Clinical Seminars Flashcards
(40 cards)
1
Q
What is multi morbidity?
A
- 2 or more conditions.
2
Q
What are the issues in elderly care?
A
- Mental health, polypharmacy, increased hospital utilisation, fragility, high treatment burden, poor quality of life.
3
Q
What is the phenotype model?
A
- A group of conditions including reduce gait speed and unintentional weight loss.
4
Q
What is cumulative deficit model?
A
- An accumulation of deficits that occur due to older age and lead to an increase in fragility index. Leading to increase risk of outcomes.
5
Q
What is polypharmacy?
A
- Concordent use of multiple items by one individual.
- Usually medications but can be dressings, appliances or sometimes blood testing equipment.
- More common in the elderly and those with multiple chronic conditions.
6
Q
What is appropriate polypharmacy?
A
- Where all the drugs prescribed are to reach a therapeutic effect.
- The drugs have reached this or will reach it in the near future.
- Optimised for minimal ADRS.
- Patient motivated and can take all the medication.
7
Q
What is inappropriate polypharmacy?
A
- Where one or more of the drugs is no longer needed because there is no evidence based indication for it, it isn’t reaching therapeutic effects or their is unacceptable ADRS.
8
Q
What types of polypharmacy are there?
A
- Minor ( 2- 4), major (>5) or hyper (>10).
9
Q
What does compliance mean?
A
- Actions, transactions and processes are completed and promises are kept.
10
Q
What does adherence mean?
A
- Shared decision making between individuals in regards to treatment decision.
11
Q
What does concordance mean?
A
- Agreement between HCP and patient in regards to the patients belief in medication taking behaviours.
12
Q
What does persistence mean?
A
- Taking full course of meals to make therapeutic.
13
Q
What is ambulatory BP monitoring?
A
- Measures the BP of a patient every 30 mins, day and night for 24 hours.
14
Q
What is home BP monitoring?
A
- Taken morning and evening for 7 days.
- Used for patients that can’t tolerate ABPM such as those with disabilities, the elderly, obese patients etc.
15
Q
What is the pathophysiology of diastolic heart failure?
A
- Low cardiac output due to ventricular hypertrophy meaning the left ventricle can’t be filled adequately leading to reduced stroke volume but normal ejection fraction.
16
Q
What is the pathophysiology of left ventricular heart failure?
A
- The left ventricle can’t pump blood adequately from the left ventricle into the ascending aorta and therefore leads to a backlog of blood into left atrium, the pulmonary vessels and the lungs.
- Leads to blood pooling in the vessels causing engorgement and fluid to build up in the vessels leading to pulmonary oedema.
17
Q
What is the pathophysiology of right ventricular heart failure?
A
- Caused by left ventricular heart failure
- Increased jugular venous pressure
- Peripheral oedema
18
Q
What does BNP indicate?
A
- Myocardial stretch that is beyond the normal range.
19
Q
What symptoms are due to overload and congestion?
A
- Weight gain, ascites, oedema, dyspnoea.
- Due to salt and water due to less efficient pumping.
- Symptoms lead to fluid accumulation.
20
Q
What symptoms are due to reduced cardiac output?
A
- Later stage when heart muscles becomes super weak.
- Leads to muscle weakness, fatigue, muscle weakness
21
Q
What symptoms are due to cardiac arrhythmias?
A
- Palpitations, lightheadness and syncope
- Due to AF
22
Q
What is the categories of cough?
A
- Acute < 3 weeks
- Chronic > 8 weeks
- Subacute 3 - 8 weeks
23
Q
What are common causes of chronic cough?
A
- COPD, asthma, upper airway cough syndrome, asthma and ACE inhibitors.
24
Q
What is the assessment of cough?
A
- Onset, duration, severity, course, intermittent or continuous, precipitating or relieving factors.
25
What is the emergency admission for cough?
- Resps less than 30 per minute
- Tachycardic - BPM more 130
- BP less than 90/60
- Oxygen sats less than 92%
- Altered level of consciousness
- Use of accessory muscles for resp
26
What are red flags for cough?
- Excessive sputum, systemic symptoms, haemoptysis, significant associated dyspnoea, chest pain, immunosuppression, abnormal chest or lung exam, elderly, risk of aspiration.
27
What is smoking cessation?
- Process of stopping/ discontinuing tobacco smoking.
28
What is nicotine replacement therapy?
- Preparations include gum, inhalers, nasal spray, oral spray, lozengers, sublinguial tablet or transdermal patch
- Should be prescribed by brand
- Duration of 8 to 12 weeks, with gradual reduction at the end
- Can be used in under 18's but up to a maximum of 12 weeks.
- Contraindicated in patients with GI conditions, diabetics, moderate to severe hepatic dysfunction and uncontrolled hypothyroidism
- Side effects include headache, dizziness, nausea, vomiting, rash and uticaria.
29
What is Bupropion?
- Relatively weak
- A selective noradrenaline and dopamine reuptake inhibitor
- Should be commenced 1 to 2 weeks before smoking is stopped.
- Can't be used in under 18s or those with certain neurological conditions and medications.
30
What is Vereniciline?
- Partial nicotine receptor agonists
| - Works by relieving symptoms of cravings and withdrawal
31
What is pulmonary rehab?
- Physical activity programme designed for patients specific to their condition and gives them advice in terms of lung health and general health/wellbeing.
- Decreases symptoms, increased quality of life and increases emotional and physical participation.
- Used in those with severe breathlessness.
32
What is renal colic?
- Acute and severe loin to groin pain.
- Peak incidence is between 40 to 60 for men and late 20's for women.
- Investigations: mid stream urine, plain abdo XR, CT scan, detailed history.
- Management: Strong analgesics through IV, lithroscopy, urotheroscopy and open surgery.
33
What diseases can lead to symptoms with the prostate?
- The prostate produces prosthatic fluid and proteolytic enzymes which breaks down clotting factors in ejaculate.
- Benign prostate hypertrophy - most common due to increase in cells themselves rather than cell size and occurs in the transitional zone. In a carcinoma, it occurs in the peripheral zone.
- The narrowing of the urethra leads to weak flow, increased in frequency, difficulty empyting or starting to urinate.
34
What is the Gleason score?
- Used to grade and access the stage of prostate cancers.
- 10 to 12 cores are taken from the prostate and the most two similar analysis are taken and used to grade from low to high.
- Less than 6 = low, 7 = intermideate and between 8 and 10 is high.
- Helps to determine treatment of the patient.
35
What are the red flags for prostate cancer?
- Males presenting with haematuria, erectile dysfunction or LUTs should be considered for DRE or PSA.
- If PSA is high or DRE abnormal then refer
36
What are the red flags for bladder cancer?
- If patients over the age of 45 present with visible haematuria without UTI or once UTI has resolved.
- Patients over 60 with non visible haematuria with dysuria or high WBC count.
- Patients over 60 with recurrent or persistant UTIs
37
What are red flags for renal cancer?
- Patients over the age of 45 with visible haematuria without UTI or once UTI has resolved
38
What is haematuria?
- Visible = appearance of blood in the urine - can be dark/red or frank blood.
- Non visible = microscopic - RBC count more than or equal to 3.
39
Investigations of haematuria?
- Urine dipstick
| - Microscopic evaulation
40
What to do with patients who have recurrent UTI's?
- Rule out red flags
- Antibiotic prophylaxis
- Good hygiene
- Vaginal oestrogen creams in post menopausal females.
