Placement Flashcards
What is a beclometasone inhaler and what colour is it?
- a steroid inhaler used to prevent asthma symptoms
- brown inhaler
What colour is a salbutamol inhaler and when is it used?
- blue inhaler
- used when needed, works by relaxing the muscles of airways leading to the lungs
What chart do we record physical examination findings on?
- National Early Warning Score chart
What are 4 viral infections which are transmitted by mosquitoes as the vector?
- Dengue
- Zika
- Yellow fever
- Chikungunya
- Japanese encephalitis
What sort of symptoms would indicate hospital admission for a 16 year old boy presenting with a 3 day history of a fever (38 C), and influenza like symptoms, he also has asthma?
- meningism (photophobia and neck stiffness) or petechial rash (rash that does not go away when pressure applied - glass test)
- suspicion of sepsis (overwhelming, whole body response to infection)
- symptoms such as rigors (high fever with associated shaking - body internal thermal set point is too high)
- change in cognitive level or confusion (think of encephalitis, meningitis, or sepsis)
- acute exacerbation of his asthma
What is an important side effect of paracetamol?
- liver toxicity in overdose
What are Non-Steroidal Anti-Inflammatory Drugs useful for?
- especially good for inflammation or MSK pain
- can also be used to lower temperature
What are some side effects of NSAIDs?
- stomach ulceration
- kidney failure
- heart failure
- worsening of asthma
What are the 4 main NSAIDs used in practice?
- ibuprofen
- naproxen
- diclofenac
- aspirin (low-dose aspirin is a blood thinner not an NSAID)
What are some side effects of codeine?
- addiction
- constipation
- drowsiness
- nausea
- dizziness
- confusion
- low blood pressure
- respiratory suppression
At what time of the day would you recommend people take ibuprofen? And what might you prescribe alongside it?
- with / after food
- Proton Pump Inhibitor (PPI)
Why should you avoid prescribing NSAIDs for a patient who has a condition where they have to take blood thinners?
- NSAIDs could cause stomach bleeding which could be very serious
What is a notifiable disease?
- A condition which if suspected/diagnosed/confirmed, health professionals must notify/report the condition to the local health protection team (proper officer of the local authority)
Name 3 reasons why it might be useful to have a system for notifying diseases?
- guide contact tracing and treat/isolate contacts to reduce morbidity and spread
- help to trace the source of infectious outbreaks (eg. food poisoning)
- contribute to epidemiological statistics
- guide targeting of immunisations
List of notifiable diseases…
What does VITAMIN CDEF stand for?
V - Vascular(caused by arterial or venous problems)
I - Inflammatory or Infective
T - Trauma (caused by injury)
A - Autoimmune (caused by the immune system)
M - Metabolic (eg. caused by deficiencies or overload of substances)
I - Idiopathic (cause is unknown) or Iatrogenic (drug side effects)
N - Neoplastic (cancer)
C - Congenital (present from birth, genetic)
D - Degenerative (gradual wearing over time)
E - Environmental or Endocrine (caused by external environment or caused by hormones)
F - Functional (disease/symptoms without an obvious underlying pathological process)
What are some benefits of antibiotic prescribing for respiratory tract infections?
- May help to shorten the duration and severity of illness if bacterial infection is present
- May help to prevent serious complications – e.g. sepsis, brain abscess, pneumonia, respiratory failure – and death
- May help to prevent hospital admission – better for the patient and the NHS
- May help to catch the illness in it’s mild stages, allowing a quicker recovery – better for the patient’s quality of life, better for the economy if people get back to work more quickly etc.
- May help to prevent the need for further GP appointments if infections are managed sooner
What are the risks of antibiotic prescribing for respiratory tract infections?
- Will have no benefit if given for viral infections, although these may get better of their own accord anyway, making the patient think that antibiotics have helped, reinforcing the idea that they are needed for mild, self-limiting infections
- May cause side effects – rash, thrush infection, upset stomach, antibiotic-associated gut infections (e.g. Clostridium difficile)
- May cause an allergic reaction
- Costs the NHS money from providing prescription
- Unnecessary antibiotic usage may contribute towards antibiotic resistance, which can be a major public health issue e.g. MRSA, multi-drug resistant TB
What are the clinical features of deep vein thrombosis?
- dilated superficial veins
- sometimes erythema
- unilateral pitting oedema
- localised tenderness along the deep venous system (ie. along the posterior calf muscles)
What are the clinical features of arterial insufficiency?
- pale, hairless leg
- cool to touch
- absent pulses
- arterial ulcers (shown in image)
What is superficial thrombophlebitis and what are the clinical features?
- Superficial thrombophlebitis = thrombosis and inflammation of superficial veins
- Clinical features: red, inflamed areas following the path of a superficial vein, warm and tender
What are the clinical features of venous insufficiency?
- brown (haemosiderin) discolouration
- oedema
- varicose veins
- varicose ulcers (usually above the ankle, medial side)
What are the clinical features of pre-patellar bursitis?
- anterior knee swellin
- soft, fluctuant to touch
- may or may not be red, warm and tender
- knee flexion may be painful
What are the clinical features of an ankle sprain?
- swelling and bruising to medial or lateral areas
- tender on palpation
- reduced range of ankle movement
- antalgia
- Ottawa rules negative
What are the clinical features of cellulitis?
- well demarcated (well-defined), red, inflamed
- warm and tender
What are the clinical features of Achilles tendonitis and/or Achilles tendon rupture?
- swelling and muscle atrophy may be evident (compare both sides)
- tenderness over the Achilles tendon
- palpable nodules may be present over the Achilles tendon
- in tendon rupture there is acute pain and complete loss of plantarflexion of the ankle
- patient unable to stand on tiptoes on the affected side and Simmonds test is positive
What are the clinical features of peripheral neuropathy?
- may or may not be painful
- reduced sensation when touched, usually worst at the toes and spreading upwards
- muscles may be weak, reflexes reduced and muscle wasting/atrophy may be seen
- ulcers can occur (shown in image)
Pitting oedema…
VITAMIN CDEF for bone…
VITAMIN CDEF for soft tissue…
Dermatomes and spinal nerves…
Spinal anatomy (vertebral bodies)…
Spondylolysis, spondylolisthesis, spondylosis…
Shoulder anatomy (anterior view)…
Shoulder anatomy (posterior view)…
Rotator cuff muscles (SITS)…
