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Year 3 > Week 15: GP/VS > Flashcards

Week 15: GP/VS Flashcards

1
Q

What is treatment burden?

A

Workload that patients experience/need to do in order to manage their chronic condition

High levels of treatment burden can cause:

Poor adherence

Disengagment with healthcare services

Poorer quality of life

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2
Q

How does treatment burden arise?

A

Due to workload volume or care deficiencies

Illness work: Work that patients and families need to do to understand their chronic illness

Treatment work: Tasks that need to be done to manage health and follow treatments set by their healthcare providers

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3
Q

What is patient capacity

A

Degree to which pts can cope with their illness and lives

Needs to be considered with workload

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4
Q

What is polypharmacy?

A

5 or more medications to a pt at one time

Due to ageing population, multi-morbidity, preventative medication

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5
Q
A
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6
Q

What is the clinical presentation of John Darlington and how do you treat it?

A

Clinical presentation:

  • Idiot (due to excessive crap in his head causing increased ICP and decreased CPP)
  • Micropenis
  • Mood disturbances

Treatment:

  • Love and tender care, or
  • Getting the stick out of his arse
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7
Q
A
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8
Q

Types of polypharmacy

A

Appropriate - pescribing for a pt with muitlple conditions where medications aligned with best evidence

Inappropriate - pescribing medications inappropriately, intended benefit not gained

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9
Q

What are the 2 main reasons for elderly to be at risk of polypharmacy?

A

Pharmacokinetics

Pharmacodynaimics

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10
Q

What types of patients are most at risk of ADRs from polypharmacy?

A

Increasing age

Increased fraility

Residents in care homes

High risk medications

Deprivation

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11
Q

How to identify which patients most at risk from polypharmacy?

A

STOPP/START (STOPP - screeining tool of older people’s medication, START - screening too to alert right treatment)

7 steps to appropriate polypharmacy:

  1. Identify what matters to pt
  2. Identify essential medications
  3. Is the pt taking uneccesary drugs?
  4. Are therapeutic objectives being acheived?
  5. Are they at risk of ADRs or suffering from them?
  6. Is the drug cost-effective?
  7. Is the pt willing/able to take the drug as intended
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12
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13
Q

4 components of pt-centred care

A

Affording people dignity, compassion, respect

Offering co-ordinated care

Offering personalised care

Supporting people to enable them to live an independent, fulfilling life

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14
Q

Ways to support self-management

A

Open questions

Affirmation

Normalisation

Reflective listening

Agenda setting - explore priorieites and produce an agenda with pt

Goal setting and action planning - support pt to identify goals and how they can work towards it

Goal follow up - explore challenges, give positive affirmation of progress and effort

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15
Q

What is person-centred self management?

A

Supporting individual to build skills, behaviours to live with their long term condition. Listening to what matter to them, and work with their families to help them manage

Not about replacing services or expecting them do everything for themselves

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16
Q

What are the social determinants of health?

A

Socio-economic, cultural and environmental conditions

Education, living and working conditions, health care services

Social and comminity networks

Individual lifestyle factors

Age, sex, constitutional factors

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17
Q

What is candidacy?

A

What shape’s poeple knowledge of and acess to health services

E.g. financial status, residency, language barriers

18
Q

Population vs. high risk approach

A

Treating people at highest ,evel of risk reduces indiviual risk but not marked reductions in population risk

Unoviersal prevention measures, shifts population risk to left, preventing disease in large proportion of people at low risk, reducing proportion of people above treatment threshold

19
Q

Obesity

A

Tier 1: Information and guidance on healthy eating, exercise

Tier 2: Multi-component weight management services inc. lifestyle interventions

Tier 3: Muti-disciplinary treatments e.g. psycholoical, pharmacotherapy

Tier 4: Bariatric surgery

20
Q

What should weight loss targets be based on?

A

Individual’s comorbidities and risk, rather than their weight alone

21
Q

Barriers to access of Glasgow Weight Management Services

A

For patients: location/timing of classes, lack of awareness of service, delay in referral-assessment-classes

For dcotors:

don’t know where the nearest centre is, lack of knowledge what service involves, practice nurses better to discuss weight than GPs

22
Q

When to refer someone for weight management services?

A

BMI >25 + diabetes

BMI 30 + Diabetes, CVD, mobility issues

BMI >40 (no comorbidity required)

23
Q

How to make John Darlington lose weight?

A

Give all his empire biscuits to Jo

Acutally lift some proper weights

24
Q

Erectile dysfucntion

A

Investigations

Psychosexual history

General - BP, BMI

Exam external genitalia

DRE

ED can be risk marker of CVD:

HbA1c

LFTs

Testosterone (hypogonadism)

PSA ( not routine). Consider if:

Age >50, abnormal DRE, risk factors for prostate Ca

Types:

Psychogenic (5%) - no physiological or neurovascular condition

Causes: stress, peformance anxiety, psycholgical problems

Organic (10%) - physical cause

Causes: CVD, Diabetes, hormonal (low testosterone, high prolactin) or drugs (Citalopram, Bblockers, Digoxin)

Treatment:

Sildenafil (phosphodiesterase type 5 (PDE5) inhibitors) - promotes smooth muscle relaxation, increaseing blood flow to penis

SE: back pain, migraine, nausea/vomiting

2nd line: alprostaldil (synthetic prostaglandin E1 analogue)

25
Q

Child protection

A

Where would you gain more information about the pt?

Medical notes

GP Child protection Lead

Child protection unit

Social Work Services

School nurse

Teacher

Risk factors:

Domestic abuse, perental alcohol/drugs misuse, child/parent mental health difficulties, non-engaging families, FGM

Next step if suspicous:

Raiase a notification of concern (NOC) - made to social work and child protection unit

Role of healthcare professional;

Act on and refer early signs of abuse

Keep accurate record keeping

Listen to views of child

Share information appropriately

Types of abuse

Physical, emotional, sexual, neglect

26
Q

Definition of child protection

A

When a child requires from child abuse/neglect. Not required for it to already have taken place, but a risk assessment.

Child protection Register:

Register where children are put on, if there are reasonable grounds to believe a child will/have suffered abuse/neglect

27
Q

Red flags of GI

A

Dysphagia

Melaena

Haematemesis

Fresh PR bleeding

Weight loss

28
Q

Drugs which can cause dyspepsia/GI bleed?

A

NSAIDs

Anti-platelets

Anti-coagulants

SSRIs

Ca channel blockers

29
Q

How can you indentify pts risk of polypharmacy

A

STOP/START screening tool

30
Q

Ways to safe guard pts from polypharmacy

A

Pharmacists - blister packs

Social carers - prompt pt to take medication

District nurse - checkw weight, BP, HR, blood monitoring

31
Q

DDx of memory loss

A

AD

Delerium

Depression

Vacular dementia

Dementia with lewy bodies

32
Q

MSSE

A

Orientation

Registration

Attention and calculation

Recall

Language

< 23/30 - cognitive impairment

< 18/30: severe impariment

33
Q
A
34
Q

AD

A

Symptoms:

Cogntive

  • Problems with carrying out activities of daily living

Non-cognitive

  • Behavioural and psychological

Agitation, wandering, aggression, depression

Treatment

Mild-moderate:

Donezepil: AChEi (acetylcholinesterase inhibtor)

SE: bracycardia, GI upset

Moderate-severe:

Memantine (NMDA anatagonist)

SE: dizziness, constipation

35
Q

Cycle of change

A

Pre-complentation

Complentation

Planning

Action - Maintenance or Relapse

5 domains in which behaviour changes occurs:

Congitive - info from the doctor makes raises pt awareness

Attitudinal - doctor helps pt develop commitment to change

Instrumental - skills pt needs are built

Planning - preparing for the time ahead inc. anticipating problems

Social support - support from friends, families, other agencies

36
Q

What does pt empowerment mean?

A

Enabling people to gain an advantage over the circumstances they are in

37
Q

What is concordance, and best predictor of it?

A

Agreement between pt and doctor, which respects the beliefs and wishes of the pt, in determining how and when medicines are to be taken

Doctor and pt relationship

Other factors: if the doctor doesn’t explain things properly, pt too tired/distracted to take in much

38
Q
A
39
Q

Upper GI Endoscopy

A

Upper GI endoscopy is the examination of lining of oesophagus, stomach and duodenum, using a flexible endoscope insterted through the throat. Biopsy can be taken.

Used for:

  • Upper GI bleeding
  • Dysphagia
  • Persistenct vomiting
  • Persistent anaemia inc. IDA

Complications:

  • Respiratory distress
  • Aspiration pneumonia

Bloated (due to air used)

  • Bleeding from biopsy site
  • Perforations
40
Q

Colonscopy

A

Examintion of the lining of the mucosa of the colon by a flexible telescope. Passed through anus to visualise rectum, sigmoid colon, descending, transverse and ascending colon. Biospies can be taken.

Peformed when:

Rectal bleeding

Change in bowel habits

Faceal occult blood +ve

Unexplained anaemia in a, at risk group

Fitness for colonscopy:

Pt needs to be assessed for:

FBC, ESR, renal function, liver function

Complications:

Rectal bleeding

Colonic bleeding

Peforation of colon

DRE (digital rectal exam) should be done first

Uusally sigmoidoscopy, done before

41
Q

Mammography

A

X-ray of the breast, using limited amount of radiation

Screening mammogram part of early detection scheme

Diagnostic mammogram evaluates a pt with exsisting breast lumps

When is it peformed:

Women 50-70, every 3 yrs

If women have had sugery for a previous breast disease

Strong family hx, of early breast cancer

Contra-indications:

Pregnancy, breast-feeding

Complications

False positives, false negatives

Year 3 (15 decks)

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