Miscellaneous Flashcards

1
Q

Define polypharmacy.

A

A person over 65 yrs taking 4 or more medications daily

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2
Q

What are the consequences of polypharmacy?

A
Costs
Adverse drug reactions
Drug-drug interactions
Non-adherence
Association with decline in functional status
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3
Q

What support is available in the community for people with chronic diseases?

A
GP
Advanced nurse practitioner
District nurse
Dietician
Physiotherapist
Occupational therapist
Psychological support: counselling, CBT, groups

Charities: BHF, BTS etc.

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4
Q

What are the issues faced by teenage girls who are pregnant?

A

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

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5
Q

What sort of questions should you ask girl under 16 about her relationship?

A
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?
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6
Q

What support is available for people with dementia in the community?

A

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

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7
Q

What is lasting power of attorney?

A

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
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8
Q

What is an advanced directive?

A

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

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9
Q

What should you consider when making a decision in the best interests of a patient lacking capacity?

A

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

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10
Q

What does DoLS stand for?

What does it mean?

A

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

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11
Q

How is a DoLS put in place?

A

At least these two needed, they then apply to the local authority

Best interests assessor (social worker, nurse, OT)

Mental health assessor (doctor)

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12
Q

What is considered when assessing someone for a DoLS?

A
Age (over 18)
Mental health
Mental capacity
Best interests
Eligibility
Any advanced directives/decisions)
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13
Q

How long does a DoLS last?

A

12 months max

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14
Q

Who can be used as an interpreter? Who cannot? Under which circumstances?

A

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

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15
Q

List some issues migrants face?

A

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

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16
Q

What are the risk factors for TB?

A

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
17
Q

Treatment for TB?

A

Rifampicin
Isoniazid
Pyrazinimide
Ethambutol

18
Q

Signs on XR for TB?

A
Consolidation
Cavitating lesion
Tree in bud sign
Hilar lymphadenopathy
Pleural effusion
19
Q

Investigations of TB?

A

Mantoux test to check for immunity

Interferon gamma release assay (sputum test for acid fast bacilli)

20
Q

Intestinal features of Crohn’s.

A
Blood in stool
Diarrhoea / constipation
Abdo tenderness
Distention
Mouth ulcers
Anal / peri-anal lesions (fistula, skin tags, abscess)
21
Q

Extra-intestinal features of Crohn’s.

A
Clubbing
Episcleritis
Arthritis
Fatty liver
Granulomata
Malnutrition
22
Q

Histological features of Crohn’s.

A
Skip lesions
Vertical fissures
Fistula
Granuloma
Transmural inflammation
Lymphocytic infiltration
23
Q

Side effects of steroids?

A
Weight gain
Acne
Irregular periods
Sleep disturbance
Mood swings, irritable, anxious
Increased growth of body hair
24
Q

List some skin causes of itch?

A

Inflammatory:

  • Psoriasis
  • Lichen Planus
  • Eczema
  • Dermatitis herpetiformis (related to Coeliac)

Infections, infestations

  • Scabies
  • Tinea (ringworm)
  • Chickenpox
  • Impetigo

Other

  • Lichen Simplex
  • Prickly heat rash
25
Q

List some systemic causes of itch?

A

HIV, Hep C

Chronic renal failure

Leukaemia

Fe deficiency anaemia

Grave’s disease

Cirrhosis

Polycythaemia vera

Diabetes mellitus

26
Q

List some symptoms of chronic renal failure?

A
Pruritus
Nausea + vomiting
Fatigue
Anorexia
Peripheral oedema
Pulmonary oedema
Polyuria, nocturia
27
Q

List some symptoms of cirrhosis?

A
Pruritis
Nausea + vomiting
Fatigue
Jaundice
Bruising
Ascites
Oesophageal varices
Dupuytren's contracture
28
Q

List some symptoms of Fe deficiency anaemia?

A
Pruritis
Fatigue
Palpitations
SOBOE
Glossitis
Angular cheilitis
29
Q

What is angular cheilitis and glossitis?

A

AC: Sore red patches in corner of mouth

Glossitis: inflammation of tounge, soreness and redness

30
Q

Symptoms of hyperthyroidisim?

A
Constipation
Feeling hot
Sweating
Anxiety
Weight loss
Oligomenorrhoea
31
Q

Symptoms of Grave’s disease?

A

Symptoms of hyperthyroidism

Plus
Pretibial myxoedema
Exophthalmos
Goitre

32
Q

What are the stages of the MSE?

Elaborate a bit on each

A

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?

33
Q

What is the difference between mood and affect?

A

Mood: the climate, what their mood is like generally

Affect: weather, what it is like today at this time

34
Q

List the thought disorders?

A

Thought insertion
Thought withdrawal
Thought echo
Thought broadcast