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Health and Society Year 4 > MSK/Neurology > Flashcards

MSK/Neurology Flashcards

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Sociology 101 flashcards
1
Q

6 factors of the National Service Framework for long term conditions (2005)

A
  • person centered
  • early recognition (prompt diagnosis and treatment)
  • early specialist rehab
  • community rehab
  • palliative care
  • supporting family and carers
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2
Q

Services available for people with neurological conditions

A

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

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3
Q

Prevalence of neurological conditions (from most common to least)

A

essential tremor > epilepsy > Parkinsons Disease > Multiple Sclerosis > dystonia > muscular dystrophy > Huntingtons Disease > Motor Neurone Disease

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4
Q

2 ADL that people with neurological conditions suffer from

A

Everyday tasks

Functional activities e.g. getting up from chair, stairs, bath

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5
Q

International Classification of Disabilities and Handicaps

A

Impairment
Disability
Handicap

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6
Q

Define impairment and give an example

A

Impairment: Disturbance affecting function (psych/physiological)
e.g. amputated leg/muscle pain

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7
Q

Define disability and give an exmaple

A

Disability: Restriction of normal activity from impairment e.g. walking

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8
Q

Define handicap and give an example

A

Handicap: Disadvantage that restricts their role that is normal for that individual
e.g. handicap

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9
Q

Medical and biopsychosocial issues with management of a patient

A

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.

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10
Q

Define the Disability Discrimination Act 1995

A

Rights to people with a disability

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11
Q

Define the equality act 2010

A

Physical/mental impairment that has a sustained and long-term effect on your ability to do normal daily activities

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12
Q

Legal requirement for a meningitis infection

A

Notifiable disease

Communicable disease control before microbiological confirmation

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13
Q

Who is responsible to ensure policies are in place and implemented

A

Consultant for communicable disease control (CCDC)

Consultant in public health medicine (CPHM)

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14
Q

What policies are in place for infectious diseases

A
  • referred early to hospital
  • cases investigated properly
  • give prophylaxis to contacts
  • info to schools, NHS
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15
Q

First line medication for meningitis

A

Benzylpenicillin IM at GP whilst awaiting transfer unless allergy

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16
Q

What is the prophylaxis for meningitis

A

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

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17
Q

What medication do you use for prophylaxis?

A

RIFAMPICIN, ciprofloxacin and ceftriaxone

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18
Q

What immunisations are given for meningitis

A

Men ACWY before uni
MenC

Offer vaccine to close contacts of person affected

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19
Q

4 risk factors for stroke

A

HTN, DM, AF, smoking

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20
Q

Score for AF stroke risk

A

CHADSVASC

congestive heart failure, HTN, age > 65, DM, previous stroke, vascular disease, sex category (1). If you have 9/9 risk is 10-27%

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21
Q

Investigation for stroke

A

CT head

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22
Q

Management of stroke

A

Thrombolysis: Alteplase within 4.5h
Aspirin: 300mg within 24 hrs or after 24 hrs if treated with alteplase

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23
Q

How long do you continue aspirin for after a stroke

A

2 weeks

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24
Q

What secondary prevention medication do you start after 2 weeks

A

Clopidogrel 75mg

Atorvastatin 20-80mg

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25
Q

7 modifiable risk factors for stroke

A

lipid modification, BP, physical activity, smoking cessation, nutrition, reduce alcohol, control comborbidities

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26
Q

Investigations for stroke risk factors

A 
ECG
ECHO
FBC
Lipid profile
Carotid doppler (stenosis)
BP (target 130/80)
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27
Q

Driving after a stroke

A

No driving for one month
Can continue after if recovery
DVLA informed if residual neuro deficit

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28
Q

What is the prevention paradox

A

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

29
Q

Legal aspects of driving in epileptics

A

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.

30
Q

Can you join the armed forced if you had epilepsy as a child

A

No

31
Q

What does the equality act 2010 state about epilepsy

A

Reasonable adjustments should be made

32
Q

Percentage of over 65’s who will have a fall

A

30% (half of these will have recurrent falls)

33
Q

Percentage of over 90s who will have a fall

A

55%

34
Q

Percentage of falls which cause a serious injury (and examples)

A

10%

Fractures, head injury

35
Q

3 psychiatric causes of falling

A

Fear of falling, social restriction, depression

36
Q

Consequences of falls for carers

A

Time and anxiety

37
Q

What do QALY show about falls

A

showed if we could reduce fear of falling may be more benefit than actually treating fractures

38
Q

9 risk factors for hip fracture

A

age, female, low body weight, smoking, ethnicity, muscle weakness, loss of balance, low bone density, steroids

39
Q

Time until treatment for hip fracture

A

Within 26 hours

40
Q

2 methods to prevent fractures

A

prevent with fall prevention, bone protection (Vit D/calcium, bisphosphonates, HRT)

41
Q

5 multifactorial methods to reduce fall risk

A

target medications, postural hypotension, environmental hazards, gait training, exercise

42
Q

6 people in the falls MDT

A

Pharmacist, OT, podiatry, GP, physio, nurses

43
Q

Explain 3 types of accommodation for the elderly

A

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.

44
Q

What should you consider when assessing the elderly for discharge (6)

A 
Joint ROM and strength
Ability to perform tasks
Stairs
Toileting
Kitchen
Cognition
45
Q

What are SMART targets used for

A

Goal setting

Specific
Measurable
Achievable
Realistic
Timely
46
Q

5 interventions for the elderly

A

strength exercises, mobility work, balance rehab, wheelchair, assessment of home

47
Q

5 discharge options

A

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.

48
Q

2 types of referrals made to social services

A

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.

49
Q

Define capacity

A

Understand, retain and communicate information

Understand potential risks

50
Q

Can people make unwise decisions

A

Yes, if they have capacity

51
Q

What happens if a patient lacks capacity and has no next of kin

A

IMCA (independent mental capacity advocate) needed

52
Q

3 types of care plans

A

Urgent care plan (crisis)
Advanced care plan
End of life care plan

53
Q

8 risk factors for substance misuse in the elderly

A 
physical mental health
long term prescription (painkillers, hypnotics, anti-anxiety)
bereavement
retirement
boredom
loneliness
homelessness
depression
54
Q

3 symptoms of substance misuse in the elderly

A

Memory problems
Changes in sleep habits
Mood changes

55
Q

What 2 things do nice assess the evidence base for

A

Clinical and cost-effectiveness

56
Q

What type of appraisals should CCGs have

A

Technology appraisals to fund the technology

57
Q

Process of technology appraisals

A
  1. Topic selection: consultation with industry, NHS and patient groups, DOH
  2. Data submission: all trial data according to NICE
  3. Data review: NICE appraisal committee allocates data to academic center for cost-effectiveness
  4. Call for contributions: stakeholders
  5. Fund: CCG may fund if service is required.
58
Q

Define ‘yellow flags’ for back pain

A

Potentially psychosocial pathologies that may prolong recover/outcome

59
Q

Give 6 examples of yellow flags for back pain

A
  • 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
60
Q

3 examples of complementary therapy for MSK pain

A

Osteopathy, Acupuncture, Chiropractic

61
Q

4 advantages of complementary therapy

A

Patient choice
Growing evidence base
Cost effective
Less invasive

62
Q

3 disadvantages of complementary therapy for back pain

A

Regulatory issues
Lack of evidence
Inertia (resistance to change)

63
Q

Define osteopathy

  • regulation

- use

A

Tough physical manipulation, stretching and massage
Statutory self-regulation
Good for back pain and sports injuries

64
Q

Define Chiropractor

  • regulation
  • use
  • benefit
A

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

65
Q

Define acupuncture

- What do nice recommend it for

A

Release neurohumoral and endorphins

- headache and migraines

66
Q

Regulation of herbal homeopathy

A

Self regulated

Accredited with professional standards authority

67
Q

Define the effectiveness gap

A

A clinical area where treatments are not satisfactory or successful due to a lack of efficacy/acceptability/side effects/compliance

e.g. back pain

68
Q

MDT for inflammatory arthritis (11)

A

GP, Consultant rheumatologist, Rheumatology nurse specialist, Physio, OT, Pharmacist, Radiographer, Social worker, Dietician, Psychologist, Orthopaedic Surgeon

Health and Society Year 4 (9 decks)

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