Lifestyle Advice and Simple Procedures

Question 1

What is the biggest cause of preventable disease and premature death in the UK?

Answer 1

Smoking!

Question 2

What diseases in smoking implicated in?

Answer 2

Premature death, cancers (resp, oesophageal, bladder, kidney, stomach, pancrease, myeloid leukameia), pneumonia, CVA, AAs, CHD, peptic ulcers, angina, PVD, asthma, miscarriage, prematurity, low birth weight, the list goes on.

Question 3

What hsould be done if someone tells their GP (or any HCP) that they smoke?

Answer 3

Advise them to try and stop and provide information about the best way to do this and help facilitate smoking cessation

Question 4

Where can a smoker be referred to to help them stop smoking?

Answer 4

A stop smoking clinic!!

Question 5

What are the NICE-recommended pharmacological smoking cessation tools?

Answer 5

• Nicotine replacement therapy
• Varenicline
• Bupropion

Question 6

If varenicline or bupropion are prescribed, what condition are they prescribed under?

Answer 6

That the patient makes a commitment to stop smoking on or before a particular date. A prescription should run until only 2 weeks post this date.

Question 7

How long should someone use nicotine replacement before their agreed stop smoking date?

Answer 7

2 weeks

Question 8

How long should someone use varenicline or bupropion before their agreed stop smoking date?

Answer 8

3-4 weeks

Question 9

Can nicotine replacement therapy, bupropion and varenicline be offered together in any combination?

Answer 9

No!

Question 10

What form can nicotin replacement therapy come in? Which ones work better?

Answer 10

Pathces, gum, nasal spray, mouth spray, inhalation cartidge, lozenges, sublingual tablets.

None of them are more effective than any other, however high dose patches or gum are more effective if the patient smokes more than 10 per day.

Question 11

How is the efficacy of nicotine replacement therapy most improved?

Answer 11

Use alongside behavioural therapies to break patterns of smoking in lifestyle.

Question 12

What is bupropion?

Answer 12

An atypical antidepressant used in smoking cessation - it is a nin-competative nicotine receptor agonist.

Question 13

When is bupropion contraindicated?

Answer 13

• Pregnancy
• Breast feeding
• Hx of bipolar
• Patients under 18

Question 14

What is Varenicline?

Answer 14

An alpha-4, beta-2 nicotinic ACh receptor partial agonist used in smoking cessation.

Question 15

When is Varenicline contraindicated?

Answer 15

• Pregnancy
• Under 18s
• History of psychiatric problems as risk of suicidal thoughts and behaviours.

Question 16

Who needs to be notified if someone has a condition which may affect their ability to drive?

Answer 16

The DVLA

Question 17

Whose responsibility is it to tell the DVLA if someone cannot drive due to a medical condition?

Answer 17

The patient/driver, but it is the responsibility of the doctor to inform a patient when this is the case.

Question 18

What does the GMC say about informing the DVLA?

Answer 18

It is the doctors responsibility to inform the DVLA if the patient fails to act.

Question 19

What are the common conditions that patients need to inform the DVLA about?

Answer 19

• Epileptic events
• Attack of giddiness, fainting, or blackout
• Severe learning disability
• Pacemaker/implanted defib device
• Diabetes with risk of hypos
• Parkinson’s
• Dementia
• Stroke/TIA
• Brain surgery or trauma
• Severe psychiatric ilness
• Visual problems in both eyes
• Deoendance on alcohol or substances

Question 20

Following a single TIA, how long should someone abstain from driving?

Answer 20

One month

Question 21

Following a TIA witha history of frquent or recurrent TIAs, how long should a patient abstain from driving?

Answer 21

3 months at least attack free

Question 22

Do all patients with Parkinson’s get their driving liscence taken away?

Answer 22

No - only if there is significant disability or variable motor function

Question 23

What are the factors that need to be considered when assessing someones fitness to fly?

Answer 23

• Mild hypoxia and lower air pressure in cabin
• Immobility
• Ability to adopt brace position
• Physical and mental ability to cope with travel
• Medical condition that may affect people around them

Question 24

What is the risk of developing a DVT following a long haul flight (4+ hours)?

Answer 24

It doubles compared to baseline.

Question 25

What causes increase risk of DVT on long haul flights?

Answer 25

Immobilisation

Question 26

How can people be advised to avoid DVT on long haul flights?

Answer 26

• Adequate hydration
• Exercise calves
• Get up from seat regularly
• Avoid excess alcohol
• Avoid tight-fitting socks or stockings
• Use of graduating compression stockings

Question 27

What is the advice given regarding flying during pregnancy?

Answer 27

• No flying past 36 weeks if uncomplicated singleton, or 32 weeks for multiple pregnancy.
• Increased risk of DVT - take appropriate precautions
• No risk of exposure of foetus to radiation unless flying multiple times per week

Question 28

What is the advice for newborns flying?

Answer 28

• If born at tern, can fly at equivalent of 41 weeks,

- If born preterm, have oxygen available for signs of respiratory distress

Question 29

A patient has had abdominal surgery. How long until they can fly?

Answer 29

10 days at least

Question 30

A patient with a colostomy bag wants to fly. Do they need to do anything extra?

Answer 30

Use a larger colostomy bag as intestinal distension will occur, causing increaseed foecal output.

Question 31

Where can a patient check to see if they can fly?

Answer 31

BA website has list of guidelines of minimal time to wait before flying (although different airlines may have different policies)

Question 32

A patient who has had TB is concerned about flying. What can you tell them?

Answer 32

If they have had adequate treatment and are non-infectious as confirmed by 2 negative sputum smears, they can fly.