Miscellaneous Flashcards
Define polypharmacy.
A person over 65 yrs taking 4 or more medications daily
What are the consequences of polypharmacy?
Costs Adverse drug reactions Drug-drug interactions Non-adherence Association with decline in functional status
What support is available in the community for people with chronic diseases?
GP Advanced nurse practitioner District nurse Dietician Physiotherapist Occupational therapist Psychological support: counselling, CBT, groups
Charities: BHF, BTS etc.
What are the issues faced by teenage girls who are pregnant?
Less likely to access ante-natal care
Financial, social problems during and after pregnancy: may have no family or partner support
Higher risk of complications: prematurity, low birth weight
Mental health: PND, often isolated, feel judged, may not have much support
Unable to continue education, less likely to get to Uni, get a good job and stable income
Higher chance of baby suffering abuse and neglect due to lack of education and support of mother, child is also less likely to achieve well in life
What sort of questions should you ask girl under 16 about her relationship?
How old is the partner? First partner? Only partner? Are you ever scared of partner? Do they give you presents/money etc for sex? Do you feel able to say no? Do your family know them?
What support is available for people with dementia in the community?
GP
Memory clinic: help them come to terms with diagnosis, coping and memory strategies
Council: home care, respite care, medications support, home modifications
Admiral nurses
Local support groups run by charities
Psych therapy: CBT, counselling
Blue badge, access to disabled toilets, identification bracelets, personal safety alarms
What is lasting power of attorney?
A legal document that allows patient to appoint someone they trust to make decisions for them when they’re no longer able to
- property, affairs, finances
- healthcare
What is an advanced directive?
A legal document that expresses the wishes of a patient regarding medical treatment, should they lack capacity in the future
Can express what treatments they wouldn’t like, not demand treatments
What should you consider when making a decision in the best interests of a patient lacking capacity?
Encourage participation from the patient
Find out the patients views, beliefs or values
Don’t make assumptions on what decision they’d likely make from their age, gender, appearance, behaviour
Will they regain capacity, if they will can the decision be postponed
Consult with family
What does DoLS stand for?
What does it mean?
Deprivation of Liberty Safeguards
Putting a person who lacks capacity under continuous supervision and control, they’re not free to leave (often care home, hospital).
This is done to keep them safe
How is a DoLS put in place?
At least these two needed, they then apply to the local authority
Best interests assessor (social worker, nurse, OT)
Mental health assessor (doctor)
What is considered when assessing someone for a DoLS?
Age (over 18) Mental health Mental capacity Best interests Eligibility Any advanced directives/decisions)
How long does a DoLS last?
12 months max
Who can be used as an interpreter? Who cannot? Under which circumstances?
Qualified interpreter ideally
Health professionals, family and friends in cases where there’s an urgent need and qualified interpreter is not available
Other patients and children should never be used
List some issues migrants face?
Infections from their country of origin
Nutritional deficiency
FGM
Ethnicity increases risks of certain conditions: CVD, diabetes, haemoglobinopathies
Mental health problems resulting from migration
Harder to access healthcare due to language barrier, health inequalities
What are the risk factors for TB?
Close contacts with a person with active TB
Immigration from high risk TB area
Homeless, IVDU
Immunocompromised:
- infants
- organ transplant
- steroid treatment
- immuno-suppressive treatments (for autoimmune diseases)
- HIV
- smoking
- diabetes
- malnutrition
- alcohol
Treatment for TB?
Rifampicin
Isoniazid
Pyrazinimide
Ethambutol
Signs on XR for TB?
Consolidation Cavitating lesion Tree in bud sign Hilar lymphadenopathy Pleural effusion
Investigations of TB?
Mantoux test to check for immunity
Interferon gamma release assay (sputum test for acid fast bacilli)
Intestinal features of Crohn’s.
Blood in stool Diarrhoea / constipation Abdo tenderness Distention Mouth ulcers Anal / peri-anal lesions (fistula, skin tags, abscess)
Extra-intestinal features of Crohn’s.
Clubbing Episcleritis Arthritis Fatty liver Granulomata Malnutrition
Histological features of Crohn’s.
Skip lesions Vertical fissures Fistula Granuloma Transmural inflammation Lymphocytic infiltration
Side effects of steroids?
Weight gain Acne Irregular periods Sleep disturbance Mood swings, irritable, anxious Increased growth of body hair
List some skin causes of itch?
Inflammatory:
- Psoriasis
- Lichen Planus
- Eczema
- Dermatitis herpetiformis (related to Coeliac)
Infections, infestations
- Scabies
- Tinea (ringworm)
- Chickenpox
- Impetigo
Other
- Lichen Simplex
- Prickly heat rash
List some systemic causes of itch?
HIV, Hep C
Chronic renal failure
Leukaemia
Fe deficiency anaemia
Grave’s disease
Cirrhosis
Polycythaemia vera
Diabetes mellitus
List some symptoms of chronic renal failure?
Pruritus Nausea + vomiting Fatigue Anorexia Peripheral oedema Pulmonary oedema Polyuria, nocturia
List some symptoms of cirrhosis?
Pruritis Nausea + vomiting Fatigue Jaundice Bruising Ascites Oesophageal varices Dupuytren's contracture
List some symptoms of Fe deficiency anaemia?
Pruritis Fatigue Palpitations SOBOE Glossitis Angular cheilitis
What is angular cheilitis and glossitis?
AC: Sore red patches in corner of mouth
Glossitis: inflammation of tounge, soreness and redness
Symptoms of hyperthyroidisim?
Constipation Feeling hot Sweating Anxiety Weight loss Oligomenorrhoea
Symptoms of Grave’s disease?
Symptoms of hyperthyroidism
Plus
Pretibial myxoedema
Exophthalmos
Goitre
What are the stages of the MSE?
Elaborate a bit on each
Appearance:
- are they unkempt
- clothing
- posture/gait
Behaviour
- eye contact
- facial expression
- level of arousal
- body language
Speech
- pressured
- volume
- tone
Mood (low, euphoric)
Affect (flat, blunted)
Thoughts
- flight of ideas
- circumstantiality
- thought disorder
Perceptions
- delusions
- hallucinations
Insight
- are they aware they may be mentally unwell?
What is the difference between mood and affect?
Mood: the climate, what their mood is like generally
Affect: weather, what it is like today at this time
List the thought disorders?
Thought insertion
Thought withdrawal
Thought echo
Thought broadcast
