MSK/Neurology Flashcards
6 factors of the National Service Framework for long term conditions (2005)
- person centered
- early recognition (prompt diagnosis and treatment)
- early specialist rehab
- community rehab
- palliative care
- supporting family and carers
Services available for people with neurological conditions
NHS: GP, geriatrics, physio, speech/language, specialist clinics
Charities
Private sector
Social services: housing, transport, education, respite care, residential nursing home
Financal/employment services e.g. jobcentre
Prevalence of neurological conditions (from most common to least)
essential tremor > epilepsy > Parkinsons Disease > Multiple Sclerosis > dystonia > muscular dystrophy > Huntingtons Disease > Motor Neurone Disease
2 ADL that people with neurological conditions suffer from
Everyday tasks
Functional activities e.g. getting up from chair, stairs, bath
International Classification of Disabilities and Handicaps
Impairment
Disability
Handicap
Define impairment and give an example
Impairment: Disturbance affecting function (psych/physiological)
e.g. amputated leg/muscle pain
Define disability and give an exmaple
Disability: Restriction of normal activity from impairment e.g. walking
Define handicap and give an example
Handicap: Disadvantage that restricts their role that is normal for that individual
e.g. handicap
Medical and biopsychosocial issues with management of a patient
Traditional: problem is for healthcare, patient is passive recipient, relief of pain will cure disability
Biopsychosocial: combined effort between patient and healthcare, management must relieve pain and prevent disability.
Define the Disability Discrimination Act 1995
Rights to people with a disability
Define the equality act 2010
Physical/mental impairment that has a sustained and long-term effect on your ability to do normal daily activities
Legal requirement for a meningitis infection
Notifiable disease
Communicable disease control before microbiological confirmation
Who is responsible to ensure policies are in place and implemented
Consultant for communicable disease control (CCDC)
Consultant in public health medicine (CPHM)
What policies are in place for infectious diseases
- referred early to hospital
- cases investigated properly
- give prophylaxis to contacts
- info to schools, NHS
First line medication for meningitis
Benzylpenicillin IM at GP whilst awaiting transfer unless allergy
What is the prophylaxis for meningitis
Give to those in prolonged close contact in a household setting 7 days before illness or those who had transient close contact at time of admission
What medication do you use for prophylaxis?
RIFAMPICIN, ciprofloxacin and ceftriaxone
What immunisations are given for meningitis
Men ACWY before uni
MenC
Offer vaccine to close contacts of person affected
4 risk factors for stroke
HTN, DM, AF, smoking
Score for AF stroke risk
CHADSVASC
congestive heart failure, HTN, age > 65, DM, previous stroke, vascular disease, sex category (1). If you have 9/9 risk is 10-27%
Investigation for stroke
CT head
Management of stroke
Thrombolysis: Alteplase within 4.5h
Aspirin: 300mg within 24 hrs or after 24 hrs if treated with alteplase
How long do you continue aspirin for after a stroke
2 weeks
What secondary prevention medication do you start after 2 weeks
Clopidogrel 75mg
Atorvastatin 20-80mg
7 modifiable risk factors for stroke
lipid modification, BP, physical activity, smoking cessation, nutrition, reduce alcohol, control comborbidities
Investigations for stroke risk factors
ECG ECHO FBC Lipid profile Carotid doppler (stenosis) BP (target 130/80)
Driving after a stroke
No driving for one month
Can continue after if recovery
DVLA informed if residual neuro deficit
What is the prevention paradox
Majority of deaths come from those with low risk factors and minority come from those with high risk factors
Population measures have a large benefit to community, low perceived benefit to individual
Targeting high risk groups has a large benefit to individual and small effect on population rate
Legal aspects of driving in epileptics
Isolated seizure: group 1: ban for 6m; group 2: ban for 5y
Repeat seizures: group 1 need to be free of seizures for 1y, if with-drawing AED then wait 6m; group 2 need to be free for last 10y.
Doctors are able to tell DVLA if you continue to drive but it is the patient’s responsibility.
Can you join the armed forced if you had epilepsy as a child
No
What does the equality act 2010 state about epilepsy
Reasonable adjustments should be made
Percentage of over 65’s who will have a fall
30% (half of these will have recurrent falls)
Percentage of over 90s who will have a fall
55%
Percentage of falls which cause a serious injury (and examples)
10%
Fractures, head injury
3 psychiatric causes of falling
Fear of falling, social restriction, depression
Consequences of falls for carers
Time and anxiety
What do QALY show about falls
showed if we could reduce fear of falling may be more benefit than actually treating fractures
9 risk factors for hip fracture
age, female, low body weight, smoking, ethnicity, muscle weakness, loss of balance, low bone density, steroids
Time until treatment for hip fracture
Within 26 hours
2 methods to prevent fractures
prevent with fall prevention, bone protection (Vit D/calcium, bisphosphonates, HRT)
5 multifactorial methods to reduce fall risk
target medications, postural hypotension, environmental hazards, gait training, exercise
6 people in the falls MDT
Pharmacist, OT, podiatry, GP, physio, nurses
Explain 3 types of accommodation for the elderly
Sheltered accommodation w warden control: live in own flat but communal areas, maybe pull cords with responder system
Residential homes: staffed by carers but not nurses, not suitable for complex behaviour or mobility issues
Nursing homes: nurses and carers: dependent and higher care needs.
What should you consider when assessing the elderly for discharge (6)
Joint ROM and strength Ability to perform tasks Stairs Toileting Kitchen Cognition
What are SMART targets used for
Goal setting
Specific Measurable Achievable Realistic Timely
5 interventions for the elderly
strength exercises, mobility work, balance rehab, wheelchair, assessment of home
5 discharge options
Home support e.g. package of care from social services
Inpatient rehab: try to return a person to their previous level of function
Residential home: may be temp (allow respite for carer) or permanent
Nursing home: temporary/ permanent.
Palliative care: last 6w of life can fast track them there. Discharge to hospice for symptom control or end of life care.
2 types of referrals made to social services
NOA notification of assessment (previously section 2s) to request social worker to be allocated. NOD notification of discharge 0 section 5: must be done within 72h of submission of the NOA. Tells social services that patient is both medically and therapy fit for discharge that day and social services input is the only factor delaying.
Define capacity
Understand, retain and communicate information
Understand potential risks
Can people make unwise decisions
Yes, if they have capacity
What happens if a patient lacks capacity and has no next of kin
IMCA (independent mental capacity advocate) needed
3 types of care plans
Urgent care plan (crisis)
Advanced care plan
End of life care plan
8 risk factors for substance misuse in the elderly
physical mental health long term prescription (painkillers, hypnotics, anti-anxiety) bereavement retirement boredom loneliness homelessness depression
3 symptoms of substance misuse in the elderly
Memory problems
Changes in sleep habits
Mood changes
What 2 things do nice assess the evidence base for
Clinical and cost-effectiveness
What type of appraisals should CCGs have
Technology appraisals to fund the technology
Process of technology appraisals
- Topic selection: consultation with industry, NHS and patient groups, DOH
- Data submission: all trial data according to NICE
- Data review: NICE appraisal committee allocates data to academic center for cost-effectiveness
- Call for contributions: stakeholders
- Fund: CCG may fund if service is required.
Define ‘yellow flags’ for back pain
Potentially psychosocial pathologies that may prolong recover/outcome
Give 6 examples of yellow flags for back pain
- belief that pain/ activity are harmful
- abnormal sickness behavior (extended rest)
- low/negative mood
- work environment (low support/ dissatisfaction)
- social problems
- seeking treatment that are excessive
3 examples of complementary therapy for MSK pain
Osteopathy, Acupuncture, Chiropractic
4 advantages of complementary therapy
Patient choice
Growing evidence base
Cost effective
Less invasive
3 disadvantages of complementary therapy for back pain
Regulatory issues
Lack of evidence
Inertia (resistance to change)
Define osteopathy
- regulation
- use
Tough physical manipulation, stretching and massage
Statutory self-regulation
Good for back pain and sports injuries
Define Chiropractor
- regulation
- use
- benefit
Diagnose, treat and prevent MSK - manual treatments for back, neck and shoulder
Statutory self-regulation
Lower back pain and OA
Small benefit after 1 year
Define acupuncture
- What do nice recommend it for
Release neurohumoral and endorphins
- headache and migraines
Regulation of herbal homeopathy
Self regulated
Accredited with professional standards authority
Define the effectiveness gap
A clinical area where treatments are not satisfactory or successful due to a lack of efficacy/acceptability/side effects/compliance
e.g. back pain
MDT for inflammatory arthritis (11)
GP, Consultant rheumatologist, Rheumatology nurse specialist, Physio, OT, Pharmacist, Radiographer, Social worker, Dietician, Psychologist, Orthopaedic Surgeon
