Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Years 1+2 > S4C1 > Flashcards

S4C1 Flashcards

1
Q

What is a Statement of intent?

A

a document that allows a medical practitioner to complete a Medical Certificate of Death for a patient in the community who is expected to die.
The GP must have seen the patient within the previous 14 days before death.
If a hospital medical practitioner completes the Statement of Intent for Salford it will be valid until 5pm the next working day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a DNA CPR forms?

A

Do Not Attempt Cardiopulmonary Resuscitation - this policy refers solely to cardiopulmonary resuscitation (CPR) in the event of a cardio respiratory arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to assess swallowing?

A

To check swallowing:

  1. Give 3oz water
  2. Drink sequentially until all is gone
  3. Hand on throat to feel when swallowing
  4. Check voice after
  5. Is any water sticking?
  6. Check for coughing, tickling, voice change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Red flags of checking swallowing?

A

Coughing
Choking
Wet vocal quality
Signs of struggle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What cells line the buccal cavity?

What do they produce?

A

Lined by oral mucosa
thick stratified squamous epithelium that is resistant to abrasion

Produces defensins to inhibit bacterial growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Saliva made up of?

A 
99% water
lingual lipases and alpha-amylase
Mucoproteins - act as lubricant
Lysozymes
Immunoglobulins - esp. IgA
Electrolytes
Calcium
Phosphate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What controls Saliva secretion?

A

secreted continuously
salivation is controlled by salivatory nuclei in medulla and pons of the brain stem
Mechanorecptors and chemoreceptors in the mouth stimulate production of saliva with a high water content
Input from higher brain centres and lower GI can induce salivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the Oesophagus

A 
Pharynx to stomach (~25cm)
Normally closed
Highly folded mucosa
Submucosa contains:
        Blood vessels
	Lymphatics 
	Nerves 
	Lymphoid tissue 
	Mucus glands
Lined by stratified squamous epithelium to resist abrasion
Muscularis layer
	Skeletal in first third - voluntary
	Mixed in middle third
	Smooth in last third - involuntary
Outer layer is mostly adventitia
        Fixed to adjacent structures by connective tissue
Last part beyond diaphragm covered with serosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What lining changes are present at the Gastro-oesophageal junction?

A

changes from squamous to columnar epithelium (glandular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the cranial nerve involved in swallowing?

A

Multiple cranial nerves transmit afferent and efferent control of swallowing.
Nerves V, IX and X provide sensory information
Nerves V, VII, IX, X, XII proved motor innervation to different areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of dysphagia?

A

Oropharyngeal
Abnormal bolus transfer to the oesophagus
Difficulty initiating a swallow
Only one manifestation of the primary disease
Oesophageal
Abnormal bolus transport through the oesophagus
Food stops after initiation of swallow
Location of the primary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the epidemiology of Dysphagia.

A

Community - 8-16% of older people have symptoms of dysphagia

Old age/ frailty - 33% of >80s have dysphagia

Hospital - Up to 47% of older patients in hospital have dysphagia

Nursing home - 50% in nursing homes have dysphagia, 80% of dementia patients have dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of dysphagia?

A

Neurological
Diseases
Injuries
Abnormalities of CNS, Anterior horn cell, PNS and neuromuscular junction

Physical -Related to head and neck impairments

Respiratory disease - COPD

Psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe Dysphagia after a stroke.

A 
50% of all stroke victims have dysphagia
Usually oropharyngeal
30% increased risk of mortality
Aspiration most important complication
Recovery in majority
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is achlasia?

A

The failure of a ring of muscle fibres, such as a sphincter of the oesophagus, to relax.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of achalasia?

A

Associated with HLA-DQw1
Circulating antibodies to enteric neurons suggest that achalasia many be an autoimmune disorder
Potentially result from chronic infections with herpes zoster or measles viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the epidemiology of Achlasia.

A

1 per 100,000 per year
Onset before adolescence
Diagnosed between 25-60
Long term risk - 13% 15 year mortality

18
Q

Describe Voluntary passive euthanasia

A

To allow the patient to die by omission by withdrawing (removing treatment to allow natural progression) or withholding (not performing) treatment

19
Q

Describe Voluntary active euthanasia

A

A person directly and deliberately causes the patients death

Some people believe this is morally better than passive

20
Q

Describe Non-voluntary euthanasia

A

The person is unconscious or otherwise unable to make a meaningful choice between living and dying, so an appropriate person takes the decision on their behalf

21
Q

Describe involuntary euthanasia

A

When the person chooses life but dies anyway

22
Q

What treatments are available for oropharyngeal dysphagia?

A 
Swallowing therapy - SALT
	Swallowing exercises
Dietary changes
	Healthy balanced diet
	Softer foods
	Thickened fluids
	Support at meal times

Feeding tubes
Provides nutrition
Given if at risk of malnutrition and dehydration

23
Q

What are the 2 types of feeding tubes?

A

Nasogastric tube - passed through nose and down into stomach
Short term
Replaced into other nostril after ~ 1 month

Percutaneous endoscopic gastrostomy (PEG) - directly implanted into your stomach
Long term
Several months before replacing
Major complications are infection and internal bleeding

24
Q

What treatments are available for Oesophageal dysphagia?

A 
Medications - PPIs
Botox - treats achalasia
      6 months
Surgery
      Endoscopic dilation
      Stent insertion
25
Q

What are the 3 integrated phases of swallowing?

Phase - muscle involved - neural control - voluntary control

A
  1. Oral - Striated - Cortex/medulla - Full
  2. Pharyngeal - Striated - Medulla - Some
  3. Oesophageal - Striated/Smooth - Medulla / ENS - None
26
Q

What is the self-regulation model?

A
  1. Stimuli are presented (i.e., something happens that provokes a reaction, whether that’s a thought, something another person said, getting significant news, etc.)
    1. The individual makes sense of the stimuli, cognitively (understanding it) and emotionally (feeling it)
    2. The sense-making leads to the individual choosing coping responses (i.e., what the person does to influence their feelings about the stimuli or the actions they take to address the stimuli)
    3. The sense-making and coping responses determine the outcomes (i.e., the individual’s overall response and how they choose to behave)
    4. The individual evaluates his coping responses in light of these outcomes and determines whether to continue using the same coping responses or alter their formula
27
Q

What are the two main types of oesophageal cancer?

A

Squamous cell carcinoma (more common in the developing world) typically occurring in the middle and upper thirds of the oesophagus
-Strongly associated with smoking and excessive alcohol consumption, as well as chronic achalasia, low vitamin A levels and, rarely, iron deficiency

Adenocarcinoma (more common in the developed world) typically occurring in the lower third of the oesophagus

- Arises as a consequence of metaplastic epithelium (termed Barrett’s oesophagus) which progresses to dysplasia, to eventually become malignant
- Risk factors for this subtype are long-standing GORD, obesity, and high dietary fat intake
28
Q

What are the clinical features of oesophageal cancer?

A

Dysphagia - characteristically progressive
-Any patient with dysphagia should be assumed to have cancer until proven otherwise
Significant weight loss - due to both dysphagia and cancer-related anorexia

29
Q

What are the red flag symptoms of oesophageal cancer?

A 
>55 yrs with weight loss
Upper abdominal pain
Dyspepsia
Reflux
Dysphagia
30
Q

What is the management of Oesophageal cancer?

A

70% of patients are treated palliatively as many patients present with advanced disease
Surgery - major as both abdo and chest must be opened
Stent - help with swallowing
Radiotherapy/chemo - reduce tumour size and bleeding
Photodynamic therapy - kills nearby cells using light

31
Q

What is Barrett’s Oesophagus?

A

Metaplasia of the oesophageal epithelial lining, whereby normal stratified squamous epithelium are replaced by simple columnar epithelium.

32
Q

What is the pathophysiology of Barrett’s?

A

The vast majority of cases are caused by chronic gastro-oesophageal reflux disease.

The epithelium of the oesophagus becomes damaged by the reflux of gastric contents, resulting in a metaplastic transformation. This in turn increases the risk of developing dysplastic and neoplastic changes.

33
Q

What part of the oesophagus is most affected in Barrett’s?

What does the endoscopy look like?

A

The distal oesophagus is most commonly affected.
On endoscopy, the oesophagus appears red and velvety, with some preserved pale squamous islands. Diagnosis relies on biopsy demonstrating the presence of simple columnar epithelium within the oesophagus

34
Q

What are the risk factors for Barrett’s Oesophagus?

A 
Caucasian
Male
>50
Smoker
Obesity
Hiatus Hernia
Family History
35
Q

What are the clinical features for Barrett’s Oesophagus?

A 
History of GORD
Retrosternal chest pain
Excessive belching
Odynophagia - painful swallowing
Chronic cough
Hoarseness
36
Q

What are the red flag symptoms for malignancy in Barrett’s Oesophagus?

A 
Dysphagia
Weight loss
Early satiety - feeling full
Malaise
Loss of appetite
37
Q

How do you manage Barrett’s Oesophagus?

A

Given a proton-pump inhibitor (typically high dose and twice daily).
Any medication that affects stomach defences (such as NSAIDs) should be stopped.
The patient should be provided with lifestyle advice to reduce the acidic stimulus on the squamous cells (the driver of the metaplastic change.

38
Q

What surrounds the salivary glands?

A

Surrounded by a Connective tissue capsule with septa that divide the gland into lobules

39
Q

What type is the salivary glands and what do they produce?

A

Compound tubuloacinar glands
- branching duct system
Produces serous, mucous or mixed secretions

40
Q

What are the different types of excretory ducts? (from small to big)

A

Intercalated ducts - small, tiny lumen, simple low cuboidal epithelium
Striated ducts - formed by merging intercalated ducts, simple columnar epithelium
Intralobular ducts - formed by merging striated ducts, gradually increase in size and become surrounded by CT
Interlobular ducts - epithelium may be pseudostratified, may possess cilia, eventually convey saliva into oral cavity

41
Q

What are the major salivary glands and the type of secretion they produce?

A

Parotid gland - serous
Submandibular - seromucous (Mainly serous)
Sublingual gland - seromucous (Mainly mucous)

Years 1+2 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions