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3a > community health > Flashcards

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

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2
Q

Left heart failure - 3 symptoms:

A
  • Fatigue/SOB increasing
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
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3
Q

right heart failure - 3 symptoms:

A

ankle oedema
sacral oedema
JVP up
hepatomegaly

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4
Q

which DIAGNOSTIC criteria used to dx heart failure?

A

framinghams (symptoms related)

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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

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6
Q

Heart failure signs on CXR: (5)

A 
alveolar oedema
Kurley B-lines
Cardiomegaly
Dilated upper lobe vessels 
Pleural Effusion
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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

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8
Q

BB: eg, MOA, sfx

A

Propranolol
block b1/2 receptors-> decreased HR/muscle pumping/contractility, reduced renin activity, vasodilation
dizziness, bradycardia

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9
Q

2 differential diagnoses for tonsillitis:

A

acute epiglottitis
scarlet fever
croup
EBV

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10
Q

commonest bacterial and viral cause of tonsillitis?

A 
strep pyogenes (Group A Strep)
RSV/adenovirus/rhino/flu
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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

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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
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13
Q

which criteria decides whether a child with tonsillitis should receive Abx?

A

Centor scoring system

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14
Q

what criteria make up the centor scoring system?

A
  • tonsillar exudate
  • tender anterior cervical lymphadenopathy
  • fever >38
  • absence cough
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15
Q

which score on centor system gets Abx?

A

3+

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16
Q

which Abx first line tonsillitis?

A

Phenoxymethylpenecillin (7-10 days)

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17
Q

if penicillin allergic, which abx for tonsillitis?

A

erythromycin (7-10 days)

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18
Q

How many times in 2 years of tonsillitis would warrant referral to ENT?

A

7

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19
Q

surgical option: tonsillitis?

A

tonsillectomy

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20
Q

3 investigations that aren’t blood tests for fall?

A 
BP - lying and standing 
BM, 
urinalysis
ECG
CXR
CT head
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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
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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

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23
Q

C big K drop in hyperkalaemia mx:

A 
calcium gluconate
bicarbonate
Insulin, Glucose
Kayexelate
Diuretics and dialysis (RRT)
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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

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25
Q

3 causes of delirium?

PINCH ME

A 
Pain
infection
Nutrition
Constipation
Hydration
Medication
Environment
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26
Q

CURB65 score of 4: tx:

A

Amoxicillin and erythromycin IV

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27
Q

assess mental capacity (4):

A

understand
retain
weigh up
communicate

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28
Q

5 principles of mental capacity:

A 
presumed
stupid answer not wrong
best interests
least restrictive
supported to make own decision
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29
Q

3 conditions for DOLs to be put in place?

A
  • a person is under continuous supervision and control
  • is not free to leave
  • lacks capacity to consent to these arrangements
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30
Q

how many people to assess for a DOLs?

A

2 - one to assess best interests, one to assess MHA

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31
Q

how long does DoLs last>

A

12 months, renewable

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32
Q

what is included in a MUST nutritional assessment?

A

BMI<18.5
active disease
weight loss 10% last 3-6/12
unable to eat for 5< days

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33
Q

DEXA scan results (-1.0- -2.5)

A

Osteopenia

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34
Q

DEXA scan result for Osteoporosis?

A

less than -2.5

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35
Q

what tx for osteoporosis?

A

bisphosphonates - alendronate

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36
Q

what needs to be considered when giving bisphosphonates?

A

need to be taken sitting up for half hour after
lots of water with them
need to be given half hour pre-food

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37
Q

pressure score system?

A

waterlow score

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38
Q

pressure score? - skin completely intact with non-blanching redness

A

1

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39
Q

pressure score? - partial loss of dermis with shallow open ulcer

A

2

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40
Q

pressure score? - can see subcut fat

A

3

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41
Q

pressure score? - can see down to bone

A

4

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42
Q

non medical management of pressure ulcers?

A

regular turning
mattress special
hydration/nutrition
hygiene

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43
Q

If <55 years old or T2DM (caucasian): BP stage 1

A 
Ace-I (ramapril) 
or ARB (losartan)
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44
Q

If >55 years old + no T2DM or afro-carribean + no T2DM; BP step 1:

A

CCB (Nifedipine)

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45
Q

step 2 for either +/-55 and DM status: BP management:

A

A+C

or A+D

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46
Q

step 3: BP management:

A

A+C+D

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47
Q

if currently on step 3 BP medication and still uncontrolled - if K>4.5:

A

+alpha or Beta blocker

Prazosin) (Propranolol

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48
Q

if currently on step 3 BPmeds and still uncontrolled but K<4.5:

A

low-dose spironolactone

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49
Q

stage 1 hypertension - what is the BP threshold and who does it apply to ?

A 
135/85 
treat if < 80yrs AND:
target organ damage, 
established cardiovascular disease, 
renal disease, 
diabetes 
10-year cardiovascular risk equivalent to 10% or greater
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50
Q

if HTN 160>100 in clinic - what stage HTN and what mx?

A

stage 2 = treat!!!

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51
Q

what is severe HTN? Ix?

A

180/110

look for cx - fundoscopy/opthalmoscope

52
Q

acute heart failure mx: to stabalise:

A
  1. IV/high dose diuretic

2. consider ventilation, monitor weight, urine output renal function

53
Q

subacute HF management: after stabalised?

A
  1. start/restart BB
  2. offer Ace-I, ARB
  3. offer spironalactone
    f/u within 2 weeks
54
Q

what type of drug is spironalactone?

A

aldosterone agonsist

55
Q

chronic HF pharmacological mx:

A
  1. Ace-I or BB or diuretic
  2. spironalactone
  3. digoxin or hydralazine
56
Q

primary prevention HF:

A

exercise, diet, lifestyle

57
Q

secondary prevention HF:

A

aspirin, statins

58
Q

tertiary prevention HF:

A

diet, exercise, diuretics - sx relief!

59
Q

community support for HF patient:

A

community district nurse for meds adherence

OT - occupational support/home safety

60
Q

who do you contact for notifiable disease?

A

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
Q

red feverish child traffic light egs (5)

A
  • 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
Q

amber feverish child traffic light egs (5):

A
  • 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
Q

if amber traffic light - what is mx?

A

safety net or refer to paeds specialist

64
Q

what is safety netting:

A

written or verbal info on warning sx and how further healthcare can be accessed
f/u
out of hours

65
Q

what is feverpain score used for??

A

assesses the likelihood of isolating streptococci in child with a sore throat

66
Q

what are the feverpain criteria?

A
  • fever >38
  • Purulence (pharyngeal/tonsillar exudate).
  • Attend rapidly (3 days or less)
  • Severely Inflamed tonsils
  • No cough or coryza
67
Q

if fever pain 2-3: mx_

A

give delayed antibiotic prescription as a safety net - tell to use if deteriorates or symptoms do not improve within 3-5 days

68
Q

if feverpain 4-5: mx:

A

give immediate abx

69
Q

4 criteria for vaginal discahrge?

A

colour
smell
consistency
amount

70
Q

what colour of vag discharge is normal?

A

thick and white

71
Q

what would brown vaginal discharge indicate?

A

irregular period/dried blood

72
Q

what would green vaginal discharge indicate?

A

bacterial infection

73
Q

cottage cheese discharge -?

A

cadida infection

vulvitis - itch

74
Q

offensive, yellow/green frothy discharge,
vulvovaginitis,
strawberry cervix:

A

trichomonasa vaginalis

75
Q

offensive thin, white/grey, fishy discharge:

A

bacterial vaginosis

76
Q

POP: MOA:

A

thickens cervical mucus

77
Q

COCP: MOA:

A

inhibits ovulation

78
Q

desogestrel MOA:

also implant and injectable

A
  1. inhibits ovulation

2. thickens cervical mucus

79
Q

copper coil MOA:

A

inhibits sperm motility and survival

80
Q

IUS: MOA:

A
  1. prevents endometrial proliferation

2. thickens cervical mucus

81
Q

which is the best form of contraception statistically??

A

implant etonogestrel

82
Q

Fraser: what is their guidelines for?

A

specific to anything to do with sex/contraception in u16s

83
Q

Gillick’s competency: what is their guidelines for?

A

consent to tx in under 16s

84
Q

what are Fraser guidelines:

A 
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
Q

absolute age where child cannot consent:

A

12 and under

86
Q

dementia screening tools in primary care? (3)

A

MMSE (mini mental state exam)
GP COG (GP assessment of cognition)**
6CIT (6 item cognitive impairment test)

87
Q

name the three Anticholinesterase Inhibitors that are first line tx for Alzheimer’s dementia?

A

Donepazil
Galantamine
Rivastigmine

88
Q

2nd line tx dementia and drug class?

A

memantine

NMDA antagonist

89
Q

non-pharma care for dementia?

A

alzheimers society
memory cafe
community AMHNs to keep patient at home
carer needs / respite

90
Q

5 principles MCA:

A 
presume capacity
support their own decision
best-interest
least restrictive 
stupid decision isn't wrong
91
Q

how to assess MCA:

A

understand
retain
weigh up
communicate

92
Q

IMCA:

A

makes sure independent medical decisions made in their best interest per their advanced directive

93
Q

MCA minimum age and specific to what?

A

16

task and time specific

94
Q

what can’t you refuse with advanced directive?

A

basic care: water by mouth, pain relief

95
Q

ddx anxiety:

A 
hyperthyroid needs to be excluded 
other MH problems
panic disorder
depression
other anxiety disorders
96
Q

GAD: how long before dx and definitions?

A

6/12
sx on most days
and free floating, non-episodic or situational

97
Q

suicide RF:

A 
FHx
previous self harm
male 
alcohol/drug misuse
lack of social support 
MH problem Hx
chronic disease age
divorced/single
unemployed
98
Q

questionnaires for anxiety?

A

GAD2/7
Beck’s anxiety inventory
Hospital Anxiety and Depression Scale

99
Q

questionnaires for depression?

A

PHQ9
HAS
Beck’s

100
Q

questionnaire for PTSD?

A

trauma screening questionnaire

101
Q

Substance misuse questionnaire:

A

AUDIT
(CAGE)
SADQ
FAST

102
Q

dependence to alcohol signs:

A

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
Q

ddx: cough: acute (<3weeks):

A

URTI
LRTI
Asthma exacerbation
Irritants - constant cough with phlegm

104
Q

ddx cough chronic (.8 weeks)

A 
TB - blood
canncer - lung/mets/lymphoma - blood
pulmonary fibrosis
CF
meds - Ace-Is
Pneumothorax - pleuritic pain
bronchiectasis
PE - pleuritic pain
105
Q

TB risk factors:

A 
HIV
smoking, DM, alcoholic, malnutrition 
overcrowded housing 
low socioeconomic
migrants
106
Q

which vaccine for TB?

A

BCG in high incidence areas

107
Q

TB: meds:

A

Isoniazid + Rifampicin
6/12
Pyrazinamide + ethambutol 2/12

108
Q

important 3 things to consider in migrant population:

A

contact tracing
psychological issues + chronic disease
language difficulty - translator
access to health

109
Q

important differential to exclude in TB:

A

pmneumonia - cap or hap

110
Q

pneumonia scoring system:

A

CURB65

111
Q

what does curb65 score?

A 
Confusion
Urea>7
Resp rate 
BP 90/60
65 age
112
Q

HAP tx:

A

co-amoxiclav

if severe + levofloxacin/ceftriaxone

113
Q

oral -> Sc morphine?

A

1/2

114
Q

Codeine to morphine -

A

divide by 10

115
Q

Syringe drivers: respiratory secretions & bowel colic may be treated by??

A

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

116
Q

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???

A

buprenorphine or fentanyl

not morphine

117
Q

if mild-mod renal impairment in palliative pt, which pain relief?

A

oxycodone > morphine

118
Q

Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with?

A

dexamethasone

119
Q

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?

A

oral haloperidol

if terminal phase - sc midazolam

120
Q

Breakthrough dose =?

A

1/6 daily morphine dose

121
Q

used in palliative care for nausea and vomiting that is due to gastric dysmotility and stasis?

A

d2 antagonists - metoclopramide

122
Q

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?

A

cyclizine

first line anti-emetic for intracranial causes of nausea and vomiting

123
Q

first-line medications for the treatment of chemically mediated nausea, such as due to opioid medications.>?

A

ondansetron

124
Q

Metastatic bone pain may respond to ?

A

analgesia, bisphosphonates, or radiotherapy

125
Q

oral morphine to diamorphine (sc) the total daily morphine dose?

A

total daily dose /3

126
Q

In palliative patients increase morphine doses by X if pain not controlled?

A

30-50%

127
Q

Hiccups in palliative care -

A

chlorpromazine or haloperidol

3a (7 decks)

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