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
