week 3 Flashcards
lasting power of attorney
legal document that lets an individual appoint one or more people to help make decisions or to make decisions in the future event of the patient lacing capacity
2 types of lasting power of attorney
1) health + welfare
2) property + financial affairs
advanced statement
written statement by the patient, setting out preferences, wishes, beliefs regarding future care
not legally binding
advance decision OR advance decision to refuse treatment
a decision a patient with capacity can make to refuse specific treatments in the future
legally binding
electrolyte imbalance caused by omeprazole
hyponatraemia
NSAIDs and electrolyte imbalance
NSAIDs can cause renal damage therefore at risk of causing electrolyte imbalance
U+E that can cause acute confusion
- uraemia
- hyponatraemia
bone profile results causing acute confusion
- hypercalcaemia
- hypocalcaemia
3 medications that can cause hyponatraemia
- omeprazole
- citalopram
- ramipril
causes of
- hyponatraemia
- dehydrated patient
- urinary Na > 20 mmol/l
Renal Na loss
- addisons disease
- renal failure
- diuretic excess
- osmolar diuresis
causes of
- hyponatraemia
- dehydrated patient
- urinary Na < 20 mmol/L
loss of Na elsewhere (not through urine)
- diarrhoea
- vomiting
- fistulae
- burns
- SBO
- trauma
- CF
- heat exposure
cause of
- hyponatraemia
- patient not dehydrated
- patient is oedematous
- neophrotic syndrome
- cardiac failure
- cirrhosis
- renal failure
cause of
- hyponatraemia
- patient not oedematous or dehydrated
- urine osmolarity > 500 mmol/kg
SiADH
cause of
- hyponatraemia
- patient not dehydrated
- normal urine osmolarity
- water overloaded
- severe hypothyroidism
- glucocorticoid insufficiency
definition of diarrhoea
- acute
- chronic
abnormal passage of loose stools more than 3 times a day
- less than 4 weeks
- longer than 4 weeks
drugs that can cause acute diarrhoea
- allopurinol
- abx
- digoxin
- metformin
- NSAIDs
- PPIs
- SSRIs
- statins
- thyroxine
red flags for diarrhoea
- blood
- persistent vomiting
- weight loss
- nocturnal symptoms
q’s in hx when suspecting an underlying cause of infective diarrhoea
- food poisoning
- travel abroad
- contact with another person with diarrhoea
signs of dehydration
- reduced skin turgor
- nausea
- light headedness
- tiredness
- dizziness
- confusion
- oliguria
indication (2) for emergency hosp admission following diarrhoea
- vomiting and inability to retain oral fluids
- features of severe dehydration + shock
complications of diarrhoea
- dehydration
- electrolyte imbalance
- IBS
- infection spreading
how long will it take for most infective diarrhoea to pass
2-4 days
how long does diarrhoea caused by campylobacter + salmonella last
2-7 days
investigation of choice when looking for an infective cause of diarrhoea
stool sample
- culture
- sensitivity
- ova
- cysts
- parasites
2 week wait for colorectal cancer
- rectal bleeding
- abdo pain
- change in bowel habit
- weight loss
- fe def anaemia
group of bacteria that cause food poisoning often to due to undercooked meat
campylobacter
causes of persistent diarrhoea (no longer acute)
- coeliac disease
- IBS
- anxiety
- hyperthyroid
- IBD
antibody test for coeliac disease
tissue trans-glutaminase antibody
marker to test for IBD
faecal calprotectin
medication to reduce bowel spasms
buscopan / hyoscine butylbromide
biggest cause of infectious diarrhoea in hospital patients
clostridium difficile
4 C’s identified by Foods standard agency to prevent campylobacter
- cleaniness
- cooking
- chilling
- cross-contamination
common side effects of opiates
- nausea
- vomiting
- constipation
- itch
advice for helping constipation
- physical activity
- fruit
- fibre
- fluids
- over the counter medications
- vertigo triggered by change in head position
- assoc. w/ nausea
- episodes last 10-20 seconds
benign paroxysmal positional vertigo
- vertigo
- tinnitus
- sensorineural hearing loss
- aural fullness
Meniere’s disease
test for BPPV
Dix-Hallpike manoeuvre
management of BPPV
- epley manoeuvre
how to test lying and standing BP
Check BP lying + then after standing at intervals of 1 3 and 5 minutes
2 important causes of hypotension + tachycardia
- acute blood loss
- sepsis
how reliable is a urine pregnancy test
97%
Trx for vertigo
- Betahistine: vasodilator in inner ear
- cyclizine, cinnarazine, prochlorperazine: vestibular sedative
why is unilateral tinnitus a red flag of vertigo
urgent MRI scan for acoustic neuroma
4 symptoms in acoustic neuroma
- unilateral tinnitus
- hearing loss
- absent corneal reflex
- vertigo
why red flag: sudden, complete unilateral hearing loss w/ vertigo
suggestive of acute ischaemia episode: posterior cerebellar artery thrombosis
why red flag: atypical episode of vertigo
if along with other transient neurological symptoms: MS
3 CNS causes of vertigo
- migraine
- MS/brain tumour
- acoustic neuroma
3 PNS causes of vertigo
- BPPV
- ototoxic drugs: gentamicin
- Labyrinthitis
features of Meniere’s disease and what is it?
disorder of inner ear of unknown cause characterised by excessive pressure and progressive dilatation of endolymphatic system
- vertigo
- aural fullness
- tinnitus
- sensorineural hearing loss
- nystgmus
direct thrombin inhibitor
Dabigitran
Direct Factor Xa inhibior
Rivaraxaban
Apixaban
symptoms of AF (4)
- palpitations
- dizziness
- chest pain
- sob
score that calculates risk of stroke in patients with AF
+ whether anticoagulation needed
CHA2DS2-VASc
score that assesses risk of bleeding for a patient on anticoagulation
HASBLED
melaena
black sticky faeces due to upper gi bleed
coffee ground vomit
haematemesis
GI causes of chest pain
- gastritis
- ulcers
- GORD
- oesophageal malignancy
- pancreatitis
- biliary collic
REsp causes chest pain
- pe
- pneumonia
- pleurisy
- lung cancer
cardiac causes chest pain
- mi
- pericarditis
- aortic stenosis
