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YR3 - R1: General Medicine > CVS Risk Factors, Instrumentation, Pain Management & Psychiatric Disease > Flashcards

CVS Risk Factors, Instrumentation, Pain Management & Psychiatric Disease Flashcards

1
Q

What is the Epidemiology of Type I DM?

A
  • During winter – viral?
  • On the rise – autoimmunity also on the rise in general.
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2
Q

What is TIDM?

A
  • HLA Locus – certain types make us more predisposed to autoimmune diseases – eg. Lupus, thyroid
  • Extrinsic triggers – eg. Viruses etc  molecular mimicry (B cells get targeted and destroyed)
  • Coeliac – autoimmune reaction to gluten in small intestine = inflammation = diarrhoea & malabsorption
  • Autoimmune endocrinopathies – eg. Addison’s disease
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3
Q

List 3 other causes of Type I DM?
- 3 meds?
- 4 other endocrine conditions?
- Commonest cause of pancreatitis?
- Hallmark of TIDM?

A

Commonest cause of pancreatitis = alcohol
Hallmark of TIDM = absolutely no insulin

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4
Q

Describe the time course of Type I DM?
- What is the best test to diagnose/differentiate TIDM vs. TIIDM?
- What is the hallmark presentation of DKA?

A
  • Honeymoon phase
  • Amount of C-peptide molecule = reflective of amount of insulin you make
  • Insulin secreted as pro-insulin from beta cells of the pancreas - half-life = 1 minute – gets destroyed in circulation - C-peptide cleaved when insulin reaches target organ
  • No C-peptide = absolutely no insulin
  • Lower than normal amounts of C-peptide = Honeymoon phase of TIDM
  • Diagnosis of TIDM vs. TIIDM = C-Peptide is higher than normal in TIIDM, can do antibodies but theyre not super sensitive
  • Paediatric patients often present to ED with severe gastrointestinal pain = hallmark of ketoacidosis
  • 50% of TIDM 1st presentations = Diabetic ketoacidosis
  • DO A BLOOD SUGAR!!
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5
Q

5 ways to test/diagnose TIDM?

A
  • Fasting, Random, Oral Glucose Tolerance Test
  • Need OGTT for diagnosis of gestational DM
  • HbA1C not reimbursed under PBS as a diagnostic tool for TIDM – only for maintenance
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6
Q

How is TIDM managed?

A

Subcutaneous – eg. Novarapid – trying to replicate normal physiological insulin levels after meals

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7
Q

What is an insulin pump and how does it work?

A

Insulin pumps – need a very motivated patient who will check BSLs regularly

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8
Q

What is the BSL considered to be a hypo? What are the signs/symptoms?

A
  • Hypo = <3.5
  • Adrenergic - sense of hunger, sense of fear, sweating, tremors, agitation
  • Neuroglycopenic = lack of attention, confusion, seizures, coma
  • Antidote = glucagon
  • Check occupation is safe
  • Driving – if having frequent hypos cant drive for 2 weeks until they disappear
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9
Q

What should you always do when a Type 1 diabetic presents with a DKA?

A
  • No insulin = glucose cannot enter cell = build-up of glucose in the blood but cells have to switch to fatty acid metabolism for energy = ketones = metabolic acidosis = Insulin infusion
  • Severely dehydrated because the kidneys are trying to dilute the urine = Normal saline
  • Potassium also goes into the cells when you give insulin = hypokalaemia = give potassium with insulin
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10
Q

What are the signs & symptoms of a DKA?

A

pH<7.35 (NR = 7.35-7.45
Bicarb <35 (NR = 35-45)
Kussmaul breathing to blow off CO2 to reduce acid

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11
Q

What are the long term complications of TIDM?

A

Long-term complications of TIDM
Advanced glycosylated products = accelerated atherosclerosis
Vasa nervorum = smallest blood vessels hence why they are first to be occluded

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12
Q

What were the results of the DCCT trial about TIDM and nephropathy?

A

DCCT – Diabetes Complications Control Trial - When you push HbA1c levels under 7% = delays all types of microvascular complications

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13
Q

Describe the course of development of nephropathy in type 1 DM? How should you prevent it?

A

Increased filtration - Proteins = toxic to nephrotic tubules = loss over time = rationale for ACEI – start early when microglobulinaemia

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14
Q

What is the commonest cause of blindness under 65yr?

A

Normal TI diabetics have high triglycerides not necessarily high cholesterol – need to give triglyceride specific treatments – statins won’t work for that.
Commonest cause of blindness <65yrs is diabetic retinopathy

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15
Q

What are the sign/symptoms of neuropathy secondary to TIDM?

A

Peripheral neuropathy – tingling, numbness, even weakness
Autonomic dysfunction – constipation, erectile dysfunction, postural hypotension, gastroparesis

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16
Q

What are the macrovascular complications of TIDM?

A

TIDM – Macrovascular complications not as common – Why? = they are usually kids!
- Takes a long time to develop

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17
Q

Other than insulin, list 2 other potential therapies for TIDM?

A

Pancreatic transplant – not common (Melbourne only) – done at same time as kidney transplant
Islet cell transplant – research stage only

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18
Q

What is the metabolic syndrome?

A

Metabolic syndrome is a collection of conditions that often occur together and increase your risk of diabetes, stroke and heart disease. The main components of metabolic syndrome include obesity, high blood pressure, high blood triglycerides, low levels of HDL cholesterol and insulin resistance.

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19
Q

Metabolic Syndrome
- Definition?
- 5 Criteria for diagnosis?

A
  • Definition: a constellation of medical conditions that commonly manifest together and significantly increase the risk for cardiovascular disease and type 2 diabetes mellitus
  • Abdominal obesity (i.e., accumulation of fat in visceral tissue) is strongly associated with an atherogenic and hyperglycemic state.
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20
Q

List 6 Features of obesity and metabolic syndrome?
List 4 Associated conditions?

A
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21
Q

Pharmacological management of obesity - 4 meds?

A
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22
Q

List the complications of the metabolic syndrome?
- Endocrinologic?
- Cardiovascular?
- Respiratory?
- Reproductive?
- Others?

A
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23
Q

What is Obstructive Sleep Apnoea?
- Definition of Apnea & Hypopnea?

A
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24
Q

What is the Aetiology & 8 Risk factors for Obstructive Sleep Apnoea?

A

An increased neck circumference (> 40 cm) is the most important risk factor for OSA.

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25
Q

Describe the pathophysiology of Obstructive Sleep Apnoea?

A
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26
Q

4 Typical symptoms of Obstructive Sleep Apnoea? 4 Signs of complications of OSA?

A
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27
Q

Describe an approach to diagnosing Obstructive Sleep Apnoea?
- STOP-BANG questionnaire?

A
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28
Q

Which 2 Laboratory tests might you consider ordering for Obstructive Sleep Apnoea diagnosis and what might they show?

A
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29
Q

When are sleep studies for Obstructive Sleep Apnoea indicated?
- What is the gold standard investigation?
- Findings?

A

Sleep studies
Indicated in all patients with excessive daytime sleepiness and at least two of the following:
1. Loud snoring
2. Witnessed choking, gasping, or apnea during sleep
3. Diagnosis of hypertension
Consider in patients with comorbidities (including complications of OSA) and risk factors for OSA.

In-laboratory polysomnography is the gold standard for the diagnosis of sleep-related breathing disorders and can also help identify other sleep-related conditions (e.g., seizures).

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30
Q

Which score is used to classify the severity of Obstructive Sleep Apnoea?

A
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31
Q

List 9 complications of Obstructive Sleep Apnoea?

A
  1. Systemic hypertension
  2. Hypoxia-induced cardiac arrhythmia (e.g., (atrial fibrillation, atrial flutter)
  3. Pulmonary hypertension and cor pulmonale
  4. Global respiratory insufficiency
  5. Cardiac infarction, stroke, and sudden cardiac death (the risk of sudden death is high in infants and the elderly)
  6. Polycythemia
  7. Risk of accidents (e.g., car crashes, occupational accidents) due to microsleep
  8. Increased risk of developing vascular dementia
  9. Poor sleep leads to increased appetite and obesity.
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32
Q

Describe an approach to the treatment of Obstructive Sleep Apnoea? First line tx?

A

Approach to Treatment of OSA
- Treat all patients with diagnosed OSA.
- First-line treatment: positive airway pressure (PAP)
- Consider alternative treatment in patients who are unable to tolerate or decline PAP:
1. Oral appliances
2. Upper airway modifications
3. Positional therapy
4. Supportive care should include management of risk factors, e.g., weight loss and sleep hygiene.

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33
Q
A
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34
Q

What is the diagnosis?

A

mild to moderate depression

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35
Q

What is the diagnosis?

A

Bipolar Disorder with Mania

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36
Q

What is Mood?
What is Affect?

A

Affect = an objective impression of a person’s mood. How another person perceives you.

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37
Q

List 6 causes of mood disorders.

A
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38
Q

List 5 Secondary causes of Depression?
List 3 Causes of Primary Depression?

A
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39
Q

What is Neuroplasticity? What role does it play in depression?

A
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40
Q

How is Depression Diagnosed?
- 3 Core features?
- 3 Additional features?
- Time period?

A
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41
Q

Epidemiology of Depression?

A
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42
Q

Treatment options for depression?
- Mild?
- Moderate?
- Severe?

A

Caution putting those you suspect BPD on an antidepressant as you can cause a full blow manic episode.

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43
Q

What is mania? (8 clinical features, duration?)
What is the difference between mania and hypomania?

A

= Antithesis of depression
Mania usually always requires hospitalization whereas hypomania can often be managed at home

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44
Q

What are 5 different types of Bipolar Disorder?

A
  1. Bipolar Type 1 with HYPER (extreme) mania. There may or may not be much depression.
  2. Bipolar Type 2 with HYPO (not extreme) mania but usually more significant depression.
  3. Rapid cycling with cycling up and down more than 4 times per year, or even ultra-rapid cycling several times within a day.
  4. Mixed States – Both manic and depressed at the same time.
  5. Cyclothymic Disorder – “bipolar light” – Hypomania and mild depression
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45
Q

What are the treatment options for Bipolar?

A

Sodium valproate + Lithium are both teratogenic so consider usage in young women.
Lifestyle changes are super important in bipolar disorder.

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46
Q

Why is Anxiety important for us to know about?

A
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47
Q

What are the treatment options for anxiety?

A

Mainstay of drug treatment for anxiety = antidepressants

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48
Q

What is Psychosis?

A
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49
Q

List 9 Psychotic Disorders on the Psychotic Disorder Spectrum?

A
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50
Q

List 6 symptoms of Psyschotic disorder (eg. Schizophrenia)?

A
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51
Q

List 4 positive and 4 negative symptoms of List 6 symptoms of Psyschotic disorder (eg. Schizophrenia)?

A

Positive = what you can see, negative = cant see.

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52
Q

Causes/Aetiology of Psychotic Disorder (eg. Schizophrenia)?
- List 6 Secondary causes?

A

Causes of Psychotic Disorder - What we Know
Primary = no obvious trigger/ ‘functional mental illness
Secondary = organic
1. Delirium
2. Thyrotoxicosis
3. Medication
4. Drugs
5. Stroke
6. Brain injury

Vulnerable brain + insult = psychosis

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53
Q

What theories underpin the aetiology of psychotic disorders (eg. schizophrenia)? = 3 main ones

A
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54
Q

Why do psychotic disorders like schizophrenia usually onset in early adulthood?

A
  • You are born with way more neurons than you need, during childhood & adolescence & early adulthood, it reshapes (neuronal pruning).
  • Temporo-parietal – sensory
  • Frontal = social interaction, drive to do things.
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55
Q

Describe the Dopamine hypothesis of Schizophrenia? Give evidence as to why it doesn’t fully explain the pathogenesis?

A

Clozapine = the most potent antipsychotic but it’s not the most potent D2 blocker

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56
Q

Describe the Glutamate hypothesis of Schizophrenia?

A
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57
Q

How do you diagnose psychosis? (3 things)
- List 10 investigations you might consider to rule out organic causes?

A
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58
Q

Why is it important to diagnose Psychotic disorders?

A
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59
Q

What are Delusions?
What are they a disorder of?

A
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60
Q

What are Hallucinations?
- What will people report?
- What will you see in someone with hallucinations?

A
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61
Q

What are Schneider’s First Rank Symptoms of Schizophrenia? (4)

A
62
Q

Epidemiology of Schizophrenia? (4)

A
63
Q

How are the subtypes of Schizophrenia categorised?

A
64
Q

What are the pharmacological treatment options for schizophrenia?

A
  • Clozapine > Olazepine/Amisulpride > Risperidone > Quetiapine
  • Antipsychotics are relatively inaffective for negative symptoms and cognitive impairment
  • Clozapine = the most effective drug by far but not first line given the dangerous side effects – must be monitored carefully (agranulocytosis), usually reserved for patients who don’t respond to the others.
65
Q

What are your options for treatment resistant schizophrenia?

A
66
Q

Describe what is involved in the long term treatment of Schizophrenia? (7)

A

Risk of relapse = high so long-term treatment is often necessary
CBT = Cognitive Behavioural Therapy
CRT = Cognitive remediation therapy (CRT), sometimes referred to as cognitive enhancement therapy or cognitive rehabilitation therapy, is a treatment method that helps individuals improve their memory, attention, organizational skills, and information processing.

67
Q

List 5 Complications of Schizophrenia?

A
68
Q

What are the developmental tasks of adolescence?
- Physical?
- Cognitive?
- Psychosocial?

A

Myelination of pathways
Beginning of adolescence = commencement of puberty
End of adolescence = complete ossification of the clavicle (anatomically) and socially – eg. End of university, marriage etc.

69
Q

What are the causes of psychiatric disturbance in adolescents?
- Constitutional?
- Environmental?
- Physical damage or illness?

A

Intra-uterine insult – eg. Fetal alcohol syndrome

70
Q

What does HEADSS stand for?

A
71
Q

Why are adolescents at risk of Psychiatric disorders?
- Explain their vulnerability?
- Explain their Capacity to contain?

A
72
Q

What percentage of adolescents engage in risky behaviours like smoking, alcohol, drugs, sex?

A
73
Q

What are 4 reasons why adolescents pose a risk to harming others?

A
74
Q

What is the prevalence of adolescent suicide and self harm in Australia?

A
75
Q

What are the suicide risk factors for adolescents? (Ask about SUICIDAL acronym)

A
76
Q

What is the Biopsychosocial model of mental health?

A
77
Q

Describe the Biological component of the Biopsychosocial model of mental health?
- 8 Biological Factors?
- 3 Neurotransmitters?
- Genetics?

A
78
Q

Describe the Psychological component of the Biopsychosocial model of mental health?
- 8 Psychological Factors?

A
79
Q

Describe the Social component of the Biopsychosocial model of mental health?
- 9 Social Factors?
- 3 Examples of cultural factors?

A
80
Q

What is the Stress Vulnerability Model of Mental Illness?

A
81
Q

Which psychological treatments are available for mental illnesses? (2)
- List 3 examples of Informal psychological help and 3 characteristics of this therapy type?

A

Psychological Treatments
1. Informal psychological help
2. Psychotherapies
- Insight-directed psychotherapies
- Cognitive behavioural therapies

82
Q

What are 3 characteristics of psychotherapies?
What are the essentials of this therapy type?
List 10 types of psychotherapies?

A

Psychotherapies
- Trained practitioner
- Sanctioned by society to do it
- Guided by some clearly articulated theory
Essentials
- Enable a person to satisfy her/his legitimate needs for affection, recognition, sense of mastery by helping him/her to correct the maladaptive attitudes, emotions, and behaviour which impede the attainment of such…
- Seeks to improve social interactions, reduce distress whilst helping to accept that suffering is an inevitable aspect of life and to use this for personal growth.
- Some have an evidence base, others not.

83
Q

What are the two main types of psychotherapies and 3 common features of all psychotherapy types?

A
84
Q

What is Cognitive Behavioural Therapy?

A
85
Q

What are Cognitive Distortions?

A
86
Q

What is the role of psychological treatments in schizophrenia?

A
87
Q

What is Social Psychiatry? 3 key areas to address?

A
  1. Housing
  2. Employment
  3. Relationships
88
Q

Social Psychiatry - Why is housing an important area to address? Examples of interventions?

A
89
Q

Social Psychiatry - Why is employment an important area to address? Examples of interventions?

A

Social Psychiatry - Employment
- Unemployment is a risk factor for psychiatric illness and suicide
- People with mental illness are overrepresented in unemployment figures
- Many people with MI would like to work
- Employment is a positive contributor to good mental health

90
Q

Social Psychiatry - Why is relationships an important area to address? Examples of interventions?

A
91
Q

What is Lithium and How does it Work?
- MOA?
- Steady state?

A

Lithium is a psychiatric medication used primarily as a first-line therapy for bipolar disorder. It is also used in treatment-resistant depression to augment antidepressants. The specific mechanism by which lithium acts to stabilize mood is not definitively known, but it is thought to be due to inhibition of the phosphoinositol cascade. Common side effects include gastrointestinal distress (nausea, diarrhea), polyuria, polydipsia, and tremor. Lithium therapy has a very narrow therapeutic index; frequent monitoring is therefore required to prevent toxicity.

92
Q

How is lithium excreted?

A
  • 95% of lithium is excreted by the kidneys.
  • It is freely filtered at the glomerulus and mostly reabsorbed in the proximal convoluted tubule via sodium channels.
93
Q

What are the indications for Lithium?

A
94
Q

What are the Adverse Side Effects of Lithium?
- 4 Non-specific?
- 2 Motor?
- 3 Dermal?
- 2 Cardiac?
- Thyroid?
- Kidneys?

A

LITHIUM: “Lithium can cause Irregular Thyroxine levels (hypothyroidism or hyperthyroidism), Heart (Ebstein anomaly), nephrogenic diabetes Insipidus, and Uncontrolled Muscle movements (tremor).”

95
Q

Explain the adverse side effects of lithium on the thyroid?

A
96
Q

Explain the renal adverse side effects of lithium?

A
97
Q

Lithium toxicity:
- At what serum levels does it occur?
- 4 Causes?
- 5 Clinical Features?

A

Toxicity occurs at serum levels > 1.5 mEq/L.

98
Q

How are the adverse side effects of lithium treated?
- General measures?
- Tremor?
- Nephrogenic diabetes insipidus?
- Lithium toxicity?

A
99
Q

What are 2 Absolute contraindications to Lithium?
What are 3 Relative contraindications to Lithium?

A
100
Q

List 3 alternative maintenance treatment options for bipolar disorder?

A

Alternative maintenance treatment options for bipolar disorder include:
1. Lamotrigine
2. Valproate
3. Carbamazepine.
Valproate and antipsychotics (e.g., olanzepine, quetiapine) can be used for treatment of acute mania and hypomania.

101
Q

What 3 tests do you need to order before prescribing lithium to women of child-bearing age?

A

Before prescribing lithium to women of child-bearing age, evaluate thyroid function, renal function, and human chorionic gonadotropin levels to rule out pregnancy.

102
Q

Describe the efficacy of Lithium in the treatment of Bipolar Disorder:
- Acute mania?
- Acute depression?
- Maintenance/prophylaxis?

A
103
Q

Describe the efficacy of Lithium in the treatment of Major Depression:
- Acute?
- Chronic?

A
104
Q

Why is it not ideal to prescribe lithium to women of child-bearing age?

A

Teratogenic effects
It appears that the risk of teratogenic effects from lithium has been exaggerated in the past. However, there is a small risk and lithium is best avoided during pregnancy. Management during pregnancy should be collaborative and requires careful informed consideration of the risks.

105
Q

What are the Recommendations for monitoring patients on lithium?

A
106
Q

Discuss the drug treatment of Bipolar Depression.
- Which drugs? (3)

A
107
Q

Describe the Clinical uses of mood-stabilising drugs:
- Lithium?
- Carbamazepine valproate and Lamotrogine?
- Olanzapine, risperidone, quetiapine, aripiprazole?

A
108
Q

What is the Mechanism of Action of Haloperidol?

A
109
Q

6 Indications for Haloperidol?

A
110
Q
A
111
Q

What are 6 Indications for Urinary catheterisation?

A
  1. Drainage of urine in Urinary retention
  2. Urinary output monitoring
  3. Taking a sterile urine sample
  4. Supportive management of immobilized patients
  5. Drug instillation (e.g., BCG instillation in bladder cancer)
  6. Bladder irrigation with saline (e.g., in haematuria with clots)
112
Q

What are the 2 types of Urinary catheterization and indications for each of them?

A

Transurethral catheterization: a urologic procedure that involves insertion of a catheter through the urethra with placement in the bladder.
- Generally the preferred method for acute bladder catheterization
Suprapubic catheterization: a surgical procedure that involves insertion of a catheter through the abdominal wall with placement in the bladder.
- Method of choice if transurethral catheterization is difficult (e.g., urethral stricture, large prostate) or contraindicated (e.g., suspected urethral trauma, recent urethral surgery, acute bacterial prostatitis)
- Often preferred for chronic bladder catheterization

113
Q

Transurethral catheterization
- Description?
- Indications?
- 3 Contraindications?
- 2 Complications?

A
114
Q

Transurethral catheterization
- Procedure in women? in men?

A

Materials (top left):
Sterile: (a) stopper; (b) 10mL syringe; (c) swabs; (d) tweezers; (e) disposal tray; (f) urinary catheter; (g) lubricant with lidocaine; (h) perforated drape; (i) sterile gloves
Non-sterile: (j) mucosal antiseptic; (k) distilled water; (l) collection bag

Procedure:
1. The sterile drape is placed over the patient. Using one hand to open the labia and the other hand to hold the forceps and water/disinfectant soaked swab, the labia and urethral meatus are cleaned (using one swab per wipe).
2. The lubricant containing lidocaine is applied to the urethral meatus and into the urethra (not illustrated). The lubricant should be given a few minutes to provide adequate numbing of the urethra. The lubrication is then applied to the catheter tip and the catheter is advanced into the urethra until urine flows.
3. The catheter is advanced fully and 10mL of distilled water are injected into the balloon port of the catheter.
4. The catheter is connected to the collection bag and is then withdrawn slowly until the balloon catches and cannot be withdrawn any further.

115
Q

Suprapubic catheterization
- Description?
- 2 Indications?
- 3 Advantages?
- 4 Contraindications?
- 3 Complications?

A
116
Q

What is a Lumbar Puncture?

A
117
Q

What are 3 Indications for a Lumbar puncture?
- In which diseases would you perform it?
- Which 4 pharmaceuticals can be administered this way?

A
118
Q

What are 5 contraindications to lumbar puncture?

A
  1. New onset neurological symptoms
  2. Infection over the site
119
Q

How is a Lumbar Puncture performed?
- Where is the needle inserted, Why?
- Which layers are pierced?
- How many mLs can be collected?

A
120
Q
A
121
Q
A
122
Q
A
123
Q
A
124
Q

What is a Thoracostomy tube?

A
125
Q

List 5 Indications for a Chest Tube?

A
126
Q

3 Contraindications for chest tubes?

A
127
Q

List 8 Complications of Chest tubes?

A
128
Q

How is a chest tube insertion performed? Where to insert?
Layers pierced?

A

Choose an insertion site at the 4th or 5th intercostal space , between the anterior and midaxillary lines.

129
Q

What is a PEG tube?

A

Percutaneous endoscopic gastrostomy - May be performed endoscopically, surgically, or fluoroscopically
Indication: nutrition support is anticipated for ∼ > 4 weeks

130
Q

List 7 Indications for a PEG Tube?

A

Commonly, PEG tubes are used to provide a route for enteral feeding, hydration, and medication administration in patients who are likely to have prolonged inadequate oral intake. Gastrostomy tubes are occasionally placed for decompression in the setting of prolonged ileus, dysmotility, or inoperable intestinal obstruction.

131
Q

What are 8 contraindications to PEG tubes?

A
132
Q

What are the 2 types of PEG tubes?

A

Gastrostomy tube (e.g., inserted via percutaneous endoscopic gastrostomy): a feeding tube that is inserted into the stomach through a small incision in the abdominal wall
Jejunostomy tube
A feeding tube that bypasses the stomach and duodenum
Used if gastrostomy is contraindicated - eg. due to gastroparesis, chronic pancreatitis

133
Q

List 9 Complications of PEG Tubes?

A
134
Q

List 4 Indications for Nasogastric tubes?

A
135
Q

List the different Possible routes for feeding?

A
136
Q

When to use an Enteral tube (Enteral tube decision tree)?

A
137
Q

List some of the contraindications for nasogastric tubes?

A
138
Q
A
139
Q

What is non-pharmacologic therapy for pain?
List 6 types.

A

Non-pharmacological pain management is the management of pain without medications. This method utilizes ways to alter thoughts and focus concentration to better manage and reduce pain.
1. Education and psychological conditioning
2. Hypnosis
3. Comfort therapy
4. Physical and occupational therapy
5. Psychosocial therapy/counseling
6. Neurostimulation

140
Q

Describe Non-pharmacologic therapies for pain:
- What does Education and psychological conditioning involve?
- What does Hypnosis involve?

A
141
Q

Describe Non-pharmacologic therapies for pain:
- What does Comfort Therapy involve?
- What does Physical and occupational therapy involve?
- What does Psychosocial therapy/counseling involve?
- What does Neurostimulation involve?

A
142
Q

Describe the World Health Organisation’s analgesic ladder for the management of pain.
- 3 Main principles?

A
  • The WHO analgesic ladder was a strategy the World Health Organization (WHO) proposed in 1986 to provide adequate pain relief for cancer patients.
  • This analgesic path is currently applied for managing cancer pain, acute and chronic non-cancer painful conditions due to a broader spectrum of diseases such as degenerative disorders, musculoskeletal diseases, neuropathic pain disorders, and other types of chronic pain.
  • The three main principles of the WHO analgesic ladder are: “By the clock, by the mouth, by the ladder”.
  • This three step approach is inexpensive and 80-90% effective when optimally utilized.
143
Q

What is patient-controlled analgesia? What are the indications for the usage of PCA?

A

Patient Controlled Analgesia (PCA) is a method of pain relief that allows a patient to selfadminister small doses of analgesia as required, from a locked programmable pump. PCA is
appropriate for patients’ who have acute pain which is likely to warrant repeated doses of
parenteral opioid.

144
Q

What are the side effects of common pain medications:
- NSAIDS? (7)

A
145
Q

What is the MOA & side effects of common pain medications:
- Tramadol?

A
146
Q

What are the side effects of common pain medications:
- morphine, fentanyl and codeine? (Opioids)

A

Opioid analgesics act on receptors in the CNS and GIT producing analgesia, respiratory depression, sedation and constipation. They act mainly at mu-opioid receptors in the CNS, reducing transmission of the pain impulse, and by modulating the descending inhibitory pathways from the brain. Cough suppression occurs in the medullary centre of the brain.

147
Q

List 5 causes of nausea and vomiting?
7 Serious causes of N&V?

A
  1. Concussions.
  2. Encephalitis.
  3. Meningitis.
  4. Intestinal blockage.
  5. Appendicitis.
  6. Migraine headaches.
  7. Brain tumors.
148
Q

What would you look for on examination of Nausea and
vomiting in adults?

A
149
Q

What are appropriate diagnostic laboratory and radiological studies to order for the evaluation of the patient with nausea and vomiting?

A

In many cases nil investigations may be appropriate. Basic
biochemistry may include (as appropriate):
* electrolytes and renal function
* full blood count
* pancreatic and liver enzymes
* glucose.
If small bowel obstruction is suspected, erect and supine
abdominal radiographs should be considered. However,
it should be remembered that these are neither sensitive
nor specific. They can be normal in patients with partial/
subacute obstruction and acute gastroenteritis may cause
a degree of small bowel dilation and some fluid levels.

150
Q

List 10 Common medications causing nausea and vomiting.

A
151
Q

Describe appropriate measures for the protection of the airway in a patient with impending airway compromise from nausea and vomiting.

A

The nauseated patient may be more comfortable in a Fowler’s or semi-Fowler’s position, but if vomiting or regurgitation occurs, or appears imminent, the patient should be placed in a reclined position with the head lower than the chest and abdomen; a partial or full Trendelenburg position is preferred. This will reduce the risk for aspiration. Also, the patient should be turned on their right side based on anatomical considerations. The right primary bronchus branches at a less acute angle from the trachea, and aspirated material is more likely to enter the right lung, at least initially. Turning the patient to the right side may spare the left lung from aspirant. While positioning the patient, initiate high volume suctioning using a tonsil or Yankauer tip. Avoid placing the suction tip too deeply into the oropharynx to avoid triggering more retching and pushing vomitus further into the airway.

YR3 - R1: General Medicine (8 decks)

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