Module 1 COTE Notes Flashcards
ALP raised in isolation?
Vitamin D deficiency
Side effect of doxycycline
Stomach irritation
anticholinergic burden
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
Hypokalaemia ECG
U-wave and T-wave inversion
Hyperkalaemia
Tented T-wave
Side effect of promorphine
leg swelling
Verification of death
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
Diastolic heart failure ejection fraction is…
Preserved
HFpEF - Heart failure with preserved ejection fraction
Approx half of HF patients, abnormal diastolic function, increased risk of AF and PHTN
Similar presentation to those with HFrEF
Charles Bonnet syndrome
Hallucinations and pseaudo-hallucinations due to poor vision function, for instance seeing shadows as being people etc
Opiate overdose signs
Pinpoint pupils
Decreased resp rate
Limpness
Pale/Clammy
Withdrawal of treatment law
Seen the same as with holding treatment in the first place
Basic care which must always be offered
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Other forms of food/fluid are not basic care and thus can be withdrawn if considered to be in the best interest of the patient
Mental Capacity Act
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
Capacity
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
DOLS Acid Test
Is the person subject to continuous supervision and control? and
Is the person free to leave?
How long does DOLS last
Up to 12 months
Malnutrition screening tool
MUST - Malnutrition Universal Screening Tool
Gold standard for checking NG position
Gold standard is to check pH aspirate to confirm position (aim <5.5)
Second line is Xray
30 day use
NJ tube check
X ray not pH - 60 day use
Treating refeeding syndrome
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
What are the geriatric giants?
The 4 I’s:
Instability (falls)
Immobility
Intellectual impairment (confusion)
Incontinence
What class of drug is normally combined with L-dopa therapy to prevent peripheral side-effects?
Carbidopa – a dopa-decarboxylase inhibitor
complications of L-dopa therapy?
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
What ABCD2 score is considered “high risk”
for a stroke and what should be done?
≥ 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
What should be done for someone with an
ABCD2 score of ≤ 3?
Specialist referral within 1 week of symptom onset, including decision
or brain imaging
If vascular territory or pathology is uncertain – refer for brain imaging
Alzheimer’s
Agnosia, Apraxia, Amnesia, Aphasia
Vascular dementia
stepwise progression of symptoms following
ischaemic brain injury
Lewy body dementia
sleep behaviour disorder, falls, impaired
consciousness, visual hallucinations, Parkinsonism
Frontotemporal dementia–
memory fairly preserved, extreme
personality changes and disinhibition
to treat Alzheimer’s
Acetylcholinesterase inhibitor Donepezil
NMDA-receptor antagonist – blocks
glutamate (memantine)
List 3 adverse effects of bisphosphonates?
Oesophagitis
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral
shaft in patients taking alendronate
How are DEXA scan scores interpreted?
- 1 to +1 = healthy
- 1 to -2.5 = osteopenia
≤ -2.5 = osteoporosis
≤ 2.5 and a current fragility fracture = severe osteoporosis
FRAX scoring
system?
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
How is malnutrition diagnosed?
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
postural
hypotension?
of >20/10 mmHg within 3 minutes of standing
