Module 1 COTE Notes

Question 1

ALP raised in isolation?

Answer 1

Vitamin D deficiency

Question 2

Side effect of doxycycline

Answer 2

Stomach irritation

Question 3

anticholinergic burden

Answer 3

Drugs affecting nicotinic and muscarinic receptors and result in cognitive decline, hallucinations, speech issues, vision issues, memory issues, confusion (brain fog), irritability (and other delirium associated symptoms, poor co-ordination, dementia, dry mouth, anhydrosis, pupil dilation, increased heart rate etc

Question 4

Hypokalaemia ECG

Answer 4

U-wave and T-wave inversion

Question 5

Hyperkalaemia

Answer 5

Tented T-wave

Question 6

Side effect of promorphine

Answer 6

leg swelling

Question 7

Verification of death

Answer 7

Any doctor can do, signed by consultant
Pupil reflex - in both eyes
Stethoscope - heart and lungs for 1 min
Pulse for 1 min
Speak to patient as normal throughout
Push on chest - pain stimulus

Question 8

Diastolic heart failure ejection fraction is…

Answer 8

Preserved

Question 9

HFpEF - Heart failure with preserved ejection fraction

Answer 9

Approx half of HF patients, abnormal diastolic function, increased risk of AF and PHTN
Similar presentation to those with HFrEF

Question 10

Charles Bonnet syndrome

Answer 10

Hallucinations and pseaudo-hallucinations due to poor vision function, for instance seeing shadows as being people etc

Question 11

Opiate overdose signs

Answer 11

Pinpoint pupils
Decreased resp rate
Limpness
Pale/Clammy

Question 12

Withdrawal of treatment law

Answer 12

Seen the same as with holding treatment in the first place

Question 13

Basic care which must always be offered

Answer 13

Oral food and fluid
Other forms of food/fluid are not basic care and thus can be withdrawn if considered to be in the best interest of the patient

Question 14

Mental Capacity Act

Answer 14

assume a person has the capacity to make a decision themselves, unless it’s proved otherwise

wherever possible, help people to make their own decisions

don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision

if you make a decision for someone who doesn’t have capacity, it must be in their best interests

treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

Question 15

Capacity

Answer 15

understand the information relevant to the decision

retain that information

use or weigh up that information as part of the process of making the decision

Question 16

DOLS Acid Test

Answer 16

Is the person subject to continuous supervision and control? and
Is the person free to leave?

Question 17

How long does DOLS last

Answer 17

Up to 12 months

Question 18

Malnutrition screening tool

Answer 18

MUST - Malnutrition Universal Screening Tool

Question 19

Gold standard for checking NG position

Answer 19

Gold standard is to check pH aspirate to confirm position (aim <5.5)

Second line is Xray

30 day use

Question 20

NJ tube check

Answer 20

X ray not pH - 60 day use

Question 21

Treating refeeding syndrome

Answer 21

IV thiamine, Vitamin B complex for first 10 days prior to feeding, low calorie intake

Daily monitoring of Refeeding bloods including U&Es/PO4/Mg and correct as necessary until stable

Question 22

What are the geriatric giants?

Answer 22

The 4 I’s:

Instability (falls)

Immobility

Intellectual impairment (confusion)

Incontinence

Question 23

What class of drug is normally combined with
L-dopa therapy to prevent peripheral side-effects?

Answer 23

Carbidopa – a dopa-decarboxylase inhibitor

Question 24

complications of L-dopa therapy?

Answer 24

Development of choreiform movements (L-dopa induced dyskinesia)

Become tolerant to the medication – even if the dose is increased the
effect will become less

Confusion

Hallucinations

Postural hypotension on starting treatment

Question 25

What ABCD2 score is considered “high risk”

for a stroke and what should be done?

Answer 25

≥ 4 = high risk

Aspirin – 300mg daily – started immediately

Specialist referral within 24 hours of onset of symptoms

Secondary prevention measures (statins, antihypertensives)

Crescendo TIAs (two or more episodes in a week) should be treated
as high risk, regardless of ABCD2 score

Question 26

What should be done for someone with an

ABCD2 score of ≤ 3?

Answer 26

Specialist referral within 1 week of symptom onset, including decision
or brain imaging

If vascular territory or pathology is uncertain – refer for brain imaging

Question 27

Alzheimer’s

Answer 27

Agnosia, Apraxia, Amnesia, Aphasia

Question 28

Vascular dementia

Answer 28

stepwise progression of symptoms following

ischaemic brain injury

Question 29

Lewy body dementia

Answer 29

sleep behaviour disorder, falls, impaired

consciousness, visual hallucinations, Parkinsonism

Question 30

Frontotemporal dementia–

Answer 30

memory fairly preserved, extreme

personality changes and disinhibition

Question 31

to treat Alzheimer’s

Answer 31

Acetylcholinesterase inhibitor Donepezil

NMDA-receptor antagonist – blocks
glutamate (memantine)

Question 32

List 3 adverse effects of bisphosphonates?

Answer 32

Oesophagitis

Osteonecrosis of the jaw

Increased risk of atypical stress fractures of the proximal femoral
shaft in patients taking alendronate

Question 33

How are DEXA scan scores interpreted?

Answer 33

• 1 to +1 = healthy
• 1 to -2.5 = osteopenia

≤ -2.5 = osteoporosis

≤ 2.5 and a current fragility fracture = severe osteoporosis

Question 34

FRAX scoring

system?

Answer 34

Parent hip fracture

Height and weight (BMI)

Smoking

Alcohol >3 units a day

Steroids

Previous hip fracture

Femoral neck bone mineral density

Female gender

Age

RA

Secondary osteoporosis

Question 35

How is malnutrition diagnosed?

Answer 35

BMI < 18.5 kg/m2

Unintentional weight loss >10% in the last 3-6 months

BMI < 20kg/m2 plus unintentional weight loss >5% within the last
3-6months

Question 36

postural

hypotension?

Answer 36

of >20/10 mmHg within 3 minutes of standing