final push Flashcards

(36 cards)

1
Q

when not to give calcium and vid D

A

breast cancer with high calcium, high PTH

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2
Q

first choice bone protection

A

zoledronic acid

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3
Q

digoxin recommended conc

A

1-2 micrograms/l

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4
Q

What is the recommended INR range in a patient with AF, receiving warfarin for the prevention of stroke?

A

2-3

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5
Q

erythromycin

A

increases INR, inhibits digoxin

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6
Q

low Na+ can be caused by

A

thiazides of hypothyroidism

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7
Q

UTI in elderly cause

A

e coli, staph, proteus sp

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8
Q

do you manage bp in stroke acutely

A

no

Guideline from NICE found here: https://www.nice.org.uk/guidance/ng128/chapter/Recommendations#maintenance-or-restoration-of-homeostasis

advise that in the acute management of ischaemic stroke to avoid treatment of hypertension unless there are certain hypertensive complications such as:

hypertensive encephalopathy
hypertensive nephropathy
hypertensive cardiac failure/myocardial infarction
aortic dissection
pre-eclampsia/eclampsia

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9
Q

5 bloods for confusion

A

FBC, glucose, Us and Es, calcium, TFTs

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10
Q

how to obtain more info in elderly

A

collateral from family, from GP, hospital records, summary care records

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11
Q

C diff complications

A

psuedomembranous colitis, toxic megacolon, peritonitis

Clostridium difficile is a very serious infection and mortality is approximately 25% for in hospital infection of frail elderly patients. This is due to a combination of the infection itself and the vulnerability of the patients which tend to be infected – the elderly, neonates, the immunocompromised etc. Severe infection is associated with the presence of pseudomembranes on sigmoidoscopy. More severe infection may lead to fulminant colitis and toxic dilatation (toxic megacolon), the diarrhoea may reduce and the abdomen swells and becomes tender. This may result in perforation, peritonitis and death. A dilated colon can often be seen on plain abdominal x-ray, with ‘thumb printing’ indentation in the wall of the colon

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12
Q

Abx causing C diff

A
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13
Q

random complication of lung tumours

A

rib erosion

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14
Q

lung mets consequences

A

Primary lung tumours can metastasise to the bone as in this case presenting with pain, anaemia, hypercalcaemia. Brain – presenting with seizures or focal neurology. Liver –presenting with jaundice, painful hepatomegly. Adrenals – presenting with Addison’s disease.

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15
Q

PCV risk for

A

stroke then ALL

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16
Q

what else can raise BNP

A

chronic kidney disease

17
Q

falls examinations

A

BP, neuro, gait and balance

18
Q

labs after fall

A

FBC, Us and Es, LFTs, CRP,

Bone profile, TFT

G and S and clotting profile

Glucose

19
Q

reversible dementia found on neuroimaging

A

normal pressure hydrocephalus, subdural haematoma (banana)

20
Q

lewy body special Ix

A

Datscan for parkinsonism

21
Q

delirium contributions

A

Post-surgery state

Morphine use

Urinary retention

Previous cognitive impairment

22
Q

supportive features for delirium diagnosis

A

Acute onset

Fluctuating course

Inattention

Disorganised thinking

23
Q

. Further components of delirium assessment

A

Collateral history

4AT test / MMSE etc / cognitive screening

Review of medications

Infection screening

Pain assessment

Environmental assessment

24
Q

legal procedure when pt tries to leave

A

Legal procedure (1 mark)

Deprivation of Liberty Safeguards (DoLS).
6. Role of procedure (1 mark)

To protect and manage care while ensuring least restrictive measures.

25
PR in faecal impaction
Small amount of type 1 stool (½) - Or copious type 6/7 stool (½) - With no sensation of defaecation (1)
26
complications and assessment of fecal impaction
27
DONT FORGET IN STROKE
BLOOD GLUCOSE
28
stroke Ix
coags, lipids, troponin
29
hyper dense area, MCA ischaemic stroke
30
absolute thrombolysis CI
31
delirium strategies
Orientation aids (clock/calendar), Reassurance, Sleep hygiene, Mobility encouragement, Hearing/vision aids, Minimise bed moves, Promote day–night rhythm.
32
delirium
Acute onset, Fluctuating course, Inattention, Disorganised thinking
33
delirium ix
ECG, FBC, U&Es, Glucose, CXR
34
best interest decision components
Past/future wishes, Input from family or LPA, Clinical benefit vs harm, Least restrictive option
35
MDT member best to assess cognition and advise on capacity
Geriatrician, Liaison nurse or dementia specialist nurse, Psychiatrist
36