GP Week Flashcards
What routine blood investigations would you do when a patient presents symptoms of alzheimer’s?
FBC - anaemia, vasculitis?
TFTs - Hypo?
Bone profile - Hyper Ca2+?
U&Es - kidney dysfunction?
LFTs
- alcoholic?
- Encephalopathy?
Glucose
- diabetic?
Vit B12
- mimic dementia
Lipid profile
- vascular dementia
List some differentials for alzheimer’s disease:
Delirium **
Depression **
Vascular dementia
Dementia with lewy bodies
Frontal - temporal dementia
Vit B12 deficiency
Hypothyroidism
What medications may aggravate or contribute to presenting symptoms of alzheimer’s?
Anticholinergics
Benzodiazepines
Antipsychotics
What plans can be made to keep a patient with suspected alzheimer’s safe at home during the follow up period?
Package of care
- social team visits
Personal care > 65 years
(<65 years costs)
Friends and neighbours
Pharmacy service
Social care
District nurses
Appropriate alarm
- smoker detectors etc
On the MMSE, what score identifies cognitive impairment?
<23
What fields does the MMSE cover?
Orientation
Registration
Attention and calculation
Recall
Language
What is your management when dementia is suspected?
> 65 years old: referral to memory clinic
<65 years: referral to neurology
What investigation is used to diagnosis alzheimer’s?
CT
What are the risk factors for alzheimer’s?
Smoking
excess alcohol
Head injury
High cholesterol
Low physcial activity
Apolipoprotein E - sporadic risk factor
What are the main symptoms of alzheimer’s?
Cognitive
- problems carrying out: Activities of daily living (ADLS)
- money handling, paying bills etc
Non - Cognitive symptoms: - behavioural - psychological (BPSD) - agitation - wandering - jealousy - aggression - delusions - information sharing
Name the treatment for mild to moderate alzheimer’s and name the side effects:
Acetylcholinesterase inhibitors:
- Donepezile
- Rivastigamine
- Galantamine
Side effects:
- syncope
- bradycardia
- G.I upset
Condratications:
- Cardiac conduction abnormalities
**need ECG before
Name some drugs given for moderate - to severe alzheimer’s:
NMDA receptor antagonist
- memantine
Side effects:
- constipation
- hypertension
- dizziness
Contraindications:
- renal impairment
List some ways to gain further information regarding families if there was concern:
Health care system
Educational system
What is it essential healthcare providers do in the setting of suspected child neglect?
Act and refer the early signs of abuse
Keep accurate records
Listen to the views of child
Review the concerns when situation is not improving
Sharing information appropriately without delay
Challenge others who appear not to be taking action `
Where are notifications of concern referred too?
Social Work Services
How long do you have to submit the documentation of a NOC?
48 hours
Name the types of abuse that are recognised:
Abuse is a form of maltreatment of a child. this can be by inflicting harm or failing to act to prevent harm.
- Physical abuse
- Sexual abuse
- Emotional Abuse/ Psychological abuse
- Neglect
Define Child Protection
When a child requires protection from child abuse or neglect.
It does not require for there to be abuse or neglect actually taken place, but if a risk has been identified to be likely to happen.
Name some causes of erectile dysfunction:
Psychosexual Arousal
CVS/ Diabetes
Genitourinary
- penis abnormalities
- prostate
Gondo-pituitary axis
What can erectile dysfunction eb sign of in an otherwise asymptomatic patient?
CVD
*you would therefore test for
- glucose
- LFTs
- FBC
- Blood pressure
etc
Name some common drugs that can cause ED:
SSRI
Tricyclics
Beta blockers Verapamil Digoxin Amiodarone Diuretics
Cimetidine
Alcohol
Hormone therapies
Compare and contrast the psychogenic and organic causes of ED:
psychogenic:
- younger
- sudden onset
- decreased libido
- spontaneous erections
- Major life events
- relationship changes
- previous psychological history
Organic:
- Older age
- gradual onset
- normal libido
- Loss of nocturnal erections
- previous medical history - CVD
What drugs can be used for ED and how do they work?
Sildenafil
Phosphodiesterase inhibitors
- increases cGMP - leading to increase in NO production = increases smooth muscle relaxation
When is sildenafil contraindicated:
Patients using nitrates
Unstable heart disease
Hypotension
Unstable angina
Recent stroke
Common side effects of viagra:
Back pain
Dyspepsia
facial flushing
migraine
care with:
- beta blockers
- grape fruit
- alpha blockers
- nitrates
What the second line if viagra fails?
Specialist clinical
- prostaglandin E1 analogue
MUSE
- in the uthera
VED
- vacuum erection device
What is the 3rd line treatment for ED?
Prosthetic surgery
Define Phimosis
Foreskin is too tight around the end of the penis
