SCA online - Long term conditions Flashcards
Atrial fibrillation
Irregular beating of the heart leads to inefficient pumping of blood around the body. Also leads to pooling of blood within the heart, leading to increased risk of clots and stroke.
CHADsVASc vs ORBIT - anticoagulation score = give DOAC
Rate control - if symptomatic, HR >110 - B blocker/ CCB (verapamil)
DOAC Counselling
Take with food/ water
carry anticoagulant alert card with you
report any signs of bleedings/ bruising - Epistaxis, haemoptysis, bleeds that do not stop, blood in stool, sputum, urine, stool, heavy menstrual bleeding
Allergic Rhinitis
allergic reaction primary effecting nose and eyes - when exposed to allergens eg dust, pollen.
Fx - congested nose, watery eyes, itchy throat
Mx
- avoidance (although if pollen, this can be difficult)
- antihistamine medication, intranasal steroid spray
- short term oral steroids if required
- if having detrimental effects on day to day life can refer to immunology
- Red flags - recurrent epistaxis, unilateral symptoms, nasal pain - 2ww ENT
Breast cancer risk factors
Fhx
bilateral breast ca
male breast ca
ovarian ca
>1 relative with breast ca
contraception
- all okay if fhx of breast ca
- only IUD (copper coil) okay if BRCA 1/2 or personal Hx of breast ca
Chronic migraine Mx
1st - lifestyle
- behavioural therapy, acupuncture, riboflavin
2nd - medication
- propranolol
- topiramate (beware in women of childbearing age due to teratogenicity)
- amitriptyline
3rd - refer
- if no response after 3 months on maximum dose
Chronic pain
Pain that lasts longer than expected.
At the point of injury, a chemical is released that switches on the pain nerves. In chronic pain, this chemical stays high (rather than reducing as the injury improves like normal), this causes the pain nerves to stay switched on and over sensitive. This means that you will keep feeling pain, despite no further damage is happening to the body. The problem is the pain itself. Although the pain hurts and is very real, it does not mean that there is ongoing damage being done to your body.
Mx/
explain there is no further damage to tissue
movement/ mobility/ exercise
Reducing analgesic medication if not helping - mainly gabapentinoids/ opioids
physiotherapy/ pain clinic
Crohns flare Mx
Not requiring hospital admission (stools >6/ day, unwell, shock etc.)
1st - lifestyle
- avoid exacerbating factors - avoid grease foods, high fibre diet, large meals, carbonated drinks, alcohol, caffeine
2nd - medication
- DO NOT change current medication - refer to gastro
- Discuss with on Call Gastro - who may suggest oral prednisolone/ budesonide with weaning regime
QRISK CVD risk counselling
QRISK - is a score that shows your likelihood of developing a heart attack or stroke over the next 10 years - compared to other people of the same demographics.
Mx
1 - lifestyle
- Stop smoking
- reduce alcohol
- healthy diet
- increase exercise
2nd - statins
- reduce QRISK by 25%
- repeat LFT + cholesterol in 3 and 12 months (if stable)
CVD Secondary prevention
1st - statins
- Atorvastatin 80mg OD
- Contraindication: pregnancy
- SE - myalgia, GI upset
- Complications - Myopathy, rhabdomyolysis
- Monitor - LFT, cholesterol at 3 months and 12 monthly thereon - target reduce non-HDL by 40%
- alternatives eg Ezetimibe
2nd - lifestyle
- diet and exercise
Cystic fibrosis
Inherited disorder mainly effecting the lungs. Leads to recurrent chest infections, but can also effect the gut’s ability to digest food and therefore lead to poor growth. There is no cure, but there are treatments that help with symptoms and quality of life.
Autosomal recessive - both parents need to be carriers to pass on gene to child
- general population risk of CF is 1/25 (4%)
Prenatal diagnosis - Chronic villous sampling or amniocentesis
Mx/
daily physio
Trifakto (new medication shown to be helpful in CF, but is very expensive) - started by specialist
Dementia
Syndrome (or group of symptoms) associated with general decline in brain function. As well as memory issues, this can also effect personality, mood, and ability to look after oneself. There is no cure, but there are ways to help with the symptoms
Mx/
take collateral Hx - safe at home, other support, carers?
community health and wellbeing team - local support team help with coping at home
refer memory clinic
bloods - rule out other causes of cognitive impairment
Diverticulitis
Small pouches within the bowel, called diverticular, become infected and inflamed.
Mx/
Abx - Co-Amox
simple analgesia (not opiates as cause constipation)
Diet - increase fibre and hydration
Exercise - regularly
Follow up - after completion of Abx
Do not give prophylactic antibiotics
Elhers Danlos syndrome
Disorder that effects the connective tissue within the body. People with EDS often suffer with joint pain/ dislocations, bruising and other complications.
Mx/
address issues directly
- avoid high impact sports
- adjust working environments to suit needs
- physiotherapy
Familal Adenomatous Polyposis (FAP)
Inherited disorder of small growths, called polyps, within the gut. Occasionally, these polyps can develop into cancer.
Screening for family members - age 10-12 (colonoscopy)
Genetic counselling
Surgery if required
Fragility fracture risk
Calculate FRAX score - risk of fragility fracture over next 10 years
If raised - for DXA scan
- T score < -2.5 = osteoporosis = treat
- T score > -2.5 = osteopenia = lifestyle modification
Mx
- Bisphosphonates - Repeat DXA in 3-5 years to see if needs to continue medication
- Lifestyle - weight bearing exercise, healthy diet rich in Ca/ Vit D, avoid smoking, reduce alcohol
Hemochromatosis
Inherited disorder where to body absorbs too much iron. Excess iron can damage organs.
Ix/
Transferrin sats >40%
HFE genetic testing
Mx/
refer to Haematology for venesection and exaulation
HFpEF (heart failure with preserved ejection fraction)
Heart pumping strength is normal, but the heart struggles to relax and fill properly between beats.
Mx/
Lifestyles - diet, exercise, moderate fluid intake
Address comorbidities - smoking, HTN, Diabetes
Medication
- Diuretics - for symptom relief (overload)
- Spironolactone
- Empagliflozin
- ACEi/ ARB - HTN
- BB/ CCB - AF
Refer to heart failure clinic
Hypertension
AKA High blood pressure, force of the blood within the vessels is too high. increasing strain on the heart and blood vessels leading to problems such as heart disease, kidney disease and strokes.
Ix/
Bloods
Urine (proteinuria)
ECG
Fundoscopy and CV examination
At home blood pressures - twice daily for two weeks then review
if <40yo = refer for secondary causes
if pregnant = refer for alternative mx
Hypertension Mx
Lifestyle
- reduce salt (<6g/day)
- Exercise >150min/ week
- weight BMI <25
- limit alcohol, stop smoking
- limit caffeine
- diet - fruit, vegetables, whole grains
- stress management
- social prescribing
Medication
- 1st - ACEi/ ARB <55yo/ T2DM OR CCB >55yo/ black
- 2nd + CCB/ ACEi
- 3rd + Thiazide like diuetric (indapamide)
- 4th + Spirinolactone (K<4.5); Doxazocin/ Bisoprolol (K>4.5)
- 5th - refer
Osteoporosis
Bones become weaker and more fragile, this means they are broken more easily. This happens mainly due to increasing age, our bones lose minerals such as calcium making them weak.
Mx
lifestyle
- weight bearing exercise, calcium/ vit D supplement, avoid smoking/ alcohol
1st - bisphosphonates PO (try two different before referral)
PO = take 30 minutes before eating once daily or once weekly sitting up with glass of water
2nd - IV bisphosphonate, denosumab (all specialist initiated)
IV = hospital (once per year, especially useful post hip fracture)
Parkinson’s disease
disorder effecting the brain - the part that controls movement and balance. Cause stiffness, shaking (tremor) and slowness of movement, difficulty walking. No cure but there are ways to help with symptoms and progression of the condition
Mx/
- Refer any suspected parkinsons disaese
- Discuss majority of patients maintain their independence and work with a MDT to provide comprehensive care (eg physio, OT, SALT, neurologist)
- Local support groups
- DVLA - able to drive as long as able, must inform DVLA and insurance
Polycystic Kidney disease
inherited condition of small fluid filled sacs (aka cysts) form on the kidneys. Does not usually give symptoms until 30yo.
Autosomal dominant - if a parent has this gene, their child has 50% chance of inheriting condition
Complications
- Kidney disease - around half of people with PKD will require treatment for kidney failure
- HTN
- Brain aneurysm (rare)
Hx (ask about)
- haematuria, swelling, urinary symptoms, headaches, visual disturbance, abdo pain
Ix/ Refer to Nephrologist or clinical genetics
Genetic testing - blood test
USS kidneys - if negative this is not diagnostic.
Asthma
Ix/
Lung function test if >5yo
Asthma control test - assess how well controlled asthma is
Mx/
Lifestyle
- avoid triggers, education and action plan, regular check ups
Medication
- Rescue - Salbutamol
- Preventative (give 4-8 weeks between each step to assess Mx)
- Do LFT before starting Mx if stable to confirm diagnosis
1st - ICS
2nd - add LTRA (montelukast)
3rd - switch to LABA + ICS (fostair, relvar ellipta)
4th - MART = LABA + ICS - no SABA. Use as rescue also.
5th - refer resp
Ensure good inhaler technique
Step down Mx if > 3 months well controlled
Post MI Mx
Aim is to prevent further MI
Lifestyle
- Stop smoking
- Exercise >150min/ week
- Diet - high fibre, fruit, veg, less red/ processed meat. avoid fatty/ fried/ sugary food.
DVLA
- Group 1 = no driving for 4 weeks
- Group 2 = no driving for 6 weeks + functional test before driving
Medications
- ACEi
- B Block
- antiplatelet (clopidogrel)
- Statin
Pre-Diabetes
HbA1C 42-47
Fasting Glu 5.5-6.9. Random Glu <11.1
Golden opportunity!
Mx
- Lifestyle
aim BMI <25, diet, exercise
- Meds
metformin/ orlistat - if no improvement with lifestyle
- Review if signs of diabetes - thirst, polyuria, tingling, visual symptoms, tiredness
- Monitor HbA1C annual
Diabetes lifestyles Mx
Diet
- reduce sugary, high carb foods
- more vegetables, lean meat, whole grains
Exercise
- >150min moderate exercise per week
Stress
- avoid stress
- mindfulness, meditation, talking therapies
Smoking
- stop
- offer smoking cessation advice, signpost
Regular FU
- HbA1C 3 monthly
- medication rv
Ulcerative colitis
Ix/ - loose bowels, abdo pain
Bloods - inc anti TTG (coeliac)
Stool - faecal calprotectin (IBD), stool culture (infection)
Complications
- Primary sclerosing cholangitis
- Colon Ca
- Fe, vitamin deficiencies
- Extra intestinal manifestations - arthritis, skin (erythema nodosum), urveitis, oestoporosis
