MISC: Notes Flashcards
1
Q
Define substance misuse
A
- Harmful use of any substance for non-medical purposes or effect
2
Q
Name some illegal drug opiates
A
- HEROINE
- CODEINE
- TRAMADOL
3
Q
Effects of illegal drug opiates
A
EUPHORIA
4
Q
Effects of Depressants
A
Anxiolytic
5
Q
Name some stimulant illegal drugs
A
- Amphetamines
- Cocaine
- Caffeine
- Crack
- Ecstacy
6
Q
Effects of illegal drug stimulants
A
Increases alertness and alters mood
7
Q
Effects of cannabis
A
Relaxation
Mild
Euphoria
8
Q
Name two hallucinogens
A
- LSD
3. Magic mushrooms
9
Q
Effects of hallucinogens
A
- Altered sensory perceptions
10
Q
Name a illegal drug anaesthetic
A
KETAMINE
11
Q
Effects of Ketamine
A
SEDATIVE
12
Q
Harmful effects of drug misuse
A
- Mortality
- Morbidity
- —–SOCIAL——- - Crime
- Violence
- Criminal justice involvement
- —-ECONOMIC—- - Productivity
- Tax
- ——PERSONAL—– - Identity
- Stigma
- Relationships
13
Q
What are the main theoretical models that lead to drug misuse
A
- Chronic recurrent illness
- Moral Model (Failure of morality)
- Socio-cultural model (health inequality)
- Behavioural model (A bad habit)
- Volitional Model (A failure of will)
- Genetic disorder
14
Q
Define addiction
A
- A severe substance use disorder - involves compulsive use of a substance despite harmful consequences
15
Q
Define psychological dependance
A
Feeling that life is impossible without drugs (fear, pain , shame)
16
Q
Define physical dependance
A
- Body needs more and more of a drug for the same effect (tolerance) - withdrawal symptoms
17
Q
What is dependence syndrome
A
3/6 or more in the past 12 months:
- Strong desire or compulsion to use
- Difficulties in controlling substance-taking behaviour
- Physiological withdrawal state when reduce use (or substitution to avoid withdrawal)
- Tolerance
- Progressive neglect of pleasures/interests, increased time spent using
- Persistent use despite evidence of harmful consequences
18
Q
What is the Diagnostic and statistical manual or mental disorders (DSM-5)
A
Experience 2-3 (mild), 4-5 (moderate), 6+ (severe) in the past 12 months:
- Consuming more than originally planned
- Worrying about stopping failed efforts to control use
- Spending a large amount of time using substance
- Use results in failure to fulfil major role obligations
- Craving
- Continued use despite health problems caused
- Continued use despite negative relationship effects
- Repeated use in a dangerous situation (driving)
- Giving up or reducing activities
- Building up a tolerance to the alcohol or drug
- Withdrawal symptoms after stopping
19
Q
Preventative factors for drug misuse
A
- Self control
- Parental minoring and support
- Positive relationships
- Neighbourhood resources
- Academic achievement
- School anti-drug policies
20
Q
Risk factors for drug misuse
A
- Aggressive childhood behaviour
- Lack of parental support
- Poverty
- Drug experimentation
- Poor social skills
- Availability of drugs at school
21
Q
Family risk factors for drug misuse
A
- Family substance use
2. Family conflict
22
Q
Community risk factors for drug misuse
A
- Availability of drugs
- Community disorganisation
- Low neighbourhood attachment
23
Q
School risk factors for drug misuse
A
Academic failure
Low school commitment
24
Q
How is drug misuse managed
A
- Tailoring support to the drug they are addicted to
- GPs, harm recustion services, detox and recovery support (local services)
- Advice and counselling
- Community prescribing (substitution treatment, goal: stop patient using illicit drugs, enable a more stable life)
- DETOXIFICATION (relapse prevention and referral aftercare)
- Residential treatment
25
What advice will I give to drug misuser
1. Support during subsitiution treatment
2. Promote reduction in stimulant use
3. Relapse prevention: planning strategies
26
How is opiate overdose treated
NALOXONE (opiate antagonist)
27
What is residential treatment of drug misuse
1. For those who wish to attain/maintain abstinence
2. Address underlying issues and learn coping mechanisms
3. Work on finding employment
28
How long does residential treatment last
3-12 months
29
Formula for unit
1. (Strength of drink x amount of liquid in ml) / 1000
30
What is considered binge drinking for women and men
Women > 6
| Men > 8
31
What is the alcohol harm paradox
1. Low SES (socio-economic groups) groups consume less alcohol than higher SES groups but these experience greater alcohol-related harm
32
Why is alcohol abuse more common these days
MORE AFFORDABLE and available
33
How does excess alcohol effect the CNS
1. Peripheral neuritis (degeneration of the nervous system supplying the limbs)
2. Marchiafava-Bignami disease
3. Central pontine myelinolysis
34
Acute effects of excessive alcohol
1. Accidents
2. Respiratory depression
3. Aspiration pneumonia
4. Oesophagi's/gastritis
5. Mallory-weiss syndrome (gastric tears - haematamesis)
6. Pancreatitis
7. Cardiac arrhythmia
8. Peripheral neuritis
9. Myopathy
10. Neurapraxia due to compression
11. Hypoglycaemia
35
What is Marchiafava-Bignami disease
1. CORPUS CALLOSUM demyelination and necrosis - atrophy
Clinical presentation:
1. Consciousness
2. Agression
3. Seizures
4. Hemiparesis
5. Ataxia
6. Apraxia
7. Coma
36
Effects of alcohol withdrawal
1. Activation syndrome
2. Grand mal seizures
3. Hallucination
4. Delirium Tremens
37
What is activation syndrome
Tremulousness
Tachycardia
Agitation
High BP
38
What is Delirium tremens
1. Tremors
2. Agitation
3. Confusion
4. Sensitivity to light and sound
5. SEIZURES
39
What is Fetal Alcohol Syndrome
RETARDATION of pre and post-natal growth
40
Clinical presentation of Fetal Alcohol Syndrome
1. Craniofacial abnormalities
3. Increase in the incidence of birthmarks and hernias
4. Mental retardation, irritability, incoordination and hyperactivity
5. Short palpebral fissure
6. Epicanthic folds
7. Thin upper lips
8. Smooth philitrrum
9. Microcephaly
10. Upturned nose
11. Hypoplastic jaw
41
Psychosocial effects of excessive alcohol consumption
1. Relationships: Violence, Rape, depression
2. Problems at work
3. Criminality
4. Social disintegration
42
How to reduce alcoholism
1. Make alcohol less affordable
2. Liscencing and import allowances
3. Marketing (limit exposure)
43
Stereotypes of anorexic girls
1. Female
2. Underweight
3. Young
4. Manipulative
44
Define Anorexia Nervosa
1. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health (BMI < 17.5)
45
Clinical presentation of anorexia nervosa
1. Fear of gaining weight or becoming fat
| 2. Visual perception in which one's body weight or shape is experienced - denial of current low weight
46
Subtypes of anorexia nervosa
1. Restricting
| 2. Binge-eating/purging
47
Define Bulimia Nervosa
1. Eating in a discrete amount of time (in 2 hours)
2. Sense a lack of control over eating during an episode
HAS PURGING PHASE
48
What is the purging phase
Recurrent inappropriate compensatory behaviour in order to prevent weight gain
49
What is binge-eating disorder
1. Eating in a discrete period of time more than most people would eat during a smilier period
2. Lack of control over eating during the episode
50
Characteristics of binge eating disorder
1. Eating more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because embarrassed how much they re eating
5. Feeling guilty after
51
What is OSFED
Other Specified Feeding and Eating Disorder - when patients do not meet full criteria for diagnosis
52
What is atypical anorexia nervosa
Despite weight loss, individual's weight is in normal range
53
Name two OSFED syndromes
1. Purging disorder
| 2. Night eating syndrome
54
What factors contribute to onset for Eating disorder
1. Combination of low self-esteem and perfectionism leading to a need for control
2. Triggers to using food as a means of self-control in this context
CORE MODEL
55
What stops eating disorders from getting better
1. Enhances overvaluation of eating: shape and weight
| 2. Terror of losing control (body image disturbances re-appear)
56
Risk factors when looking at a patient with potential eating disorder
1. Severe restriction of food/fluid
2. Electrolyte imbalance
3. Bone Deterioration
4. Haematamesis from vomtiting
5. Alcoholism
6. Muscular weakness
6. Breathing problems
7. Ectopic beats, tachycardia, bradycardia and low BP
8. Rapid weight loss
9. Risky behaviours (suicide)
57
Treatment of eating disorders
1. Doing therapies
2. Diary keeping and weight monitoring
BULLIMIA: Cognitive Behaviour Therapy
ANOREXIA: Specialist Support Clinical Management or CBT
58
What is 'nerd' factor
1. Structured treatments count beans (more evidence than should be)
59
What is the government's alcohol strategy
1. Minimum pricing
2. Licensing
3. Law
60
Risk factors for breast cancer
1. AGE
2. Lifestyle:
Overweight
Alcohol
Smoking
Occupational exposure (night shift work)
Physical Inactivity
3. Oestrogen exposure (HRT, Obesity, breastfeeding and menarche)
4. Family History
5. Genetics
61
What gene mutation increases chance of developing breast cancer
1. BRCA1 + BRCA2
62
What condition is caused by BRCA1 + 2 specifically
Hereditary breast-ovarian cancer syndrome
63
What is hereditary breast-cancer syndrome
Higher risk of breast AND ovarian cancer in individuals
64
What conditions increase the risk of breast cancer
1. Diabetes Mellitus
| 2 .SLE
65
Diagnosis of breast cancer
1. BIOPSY
2. FBC
3. MAMMOGRAPHY (2 taken from the side and above breast ) >35
4. Fine needle aspiration of lump (as it could be a cyst)
5. Ultrasound + MRI <35
6. History + Examination
PUMB
P - palpation
U - Ultrasound
M - Mammogram
B - Biopsy
66
What colour would fluid collected from cysts and lump of a breast indicates breast cancer
1. Blood fluid
67
Clinical presentation of breast cancer
1. Lump that feels different to the rest of the tissue (detected by mammogram) or in axillary lymph nodes
2. Thickening
3. One breast is larger or smaller
4. Change in nipple position or shape (becoming inverted)
5. Dimpling
6. Discharge
7. Constant pain in part of the breast
8. Paeu d'orange skin due to inflammation
9. Paget's disease of the breast
68
What is Paget's disease of the breast
Skin changes resembling eczema (redness, discolouration and flaking)
Itchy, burns and pains later
69
What are phyllodes tumours
Tumours formed within the storm of the breast tissue
70
What breast lump is common between the age of 15-30
1. FIBROADENOMAS
71
What are fibroadenomas
Benign breast tumours made of storm and epithelial tissues
72
Role of breast lobules
Milk producing glands
73
How can we detect fibroadenomas
1. Painless
| 2. Firm or rubbery
74
WHAT IS THE COMMON BREAST LUMP between 30 and 45
Fibrocystic change
75
Common breast lump between 45-55
Breast cyst
76
Post-menopausal breast lump
Cancer
77
The prevalence of what breast lump decreases over time
Diffuse nodularity
78
Four purposes of surgical interventions
1. Cure
2. Staging
3. Minimise recurrence
4. Information to tailor treatment
79
Surgical intervention for breast cancer
1. Selective Aillary surgery to treat lymphoedema
80
Benefit of selective axillary surgery
1. Staging accuracy
2. Sentinel Node Biopsy
3. Breast conservation surgery
4. Therapeutic mammoplasty
5. Local perforator flaps
6. Prosthesis
7. Risk reducing surgery
81
Con of selective axillary surgery
1. No survival benefit of clearance
82
Where is the sentinel node located
Node on upper outer part of breast
83
How does cancer spread in the lymph nodes
1. Start as isolated tumour cells
2. Form micro metastases
3. Form macro metastases
84
What size are lymph tumours that are micrometastatic
0.2 mm
85
What size are lymph tumours that are macro static
2.0mm (these need clearance or can erupt the lymphatics)
86
What is breast conservation surgery
Alternative to mastectomy:
Limits cosmetic damage caused by surgery
87
Requirements needed for breast conservation surgery
1. CLEAR MARGINS
| 2. Breast radiotherapy
88
How do we localise and impalpable cancer
1. Wires inserted into the breast
| 2. Iodine-125
89
What is therapeutic mammoplasty
1. Operation to remove cancer and reshape breast to leave normal breast shape
90
What is local perforator flaps
1. Subcutaneous fat or skin is remove from distant part of the body to reconstruct the excised part (Make boobs look a bit like moobs)
91
What two types of breast reconstruction do we have
IMMEDIATE (at time of mastectomy)
| DELAYED
92
Outline the types of breast reconstruction
1. Implant added
- ----AUTOLOGOUS-----
2. Pedicled flap (from abdo or lat areas - contains all layers of the skin including subcutaneous tissue and keeps all blood vessels intact)
3. Free flap (Creating a vascularised flap of tissue - has re-attached blood supply - and adding it to the breast to increase volume) - Latissimus dorsi, abdo or gluteus maximus)
93
When is surgery contraindicated
Locally advanced tumours or inflammation has occurred in the breast
94
How is male breast cancer treated
1. Mastectomy + Radiotherapy
95
T assessment in breast cancer
T1 - Size < 2
T2 - Size 2-5
T3 - >5
T4 - Tumour extends to skin or chest wall
96
N assessment in breast cancer
N0 - No lymph node metastasis
N1 - Metastasis to ipsilateral, moveable and axillary Lns
N2 - Metastasis to ipsilateral fixed axillary
N3 - Metastasis to infra claviclular and supraclavicular
97
What is adjuvant therapy of early breast cancer
1. Prevent or delay the subsequent appearance of metastatic disease
2. Eradicate unapparent micromeastases which are thought to account for distant treatment failure following local treatment alone
98
What is neo-adjuvant therapy of early breast cancer
1. To downside a breast tumour to make breast conserving surgery possible
2. Early systemic therapy in high risk patients
99
What treatments are used for early breast cancer
1. Radiotherapy
2. Endocrine treatments
3. Chemotherapy
4. HER2 targeted treatments
5. Novel targeted treatments
100
When is radiotherapy done for breast cancer
1. Lumpectomy
| 2. Post-mastectomy
101
What treatment is given for early breast cancer
1. Oncotype DX
2. Oestrogen receptor
3. Herceptin
102
What is Oncotype DX
Predicts how likely cancer will come back following surgery
103
What is the role of HER2
controls cell growth and repair
104
Why is Herceptin given
It reduces the amount of HER2 in cancer cells topping them from growing
105
Four aspects on deciding what early breast cancer patients need chemotherapy
1. Biological consideration (HER2, Grade, genomics)
2. Anatomical consideration (Node and size)
3. Co-morbidity
4. Patient Choice
106
Chemotherapy treatment for breast cancer
1. ANtracyclines (cause DNA crosslinks preventing replication)
2. Taxens (prevent microtubule formation so cells can't divide)
107
Name two antracyclines
Doxorubicin
| Epirubicin
108
Name two Tameness
Docetaxel
| Paclitaxel
109
When is endocrine therapy given to breast cancer patients
1. Those who have been taking tamoxifen for 2 - 5 years
| 2. Postmenopausal women with oestrogen-receptor positive invasive breast cancer
110
What is endocrine therapy
Aromatase inhibitor
111
What is aromatase inhibitor
1. Catalyses process of oestrogen synthesis (blocks oestrogen production)
112
What is Tamoxifen
SELETIVE OESTROGEN RECEPTOR MODULUATORY (blocks growth of cancer cells)
113
How does Herceptin cause toxicity
1. Inhibits HER2 cell survival pathway
2. Congestive heart failure
3. Endothelial dysfunction (increased activation of oxygen species and NO inhibition so impaired blood flow to myocytes)
HER2 increases NO and reduces effects of oxygen species
114
Who needs radiotherapy after mastectomy
1. >5cm
2. Positive resection margin
3. Skin involvement
4. 1 or more positive nodes
115
Side-effects of radiotherapy in breast cancer
1. Rib fracture
2. Pain and skin changes
3. Fatigue
4. Lymphedema
116
Define advanced breast cancer
1. Has spread locally to the extent of inoperable (METASTATIC)
Non-curable
117
How is advanced breast cancer diagnosed
1. XRAY
2. CT
3. Bone scan
Assess ER and HER2 if still not clear
118
Common sites of breast cancer metastases
1. Bone
2. Lymph nodes
3. Liver
4. Lung
5. Brain
119
What is given is ER positive breast cancer
1. Aromatase inhibitor
2. Tamoxifen
3. CDK4/6 inhibitors
120
ER weak chemotherapy treatment
First: Anthracyclines
Second: Taxene or carboplatin
Third: Capecitabine/Vinorelbine
Fourth: Eribulin
121
Treatment for HER@+ breast cancer
HER2 Targeting therapy
First: Herceptin + pertuzumab with docetaxol
Second: TDM1 (perception bound to a chemotherapy agent)
Third: Herceptin + lapatinib
122
Supportive therapy for advanced breast cancer
1. Radiotherapy (stop bone, brain and skin metastases)
2. Surgery (Bowel obstruction, brain metastases, fractures and RFA)
3. Nursing (support)
123
Radiotherapy for brain metastases
STEREOTACTIC
124
NHS support for breast cancer patients
1. Macmillan nurses
125
Role of Key worker
Provide support throughout patient journey
126
What size things does a key worker do for a breast cancer patient
1. Empower them (information on treatments and prognosis)
2. Connecting (build up rapport)
3. Value patient's unique charcaertistics
4. Finding meaning - helping patient make sense of what is happening
5. Preserving integrity
6. Doing for (sorting out their benefits)
127
Effects of chemotherapy treatment
1. Infertility
2. Altered body image
3. Premature menopause
128
What are breast cysts
1. Palpable, fluid-filled rounded lumps not fixed to surrounding tissue
129
How is breast cyst diagnosed
Aspiration (treated with aspiration)
130
What are intrasductal papillomas
Benign, warty lesions behind the areola
131
Chemotherapy in Breast Cancer
1. Epirubicin
| 2. CMF (CYCLOPHOSPHAMIDE + METHOTREXATE + FLUOROURACIL)
132
What is the name of the aromatase inhibitor given
ORAL ANASTROZOLE
133
How is premenopausal and ER positive treated
ORAL GOSERELIN (GnRH analogues)
Ovarian ablation by surgery and radiotherapy (stops oestrogen synthesis)
134
How is Radiotherapy to bony lesions treated
ORAL ALENDRONATE
135
How is breast cancer prevented
1. Promote awareness
| 2. Screening (2-view mammography) every 3 years
136
Define lymphoedema
1. Chronic non-pitting oedema due to lymphatic insufficiency
137
What part of the body is affected by lymphoedema
Legs (they become huge)
138
What causes primary lymphoedema
Milord's disease
139
What causes secondary lymphedema
```
Filarial infections (worms that infect lymphatic system stopping drainage)
Malignancy
Trauma
Radiotherapy
Surgery
```
140
How is lymphedema treated
1. Compression stocking
| 2. Physical massage
141
How is Filariasis treated
ORAL DIETHYLCARBAMAZINE
142
How is recurrent cellulitis treated (worsens the lymph vessel damage)
ORAL PHENOXYMETHYLPENICILLIN
143
Clinical presentation of CO
1. Mistaken for viral
2. Hypoxia but no cyanosis
3. Vomiting, increased pulse and tachypnoea
4. Headache, coma, convulsions and cardiac arrest
5. Metabolic acidosis and hypertonia
144
How is CO diagnosed
1. O2 sats normal
| 2. ABG (need to look at saturated oxygen haemoglobin and COhb)
145
How do we diagnose CO form ABG
1. Venous COhb > 3% in non smokers are >10 in smokers
Normal: <5%
146
How is CO treated
1. Remove from CO source
2. Give 100% O2 until COhb <10%
3. Hyperbaric O2 treatment hastens CO elimination
4. IV MANNITOL to reduce ICP
147
How are withdrawal symptoms of opioids treated
METHADONE
148
Clinical presentation of opiate overdose
1. Pinpoint pupils
2. Reduced resp rate
3. Coma
4. Hypothermia, hypoglycaemia and convulsions
149
How is opiate overdose treated
1. IV NALOXONE until breathing is adequate
150
What insecticide commonly cause poisoning
ORGANOPHOSPHORUS insecticides
151
How do OP insecticides cause poisoning
Inhibit ACh binding so they accumulate at peripheral cholinergic nerve endings and central
152
Clinical presentation of OP insecticide poisoning
```
SLUD
Salivation
Lacrimation
Urination
Diarrhoea
```
Anxiety and restless ness
Abdo colics
Chest tightness
Sweating
Small pupils, coma, resp distress and bradycardia
153
How is Op insecticide poisoning diagnosed
Measure erythrocyte ACh activity
154
How is OP insecticide poisoning treated
1. Wear gloves and remove soiled clothes and wash skin
2. IV ATROPINE every 10 mins until skin is dry, pulse > 70 and pupils dilated
3. IV PRALIDOXIME to stop inhibition of ACh
155
How does cocaine overdose damage the body
1. Blocks dopamine reuptake
2. Blocks noradrenaline uptake - tachycardia
3. Blocks serotonin reuptake - hallucinations
156
Clinical presentation of cocaine overdose
1. Agitation
2. Tachycardia
3. Hypertension
4. Sweating
5. Hallucinations
6. Convulsions
7. Metabolic acidosis
8. Hyperthermia
9. Rhabdomyolysis
10. Dissection of aorta, myocarditis, MI, dilated cardiomyopathy
157
Treatment of cocaine overdose
1. IV DIAZEPAM to control agitation
2. IV GLYCERYL TRINITATE to lower BP
3. VERAPAMIL
Beta-adrenoceptors contraindicated as they worsen hypertension
158
What is amyloidosis
1. Proteins are at risk of misfiling
2. Causes proteolysis
3. Proteins do not dissolve during proteolysis causing fragments to aggregate - oligomers
4. Hydrophobic beta-pleated sheets not dissolved
5. Oligomers aggregate together an make amyloid fibrils
159
Clinical presentation of amyloidosis
```
HEART and KIDNEY most commonly effected
1. Nephrotic syndrome
2. Proteinuria
3. Diastolic or systolic HF
4. EKG changes (atrioventricular block or sinus node dysfunction)
5. Orthostatic hypotension
------- LIVER and GI------
Raised AST and ALT
Raised alkaline phosphatase
Hepatomegaly
Deposits on tips of intestinal villi causing diarrhoea
```
--------EYES-----
Racoon eyes due to deposition in blood vessels and reduced activity of factor X
---------ENDO---
Enlarged tongue
Hypothyroidism
160
How is amyloidosis diagnosed
1. Biopsy of tissue with CONGO RED stain + polarised light = green
2. Type of amyloid protein via protein electrophoresis
161
Two types of amyloidosis
AL - common
| AA
162
How is amyloidosis treated
1. HIGH DOSE MELPHALAN (chemotherapy) and DEXAMETHASONE
163
Risk factors for erectile dysfunction
1. Lack of exercise
2. Obesity
3. Smoking
4. Hypercholesterolaemia
5. Metabolic syndrome
164
Clinical presentation of erectile dysfunction
1. Pyronie's disease (fibrous plaque in pens causing bent erection)
2. Hypogonadism
3. Prostatic enlargement
4. GP and HR
165
What conditions can cause erectile dysfunction
1. Diabetes Mellitus
2. MI
3. Hypertension
4. Renal Failure
5. Trauma
6. Prostatectomy
166
How is erectile dysfunction diagnosed
1. Fasting glucose
2. Lipid profile
3. Morning testosterone (if low, check FSH, LH and prolactin)
167
Treatment of erectile dysfunction
1. PDE5 inhibitors : Sildenafil
Second: Alprostadil intracavernous injection or intraurethral
Tertiary: Vacuum constriction devices (passive engorgement)
168
Define priapism
1. lasts 4 hours
169
Why does priapism have to be corrected
Causes ischaemia and damage
170
Treatment for priapism
1. Aspirate with 19 gauge needle
| 2. Inject phenylphrenine
