community health Flashcards
1
Q
define heart failure:
A
Pathophysiological process where the heart as a pump is unable to meet the metabolic requirements of the tissue for oxygen and substrates despite the venous return to the heart being either normal or increased
2
Q
Left heart failure - 3 symptoms:
A
- Fatigue/SOB increasing
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
3
Q
right heart failure - 3 symptoms:
A
ankle oedema
sacral oedema
JVP up
hepatomegaly
4
Q
which DIAGNOSTIC criteria used to dx heart failure?
A
framinghams (symptoms related)
5
Q
which specific blood test would you use to investigate HF and why?
A
BNP
hormone produced mainly by the left ventricular myocardium myocytes in response to strain
6
Q
Heart failure signs on CXR: (5)
A
alveolar oedema Kurley B-lines Cardiomegaly Dilated upper lobe vessels Pleural Effusion
7
Q
ACE-I: eg, MOA, sfx:
A
Lisinporil
inhibits the conversion of Angiotensin 1 to 2. Leads to reduced preload and afterload, decreased aldosterone. Vasodilation.
Ace cough – dry
8
Q
BB: eg, MOA, sfx
A
Propranolol
block b1/2 receptors-> decreased HR/muscle pumping/contractility, reduced renin activity, vasodilation
dizziness, bradycardia
9
Q
2 differential diagnoses for tonsillitis:
A
acute epiglottitis
scarlet fever
croup
EBV
10
Q
commonest bacterial and viral cause of tonsillitis?
A
strep pyogenes (Group A Strep) RSV/adenovirus/rhino/flu
11
Q
What tool could you use to decide if the feverish child needs to be urgently seen by paediatrics or requires admission?
A
Nice 2013 Feverish Illness in children guidelines traffic light system
12
Q
2 red criteria traffic light guidelines for feverish child:
A
grunting pallor weak/high pitch/cont. cry no response to social cues appears ill to healthcare professional RR>60 mod/sev indrawing chest reduced skin turgor <3/12 + 38deg non-blanching rash bulging fontanelles neck stiffness status focal neuro
13
Q
which criteria decides whether a child with tonsillitis should receive Abx?
A
Centor scoring system
14
Q
what criteria make up the centor scoring system?
A
- tonsillar exudate
- tender anterior cervical lymphadenopathy
- fever >38
- absence cough
15
Q
which score on centor system gets Abx?
A
3+
16
Q
which Abx first line tonsillitis?
A
Phenoxymethylpenecillin (7-10 days)
17
Q
if penicillin allergic, which abx for tonsillitis?
A
erythromycin (7-10 days)
18
Q
How many times in 2 years of tonsillitis would warrant referral to ENT?
A
7
19
Q
surgical option: tonsillitis?
A
tonsillectomy
20
Q
3 investigations that aren’t blood tests for fall?
A
BP - lying and standing BM, urinalysis ECG CXR CT head
21
Q
3 causes of falls in elderly:
A
Lower limb muscle weakness Vision problems Balance/gait disturbances (diabetes, rheumatoid arthritis and parkinson's disease etc) Polypharmacy (4+ medications) Incontinence >65 Have a fear of falling Depression Postural hypotension Arthritis in lower limbs Psychoactive drugs Cognitive impairment
22
Q
complaining of severe muscle pain and begins to vomit. You notice she has a bruise covering her left thigh and buttocks. Her urine looks brown in the catheter.
What blood tests would you order?
A
Creatinine Kinase
UE - hyperkalaemia
myoglobin
23
Q
C big K drop in hyperkalaemia mx:
A
calcium gluconate bicarbonate Insulin, Glucose Kayexelate Diuretics and dialysis (RRT)
24
Q
4 major components and an example of each for comprehensive geriatric assessment:
A
medical assessment - meds rec - Dr/pharmacist
psych assessment - cognition/mood - psychol/Dr
functional assessment - gait - PT/SALT..
Social/env assessment - home safety - OTs
dietician - nutrition assessment
25
3 causes of delirium?
| PINCH ME
```
Pain
infection
Nutrition
Constipation
Hydration
Medication
Environment
```
26
CURB65 score of 4: tx:
Amoxicillin and erythromycin IV
27
assess mental capacity (4):
understand
retain
weigh up
communicate
28
5 principles of mental capacity:
```
presumed
stupid answer not wrong
best interests
least restrictive
supported to make own decision
```
29
3 conditions for DOLs to be put in place?
- a person is under continuous supervision and control
- is not free to leave
- lacks capacity to consent to these arrangements
30
how many people to assess for a DOLs?
2 - one to assess best interests, one to assess MHA
31
how long does DoLs last>
12 months, renewable
32
what is included in a MUST nutritional assessment?
BMI<18.5
active disease
weight loss 10% last 3-6/12
unable to eat for 5< days
33
DEXA scan results (-1.0- -2.5)
Osteopenia
34
DEXA scan result for Osteoporosis?
less than -2.5
35
what tx for osteoporosis?
bisphosphonates - alendronate
36
what needs to be considered when giving bisphosphonates?
need to be taken sitting up for half hour after
lots of water with them
need to be given half hour pre-food
37
pressure score system?
waterlow score
38
pressure score? - skin completely intact with non-blanching redness
1
39
pressure score? - partial loss of dermis with shallow open ulcer
2
40
pressure score? - can see subcut fat
3
41
pressure score? - can see down to bone
4
42
non medical management of pressure ulcers?
regular turning
mattress special
hydration/nutrition
hygiene
43
If <55 years old or T2DM (caucasian): BP stage 1
```
Ace-I (ramapril)
or ARB (losartan)
```
44
If >55 years old + no T2DM or afro-carribean + no T2DM; BP step 1:
CCB (Nifedipine)
45
step 2 for either +/-55 and DM status: BP management:
A+C
| or A+D
46
step 3: BP management:
A+C+D
47
if currently on step 3 BP medication and still uncontrolled - if K>4.5:
+alpha or Beta blocker
| Prazosin) (Propranolol
48
if currently on step 3 BPmeds and still uncontrolled but K<4.5:
low-dose spironolactone
49
stage 1 hypertension - what is the BP threshold and who does it apply to ?
```
135/85
treat if < 80yrs AND:
target organ damage,
established cardiovascular disease,
renal disease,
diabetes
10-year cardiovascular risk equivalent to 10% or greater
```
50
if HTN 160>100 in clinic - what stage HTN and what mx?
stage 2 = treat!!!
51
what is severe HTN? Ix?
180/110
| look for cx - fundoscopy/opthalmoscope
52
acute heart failure mx: to stabalise:
1. IV/high dose diuretic
| 2. consider ventilation, monitor weight, urine output renal function
53
subacute HF management: after stabalised?
1. start/restart BB
2. offer Ace-I, ARB
3. offer spironalactone
f/u within 2 weeks
54
what type of drug is spironalactone?
aldosterone agonsist
55
chronic HF pharmacological mx:
1. Ace-I or BB or diuretic
2. spironalactone
3. digoxin or hydralazine
56
primary prevention HF:
exercise, diet, lifestyle
57
secondary prevention HF:
aspirin, statins
58
tertiary prevention HF:
diet, exercise, diuretics - sx relief!
59
community support for HF patient:
community district nurse for meds adherence
| OT - occupational support/home safety
60
who do you contact for notifiable disease?
Proper Officer' at the Local Health Protection Team needs to be notified. They in turn will notify the Health Protection Agency on a weekly basis.
PHE
61
red feverish child traffic light egs (5)
- pale/ mottled / ashen / blue
- reduced response to social cues/unresponsive/weak-high pitch continuous cry/looks ill to health professional
- grunting, RR>60, chest indrawing
- reduced skin turgor
- age<3/12 + fever>38
- meningism
- seizure/status/focal neuro
62
amber feverish child traffic light egs (5):
- pallor reported by parent/carer
- decreased rousability
- nasal flaring
- sats <95, chest crackles
-tachycardia
- CRT>3secs
- 3-6/12 + fever >39
- fever >5days
- rigors
swelling/non-weight bearing
63
if amber traffic light - what is mx?
safety net or refer to paeds specialist
64
what is safety netting:
written or verbal info on warning sx and how further healthcare can be accessed
f/u
out of hours
65
what is feverpain score used for??
assesses the likelihood of isolating streptococci in child with a sore throat
66
what are the feverpain criteria?
- fever >38
- Purulence (pharyngeal/tonsillar exudate).
- Attend rapidly (3 days or less)
- Severely Inflamed tonsils
- No cough or coryza
67
if fever pain 2-3: mx_
give delayed antibiotic prescription as a safety net - tell to use if deteriorates or symptoms do not improve within 3-5 days
68
if feverpain 4-5: mx:
give immediate abx
69
4 criteria for vaginal discahrge?
colour
smell
consistency
amount
70
what colour of vag discharge is normal?
thick and white
71
what would brown vaginal discharge indicate?
irregular period/dried blood
72
what would green vaginal discharge indicate?
bacterial infection
73
cottage cheese discharge -?
cadida infection
| vulvitis - itch
74
offensive, yellow/green frothy discharge,
vulvovaginitis,
strawberry cervix:
trichomonasa vaginalis
75
offensive thin, white/grey, fishy discharge:
bacterial vaginosis
76
POP: MOA:
thickens cervical mucus
77
COCP: MOA:
inhibits ovulation
78
desogestrel MOA:
| also implant and injectable
1. inhibits ovulation
| 2. thickens cervical mucus
79
copper coil MOA:
inhibits sperm motility and survival
80
IUS: MOA:
1. prevents endometrial proliferation
| 2. thickens cervical mucus
81
which is the best form of contraception statistically??
implant etonogestrel
82
Fraser: what is their guidelines for?
specific to anything to do with sex/contraception in u16s
83
Gillick's competency: what is their guidelines for?
consent to tx in under 16s
84
what are Fraser guidelines:
```
child understands professional advice
cannot persuade to tell parents
will continue/start doing it anyway
their physical/MH likely to suffer if don't get it
best interests
```
85
absolute age where child cannot consent:
12 and under
86
dementia screening tools in primary care? (3)
MMSE (mini mental state exam)
GP COG (GP assessment of cognition)**
6CIT (6 item cognitive impairment test)
87
name the three Anticholinesterase Inhibitors that are first line tx for Alzheimer's dementia?
Donepazil
Galantamine
Rivastigmine
88
2nd line tx dementia and drug class?
memantine
| NMDA antagonist
89
non-pharma care for dementia?
alzheimers society
memory cafe
community AMHNs to keep patient at home
carer needs / respite
90
5 principles MCA:
```
presume capacity
support their own decision
best-interest
least restrictive
stupid decision isn't wrong
```
91
how to assess MCA:
understand
retain
weigh up
communicate
92
IMCA:
makes sure independent medical decisions made in their best interest per their advanced directive
93
MCA minimum age and specific to what?
16
| task and time specific
94
what can't you refuse with advanced directive?
basic care: water by mouth, pain relief
95
ddx anxiety:
```
hyperthyroid needs to be excluded
other MH problems
panic disorder
depression
other anxiety disorders
```
96
GAD: how long before dx and definitions?
6/12
sx on most days
and free floating, non-episodic or situational
97
suicide RF:
```
FHx
previous self harm
male
alcohol/drug misuse
lack of social support
MH problem Hx
chronic disease age
divorced/single
unemployed
```
98
questionnaires for anxiety?
GAD2/7
Beck's anxiety inventory
Hospital Anxiety and Depression Scale
99
questionnaires for depression?
PHQ9
HAS
Beck's
100
questionnaire for PTSD?
trauma screening questionnaire
101
Substance misuse questionnaire:
AUDIT
(CAGE)
SADQ
FAST
102
dependence to alcohol signs:
Subjective awareness of compulsivity
Avoidance or relief of withdrawal by drinking
withdrawal sx
Drink seeking behaviour
Reinstatement after a period of abstinence
Increased tolerance
Narrowing of repitoire
103
ddx: cough: acute (<3weeks):
URTI
LRTI
Asthma exacerbation
Irritants - constant cough with phlegm
104
ddx cough chronic (.8 weeks)
```
TB - blood
canncer - lung/mets/lymphoma - blood
pulmonary fibrosis
CF
meds - Ace-Is
Pneumothorax - pleuritic pain
bronchiectasis
PE - pleuritic pain
```
105
TB risk factors:
```
HIV
smoking, DM, alcoholic, malnutrition
overcrowded housing
low socioeconomic
migrants
```
106
which vaccine for TB?
BCG in high incidence areas
107
TB: meds:
Isoniazid + Rifampicin
6/12
Pyrazinamide + ethambutol 2/12
108
important 3 things to consider in migrant population:
contact tracing
psychological issues + chronic disease
language difficulty - translator
access to health
109
important differential to exclude in TB:
pmneumonia - cap or hap
110
pneumonia scoring system:
CURB65
111
what does curb65 score?
```
Confusion
Urea>7
Resp rate
BP 90/60
65 age
```
112
HAP tx:
co-amoxiclav
| if severe + levofloxacin/ceftriaxone
113
oral -> Sc morphine?
1/2
114
Codeine to morphine -
divide by 10
115
Syringe drivers: respiratory secretions & bowel colic may be treated by??
hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide
116
opioids of choice for pain relief in palliative care patients with severe renal impairment, as they are not renally excreted and therefore are less likely to cause toxicity???
buprenorphine or fentanyl
not morphine
117
if mild-mod renal impairment in palliative pt, which pain relief?
oxycodone > morphine
118
Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with?
dexamethasone
119
A 65-year-old female with metastatic breast cancer is reviewed in clinic. Her husband reports that she is increasingly confused and occasionally appears to talk to relatives that are not in the room. She undergoes investigations for reversible causes, of which none are found. If conservative measures fail and she continues to be confused/agitated, mx?
oral haloperidol
if terminal phase - sc midazolam
120
Breakthrough dose =?
1/6 daily morphine dose
121
used in palliative care for nausea and vomiting that is due to gastric dysmotility and stasis?
d2 antagonists - metoclopramide
122
80F on the ward complaining of severe nausea. She is unable to keep food down because she feels too sick and is asking for medication to help her feel better. She is being currently managed by the palliative care team because of incurable late stage lunge cancer with secondary cerebral metastases. mx?
cyclizine
| first line anti-emetic for intracranial causes of nausea and vomiting
123
first-line medications for the treatment of chemically mediated nausea, such as due to opioid medications.>?
ondansetron
124
Metastatic bone pain may respond to ?
analgesia, bisphosphonates, or radiotherapy
125
oral morphine to diamorphine (sc) the total daily morphine dose?
total daily dose /3
126
In palliative patients increase morphine doses by X if pain not controlled?
30-50%
127
Hiccups in palliative care -
chlorpromazine or haloperidol
