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