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Phase 3b > Community and Palliative > Flashcards

Community and Palliative Flashcards

1
Q

Chronic fatigue syndrome diagnosis and management

A

At least 4 months of disabling fatigue affecting physical and mental function at least 50% of the time in absence of any other disease which may explain symptoms

CBT
Graded exercise therapy
Pacing (organising activities to avoid tiring)

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2
Q

Levels of non-alcoholic fatty liver disease

A

Steatosis - fat in liver
Steatohepatitis - fat with inflammation
Liver cirrhosis

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3
Q

What metabolic syndrome is related to fatty liver

A

Insulin-resistance

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4
Q

Investigations following incidental finding of fatty liver on ultrasound

A

Enhanced liver fibrosis blood test
ALT > AST
FIB4 or NAFLD fibrosis score + FibroScan (liver stiffness with transient elastography)
Specialist referral - liver biopsy gold standard

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5
Q

Management of fatty liver disease

A 
Lifestyle changes e.g. weight loss 
Gastric banding
Metformin
Manage co-morbidities 
Annual review and education
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6
Q

Blood pressure target in T2 diabetes and what BP drug

A

140/80
130/80 if end-stage organ failure present
ACE-inhibitors

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7
Q

HbA1C target if only lifestyle management or metformin

A

48mmol/mol

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8
Q

When to add second drug to metformin

A

58mmol/mol

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9
Q

What drugs can you add to metformin in T2 diabetes

A 
Sulfonylurea 
Gliptin 
Pioglitazone 
SGLT-2 inhibitor 
OR insulin therapy
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10
Q

What insulin therapy should be started in T2 diabetes

A

Human NPH insulin (isophane, intermediate acting) at bedtime or twice daily

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11
Q

When should you offer a statin to a T2 diabetic?

A

if QRISK-2 score is >10%

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12
Q

What statin should be offered in T2 diabetes?

A

Atorvastatin 20mg od (80mg if existing CVD)

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13
Q

When to use a glucagon-like peptide mimetic in T2 diabetes?

A

Triple therapy contraindicated or not effective

> 35 BMI and psychological or medical problems associated with obesity

<35 BMI and can’t have insulin therapy

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14
Q

35 year old female with chronic pain all over her body, feels lethargic, with ongoing headaches and sleep disturbances - what management approach would you take?

A

Explanation
Aerobic exercises
CBT
Medication (amitriptyline, duloxetine, pregabalin)

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15
Q

How many tender points do you need for a diagnosis of fibromyalgia to be likely?

A

At least 11 out of 18

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16
Q

Risk factors and symptoms suggesting diverticular disease

A

Age, lack of fibre, obesity, sedentary, smoking, NSAIDs

Change in bowel habit
Blood in stool
Abdominal pain

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17
Q

What complications could arise from diverticular disease?

A 
Haemorrhage 
Diverticulitis 
Fistula 
Perforation and fecal peritonitis 
Perforation and abscess development 
Diverticular phelgmon
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18
Q

Diverticular disease investigations and management

A

CT cologram
Increase dietary fibre intake
ABx for diverticulitis

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19
Q

Diverticulitis signs and symptoms

A 
Nausea, vomiting and fever 
Constipation or diarrhoea 
Severe abdominal pain in left lower quadrant 
Guarding and rigidity 
Frequency, urgency or dysuria 
PR bleeding
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20
Q

Causes of PR bleeding

A 
Haemorrhoids 
Anal fissure 
Carcinoma 
Colorectal polyps 
IBD 
Rectal prolapse 
Diverticular disease (elderly)
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21
Q

Causes of diarrhoea in children

A

Acute: gastroenteritis (rotavirus) - fever and vomiting for first two days, lasts a week. Treat with rehydration

Chronic: Cow’s milk intolerance, coeliac, Toddler’s diarrhoea (with undigested food and varying consistency )

22
Q

Chronic bronchitis antibiotic

A

Amoxicillin, tetracycline or clarithromycin

23
Q

Uncomplicated community-acquired pneumonia antibiotic

A

Amoxicillin (doxycycline or clarithromycin if pen allergy. Add flucloxacillin if staph)

24
Q

Atypical pneumonia antibiotic

A

Clarithromycin

25
Q

Hospital-acquired pneumonia antibiotic

A

Within 5 days of admission: co-amoxiclav or cefuroxime

26
Q

Management of eczematous lesions on scalp, nasolabial folds, auricular and peri-orbital areas

A

Seborrheic dermatitis
Face and body:
topical antifuncal e.g. ketoconazole
Topical steroids

Scalp:
Head and Shoulder shampoo

27
Q

Treatment of cradle cap in children (erythematous rash with coarse yellow scales)

A

Baby shampoo and oils

Topical hydrocortisone if severe

28
Q

Reflux red flags (ALARMS)

A 
Anorexia 
Loss of weight 
Anaemia 
Recent onset 
Melena/haematemesis 
Swallowing problems
29
Q

Reflux medication ladder

A

Antacid (Gaviscon)
(H2 blocker (ranitidine))
PPI (lansoprazole)

30
Q

Test for H.pylori

A

Breath and stool test

31
Q

Difference between HDLs and LDLs

A

HDLs take cholesterol to the liver to be expelled

LDLs deposit cholesterol in the arteries

32
Q

What is a normal cholesterol

A

5 and under

33
Q

What dose of statin is used for primary prevention?

A

20mg

34
Q

What dose of statin is used for secondary prevention

A

80mg

35
Q

Three uses of calcium channel blockers

A
  1. First or second line for hypertension
  2. Symptom control in stable angina
  3. Supraventricular arrhythmias - controls heart rate (supraventricular tachy, AF, atrial flutter)
36
Q

Main side effects of amlodipine and nifedipine

A

Ankle swelling, flushes, headache, palpitations due to vasodilation and tachycardia

37
Q

How should GTN be taken in angina?

A

If prophylactic, spray sublingually prior to starting an activity
Sit and rest for 5 mins
If pain is still there then spray another
Wait 5 mins
If pain still there, call 999

38
Q

What side effects should be expected from GTN spray use

A

Headaches, flushing, light-headedness and hypotension

Sustained use can lead to tolerance

39
Q

ABCD2 score in strokes

A 
Age >60 (1)
Blood pressure >140/90 (1)
Clinical features: unilateral weakness (2); speech impairment without weakness (1) 
Duration >60 (2), 10-59 (1)
Diabetes (1)
40
Q

Asymptomatic T2 diabetes investigation

A

Two HbA1c on different days (only one if symptomatic) - if >48mmol/L

41
Q

When can you test for gestational diabetes and what do you do?

A

24 - 28 weeks
Fast overnight, blood test in morning
Given glucose drink
Blood test 2 hours later

42
Q

What is the cut off for 2 hour plasma glucose for gestational diabetes?

A

5.6mmol/L (7.6 if fasting glucose)

43
Q

Management for gestational diabetes?

A

Lifestyle

Insulin

44
Q

HbA1c for pre-diabetes

A

41-47

45
Q

Fasting blood glucose for pre-diabetes

A

5.5-6.9

46
Q

2 hour blood glucose for pre-diabetes

A

7.8-11.1

47
Q

What do you monitor before putting on metformin?

A

Kidney function

48
Q

Who should you not investigate diabetes with HbA1c?

A

Children
Pregnant women
People on corticosteroids
Symptoms of less than 2 months

49
Q

Diagnosis of diabetes with fasting and 2 hour

A

Fasting - 7

2 hour - 11

50
Q

What are purpura?

A

Small, raised areas of bleeding under the skin

51
Q

Henloch-Schonlein purpura presentation

A

Areas of palpable purpura over extensor surfaces of arms and legs and buttocks

Polyarthralgia

IgA nephropathy e.g. haematuria and renal failure

Abdominal pain

52
Q

HSP management

A

Analgesia for arthralgia
Supportive treatment of nephropathy (steroids and immunosuppressants)
Self-limiting

Phase 3b (18 decks)

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