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Phase 3a AW > SAQ 2017 > Flashcards

SAQ 2017 Flashcards

1
Q

16 year old woman brought to GP by father presenting with 6 month history of abdominal fullness on eating, alleviated by vomiting, with reduced food intake. She was unhappy with her weight and felt fat. BMI of 16. You suspect an eating disorder.

3 organic causes of symptoms (3 marks)

A

Malignancies, GI disease, endocrine disease (e.g. diabetes mellitus, hyperthyroidism), chronic infections and chronic inflammatory conditions

Alcohol or substance abuse

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2
Q

Bulimia:

3 other tests to do(3 marks)

A

Include: Signs found in: vomiting, starvation
• ECG
• U&Es-hypokalaemic, hypocholeraemic alkalosis; hyponatraemia, hypomagnesaemia, raised urea (dehydration)
• FBC- normocytic anaemia, leucopenia
• LFTs- abnormal LFTs
• Serum glucose and lipids- hypoglycaemia, hypercholesterolaemia, hypercarotenaemia
• TFTs- reduced T3
• Amylase- raised serum amylase
• DEXA scan for identification of osteopenia and osteoporosis
• Others- raised growth hormone and cortisol

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3
Q

What is the criteria for diagnosis of anorexia nervosa?

A

All of the following:

  1. Low BMI <17.5kg/m2
  2. Self-indulged weight loss (poor calorie intake, vomiting, exercising)
  3. Overvalued ideas: dread of fatness, low target weight
  4. Endocrine disturbance (hypothalamic-pituitary-gonadal axis, resulting in amenorrhoea, raised cortisol, growth hormone etc)

Pre pubertal- failure to make expected weight gains; delayed pubertal events

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4
Q

What is the diagnostic criteria for Bulimia?

A

All of the following:

  1. Binge eating
  2. Strong cravings for food
  3. Methods to counteract weight gain (vomiting, laxatives, fasting, exercise etc)
  4. Overvalued idea: dread of fatness, self-perception of being too fat, low target weight
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5
Q

4 physical signs you would expect with anorexia

A
  • Emancipation
  • Cardiomyopathy
  • Amenorrhagia; infertility; reproductive system atrophy
  • Constipation; abdo pain
  • Cold intolerance; lethargy
  • Bradycardia; hypotension; cardia arrhythmias, heart failure
  • Lanugo: fine, downy hair on trunk; loss of head hair
  • Peripheral oedema
  • Proximal myopathy; muscle wasting
  • Osteoporosis; fractures
  • Seizures; impaired concentration; depression
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6
Q

Down’s Screening / Amniocentesis

35 year old woman is 15 weeks pregnant and is concerned about Down syndrome due to her age.
What screening should be offered to her?

A

Quadruple test (too late for combined test). Measures serum markers.

Low AFP, low oestriol, high HCG, low PAPP-A, thickened nuchal translucency

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7
Q

She is given a risk of 1/70 following screening. Amniocentesis is offered to diagnose.
What 4 possible complications of amniocentesis that should be mentioned when obtaining consent?

A
  • Miscarriage
  • Injury from the needle
  • Infection
  • Rhesus disease
  • Talipes (club foot)
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8
Q

What drug should she be given on the day of the procedure?

Why?

A

Rhesus immunoprophylaxis- Anti-D

fetomaternal transfusion is a risk in amniocentesis and CVS

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9
Q

Name 3 other chromosomal abnormalities and their names

A

Edwards (trisomy 18)
Patau’s (trisomy 13)
Fragile X (trinucleotide repeat disorder)

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10
Q

6 year old child presents to A&E with a 2 day history of high fever. Arrives with a decreased consciousness level.
What should be the initial management of child with decreased consciousness (3 marks)

A 
ABCDE
IV access
Get bloods
Fluid bolus
Broad-spectrum antibiotics- cefotaxime or ceftriaxone
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11
Q

On examination there is a non-blanching purpuric rash.

Give 2 causes of a purpuric rash in a child of this age. (Age 6) (2 marks)

A 
Meningococcal septicaemia
Acute lymphoblastic leukaemia
Congenital bleeding disorders
Immune thrombocytopenic purpura
Henoch-Schonlein purpura
Non-accidental injury
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12
Q 
Meningococcal septicaemia:
Blood gases:
Acidotic
Low CO2
Low bicarbonate
Low BE

What is the abnormality shown on the blood gases? (1 mark)

What is the cause of this abnormality?

A

Metabolic acidosis with respiratory compensation

Sepsis?? Check

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13
Q

Meningococcal septicaemia

What treatment would you give to family as prophylaxis (1 mark)

A

Rifampicin
Adults- 600mg every 12 hours for 2 days
Child- 10mg/kg every 12 hours for 2 days

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14
Q

What is Need, defined by NICE (1 mark)

A

The ability to benefit from an intervention

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15
Q

What is an example of a health related intervention that is supplied, but not needed or demanded. Explain why. (1 mark)

A

Routine Caesarean sections on women with a history of a previous Caesarean section

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16
Q

What is an example of a health related intervention that is supplied, needed but not demanded. Explain why. (1 mark)

A

Smoking cessation
Alcohol cessation,
Colorectal screening

Colorectal screening- People don’t demand it, but it is needed for detection of colorectal cancer

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17
Q

Define epidemiological health needs assessment (2 marks)

A

Person, place and time. Assess a problem, the size of it, the services available for this issue, the evidence base for effectiveness and cost-effectiveness. Then make recommendations.

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18
Q

Define corporate health needs assessment (1 marks)

A

Collects the views of stakeholders e.g. service users, GPs, other health professionals, and asks them what they believe the need is

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19
Q

Define comparative health needs assessment (1 mark)

A

Taking 2 populations and compare the services available in one with another. Shows the effectiveness of the intervention

20
Q

Limitation of comparative health needs assessment (1 mark)

A

Hard to find a comparable population.
Poor data quality/ unavailable data
Neither group may be using the ideal service

21
Q

Down’s w/ Depression
Sheltered accommodation 45 year old Down syndrome patient is presenting with a 6 month history of agitation, incontinence of urine, attacking other residents,
Suspected diagnosis of depressive syndrome
What three features in the history would clarify this diagnosis. Give an area and an example of each (3 marks)

A
  • Low mood, which varies little from day-to-day and is unresponsive to circumstances
    • Loss of interest or pleasure in almost all activities
      Fatiguability on minimal exertion leading to diminished activity (anergia)

Biological symptoms-loss of appetite, psychomotor retardation, early morning wakening

Cognitive symptoms- reduced memory and concentration, poor self-esteem, guilt, hopelessness, suicide or delf harm

22
Q

Down’s with depression:

What two other differentials are possible? (2 marks)

A

In Down’s, early onset dementia, hypothyroidism, infection

Others-Medication induced low mood, infection, pain, hypothyroidism

23
Q

Down’s with depression:

Two further investigations? (2 marks)

A

-FBC: Check for anaemia (low HB), infection (high WCC), high MCV (high alcohol intake)
- U+Es (hyponatraemia, renal function)
-LFTs and gamma GT ( also high alcohol intake)
Thyroid function tests (hyper- or hypothyroidism) and calcium (hypercalcaemia)

Other investigations if indicated- CRP/ESR, Vit B12 and folate,urine drug screen, ECG, EEG, CT

24
Q

Down’s with depression:

What non-pharmacological interventions could help him? (3 marks)

A
  • CBT
  • Group therapy
  • Physical activity
  • Lifestyle changes- healthy diet, regular sleep times, avoid alcohol
25
Q

Down’s w/ Epilepsy (Mental Capacity and deprivation of liberty)
Chap with Down’s, cerebral palsy and epilepsy supported by sister whole life. Sister can no longer support him.Steps to assess mental capacity (4 marks)

A
  • Understand info
  • Retain info
  • Weigh up info to make a decision
  • Communicate the decision by any means
26
Q

What are the best interest principles? Not in exam but good to know

A
  1. Presumption of capacity – you have the right to make your own decisions and must be assumed to have capacity to do so unless it is proved otherwise.
  2. Right to be supported to make your own decisions – all practicable steps must be taken to help you make your own decision before anyone concludes you are unable to do so. 
  3. Right to make eccentric or unwise decisions – you are not to be treated as being unable to make a decision simply because the decision you make is seen as unwise. 
  4. Best interests – any decision made, or action taken, on your behalf if you lack capacity must be made in your best interests. 
  5. Least restrictive intervention – anyone making a decision on your behalf must consider all effective alternatives and choose the less restrictive of your basic rights and freedoms in relation to risks involved.
27
Q

What 3 things are required for a deprivation of liberty standard?

A

They lack capacity to consent to care and treatment arrangements.

They are under continuous supervision and control.

They are not free to leave.

28
Q

What does a DoL safeguard ensure? (2 marks)

A

That steps are provided for a deprivation of liberty to be continually assessed and monitored, so that it remains in the best interests of a person. It can be challenged in the Court of Protection and a representative i.e. family member of the patient can attend.

29
Q

How long does a DoL safeguard last? (1 mark)

A

Indefinitely, until it is decided it is not in the best interests of the patient.

30
Q

Fainting epileptic woman
50 year old woman presents with her friend following ?seizure. Her friend reports that she felt confused, and then had twitching of her right eye, before collapsing to the ground shaking. This lasted 3 minutes before she started to regain consciousness. She is still confused.
You conclude that what occurred was an epileptic attack.

What 3 features from the history support epilepsy as a diagnosis?		(3 marks)
A

Tonic-clonic movements
Post-ictal confusion
Loss of consciousness

31
Q

What 2 non blood investigations would you do? (2 marks)

A

EEG

MRI

32
Q

How long can she not drive? (1 mark)

A

6 months

33
Q

She then has another seizure.

What is first line management for this patient? (3 marks)

A

Sodium valproate is used first-line for patients with generalised seizures

34
Q

NEC
28 weeks gestation, following a placental rupture. Then when he was 2 weeks old he suddenly turned gray and non responsive.

Apart from NEC, what 2 conditions could cause this presentation? (2 marks)

A 
Severe gastroenteritis
Sepsis
Hirschsprung's disease
DKA
UTI
35
Q 
Blood gases
	Acidotic
	Low O2
	High CO2
	Normal bicarb
	Normal BE
	What does the blood gas show?							(1 mark)
A

Respiratory acidosis

36
Q

Two bowel specific complications of NEC? (2 marks)

A

Death
Bowel perforation
Peritonitis
Short bowel syndrome

37
Q

Three radiological findings suggestive of NEC (3 marks)

A

-Dilated bowel loops
-Bowel wall oedema
-Pneumatosis intestinalis (intramural gas)- gas cysts in wall
-Portal venous gas
Pneumoperitoneum resulting from perforation
-Air both inside and outside the bowel wall (Rigler sign)
-Air outlining the falciform ligament (football sign)

38
Q

Two immediate non surgical interventions for NEC (2 marks)

A

ABCDE

Broad spectrum antibiotics

39
Q 
NSTEMI 
Otherwise fit and well 50 year old man with a long family history of ischaemic heart disease presents with NSTEMI. He is treated with a stent.
He is started on 
	Bisoprolol
	Atorvastatin
	Clopidogrel
	Lansoprazole
For the first three of these, explain why in laymans terms he is prescribed them, and two side-effects										(6 marks)
A

Bisoprolol- Reduce blood pressure by reducing flow of blood to the heart
SE- Nausea, fatigue, hypotension, bronchospasms

Atorvastatin- Reduce cholesterol in the blood. Reduce risk of clotting.
SE- Joint pain, diarrhoea, indigestion, muscle pain, nausea

Clopidogrel- thins the blood to reduce risk of clotting.
SE- Thrombotic thrombocytopenic purpura, haemorrhage, headache, nausea, bruising.

40
Q

Two weeks later, he is feeling exhausted on exertion and is trying to remain as fit as he used to be. He presents with 100/80 BP. The cardiology discharge form advised that you titrate bisoprolol to the highest dose.
What would you do? And why? (1 mark)

A

Stop the bisoprolol?

41
Q

What non-pharmacological measure would you advise for him?(1 mark)

A

Lifestyle changes- Diet, exercise, reduce BMI, stop smoking

42
Q

Heart failure treatment
88 year old chap with heart failure and renal failure. Consultant decided that they had tried every management to the maximal extent and that in the next few weeks the patient would die.
Four domains of the geriatric assessment, and a member of the MDT for each (4 marks)

A

Medical assessment
Doctor, nurse, pharmacist, dietician, SaLT

Functional assessment
OT,PT,SaLT

Psychological assessment
Doctor, nurse, OT, psychologist

Social and environmental assessment
OT, SW

43
Q

Three things to consider in an advanced care plan (3 marks)

A

The main goal is to clarify peoples’ wishes, needs and preferences and deliver care to meet these needs.

  • What you want to happen
  • What you don’t want to happen
  • Who you want to speak for you
44
Q

?PCOS Menorrhagia
Woman presents with irregular cycle since a menarche of 12. She has a 32-40 week cycle, that she would like to be more regular.
Give two possible causes of irregular cycle (2 marks)

A

Dysfunctional uterine bleeding

PCOS

45
Q

If she had hirsutism and weight gain, what two tests? (2 marks)

A

USS

Bloods- FSH, LH, testosterone, TFTs

46
Q

What two non hormonal interventions to control dysmenorrhoea and menorrhagia? (2 marks)

A

Tranexamic acid

Mefenamic acid

47
Q

Menorrhagia

What three management options would you advise? (3 marks)

A

Weight loss and exercise, Smoking cessation

Treat menstrual problems- COCP

Hirsutism- anti-androgen e.g. cyproterone.

Phase 3a AW (7 decks)

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