 - annual review
Comprehensive baseline assessment at 30 - memory, executive functions, praxis, visual spatial skills, language (written and verbal), attention, processing speed
Special psychiatrist referral
DSQIID - Dementia Screening Questionnaire for Individuals with Intellectual Disability

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122
Q

What does a confusion screen entail?

A

Bloods
ECG
Urinalysis
CT head
CXR
Sputum culture?

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123
Q

What bloods are done in a confusion screen? What causes of confusion are they looking for?

A

FBC - infection, anaemia, malignancy
U&E - hyponatraemia, hypernatraemia
LFTs - liver failure, secondary encephalopathy
Coagulation/INR
TFTs - hypothyroidism
Calcium - hypercalcaemia
B12 + folate/haematinics - B12/folate deficiency
Glucose - hypo/hyperglycaemia
Blood cultures

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124
Q

What can B12 deficiency cause?

A

Subacute combined degeneration of spinal cord

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125
Q

Why do you do a confusion screen?

A

To ensure no reversible cause of dementia

126
Q

What other confusion tests are there?

A

4AT - alertness, cognition, attention, acute change/fluctuating course
10-point cognitive screener
6-item cognitive impairment test
Memory impairment screen
Mini-cog

127
Q

What are the 5 main points of the mental capacity act?

A
  1. Presumption of capacity
  2. Support individuals to make their own decisions
  3. Unwise decision do not mean lacking in capacity
  4. Best interests
  5. Less restrictive option - must consider whether possible to act in a way that would interfere least with person’s rights/freedoms
128
Q

What questions do you need to answer when assessing capacity?

A
  1. Does the person have an impairment of their mind or brain, whether because of an illness, or external factors such as alcohol or drug use?
  2. Does the impairment mean a person is unable to make a specific decision when they need to?
  3. Can they understand the information relevant to the decision?
  4. Can they retain that information?
  5. Can they use or weigh up that information as part of the process in making that decision?
  6. Can they communicate that decision back to you?
129
Q

What is normal pressure hydrocephalus?

A

Blockage to outflow of CSF with no raised ICP

130
Q

What can cause normal pressure hydrocephalus?

A

SAH
Head trauma
Infection
Tumour
Surgical complications

131
Q

What is hydrocephalus?

A

Raised intracranial pressure due to increased fluid in the brain

132
Q

What can cause hydrocephalus?

A

Genetics
Strokes
Meningitis
Tumours
Head injury

133
Q

What is multimorbidity?

A

People with multiple health conditions
Often long-term and complex conditions requiring ongoing care

134
Q

What can affect multimorbidity?

A

Increases with age and poorer socioeconomic status
Individual lifestyle factors and combined effect of lifestyle factors associated with likelihood of simultaneous presence of three or more chronic conditions in the same subject

135
Q

What is polypharmacy?

A

Concurrent use of multiple medications in an individual

136
Q

What is appropriate polypharmacy?

A

Prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and where the medicines are prescribed according to the best evidence

137
Q

What is problematic polypharmacy?

A

Prescribing of multiple medications inappropriately or where intended benefit of the medication is not realised

138
Q

Name 5 anti-cholinergic side effects

A

Can’t see, can’t pee, can’t climb a tree
Eyes - blurred vision, dry eyes
Brain - drowsiness, dizziness, confusion, hallucinations
Heart - rapid heart rate
Bladder - urine retention (unable to empty your bladder)
Skin - skin-flushing, unable to sweat, overheating
Bowel - constipation
Mouth - dry mouth

139
Q

What can anti-cholinergics be used to treat?

A

Asthma
Cardiovascular disease
COPD
Mydriasis
Parkinson’s disease
Urge incontinence

140
Q

What are the risks of stopping statins?

A

Associated with 33% increased risk of admission for a cardiovascular event in 75-year-old primary prevention of patients
Lower relative risk of cardiovascular event following discontinuation of statins in a diabetic patient

141
Q

In whom are hypoglycaemic events be more common in?

A

Incidence of serious hypoglycaemia higher in insulin users
Recent hospital discharge was strongest predictor of subsequent hypoglycaemia in older persons with diabetes

142
Q

What can increase risk of orthostatic hypotension including specific medications?

A

Age (10% over 85s)
Number of medications
Hydrochlorothiazide (65%)
Lisinopril (60%)
Furosemide (56%)
Trazodone (58%) - antidepressant
Terazosin (54%) - alpha blocker

143
Q

What are the effects of multimorbidity?

A

Higher risk of safety issues
Poor medication adherence and adverse drug events - polypharmacy
Complex management
More frequent and complex interactions with health care services
Greater susceptibility to failure of care delivery and coordination
Need for clear communication and patient-centred care due to complex needs
Demanding self-management and competing priorities
Vulnerability to safety issues
Possible diagnostic overshadowing

144
Q

What are the effects of appropriate polypharmacy?

A

Potential to improve QOL, longevity and minimise harm from medications

145
Q

What are the effects of problematic polypharmacy?

A

Hazardous interactions
Pill burden unacceptable to patient
Demands make difficult to achieve clinically useful medication adherence
Medicines prescribed to treat S/E of other medicines where alternative solutions are available to reduce number of medications prescribed

146
Q

What does the mnemonic SAD PERSONS stand for and what is it used for?

A

Used for assessing suicide risk
S - sex (male)
A - age (< 19 and > 45)
D - depression
P - previous attempt/parasuicide
E - excess alcohol or substance usage
R - rational thinking loss
S - social supports lacking
O - organised plan
N - no spouse
S - sickness

147
Q

What is a disability?

A

Related to anyone with a physical, sensory, or mental impairment which seriously affects their daily activities

148
Q

What is a visual impairment?

A

Small percentage see nothing
Some differentiate between light and dark
No peripheral vision
No central vision
Patchwork of blanks and defined areas
Some can see enough to read text, although may have difficulty crossing roads

149
Q

What is macular disease?

A

Disease causing damage to the retina

150
Q

What does the macular do?

A

Central part of retina which we use for detail (reading/writing)

151
Q

How is age related macular degeneration treated?

A

No cure
Can be slowed/halted in some cases with medical treatment, drug therapy, or laser treatment
Most common eye condition in the UK

152
Q

What are retinitis pigmentosas?

A

Inherited diseases of the retina

153
Q

What happens in retitinitis pigmentosa?

A

Leads to gradual reduction in vision - night and peripheral vision affected first followed by difficulties in reading and colour vision
1 in 3000 affected in the UK

154
Q

What is glaucoma?

A

Disease affecting optic nerve
Irreversible

155
Q

What are the dangers of glaucoma?

A

In early stages no obvious symptoms
40% optic nerve can be damaged before vision loss noted

156
Q

How common is glaucoma?

A

2 in 100 over 40

157
Q

What is diabetic retinopathy?

A

Damage to blood vessels due to high glucose
If caught early can be successfully treated with laser treatment
Stops it progressing but cannot restore loss
Leading cause of blindness in adults over 65

158
Q

What is Charles Bonnet Syndrome?

A

When people live with sight loss, brain not receiving as many pictures
New fantasy pictures or old pictures stored in brains released and experienced as though seen
Generally affects people who lost sight later in life but can affect someone of any age

159
Q

How common is sight loss?

A

> 2000 children in UK
1 in 5 > 75 visually impaired
1 in 2 > 90 visually impaired
8% born with impaired vision
2% see nothing at all
Older visually impaired 3x more likely to experience depression

160
Q

What is the law around age to consent?

A

Under 16 - cannot consent to sex with someone over the age of 16
Under 13 - statutory rape even if have sex with someone of the same age
If 14/15 can have sex with someone who is no more than 2 years older than them

161
Q

What might the symptoms of gonorrhoea be?

A

Deep dispareunia
Green discharge

162
Q

What might the symptoms of chlamydia be?

A

Silent
Deep dispareunia
White discharge

163
Q

What might the symptoms of trichomonas vaginalis be?

A

Green/yellow frothy discharge
Vaginal itching and irritation

164
Q

What might the symptoms of bacterial vaginosis be?

A

White discharge
Soreness/irritation
Smelly discharge

165
Q

What questions should you ask about last sexual contact?

A

Timing
Consent
Relationship
Sex and country of origin
Types of sex - don’t forget oral!
Contraception
Other sexual partners
HIV risk factors
Paid for sex/been paid for sex

166
Q

What amount of time needs to have elapsed for a vaginal/cervical swab to be accurate?

A

2 weeks (chlamydia and gonorrhoea)

167
Q

What amount of time needs to have elapsed for a STI blood test to be accurate?

A

12 weeks (3m) (syphilis and HIV)

168
Q

What are the Fraser Guidelines?

A

Part of Gillick Competency
Young person cannot be persuaded to inform their parents/carers that they are seeking this advice/treatment
Young person understands advice being given
Young person’s physical/mental health or both is likely to suffer unless receive the advice/treatment
Young person’s best interests to receive the advice, treatment, or both without their parent/carers consent
Young person likely to continue having sex with or without contraceptive treatment

169
Q

What are the child protection concerns with children under 16 having sex and what could be signs of this?

A

Possible indicator of child exploitation/grooming
Presenting repeatedly with STIs or TOP
Partner > 18
Feeling uncomfortable with having sex
Isolated from partners family/friends
Partner in a position of power eg teacher, scout leader
Being given lots of gifts from partner as rewards for certain behaviours

170
Q

What are some of the CIs for prescribing the COCP according to the UKMEC guidelines?

A

Pregnant
> 35 and smoker/stopped smoking less than 1 year ago
BMI > 35
Hypertension
Migraine with aura
Breastfeeding up to 6 weeks
CVS and VTE risk factors
FHx or personal hx breast cancer

171
Q

What is ectropion?

A

Columnar epithelium coming out of cervical os
Normal
May cause spotting or bleeding after sex

172
Q

What are the components of chronic pain?

A

Physical
Psychological
Environmental
Sensitisation
- Allodynia
- Hyperalgesia

173
Q

What are the 3 different classifications of opioids?

A

Naturally occurring compounds
Semi-synthetic
Synthetic

174
Q

Name 2 naturally occurring opioids

A

Morphine
Codeine
Thebaine
Papaverine

175
Q

Name 2 semi-synthetic opioids

A

Diamorphine (heroin)
Dihydromorphine
Buprenorphine
Oxycodone

176
Q

Name 2 synthetic opioids

A

Pethidine
Fentanyl
Methadone
Alfentanil
Ramifentanil
Tapentadol

177
Q

What are the 3 opioid receptors and where are they?

A

MOR, KOR, DOR
Distributed throughout the CNS and to a lesser extent the periphery
Also in the vas deferens, knee joint, GI tract, heart and immune system

178
Q

How do opioids work?

A

Presynaptic inhibition of neurotransmitter release

179
Q

What are the GI S/E of opioids?

A

Constipation
N&V
Weight gain

180
Q

What are the respiratory S/E of opioids?

A

Sleep disordered breathing
Respiratory depression

181
Q

What are the CVS S/E of opioids?

A

Increased CVD risk

182
Q

What are the CNS S/E of opioids?

A

Dizziness
Sedation
Falls (fracture risk)
Respiratory depression

183
Q

What are the endocrine S/E of opioids?

A

Hypogonadism
Opiate induced androgen deficiency
Sexual dysfunction - erectile dysfunction
Infertility/reduced fertility
Fatigue
Decreased testosterone
Osteoporosis
Oligomenorrhoea
Galactorrhoea

184
Q

What are the immune S/E of opioids?

A

Pneumonia
Reduced immunity

185
Q

What do you need to look out for in long term opioid prescribing?

A

Addiction and misuse
Tolerance
Withdrawal
Hyperalgesia
Depression

186
Q

What non-pharmacological ways are there of treating pain?

A

Physical - weight loss, smoking cessation, exercise (stretching, physio, yoga, pilates), joint injections
Psychological - counselling, CBT, music, meditation, relaxation
Complementary therapy - massage, reflexology
Occupational - work place based review

187
Q

What pharmacological ways are there of treating pain?

A

Non-opioid analgesics - intermittent usage, slow/low
Adjuvant analgesics - anti-convulsant, anti-depressants, lidocaine patches

188
Q

What are the potential signs of abuse and dependency of opioids?

A

Use of pain medications for things other than treatment
Impaired control (of self or medication use)
Compulsive use of medication
Continued use of medication despite harm or lack of benefit
Craving or escalation of medication use
Selling or altering prescriptions
Stealing or diverting medications
Calls for early refills/losing prescriptions
Reluctance to try non-pharmacological interventions

189
Q

What are the key associations with opioid dependency?

A

Age - higher in younger, decreases as age increases
Marital status - highest in those cohabiting but not married
Employment - highest in those unemployed
Strong association with very bad health
Higher association between buying on the internet and dependency

190
Q

What is the definition of a total anterior stroke from the Bamford criteria?

A

All 3 of…
1. Unilateral weakness/numbness
2. Homonymous hemianopia
3. Higher function impairment eg dysphasia

191
Q

What is the definition of a partial anterior stroke from the Bamford criteria?

A

2/3 of…
1. Unilateral weakness/numbness
2. Homonymous hemianopia
3. Higher function impairment eg dysphasia

192
Q

What is the definition of a posterior circulation syndrome from the Bamford criteria?

A

One of
1. Ipsilateral CN and contralateral body deficit
2. Bilateral deficit
3. Isolated homonymous hemianopia
4. Gaze paresis
5. Cerebellar symptoms - vertigo, ataxia, nystagmus

193
Q

What is the definition of a lacunar stroke from the Bamford criteria?

A

Pure motor/sensory symptoms
Sensorimotor
Ataxic hemiparesis

194
Q

Name 3 posterior circulation syndromes

A

Weber’s
Wallenberg’s
Lateral pontine

195
Q

What is Weber’s syndrome?

A

PCA
Affects midbrain, cerebral peduncles, oculomotor nucleus
Ipsilateral oculomotor palsy + contralateral weakness

196
Q

What is lateral pontine syndrome?

A

AI cerebellar, lateral pons, pontine tracts, CN7 nucleus, cerebellum
Ipsilateral facial spinothalamic - loss + contralateral body spinothalamic loss + facial nerve palsy + vertigo/ataxia/nystagmus

197
Q

What is wallenberg’s syndrome?

A

PI cerebellar
Lateral medulla, medullary tracts, cerebellum
Ipsilateral facial spinothalamic loss + contralateral body spinothalamic loss + vertigo/ataxia/nystagmus

198
Q

What is the treatment for hypertension in haemorrhagic stroke?

A

If S>150 then labetol

199
Q

What reversal of coagulopathy can be given for warfarin?

A

Prothrombin complex concentrate + vitamin K

200
Q

What reversal of coagulopathy can be given for dabigatran?

A

Idaracizumab

201
Q

What is the secondary prevention for stroke?

A

Aspirin 300mg for 2 weeks post stroke
1st line - clopidogrel 75mg lifetime
2nd line - aspirin + dipyriamole
Statin

202
Q

What is a severe SDH?

A

> 10mm or > 5mm with midline shift/neurological dysfunction

203
Q

How is a severe SDH treated?

A

Surgery
Anti-epileptics (phenytoin/keppra)

204
Q

What is a moderate SDH?

A

< 10mm or <5mm midline shift and no neurological dysfunction

205
Q

How is a moderate SDH treated?

A

Antiepileptics
FU CT 2-3 weeks

206
Q

How is a chronic SDH treated?

A

Same as severe but elective surgery

207
Q

What is nimodipine used for?

A

Preventing vasospasm

208
Q

What are the indications for a CT within 1 hour?

A
  1. GCS < 13 at time of injury
  2. GCS < 15 2hrs post injury
  3. Depressed/open skull fracture
  4. Basal skull fracture signs
  5. Focal neurological deficit
  6. Post-traumatic seizures
  7. > 1 episode vomiting
209
Q

What are the signs of a basal skull fracture?

A
  1. Haemotympanum
  2. CSF rhinorrhoea
  3. Battle’s sign (mastoid bruising)
  4. Panda eyes
210
Q

What are the causes of bacterial meningitis?

A

Explaining Big Hot Neck Stiffness
0-1 month = E coli, group B strep
1 month-6 years = Hib, Neisseria meningitidis, Strep pneumoniae
6 years + = N meningitidis, Strep pneumoniae
60+/immunocompromised = N meningitidis, Strep pneumoniae, LISTERIA monocytogenes

211
Q

What is the treatment if there is suspected bacterial meningitis?

A

IM benpen

212
Q

What is the treatment for bacterial meningitis by age group?

A

< 3 months = IV cefotaxime + IV ampicillin/amoxicillin
> 3 months = IV ceftriaxone +/- IV dex
> 60/immunocompromised = IV ceftriaxone and IV amoxicillin +/- dex

213
Q

When should you give steroids in meningitis treatment?

A
  1. Purulent CSF
  2. Protein > 1g/L
  3. CSF WCC > 1000/mL
  4. Bacteria visible on gram stain
214
Q

What are the scores for the motor section of the GCS score?

A

6 - obeying commands
5 - localising to pain
4 - withdrawing from pain
3 - flexing
2 - extending
1 - no response

215
Q

What are the scores for the voice section of the GCS score?

A

5 - orientated
4 - confused
3 - words
2 - sounds
1 - no response

216
Q

What are the scores for the eyes section of the GCS score?

A

4 - spontaneously opening
3 - open to voice
2 - open to pain
1 - no response

217
Q

What are the symptoms of normal pressure hydrocephalus?

A

Wacky
Wobbly
Weeing

218
Q

What are the differentials of dementia?

A

Depression
NPH
Hypothyroidism
Addison’s
B12/folate/thiamine deficiency
Syphilis
Brain tumour
SDH
Chronic drug/alcohol use

219
Q

What is Alzheimer’s associated with?

A

FHx, Caucasian
Down’s syndrome
Slow, steady decline
Memory, understanding, learning

220
Q

What is Lewy body dementia associated with?

A

Old men with FHx
Hallucinations, falls, REM sleep disorder, fluctuating, parkinsonism

221
Q

What is the first line treatment for Alzheimer’s and Lewy body dementia?

A

Acetylcholine esterase inhibitors - rivastigmine, donepezil, galantamine

222
Q

What is the second line treatment for Alzheimer’s and Lewy body dementia?

A

NMDA receptor antagonist - memantine
Anti-psychotics for hallucinations

223
Q

What is vascular dementia associated with?

A

Stepwise, focal neurological deficits
Low mood, depression, slowed thinking and reasoning

224
Q

How is vascular dementia treated?

A

Aspirin 300mg + clopidogrel 75mg

225
Q

What is frontotemporal dementia associated with?

A

FHx
Personality change
< 65
Gambling, memory preserved, lack of insight, speech

226
Q

What is mild cognitive impairment?

A

No significant life impact/progression

227
Q

What drugs can cause falls?

A

Opioids
Antihypertensives
SSRIs
Drug interactions
Polypharmacy

228
Q

What are the peripheral causes of dizziness/vertigo?

A

Ear causes
- BPV
- Acute labyrinthitis
- Meniere’s disease
- Acoustic neuroma

229
Q

What causes BPV and what are the symptoms?

A

Debris in semicircular canal
Head movement
Vertigo for a few seconds

230
Q

What are the symptoms of acute labyrinthitis?

A

Vertigo + N&V
No hearing loss/tinnitus
Vascular/virus

231
Q

What are the symptoms of Meniere’s disease?

A

Vertigo > 20 mins + deafness + tinnitus
Bed rest

232
Q

What are the symptoms of acoustic neuroma?

A

Unilateral hearing loss then vertigo +/- raised ICP

233
Q

What can cause central vertigo?

A

MS, stroke, migraine, trauma, motion sickness, alcohol

234
Q

What are the symptoms of pre-eclampsia?

A

Severe frontal headache
Epigastric pain
N&V
Visual disturbances
Swelling of hands and feet
Liver tenderness

235
Q

How is pre-eclampsia diagnosed?

A

Over 20 weeks
Hypertension > 140/90 with proteinuria

236
Q

How can you treat pre-eclampsia?

A

Antihypertensives - labetol (1st line), methyldopa, nifedipine
Monitor foetal growth
Fluid restriction
If BP uncontrollable - deliver with MgSO4 before

237
Q

What is eclampsia?

A

Tonic-clonic seizures due to uncontrolled pre-eclampsia
Placental distress causing vasospasm widespread in body leading to hypertension that can lead to vasospasm in the brain causing seizures

238
Q

What is HELLP syndrome?

A

H - haemolysis
EL - elevated liver enzymes
LP - low platelets
Typically occurs in 3rd trimester
Blood transfusions, platelets, MgSO4

239
Q

How can you diagnose gestational diabetes?

A

Fasting > 5.6
2hr plasma glucose > 7.8

240
Q

What can you do to reduce the risks of pre-term labour?

A

Tocolytic drugs - slow down contractions (nifedipine)
MgSO4 to promote brain development
Steroids (dexamethasone) to promote lung and brain development

241
Q

What are the 4 Ts of PPH?

A

Tone - uterine atony
Trauma - lacerations during birth
Tissue - retained POC
Thrombin - coagulopathy

242
Q

What is foetal hydrops?

A

Abnormal fluid accumulation in 2 or more foetal components

243
Q

When are anti-D injections given during pregnancy?

A

28 and 34 weeks

244
Q

What can cause intrauterine growth restriction?

A

Extremes of maternal age
Interpregnancy gap < 6 months
Previous SGA baby
Placental insufficiency
Substance abuse/medications (warfarin)
Maternal starvation
Maternal infection
Foetal chromosomal/genetic/congenital anormalities
Placental dysfunction

245
Q

What is a first degree peroneal tear?

A

Fourchette and vaginal mucosa damaged
Underlying muscles exposed but not torn

246
Q

What is a second degree peroneal tear?

A

Posterior vaginal wall and perianal muscles. Sphincter intact

247
Q

What is a third degree peroneal tear?

A

Anal sphincter torn but rectal mucosa intact

248
Q

What is a fourth degree peroneal tear?

A

Anal canal opened, tear may spread to rectum

249
Q

What can cause foetal distress during labour?

A

Cord prolapse
Pre-eclampsia
Placental abruption
Low levels of amniotic fluid
Breech
Hypoxia
Maternal sepsis
Should dystocia

250
Q

What is cord prolapse?

A

When cord prevents out of cervix before uterus
Contractions cause cord compression so cuts off O2 supply to foetus

251
Q

What are the different types of cord prolapse?

A

Overt - happens after sac burst
Abdo - ill fitting or non-engaged presenting part
Vaginal - can be felt within vagina, if pulsating baby still alive

252
Q

Name a GnRH receptor antagonist

A

Zolotex injections
Degarelix
Goserelin

253
Q

What are the risk factors of fibroids?

A

Obesity
Early menarche
1st degree relative(s) with fibroids
Hypertension
Alcohol
Poor diet

254
Q

What are the protective factors for fibroids?

A

Exercise
Increased parity
Smoking

255
Q

Name 4 other causes of vaginal bleeding

A

Endometrial polyps
Ectopic pregnancy
Endometrial hyperplasia
Endometrial cancer (post-menopausal)
POP
IUCD
Anticoagulant treatment

256
Q

When should you offer antihypertensives with stage I hypertension?

A

If < 80 and any of the following
- Target organ damage
- Established CVS disease
- Renal disease
- Diabetes
- QRISK > 10%

257
Q

What HbA1c suggests diabetes and pre-diabetes?

A

Diabetes > 48
Pre-diabetes 42-47

258
Q

What is the 1st line treatment for T2DM?

A

Metformin

259
Q

When should you add an SGLT2 inhibitor to metformin as first line for diabetes treatment?

A

If CVD, high risk for developing CVD (QRISK > 10%), HF
eg empagliflozin
Have CVS benefits (protective)

260
Q

What are the S/E of SGLT2 inhibitors and why?

A

UTI
Inhibits glucose reabsorption in kidney so glucosuria

261
Q

What can you give if metformin is not tolerated due to S/E (gastric)?

A

Modified-release metformin

262
Q

What can you give if metformin is CI?

A

If risk of CVD/HF - SGLT2 monotherapy
If not at risk - DPP4 inhibitor or pioglitazone or sulphonylurea

263
Q

What is the 2nd line treatment for T2DM?

A

Add one of
- DPP4 inhibitor
- Pioglitazone
- Sulphonylurea

264
Q

What is the 3rd line treatment for T2DM?

A

Add another drug
Start insulin therapy

265
Q

What is the FEVERPAIN score?

A

FEVER lasting 24 hours
Pus on tonsils
Attend rapidly (ie symptoms onset < 3 days)
severely Inflamed tonsils
No cough or coryza
If >4 then antibiotics

266
Q

What antibiotics would you give for strep throat?

A

Phenoxymethylpenicillin
Clarithromycin if penicillin allergic
7/10 days

267
Q

What is the most common cause of bacterial tonsilitis?

A

Strep pyogenes (gram positive coccus)

268
Q

What FEV1/FVC suggests asthma and what improvement with a SABA is required?

A

< 70% predicted
12% improvement with SABA

269
Q

What are the symptoms of a moderate asthma attack?

A

PEFR 50-75% best/predicted
Speech normal
RR < 25
HR < 110

270
Q

What are the symptoms of a severe asthma attack?

A

PEFR 33-50%
Can’t complete sentences
RR > 25
HR > 110

271
Q

What are the symptoms of a life threatening asthma attack?

A

PEFR < 33%
Sats < 92%
Normal pCO2 4.6-6.0
Silent chest, cyanosis, feeble resp effort
Bradycardia, dysrhythmia, hypotension
Exhaustion, confusion, coma

272
Q

What treatment can be given for regular migraines?

A

Beta blockers
CI in asthma - topiramate

273
Q

What are the problems with topiramate?

A

May be teratogenic
Reduces effectiveness of oral contraceptives

274
Q

What are the red flags of a headache?

A

Thunder clap - SAH
Immunocompromised
Triggered by cough, valsalva, sneeze, exercise - raised ICP until proven otherwise
Impaired level of consciousness + vomiting (> 1) - CT
Progressively worsening + higher functioning impaired - CT
Hx current cancer - ?mets
Worsening with fever
Change in personality
Orthostatic
GCA signs
Meningitis symptoms

275
Q

When are NSAIDs CI?

A

NSAID
Nursing and pregnancy
Serious bleeding
Allergic asthma
Impaired renal function - incl renal artery stenosis
Drugs (anticoags)

276
Q

Name 3 cyanotic congenital heart defects

A

R -> L shunt
- Truncus arteriosus
- Transposition of the great vessels
- Tricuspid atresia
- ToF
- Total anomalous pulmonary venous return
Hypoplastic L heart syndrome

277
Q

Name 3 acyanotic congenital heart defects

A

L -> R shunt
- ASD
- VSD
- AVSD
- PDA
Outflow tract obstructions
- Aortic stenosis
- Pulmonary stenosis
- Coarctation of the aorta

278
Q

What is Eisenmenger’s syndrome?

A

Increased flow L -> R through shunt increases pressure
R hypertrophy
Eventually shunt reversal -> cyanotic

279
Q

What are the S&S of acyanotic heart defects?

A

Tachycardia, tachypnoea
Faltering growth
Sweating
Pulmonary hypertension leading to HF -> oedema, fatigue, frequent chest infections

280
Q

When will
i) ASDs close?
ii) VSD close?

A

i) By 1
ii) By 10

281
Q

How do babies with cyanotic lesions survive?

A

Also need acyanotic lesion to counteract cyanotic

282
Q

What does TGA look like on a CXR?

A

Egg on a string

283
Q

What are the RF for TGA?

A

Male
Maternal age > 40
Maternal diabetes
Rubella
Alcohol

284
Q

How do you keep acyanotic lesions open?

A

Prostaglandin E1

285
Q

What is tricuspid atresia?

A

No tricuspid valve
RV hypoplasia as underdeveloped

286
Q

What does ToF look like on CXR?

A

Boot shaped heart

287
Q

What are the RF for ToF?

A

Male
1st degree relative Hx CHD
Teratogens - alcohol, warfarin
VACTERL
CHARGE
DiGeorges

288
Q

What does VACTERL stand for?

A

Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal abnormalities
Limb abnormalities

289
Q

What does CHARGE stand for?

A

Coloboma
Heart defects
Atresia choanae
Retardation of growth/development
Genital/urinary abnormalities
Ear abnormalites/deafness

290
Q

What is the new most common causes of epiglottitis?

A

Strep pneumoniae (was Hib)

291
Q

What are the 4 D’s of epiglottitis?

A

Dyspnoea
Dysphagia
Drooling
Dysphonia (hot potato voice) + tripod

292
Q

How is epiglottitis treated?

A

Do not examine throat
Secure airway - ENT/ anaesthetics
O2
Nebulised adrenaline
IV fluids
Cefotacime/ceftriaxone

293
Q

What antibiotic can you give for whopping cough and when can you give it?

A

Clarithromycin
If cough present < 3 weeks

294
Q

What is CF?

A

Autosomal recessive genetic disease of CFTR gene
In caucasian population

295
Q

What is the role of the CFTR protein?

A

Chloride channel in epithelial tissue
Affects both Cl- and Na+
Reduces water in secretions therefore thickened

296
Q

What are the problems with thickened fluids in CF?

A

Lungs - thick mucus, increased risk infection
Pancreas - duct damaged in utero, pancreatic insufficiency, CF-related diabetes, require creon and vitamin ADEK supplements
GI - liver and bowel problems
Reproductive - men infertile (absent vas deferens), women must time pregnancy as causes deterioration of lung health

297
Q

What signs can you get in CF?

A

Delayed meconium ileus
Recurrent chest infections
Steatorrhoea - frothy, pale stools
Nasal polyps
Clubbin

298
Q

What medications can be used to treat OCD?

A

Clomipramine (TCA)
SSRIs

299
Q

What are the 3 core symptoms of depression?

A

Sustained low mood
Reduced energy
Anhedonia

300
Q

What are the other symptoms of depression?

A

Reduced libido
Poor sleep - early morning waking
Diurnal mood variation - worse in morning
Agitation, anxious
Poor appetite
Worthlessness, hopelessness, guilt
Poor concentration, memory
Thoughts + speech slowed
Suicidal ideation/attempt

301
Q

What are the symptoms of psychotic depression?

A

Derogatory auditory hallucinations
Delusions of guilt
Nilhilistic delusions
Persecutory delusions

302
Q

How is psychosis diagnosed?

A

1 or more
- thought alienation
- passivity phenomena
- 3rd person auditory hallucinations
- delusional perception
2 or more
- delusions
- 2nd person auditory hallucinations
- other hallucinations
- thought disorder
- catatonia
- -ve symptoms
- amotive
- poverty of speech
- self neglect
- lack of insight

303
Q

What are the positive symptoms of psychosis?

A

Delusions
Hallucinations
Disorganised speech/behaviour

304
Q

What are the negative symptoms of psychosis?

A

Lack of emotion
Monotone, one-syllable answers
Few gestures
Difficulties thinking/coming up with ideas
Decreased ability to initiate tasks
Decreased motivation/drive
Lack of interest in other people
Inability to feel pleasure
Lack of spontaneity

305
Q

What are the S/E of lithium?

A

LITHIUM
Leukocytosis
Interstitial nephritis/insipidus
Tremor (fine)
Hydration decreased
Increased skin/GI and memory problems
Underactive thyroid
Mum’s beware (Ebsteins anomaly)

306
Q

What are the symptoms of lithium toxicity?

A

Coarse tremor
Hyperreflexia
Acute confusion
D&V
Coma
Death

307
Q

What is in the cluster A of personality disorders?

A

Paranoid
Schizoid
Schizotypal

308
Q

What is the difference between the cluster A personality disorders?

A

Paranoid - distrust and suspicious towards others without adequate reason to be suspicious
Schizoid - avoiding social situations, limited range of emotional expression (Matt)
Schizotypal - intense discomfort with close relationships and social interactions (Tim)

309
Q

What is in the cluster B of personality disorders?

A

Antisocial
EUPD
Histrionic
Narcissistic

310
Q

What is the difference between the types of cluster B personality disorders?

A

Antisocial - impulsive, irresponsible, criminal behaviour
EUPD - fluctuating emotions (period)
Histrionic - uncomfortable if not centre of attention, feel constantly have to seek attention (Joe)
Narcissistic - self-centred arrogant behaviour, lack of empathy and consideration towards others (G)

311
Q

What is in cluster C of personality disorders?

A

Avoidant
Dependant
OCD/anakastic

312
Q

What is the difference between the cluster C of personality disorders?

A

Avoidant - chronic feelings of inadequacy, highly sensitive to being negatively judged by others (me)
Dependant - anxious, feel helpless, submissive, incapable of taking care of themselves, trouble making simple decisions (Soph)
Anankastic - obsession with orderliness, rigidity and stubbornness (Ellie)

Community and public health (2 decks)

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