Dr. Morgan Flashcards
Define Counselling
Counselling is a process aimed at influencing individuals’ knowledge about their health and healthcare with a purpose to not only inform but also to change behaviour
Principles of counselling (hint: 7)
Principle of acceptance
Principle of communication
Principle of empathy
Principle of non-judgemental attitude
Principle of confidentiality
Principle of individuality
Principles of non-emotional involvement
The most common sickle cell syndromes (i.e., genotypes) are (hint: 3)
Sickle Cell Anaemia - 65%
Hemoglobin SC disease - 25%
Hemoglobin S Beta Thalassemia,
Some people with sickle cell trait can show the hematological abnormalities of sickle cell syndrome, T/F
FALSE
Sickle trait not associated with any hematological abnormalities
Sickle cell disease is the most common inherited blood disorder, T/F
TRUE
Male to female ratio of SCD IS 1:2, T/F
FALSE
Male / Female 1:1
Composition of Adult hemoglobin A2 is ________
2-alpha chains & 2-delta chains
There are 6 different globin chains, name them
( i ) Alpha with 141 a.a ( ii ) Beta ( iii ) Gamma ( iv) Delta
(v) Epsilon ( vi) Zeta All with 146 a.a
In HbS there is substitution of Thymine for Adenine in the 6th codon of beta chain, T/F
TRUE
The loss of _______ is central to the pathophysiology of sickle cell disease
red blood cell elasticity
Sickle cells only function/last for __ to __ days
10 - 20 days
Clinical features of Sickle anemia varies among patients, T/F
TRUE
The earliest clinical feature of sickle cell anemia is ______
Dactylitis- painful swellings of the hands and feet
The anemia in SCD is microcytic hypochromic, T/F
FALSE
Normocytic normochromic anemia (Hall mark on FBC)
The average Hb conc. in SCD is ______
8g/dL
Howell-Jolly bodies and Paperiheimer bodies on blood smear of SCD patient reflects ______
Functional asplenia
Prominent blood smear features of sickle cell disease (hint: 6)
Sickled cells, target cells and ovalocytes.
Polychromasia, basophilic stippling, and normoblasts are prominent
WBC count increases in vaso-occlusive crises state, T/F
TRUE
Platelet aggregation is increased in SCD, T/F
FALSE
Platelet aggregation is decreased, the likely result of in vivo platelet activation
Platelet count is decreased in SCD, T/F
FALSE
The platelet count is increased (approximately 440 × 109/L), reflecting reduced or absent splenic sequestration
Total platelets are decreased during vaso-occlusive crises, T/F
TRUE
The level of _______ indicates the severity of bone crises in SCD
Serum alkaline phosphatase
Gold standard for diagnosing SCD is
Hb Electrophoretic or chromatographic separation of haemoglobins in haemolysates prepared from peripheral blood
Lab tests to diagnosis of SCD (hint: 3)
- Haemoglobin solubility test
- Sickling test
- Hb Electrophoretic or chromatographic separation of haemoglobins in haemolysates
List the 4 types of crises in SCD
Vaso occlusive
Aplastic
Sequestration
Hemolytic/ hyperhemolytic
Concerning SCD crises, the hallmark of the disease is _______
Vaso occlusive crisis
Aplastic crisis in SCD is caused by _____
Parvovirus B19
Concerning Sequestration crisis in SCD
- Major Hb conc. crisis is Hb conc of ____
-Minor Hb conc. crisis is Hb conc of _____
Major Hb <6g/dl
Minor Hb >6g/dl
Fall in >3g/dl from baseline is which SCD crises
Major Hb sequestration crisis
A person has G6PD-def. and diagnosed to have SCA, which crisis will he likely come down with?
Hemolytic/ hyperhemolytic
List the Management principles in SCD (hint: 5)
History, Physicals, Lab. Investigation
Health maintenance
Management of Sickle emergencies
Infection prevention
Pain management
Chronic disease/complication management
Which investigation is indicated for brain study in SCA patients
Transcranial doppler ultrasonography
What nutritional supplement do SCD patient need in health maintenance
Folate
Penicillin prophylaxis should begin at ____ age for SCD patient
2 Months
In health maintenance in SCD, frequent visits should be every __to __ months
3 to 6 months
In health maintenance in SCD patient, Pneumococcal vaccination is indicated at 7yrs of life, T/F
FALSE
Pneumococcal vaccine at five years
Acute chest syndrome is treated with _____
Blood transfusion
Eye trauma is an emergency in Sickle cell trait, T/F
TRUE
Eye trauma is an emergency in ALL sickle conditions(including sickle trait)
Onset of Priapism is common in the morning, T/F
TRUE
Treatment of stroke in SCD is with chronic transfusion to maintain sickle Hb(PCV) levels at or below _____
30%
Chronic pain (in SCD material) is pin lasting for > _____ to ___ months
> 3 to 6 months
The risk factors that points to progressive renal failure are (hint: 3)
Anemia, Proteinuria, Hematuria
NSAID is contraindicated in renal failure, T/F
TRUE
Mention Anti-sickling drugs (hint: 2)
Solamin, Niprisan
Drugs to increase Fetal hemoglobin (hint: 4)
5-azacytidine
5-aza 2’-deoxycytidine
Cytosine arabinoside
Hydroxyurea (10-15 mg daily)
Highest cause of death in SCD is _____
Infection
Ways to prevent SCD are (hint: 2)
Screening
Counselling of carriers
Concerning screening of Chlamydia as one of the ways to reduce PID, annual screening is recommended for ______ & _____
Annual chlamydia screening is recommended for:
Sexually active women 25 and under
Sexually active women >25 at high risk
To reduce the incidence of PID, pregnant women are recommended to screen for Chlamydia at _____ trimester
1st trimester
Ways to prevent PID (hint: 6)
Abstinence
Use of condoms correctly and consistently
Avoiding multiple sexual partner
Prompt diagnosis and appropriate treatment of STI/PID
Routine screening for STI where risk exist
Contact tracing for screening/ treatment of partner
The 2 forms of PID are _____ & ____
Acute & Chronic PID
___% of infections occur following procedures that break cervical mucous barrier.
15%
About 55% are spontaneous infections in sexually active females of reproductive age, T/F
FALSE
About 85%
Most cases of PID are Monomicrobial, T/F
TRUE
Most common pathogens in microbial etiology of PID are _____ & ______
N. gonorrhoeae
C. trachomatis
N. gonorrhoeae and C. trachomatis are present in combination in approximately 25%-75% of patients
Between C. trachomatis and N. gonorroeae which has more severe tube involvement
C. trachomatis
Two major sequelae of PID with N. gonorrhoeae + prior C. trachomatis infection are
Infertility & Ectopic pregnancy
In < 1% of cases, acute PID can stem from other routes such as (hint: 3)
hematogenous routes
Lymphatic spread
transperitoneal spread
99% of cases of Acute PID is from ____ route
endometrial-endosalpingeal-peritoneal route
Concerning the pathophysiology of PID, the first stage is ________
acquisition of a vaginal or cervical infection (STDs) usually asymptomatic
Acute perihepatitis extending for PID is called ______
Fitz-Hugh−Curtis syndrome
Abnormal vaginal discharge is present in approximately 90% of cases, T/F
FALSE
75%
Diagnosis of PID recommended by CDC is
The CDC recommends instituting empiric treatment when a young woman who is at risk for STI has pelvic/lower abdominal pain, no identifiable cause for her illness other than PID, and, on pelvic examination, 1 or more of the following minimal criteria
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Diagnosis of PID is usually clinical, T/F
TRUE
________ confirmatory investigation is gold standard for PID
Laparoscopy
Complications of PID (hint: 4)
Tubo-ovarian abscess
Infertility
Ectopic pregnancy
Chronic pelvic pain
The CDC recommended OUTPATIENT treatment for PID
- Regimen A
- Regimen B
Regimen A consists of the following
Ceftriaxone 250 mg IM in a single dose
Regimen B
Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally in a single dose
PLUS - Doxycycline 100 mg orally 2 times a day for 14 days
Metronidazole 500 mg orally 2 times a day for 14 days can be added if there is evidence or suspicion of vaginitis or if the patient underwent gyneacological instrumentation in the preceding 2-3 week (FOR BOTH
`The CDC recommended IN-PATIENT treatment for PID
- Regimen A
- Regimen B
Some experts recommend rescreening for C. trachomatis and N. gonorrhoeae __ to __ weeks after completion of therapy in women with documented infection with these pathogens
4-6weeks
In continuity of care, care is less costly, T/F
TRUE
Holistic care synonyms are (hint: 3)
Holistic health
Wholistic health,
Holism
Define Holistic care
A healing approach that considers the whole person-body, mind, spirit and emotions- and their interactions in the process of promoting health and well-being and treating disease
Types of treatment techniques a holistic practitioner can use
- Patient education on lifestyle changes and self-care
- Complementary and alternative therapies
- Western medications and surgical procedures
Chiropractor is a holistic provider, T/F
TRUE
Holistic medicine focuses mostly on lifestyle changes, T/F
TRUE
In home visits, the health worker assesses the ______ & _______ in order to provide the necessary health related care
Home & family situation
To conduct home visits effectively, physicians must acquire 3 things, name them
- fundamental and well-defined attitudes
- knowledge and skills
- an inexpensive set of portable equipment
Telephone and telemedicine have no role in Home visits, T/F
FALSE
The four major types of home visits are
- Illness home visits
- Home visits to dying patients and families
- Assessment home visits
- Hospitalization follow-up home visits
Hospitalization follow-up home visits can also be called ______
Monitoring home visits
Concerning the settings of home visits, match the type of home visits that applies
a. Parents with newborn
b. Polypharmacy
c. Terminal care
d. Emergency
e. Chronic illness
f. Pronouncement of death
g. Excessive use of health care service
h. Acute illness
i. Grief
j. Multiple medical problems
k. Poor compliance
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Assessment home visit can also be described as ________ home visit
Investigational home visit
Assessment home visit is valuable in assessing the need for nursing home placement of a frail elderly patient with uncertain social support, T/F
FALSE
It is INVALUABLE
_______ home visit is useful when significant life changes have occurred
Hospitalization follow-up home visit
Concerning conducting a home visit, list the steps in planning (hint: 6)
- Clarify the reason for the visit and carefully plan the agenda
- Gather the necessary equipment and patient education materials
- Have a map, the patient’s telephone number and directions to the patient’s home
- Set a formal appointment time for the visit involving the patient & home care service team
- Coordination of house call to allow for the presence of key family members or significant
- Confirm the appointment time with all involved parties before departure
Concerning home visit, the physician-supplied equipment is divided into 2, which are
Essential
Optional
Glucometer is an essential physician-supplied equipment, T/F
FALSE
Patient educational material is an essential physician-supplied equipment, T/F
FALSE
List the issues to assess during home visit (home visit checklist)
I Immobility
N Nutrition
H Housing
O Other people
M Medications
E Examinations
S Safety
S Spiritual health
S Services by home health agencies
Physician can make assumption about social class/material wealth based on the the patient’s environment, T/F
FALSE
Define mental health care in primary care
defined as “the provision of basic preventive and curative mental health care at the first point of contact of entry into the health care system.”
The two main diagnostic categories of common mental disorders are
Depressive disorders and Anxiety disorders
Define depression
Depression is a disorder of the mood that causes a persistent feeling of sadness and loss of interest (also called major depression)
Major depressive disorder (MDD) has been ranked as the 2nd cause of the burden of disease worldwide in 2008 by WHO, T/F
FALSE
3rd
Approximately 80% of MDD patients who achieve remission experiencing at least one recurrence in their lifetime, T/F
TRUE
List the Risk factors for Depressive disorders (hint: 9)
Family history and Genetics
Gender: F>M = 2:1
History of trauma/abuse
Chronic Stress
Unresolved Grief or Loss
Personality Traits
Medication and Substance Use
History of other Mental Disorders
Chronic Medical Condition
(Divide it into Modifiable & Non-modifiable)
Hypothyroidism can cause depression, T/F
TRUE
The DSM-5 criteria for Major depressive disorder (hint: 4)
- Five or more out of 9 symptoms (including either depressed mood, or loss of interest or pleasure) in the same 2-week period.
- Each of these symptoms needs to be present nearly every day
- Symptoms cause significant distress or impairment
in daily function - Symptoms are not secondary to substance use
or a general medical condition
List the 9 symptoms associated with Depressive disorders (e.g., MDD)
- Depressed mood (subjective or observed); can be an irritable mood in children and adolescents, most of the day;
- Loss of interest or pleasure, most of the day;
- Change in weight or appetite. Weight: 5% change over 1 month;
- Insomnia or hypersomnia;
- Psychomotor retardation or agitation (observed);
- Loss of energy, or fatigue;
- Worthlessness or guilt;
- Impaired concentration or indecisiveness; or
- Recurrent thoughts of death or suicidal ideation or attempt
In the pathophysiology of MDD, which central nervous system neurotransmitter activity plays an important factor
Serotonin (5-HT)
With adequate treatment of MDD, median time at recovery is ____weeks
20 weeks
Risk factors for suicide (hint: 10 - “IS PATH WARM”)
ideation, substance use, purposelessness, anger, trapped, hopelessness, withdrawal (social), anxiety, recklessness, mood change (dramatic)
The lifetime risk of suicide in an untreated MDD is ___%
20%
In each episode of MDD, risk of suicide becomes greater, T/F
TRUE
Depression Rating scales and screening tools can be used alone to diagnose Depression, T/F
FALSE
should be used to augment information from the clinician’s diagnostic assessment
Concerning Patient Health Questionnaire (PHQ-9) Depression rating scale,
score of 22 is ____
score of 6 is _____
score of 18 is _____
score of 11 is _____
In the mgt of MDD, TCA may cause exacerbation of cardiac conduction abnormalities, T/F
TRUE
Diagnosis of Depression is mainly clinical, T/F
TRUE
Factors that favour general advice and active monitoring in Depression (hint: 6)
- four or fewer of the above symptoms with little associated disability
- symptoms intermittent, or less than 2 weeks’ duration
- recent onset with identified stressor
- no past or family history of depression
- social support available
- lack of suicidal thoughts.
Factors that favour more active treatment of Depression in primary care are (hint: 5)
- five or more symptoms with associated disability
- persistent or long-standing symptoms
- personal or family history of depression
- low social support
- occasional suicidal thoughts.
A major differential to rule out in a suspected case of MDD is _______
Hypothyroidism
Mention Non-pharmacological modalities for treatment of MDD
- Lifestyle modification
- Psychotherapy (e.g. cognitive behavioural therapy (CBT) and interpersonal therapy)
- Phototherapy
- Refer patient to local support groups (if there are any)
The standard treatment for MDD with seasonal pattern is _______
Phototherapy
In pharmacotherapy for MDD, the classes of drugs that can be used are (hint: 6)
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs
- Serotonin modulators
- Atypical antidepressants
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
Concerning Pharmacotherapy for MDD, the first line for treatment is ____ class of drug
Selective serotonin reuptake inhibitors (SSRIs)
Other treatment modalities of MDD excluding Non-pharmacological and pharmacotherapy) (hint: 3)
- VAGAL NERVE STIMULATION
- ELECTROCONVULSIVE THERAPY (ECT)
- TRANSCRANIAL MAGNETIC STIMULATION (TMS)
Treatment of choice for MDD with severe suicidal ideation or food/drink refusal is __________
ELECTROCONVULSIVE THERAPY (ECT)
Concerning continuity of care, end continuity of care when patient is not seeking health, T/F
FALSE
a commitment despite referral, death, failure or cure, and whether the patient is seeking health care or not
Continuity of care does not include responsibility for preventive care, T/F
FALSE
includes responsibility for preventive care and care coordination
Mention 5 benefits of Continuity of care
- It enhances a bond between the physician and patient characterized by loyalty, trust and sense of responsibility
- It enables the physician in detecting early signs and symptoms of organic disease and differentiating it from a functional problem
- Families receiving continuing comprehensive care have a decreased incidence of hospitalizations, fewer operations, and less physician visits for illnesses
- Continuity of care improves quality of life especially for those with chronic medical illnesses such as asthma and diabetes
- Care is less costly
The transfer of responsibility from the original physician to another physician is consultation, T/F
FASLE
Concerning referral, the transfer of responsibility should never be total, T/F
TRUE.
Well, in Collateral Referral there is transfer of complete responsibility for a limited period
A physician that initiates a consultation is called _______
Referring Physician
A physician that initiates a referral is called _______
Referring Physician
A person who is consulted or to whom the patient is referred to is called ________
Consultant:
Mention two types of consultations
Informal and Formal
Telephone communication is not a part of Formal consultation, T/F
FASLE
May use telephone if consultation is urgent
In informal consultation, the consultant and the doctor requesting consultation sees the patient together, T/F
FALSE.
Formal
In formal consultation communication must be in writing, T/F
FALSE
Telephone communication may be used in cases of emergency
Mention the 4 types of referral
- Interval referral
- Collateral referral
- Split referral
- Cross referral
In Interval referrals, the patient is referred for care of some specific problem for a limited period, T/F
FALSE
referred for complete care for a limited period
Concerning Interval referral, the referring physician has no responsibility during the limited period of referral, T/F
TRUE
Concerning Collateral referral, the referring physician has no responsibility during the limited period of referral, T/F
FALSE
The referring physician retains overall responsibility
In Collateral referral, the referring physician only refers the patient for care of some specific problem for a period of time, T/F
TRUE
Which type of referral takes place under multispecialist practice
Split referral
Responsibility is divided evenly among two or more physicians
In which type of referral does the referring physician accept no further responsibility
Cross referral
Cross referral can only be initiated by the patient (self-referral), T/F
FALSE
Occurs after self referral by the patient or even after referral by the family physician
Whenever the patient or family express doubt or shows lack of confidence in diagnosis or management is a reason for referral, T/F
TRUE
A referral from Primary health care system to Secondary health care system is ________
Vertical referral
A referral from a Tertiary health care system to a Tertiary health care system is ________
Horizontal referral
A referral within the same institution (hospital) is called ________
Internal referral
In referral, patients must be involved in decision making, T/F
TRUE
Patients’ Irritability and stubbornness is a valid reason for referral, T/F
FALSE
Wrong reason
Concerning the consultation process, it is not necessary for the family physician to provide feedback to the consultant regarding the outcome of his recommendation, T/F
FALSE
The family physician provides feedback to the consultant regarding the outcome
Steps of referral process (hint: 8)
- Establish a good relationship with the patient.
- Establish the need for a referral.
- Set objectives for the referral.
- Explore resources availability.
- Patient decides to use or not use.
- Make pre-referral treatment.
- Facilitate, coordinate referral.
- Evaluate and follow up
Mention the responsibilities of the referring physician (hint: 5)
- Selection of the consultant
- Adequate transfer of information
- Patient preparation and compliance
- Evaluation of information
- Feedback to consultants
In selection of a consultant, the personality compatibility with the patient is important, T/F
TRUE
Components of a Referral letter (hint: 12)
- Identifying data of the patient
- Identifying data of the referring physician
- Date
- Statement of the problem/PC
- Relevant history
-Statement of the problem
-PMHX/PSHX
-Current drug Hx/allergies - Relevant Examination findings
- Include results of relevant investigations
- Working assessment
- Describe treatment initiated
- State reason for referral
- State what information you have given to the patient regarding the referral.
- Indicate your willingness to be involved in the ongoing care of the patient
Referrals and consultations should be subjective, T/F
FALSE
Objective
The principles that guide referral and consultations are (hint: 3)
Objective, Timely/ prompt and individualized
Diagnosis of Poisonings is primarily laboratory, T/F
FALSE
Diagnosis is primarily clinical, but for some poisonings laboratory investigations may be helpful
What is Munchhausen syndrome by proxy
Parent, who may have some medical knowledge, poison their children because of unclear psychotic reasons or a desire to cause illness and thus gain medical attention
Patients who ingest multiple substances (poisons) are less likely to have symptoms characteristic of a single substance, T/F
TRUE
Inhaled toxins are likely to cause lower airway symptoms of non-cardiogenic pulmonary edema if they’re less water soluble, T/F
TRUE
Inhaled toxins are likely to cause symptoms of upper airway injury if less water soluble, T/F
FALSE.
If water soluble
SLUDGE syndrome is seen in Cholinergic (nicotinic) poisoning, T/F
FALSE
Cholinergic- muscarinic
If blood levels of a substance or symptoms of toxicity increase after initially decreasing or persist for an unusually long time _____________ should be suspected
Bezoar, a sustained release preparation or re-exposure should be suspected
Concerning poisonings, ________ is usually given particularly when multiple or unknown substances have been inngested
Activated Charcoal
Mechanism of Activated Charcoal in mgt of ingested poisons
Activated Charcoal works adsorbing toxins
Dose of Activated charcoal in
- younger children
- in Adults & older children
a dose of 1-2g/kg in children and 50-100g for older children and adults 4-6hourly as a slurry in water or soft drinks
Use of charcoals adds little risk unless patients are at risk of ______ & _________
vomiting and aspiration
Use of Activated charcoal is ineffective in ingestion of which toxins (hint: 3)
caustics, alcohols and ions
Gastric emptying is contraindicated in ______ substance
Caustic substance
The preferred method for gastric emptying in poisoning is ________
Gastric lavage
__________ is indicated for serious poisons due to sustained release preparations or substances not adsorbed by charcoal such as heavy metals, packs of cocaine or for suspected bezoars
Whole Bowel Irrigation
Solution used for whole bowel irrigation contains _______ & _______
polyethylene glycol (which is non absorbable) and electrolytes
Concerning poisoning, general indications for Hospital Admission
Altered consciousness
Persistently abnormal vital signs
Predicted delayed toxicity – slow release of toxins
For Psychiatric evaluation
Mention prevention of poisoning (hint:
- Use of child-resistant container with safety caps
- Clearly labeling household products and prescription drugs
- Storing drugs and toxic substances in SAFETY CABINETS that are labeled
- Promptly disposing expired medication e.g flushing them down the toilet.
- Use of Carbon monoxide detectors
- Public education measures to encourage storage of substances in their original containers not kerosene in sprite bottles
The principal toxic metabolite of acetaminophen is __________
N-acetyl-P-benzo quinone imine (NAPQI)
Concerning Acetaminophen toxicity/poisoning, an adult overdose must total 100mg/kg within 24hours, T/F
FALSE - 150mg/kg in 24hrs
To cause toxicity, an adult overdose must total = 150mg/kg (i.e about 7.5g in adults) within 24 hours (about 15 tabs)
All patients with non-accidental ingestion of Acetaminophen overdose should be considered as attempted suicide, T/F
TRUE
Acetaminophen is commonly used for suicide
Likelihood and severity of hepatotoxicity from Acetaminophen overdose can be predicted by __________ & _________
serum acetaminophen levels (accurately)
Rumack-Mathew nomogram (If time of ingestion is known)
Antidote for Acetaminophen overdose is ________
and the dose (iv and Oral)
n-acetylcysteine
IV Loading dose of 150mg/kg in 200mls of 5% D/W given over 15 mins. Maintenance 50mg/kg in 500mls of 5% D/W over 8 hours then, 100mg/kg in 1000ml of 5% DW over 16 hours
Loading dose of 140mg/kg, then 17 additional doses of 70m/kg every 4 hours
Treatment for Carbon monoxide poisoning
Remove px from source of exposure
Stabilize as necessary
100% O2
Supportive treatment
Measurement of carboxy Hb levels __________
co-oximeter
Also with Arterial Blood gas
Acid caustics cause coagulation necrosis, T/F
TRUE
Alkali caustics cause coagulation necrosis, T/F
FALSE
Alkali Cause Liquefaction necrosis
Between Acid caustics and Alkali caustics which is more corrosive?
Alkali caustics
Alkali Cause Liquefaction necrosis, no eschar forms, damage continues until alkali is neutralized or diluted
Eschars are not formed with ingestion of Alkali caustics, T/F
TRUE
Acid caustics affect esophagus more than stomach, T/F
FALSE
Acid caustics tend to affect the stomach more than the esophagus
IV corticosteroids and prophylactic antibiotics are recommended in Caustic ingestions, T/F
FALSE
Not recommended
Neutralization of Acid caustic ingestion is part of the treatment, T/F
FALSE
Attempts at neutralizing with alkali and vice versa is contraindicated, because severe exothermic reactions
Activated charcoal is contraindicated in Caustic ingestions because of _________ & __________
Activated charcoal may infiltrate burned tissue and interfere with endoscopic evaluation
Management of Caustic ingestion is mainly supportive, T/F
TRUE
Antidote for Opioid is ____
Naloxone
Antidote for Tricyclic antidepressants
NaHCO3
Antidote for Metho haemoglobin
Methylene blue
Antidote for Iron
Deferoxamine
Antidote for Organophosphates
Atropine
Pralidoxime
Antidote for Benzodiazepines
Flumazenil
Definition of Family (hint: 4 lines)
A group of individuals who are related biologically, legally or by choice and from whom one reasonably expects a measure of support in form of food, clothing, shelter or emotional nurturing and who shares a past, present and future and includes all who contribute in one way or the other to the family culture
A family group consisting of two people living together, ususally a woman & a man, without children is called?
Dyad family
Family medicine is a primary care oriented specialty, T/F?
TRUE
Define Family Medicine
A group of individuals who are related biologically, legally or by choice and from whom one reasonably expects a measure of support in terms of food, clothing, shelter or emotional nurturing and who shares a past, present and future and includes all who contribute in one way or the other to the family culture.
Domains of Family medicine are (hint:3)
Hospital-based care, Family care & Primary care
Khan’s 7-stars doctor (hint: picture the start)
Community leader, Communicator, Care provider, Decision maker/Advocate, Manager, Researcher, Coordinator
Define Ageing
Ageing can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility
Ageing is a time related decline in the physiological functions necessary for survival and reproduction
Reasons for rising ageing population (hint: 3)
- Breakthroughs in healthcare = increased life expectancy.
- People choosing to have smaller families.
- Falling birth rates:
Later marriages
Better education about contraceptives.
increased number of women working.
Classify ageing
- Objective
- Subjective
- Functional
According to WHO, adult aged >65 is elderly, T/F
FALSE
WHO: adults aged ≥ 65 years
List the concepts of ageing (hint: 5)
- CHRONOLOGIC AGEING (change in the no. of years lived)
- BIOLOGIC AGEING (changes in physiology)
- PSYCHOLOGIC AGEING (changes in behavior, personality & act)
- SOCIAL AGEING (changes in roles & relatonships)
- COGNITIVE AGEING (changes in the basic process of learning & memory)
Mnemonic: Biopsychosocial C^2
Biologic/biological ageing is also called ______ or _____
Senescence or Physiologic ageing
Social ageing is profoundly influence by the society’s culture, T/F
TRUE
The two major categories of ageing theories are
The Programmed theories
The Damage of Error theories
A major hallmark of ageing is a decrease in inflammatory levels reflected by lower levels of circulating pro-inflammatory cytokines, T/F?
FALSE.
Increased levels
Hearing loss that occurs in ageing is usually to low frequency sound, T/F
FALSE
High frequency sounds
Problem solving skills increase with age, T/
TRUE
Intellectual functioning defined as “stored” memory decrease with age, T/F
FALSE.
Increases with age
Emotions play a significant role in appetite & digestion, T/F
TRUE
Orthostatic hypotension is relatively common in the elderly, T/F
TRUE
The symptoms of climacteric period are typically present for about ____
5 years
Autoimmue disorders increased in older adults, T/F
TRUE
increase in findings of positive
rheumatoid factor, anti-nuclear antibody, and false-
positive syphilis screens in healthy older adults
Lipofusin is ageing pigment, TF?
TRUE
Define Patient centered care
“providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” (Institute of Medicine (IOM) definition)
Picker’s Eight (8) dimensions/principles/core values of Patient centered care
(hint: PACE CRII)
P - Physical comfort
A - Assess to care
C - Coordination and integration of care
E - Emotional support
C - Continuity and transition
R - Respect to patient’s preferences
I - Information and education
I - Involving friends and family
Patient’s expectation is based on his/her understanding of the disease, T/F
TRUE
Advantages of taking Illness experience or Actual Reasons for Coming (hint: 6)
- It will ensure patient’s satisfaction.
- It will reduce doctor/clinician shopping/hopping.
- It will reduce legal suits by angry patients.
- It will help physician’s ability to deal with patient’s needs for Education
- It helps with Reassurance
- It helps with Treatment
Mention the 6 basic components of Patient centered care model
- Exploring & differentiating both the disease and the illness
- Understanding the whole person
- Finding common ground with the patient-mutual decisions (problems, goals, roles)
- Incorporating health promotion and disease prevention
- Enhancing doctor- patient relationship
- Being realistic with time and resources
Concerning PCC, disease is mainly biological and ______
Psychological
Concerning PCC, illness includes not just the biological and psychological aspect but also the _____ & ______
Social and Spiritual
Tools used in understanding the whole person are (hint: 4)
family life cycle, family status, family genogram, family circle
Disease prevention/reducing the risk of acquiring a disease can be achieved via (hint: 4)
- Risk avoidance
- Risk reduction
- Early identification
- Complication reduction
All older person ages at the same rate, T/F
FASLE
HETEROGENEITY OF AGEING
There is constriction of homeostasis (i.e., Homeostenosis) from ___ age
30years
With advancing age (from age of 30 years) there is constriction of homeostasis (HOMEOSTENOSIS)
Beginning age of “Elderly”:
-WHO: adults aged: ___
-UN General Assembly: ____
-Developed Countries: ___
-Less developed areas esp SSA: ___
WHO: adults aged ≥ 65 years
UN General Assembly: ≥ 60 years
Developed Countries: ≥ 65 years
Less developed areas esp SSA: ≥ 60 years
The Global Agewatch index ranks countries by how their older populations are faring using key indices (hint: 4)
- Income security
- Health Status
- Capability
- Enabling societies and environment
Care of the Elderly is longitudinal, T/F
TRUE
Comprehensive Geriatric assessment is multidimensional. the 4 domains (4 most important areas of care) assessed are
- Functional ability
- Physical health
- Mental health/cognition
- Socio-environmental
Health characteristics of the elderly (hint: 7)
- Multiple morbidities
- Atypical presentation of diseases
- Multiple pathologies causing a particular disease
- More complications arising from diseases
- Prolonged hospital stay
- Poor recovery from diseases
- Deranged social factors
The differences of elderly assessment from standard medical evaluation (hint: 3)
- Including non-medical domains
- Emphasis on functional capacity and quality of life
- Incorporating a multidisciplinary team
GERIATRIC GIANTS- The 14 I’s
- Intellectual impairment
- Insomnia
- Impaired hearing
- Impaired vision
- Impaction
- Incontinence
- Impotence
- Instability- falls
- Immobility -
- Inanition
- Immune-deficiency
- Infection
- Iatrogenia
- Isolation
Define functional status
Functional status refers to a person’s ability to perform tasks that are required for living.
The two (2) key divisions of functional ability
- Basic activities of daily living (BADL)
- Instrumental activities of daily living (IADL)
self-care activities that a person performs daily is called ______
Basic activities of daily living (BADL)
What tool is used to assess the Basic activities of daily living (BADL)
The Katz index questionnaire
List the Basic activities of daily living (BADL)
Continence
Toileting
Bathing
Dressing
Feeding
Transferring
The highest scores in the Ketz index is ____
6
_______ activities are activities that are needed to live independently
Instrumental activities of daily living (IADL)
_____ tool aids in assessing the Instrumental activities of daily living (IADL)
Lawton- Brody instrumental tool
For the Physical health assessment of the elderly, special topics includes (hint: 6)
- Nutrition
- Vision
- Hearing
- Fecal and urinary continence
- Balance and fall prevention, osteoporosis
- and Polypharmacy
Coomon causes of vision impairment in the elderly (hint: 4)
Presbyopia,
glaucoma,
diabetic retinopathy,
cataracts.
In Diabetic retinopathy, there is blurring of the peripheral vision to blindness, T/F
FALSE
Blurring of central vision to blindness
In Glaucoma, there is loss of central vision, T/F
FALSE
Loss of peripheral or “side” vision
Most common type of hearing loss in the elderly is ______
Presbycusis
What tool is used to assess patient’s risk of falls
The Tinetti Balance and Gait Evaluation
