gen med 6 summ Flashcards
Describe the evaluation of physical and mental development of a 9 month old baby
- measurement of
- height, weight, body mass,
- head and chest circumference,
- dentition, development of sensory receptors, movement and speech
Height - NB=48-52- upper limit 52 +(2cmx 9mo) 18 = 66-70cm
Weight(NB=2.5-3.5kg. gain 600g/mo) 2.5-3.5 +(600 x9) = 7.9=8.9kg
Head circumference 34 at birth + 1cm a month + n 9 = 43cm
chest circ+ 30.5-33 plus no of mo
o At 9 months – motor crawling, sits unsupported, pincer,
o Speech – polysyllabic babble
o Social – fear of strangers, peak a boo
Dentition: check for upper central incisor, upper lateral incisor eruption and lower central incisor eruption
- lower central incisior 6-10months)
- upper central incisor-8-12months,
- upper lateral incisior-9-13 months,
Describe the content and aims of the 3 main areas of preventive medicine
- Primary prophylaxis comprises both the healthy individual and those at risk.
- The GP rolehere is to prevent the occurrence of a disease
- Secondary prophylaxis is the early detection of a disease, before onset of symptoms.
- provide early treatment which aims to improve disease prognosis and reduce it’s frequency
- Tertiary prophylaxis (dispensarization, follow-up).
- prevents the progression and complications of a disease in people already suffering from different diseases,
- prolong their lives and exert a positive effect on their quality of life
Describe 5 non-verbal signs and related to them diseases
- Body-language/kinesis: Parkinson’s disease tremor, bradykinesia, masked facies (hypomimia)
- Touching: hypoesthesia (Beriberi disease, ulnar nerve palsy), hyperesthesia (peripheral neuropathy-diabetes/chronic alcohol abuse), anaesthesia.
- Paralanguage: TONE, SPEED, LOUDNESS OF VOICE - stroke patient (apraxia), dyslexia (specific learning disorder)
- Proxemics: autism spectrum disorders
- General appearance: cachexia in malnutrition, cyanosis or pitting edema (pulmonary/cardiac disease), ascites (liver/renal failure), necrotic toes (vascular disease),icterus (jaundice). Schizophrenia (neglected hygiene)
Describe general advice on how to feed, keep healthy and bring up an 8 month old child
feeding
- Feed 5x per day with 3.5 hr interval
- 100+10xmonth: 180ml per meal
- new food should be introduced step by step patiently
- variety of foods: baby cereal, fruits and veg, and mashed or pureed meats.
- check if they’re feeding:
- Diapers are changed after every feeding, presence of stool and urine
- Follow the growth curve=gains 20g/ day min
caring
- Keep track of the immunization schedules
- cords are out of reach, lamps, tv and furniture are secure.
- keep away small toy pieces or objects that are lying.- developed pincer grasp mouth tactile
- Motor games, sensory games and communication games
Describe 5 behavioural risk factors
Smoking
Unhealthy diet
Alcohol abuse
Low physical activity
stress
5 Characteristics of General practice/family medicine
-
Initial contact with the health care system,
- free access provided, for any type of medical condition.
- Acts as a “gate keepers” within the health care system, should be available to patients 24 hours a day, 7 days a week.
- Coordination and effective utilization of health care resources, in cooperation with other medical specialists.
- refer patient to out of hospital consultation by a medical specialists or hospitalization.
- The GP activities include both non-medical/medical activities and functions in close cooperation with the health care and social units and structures.
- Responsibility for the health of the community as a whole
- Decision making based on the frequency of the disease in the community.
- The GP should know the incidence structure their region, which assist them with decision making
- Early detection of health problems
- management of acute and chronic medical conditions in a given patients
Describe 5 consecutive phases of the family circle
- Unattached Adult-the main issue occurring in this first stage is accepting parent offspring separation
- Newly married Adult-Young couples starting newly married life
- Pre-school age children-The young couple has a child. All the activities related to growth and development of the child
- School age children-sleep nutrition are affected
- Teenage child-most challenging is management of chronic disease
Follow-up observation in general practice about patient with ischemic heart disease
- sx is sternocardia/angina pectoris
- Follow up = monitoring of patients/diseases and control of the disease development.
- ECG,
- lipid profilefollowed up.
- blood pressure
rx: usuals: rdece rf, lifestyle change, pain management etc
delivering bad news: BiCH SFP was bad
- Background-be completely familiar with the patient situation before delivering the news, enough time for discussion and make decision who will attend the consultation
- Clarifying what the patient already knows-start with information that is already familiar with the patient which gives information to what extend the patient or family understand the situation
- How much does the patient want to know-every person has the right to refuse to receive information about their medical status or to ask someone else to speak on their behalf
- Sharing information-information should be presented gradually, the patient should be encouraged to ask questions
- Feelings- denial, anger, bargaining, depression and acceptance. The patient and their family need to react emotionally. In such situation nonverbal signs are of vital importance
- Planning subsequent actions- the patient and family should know what to expect next- a_dditional medical procedures_, organizing medical care in home or hospital setting
effective performing of the consultation includes
Opening of the consultation
Elucidation of the health problem
Negotiation of action for achieving a solution of the health problem
Closing of the consultation
describe 5 communicative techniques:
- Greeting-specify how the patients want to be called
- Inviting-the patient is invited and shown where to sit down
- Social contact/transition-primary consultation: pay attention and obtain personal information familiar patien: a short social conversation before the medical
- Orientation-examination will encourage free and easy sharing of health problems
- Active listenin-direct the consultation to the cause of the particular appointment
Follow up observation in general practice in a patient with diabetes mellitus
- body mass index
- blood pressure, pulse,
- lipid profile & Fasting lipids
- ECG
- HBA1c test
- Referral to an ophthalmologist yearly for retinal examination
- Urine glucose, check for proteinuria and do a ketone test
KÜBler-Ross stages for delivery bad news UDABAR
o uncertainty
o denial- disbelief (“no-not me”)
o anger- it’s not fair, why me”)- directed at medical staff/ healthy ppl
o depression- God says nah you’re dying G
o bargaining-bargaining with Go
o acceptance-patient given up the struggle for life, sleeps, withdraws o
o restoration of inner balance
diff betwe gerontology and geriatrics
Gerontology: study of physical and psychological changes that occur in old age
Geriatrics: is the branch of general medicine concerned with
rehabilitative, psychological and socialaspects of illness in the elderly
define a medical consultation
direct or indirect interaction between physician and patient with the use of comm verbal or non verbal, discussing health related issues
characteristics of GP related person-centred care
- consideration the patient’s environment in which the health problem comes from and base consultation on that
- consultation should based on phys-pt relationship respecting autonomy of pt
- communicate w/ pt and give priority to what they decide
- continuous and prolonged care
definition for verbal communication?
communication through spoken and written words
WHO, 2002, gives the following definition of palliative care
approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
The purpose is ensuring quality of life
Patients under home healthcare are divided into several groups
moppn
Medico-psychological care
Medical-social services
Occupational, speech + language therapy
Physical therapy
Nursing care
5 groups of difficult patients and give your opinion why these patients are difficult
The Sherman tank –always on the attack and doesn’t worry about being polite, just get their points across in anyway they can.
The exploder-temper tantrum, raging outbursts, out of control.
The know it all -expert on all matters, feels others are stupid
The staller-indecisive, lack-follow through, cannot make up their minds
The complainer-finds fault in everything,
The clam-silent, just says “yes or no” refuse to cooperate, won’t effectively communicate, hard to open to us
General practitioner activity for reproductive health
WHAT DOES REPRODUCTIVE HEALTH INCLUDE
Sexual and reproductive health(educate teens, premarital)
Sexual transmitted diseases(education and prevention)
Family planning( contraception)
preg Women’s consultation
Prenatal and postnatal consultations
Screening of oncological diseasesof the breast and uterus(screens)
reproductive health includes
- to be able to have safe, satisfactory sex life
- to have ability to reproduce and decide whether to have children & no of children
male hormonal contraception
- LH-RH agonist (chemical castration) and GnRH agonists (both for prostate cancer treatment also, decrease testosterone level)
- Anti- androgens (cyproterone acetate),
- estrogensor androgens or a combination of both
- LH-RH agonist + antiandrogen >complete androgen blockade
classical contraception
- Coitus interruptus: withdrawal before ejaculation
- Saxonian intercourse (retrograde ejaculation)
- Coitus hispanicus - ejaculation in vaginal vestibular (due to acidic pH which kills sperm)
- Sexual abstinence infertile period of women
- natural methods (calendar method, basil body temperature method, cervical mucosa method)
- Hormonal methods: oral contraceptive
- Barrier method: male condom, cervical cap
- Intrauterine pessary
3 action areas of EBM
- The patient treatment is based on scientific evidence
- Published scientific literature
- Public health: creates n_ew scientific strategies_ and effective health care
A 51 year old female has had fatigue, weakness and shortness of breath with exertion during the past 4-5 days. Symptoms were exacerbated by activity and relieved by rest and lying supine. He also felt palpations intermittently. The patient denied abdominal pain, chest pain, congestion, nausea, vomiting, diarrhoea, constipation, dysuria, headache, chills, hemoptysis, neck pain, rash or sore throat.
Past medical history: Diabetes mellitus non-insulin dependent Physical examination:
o General appearance: pale, non-icteric
o Eyes: sclera non-icteric
o Chest: clearto auscultation bilaterally
o CVS: mild tachycardia, no hypotension
o Abdomen: soft, non-tender, non-distended. Positive bowel signs o No lymphadenopathy
- most likely diagnosis?
- confrim dg?
- dx?
- lab?
- LHF: cause lungs are clear bilaterally and sob. STABLE ANGINA
- ECG, XRAY, CT angio= Gold
- myocarditis, endocarditis, pericarditis, asthma? MI,
- FBC, cardiac enzymes, spirometry, lipid profile, glucose, c-rxtive,
Describe the advantage of homecare
- Observant physician can obtain additional information about his patient during the home visit.
- One-one attention
- patients feels at ease + is more likely to confide
- Family support
- Familiar surrounding
- More independence
Describe the evaluation of physical and mental development of a 7 month old baby
measurement of height, weight, body mass, head and chest circumference, dentition,
development of sensory receptors, movement and speech)
height: 50 cm + (2x7) = 64 cm
weight: 2.5-3.5 + (0.6x7) =7.7
head circ= 34+7= 41cm
chesst circ: 30.5-33 + 7 =40 cm
gross motor: sits w/o support, Fine motor:
speech: polysyllabic babble
social: fear of strangers
feed and take care of a 6 year old
feeding
- Breastfeeding for the first 4 - 6 months
- 160ml on each feeding (100 + no of months)
- after 4 months include Mashed fruits and veg are during one meal a day mixed with milk
caring
- assist the Childs development by
- talking to them, playing with them,
- choosing games and toys appropriate for their age.
- 6 mo of first year they should take care of speech development.
ask to be performed by the GP in the process of consulting are
Opening of the consultation
Elucidation of the health problem
Negotiation of action for achieving a solution of the health problem
Closing of the consultation
regular observation of normal pregnancy include
first visit
- history
- ,gyne status: 1st visit, 4 mo, prn
- Due date
first trimester visit: 1x/ mo 2x mo 9/10
- bp, blood type, US
- anthropometric asses
- US 16-20 wk
- FHR: 1x 5,6,7 2x 9,10
- clinical lab:
- blood:hb, mch,mcv,
- urine: gluc, ketones, urobillinogen
- vag smear rpt 9 mo
- huv, hep b, syph
post natal - 42 days
- blood 1x
- bp
- uterine invol, genital bleeding mental status
- mammary develop 2x(7th day& 30th)
what do you do at 7 mo w/ bcg
Check for BCG mark, children w/o mark
are given Mantoux test + if it’s negative,
give BCG vaccine.
concept of palliative care describes the care for patients as
- relieve pain and suffering alongside rx
- intergrate spiritual and psychological aspects
- ensure qol-
- allow attidute to death as natural process
- team apporoach to meet needs of family
- suppoert of family
*
General criteria used by GP’s at the selection of the patients, which are suitable for home health care
- long term care: chronic disease / palliative care
- phone call confirmation before hoe visit
- weighing the urgency of home visit with hospital referal
- previous knowledge of the health of the pt
*
WHO’s definition of reproductive health
State or condition free of disease and disturbances in reproduction system in both sexes
Definitions specific for the male reproductive problems
primary male infertility: man’s past and present failure to impregnate a woman.
secondary male infertility:
Mechanical contraception and surgical reversal methods
- Male surgery:
- Vasectomy – very common + effective method , damage of scrotal and inguinal part of the vas deferens
- Vasovasotomy = Reversing operation – reversal of vas deferens discontinuity in vasectomy
- Vasostomy = Implantation of epididymis
- vasoepididymostomy -> anastomosis between vas deferens and epididymis
- Vaso-orchidostomy = Anastomoses or implantation of vas deferens in testicles
- Mechanical obstruction = at any level at pathway of sperm transport may lead to azoospermia, and male contraception
- Female surgery: Tubal Ligations &removal of fallopian tube(salpingectomy)
- Mechanical – barrier method (male condoms, cervical caps cervical sponges)
MAIN POSTULATE OF EBM ???
Any clinical decision and every technological operation should be based on the strict scientific evidence
female GP consultation for different age groups
teens and young women: health promotion activities regarding hygiene of sexual organs
pregnant/young mums: observation for entire preg and regular check ups
middle aged to older women: Prevention and early diagnosis, timely and effective treatment of gynaecological diseases. and pre cancer
6 years old child and his parents visit the General practitioner. The child complains of thirst, lost of weight, frequent urination and skin itching for 1 month. The day of consultation epigastric pain appeared, nausea and vomiting. No fever
- dx
- dg
- lab tests
- confirm lab test
- db ketoacidosis( itch and thirst and ab pain), hyperuricemia(itcing) gilbert syndrome
- diabetes type 1
- random blood glucose,OGTT, Hb1Ac, urine analysis(ketones/ glucose) bilirubin lvls, uric acid lvls
- OGTT
describe moro reflex and dg value
ends at 3-4 months abduction, adduction, crying
- over 4 mo= neurological disease
- assymetrical: hemiparesis, brachial plexus injury, calvicular fracture
- abscence in legs: lower spine injury, developmental displasia of hip
signs of pain in infants
crying
cooing
fist shrink
suck pacifier
contraction and relaxation of body
pro’s and con;s of natural contraception
pro’s
- no cost,
- no risk to health,
- no secondary effects
- doesn’t interfere w/ breast feeding
- increases knowledge about reproductive cycle
con’s
- no STD protection
- not effecient
- requires regular periods
- vaginal infections affect cervical mucus method
pro;s and cons of CONDOMS
prondoms
- low cost
- easily accesible
- prolong erection
- No side effects
- protect from most STD
condom cons
- low effeciency
- efficiency depends on correct use
- latex allergy
- have to apply it immediatley before sex- deads the mood
intrauterine pessary pro’s and cons
pessary pro’s
- fast
- continous effect
- don;t interfere w/ sexual intercourse
cons of pessary
- perfect health of reproductive system required
- bleeding in 1st 3 months
- increased menses in 1st 3 mo
pro’s and cons of hormonal contraception
pro’s
- very high efficiency
- doesnt affect sexual intercourse
- long term effect
- decreases amount of menses- dysmenorhea releif
- prevents ovarian cysts
- prevents endometriosis and endometrial cancer
cons
- emotional instability
- require regular strict use for efficiency
- some cause weight gain
- increase risk of fibroids
- increase coagulation risk
what is the GP practice
General Practice is clinical and academic discipline with its own educational content
and scientific research, based on evidence and clinical activities specifically oriented to
primary health care
how often should a child up to 1 year visit the General practice in terms of child consultation
Every month-
- measure height weight, head+chest circum,
- assess neurological and mental development.
1 and 4 months-hip joints
6 and 12 months- FBC, urine test.
Primary practices (GP) perform a package of medical and non-medical services, which requires a list of specific resources:
- Medical training
- Medical personnel
- Financing
- Medical equipment and supplies o
- Health facilities
what is the paternalisgic approach
- Doctor has role of the parent and has a directive role
- one way transfer of knowledge of physician to pt
- Patient is submissive and has passive role
- doctor is expert and pt should cooperate
what is communication
process of interaction between ipeople by means of different signed systems – >verbal and non-verbal.
whart is a competancy
factors that determine succesful performance
consists of skills, job attitude and knowledge
complications of nephrolithiasis
acute pyelonephritis
abscess
infective hydronephrosis
loss of renal function
urosepsis
urinarty fistula
what is empty nest syndrome
psychological conditions affecting parents (women) when kids leave home characterized by
- sadness and loss
- common around autumn / after marriage
list family issues
- undiagnosed mental conditions
- single parent/ divorce
- drug addiction/ substance abuse
- infertility
- familiy member w/ chronic or terminal illness
EVIDENCE BASED MEDICINE DIVISIONS
- mandatory
- reccomended
- optional
e.g. varicocele
mandatory is Physical exam
reccomended is US
optional is doppler which can detect assoc patholigies e.g. HYDROCELE/ EPIDIDYMITIS
descending order of scientific evidences according to their reliabilitiy
MYSEEC
- meta analysis
- systemic review
- evidence from clinical trials
- expert analysis
- clinical appraisal of evidence
CATEGORIES OF RECCOMENDATIONS OF EBM according to OXFORD CENTRE
Level 1: level of evidence obtained from meta-analysis or clinical trials with precise protocol – level 1a + 1b
Level 2: level 2A and 2B, grade of recommendation latest system (strong and weak)
Level 3
Level 4
?????????
3 model’s of consultation
Berne’s Transactional model 3 states of ego:
- parent (authority, critical/caring)
- adult (logical)
- child (intuitive, spontaneous/dependent)
Byne & Long model helps with structure of consultation
- DR establishes relationghip with patient & tries to find reason for visiting
- verbal&physical exam,
- consider the problem and plan of action, ends consultation
Stott & Davis model = 4 areas to be explored in each consultation.
- manage presenting problem
- manage continuing problems
- modification of self-seeking behaviours
- opportunistic health promotion
Describe all 7 questions in Hellman model of consultation:
(list and describe them all)
- What has happened – organizing symptoms and signs into recognizable pattern and giving it a name or identity.
- Why has it happened – explains etiology
- Why has it happened to me – tries to r_elate the illness to aspects of the patient,_ such as behaviour, diet, body build, personality or Heredity
- Why now – concerns the timing of the illness and its mode of onset – sudden or slow
- What would happen if nothing was done about it this considers it’s unlikely course outcomes prognosis and dangers
- What are its likely effects on other people – loss of income or employment, strain on family relationships
- What should I do about it/who should I turn for further help – strategies for treating condition including self medication, consultation with friends or family, or going to see a doctor
approaches to GP practice
hollistic: physical,biological, social = pt oriented
pure bio: disease oriented
pure social
anthropological
transactioal: give and take
5 groups of symptoms in patient need palliative care in general practice
- pain- analgesics
- depression- anti depressants
- cachexia and anorexia
- dyspnoea
- constipation- change rx or give laxative
- insomnia- hypnotics
7. fever + neutropenia (lec)- antipyretics(nsaids, paracetamol)
8. fatigue (lec)
9. malignant wounds lec) - regular redressing of wound
signs of HF
Hydrostatic edema - handbook
o Fatigue & shortness of breath are cardinal symptoms
o Orthopnea
o Cheyne-stokes respiration (cyclic respiration)
o Acute pulmonary edema
o (congestion of liver - lead to RUQ pain)
what is te end point of evidence based medicine
trusted evidence
informed decision
better health
levels of health care in bulgaria
primary: outpatient clinics/ group practices
secondary : specialized non hospital structure
tertiary: hospitals and hospices
5 types of addictions
Substance addiction: 1. Alcohol, 2.tobacco, 3.Opiod & Cocaine addiction
Process addictions: 4. Gambling, 5. shopping, 6. internet 7. food
Social: Alcohol, tobacco, caffeine
Medical: Opioid Analgesics, anxiolytics and hypnotics.
Recreational drug use: Cocaine, cannabis
Behavioural addiction: Gaming, shopping, sex, social media
types of substance abuse and their signs
- stimulant
- caffeine nicotine, cannabis, cocaine
- increased sympathetic tone, hyperactivity, alertness
- depressant
- opiates: morphine, codeine,
- pain relief, reduced pain sensitivity, euphoria, respiratory depression, coma
- hallucinogen= LSD
- sedative, anxiolytic, hypnotic
- BDZ phenobarb
- anxiety disorders, depress respiratory and CDV centres
- alchohol
- Reduced coordination, reduced concentration, aggression, impaired judgment, slurred speech.
what is meta communication
communication that indicates h_ow verbal information should be interpreted_ & concerns stimuli surrounding the verbal communication that also have meaning, and w_hich may or may not be congruent,_ supportive or contradictory of that verbal communication.
signs of pain in adult
- facial grimace
- agitation
- tense and uneasy- draw up legs
- guarding, immobility
- small or slow movements
pain in infants
- facial expression – squeezing eyes shut
- high pitched cry that lasts longer than usual
- behaving irritably
- not eating or sleeping
neonatal screening
- PKU, galactosemia,cystic fibrosis
- Congenital Adrenal hyperplasia, Congenital Hypothyroidism,
- SCID,
describe mumps
- acute systemic viral disease caused by virus paramoxyvirus typically affecting school children in late winter/early spring
-
sx:
- inflamm of salivary gland mainly parotid.
- other: orchitis, meninges,
- rash
- inflamm of salivary gland mainly parotid.
- prog: ends in seven days. orchitis can be tender for weeks
Describe Galant reflex and it’s diagnostic value
- ventral suspension (face down) and stroking down in the paravertebral area on one side.
- response is: swinging of the pelvis towards the stimulated side (laterally flex).
- Disappears in 3-4 months.
Diagnostic value
- Absence= sensory loss in the case of a myelomeningocele.
- Persistence; can affect the child’s ability to sit, poor posture (scoliosis
Mantoux: what is it? How to perform it? How to interpret it?
check immunity against TB in children w/o the BCG scar on their shoulder after previous immunisation.
- no scar: inject 5 IU Purified protein derivatives intradermally
- check skin in 3 days fir rxn
- induration of 5mm or more is positive in HIV patients
- 15mm+ is considered positive in persons with no known risk factors
information provided in ECG
- electrical activity of heart
- detection of electrolyte disturbances
- screening of IHD in stress test
- non cardiac: pulmonary embolism, hypothermia
types of consultation
direct: face 2 face
indirect: virtual phone, medical records
dehydration complciations in children
- hypovolemic shock
- seizure_ electrolyte imbalance
- UTI, renal stones, kidney failure
screening for prostate cancer
- DRE &PSA test
- transretal US
- Computed Axial Tomography
- BIOPSY_ confirm dg and exclude prostate cancer
ECG for Acute ANTERIOR MI
SALI
- septal: V1,V2
- anterior: V3&V4
- lateral: , avL,V5,V6
- inferior: I,III, avF
ANTERIOR
- ST elevation in V3&V4
- reciprocal reduction in II,III,avF
define melena
tar like stook d/2 bleedig in the upper GIT
defenie open and closed questions
open: allow long answers with more information ‘ tell me more about x’
closed: structure information to provide a simple answer after open Q
EXAMPLES of DIRECT BLOCKAGE OF SPERM
gonadotoxic:
chemo, radiation, immune therapy w/ antibodoes
activity of GP in basic prophylactics
- primary prophylaxis: healthy and risk pts
- assess risk factors & bad habits
- health promotion and education
sperm production and sperm transport
sperm production
- produced in the germ epithelia of seminiferous tubules
- spermatogonia-mitosis-spermatocyts-meisis-spermatids-spermatogen-spermatoa
sperm transport
- from seminiferous tubules via rete testis to epidydimis where they are stored and mature into spermatozoa
describe rubella
acute viral disease in kids and adults caused by rubella virus
- sx: characteristic rash, lymphadenopathy and fever
- maculopapular rash is 1st sx lasts for 3 days -> hemmorhagic exanthema
- requires isolation
- maculopapular rash is 1st sx lasts for 3 days -> hemmorhagic exanthema
- prognosis: supportive rx, lasts
- CONGENITAL RUBELLA- during preg
- Congenital heart disease, Cataract, Deafness
risk of toxoplasmosis for the fetus
risk of toxoplasmosis increases as time passes
- First trimester: 15% of fetus infected
- Second trimester: 30% of fetus infected
- Third trimester: 60% of fetus infected
severity of fetal condition decrease w/ time
RF: cat contact, undercooked meat, unwashed veg
paediatric consultation
physical assesment
mental assesment
feeding and care of the child
morphological and functional features of growing and developing children’s organism
list of physio organ changes
follow up for HTN PT
CDV: bp, pulse ecg, lipid profile
vascular atheroslerosis; palpate pedal pulse, doppler
nervous system: angiography MRI
renal failure: creatinine, urine analysis for proteinurua,
visual: ocular fundus exam
Principles of CPR
- restore effective circulation and ventilation
- avoid excessive ventilation
- prevent irreversible cerebral damage due to anoxia which may occur inas little as 4 mins
- provide good quality compressions
- minimise interruptions to chest compressions
technique of active listening
Observe
Listen
Paraphrasing-to convey interest, encourage to keep talking
Verbalising emotions: shows that one understands
Summarizing: review progress, establish a basis for further discussion
Clarifying: clarify what is said, helps the speaker
Encouraging
balancing
Legal aspect of evidence based medicine
DOG the law
- Doctor are protected by the law
- On the other side patients should be encourage in making clinical decisions
- Good collaboration between the doctor –patient is strongly needed
Definition of family cycle
emotional and intellectual stages you pass through from childhood to your retirement years as a member of a family are called the family cycle
Goals of geriatric care
KEMS geriatric sugar dad
keep the people as independent as possible in their own home
Early detection and appropriate treatment of disease
Maintenance of maximum independence consistent with irreversible disease and disability
Sympathetic care and support during terminal illness
triad of female athlete
- Osteoporosis
- Amenorrhea
- Eating disorders – anorexia , bulimia
Types of financing of health care
BIMCARE
Budget Insurance Mixed
sx of diff types of tumour
penilw
testicular
bladder
renal
penile tumour
- skin thickening/ colour change
- ulcer / sore
- red lumps beneath foreskin
- small crusty lumps
Testicular
- lump/enlargement in either testicle
- heaviness and pain in scrotum
- sudden fluid accum in scrotum
- A dull ache in the abdomen/ groin
bladder cancer
- blood clots in urine
- burning during urination
- frequency and nocturia
- difficulty passing urine
renal cancer
- hematuria
- unilateral lower back pain w/ mass
- fatigue, loss of appetite and weight loss
- fever w/o infection
complication of catheterization
colonization by bacteria –> UTI – >urosepsis /septicaemia
what is the NEIGHBOUR MODEL
- First stage – connecting the doctor establishes a rapport with the patient
- Second stage – summarizing the doctor states this summary to the patient (of why the patient has come).
- Third stage – handover – the doctor and patient make a plan together
- Fourth stage – safety netting – a contingency plan is formed and this covers the patient and the doctor if the doctor has got the diagnosis wrong or if something unprecedented happens.
- Fifth stage – housekeeping – helps to acknowledge and deal with any emotions arising from the consultation before we see the next patient.
what is safety netting
creating a contingency plan relevant to that patient, to ensure that the plan works out and that the patient is safe in any foreseen or unforeseen eventualities.
SOURCE OF INFO FOR EBM
- electronic database
- medical journal
- monograph
- systemic review and short communication
- meta analysis
- clinical practical guidlines
- clinical trials
gp practices are what?
- outpatiet clinical for individuals
- group medical practices for primary care
disadvantages of home care
- pt isn UNDER 24 HR SUPERVISION
- risk of FATALITY?
- patient could EXAGGERATE or give FALSE info
- high risk of NEGLECT
red flag signs doe cauda equina / serious back pain
4ADRRRIP
- abnormal gait w/p heel toe ambulation
- absent perineal reflex
- acute bilateral sciatica
- acute urinary retention
- Drop foot
- recent dg of mg
- recent infec
- recument worsening of pain
- IV drug abuse
- progresseive neuromotor/sensory loss
11.
