SCA online - Investigations/ Results

Question 1

AKI

Answer 1

Kidneys are a filtering system, getting rid of waste in the urine. an AKI means that the kidneys are not functioning as well as they should be.

Qs
Pre renal - drinking, thirst
Renal - infection, injury, medications
Post - LUTS, haematuria, urine output

Question 2

AKI Mx

Answer 2

Same day admission
AKI Stage 3
- Creatinine > 3x baseline
- Creatinine raised by 26 within 48hrs
- Urine output < 0.3ml/kg/hr in 24 hrs

Suspected obstruction, sepsis, pul oedema/ hypovolaemia

If not for same day then liaise with nephrology within 24hrs if:
stage 4/5 CKD
glomerulonephritis, vasculitis
renal transplant

Question 3

New AF

Answer 3

Heart to beat irregularly leading to inefficient blood flow. This also leads to increased risk of blood clots, which can lead to a stroke in the brain.

Causes
Idiopathic
Cardiac - IHD, CHF
Resp - Infection, Lung ca
Systemic - alcohol, hypothyroid, electrolyte imbalance, diabetes

Question 4

Stable AF Mx

Answer 4

Rate control - B Blocker, CCB (verapamil), Digoxin (in sedentary patients)
FU in 1 week

Anticoagulation
- CHADsVAS vs ORBIT

DVLA
Group 1 - do not drive if AF causes incapacity
Group 2 - must inform DVLA. do not drive if AF causes incapacity.

Question 5

Childhood behavioural issues

Answer 5

Influences on behaviours (Qs to ask)
- life changes - moving house/ school
- parent stress
- attention seeking

Mx
Personal approach - parenting is unique. be yourself
consistency - choose a method and stick with it
communication

Question 6

Paget’s disease

Answer 6

a chronic bone disorder that causes bones to grow larger, become weaker, and sometimes deform

Fx:
bone pain
fractures (pathological)
arthritis
nerve compression neuralgia
rare - osteosarcoma

Ix:
X ray
Bloods - ALP raised (isolated)

Mx:
rheumatology refer - bisphosphonates

Question 7

Chronic fatigue syndrome

Answer 7

feeling of extreme tiredness all of the time - more so than after a long day, or lack of sleep and does not improve despite good rest and has significant impact on your life. the condition is common but we have a poor understanding of why it happens. It is a chronic condition that some days will be better than others.

Fx
muscle pains, headaches, brain fog
physical/ mental activities can be unmanageable
Red flags - weight loss, loss appetite, RO Ca

Ix
Full Hx and examination. Assessment of psychological and social wellbeing.
Bloods, urine (thyroid, menopause, vitamins)

Mx
Refer to Rheum/ specialist Chronic fatigue specialist clinic
Dietary advice + healthy living
CBT - therapy

Question 8

Gout

Answer 8

Build up of uric acid within the bloods that accumulates within joints causing pain and swelling - triggered diet (rich, sugary, meaty, foods) alcohol, obesity, family Hx, medications (diuretics, aspirin)

Mx/
acute - NSAIDs, colchicine
prophylaxis (4 weeks post acute attack) - allopurinol
address risk factors

Question 9

Spirometry

Answer 9

Obstructive
FEV 1 <80%
FEV 1/ FVC <0.7
eg - asthma, copd, CF, bronchiectasis

Restrictive
FEV 1 <80%
FEV 1/ FVC >0.7 (normal)
eg - Pulmonary = ILD, Pul oedema, Lung Ca
non pulmonary = kyphoscoliosis, MND, obestiy/ pregnancy

Question 10

COPD

Answer 10

Common, long term, lung condition that makes breathing difficult. Although there is no cure, there are many medications that can help symptoms.

Ix/
Spirometry - Obstructive pic FEV 1/ FEV <0.7 (no reversibility)D

Question 11

COPD Mx

Answer 11

Smoking cessation
annual Flu/ one off Pneumococcal vaccines
Pulmonary rehabilitation
Optimise co morbidities

1st
SABA/ SAMA

2nd
- if steroid responsive/ asthmatic features = LABA + ICS

• if not asthmatic features = LABA + LAMA (eg Respimat, Ellipta)

3rd
= LABA + LAMA + ICS (eg Trelegy, Trimbow)

Frequent exacerbations - Abx + PO steroids (amox + pred)

Ensure good inhaler technique

Ensure good mental health support - high risk of anxiety/ depression

Regular Follow up and Safety netting

Question 12

Lumbar disc degeneration (aka disc prolapse, slipped disc)

Answer 12

Soft cushion between the bones of the spine, bulge outwards and press on the nerves.

Red flags
- night pain, progressively worsening pain, systematic sx (fever, night sweats, weight loss), prev Ca, loss of bowel/ bladder ca

Ix
gold standard: MRI spine

Mx/
NSIADs/ analgesia
Physio

Question 13

Dealing with angry patient

Answer 13

• Listen to the patient - let them finish their narrative
• Apologise for situation
• Ask about the person in question eg child missed appendicitis - ask about child currently
• Show empathy, understand how distressing this must be
• Stay calm
• make complaints to practise manager in writing, who will acknowledge within 48 hrs and reply within 10 days

Question 14

Dengue Fever

Answer 14

Virus spread by mosquito bites, mainly in tropical countries

Fx
headaches, fevers, muscle aches, fatigue

Red flags
vomiting, abdominal pain, bleeding

Ix
specific blood test (NS1 rapid diagnostic test)

Mx
self resolve
if red flags or in shock - hospital admission

Question 15

Non alcoholic Fatty liver disease

Answer 15

fat build up within the liver. The liver is important in helping digest food, store energy and remove toxins.

associated conditions
HTN, high cholesterol, T2DM

Mx
Calculate NAFLD Fibrosis score - may need to refer hepatology - liver ca surveillance, consideration for transplant, start medications
Monitor bloods, BMI, CVD risk, lifestyle measures, reduce alcohol

Question 16

Hepatitis C

Answer 16

Infection in the blood that can effect the liver. most commonly transmitted through sharing of needles, blood transfusions, sexual contact.

Mx
Explanation of condition - 25% self resolve, 75% chronic. Increases risk of liver damage and liver Ca
Refer to Hepatology
Stop alcohol intake
Prevent transmission - stop sharing needles, sexual contact (use condoms)
Regular FU - inc bloods (HIV, Hep A/ b, Iron studies, LFTs etc)

Question 17

Huntington’s disease

Answer 17

Genetic condition that effects the brain causing difficulty in movement, thinking and behaviour. Symptoms are progressive, there is not current cure, but there are treatments to help manage symptoms.

Mx
Refer to neurology for symptomatic management
Genetic counselling
SSRI - depression
Support services
regular FUs

Question 18

Hyperhidrosis

Answer 18

Excessive sweating - can be local (eg armpits, feet) or general

Mx
Patient information
Aluminium chloride (roll on solution)
Hydrocortisone cream
If no improvement after 6-12 weeks - for Derm input - botox, oral/ topical therapies, surgery

Question 19

HPV result (smear test)

Answer 19

HPV (human papillomavirus) is very common, is passed through sexual contact, most of the time it will get better on it’s own. Rarely, it can be associated with cervical cancer, and this is why we screen.

Dyskaryosis - means changes to the cells.

Smear test screening does not show cancer.

Smear testing
Age 25-50 every 3 years
50 - 64 every 5 years

Question 20

Colposcopy explanation

Answer 20

Look at cervix under a microscope - may need to take biopsies (will feel like a small pinch or light period pain). Takes roughly 15-20minutes, very common and safe procedure.

Question 21

Long COVID

Answer 21

Common but poorly understood medical condition. Commonly causing fatigue, breathlessness, muscle aches.

Mx
Ensure no other cause of symptoms
patient information
Primary care support groups
Refer MDT Long covid clinic

Question 22

Osteoporosis

Answer 22

Bones become weak and fragile, more prone to breaking. Most common in post menopausal women, but men get this too. Or people on long term steroids. There is a lot that can help this however.

Mx
DEXA scan - indicates severity of osteoporosis
FRAX score - indicates risk of fracture over next 10 yrs
Lifestyle - weight bearing exercises, diet
Bisphosphonates - take tablet once a week, sitting upright, 30 mins before food with water. (risk of osteonecrosis to jaw, femoral fractures - these are very rare)
Calcium and Vit D supplements
Refer endocrine - denosumab, if 2 bisphosphonates tried and not tolerated

Question 23

Post partum thyroiditis

Answer 23

autoimmune condition typically presents within the first year after childbirth, affecting 5-10% of women.
There are three distinct phases:
- hypERthyroid (1-3 months)
- hypOthyroid (3-6 months)
- recovery - thyroid functions gradually returns to normal by 12 months

Mx
all PPT refer to endocrine
manage symptoms eg B blocker (if palpitations, beware of asthma)

Question 24

Pre diabetes

Answer 24

HBA1c 42-47

High sugar levels are called diabetes. Pre diabetes is a golden window between normal and diabetes. It indicates that currently there is a high chance of developing diabetes. However this is a golden opportunity to lose weight, improve health eating and increase exercise to prevent the development of diabetes.

Repeat HBa1C in 12 months
Monitor for symptoms of Diabetes

Question 25

Rheumatoid arthritis

Answer 25

Autoimmune condition effecting the smaller joints particularly hands and feet, but can effect anywhere. This can lead to pain and reduced function without treatment.

Mx
refer rheumatology urgent (within 3 weeks) - (refer despite normal bloods)
NSAIDs/ analgesia + PPI - do not prescribe steroids until Rheum rv

Question 26

Sudden cardiac death

Answer 26

rare but serious event where the heart stops working - usually due to underlying heart condition.

Red flags
unexplained fainting
chest pain or fainting during exercise
FHx young person heart issues

Ix
ECG

Mx
refer paeds cardiac if ECG abnormal
reassurance and education if asymptomatic and normal ECG

Question 27

INR Monitoring

Answer 27

INR indicates how well Warfarin is thinning the blood

Abnormal INR Mx
INR 3-4.5 = stop warfarin for 2 days and repeat INR and FU

INR 4.5 - 8 without bleed = stop warfarin, consider oral vit k , resume warfarin when INR <3.0, more frequent monitoring

INR >8 without bleed = stop warfarin, start oral vit K, recheck INR in 1-2 days

if bleeding for hospitalisation (regardless of INR)

Question 28

INR vs DOAC

Answer 28

INR Pros (safer for)
- Renal impairment
- Prosthetic heart valves
- Drug interactions (anticonvulsants, antiretrovirals) - although warfarin has more common interactions

Question 29

Testosterone replacement therapy for men

Answer 29

Testosterone level <10 - consider treatment

Mx
Refer to Endocrine for management
Address other issues - mental health, physical activity, health diet, sleep, stress, relationships/ work

Question 30

Diabetes

Answer 30

condition in which the blood sugar levels are too high - leading to excessive thirst, urinary frequency, tiredness. Increase risk of damage to heart, brain, eyes, nerves in the long term.

Mx
regular bloods (HBA1C and others) every 3-6 months - aim for HBA1C <48 (unless taking sulphonurea hba1c <53)

1st - lifestyle

2nd - metformin
- consider statin

3rd (try two before moving onto 4th line)
- Cardiovascular/ Renal disease = SGLT 2i (empagliflozin - risk of UTI, euglycaemic ketoacidosis)
- Obese = GLP1 (semaglutide)
- Frail = DPP4i (Sitagliptin
- Require rapid reduction in HBA1C = Sulphonylurea (Gliclazide - risk of hypos)

4th
- refer endocrine - consideration for insulin

Question 31

Factors effecting HBA1C

Answer 31

Hx
Diet
Stressors
Symptoms - thirst, urine, tingling fingers, infections, visual disturbance
adherence to medication
supportive friends/ family
smoking